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Johann Hari @johannhari101
, 22 tweets, 5 min read Read on Twitter
We need to have a nuanced conversation about chemical anti-depressants. Take a look at this story:…
A Guardian blogger claimed that my book tells people to stop taking anti-depressants & this idea got quite widely spread. My book doesn’t say that. Their readers’ editor has now issued a clarification.
In fact it says, p37: “I don’t want to take away anything that gives anyone some relief. If for you the benefits outweigh the side-effects, you should carry on.” That’s been my advice to my own relatives.
Here’s the more complex truth about chemical anti-depressants. Depression is measured by something called the Hamilton Scale. It runs from 1 (where you’d be joyful) to 59 (where you’d be suicidal)
To give you a sense of what movement on the Hamilton Scale looks like, if you improve your sleep patterns, you gain 6 points on the Hamilton Scale. According to the leading expert at Harvard Medical School, chemical anti-depressants give you on average a boost of 1.8 points.
It’s important to say: that’s an average. I initially got more than that, and over time got less than that. (Also some experts say it’s a bigger average boost than that – but not by a huge amount).
1.8 points is not nothing. For people in terrible pain (as I was), it is real relief, and therefore has real value.
But for huge numbers of people – more than 50 percent, according to this major study, cited by the very person who wrote the Guardian blog post attacking my position – it is isn’t enough to provide lasting relief for depression…
I think this is a pretty common-sense position. 1.8 points is not nothing; these drugs give some real relief to some people & therefore have some value; but they don’t solve the problem for most people.
This is why we need to expand the menu of options for depressed people, to include solutions that deal with the underlying problems. Nobody wants to take anything off the menu.
(The leading expert at Harvard Medical School also responded to meta-analyses and showed why we need to handle some of them with caution, because the benefits they suggest are overstated. He explains why on my website & in many scientific papers:… )
There are some people who get some relief from taking anti-depressants who don’t currently take them. There are others who take them and experience very bad side-effects who would benefit from stopping. I think everyone knows this.
My book says if we get stuck at the debate ‘are chemical anti-depressants good or bad?’ we’re missing the point. They provide relief for some, and therefore have some value, but don’t solve the underlying problems & need to be part of a much bigger strategy.
My position – that we urgently need to deal with the deeper causes of depression, rather than just pathologizing our pain – is the position of the World Health Organisation and the United Nations. Take a look at what the UN’s leading doctor says on this…
For something as devastating as depression – the worst thing I have ever been through – we need every strategy and tool on the table, as I make clear in my book.
Everyone in this debate agrees (including Dr Cipriani, co-author of this new report, who I discussed this with) there are big social &psychological causes of depression – I write about 7 in Lost Connections – & many are rising. We need to deal with these deeper causes urgently
The other day, I did a radio show with a psychiatrist who said he thought, based on the reports, that my book was an attack on chemical anti-depressants – but then he read it & realized it’s not that at all.…
The interviewers who have read the book point out that I don’t urge anyone to stop taking these drugs, and that it’s a bizarre distortion of what I’m saying to claim that:…
We are in the middle of a depression and anxiety emergency. Some depressed & anxious people will benefit from chemical relief (as I did for a time). All of them will benefit from us dealing with the deeper causes of depression. That’s our most urgent public health task now.
(Sorry for the long thread, but the reason to write a 300-page book is that you want to express thoughts that don't lend themselves well to 280-character simplifications.)
I accidentally put the wrong link with one of my tweets. The leading Harvard expert in fact explains why we need to be cautious about some meta-analyses here:…
This is a good, balanced postscript to the discussion of the past few days - rightly praises the study & the drugs; & rightly talks candidly about their limitations too.…
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