Effectiveness of Antidepressants on Mental Health

Introduction:

The question within this project brings an insight to how drugs could affect the mental health of an individual positively as well as negatively. It also draws attention to whether the benefits of antidepressants outweigh the risk; hence, suggesting that there are advantages and disadvantages of taking antidepressants.

Moreover, the main aim of this project is to provide evidence of how antidepressants could affect a person’s mental health negatively and positively and to thoroughly explain the effects of the drugs on the body. I would then elaborate on whether I believe antidepressant should be used for mental health or not. Furthermore, there are different types of mental health illness. However, I have decided to focus on Depression because studies show that the amount of people who are going through depression is increasing. This intrigued me to do more research because antidepressants can help to relieve the symptoms.

Within this project, I would be using a wide range of resources. For instance, I would use primary resources such as books and newspaper articles to look for statistics and key information that would help to explain what antidepressants are. Some key information includes the analysis of an average human brain and the brain of a person that takes antidepressants. Furthermore, I would speak to some individuals that are suffering from depression or anxiety to gain more knowledge on depression and to thoroughly understand the effect that antidepressants could have on the individual.

I would also use secondary resources such as the internet to support my points that are yet to be established. Secondary resource could provide factual evidence with analysis of any long term and short-term effect that occurs after taking these drugs.

The reason behind why I decided to focus on antidepressants within this project stems from a wide range of sources.  Firstly, it came to my knowledge that many students were expressing suicide thoughts in school, be it in high education or lower education.

In addition, statistics show that the suicidal rates are increasing, and there must be a reason behind it.

I understand that there could be other factors that are contributing to the increase in suicide rates. However, in the cases that I have researched, many patients that use these ‘effective’ drugs are committing suicide. This has encouraged me to research if antidepressants truly help to eradicate the mental illness or whether it make the patient’s situation worse.

The main arguments within this project would be focussed on the effectiveness of antidepressants on Depression and how these chemicals immensely improve the lives of many in the United Kingdom (UK). Most importantly, the arguments would also illustrate the side effects of antidepressants and whether they should be given to patients.

What are antidepressants?

Firstly, antidepressants were first developed in the 1950s. They are medications commonly used to treat depression. They are also used for other health conditions, such as anxiety, pain and insomnia. Although antidepressants are not FDA-approved specifically to treat ADHD, antidepressants are sometimes used to treat ADHD in adults[1].

 

How do antidepressants work?

The brain is made up of millions of cells, which transmit messages from one to another, using chemical substances called neurotransmitters. It is thought that when an individual is experiencing depression, two of these neurotransmitters are particularly affected – Serotonin, sometimes referred to as 5HT, and Noradrenaline. It is thought that these chemicals may be produced in lower quantities in the brain of those that suffer from depression.

Antidepressants increase concentrations of these two chemicals, thereby increasing the function of the parts of the brain that use serotonin and Noradrenaline. This helps the individual that uses this drug to feel better. This is because selective serotonin reuptake inhibitors (SSRIS) inhibit serotonin from being reabsorbed back into the nerve cells that they came from. This leads to an increase in concentration of serotonin in the synapse. Scientists believe that this extra serotonin can then strengthen communication between nerve cells, specifically those associated with mood regulation[2].  Sometimes, the reuptake of serotonin or noradrenaline occurs too soon. As a result, the brain does not have enough of the neurotransmitter. This can cause depression.

Moreover, different types of antidepressants work differently. Some anti-depressants slow the reuptake process of Serotonin or Noradrenaline in the brain. Other antidepressants interact directly with the receptors that release their neurotransmitters[3].

What are the different types of antidepressants and their effects on the brain?

There are four main types of antidepressants, which include selective serotonin reuptake inhibitors (SSRIs), Serotonin-noradrenaline reuptake inhibitors (SNRIs), Tricyclic antidepressants (TCAs) and Monoamine oxidase inhibitors (MAOIs)

SSRIs are considered selective because they only seem to primarily affect serotonin and no other transmitters. They help to ease depression by increasing levels of serotonin in the brain. Serotonin is one of the chemical messengers (neurotransmitters) that carry signals between brain cells, across the synapse. SSRIs block the reabsorption of serotonin in the brain, making more serotonin available.[4] This makes the individual taking the drug to feel relaxed and happy.

Furthermore, SSRIs are frequently prescribed for anxiety disorders, such as social anxiety disorder, panic disorders, obsessive–compulsive disorder (OCD), eating disorders, chronic pain and occasionally, for post-traumatic stress disorder (PTSD). They are also frequently used to treat depersonalization disorder, although generally with poor results. Examples of SSRIs include: citalopram, escitalopram, fluoxetine, paroxetine and sertraline

Similarly, SNRIs work by ultimately effecting changes in the brain chemistry and communication in brain nerve cell that is known to relieve depression[5]. They block reabsorption of neurotransmitters serotonin and norepinephrine, which are glycoproteins present in the synapse, in the brain. In addition, SSRIs take extra neurotransmitters from the synapses and transfer them back to the presynaptic nerves for further use[6].  In other words, SNRIS inhibit the reuptake of serotonin and norepinephrine. This causes and increase in concentration of neurotransmitters in the neurons. This increased concentration changes mood and enhances the alertness of the individual going through depression. Examples of SNRIs include: desvenlafaxine (Pristiq), duloxetine (Cymbalta), venlafaxine (Effexor), venlafaxine XR (Effexor XR), milnacipran (Savella), and levomilnacipran (Fetzima).

