The Antidepressant Debate

Twitter has been aflame recently with a debate about depression and the use of antidepressants, spurred on by recent contentious articles from Will Self and Giles Fraser, and various interviews on the topic on Radio 4 (Ruby Wax being perhaps the most high profile.) I wanted to post links to what I think are three of the best posts discussing and responding to the debate, and which I think capture very well the reasons why people have been so frustrated by the framing of the issues.

Firstly, GP Margaret McCartney takes on the issue raised by Fraser’s article of equating depression with ‘unhappiness’ (which dismisses both the seriousness of depression and it’s validity as an illness by conceptualising it as just one end of the normal spectrum of mood). For me one the strongest points comes at the end of article, where she picks up on an issue that is really worthy of debate – why are the huge waiting lists for therapy tolerated in mental health, when similar delays for physical treatments would cause outrage?

Secondly, lecturer and blogger Pete Etchells carefully pulls apart the simplistic framing of the debate as being that ‘the drugs don’t work’, explaining why the evidence is still unclear and why the most useful focus would be on how to better answer the question. Anything until this is really just anecdote and opinion, and risks stigmatising those in need of treatment, rather than improving the evidence base about which treatment would be best.

Finally, an excellent post by blogger The Dirty Ho which explains that while there is a useful debate we could be having – about medicalisation and the role of drug companies in influencing prescribing – unfortunately the framing of the discussion so far has limited this to pill-shaming and confusion over the reality of depression as an illness. I very much agree with the point made about Fraser’s reaction as well, which could have simply acknowledged the problems with his original article rather than rejecting the criticisms as ‘misinterpretation.’   (On a side note – I saved this article in my zotero collection, and now have “@TheDirtyHo” as the first author listed in my library…)

I don’t think this debate is going away anytime soon, and this is really just the most recent flare up of a long standing issue. However, I think the articles above all point to ways we could effectively move forward, in terms of refining the debate, thinking about what the real issues are, and understanding the need for more evidence rather than more rhetoric.

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