New research suggests antidepressants may not be as effective in treating the causes of depression.
The use of antidepressants amongst the UK population is becoming more and more ubiquitous as the years progress, with research indicating that levels of prescription are on the rise for the sixth year in a row, reaching a total figure of 83.4 million prescribed between 2021-2022. There is reason to believe that the student population is well represented in these figures – the proportion of individuals aged 18-24 reporting suicidal thoughts or feelings stands at 22% – more than double that of the adult population. In the aftermath of a pandemic that left many isolated and estranged from loved ones for months at a time, this comes as little surprise. Research conducted prior to the pandemic, in March 2020, indicated that 21.5% of UK university students had a mental health diagnosis and 33.9% had experienced psychological distress whilst at university that had prompted them to seek professional help.
The question remains whether the rise in prescription of antidepressants represents an incline in the incidence of mental health conditions amongst the student population and UK as a whole, or rather simply reflects an increased willingness for those who suffer from depression or other mental health conditions to seek help – with the prescription of antidepressants being the natural conclusion of that process. Regardless, our considerable degree of reliance on them as a population is undeniable.
For those who are unfamiliar with the rationale behind the use of antidepressants – they are essentially intended to correct a balance in serotonin in the brain of users, following the belief that such a chemical imbalance causes symptoms of depression. The most commonly prescribed antidepressant is the selective serotonin reuptake inhibitor, or SSRI. SSRIs work by blocking the reuptake of serotonin into the nerve cell from which it was produced, allowing the chemical to act for longer on the brain. SNRIs, or serotonin and noradrenaline reuptake inhibitors work in a similar way, but also block the reuptake of noradrenaline, and may be prescribed in more extreme cases of depression or anxiety. Both of these kinds of antidepressants are thought to create fewer unpleasant side effects than other antidepressants. Tricyclics and monoamine oxidase inhibitors (MAOIs) are examples of less commonly prescribed antidepressants, which both carry higher risk of severe and unpleasant side effects but work in a similar way to redress imbalances of serotonin and noradrenaline in the brain.
In essence, the prescription of antidepressants and recommendation of their use in a medical setting is based on the notion that depression is caused by a chemical imbalance in the brain. In a rather ground-breaking development in the field of mental health however, a major review was published earlier this year that indicates that there is no convincing evidence to suggest that depression is caused by a chemical imbalance, or abnormalities of serotonin levels in the brain. With one in six of us being prescribed antidepressants in the UK, the discovery that there is potentially no legitimate link between the supposed cause and cure we are being offered is remarkable, particularly considering the range and severity of potential adverse side effects for those who use SSRIs.
According to leading UK mental health charity Mind, side effects of the most commonly prescribed antidepressants range from: headaches, nausea, diabetes, gastrointestinal bleeding, and (seemingly counterproductively) suicidal feelings. Is the risk of such severe side effects justified when the supposed benefit is potentially nothing more than a placebo effect?
That’s a big question, and the answer is that we don’t really know. The application of different antidepressant medications is an imprecise science – while there may be no (as yet discovered) direct link between the occurrence of depression and the chemical imbalance drugs like SSRIs work to correct, there’s no denying that for many people, they do work. The figures are rough, but up to 60% of users respond positively to their first interaction with an antidepressant medication. The issue is that we don’t know how they work, and it’s often a matter of trial and error. Much like with the variety of birth control options available, the balancing of maximum efficacy and minimum adverse side effects is entirely dependent on the individual in question and varies for everyone. Antidepressants can take as long as 6 months to significantly alleviate symptoms of depression and can cause a period of worsened mental health in the initial stage of taking the medication – and again the cause of this is somewhat of an enigma to scientists and researchers.
None of this is to invalidate the experience of those who have had a positive experience of using antidepressants and find that they have led to a significant improvement in their mental health. Evidently, they work for many, and it is important to recognise the life-saving potential they can have for such people. But on the back of this new wave of research, there is an argument for a reconsideration of the degree of selectivity with which they are prescribed, until we know with more certainty in what specific context they work, and for whom.
A third of UK university students who drop out of higher education cite mental health reasons, as the state of student mental health continues to worsen. Students are found to be at higher risk of developing mental health problems than their non-student peers, with students in their third and fourth years of education at even higher risk. Higher education is in desperate need of a comprehensive strategy to tackle the bigger picture of student mental health behind these grave statistics, and clearly, an increase in the prescription of antidepressant medication alone is not sufficient.
