As a production for the digital magazine Inspire The Mind the latest podcast in the At the Back of Your Mind Series was titled: Serotonin: What is its role in treating depression?
The following is a transcription of this episode [any errors in the transcription are due to me]. My understanding is the podcast team also transcribe each episode and I will post a link to this transcription when available.
Serotonin: What is its role in treating depression?
20 April 2023, Podcast by At the Back of Your Mind [recorded 16 February 2023]
Our Hosts, Maryam Matter, Juliette Giacobbe and Dr Carolina Estevao are once again joined by King’s Professor of Biological Psychiatry Carmine Pariante to talk about the continued debate surrounding the serotonin hypothesis of depression and the use of antidepressant medication.
How are you girls?
We are good.
Very good, so today’s topic is should we trust SSRIs?
SSRIs are antidepressants and they are the main class, I mean type of antidepressant that are currently prescribed to people in the UK and in the world in general. [The acronym] stands for Selective Serotonin Reuptake Inhibitor.
So serotonin is a neurotransmitter. It is a molecule that is responsible for transmitting information in the brain and it is involved in regulating mood, appetite, sleep and other functions. So you wouldn’t be surprised that someone who is depressed has their mood, appetite and sleep effected. There is this theory that came about in the 1950s/60s. It was first proposed in fact in 1965, that, em, this theory wold explain depression from a biochemical perspective just focussing on serotonin. Essentially [this theory] says if there is a deficiency of, or lower levels of serotonin in the brain, which can be caused by genetics, stress and medical conditions. Essentially lower serotonin = depression. If you increase serotonin you reduce depression. Which is not as straightforward as you would think.
One thing that led people to believe that serotonin might be responsible for depression is the fact that a lot of previous types of antidepressants targeted serotonin in the brain. Therefore they developed something that only targeted serotonin, or could at least increase its availability in the brain. Am I correct Maryam? Our Resident!
Our psychopharmacology expert [giggles].
The pharmacologist. Em, no, just from my undergraduate, not an expert for sure, but, SSRIs they work by stopping these transporters which specifically clean up serotonin when there is too much serotonin in the gaps between our brain cells. So SSRIs basically inhibit them and stop those transporters from cleaning up as much serotonin. That is why serotonin is known as the ‘happy hormone’ or ‘the chemical’ because when there is more serotonin in those spaces, that hasn’t been mopped up, we feel happier! And we feel less depressed.
Because we have more serotonin available.
Lately, there’s been a lot of controversy in the media with, you know, very, I would say strong titles basically saying that, you know, there is no foundation to the chemical imbalance theory of depression. We know that there is a lot of headlines basically partially invalidating antidepressants or saying that they don’t actually work and giving them a bad rep.
However, there are more than 8.3 million patients in England, England alone, that received antidepressants in the year 2021/22.
8.3 million! That is almost as many people as live in Portugal, my home country. Probably close to Belgium as well Juliette. Is that right?
There’s more people in Belgium . . . [giggles] . . . by a smidge. Not by much, yeah [giggles]. But I agree with you! Because if there are so many people taking an antidepressant – if those claims in the media that there’s no evidence of serotonin having, you know, a role in depression – then why are people taking all these pills?
I think the best thing we could do is to bring in a guest who has developed all of his career around depression and has done a lot of work about serotonin, treatments for depression, interventions, and what is happening in the brains of depressed people. Should we bring in Professor Carmine Pariante?!
Well Hi Carmine. Welcome to At the Back of Your Mind podcast.
Professor Carmine Pariante: Hi! Thank you for having me.
Today we are recording from quite a few places, right!
Yes, I am in India.
I am in Dubai.
I am in Rome [Carmine Pariante].
I’m still In London [giggles] no sun for me!
Oh Juliette! [giggles]
Now Carmine. I think everyone knows you. But would you like to introduce yourself to our listeners that might not have listened to the episodes special?
