Nearly 35 years ago US drug regulators approved Prozac, the first in a series of blockbuster antidepressants known as selective serotonin re-uptake inhibitors (SSRIs). Prozac and its cousins were hailed by patients and doctors as miracle drugs. He lifted the gloomy mood quickly and seemed to have no qualms. There was a daily pill to help – divorce, bereavement, problems at work, and anything else that made you sad. Many people have been on these drugs for the rest of their lives. Today, one in seven people and one in ten people in Western countries take antidepressants.
SSRIs have lost their sheen. An increasing number of studies show that they are less effective than thought, Drug companies often selectively publish the results of clinical trials, withholding those in which the drugs do not work well. When the results of all trials submitted to the US drugs regulator between 1979 and 2016 were examined by independent scientists, it was found that antidepressants had a substantial benefit beyond a placebo effect in only 15% of patients.
Clinical guidelines have been revised accordingly in recent years. The drugs are no longer the recommended first line of treatment for less severe cases of Depression, For these, self-help guidance, behavioral therapy, and recommendations for things like exercise and sleep are better. For work burnout, a sick note for time off may be sufficient. Medications should be reserved only for more severe depression, where they can actually be life-saving.
The problem is that many people who don’t need antidepressants are already on them, refilling prescriptions written years or decades ago. They should be helped to get rid of the addiction. Side effects are often life-limiting and become life-threatening as people age. They include sexual dysfunction (which sufferers describe as “genital anesthesia”), lethargy, emotional numbness, an increased risk of birth defects during pregnancy, and, in older people, stroke, falls, seizures, heart problems, and surgery. Bleeding after. This threatens health care systems as long-term users age.
Doctors rarely talk to patients about stopping drugs because they fear it could lead to drug withdrawal. depressive symptoms, But for many people it may be safer to hold off. Even among long-term users with multiple previous episodes of depression, a recent trial in the UK showed that 44% of patients could safely stop taking the pills. For milder cases, the success rate is probably higher still.
Many things are needed for change to happen. Doctors need guidelines on how to de-prescribe drugs. Health-care insurers and providers such as the UK’s various National Health Services should start paying for ways to deliver drugs that help people who want to stop taking them, but avoid serious withdrawal effects. need to reduce them. These include liquid formulations, tapering strips containing tablets with progressively lower drug concentrations, and the services of compounding pharmacies, which prepare bespoke doses. 70% of people who have used tapering strips in the Netherlands have managed to quit successfully.
All of this may cost more than filling prescriptions today. But with so many people on the drugs, the cost of the side-effects soon adds up. Add to this the misery of the millions whose lives have been deprived of their ordinary pleasures by useless prescriptions, and the case for change is irresistible.
© 2023, The Economist Newspaper Limited. All rights reserved. From The Economist, published under license. Original content can be found at www.economist.com
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