Furthermore, Cyclic antidepressants are designated as tricyclic or tetracyclic, depending on the number of rings in their chemical structure — three (tri) or four (tetra)[7]. This means that tricyclic antidepressants have three rings of atoms in their chemical structure.

TCAs work by affecting the changes in the brain chemistry and communication in the brain nerve cell that has known to regulate an individual’s mood, to help relieve depression. The ultimately block the reabsorption of neurotransmitters serotonin and norepinephrine (also known as noradrenaline and it is a naturally occurring chemical in the body that acts as both a stress hormone and neurotransmitter). By blocking the reuptake of the serotonin in the nerve cells, there is an increase in the levels of serotonin in the brain. This then helps to regulate the mood of the person that takes the drug. Examples of TCAs include:  imipramine, amitriptyline, doxepin, mianserin, trazodone, and lofepramine.

Lastly, MAOIs also ease depression by affecting the neurotransmitters that are used for communication between cells. They work by effecting changes in the brain chemistry that are operational in depression. In addition, the enzyme, monoamine oxidase is involved in removing the neurotransmitters norepinephrine (also known as noradrenaline), serotonin and dopamine from the brain. MAOIs prevent this from happening, which makes more of these brain chemicals available to effect changes in both cells and circuits that have been impacted by depression[8]. In addition, MAOIs are sometimes used to treat conditions other than depression, such as Parkinson’s disease. Examples of MAOIs include: rasagiline (Azilect), selegiline (Eldepryl, Zelapar), isocarboxazid (Marplan), phenelzine (Nardil), and. tranylcypromine (Parnate)

Abstract:

This essay discusses the effects of antidepressants and the effects that is it has on the mental health of an individual. The aims of the project was to gain further insight on the effectiveness of antidepressants on mental health. The essay further explores the most common side effects and rare side effects from taking antidepressants.

The essay also discusses the advantages of using antidepressants. This enabled me to compare and contrast the effectiveness of antidepressants as a whole.

Within this project, I focussed on depression, which is a form of mental health illness. I decided to make depression the focus because statistics show that the number of students in university and a level have shown an increase in the number of those that have depression. In addition, the number of suicide rate has increase.

I have used a range of resources to gather information, which helped me to come to an overall conclusion. For instance, I have used primary research such as questionnaire, dictionary and online book. I have also used secondary research such as the internet. I used to internet to gain access to articles and theories based on the effects on antidepressants on mental health. Some of these resources came from very reliable sources such as the official NHS website. However, some information were obtained from unreliable sources, as professionals in the health field did not write the information.

In summary, I concluded that although antidepressants may have side effects, the advantages of taking the drugs outweigh the risks. In addition, statistics showed that over 50% of people who took the drug noticed an improvement in their mood. This suggests that antidepressants are effective in relieving the symptoms of depression.

Discussion

Depression is a type of mental health illness, which affects about 121 million people worldwide, and is a leading cause of disability according to the world health organization (WHO)[9]. The updated statics on March 2018 regarding the rate of depression by WHO now states that 300 million people of all ages suffer from depression globally.

Furthermore, there is no cure to this chemical imbalance in the brain. However, there are effective psychological and pharmacological treatments for depression. For instance, some medications could help to alleviate some of the symptoms of moderate, and severe depression. However, it is usually not a long-term solution. As an example, antidepressants because they help to increase the level of serotonin and noradrenaline in the nervous system. These neurotransmitters are involved in regulating mood, which is what depression affects.

By contrast, the psychological treatments are effective treatments that can be provided by health care providers to help treat depression. This involves behavioural activation, cognitive behavioural therapy [CBT], and interpersonal psychotherapy [IPT][10].

Opinions vary on how effective antidepressants are in relieving the symptoms of depression. Many believe that even though antidepressants have side effects, its benefits outweigh the risks. However, some believe that further research needs to be done regarding drugs being used to treat patients with mental health because the yearly statistics of suicide is still rising; the increase accelerated after 2006.

Point 1: Many who believe that antidepressants are effective for mental health may argue that antidepressants are effective because the drugs enable people to get on with their everyday life by relieving the symptoms of depression, such as feeling sad and exhausted. For instance, during my research time, I spoke to a close friend that was going through depression. When I asked her whether she believes that the drugs helped her, she said, ‘I believe that I saw a change in mood slowly, but I can’t agree it was just the drugs that helped me’ She then went on to say that she believes [CBT] helped her to start recovery. This implies that antidepressants are quite effective because its use has been successful in helping a teenagers’ life. It helped to regulate her mood, which is the main effect that antidepressants are expected to have on the patients that take the drugs.