Professor Carmine Pariante: Of course. I am Carmine Pariante and I am a psychiatrist, I am a Professor at Kings College London, and am Professor of Biological Psychiatry at the Institute of Psychiatry, Psychology and Neuroscience. I am also a consultant psychiatrist so I work with people with mental health disorders or problems.
And a lot of the work you have done in your career is around depression and explaining mechanisms of depression and investigating treatments and interventions for depression, is that right?
Professor Carmine Pariante: Yes, trying to understand how antidepressants work is one of my passions and one of my most important work streams.
We are interested to hear your thoughts on the strength of the evidence behind the serotonin hypothesis of depression?
Yes, I mean, I have said it many times before because this controversy does come back every few months or years, so yes.
It’s like a boomerang!
Professor Carmine Pariante: Yes, it is a little like a boomerang. At the core of it, I think, there is a simplification of how we are trying to explain depression to the general public but also I think for us as researchers and specialists is to try and have a working model of in trying to understand what we know, certainly what we knew until a few years ago about depression. I think the link between serotonin and depression is incontrovertible. So saying that serotonin is involved in depression, in depressive symptoms and also of course in emotions that have to do with depression. So for example, salience, the importance of how we respond to the environment, I think is very clear. But the key point I want to put across first is that saying ‘serotonin is involved in depression’ doesn’t mean to say that serotonin is the only cause of depression, the abnormality in the serotonin system is the only cause of depression. But certainly, serotonin is at some point is of a path that leads to depression from psychological events, psychosocial circumstances or stressors that of course create depression in the individual, some individual, vulnerable to these pressures, leads to depression.
Professor Carmine Pariante: I think that there are many many evidence that serotonin is involved in depression. The first, I know it is a bit circular an argument, but actually it is a valid argument that we should not somehow discard, is that fact that a lot of antidepressants today, including some that were developed more than 40 years ago, have an action on serotonin, with, what we say in technical terms they block the reuptake of serotonin. In other words they allow more serotonin to be present in the communication between brain cells so they kind of reinforce the communication between brain cells that use serotonin as chemical messengers. Again, the key point that I want to put across here is that, even if we are having a theoretical discussion on what serotonin really is and how much is it important in depression, the fact that antidepressants are effective medications, and I think that is another point I want to put across very clearly at the beginning. That antidepressants are effective, there has been hundreds of studies demonstrating this and meta-analyses, which are of course a way of putting together all these studies together. Antidepressants are effective in improving mood and re-instating the functioning of people who feel unwell. I mean, they are not perfect drug, they have got side effects as all other medications, they don’t work in everybody as in all other medications. If you look at what we call the effect-size, if you try to quantify the beneficial effect of antidepressants they are very similar to the beneficial effects of other medications in other medical conditions. You know, there is no silver bullet in any aspect of medicine, em, antibiotics, drugs for hypertension, yow know, you name all the other medication or conditions and the effect, what we call the effect-size will be – the strength of the effect – will be very similar to the ones we have in mental health in general and in antidepressants in particular. So, yeah, I think we are still struggling across all of medicine with the fact that we are using imprecise medicine that are not perfect and that should be improved but are the best that we have at the moment.
Professor Carmine Pariante: The first antidepressants that were discovered were later found out to act on serotonin and then some of the new antidepressants were specifically developed by using the serotonin as the target. These medications have a clinical effect, as strong manifestation that serotonin is directly involved in depression. Is it the only cause, the only biological cause, of course it is not, but it is certainly part of it. There are other evidence as well that support this notion. So, for example, in some vulnerable individuals if you decrease the level of serotonin in the brain – you can do this by giving some diet that use tryptophan which is the amino acids precursor of serotonin – so basically the compounds which serotonin is synthesised from in the brain – if you deplete the body of tryptophan then you deplete the serotonin in the brain and if you do that in vulnerable individuals who have already been depressed in the past they tend to have a relapse. That is other strong evidence which has been replicated many many times
Professor Carmine Pariante: Then, of course, there is all the evidence from the very initial studies that medication that, eh, used to act in general not only on serotonin but many other neurotransmitters in the brain including serotonin, for example the famous anti-hypertensive drugs early on in the history of medicine, scientists found that induced depression in older people. In trying to understand what this medication did they found that they were lowering the levels of monoamines – noradrenaline and serotonin in the brain.
