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Large Lancet study finds anti-depressants do work. Indian docs say problem is attitudes

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A Lancet study claims to finally put to rest one of medicine’s biggest debates –the effectiveness of anti-depressants. It turns out, they actually work.

New Delhi: A global study that strongly backs the effectiveness of anti-depressants has come as a big boost to the mental healthcare sector in India – home to one-sixth of the world’s depression patients.

A recent study published in the medical journal Lancet, proves that anti-depressants actually work better than placebo pills. Leading psychiatrists in India welcome the study as scientific validation of their endeavour to highlight the seriousness of mental health in medical discourse and the need for medication.

Mental health has long been a taboo in India where most people refuse to consider it as an illness and therefore do not seek treatment or medication.

“This study is extremely relevant in India’s context, as 85 per cent of people suffering from clinical depression in the country remain untreated, according to the National Mental Health Survey of India, 2016,” Dr Rakesh K Chadda said. Dr Chaddha heads the psychiatric department of the All India Institute of Medical Sciences (AIIMS)

“Medications are definitely required in moderate to severe depression,” Dr Chadda told ThePrint.

The study and why it’s relevant

322 million people in the world were suffering from depression as of 2015, with over 50 million of those cases being reported from India, according to a WHO study.

Up until now, there was significant debate within the medical community about the actual efficacy of anti-depressants. This was a consequence of a previous lack of access to unpublished clinical trials and a paucity of data.

Many studies on anti-depression medicines were also discredited as they were directly funded by pharmaceutical companies.

The Lancet research by multiple mental health professionals and researchers, which analysed data from 522 trials of 21 common anti-depressants, showed that most medication is more effective at reducing symptoms of acute depression in adults, as compared to a placebo. The study also showed that there are significant differences between the effectiveness of each drug.

Anti-depressants ranged from being a third more effective to twice more effective than placebos.

As of 2015, there were 3,800 psychiatrists, 898 clinical psychologists, 850 psychiatric social workers and 1,500 psychiatric nurses in India, according to a response from the ministry of health and family.

This means that there are 3 psychiatrists per million people, which is 18 times lower than the commonwealth norm of 5.6 psychiatrists per 100,000 people, data from WHO said.

A study published in the Indian Journal of Psychiatry in 2000 also said that the medication Fluoxetine (commonly known as Prozac in the US) was the second-most prescribed anti-depressant in India. The recent Lancet study said the drug is one of the least effective.

Escitalopram, sertraline and mirtazapine, however, which are also widely used in India, rank fairly high in terms of both efficacy and acceptability.

Vindication for Psychiatry

Dr Samir Parikh, director of Mental Health and Behavioural Sciences at Fortis Healthcare, said the efficacy of anti-depressants was never in question.

“These stories that placebo is more effective than anti-depressants is rubbish, rank rubbish. But these also circulate now and then,” he said.

“Every time a story like that comes, it hurts the well-being of hundreds of people around. You don’t want an already stigmatised branch to have any more stigma or discrimination attached to it,” Dr Parikh said.

He welcomed the study as conclusive proof that will “settle the debate once and for all.”

However, the Lancet paper only studied short-term effectiveness of anti-depressant use.

When asked about potential long-term side effects, Dr Parikh said that with designer anti-depressants that came in the 1990s, a lot of the side effects were also mitigated.

Dr Chadda from AIIMS also agrees that “Anti-depressants are potentially safe medications provided they are taken under proper medical care.”

“They relive the extreme distress and pain caused by depression by neutralising the biochemical disturbances associated with depression in the brain,” he said.

‘Medication shouldn’t be the first knee-jerk response by doctors’

However, many mental health care professionals don’t agree entirely with a purely medication-based approach to combating depression.

While they agree anti-depressants are necessary for patients suffering from severe depression, many say there is a lack of a holistic approach when it comes to dealing with mental health.

“The dispute comes from the fact that they are often abused, overused and overprescribed by doctors who may not diagnose correctly and are not authorised to prescribe it,” said Dr Deepak Raheja, eminent psychiatrist and Director of Hope Care India.

Dr Raheja said this is due to the substantial gap between the number of mental health practitioners and the people who need help in India.

“We need to understand that these illnesses have a bio-psycho-social root, and all of them need to work in sync for the best prognosis and recovery to happen,” he said.

Child and adolescent psychologist Dr Shelja Sen said that prescribing heavy anti-depressants to those who might benefit from other forms of therapy actually takes away the patient’s choice.

She said it makes patients believe that “something is wrong with me, and the medicine will fix me.”

“Medication shouldn’t be the first knee-jerk response by doctors, until they feel like it’s necessary,” she said.

“The side-effects are also evident, especially in young people,” Dr Sen added.

Ruchika Kanwal, a cognitive behavioural therapist at the Karma Centre for Counselling and Well-being, said there is a hubris that psychiatrists have.

“As they want to continue running their OPDs, they won’t send them for therapy and will tell them only medications can cure you. We, as psychologists, don’t often get the needed help and cooperation from psychiatrists,” she said.

Dr Chadda from AIIMS said that the culture of silence surrounding mental health needs to be broken.

“Depression is many times not considered an illness, and this myth needs to be corrected. Depression is an illness like diabetes, hypertension or epilepsy where treatment needs to be taken for a long time,” Dr Chadda said.

Also read: Swimming with invisible weights tied to your ankles: My battle with depression, to understand more about the illness.

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  1. It is high time that we should break the taboo associated with mental health. Companies like RoundGlass Peace are doing a great job by bringing a change in the society

  2. This Lancet study has many methodological issues. These are addressed in the article “Challenging the New Hype About Antidepressants,” written by Dr. Joanna Moncrieff (you can find this article on Google).

    Also, we need to remember that there are other ways of treating psychiatric patients. A study published in JAMA reported how a peer support program (called “The Friendship Bench”) resulted in greater benefits to patients than standard care [see the article titled “Effect of a Primary Care–Based Psychological Intervention on Symptoms of Common Mental Disorders in Zimbabwe: A Randomized Clinical Trial” by Chibanda, D (2016)].

    Additionally group mindfulness programs can be implemented. Many studies have also shown that the practice of mindfulness brings about changes in the structure and function of the brain in positive ways.

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