False Information about Antidepressants

The UK NHS website, as you would expect, aims to offer helpful advice on a large range of medical matters for the lay public. For example, if you’re concerned about an ingrowing toenail, you can learn how to recognise and treat this condition, although I have to say the pictures they show are of rather horrible gross examples. And the advice for preventing ingrowing toenails includes this patronising admonition: ‘Do not wear shoes that are too tight or do not fit properly.’ Gee thanks, I’d never have thought of that.

Browsing further through the website, I came across a section on stomach cancer where we find this: ‘How to reduce your risk of getting stomach cancer: Do try to quit smoking.’

Now really. What’s the good of merely trying to quit smoking? If you’re a smoker who’s afraid of getting stomach cancer – and you’d better be very afraid – and you want to reduce your risk of getting it, to say nothing of the risk of other cancers such as those of the lungs or urinary bladder, you need to stop smoking. Right now.

Off the rails
But it’s when we get to the sections dealing with psychological problems, specifically with depression and so-called antidepressants, that the writing goes off the rails. There’s a section headed ‘How antidepressants work’ under which we find:

     It’s thought antidepressants work by increasing levels of chemicals in the brain called neurotransmitters.  Some neurotransmitters, like serotonin and noradrenaline, are linked to mood and emotion.

So, if serotonin and noradrenaline are linked to mood and emotion, does this mean that abnormalities in the levels of these substances may cause disturbances of mood and emotion?

We can also learn about different types of antidepressants, in particular, selective serotonin reuptake inhibitors, of which a prescription drug called Sertraline is an example. And how does Sertraline work to treat depression, or as we might put it in lay terms, abolish unhappiness? The repetitive answer is:

     Sertraline is thought to work by increasing the level (singular) of serotonin (a chemical in the brain linked to mood) [so that] when serotonin levels (plural) are normal, this may reduce stress levels and negative thoughts. (My emphasis.)

What the good old NHS seems to be saying, in other words, is that depression is caused by a low level of serotonin and it can be treated by increasing the level thereof. Unfortunately, however, these statements are false, since the ‘low serotonin causes depression’ theory was debunked in 2022. See https://www.nature.com/articles/s41380-022-01661-0

So, I contacted the NHS and asked them, in relation to their statements about Sertraline, ‘Thought by whom and on what grounds? In reply, they referred me to the National Institute for Health and Care Excellence (NICE), wither I went. This seems to be aimed at doctors, but with the patronising and obvious advice they offer, one wonders about the point of such an institution. For example:

      When considering treatments for people with depression:

• carry out an assessment of need
• develop a treatment plan
• take into account any physical health problems
• take into account any coexisting mental health problems

The only information I could find on NICE’s website about how antidepressants might work was this:

‘Selective serotonin reuptake inhibitors [a type of so-called antidepressant] modify neuronal transmission in the brain.’ Maybe they do, but how does this treat depression? Back to the NHS, who told me, ‘We have looked into this; however, we believe that the current content is in line with these sources.’

The highly esteemed Royal College of Psychiatrists
I was also referred to the pronouncements of the Royal College of Psychiatrists, which likewise is aimed at the lay public; it’s almost as bad as NICE. They say:

     As with many other kinds of medications and treatments, we don’t know for certain how antidepressants work. We do know that they affect the activity of certain chemicals in our brains. These are called neurotransmitters, and pass signals from one brain cell to another. The neurotransmitters most affected by antidepressants are serotonin and noradrenaline. However, research suggests that antidepressants work on the brain in multiple ways that go beyond simple chemical reactions. (My emphasis.)

This is hardly satisfactory. If they don’t know for certain how antidepressants work, do they know to some extent how they work? If so, to what extent, and on what evidence? And it’s hardly satisfactory to say ‘research suggests’. Do they have nothing better to offer than suggestions?

Generalised statement
Back to the NHS. They replied:

     The information on NHS.UK is written for the lay person and not for health professionals…The expression ‘It’s thought antidepressants work…’ is therefore a generalised statement and can be interpreted as thought by doctors and pharmacists, etc.

Now we’re going round in a circle. Who are these unnamed doctors and pharmacists, to say nothing of the mysterious ‘etc.’ people, whose thoughts can be interpreted as a generalised statement? Of course, they can’t answer that, but this is their last word:

     The NHS.UK website reflects the NICE guidance; that’s our policy. Respectfully, there’s nothing more we can usefully discuss with you about antidepressants.

So there! It seems the NHS can only parrot NICE and the Royal College of Psychiatrists. Does it have no discretion to make an independent assessment? Apparently not.

I don’t want to discuss antidepressants with the anonymous ‘NHS website content team’. I want them to change what they say on their website to reflect the truth as far as it’s known. Something like this:

‘It’s unknown how so-called antidepressants work, if they do. Possible ways are a placebo effect (you hope and expect to feel better, so you do); emotional blunting, which some people may prefer to the undrugged state; or natural recovery with the passage of time.’

Antidepressants are neuroactive substances which produce an altered state in the brain such as a chemical imbalance. There’s no evidence that they cure or alleviate the underlying brain mechanism, if such exists and can be identified, in people who feel depressed.

Note: The above is not intended as medical advice. If you’re taking antidepressants do not stop them without consulting your doctor.

Text © Gabriel Symonds

Picture credit Olga Gryb on Unsplash