Anti-depressants: research on whether they increase the risk of relapse

Depression and anti-depressants

Recent research suggests that people suffering from depression who use anti-depressants are more likely to relapse after stopping, than those who do not use anti-depressants.

In fact, according to a study by Paul Andrews, Evolutionary Psychologist and Assistant Professor in the Department of Psychology, Neuroscience & Behaviour at McMaster University, sufferers who use anti-depressants aretwice as susceptible to further episodes in the future.

His meta-analysis considered numerous other research findings and discovered that people suffering from depression who took no medication had a 25% chance of relapsing, whilst those who took medication and then stopped were 42% more likely to have another depressive episode.

Why is this?

The brain self-regulates the production of serotonin and other neurotransmitters. Anti-depressants are intended to disrupt and alter production. Andrews notes that whilst anti-depressants reduce symptoms for some sufferers in the short term, there seems to be an issue over their long-term effect. It seems that the brain can over-correct once medication is stopped and struggles to re-establish healthy self-regulation.

Anti-depressants can leave people stuck in a cycle where they need to keep taking them to prevent a return of symptoms” says Andrews.

He goes on to suggest that depression may actually be a natural and beneficial – though painful – state in which the brain is working to cope with stress.

“There’s a lot of debate about whether or not depression is truly a disorder, as most clinicians and the majority of the psychiatric establishment believe, or whether it’s an evolved adaptation that does something useful”, he says.

Andrews’ paper, Blue Again: perturbational effects of anti-depressants suggest monoaminergic homeostasis in major depression, has been published in the journal Frontiers in Psychology.

In major depressions where there is a significant loss of functionality or risk of suicide, anti-depressants are clearly necessary. This research, however, reinforces the need to be cautious in starting on anti-depressants in cases of mild or medium depression.

Concern has been expressed recently about GPs prescribing anti-depressants too quickly, in circumstances where psychotherapy and counselling should be the treatment of choice. Click here to read more about this.

Andrews’ research raises two interesting and related points for those interested in psychotherapy – the self-regulation of the psyche and the positive purpose of depression.

Carl Jung observed that it is not only the body that self-regulates, but that the psyche also self-regulates.

It does this without us noticing – through dreams, images and other unconscious contents. Our unconscious and consciousness interact to provide a healthy balanced psyche.

(For a brief summary of Self-regulation of the psyche, see the Jung Lexicon on the New York Association for Analytical Psychology - click here.)

When there is a disturbance in the psyche, the self-regulatory function can become disrupted. Jung explained:

“The aim of analytical psychotherapy, therefore is a realisation of unconscious contents in order that compensation may be re-established”.

If, therefore, a depression is caused by a disturbance in the self-regulation of the psyche, it may be more beneficial to make conscious the repressed contents of the unconscious through psychotherapy, than to take medication.

Jung tended to have a teleological attitude to the psyche – rather than focus on its diseases and dysfunctions, he saw the psyche as trying to heal itself. When faced with a psychological difficulty of some sort, he would enquire as to what healing the psyche was trying to achieve.

In 1959 Jung received a letter seeking advice as to how to deal with feeling depressed. There is not space here to include the whole of his reply, but here is an extract:

I am sorry you are so miserable. “Depression” means literally “being forced downwards”. …

When the darkness grows denser, I would penetrate to its very core and ground, and would not rest until amid the pain a light appeared to me, for in excessu affectus [in an excess of affect or passion] Nature reverses herself.

I would turn in rage against myself and with the heat of my rage I would melt my lead. I would renounce everything and engage in the lowest activities … I would wrestle with the dark angel until he dislocated my hip. For he is also the light and the blue sky which he withholds from me.

Anyway that is what I would do. What others would do is another question, which I cannot answer. But for you too there is an instinct either to back out of it or to go down to the depths. But no half-measures or half-heartedness.”

In essence what Jung is saying is that he would wrestle with the depression in order to extract its meaning, the thing of great value that is hidden in it.

By comparing the struggle with depression to Jacob’s struggle with the angel of God, Jung not only draws attention to the profound difficulty of the struggle, but also to its meaning as relating to a struggle with something of higher value within oneself.

Having survived the struggle, Jacob demands a blessing and, as his reward, is renamed Israel “because you have fought with God and man and have won“.

Jacob’s hip never recovered – we are wounded by our struggles in life – but his wrestle in the dark night with such a powerful force was a key transformative experience in his life that enabled him to fulfil his potential.

Depression feels like a wholly negative state of hopelessness and despair. Meaning and fulfilment in life are lost. We are stuck. But if, instead of seeking a quick solution through anti-depressants, we struggle with the darkness until it reveals its meaning, our depression can be a positive life-enhancing and even life-changing experience.

Jacob went on to father the people Israel. As a result of his titanic struggle he became fruitful, a leader and a mature man in his own right.


Posted on

Comments are closed.