And, I think evidence is still coming, right, in terms of understanding if there is actually lower serotonin in the brain of people with depression, because if you look at the literature people are trying to develop PET-tracers so that you can pick up serotonin in the brain of people who are depressed and are not under antidepressant treatment versus control participants, so healthy people who do not have depression and there is early evidence, I think from last year, going in that direction. But, what other experts are saying, like a lot of it goes exactly in the same direction as you, which is: we didn’t have very specific technology to measure this specifically but there is a lot of evidence around it to show that serotonin is involved in depression regardless and that, actually, antidepressants are still very effective regardless of what causes depression in the brain, right?
Exactly, I think one of the big criticisms to the papers that came out recently and the papers that showed, for example, that there was no difference in the levels of serotonin between depressed and non-depressed individuals, that the way to measure serotonin was to measure serotonin in the blood or in tissues of diseased people. Now, studies that measure live serotonin inside peoples brains that’s what can give you the answer whether there is a different level or there are differences in levels of serotonin in the brains of people and I think those studies are a lot more challenging because we can’t just poke inside peoples brains . . .
[giggles] bit invasive . . .
Just a little bit [giggles] . . .
But I think there is a study led by Professor David Nutt that maybe has come out already . . .
Yeah, that’s the one I was mentioning, it came out, I think, in late 2022, and yeah, it is literally very fresh evidence for the question people have been asking for a long time and even then I think there is always limitations so people will always still want to, you know, look a little bit deeper because one of the points that was brought up in this paper looking at literally, you know, radio-tracers in the brain to measure live serotonin, what they were saying is that it doesn’t necessarily allow for causality for example. It still does not tell you that this difference in serotonin causes depression and I think that was the point that Carmine was making, that regardless of whether, you know, it causes it or not, serotonin is involved [interrupted]
It is definitely involved!
[resumes] And there is a lot of clinical evidence that shows the effectiveness of SSRIs in patients. Carmine, I had a question for you with regards to that. So, one thing, that you know, some people talking about this serotonin controversy were saying is that the problem is that people take antidepressants because they are led to believe that depression is caused by a chemical imbalance in the brain. Would you say that that is something wrong to say to patients or people? Because even though serotonin might not be the cause there are still a lot of biological changes in depression, right?
Professor Carmine Pariante: Yes, of course. So I don’t think that it is wrong to explain to people that there is a chemical imbalance or there are biological changes or there are changes in the way brain cells in the brains of people when they are depressed. I think these are all true statements. And, you know, the serotonin is just one of the many biological mechanisms in the brain that are affected in depression, is not the only one, but certainly the fact that there are changes in the brains of depressed patients. Again, is something for which there is overwhelming evidence. If you look at studies using imaging of the brain, for example MRI or Magnetic Resonance Imaging of the brain, where they take, if you like, a picture of the brain, then the brain of depressed patient is different from a structural point of view, is different from a functional point of view, so the way brain areas are connected to each other is different in specific brain areas involved in emotions, and em, especially in emotions that are related to depression like feelings of unhappiness or feeling of threat from the environment, these brain areas tend to work abnormally compared to healthy brain. Of course, a lot of this abnormality returns to normal when people improve but certainly during the state of depression there are abnormalities. So all of this evidence is there and is overwhelming. I think the main conclusion from the paper that came out last year and has been so much discussed in the media, which I think is a perfectly legitimate conclusion, is that if you try to measure serotonin using the really blunt and imprecise instruments that we have at the moment with very little direct access to the brain in terms of measuring serotonin or other chemicals involved in serotonin, then of course it is true that you find very little differences and perhaps no differences and studies go in different directions, these were studies that were small, eh, still are small that were downward limited to technologies. However, having said all of that, I think that the clinical conversation on antidepressants we should focus on the clinical effectiveness is unrelated to the discussion on whether or not serotonin is the cause of depression.
