Following anxiety, schizophrenia, as well as bipolar disorder, depression is amongst the most common mental health condition in the world. Depressive symptoms become more common with time (Miller & Campo, 2021). In the summer of 2021, over one in six adults aged 16 and older in United Kingdom were suffering from depression. In comparison to early 2021 and November 2020, this is a smaller number (21 percent) and (19 percent) respectively. Millions of individuals throughout the world suffer with depression, a condition that can be life-threatening. Over £9 billion was spent in just the year 2000, making it a huge burden for both individuals and society as a whole. The World Health Organization (WHO) ranked it as the third most prevalent contributors to global disability by 2004 (and the first in the developed world), and predicts it will be the major cause by 2030 (MHF, 2022). It is indeed possible for depression to be passed down from one generation to the next. Antidepressants, like psychotherapy, are essential to the treatment of depression. They are designed to alleviate symptoms and reduce recurrence.
Antidepressants’ efficacy in alleviating the symptoms of depression is a hotly debated topic. Those who doubt their usefulness are outnumbered by those who believe they are indispensable. These drugs may assist in some cases but not in others, just like many other therapies (Read et.al, 2019). The following section provides the critical evaluation of the claim pursuant to the antidepressants being an effective treatment for depression.
With International Classification of Diseases 10 [World Health Organization, 1992], depression is defined as a mental illness characterised by a combination of depressed mood, anhedonia, and a lack of energy. Some of the other side effects comprises a decrease in attention and self-esteem, as well as thoughts of self-harm, disrupted sleep, and a decreased appetite (MHF, 2022). Depression can be classified as mild, moderate, or severe based on the veracity of their symptoms. Antidepressants are considered as the first-line medication for moderate as well as severe depression, while ‘watchful-waiting’, exercise, as well as problem – solving abilities are indicated for mild depression.
But despite the fact that antidepressants were discovered by chance, their effectiveness in treating depression has long been contested, with particular attention paid to the significance of placebo responses in antidepressant efficacy trials. Even while antidepressants have both short- and long-term advantages, key difficulties like as intolerance, a delayed therapeutic start, limited effectiveness in milder depression, as well as the occurrence of treatment-resistant depression still remain today. However, prescription percentages for antidepressants (ADs), despite evidence of considerable adverse effects, such as withdrawal symptoms, as well as minimal effectiveness as opposed to placebo for short-term therapy of major depressive disorder, remain high and continue to rise. Long-term use and repeat prescriptions appear to be more to blame for these high rates than depression or the influx of new patients (Saveanu et.al, 2015).
Read et.al, (2019) within his research presents the findings of a convenience sample of 752 adults in the United Kingdom who had used antidepressants but no other psychiatric medications ‘during the previous two years’ as well as completed the online Medications for Mental Health Survey. The majority of individuals (34 percent) had either stopped taking antidepressants or had attempted and failed to do so (36 percent). Some 76% of those who were still taking them had been doing so for a year or longer, while 36% had been taking them for five years or more or more. More over two-thirds of those polled predicted that it would take them a long time. At least 48 percent of patients did not have their medications evaluated at least every three months. Nearly two-thirds (65%) had never discussed the possibility of quitting with their doctor. Half of individuals who had stopped taking the medication did so without visiting a physician, according to the survey. In contrast, 66% of individuals who took a break after seeing their doctor felt that the doctor was supportive of them (Dudas et.al, 2018). Use of antidepressants in chronic conditions is a major factor in explaining the high rates, which in turn is partly attributed to withdrawal symptoms. In order to foster a cooperative therapeutic relationship, prescribers should work hard to ensure that they are well-informed about the potential withdrawal symptoms and that their opinions on when to begin and stop taking medicine are heard and respected. The time duration with respect to a patient on antidepressants should be discussed at regular intervals. Disagreements between a prescriber and a patient should be discussed with consideration. Addiction tomedicine users who want to stop using their medication should be given encouragement and assistance. Responsible recommendations imply that a person’s ability to withdraw successfully depends on two things: their own flexibility in terms of how long it takes, as well as the support of others around them (Read et.al, 2019).
