IntroductionThere is a
substantial accumulation of evidence to suggest that holistic methods, such as
a physical exercise, yoga and cognitive behavioural therapy, are beneficial treatments
for patients with moderate and mild depression. Through the research I have
undertaken, I have collated views of how GP’s and clinical psychologists
responded to anti-depressants and holistic methods in the treatment of
depression. My dissertation summarises the benefits of using exercise, yoga
therapy, as well as cognitive behavioural therapy to treat mild or moderate
depression, the restrictions to its more comprehensive use, how these
restrictions might be overcome, and how the reduction of anti-depressants and
increasing of holistic methods will have a welcome benefit on the economy,
environment and society. However, in order to balance these views, I have
clearly stated the benefits of anti-depressants in order to aid the treatment
of depression. The aim of my dissertation is to advocate the awareness of holistic
treatments for moderate depression as a practical and rational available treatment
for GPs, and a natural option that patients can both understand and choose for
themselves.Background                  AntidepressantsGeneral
practitioners (GPs) prescribe most medication for treating depression, including
anti-depressants, with a total 60-85% of adults receiving them for the
treatment of depression in the USA1 2, and an approximate of
5-16% of adults acquiring antidepressants in the USA and Europe yearly3. A combination of several
factors contributed to the increase in percentage of prescriptions annually: the
invention of tricyclic antidepressants (TCAs) in the late 1950s4, and the introduction of selective
serotonin re-uptake inhibitors (SSRIs) in the 1980s5; an escalation in the
continual prescribing in the 1990s and 2000s6; and the current increase
in the dosage of anti-depressant. These statistics are reinforced by
the NHS prescribed 64.7 million variants of anti-depressants in England in 20167,
pushing the boundaries to exceed a record number of medication dispensed in
2015, the most recent annual data from NHS Digital showed. Worryingly, this has
incited an escalating trend that has seen the number of pills given to patients
more than double over the last decade. These statistics provoked questions over
whether this dramatic incline in prescribed medication suggests that GPs are freely
providing anti-depressants rather than considering alternative treatments in
order to relieve patient’s mild and moderate depression.This increase in
the distribution of medication is concurrent with the introduction of SSRI’s, a
new variant of antidepressant drugs. While SSRIs are claimed to induce fewer
harmful side effects than former antidepressants8,
their success and safety are increasingly being disputed. Claims of withdrawal effects
are troubling9,
despite being commonly referred to not an addictive drug, as well as inducing insomnia,
nausea, and weight gain/loss that has been treated with escalating concern in
the media and by regulatory bodies, such as the FDA. Through primary research,
a concurrent statement from clinical psychologists advises patients against anti-depressants due to analysis that anti-depressants are
in fact considered to be as effective as a ”placebo”. According to these health professionals, the
”methodology of the FDA is weak”, and around ”70% of my patients do not
believe in the use of anti-depressants and believe they are ineffective,
preferring therapeutic methods instead”. Though anti-depressants are
associated with, positive effects for some patients, the more crucial side effects that correlate with the drug
use, such as increased proportion of self-harm and suicide need to be addressed.
These factors combined with high costs and low treatment completion, the
benefits of using these antidepressants as a first-line treatment for mild or moderate
depression is questionable. Despite
prescribing anti-depressants, GP’s understand the side-effects and drawback
associated with these drugs in question, therefore strict clinical guidelines
state that this form of medication should not be classed as first-line
treatment for mild or moderate depression. GP’s are aware of the benefits of
offering patient’s choice, though are often posed with difficult approaches to the
number and value of options available, as choice of treatments can often be
hard to come by. 78% of GPs believe that an alternative approach might have
been more appropriate, despite prescribing a specific anti-depressant.10
66% feel that there is no other option but to prescribe anti-depressants
because suitable alternative was not available.11
Therefore, clearly there is a difference in morals amongst GPs between
prescribing anti-depressants and the effectiveness of them.  How effective are
anti-depressants?A study published in July 2017, uses a
methodology of interviewing 27 GPs, to determine how they prescribe
anti-depressants, whether this involves medicalised or non-medicalised
patient-centred approaches. The overall results show that GPs were ignorant of the
knowledge that higher doses lacked greater efficacy and therefore a change to
the prescription or prescribed dosage within 1-2 weeks, choosing to prolong
switching or increasing medication after 8-12 weeks.12 A
common cause for this is a pressure on medical professionals to continually
prescribe anti-depressants due to a fear of symptoms of depression recurring,
lack of awareness of all unanticipated problems, because amongst GPs, there is
a lack of safety concerns regarding the dispensation of anti-depressants. Due to the variety of anti-depressants available, it is
difficult for GPs to assuredly calculate how well medication will help a
particular individual. Therefore, GPs will advise treatment that is tolerated demonstrated
the desired effect. An
important consideration is that the sample of anti-depressants prescribed by
GPs were influenced by how serious they classified the depression, the
patient’s symptoms, previous clinical experience of the GP, alongside health
factors, such as age and gender. Though treatment options were agreed to between
patients and doctor, the most commonly prescribed were SSRIs, as they are
considered to be the most effective, and induce the fewest side effects when
compared to TCAs (Tricyclic antidepressant). However, citalopram and escitalopram are associated with ventricular
tachycardia and sudden cardiac death, according to the Medicines of Healthcare
Regulatory Agency (MHRA)13,
