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Treatment resistant depression: what are the options?

BMJ 2018; 363 doi: (Published 18 December 2018) Cite this as: BMJ 2018;363:k5354

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Re: Treatment resistant depression: what are the options?

As a member of the online prescribed harmed community, I read with interest the article by Greta McLachlan on treatment resistant depression. I was prescribed antidepressants for 35 years and derived little benefit from any of them. I believed that my “depression” was somehow untreatable and therefore something to be endured. I lost hope many years ago. I was always too frightened to come off the drugs but at age 62 I finally became drug free and feel mentally stable for the first time since the age of 20. In my case, the underlying cause of decades of “depression” was undoubtedly a benzodiazepine also prescribed to me since the age of 20. I was unaware this was the cause of my ongoing “mental health” problems. Would I have been classed as “treatment resistant” or as someone who had been treated successfully? I suspect it would have been the latter.

The article on TRD states “NICE’s definition would mean 2.7 million people in the UK have treatment resistant depression (between 10% and 30% of people with depression), an unmanageable number for the NHS’s psychiatric services.” Yet, MIND estimates that 3.3 in 100 people suffer from depression in England, this equates to a total of 2.2 million sufferers across the UK. (1) In February 2018, The Times reported that “about two million people in Britain are thought to suffer from depression, yet studies suggest that only a sixth get the help they need.” (2) This would suggest that only 333,000 are getting the help they need, yet there are at least 9 million patients on antidepressants in the UK. I wonder which definition of depression is being used in these varying estimates and how many of the 9 million patients on these drugs never really needed them in the first place.

I now know that SSRI antidepressants have very limited efficacy and if I had been informed of that years ago I would have realised that the drugs were the problem and not my mental health. Perhaps the real underlying cause could then have been identified. The difficulties of trying to taper off these drugs are immense and for many patients no warnings were given that this could in fact be the case. This coupled with the limited benefits means that for many patients the risks simply aren’t worth it. As Dr Des Spence states “Antidepressants are a problem for millions. The truth is, antidepressants lack efficacy, have a high placebo response and risk a long-term form of dependence.” (3)




Competing interests: No competing interests

21 December 2018
Fiona H French
Member of online patient support community for prescribed drug dependence
Aberdeen, Scotland