Professor Carmine Pariante: So, in that sense, given that someone who is not a scientist might get all these conflicting messages about SSRIs, plus there is another factor that I think we might forget because we are so in the research is that a lot of people are given SSRIs but they don’t take them the way they are supposed to take them, they miss doses or they are given a dose that is too high or too low, they have side effects, eh, they might not go back to their doctor to change their SSRI for something else and they have negative experiences with the antidepressants they are given. So there might be a kind of bias towards antidepressants from the start from the patient side because they have heard all of these stories, which advice would you give to them? Let’s say they are not your patient, they are someone you know, they have been prescribed an SSRI and they have their doubts. How would kind of calm their mind?
Professor Carmine Pariante: For me, the first question is does this person really need a medication or not? I think that is the question we always ask and we try to, kind of, make a decision together with the person with depression whether the person is on an antidepressant or not. Kind of regardless of whether we are talking about an antidepressant that works on serotonin or other antidepressants. I have to say, of course, most of the antidepressants people use today, not all of them but most of them, act through serotonergic mechanisms. One of the reasons that these medications have been around for many many years, and among other things they are generic so they are cheap for prescribing and there is so much data in terms of safety and clinical effectiveness. So the first question is does this person need medication or not? As everything in medicine, again I always go back to try to find parallels between what we do and what we do in the rest of medicine because I think it is important that we bring back psychiatry in the field of health and health is just health, there is not separation between mental health and physical health. So that’s why I always want to bring back psychiatry in the context of medicine because also the example that we have from medicine help us understand the conversation about psychiatry. So, if you think about most of the disorders that we treat, you know diabetes, hypertension, even to be honest cancer early on when the cancer is very small we always have to make a decision, is the risk and discomfort associated with the medication, worse or better than the risk and discomfort associated with the illness? And different people for different risk factors at different stages of the illness will have different answers. So that’s the first question. Now, if someone appears to be in need of a medication, let’s say in the context of depression someone who has been really impaired by depression, where the sadness has been pervasive, there has been an impact on the day to day functioning, so perhaps someone has not been able to work as effective as before, em, there may be consequences in terms of family life, there may be consequences on social life, em, you know, in some of the more severe cases thoughts that life is no longer worth living or thoughts about taking their own life, well when we are in situations like this antidepressants is needed. And then of course, as you said Carolina, they need to be taken properly, so they need to be taken every day, they need to be taken at the right dose and they need to be taken for at least a few months, em, antidepressants may help quite quickly, as in days or weeks, but the effect to be maintained in the long time they need to be taken for at least, I mean we always recommend for a first episode of depression, so the first time someone experiences depression, that the minimum people should take it is for 6 to 9 months for full wellbeing, so not from the start but 6 to 9 months after they have been well. Then of course, they should be discussed with the doctor and if at that point the decision is to stop them then the antidepressant should be stopped slowly because they do give withdrawal effect, again some people experience stronger symptoms, some people experience really mild symptoms, it is very subjective but in any case we always recommend that antidepressants should not be stopped abruptly, should never be stopped without consulting a doctor, should always be stopped slowly over at least 4 weeks, ideally two or three months. So all of these precautions, which are the same that we would take any time we have another medication that we take longer for other medical disorders.
I think, overall, what you highlight is the importance of discussing antidepressants with, you know, health professionals and not make those decisions on your own, because everybody might not know all of this and might not have all of this information by just looking at things on GOOGLE or listening to the media and I think that can have quite a strong influence on people [gentle laughter]. . .