However, a very important aspect of what was said is that antidepressants was not the only thing that helped, but cognitive brain therapy also did. This elucidates that there are alternatives to using antidepressants and these methods might be much better as there are likely to be less side effects. Even though this is one testimony, many more people have testified in noticing a change in their mood once they took the antidepressants.

In addition, the NHS supports the use of antidepressants because they believe that it helps to relive long-term pain and are most effective in relieving symptoms quickly, particularly in cases of severe depression[11].

By contrast, some people argue against the use of antidepressants because although people are seeing an improvement in their health, more research needs to be done on the drugs. This ideology stems from the information that ‘Researchers think that the changes in the receptors cause mood to improve, but they do not completely understand yet how this happens’[12]. This poses questions on why these drugs would be given to patients when enough research has not been done.

Furthermore, during my research I found out that someone could be diagnosed with depression by what they tell their general practitioner ‘We currently diagnose depression based on what individuals tell us about their feelings – or those of their loved ones’[13]. This suggests that a person that does not have depression could be mistakenly told that they have depression, based on word of mouth. This means that more awareness needs to be raised on the method by which people are being diagnosed with mental health. For instance, more research needs to be done, to study the effects on the brain of those that have depression to identify clear patterns. This would be beneficial for both the practitioner and the community because general practitioners would have more data to look at, before prescribing a wrong medication to someone that does not need it.

Additionally, studies show that the brain of an average human is different to the brain of someone that has antidepressants ‘we have managed to identify a network of brain regions that is affected in people with depression’. This means that many more people that go to the doctors could now be examined to see if their brain shows similar patterns to those that has depression, before they are given medications to help relieve the symptoms of antidepressants. However, some argue that general practitioners should not solely base the fact the someone has depression using only the patterns in their brain, comparison to the brains of other patients.

Nevertheless, they should still take into consideration the patients feelings. This is because everyone is different, and people change. Therefore, what is known to be the norm for identifying whether someone has depression might completely be different for another person. As an example, they could show other patterns in their brain that others do not show. Does this then mean that they cannot receive treatments? If they are not, this would raise ethical issues because many believe in the sanctity of life and that all life must be respected and protected. This infers that every life is important and us as a human race should work collectively in helping each other, and in terms of this person’s case, it would be a more compassionate thing to help them, so that they can live a better life.

Moreover, I also asked my friend how she came to understand that she had anxiety/depression. She said that I knew when it started to muddle into my daily life and due to that it was making it a lot harder to do my speaking assessment. I kept having panic attacks because I was scared. But when I got to sixth form, my anxiety got so much worse and I knew it became a problem when I felt like I couldn’t live a normal life without thinking about the worst that could happen. I experienced many panic attacks every day and started to avoid people and school, and my anxiety lead to my depression getting worse.  She then went on to say that she went to the doctors and that was when she was diagnosed with anxiety.   I asked whether she went for regular check-ups before she was diagnosed, and she said, ‘I saw my doctor regularly first’ She also said that she went for cognitive brain therapy sessions a few months before she was given her medication.

This means that general practitioners do not immediately give patients the drugs, to help reduce the symptoms, however several means of actions need to be taken before the treatment can begin. This is very imperative as it means that patients health is taken into consideration and it minimises the side effects that the antidepressants could have.

Point 2: Many argue that even though antidepressants may be effective; like all drugs there are still side effects that could occur by using the drug. These side effects vary according to the type of antidepressant, age of the patient and the condition that the drug is used for.

A major argument epitomizes that fact that some side effects could lead to the condition getting worse.

However, when I interviewed my friend, I also asked whether the doctors explained the side effects of the drug to her and she said yes. She also said that she is a lot better now and that she is not in depression anymore and that ‘I haven’t had panic attacks in a long time’ This means that although there may be side effects, the benefits of the drugs outweigh the risks, and therefore supports the arguments that antidepressants are very effective in regulating mood and relieving symptoms of depression. Her condition did not get worse, but got better, and this is the same for most people that use the drugs. This is because ‘4 out of 5 get better in time’[14]

Also, according to the Royal College of Psychiatrist, the side effects are usually mild and tend to wear off after a couple of weeks. The newer antidepressants (called SSRIs) may make you feel a bit sick at first, and you may feel more anxious for a short while. However, the older type of antidepressants can cause a dry mouth and constipation[15].

Side effects of (SSRIs) and TCAs

There are many side effects, which that could occur due to taking selective serotonin reuptake inhibitors. For instance, according to the Royal college of Psychiatrists, you may feel sick and more anxious during the first couple of weeks of taking them. This implies that antidepressants may have negative effects on the health of the patient that takes the drugs. Therefore, patients must be aware of the side effects before taking the medication.