Miller & Kampo (2021) within their research asserts that the rate of adolescent suicide has been rising steadily for more than a decade and depression amongst adolescents has been on the rise for a long time now. Depression in adoloscents an be effectively treated by psychotherapy and antidepressant medication. There is still a need for better therapy for adolescents who do not even respond to present therapies, as well as more emphasis paid to the need for treatment of parental depression (Miller & Kampo, 2021).
According to Cipriani et.al, (2018), while both pharmaceutical and nonpharmacological therapies are available, antidepressants are far more typically prescribed due to a lack of funding. Use of these drugs must rely on the most up-to-date scientific research available. Since the earlier study focused on the acute treatment of people with unipolar major depressive illness, researchers set out to update and broaden the scope of the research. Researchers conducted a comprehensive evaluation and meta-analysis of network data. Searches were conducted on the Cochrane Central Register of Controlled Trials (CINAHL), CINAHL In-Process; MEDLINE, PsycINFO; MEDLINE In-Process; the online sites of regulatory authorities as well as international registers for published as well as unpublished double-blind, randomized controlled trials from their inception to January 8, 2016. For the acute treatment of major depressive illness, the researchers included placebo-controlled as well as head-to-head studies of 21 antidepressants used for people (aged 18 or older and of both sexes). Researchers did not even consider quasi-randomized studies or trials that included at least 20 percent of individuals with bipolar disorder, or treatment-resistant depression; psychotic depression, or patients with a major concurrent medical ailment in our review process. Researchers followed a predetermined structure while extracting the data. In individuals with major depressive illness, all antidepressants were more effective than placebo. When placebo-controlled studies were included in the study, the variations in effectiveness and acceptability across active medications were smaller, but in head-to-head trials, there was more variability (Niciu et.al, 2018). Evidence-based practise should benefit from these findings and be used by patients, clinicians, guideline creators, and policymakers to make informed decisions about which antidepressants to prescribe Cipriani et.al, (2018).
Most people believe that antidepressants are ineffective for mild to moderate depression, which includes the vast majority of people who are depressed and therefore are provided treatment in primary care, where pharmaceutical interventions are sometimes the sole treatment option for mild to moderate depression. There are still treatment-resistant forms of depression that do not improve with many antidepressants, despite the fact that antidepressants have come a long way (Carvalho et.al, 2013). Antidepressants and mood stabilisers (such as lithium or lamotrigine) are commonly combined in an effort to improve the efficacy of pharmacological therapy. Further, antidepressants and cognitive behavioural therapy (CBT) are progressively being used in the treatment of mild to severe depression. It takes time for CBT to address the underlying reasons of depression and the methods for overcoming it, whereas antidepressants instantly alleviate symptoms (Tansey et.al, 2013).
(Jakobsen et.al, 2017) asserts within their research that the first-line therapy for depression is generally SSRIs, and prescriptions for SSRIs (Selective serotonin reuptake inhibitors) are on the rise. SSRIs have been studied in adults with major depression in meta-analyses and shown to have a statistically important influence on depressed symptoms, according to many of these studies. The goal of the researcher’s study was to evaluate the impact of SSRIs on adults with major depressive illness in comparison to placebo, ‘active’ placebo, or no intervention. The Cochrane Library, PsycINFO, PsycLIT, EMBASE, PubMed, Science Citation Index Expanded, European and American clinical trial registrations, pharmaceutical company websites, the FDA and the European Medicines Agency’s website were all searched till January 2016. SSRIs may have quantitatively major effects on depressed symptoms; however, all trials were likely to face the high risk of bias, and the therapeutic importance is unclear. There is a high risk of both serious and non-serious adverse effects associated with the use of SSRIs.