100%. And I think what you were saying about environment, it is so important to remember that environment plays a really big role in how we, how we manage our mental wellbeing and learning those tools to deal with it when it does go sour. A lot of the points that have been said have obviously hit close to home for me, not so obviously for our listeners but I am going to explain. So it’s funny that Carolina brought up about the, kind of reliance on antidepressants and like the addiction worries that some of the public may have because that was actually a worry of my family when I started experiencing problems with my mental wellbeing around 10 years ago now. My family were really worried about me going to the GP about it because they were like if you are taking antidepressants you are going to get addicted and it was just this whole, you know, completely valid fear for a 17/18 year old to be on medication for their mental wellbeing, em, at that time and that’s not even that young, but I totally understand where they were coming from. So I was initially prescribed Citalopram on a really low dose and I took it super inconsistently which wasn’t great because of my age and because of my worries with my family, you know, saying that I’ll get addicted, it was quite counterintuitive I found it hard to be consistent with it because of my depression like because I would forget to take it or because I wasn’t sure it was working. Then, after a couple of months of Citalopram I just didn’t bother because I had had some really negative experiences with the GP and I am sure some of our listeners can relate, em, not to say that all GPs are like that bujt that was my experience and then it took almost another 10 years until I decided to re-explore medication as an option after trying countless psychotherapy, I tried Cognitive Behavioural Therapies, I tried lots of different things and I actually had my own internalised stigma and I wonder if anyone can relate to that towards medication even though I was working in the mental health field and I still am. This actually stopped me from seeking it [medication] as an option and I feel this relates to what we were talking about with the media that antidepressants have a really bad reputation of kind of causing, or in some cases even exacerbating the symptoms you are attempting to alleviate when you take antidepressants. Through undesirable side effects, so I have heard people, you know, feel more suicidal or have more suicidal ideation once they are taking medication or they might experience high levels of anxiety so that was another worry for me. Em, but somebody senior to me who I really respected, posed the question, is it fair to kind of withhold that potential opportunity of feeling or getting better through medication and I felt, ok, it kind of just clicked like I was robbing myself of that option because of my own stigmas, em, so I decided, you know, it’s worth trying. If it doesn’t work, it doesn’t work, right, but as long as you are communicating with your GP and the medical professionals you are supposed to, then it is definitely worth a shot. I didn’t want to continue working and living in the state I was in, like it just wasn’t bearable and again I am sure a lot of listeners can relate to that. So my personal experience with Sertraline, so I started in December 2021, so I was 26, and I started on 50mg of Sertraline, so a slightly lower dose as they wanted to see how it goes and you are right the side effects are horrible in the first couple of weeks [gentle laughter], em, you feel sick all the time, you feel like you are going to throw up, that you do feel the immediate effect, you can kind of feel it almost like a wave over your body, that was like the first day when I took it, I was kind of like wooah I can actually feel like something is happening because serotonin is not just in our brains obviously it is all through our body. I decided in April last year, so 2022, that was after taking the lower dose of Sertraline, like consistently, I spoke to my GP about doubling the dose or just like increasing the dose because I was still feeling really low. She agreed that we could go up to 100mg, so that was all cool and we went ahead with it and she said just let me know how you get on and we were having regular check-ins, you know, every couple of weeks, we started to space them out a bit more and things started getting easier and there was less side effects and I am still, to this day, taking the 100mg Sertraline tablets. Sertraline is an SSRI and so is Citalopram but it is ales common one. And, I kind of just wanted to say that from my experience, personally, that Sertraline has allowed me to have a lot more control over my emotions especially crying for example. I didn’t really have much control over crying it would just kind of hit me and that was that. Especially when I accidently missed a day even earlier on in the process of starting medication I would really feel the difference and the decline in my mood. But the best way to describe it would be that I am less overwhelmed by my emotions or my circumstances like my environment or, you know, external stressors I am less overwhelmed by them. So for me, actually switching to medication and exploring that option has really helped but I know it is different for everyone and everyone is on their own mental health journey, so as per the rest of the advice on thjs episode please speak to a medical professional who can help you navigate what it is that you need.