had influenced prescribers who were now using less citalopram and more
sertraline. However,
for severe depression the drug mirtazapine’s side effects were considered
beneficial for some patients for underweight patients as the weight gain caused
by the drug was useful, while the insomnia and anxiety symptoms were relieved
by the sedative side effects for patients. The fear amongst patients was a recurrence
of the depression, due to withdrawal or reduction of antidepressants, which
could result in more harmful side effects than positive ones, was deliberated amongst
GPs and patients. This was particularly a hazard for patients with severe depression,
as reduction caused challenges depending on the stability of individuals, and
whether they could cope without them. Higher SSRI doses associated
with long-term B&Z treatment were considered to be linked with
patients being more complicated, possibly having greater psychiatric
multimorbidity as well as underlying social and personal issues not being
addressed but medicated instead. Patients were generally more willing to engage
and seek pharmacological treatment and resisted reductions. However, clinicians
rarely consider adverse effects with higher SSRI doses increasing anxiety or
B&Z’s lowering mood.Thus, this study reveals that
people with depression may decide for the option of anti-depressants due to
this being the primary option of GPs, rather than having the inability to
explore further options. This restriction often placed on GPs for depressed
cases can cause patients to rely more heavily on the use of anti-depressants
which can have a damaging effect both physically and mentally. From primary
research, the clinical psychologist that I contacted believed that holistic methods should be more heavily
promoted within GPs, and that they should be a main focus of treatment for mild
depression, and considered for moderate depression. Therefore, this study
demonstrates that those who benefit from anti-depressants, are likely to show
symptoms corresponding with more severe cases of depression, such as major
depression and bipolar depression, and therefore are less effective against
mild depression in comparison to chronic depression. Overall, anti-depressants that were
used regularly, such as tricyclic antidepressants, carried out their functions
well. Therefore, without anti-depressants, 20 to 40 patients who took the
placebo, but with severe depression noticed an improvement in their symptoms
within six to eight weeks. A considerable greater proportion between 40 to 60
patients did feel an improvement in their symptoms by taking the
anti-depressant within six to eight weeks. In other words, antidepressants
improved symptoms in about 20 more people out of 100 though for moderate
depression rather than mild depression.From my research and the pie chart shown, 30% of registered
mental health nurses always prescribed anti-depressants, 40% often prescribed anti-depressants,
and 30% sometimes prescribed anti-depressants, though 0% never prescribed
anti-depressants. This data clearly describes that all registered mental health
nurses, will prescribe anti-depressants, though this is dependent on the type
of depression, because 50% treated patients with major depression, and 60%
treated patients with bipolar depression, and 70% treated patients with psychotic
depression.  This means that there I a
need for anti-depressants for major depressive types, particular depression
symptoms that changes aptients characteristics severely, such as bipolar and psychotic
depression. Mental health nurses who treated patients with seasonal affective disorder
and atypical depression, sometimes What are the positive and negative
effects of reducing ant-depressants socially, environmentally and economically?EnvironmentalIf the usage of
antidepressants were reduced, this would have significant positive effects
environmentally, socially and economically. Regarding the environment, these
drugs are passing through the water supply, therefore harming aquatic life. It
is believed that once pharmaceuticals are consumed, the patient will absorb all
the chemicals into their blood stream to induce feelings of content. However,
in actuality though the body absorbs
the anti-depressant, and the biochemistry of the brain changes accordingly, the
chemicals are secreted from the body as waste. Though the impurities within
the water are treated, the filtering is not effective enough that the pharmaceuticals
are removed. This means that the drugs are existent in the water, and is integrated
into lakes and streams.Fluoxetine,
a selective serotonin reuptake inhibitor (SSRI) antidepressant, is frequently found in the aquatics. This type of drug alters the chemicals in the brain that are
instable in patients with depression.14 In a study completed by a researcher
at the Center for Marine and Environment Research in Portugal, Maria
Gonzalez-Rey, it was discovered that when mussels were exposed to
fluoxetine, the drug caused changes in the DNA structure, which developed into
DNA damage and growth complications. 15  Anti-depressants
are only anticipated to alter chemicals in humans, but as seen with aquatic
life, mussels in particular, the same chemicals can also affect animal
differently, and harmfully.The drug has such a huge effect on aquatic life as
it is stored in fish’s vital organs and tissues, including livers, brains, and muscles,
where it not only modifies physical attributes caused by changes to their DNA, but
also has immense impact on their emotion.  Male fish sought solitude in
remote environments, were ascertained to be more
hostile, and regularly
complete identical tasks. This contentious
behaviour led directly to the death of female fish, and therefore reproduction became
restricted.  Furthermore, the anxiety levels were increased, inducing the possibility of
catastrophe, because the animals will have limited awareness of danger and become
targets in the food chain.Therefore, this study suggests that the reduction
of anti-depressants will lead to less harm to aquatic life reducing the anxiety
levels which induces the
possibility of catastrophe, because the animals will have limited
awareness of danger and become targets in the food chain. This increases reproduction
of animals, and the passing of desired alleles to the next generation, which
increases the number of organisms without fluoxetine and other harmful antidepressants
in their systems. Anti-depressants have a wholly negative effect on the environment,
as it increases stress in

