In a recent BBC documentary: ‘The Doctor Who Gave Up Drugs’ Dr Chris Van Tulleken (Dr CVT) set out to answer the above question. Here I summarise the section of part 2 of this documentary (which deals with teen mental ill health and antidepressants) and throw in a few links and additional commentary.
You can watch the documentary on BBC iPlayer here at least until Late June 2018, although TBH you may as well save yourself 50 mins and just skim read what’s below.
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Introduction: why are prescriptions for antidepressants in the UK increasing?
The general gist of the documentary is that we’re relying more on drugs to treat teenagers’ mental ill-health, but we could be giving out pills to thousands of teenagers which are not only ineffective but actually have severely dangerous side effects.
The number of British teenagers prescribed antidepressants has almost doubled in 10 years: in 2005, 30 000 teenagers were prescribed antidepressant drugs, increasing to 58, 000 in 2015.
The Increase in antidepressants: a visual representation
Each ping pong ball represents 4 teenagers prescribed antidepressants
2005
2015
This increase might be because more people are getting diagnosed and more effectively treated, however it might reflect the fact we are quicker to seek medicalised solutions to ‘depression’, and that these drugs are not effectively dealing with the underlying causes of depression, and maybe this doubling of prescriptions in 10 years is no a long term solution to depression.
A case study of teenage depression
To provide us with a ‘human face’ of depression, the documentary now visits Jess, 15 year old teenager who has been on antidepressants for 8 months and whose suffered from anxiety since she was a young girl, finds school stressful because she feels trapped (30 odd kids in a class, with everyone close together). She hasn’t been in lessons for 10 months, and may not be doing her GSCEs.
Following counselling, she was put on Sertraline to combat her depression, 100 mg, double the normal dose of 50 mg. We now get the usual trawl through the possible side effects of the drug, and it’s not pretty: clinical trials have shown an increased risk of suicidal behaviour in adults aged less than 25 years, and Jess says she has felt more suicidal since starting the medication.
Interestingly, Jess states a desire to be free of the drugs, while her mother appears more relaxed, saying that there’s evidence that they work, and that her daughter shouldn’t be afraid of the stigma attached to taking antidepressants: the idea of just ‘pulling yourself together’ and coping is outdated.
Research evidence on the effectiveness of antidepressants
Dr CVT now looks at a recent study conducted by professor Andrea Cipriani of the University of Oxford. This study summarised all available evidence of how effective 14 antidepressants are in children and adolescents specifically, (rather than just evidence from adult trials). The basic research question was ‘do these drugs work’ (not ‘how do these drugs work), and they compared the drugs with each other and against the effectiveness of a placebo, a sugar pill.
They found that only one drug: fluoxetine, or prozac, was more effective than a sugar pill in combatting depression among teenagers, which is worrying given that around 40% of teenage prescribed antidepressant drugs are on Sertraline. However, there is still a level of uncertainty around the research on the effectiveness on Fluoxetine – because people respond very differently to the drug.
Where Sertraline there is good evidence that it works for adults, but the problem here is that teenagers brains are wired differently, and professor Cipriani’s research suggests what works for adults may not work for teenagers.
Wilderness Therapy as an alternative means of treating mental ill health
Dr CVT says there’s lots of evidence that being active out of doors is effective in treating mental ill health, especially depression.
To test this out, the documentary now returns to Jess, one month on, who has now had her prescription of Sertraline increased to 125 milligrams, and feels increasingly panicky and has upped her rate of self-harm, and expose her to a ‘therapeutic intervention’, in the form of the ‘Wilderness Foundation’ which uses activities in wild spaces and one on one counselling to help teenagers suffering from mental ill-health.
Research conducted by the University of Essex suggests that 83% of the kids on the charity’s leading scheme have successfully gone on the further education or full time employment.
Jess gets taken along to the the Wilderness Foundation for a day to do ‘stuff’ outdoors, and we get treated to footage of Jess in an extremely pleasant wooded glade sparking a fire to life and putting up a hammock. Wilderness therapy is apparently well established in the USA, and it certainly seems to work for Jess, who spends 6 hours out of doors.
Do antidepressants ’cause’ an increase in teen suicides?
The documentary also visits one mother, Sarah, whose daughter Rachel killed herself within 11 days of an increase in her dose of Sertraline.