Professor Carmine Pariante: We tend to talk a lot about the bad reputation of antidepressants and the fact that the media somehow always describes them in a negative way and I think even that is a little bit of an overstatement, because especially now so that you have the opportunity for everybody really to offer their opinion. We also have, when there are these media debates, there is also a lot of people that express on social media their support for their use of antidepressants, the fact that antidepressants were really helpful and beneficial and saved their life or lots of people that they cared for. You know, we have sometimes journalists and writers that go public in the media with their own experience and, in fact, I think possibly one of the negative consequences of having this debate in a way that is sometimes so controversial is that people who have benefits from antidepressant, people who are considering taking it, or they have taken it and had a positive experience in terms of having improved, they may feel discriminated or stigmatised or criticised because they have taken the antidepressant. So, it is important that when we have this media debate it is always balanced and nobody feels bad about their own experience, about their own emotions, or that somehow their experiences are not validated or recognised because someone has said antidepressants don’t work.
Absolutely and I think if our listeners are interested in what Carmine was just mentioning you can just look up #postyourpill, post-the-pill, I should know the exact hashtag, eh, but essentially it is a movement that I think was started a couple of years ago by Dr Alex George the NHS doctor who went on the —— and he posted, posts, his antidepressant pills to try and stop the stigma and lots of people have taken that on to show how prevalent it is that people take antidepressants all the time.
Yeah and it’s prevalent for a reason as well. These drugs are not prescribed because they do not work as they actually do help people and I agree with Carmine that in the media, sometimes like, that part is more of like a foot note than, you know, what is highlighted and I feel like, you know, it is giving them a really bad rep for not always good reasons and the debate is not always balanced the way it should be.
We wanted to ask if you had any thoughts on what the future of antidepressants might look like in terms of research and what might appear on the market because obviously while SSRIs are effective there still are some side effects and the idea is always to, you know, try and come up with better treatment options than the ones we have. What’s it looking like at the moment? What are people working on? What’s hot [gentle laughter] in the antidepressant research at the moment?
Professor Carmine Pariante: I mean it’s interesting because I think SSRIs or Selective Serotonin Reuptake Inhibitors or other medications that most people take at the moment as antidepressants, with all their limitations, are somehow here to stay at least for the foreseeable future because they are, as I have said, they have been used for many years, they are all available to the NHS and so for people who respond to these medications and they don’t experience side effects that are very severe, then this probably will remain the mainstream, at least as a first or second-line treatment – so the first medication someone takes or the second medication someone takes when they have a depression or a problem. What we are trying to do, I say we as the community of academic psychiatrists and psycho-pharmacologists working in this field is to try to understand what new antidepressants we can develop for people that are not responding to all the antidepressants that are currently available or they cannot take them because they are very sensitive to the side effects. And, of course, different biological mechanisms are being implicated by, a, recent research and one of which, I am particularly passionate about it, is inflammation because it is a main area of our research group for many years. And so this is the notion that in depressed people as part of their general state of arousal and stress that they experience because of the emotional turmoil there is also a biological activation of stress mechanisms in the body and one of the key mechanisms that operates in the body during stress is inflammation so an activation of the cells of the immune system and we know that the activation of cells of the immune system in the long term, so over weeks or months, start having a potential negative effect on the brain, perhaps making the brain more vulnerable to depression or to the maintenance of depression or makes the brain less able to respond to antidepressants. So, we certainly think that tackling inflammation in the people who have depression and also have clear evidence of high inflammation maybe a strategy and there have been some studies showing that adding an anti-inflammatory to an antidepressant had a therapeutic effect. Again, I am talking about people who have more severe forms of depression with treatment resistant depression so you don’t respond to one, two or three of the available antidepressants and they have clear evidence of high inflammation. So, that’s a strategy, a strategy which at the moment is still under investigation within research settings and hopefully some of it will be translated into benefit for the larger clinical population for clinical use later in the next few years.
