A Shock to the Medical System

Much has been made of the recently published study, which was based on a large number of clinical trials, that anti-depressants have no more effect than a placebo (a sugar pill with no chemical properties).  What is striking about the research is that it examined four of the leading anti-depressants – the three best known in Ireland are prozac, effexor and seroxat. 

Contrary to what many might believe, I am quite disappointed to learn of the study’s findings.  I never had any difficulties with medication as a symptom reducer; my issue is that drugs are a substitute for what individuals – depressed or anxious – need to do for themselves.  However, the process of taking responsibility for our own vulnerabilities takes time and patience and the short-term use of medication may ease the pain of that examination and resolution of our inner turmoil.  Medication cannot deal with inner conflicts.  What may arise from these findings is the breaking of the myth that depression is a biological rather than a psycho-social experience. 

Depression, metaphorically means ‘black hole’ and there is no greater darkness than the alienation from self and from others.  The theory behind the use of anti-depressants is that the dosage would provide a ‘lift’ in the person’s mood and enable them to continue with their daily activities.  Anti-depressants do not provide the means to go into the black hole, discern its meaning and to realise that a truly sacred person is hidden behind that dark screen.  The intention of the depression is to draw attention, care, empathy to those aspects of self the individual has suppressed in the face of abandonment experiences.  The more harsh and violent the abandonment, the more the person plunges into the darkness of oblivion.  Depression also means that it is too threatening to dare reach out to another and the hope is that in their depression others will reach out to them.  Those of us who are empathic to those who become depressed need to realise that great patience is required because the person who is depressed has an overwhelming fear of letting love in.  To do that would mean to risk losing it again.  It reminds me of a young man who was determined to take his own life, saying to me ‘you’re giving me hope and it’s upsetting my resolve to take my life.’

Ultimately, helping individuals who are depressed is about fostering hope and supporting them to lift their own spirits by embracing their own sacred person.  In the words of the Buddha ‘you can travel the entire world and not find anybody more deserving of love than yourself.’

It is alarming that the published review of clinical trials found little evidence of benefit when analysing both unpublished and published data from the drug companies.  This finding raises serious questions regarding the integrity of drug companies.  Have medical doctors and the public been given reports of exaggerated benefits?  I found the responses from a spokesperson from GlaxoSmithKline who manufacture seroxat curious to say the least: ‘The authors have failed to acknowledge the very positive benefits these treatments have provided to patients and their families dealing with depression, and their conclusions are at odds with what has been seen in actual clinical practice.’  Eli Lilly, who manufacture prozac had a more or less similar response.  I’m confused here!  I was under the impression that stringent drug trials are carried out before a drug is made available for prescription to the public.  These studies need to be of a double-blind nature so that the drug being investigated shows a significantly higher therapeutic effect than a sugar pill.  For the drug companies to claim that clinical practice gives credence to the benefits of their drugs is neither professional nor ethical.  There are all sorts of reasons why a drug may appear effective when prescribed by a medical doctor – the person’s own expectations, the persuasive power of the doctor (known as the ‘doctor as drug’), a positive and comforting relationship with the doctor, belief in what the doctor say ‘this will really help your depression’ and other such possibilities.  What is important about these variables is that they have nothing to do with the chemical properties of the anti-depressant.  It would appear that the Government has an important responsibility to more thoroughly check the claims of drug companies, not least because of the side-effects, but also that its high expenditure on these drugs could be more beneficially applied to the psycho-social treatment of depression.

Dr. Tony Humphreys practices clinical psychology and is author of several books including Whose Life Are You Living.