On Saturday 17 August 2013 the BBC run a number of news reports which shows that the prescription of anti-depressants are on the rise significantly and some patients are not receiving the right treatment (http://www.bbc.co.uk/news/health-23737359 http://www.bbc.co.uk/news/health-23545242). Is there anything which the NHS or drug companies can do to stop this increase in the prescription of anti-depressants? This blog explores the alternatives and suggests why the traditional anti-depressants are being over prescribed and perhaps do not work.
There are two types of depression for the layperson; first reactive depression, which is the result of life changes, such as being made redundant or having a marriage breakdown. And second endogenous, which is a biological and long-term condition that is not associated with any specific event which has occurred in the last six months. The treatment of these two types of depression can be completely different and this can impact majorly on the effectiveness and cost of the treatment. To be specific, reactive depression tends to respond very well to counselling or therapy such as Cognitive Behavioural Therapy (CBT); whereas endogenous depression appears to show a greater success with pharmaceutical treatments such as the traditional anti-depressants. However these two forms of depression are not exclusive and hence one may have a genetic or biological pre-disposition to depression and a life changing event may trigger the depression and/or anxiety attacks.
As professors and doctors explained on the BBC Breakfast show (17 August 2013), it is extremely difficult for individuals who have depressive symptoms to gain access to counselling within a six month to one year period, therefore the patients choose the option of anti-depressants that may start working within one month. However, the question is whether these drugs are really treating the condition (or the symptoms) and whether the NHS should do more to enable counselling and therapy?
The typical anti-depressant which is prescribed is a SSRI or SNRI; these drugs stop the reuptake of specific neurotransmitters by the pre-synapse; specifically serotonin and noradrenaline (or norepinephrine if you are in the USA). The two drugs have evolved since the 1960s and in all honesty, the newer strains are just more potent at stopping the reuptake of serotonin and noradrenaline. However more recent evidence has shown that the so-called cause of depression is not the transmission of serotonin or noradrenaline between the pre- and post-synapse but actually other supporting structures of the brain known as glial cells which are not functioning properly (Cotter et al., 2002).
The problem is pharmaceutical companies are making vast amounts of money on selling the old fashioned anti-depressants, such as SSRIs, which do not actually treat the depression. All these drugs do is keep the patients from having a relapse, but only in about 60-70% of cases. The fact is treatment of glial cells (which support the synapses) could actually cure depression and anxiety, but of course this would not be financially beneficial to the pharmaceutical companies or the GPs who earn money by supplying such drugs.
We then come to the issue of whether counselling or treatments such as CBT, and whether they are more effective than the traditional anti-depressants. The truth is, for certain types of depression these are more effective and can help sufferers in a shorter period of time. The problem is such treatment costs significantly more money than anti-depressants and the government are unwilling to fund an increase in the number of clinical psychologists who are able to provide this type of treatment. The question is why? It is not an easy question to answer and anyone who had watched BBC Breakfast on the August 17 2013 can understand why it is so complex.
First, we know that exercise can help to reduce depression in certain people who have such symptoms. Therefore one argument is to increase the availability of exercise and social recreation, which is cheaper than training more clinical psychologists. It is true that this type of treatment can help many individuals who have endogenous depression. Second, the pharmaceutical companies make massive amounts of money on selling the old treatment for depression and the amount of tax which the government receives from this kind of sale and research is astronomical; therefore it would not be advantageous in monetary terms to research treatment of glial cells. Finally, diet can help in many cases of depression, therefore it is easier for the government to encourage a healthy diet, rather than train more clinical psychologists to tackle the problem. This final point is very important as the diet of the nation can not only help people with mental health issues but can also reduce the cost of other NHS issues such as heart disease and cancer (also including the first point about exercise).
However my argument is that pharmaceutical companies should be encouraged to take a more ethical standpoint when developing anti-depressants which actually cure the disorder rather than looking after their own shareholders interest and making profit on drugs which do not actually treat the illness but just keep it at bay. For more information on glial cells and depression read publications by Dr Colin Hendrie from the University of Leeds (http://www.psyc.leeds.ac.uk/cgi-bin/10/search/pubs/index.pl?--colinh--)