Professor Carmine Pariante: Another area that has really been booming recently is the use of, eh, medications that can be broadly defined as psychedelics though they are actually are different medications with different mechanisms and it is interesting because some psychedelics or some medications which could have psychedelic action such as Ketamine work on a different brain mechanism which is called glutamate it kind of shows that so many different chemicals in the brain are changed during depression [gentle chuckle] so that you can have an antidepressant effect by targeting completely different mechanisms. So Ketamine works by targeting a different receptor, a different chemical, it is nothing to do with serotonin yet has been shown to have quite rapid and profound antidepressant effect. Again, we are talking about a medication that has to be used for people who have not responded to other antidepressants and has potential for quite a lot of side effects so it is really for more clinically severe cases.
Professor Carmine Pariante: Psychedelics, the most famous one for which there is more data accumulating through clinical trials is Psilocybin and of course what people forget to mention sometimes is that Psilocybin also works on serotonin and so somehow, you know, if you look at how Psilocybin and psychedelics are in general debated, there is a relatively good acceptance in terms of public opinion and the media as a potential strategy for wellbeing of treatment of depression and I would say, in fact, there is too much of a positive attitude towards this approach towards medication. And again, I want to emphasise that Psilocybin and similar medication are only for people who have very severe depression, it can only be taken and prescribed within quite complex therapeutic settings, so this intervention are, em , used, they are psychotherapy based with the assistance or help of psychedelics. So they are kind of complex, intense and only for people who experience quite severe treatment resistant depression. But it is interesting, that also, and I want to say that again, that Psilocybin really works on serotonin and so that part of it somehow is lost in the general conversation, but Psilocybin in itself is one more demonstration that serotonin is involved in depression.
I would just like to remind our listeners that when we are discussing Ketamine, Psilocybin or any hallucinogenics that these are very well controlled experiments made in very specific doses with very specific individuals, the kind of party doses or the social way of using these drugs [laughter] does not necessarily [more gentle laughter] bring benefit for anyone who consumes them or anyone around them and is not a solution if people are feeling unwell. They can access these treatments in clinical trials or other ways through the medical system or, em, ethically approved research but please do not go out and try to medicate yourselves with these substances.
So, Carmine are there any points on, you know, antidepressants, SSRIs, that you would maybe like to let our listeners know about before we finish off?
Professor Carmine Pariante: So, what I want to stress is that the distinction between depression or clinical depression, so what we would define as a disorder, and the transient experience of sadness or distress that all of us can have in response to what happens to us in our life and environment, is a distinction that is always important to remember and that is why it is important that people talk to their GP or to other doctors. And, when I am defending the use of antidepressants for people who have clinical depression, I, at the same time I also want to stress that antidepressants should not be prescribed to everybody who is experiencing normal, transient phase of distress in their life. I don’t want to medicalise sadness. I don’t want to medicalise the ups and downs of everyday life. That’s the first point. The second point I want to make, is that of course, antidepressants should always be prescribed together with psychological treatment because we know they potentiate each other and in some cases, antidepressants even in the presence of clear suffering they may not be the first option people may be, should be offered psychological support first and the antidepressant used as second choice or added to the psychotherapeutic or psychological intervention. Now of course, that’s in an ideal world where most people could have psychological support through the NHS which we know that is not always true and in fact the UK has one of the few organisations, is one of the few systems in the world that offers psychological treatment through the NHS, in other countries even in the Western world psychotherapeutic support is only predominately offered through private means for people who can afford it. I really want to advocate that the cost of providing psychological support to people is really important and has a really beneficial effect on society in terms of bringing people back to recovery and bringing them back into a functional life. If all of this, of course, doesn’t work, if the crisis is not transient and psychological support is not enough then antidepressants are required.
Thank you so much Carmine you have given us a lot to think about. Thank you for your time.
Professor Carmine Pariante: Thank you for having me
And we will speak to you soon. Thank you so much.
Thank you so much.
Thank you, bye.