Rachel’s story seems similar to Jess’: she found secondary school difficult and hit a wall at GCSEs, finding it difficult to cope with the stress. After a visit to the Child and Adolescent Mental Health Services, she was prescribed fluoxetine and experienced the following side effects after 2 weeks:
- Violent thoughts
- Disturbing dreams
- Bodily shaking
- Nosebleeds
Rachel tried to hang herself at one point, and after several months of this, she was prescribed a different drug: Sertraline. She actually wanted this herself, she wanted something to work, but within 11 days of an increase in her dose of this second antidepressant Rachel killed herself.
Rachel’s mum Sarah doesn’t blame the Doctors as they were just following the approved ‘pathways’ to treating mental illness laid down in the formal guidelines, she blames the system which seems to based on inadequate knowledge of the harmful side effects of these drugs.
NB – we cannot actually prove a causal link
Could antidepressants actually be harming our children’s health?
Drug trials should not only tell us if the drugs are effective, they should also tell us if the drugs have any harmful side effects. The problem is that many of the drugs trials are run by drugs companies, with a vested interested in making their drugs look both effective and sage.
Dr David Healy is one of the few people to have done independent research into the effectiveness and safety of antidepressants with the raw data provided by the company. He argues that we need to see the raw data to uncover how the drugs affect individual patient – and this raw data can run into several reams of paper if there 100s of people in a trial.
It is extremely rare for drugs companies to release this original data, in fact, it’s only happened once when in 2004 legal challenges were made against claims made about the effectiveness of Seroxat, and antidepressant manufactured by the pharmaceutical company GlaxoSmithKline.
Dr David Healey analysed this original data and found that the claims made in the original 10 page article summarising the findings of the trials which claimed the drug was not only effective but also sage, were basically false, with Healey’s team finding that not only did the drug not work, but that the number of teenagers who developed suicidal thoughts following the use of the drug was three times greater than intimated in the original study, in which this side effect was described as ‘some teenagers becoming more emotionally labile’.
This research actually led to GlaxoSmithKlein being fined $3 billion in penalties and fines for health care fraud.
Dr David Healy says that in between the raw data and the sometimes misleading ‘main articles’ on the research findings published by the drugs companies, there are ‘company reports’, and even if we dig into these, there is cause to be concerned over the safety of many of antidepressants.
The rest of the documentary
The documentary returns to Jess, who has kept up her therapy for 6 months (I think it’s 6 months, it’s not that clear) and after some ups and downs (including one suicide attempt at school) the therapy seems to be working – she gets taken through a process of gradually having things she finds difficult added into the programme, and eventually manages to cope with going shopping and buying something (progress for her, in dealing with crowds).
After 6 months, Jess even manages to return to school and sit her mock GCSE exams, and at the very end of the documentary, we even see her at her 16th birthday party on stage singing, in front of friends and family.
The documentary also pays the standard visit to the Clinical Lead for Child Mental Health Care Services who reiterates that all Doctors are doing in prescribing antidepressants is following NICE guidelines, which are based on the best available evidence, however, Dr CVT’s point is the best available evidence is shaky at best.
NICE refuse to be interviewed, but do say they are reviewing their guidelines
Conclusions
The whole point of the documentary seems to be to inform us of the uncertainties surrounding the effectiveness and safety of many of the antidepressants we are increasingly prescribing to our teenagers.
Dr CVT suggest we are far too trusting of the research done by drugs companies, and we shouldn’t allow them to control the information we have about these drugs… we should be much more sceptical, and in the meantime, we should pursue alternative treatments such as wilderness therapy and mindfulness which are unlikely to cause harm.
K.T.’s Commentary
One thing I want to pick up on his the ‘social causes’ of Jess’ anxiety. Basically, it seems she just hates the crowded environment of the school, along with all the stress of testing that goes along with it….
Personally, I get this, it has exactly the same effect on me as a teacher.
I also get the ‘wilderness therapy’ as a solution – I love being outdoors, walking: it’s just that I don’t need anyone to structure it for me, I also don’t really regard it as ‘therapy’ – rather it’s just ‘doing something enjoyable’.
It appears to me that Jess’ depression is pretty much 100% socially induced – by the school system. Get her back to nature, and doing something ‘naturally’ empowering, and she’s O.K, as she is singing in front her friends and family – surely it’s the social context that’s the problem?
It’s not rocket science is it! What needs to change here is society, although that’s easier said than done.
I also have to admit being a bit taken aback by the size of that GSK fine – $3 billion for health care fraud, that’s something I’m going to have to come back to later!
Sources/ find out more!
Disclaimers/ health advice provided in the documentary
Doctor Chris Van Tulleken reminds us that it might be dangerous to stop taking antidepressants suddenly and that any change of dose should only be made with medical supervision.
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