1 Prevalence, duration and indications for
prescribing of antidepressants in primary care. Petty DR, House A, Knapp P,
Raynor T, Zermansky A, Age Ageing. 2006 Sep;
35(5):523-6.

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2 Patient factors associated with SSRI dose for
depression treatment in general practice: a primary care cross sectional study. Johnson
CF, Dougall NJ, Williams B, MacGillivray SA, Buchanan AI, Hassett RD BMC
Fam Pract. 2014 Dec 24; 15():210

3 Excess risk of hip fractures attributable to the use of antidepressants
in five European countries and the USA. Prieto-Alhambra D, Petri H, Goldenberg JS,
Khong TP, Klungel OH, Robinson NJ, de Vries F, Osteoporos Int. 2014 Mar; 25(3):847-55.

4 https://www.healthline.com/health/depression/tricyclic-antidepressants-tcas

5 Middleton
N, Gunnell D, Whitley E, Dorling D, Frankel S. Secular trends in antidepressant
prescribing in the UK, 1975-1998. J Public Health
Med. 2001;23(4):262–267. doi:
10.1093/pubmed/23.4.262.

6 Petty DR,
House A. Knapp P, Raynor T, Zermansky A. Prevalence, duration and indications
for prescribing of antidepressants in primary care. Age & Ageing. 2006;35(5):523–526.
doi: 10.1093/ageing/afl023

7 https://www.theguardian.com/society/2017/jun/29/nhs-prescribed-record-number-of-antidepressants-last-year

8 https://www.nhs.uk/conditions/ssri-antidepressants/

9 https://www.addictioncenter.com/stimulants/antidepressants/

10 https://www.mentalhealth.org.uk/sites/default/files/up_running_report.pdf

11 https://www.mentalhealth.org.uk/sites/default/files/up_running_report.pdf

12 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5473964/

13 37. Medicines
and Healthcare products Regulatory Agency. Citalopram and escitalopram: QT
interval prolongation—new maximum daily dose restrictions (including in elderly
patients), contraindications, and warnings. Drug Safety Update.
2011;5(5):A1. http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON137769.  Accessed 13 June 2017.  

14 https://www.drugs.com/fluoxetine.html

15 https://edblogs.columbia.edu/scppx3335-001-2014-1/2014/04/02/are-fish-and-plants-on-antidepressants/

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