Last week a UK documentary set Twitter ablaze in discussing whether young people have become over-medicalised in pursuit of good mental health. Abi Crossland-Otter, a trainee counsellor currently working as a support worker on a mental health ward, argues that the communities people are exposed to in hospital offer more therapeutic value than the drugs administered.

According to the latest Adult Psychiatry Morbidity survey, published in 2014, at least 50 percent of people diagnosed with depression in the UK are taking antidepressants.

In his book Lost Connections, author and journalist Johann Hari makes the alarming statement that "the proportion of people who continue to be depressed [whilst on antidepressants] is found to be between 65 and 80 percent."

"As someone who works in a psychiatric hospital, I have personally seen the incredibly positive effects antidepressants have on some patients as from one day to the next they become healthier and happier. Conversely, however, I also see how these antidepressants are not enough."

Hari believes the reasoning behind this disconcerting statistic is that depression is as much sociocultural as it is biological. This means that the cause of depression may not lie in our brains, but in the way we live today.

The World Health Organisation backs this premise. “Mental health is produced socially: the presence or absence of mental health is above all a social indicator and therefore requires social, as well as individual solutions,” the WHO said in 2011. These individual solutions may well be pharmaceutical, but the emphasis here is that without taking social action too, the effect is unlikely to be as powerful or permanent.

Psychiatrist Professor David Healy goes so far as to suggest that “there was never any basis for [antidepressants], ever. It was just marketing copy…” If this is the case, what about the 20-35 percent of people that antidepressants are working for? Hari suggests there may be a placebo effect at play.

Placebo permatations

In an experiment conducted by Irving Kirsch on the effects of antidepressants versus placebo, it was found that 50 percent of the group improved with the placebo sugar pill, whilst only 25 percent improved through the real antidepressants, and the other 25 percent improved naturally, with no aid. With these findings in mind, it appears it is just as effective to take an antidepressant as it is to do nothing – and it is even more effective still, to simply believe you will feel better.

Following these unexpected findings, Irving collaborated with scientist Thomas J. Moore to investigate the research that is submitted by drug companies to the Food and Drug Administration (US). Together, they discovered that only 40 percent of the trial findings submitted are released, with that 40 percent being made up of the results that support the role of antidepressants in alleviating depression. When Kirsch and Moore gained access to 100 percent of the unreleased studies, they found the ugly and startling truth suggesting antidepressants only provide an improvement of 1.8 points, out of a possible 51 on the Hamilton Depression Rating Scale.

Despite the evidence contesting the efficacy of antidepressants, as someone who works in a psychiatric hospital, I have personally seen the incredibly positive effects antidepressants have on some patients as from one day to the next they become healthier and happier. Conversely, however, I also see how these antidepressants are not enough as patients who are discharged, seemingly better, are re-sectioned, despite the continuation of their medication. This is likely to be because the collaborative society they were surrounded by in hospital ceases upon returning to the outside world where the sociocultural problems which once contributed to their depression remain unresolved.

The depression that so many of us are suffering from seems a clear and crucial sign that something is not right. If that something is sociocultural, a drug will not fix it.

This is not to say that we are suddenly without solutions to depression, but it may be time to consider redefining what we have come to know as ‘antidepressants’. As Hari suggests, “an antidepressant […] isn’t just a pill. It’s anything that lifts your despair”. Alternative or additional solutions include therapy, talking about our feelings, reconnecting with people, finding meaningful work, reassessing what is important to us, practicing mindfulness and exercising.

The pharmaceutical industry which drives the affluence of antidepressants as a solution to depression is so powerful that redefining what constitutes antidepressants may seem impossible. Hari likens the social change necessary for this movement to campaigns that have fought for race, gender and LGBT equality.

It is important to consult your GP if you wish to discuss the efficacy of any antidepressant you may be on, and before changing or stopping any medication.