Further side effects from SSRs include difficulty in remembering, confusion, problems with urinating, and episodes of aggression (these are very rare) and indigestion, which could be prevented by taking the drugs with food[16].  On the contrary, However the Royal college of Psychiatrist say that the side effects usually wear off over a couple of weeks as your body gets used to the medication. This means that the side effects are usually minor and therefore the benefits of using the antidepressants outweighs the risks.

Similarly, there are side effects from taking TCAs. They commonly cause dry mouth, a slight tremor, fast heartbeat, constipation, sleepiness, and weight gain. However, in the elderly, they may particularly cause confusion, slowness in starting and stopping when passing water, faintness through low blood pressure, and falls[17].

The similarities between SSRIs and TCAs is that they both cause Anticholinergic effects (dry mouth, blurred vision, drowsiness, constipation, and difficulty in urination), and they both cause Cardiovascular effects e.g. increased heart rate.

However, the differences in the side effects of these two antidepressants is since SSRIs affect fewer sites of action than TCAs, and as a result cause fewer types of adverse effects. For instance, several studies have shown that some TCAs may be more effective than SSRIs in depressed in-patients. Also, a recent nationwide population-based study revealed that the use of tricyclic antidepressants is associated with a higher rate of stoke, compared to use of SSRIs[18].

In summary a recent meta-analysis found that SSRIs are noticeably better tolerated compared with TCAs in young patients[19]. This insinuates that although SSRIs and TCAs have similar effects on patients suffering from depression, SSRIs are a better antidepressant to TCAs because there are less side effects from taking the drug, and they are better tolerated compared with TCAs.

Side effects of SNRIs and MAOIs

The side-effects are very similar to the SSRIs, although Venlafaxine should not be used if you have a serious heart problem. It can also increase blood pressure, so this may need to be monitored.

By contrast, MAOIs are rarely prescribed these days. This is majorly influenced by the ideology that MAOIs can cause a dangerously high blood pressure if the patients eat certain foods that contain Tyramine. To prevent this, doctors give the patient a list of foods to avoid. Also, the most common side-effect with MAOIs is postural hypotension (feeling dizzy when you stand up). This is more likely to occur in the elderly. The less common effects are headaches, constipation and a dry mouth.

Lastly the very rare side effects include Peripheral neuropathy (weakness, cramps, and spasms, a loss of balance or tingling, numbness, and pain), and problems with the liver. Therefore, certain patients are not allowed to have certain antidepressants. For instance, patients who are pregnant, who have previously had a stroke, who has a heart disease and many more.

Overall, the different types of antidepressants are all equally as good at treating depression. Nevertheless, most people who need to take antidepressants are prescribed a SSRI. This is because they are generally safer, and their side effects are more tolerable than other types of antidepressants.

Point 3: The arguments about the effectiveness of antidepressants is linked with the doses of the drug that the patient takes. This is because some people believe that the higher the dose of drugs, the more effective the drug but the more side effect it has on the patient. This then links with the safety of the drugs because if there are more side effect, the antidepressant is to be considered more unsafe.

With some types of tricyclic antidepressant, the initial dose that is started is often small and is increased gradually to a full dose. However, a problem that sometimes occurs is that some people remain on the initial dose which is often too low to work fully[20].

This affects the evidence for and against the effectiveness of antidepressants because patients who do not use the drugs correctly may argue that antidepressants are not useful because they do not see a difference in their mood. Their argument should be invalid because the drugs are not being used properly, therefore they cannot carry out their full effect. This means that it would be very unlikely that they patient should notice change in their mood.

Also, according to the article by Dr Laurence Knott in August 2017, some people notice an improvement within a few days of starting treatment. However, an antidepressant often takes 2-4 weeks to build up its effect and work fully. DR Knott believe that patients should not stop the treatment after a week a so, thinking that the antidepressants are not working. However, he says that it is best to wait for 3-4 weeks before deciding if an antidepressant is helping or not[21]. I completely agree with DR Knott because it makes the research on the study of the effects of antidepressant on mental health much easier to analyse because the evidence would be much more reliable.

In addition, not only can the therapeutic dose not be reached, some patients might go over the therapeutic dose. In other words, there could be an overdose of antidepressants. This would have a negative effect on the patient. This is because those who overdose on antidepressants may also experience serotonin syndrome. Serotonin syndrome is a serious negative drug reaction that occurs when too much serotonin builds up in your body[22].Serotonin syndrome is known to cause nausea, vomiting, stomach cramps, changes in blood pressure, coma, convulsions and death.

Additionally, SSRIs are known to be much safer in overdose than all other antidepressants. Therefore, SSRIS are mainly used to treat those with depression. However, a disadvantage to this is that it is expensive to make these drugs. On the other hand, other antidepressants such as tricyclics have generic versions that are far less expensive. This could be why TCAs are also used. However, it also comes with a disadvantage because disturbance of blood pressure, seizures, coma and many more can occur with an overdose of TCAS as little as 5 time the patients therapeutic dose[23].