There are a vast range of treatment protocols, each with a different level of rigour and evidence-based support. There are certain differences between primary care recommendations and those for specialised care, with the option of therapy differing depending on the location. At first, it appears that patients visiting a psychiatrist receive more than twice as much psychotherapy and about a third as much medication as those seeing other healthcare professionals (Hetrick et.al, 2012). Additionally, individuals seen by a psychiatrist appear to be half as likely to have failed treatment as those seen by a primary care clinician (independently with no specific effects of psychotherapy or prescriptions). Antidepressant medicines have been shown to be beneficial in the treatment of acute depressive episodes in adults by several studies. There should be no room for partial progress in acute therapy, which should always be the aim. If existing therapies are administered correctly, this aim can be realised in the vast majority of individuals. Patients with acute coronary syndrome and depression benefited clinically from SSRI sertraline medication for their sadness and anxiety. Because of its less adverse effects, SSRIs should be prescribed to patients with comorbid conditions such high blood pressure or coronary artery disease (Penn & Tracy, 2012). Antidepressants can interact with other medications, so doctors need to be aware of this. In the event of an overdose, patients with suicidal tendencies should be given a less hazardous medication.
Within their research Pigott et.al, (2010) asserts that antidepressant efficiency and effectiveness research is examined in this publication. According to meta-analyses of FDA trials, antidepressants are only slightly effective when compared to placebos, and that there is significant publication bias in these studies that increases their apparent efficacy. It has been shown in these meta-analyses that researchers often fail to disclose negative outcomes for the pre-specified primary endpoint when they submit it to the FDA, while reflecting in studies the results from another, secondary, or even a new way of measuring as if it were their primary measure. With an apparent steadily growing dropout rate across every trial phase, the STAR*D analysis indicated that antidepressant therapy efficacy was probably significantly lower than the modest one stated by the study authors. A re-examination of the present standard of care for depression is called for in light of the findings discussed here (Pigott et.al, 2010).
The benefits of antidepressants are undeniable in the short and long term, but they also have drawbacks, like intolerance, prolonged therapeutic start and restricted efficacy. Antidepressants may have limited effectiveness as they increase monoamine levels, considering the fact that people with depression do not have decreased amounts of these neurotransmitters (Niciu et.al, 2018). This is a possible concern. A rise in monoamine levels occurs immediately upon antidepressant use; nevertheless, therapeutic delays are typical. Subsequently neurophysiological modifications, including such altered expression of monoaminergic receptors, intracellular impacts on metabotropic enzyme cascades, including subsequent adjustments in nuclear synthesis of proteins like brain-derived neurotrophic factor, appears to affect therapeutic benefits. Existing drugs may be ineffective because they target an “upstream” or “indirect” site in the body, rather than the intended one (Dudas et.al, 2018).
This shows that there is a need for clinicians and healthcare professionals to inculcate effective treatment plans for patents who have been suffering from depression such that an effective combination of anti-depressants along with best suited therapy regime is suggested as a treatment option.
Conclusion
Throughout the short and long term, antidepressants have a significant impact on millions of people who suffer from depression. If the patient is improving from antidepressant medication, does it really matter if this is done through the placebo effect or the medicine itself? A perfect antidepressant has not been developed, as it is obvious that three fundamental issues of intolerance, delayed therapeutic start, and restricted effectiveness continue. Treatment for depression in the future must focus on new goals and use a personalised strategy in order to enhance this. Modern psychiatry is based on the reality that these treatments are being used by millions of people every day, and practitioners are aware of the limits, side effects, and necessity of considering the psychosocial requirements of the individual they are treating holistically.
Many patients benefit from clinical judgement including individualised pharmacological tailored made treatment plans, despite the fact that standards are followed in the majority of cases. The need for comprehensive health regime is required to be provided to patients along with prescribing antidepressants such that the negative effects of it can be balanced in the long term by providing exercise plan, therapies and other related interactive sessions.
References
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