Antidepressants can help fight depression, but are not a substitute for treatment. (imago / Pascal Fossier)
Professional associations and health insurance companies report an increase in depressive symptoms during a pandemic. Either way, the number of prescriptions for antidepressants has been increasing for years. Their effect is not undisputed.
“The first time I thought something was wrong it was clearly demonstrated by extreme insomnia. I think it was like that in fifth or sixth grade in high school. I just couldn’t get myself. back to sleep.”
Clara Güll must have been 12 years old. The family goes to the family doctor with suspicion. Clara Güll didn’t learn of the diagnosis of “recurrent depression” until years later – but she noticed at the time that discussions about prescribed therapy with the psychologist were good for her.
Lack of psychotherapists in Germany
Since then, she has repeatedly had phases of more severe depression and even thoughts of suicide. “There is a great void in you. It is very heavy, like something is sitting on you and like you are so cut off from the world, you feel completely alone.” The 28-year-old treats these feelings artistically, writes songs and poems. She continues to be in therapy and has also been taking antidepressants for about three years. At first, she had reservations:
“Oh my God, antidepressants, they have such a bad reputation. And actually, I don’t want that at all. I don’t want to get addicted to any drugs and I’m also afraid it will rob me of my creativity. , that it will change me. “
Ulrich Hegerl is familiar with such reactions. He is chairman of German Depression Aid and professor of psychiatry at the University Clinic in Frankfurt am Main. After years of experience with patients, he considers the positive effects of antidepressants to be indisputable. Mainly because there are not enough psychotherapists in Germany. Antidepressants can help here, for example for first aid. Even if their operation is not yet completely clear.
“We know they influence messenger substances, serotonin, norepinephrine. We know that. But how exactly this works its effect is not understood, as we do not know the exact mechanism of the disease of depression. There are so many changes in the brain in depression that it is still not clear exactly: what is the cause and what is the consequence of depression? “
There are many reasons for depression
Depression is an interaction of several factors: a genetic predisposition, a deficiency or imbalance of certain messenger substances in the brain and stressful experiences – according to the current state of research. Which of these is the most important depends on who you ask.
“Most people think that depression is primarily a reaction to difficult life circumstances. But when you have a lot of experience with people who suffer from depression, you find that you clearly overestimate these influences. The deciding factor is your disposition. “
However, this position is not undisputed – especially by researchers who work less concretely with patients, but rely on the study situation.
“Why is it never diagnosed? Why can’t you look into the brains of patients who are diagnosed to see how their serotonin levels are really determined? The brain thinks, is incredibly small, and only exceeds normal in some people. “
On average, a slightly increased serotonin level can be determined – but this is not automatically the case in individual cases, explains Stephan Schleim. The Associate Professor of Theoretical Psychology at the University of Groningen says: Depression cannot be diagnosed in the brain, but only through diagnostic conversation.
“The biological approach has imposed itself in research. And then not even a global biological approach, but very reductionist which essentially aims to reduce the human being as a whole to cerebral circuits, to molecules.”
The placebo effect is underestimated
Stephan Schleim therefore advises caution when using antidepressants. On the one hand, they are not a substitute for psychotherapy, and on the other hand, they are often only effective for moderate to severe depression. But here too, the placebo effect is often underestimated, as several studies have shown in the meantime.
“The first problem is that we now have relatively good data on what to think of antidepressants in terms of their effectiveness against depression if only antidepressants are prescribed. This is the difference between a placebo effect and some antidepressants – especially in mild and moderate depression compared to the real drug – that this difference was in fact only determined at around 20 percent “, criticizes Gerd Glaeske, pharmacist and health scientist at the University of Bremen .
In addition: “You should also pay more attention to the side effects of the drug and the sometimes severe withdrawal symptoms that people may experience. “
Further efficacy studies are desirable
Here too, adds Stephan Schleim, the data situation is still quite slim. Nevertheless: in Germany, the prescription of antidepressants has increased by around 40% over the past ten years – as data from health insurance funds show. And despite all the criticism: Stephan Schleim and Gerd Glaeske also point out that antidepressants can help.
However, close monitoring and additional psychotherapy are important. And: other studies – independent of the pharmaceutical industry – on the effectiveness of antidepressants.
In any case, Clara Güll does not want to do without it yet: “I think I could rather imagine stopping the drug before therapy. But the two are still a long way off, so I don’t have a concrete plan to stop what. I’m just trying to use it for as long as possible. “