This causes people to question the use of antidepressants because there are many precautions that needs to be taken to ensure that someone seeking help does not become addicted to the drug and potentially develop serotonin syndrome. This further implies that antidepressants should not be used because it is not entirely safe.

Point 4: Moreover, those who argue against the effectiveness of antidepressants on patients that have depression due to the side effects, suggest that a psychological approach of helping patients going through depression should be used. This brings me to my next point which focuses on the alternatives of antidepressants.

Firstly, many suggest that cognitive brain therapy should be used instead of antidepressants because there are no side effects at all.  As an example, the friend that I interviewed explained that cognitive brain therapy helped her to understand what she was going through and to be well again. This suggests that antidepressants may not be as useful as they are portrayed to be, rather it demarcates that cognitive Brain therapy was the catalyst to the heeling. Perhaps using cognitive brain therapy alone could help patients without another medical interaction.

This argument is supported by the National Institute for Health and Care Excellence (NICE). This is because the NICE guidelines recommend that antidepressants should not be your main treatment. However, they suggest that before prescribing you medication, the doctor should recommend exercise or a talking treatment such as CBT[24].

According to the NHS, CBT can help a patient to understand their thoughts and behaviours and how they can affect the patient. CBT also helps the patient to recognise their past events and how it shed the patient. Most importantly, it helps the patient to concentrate on how they can change the way they feel and how to overcome negative thoughts. This is very likely to have a positive impact on the patients’ mental health because when the patient understands their self, it could make the healing process easier and the patient is less likely to show symptoms of depression because their attention is elsewhere.

An advantage of CBT is that there are different formats. As an example, there are face to face therapy and an online CBT. This ensure that patients who do not feel comfortable talking to someone directly do not miss out on the help. Another advantage of CBT is that is inexpensive, and it can be completed in a relatively short period of time compared to other talking therapies.

By contrast, antidepressants are very expensive as they cost the NHS £780,000 per day. There is has also been a 54% increase in the number of children prescribed antidepressants in the UK  2005-2012[25]. This means that the number of antidepressants being produced would have to increase in other to meet the needs of the patients. Therefore, more money is required. This could then affect citizens pay taxes economically because more tax may need to be collected in other for the National Health Service (NHS) to afford the increase in demand for antidepressants. It would also affect citizens environmentally because more carbon dioxide would be released, as more fossil fuels would be required to provide energy during the process of manufacturing new drugs. This would gradually further the impact of climate change, alongside the problems that comes with it. For example, destruction of life and housing.

A disadvantage of CBT is that it is time consuming and it may not be suitable for patients with more complex mental health needs or learning difficulties as it requires structures sessions. Another disadvantage is that the waiting list is too long and ‘it does not work for everyone’. Those who are in favour of the use of CBT would argue that this argument is not substantial because not all that use antidepressants notice a change for the better. For instance, a user said ‘Antidepressants did not work for me – I took [an antidepressant] for many months without recovering from depression. [For me], mindfulness helps to change the way you think and how you deal with negative thoughts’[26]. This implies that antidepressants should not be used because it is not proven successful in this case, whereas CBT is shown to be more beneficial to the patient.

Secondly, according to the NHS Research suggests that regular exercise may be a more effective treatment for mild depression than antidepressants. This is because exercise helps boost levels of chemicals called serotonin and dopamine in the brain, which can lift a person’s mood. Furthermore, exercising on a regular basis can boost self-esteem and confidence, which can help to relieve symptoms of depression.

Exercise is also more inexpensive than antidepressants and helps to carry out similar functions to using the drugs. By contrast, a disadvantage of this is that some patients that are going through depression may not be able to exercise due to disabilities. This means that this alternative does not consider all patients, whereas antidepressants do.

Thirdly, there are alternatives remedies that could help to treat depression. As an example, St John’s Wort is a herbal remedy available from chemists. Studies show that this remedy is effective in mild to moderate depression. It seems to work in much the same way as some antidepressants, but some people find that it has fewer side effects. However, one problem is that they could affect the way other medications work. I know this because it can interfere with other medicines like ‘the pill’.[27] Overall St John’s Wort could be used rather than antidepressants because it is less expensive. Also, there are no side effects to John’s Wort but there are many side effects from antidepressants even though the y both carry out similar roles. Therefore, antidepressants should not be used to treat depression. This alternative is also supported by the Cochrane review. This is because their review of 29 international studies on 5489 patients with depression, that compared treatment with extracts of St. John’s Wort for 4 to 12 weeks[28], concluded that St. John’s Wort may be as effective as standard prescription antidepressants for depression with fewer side effects than antidepressants. This further implies that antidepressants shouldn’t be used because there is a cheaper alternative that carries out a similar function to it.

Fourthly, the NHS suggests that electroconvulsive therapy (ECT) may be used in case of severe depression. At first, an anaesthetic is given to the patient to help relax their muscles. Afterwards, the patient receives an electric current to their brain through electrodes placed on the head. This is usually given twice a week for three to six weeks. The NHS say that it is not exactly clear how ECT works, but recent studies suggest that it helps reduce connections in an area of the brain linked to depression. On the other hand, there are side effects to this alternative such as headaches, memory problems and nausea. However, these side effects are better than the side effects caused from using antidepressants. Therefore, this method should be used to treat depression, rather than the use of antidepressants. Although big disadvantage of this method is that it would be more expensive for the NHS. This suggests the use of antidepressants over the use of the Electric shock treatment.

Lastly, Repetitive Transcranial Magnetic Stimulation is also another alternative, which uses magnetic waves working directly on stimulating nerve cells in the brain. The treatment been approved by NICE as an effective and safe method of treating depression in the United Kingdom and is known to be non-invasive.[29]. Another advantage of this treatment is that it a Does not require anaesthesia and it has been approved by the FDA Approved in 2008 for the treatment of depression[30].

However, there are several side effects. These include facial twitching during the treatment, skin redness at site of coil placement, time consuming and many more. This means that antidepressants should be used instead of the alternative because the disadvantages of this method outweigh the risks.

PONT 5: Finally, the last argument within this project focussed on the Placebo effect. This is because many who do not support the use of antidepressants believe that the effects of using the drug and believing that you are taking the drug is very similar. They believe that the changes in the brain of someone who has not taken the drugs show similar changes to the brain to someone who is on the medication. This further suggests that antidepressants may not be as effective as they are made to be, but in fact, the real recovery of the patient depends of their psychological state. For example, someone who has taken a placebo would believe that the fake drug they are consuming is going to help them recover. This could make them to feel happier because they are ‘getting help’. Similarly, someone who has taken the actual antidepressants is more likely to feel the same way. This means that when their brains are scanned. They are very likely to show similar images.

By contrast, according to the Royal College of Psychiatrists, an estimate of 50-65% of people treated with an antidepressant for depression will see an improvement, compared to 20-25% of those taking inactive ‘dummy’ pills (placebo). This means that antidepressants are really effective on mental health because a large number of people can testify of its benefits. In summary, many agree that most people do benefit from antidepressants, even if it is sometimes a result of the placebo effect[31].

In addition, this argument is further supported by figure 3 on the Appendix (II), which shows the effects of antidepressants, and the placebo effect on a human Brain. The antidepressant in this figure is Fluoxetine, which is also known as Prozac. This is a type of SSRI antidepressant.

Figure 3 shows that the brain activity of those with placebo drugs and the actual drugs are very similar in pattern. This suggests that antidepressants do not have significant effect on the mental health of an individual. However, it implies that the individual may have not had depression or that the healing of depression is due to psychological effects. This further suggests that although antidepressants are helpful, some of the benefits are due to the placebo effect.

On the contrary, figure 2 on the Appendix (II) highlights a clear disparity between the a   depressed human brain and a recovered brain from taking antidepressants. Figure 2 shows that there is more brain activity in the brain of the recovered patient. This indicates that antidepressants are useful and that they have a positive impact on mental health because the patient’s brain is much more active than usual. This signifies that there has been an improvement in their health and overall mood.

According to an article by Dr Knott, about 5 to 7 in 10 people with moderate or severe depression have an improvement in symptoms within a few weeks of starting treatment with an antidepressant. However, up to 3 in 10 people improve with placebos. This is because some people would have improved in this time natural. This statistic supports the use of antidepressants because over 50% of the patients who use it are noticing a better change in their mood. This is a lot more that 30% of people who claim to have noticed a better change in their mood through taking placebos.

Furthermore, according to the NHS, researchers that conducted a review of trails of antidepressants found that all 21 studied antidepressants worked better than a placebo. The research was a systematic review and meta-analysis of double blind randomised controlled trials assessing antidepressants for adults with depression.

This study elucidates that antidepressants are effective on mental health. However, this does not mean that antidepressants are highly effective. It means that people are more likely to see their symptoms improve if they take an antidepressant than if they take a placebo.

In addition, studies of people with moderate or severe depression showed about 20 to 40 out of 100 people who took a placebo noticed an improvement of their symptoms within six to eight weeks. However, about 40 to 60 out of 100 people who took an antidepressant noticed an improvement of their symptoms within six to eight weeks[32]. This means that antidepressants improved symptoms in about 20 out of 100 people. This suggests that antidepressants are not as effective as they are made to be.

Conclusion

Before this project, I believed that antidepressants definitely have an effect on the mental health of an individual, and should therefore be used to treat depression. However, I also believed that not only does it have positive effects on mental health; it also has negative effects too. This was the main aim of my project.

In summary, I noticed that there was a clear disparity between the arguments for and against the use of antidepressants. The main arguments presented in support of the use of antidepressants were 5 to 7 in 10 people with moderate or severe depression have an improvement in symptoms within a few weeks of starting treatment with an antidepressant. Similarly, the other argument in support of the use of antidepressant was that about 40 to 60 out of 100 people who took an antidepressant noticed an improvement of their symptoms within six to eight weeks. Both of these arguments show that the use of antidepressants have made a massive impact on the lives of many people and has shown to be effective at the job that it does (to regulate mood).This means that antidepressants should be used to treat mental health.

By contrast, the main arguments against the use of antidepressants is that there are side effects of the drug. These side effects include headaches, increased depression, nausea and many more. This suggest that despite the fact that antidepressants might be effective in improving a patient’s mental health, it also affects the patient at the same time. On the contrary, depression may not necessary caused by the lack of serotonin despite the fact that the symptoms are reduced by antidepresssnats which work to increase the level of serotonin in the brain.

In addition, the other main argument against the use of antidepressants is the placebo effect. This argument provided a strong perspective against the use of antidepressants because it implied that they were ineffective in relieving the symptoms of depression, However they suggested that the real healing from antidepressants comes from the psychological mindset of the patient. For instance, believing that you will get help may trigger the release of more serotonin in the brain, meaning that the patient would be happier. In other words, they would notice an improvement in their mood.

Additionally, a researcher said that some of the conditions of his clients improved when they began taking antidepressants and sometimes it did not. For instance, research from the psychology textbook showed that twin that had depression where given the same antidepressant. One twin noticed an improvement in mood, but the other twin did not. This showed that although antidepressants are very effective on depression, the same antidepressant might not work as effectively as they would on certain people.

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Furthermore, another main argument against the use of antidepressants is that they are very expensive and there are alternatives that could be used. However, a main disadvantage of most of these alternatives is that the side effects are greater than using an antidepressant. This means that antidepressants should be used on mental health such as depression because it regulates the patients’ mood without too much side effects. Therefore, this implies that antidepressants are more efficient.

On the contrary, However the Royal college of Psychiatrist say that the side effects usually wear off over a couple of weeks as your body gets used to the medication. This means that the side effects are usually minor and therefore the benefits of using the antidepressants outweighs the risks.

• The disadvantages of most of the alternatives are that its is very expensive.

 Critical Evaluation

The topic of my project was decided because there has been an increase in the number of students that have depression. The number of antidepressants that are provided by the NHS has also increased. This implies that more patients can gain help. However, this has not been the case. This is because the number of people that have depression are still increasing. This made me question the effectiveness of antidepressants, as the numbers should show a gradual decrease. However when reviewing my project I came to an overall conclusion that antidepressants are very effective.

It was quite difficult for me to find sources that I could use to counteract the arguments in support of the use of antidepressants. Some of the resources were very reliable as they came from professional organizations. However, some resources were not trustworthy because they were written from a bias perspective of those that felt that antidepressants were unhelpful and those who felt that it was helpful.

One of the main skill I have acquires during this project is my ability to critically analyse sources from different perspectives. I made a research record table, which included a section where I discussed the limitation and key points obtained from each source. This table enabled me to have visual representation of my sources and it allowed me to disregard the sources that had the most limitations.

Another skill that I have developed is my ability to research using different mediums. I broadened my research to books, newspaper articles and professional websites. This enabled me to gather a good amount of information that contained various points of views from both professional organisations and patients who have suffered from mental health.          Nevertheless, I have developed independent learning skills. This is because I had to work by myself to gather all my research, and discern which information from my research I should use in my project.

In addition, I believe that this project has helped me to improve my critical writing skills. This is because despite the fact that antidepressants definitely has an effect on mental health, I had to find arguments against the use of antidepressants to challenge the arguments in support of using antidepressants.

My strengths during this project was the ability to organize my project, for example I made a chart of Excel which enabled me to track how much I have completed for each section of my project. This tracker also alerted me of how long I took to complete each section,. This then enabled me to plan, to ensure that I have enough time to complete other aspects of my project.

Another use of time management I used was my reflective project activity log. This helped me to check all the things that I have done and any progress that I had made so I can look back and see what I have to complete for next time.

Another success from this project is that I gained evaluative skills and I remained committed to the project. Despite the fact that there were other things such as examinations, I showed self-discipline by ensuring that I made time to do some aspects of the project even if was a small adjustment.  Furthermore, I have learnt how to paraphrase my research in to my project. I did this by researching online and watching YouTube videos on how to paraphrase. This ensured that I would avoid plagiarism in my project.  Moreover, I also used YouTube to watch videos of people that have suffered from depression and their experiences from it. This enabled me to expand the little knowledge that I currently had on depression. However, I had to be careful not to show bias in my arguments.                                                               I also watched videos on doctors and their perspectives on whether antidepressants should be used on mental health patients. This helped me to compare different perspectives, with regards to the perspective of an ordinary person and the perspective of a general practitioner.

Despite my achievements, I encountered a downfall when completing this project. The main downfall was my time management skills. Despite the fact that I has a plan to guide me, it was not guaranteed that every aspect of the plan was to be followed.

Additionally, another problem that I faced whilst completing this project was that it was difficult to critically analyse my sources because the information that I obtained were quite repetitive and simple.

If I had the opportunity to do this project again, I would explore a wider range a of sources which I could use to support my arguments. I would also explore a wider range of mental health illness and the effects antidepressants has on them. As an example, Schizophrenia, Bipolar disorder, Post Traumatic Stress Disorder, Personality disorders, Paranoia and many more. This would help me to come to a better conclusion that antidepressants has a beneficial effect on mental health as a whole.                                                                               Furthermore, I would also like to analyse the effects of other drugs on mental health to thoroughly understand why antidepressants are the main drugs used to treat depression.

As a whole I learnt to be well organised and to take control over my studies. I have also learnt to develop research, by recognising bias. In addition, I sincerely believe that the Extended Project Qualification has helped me to explore further aspects of the subjects that I would love to study at university. It has helped me to understand the importance of planning and effective research skills.

[1] https://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml

[2] http://www.medicaldaily.com/how-antidepressants-work-brain-comprehensive-guide-336250

[3]https://books.google.co.uk/books?id=1l3xyXo_KtgC&pg=PA9&dq=what+are+antidepressants&hl=en&sa=X&ved=0ahUKEwie2rDt-PDYAhVhDMAKHeerCkAQ6AEILjAB%20-%20v=onepage&q=what%20are%20antidepressants&f=false#v=snippet&q=what%20are%20antidepressants&f=false

[4] https://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825

[5] https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20044970

[6] https://www.goodtherapy.org/drugs/antidepressants-snris.html

[7] https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046983

[8] https://www.mayoclinic.org/diseases-conditions/depression/in-depth/maois/art-20043992

[9]https://books.google.co.uk/books?id=1l3xyXo_KtgC&pg=PA9&dq=what+are+antidepressants&hl=en&sa=X&ved=0ahUKEwie2rDt-PDYAhVhDMAKHeerCkAQ6AEILjAB%20-%20v=onepage&q=what%20are%20antidepressants&f=false#v=snippet&q=what%20are%20antidepressants&f=false

[10] http://www.who.int/mediacentre/factsheets/fs369/en/

[11] https://www.nhs.uk/conditions/antidepressants/

[12]https://books.google.co.uk/books?id=1l3xyXo_KtgC&pg=PA9&dq=what+are+antidepressants&hl=en&sa=X&ved=0ahUKEwie2rDt-PDYAhVhDMAKHeerCkAQ6AEILjAB%20-%20v=onepage&q=what%20are%20antidepressants&f=false#v=snippet&q=what%20are%20antidepressants&f=false

[13] https://www.independent.co.uk/news/science/a-brain-scan-to-tell-if-you-re-depressed-and-what-treatment-is-needed-a7664016.html

[14] http://www.beh-mht.nhs.uk/Downloads/Patient%20and%20carers/Conditions%20leaflets/Depression-information-for-patients-and-carers.pdf

[15] http://www.rcpsych.ac.uk/healthadvice/problemsanddisorders/depression.aspx

[16] https://www.rcpsych.ac.uk/healthadvice/treatmentsandwellbeing/antidepressants.aspx

[17] https://www.rcpsych.ac.uk/healthadvice/treatmentsandwellbeing/antidepressants.aspx

[18] http://www.emedexpert.com/compare/ssris-vs-tca.shtml#4

[19] https://www.ncbi.nlm.nih.gov/pubmed/24998011

[20] https://patient.info/health/depression-leaflet/antidepressants#nav-1

[21] https://patient.info/health/depression-leaflet/antidepressants#nav-1

[22] https://www.healthline.com/health/can-you-overdose-on-antidepressants#if-you-suspect-an-overdose

[23] http://www.emedexpert.com/compare/ssris-vs-tca.shtml#4

[24] https://www.mind.org.uk/information-support/drugs-and-treatments/antidepressants/alternatives-to-antidepressants/#.WxAiy-4vzIU

[25] https://ww.smarttms.co.uk/antidepressants-uk-statistics/

[26] https://www.mind.org.uk/information-support/drugs-and-treatments/antidepressants/alternatives-to-antidepressants/#.WxAiy-4vzIU

[27] https://www.rcpsych.ac.uk/healthadvice/treatmentsandwellbeing/antidepressants.aspx

[28] http://www.cochrane.org/CD000448/DEPRESSN_st.-johns-wort-for-treating-depression.

[29] https://www.smarttms.co.uk/antidepressants-uk-statistics/

[30] https://lindnercenterofhope.org/blog/advantages-and-disadvantages-of-tms/

[31] https://www.nhs.uk/conditions/antidepressants/

[32] https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0087089/