Antidepressant Business

The treatment of depression too often means treatment with antidepressants. Australia has one of the highest rates of antidepressant use in the world. This continues to increase despite mounting evidence they are not especially effective. The apparent falling effectivenessof the medications seems to be an increasingly common phenomenon. It is argued that doctors have become too reliant on them and tend to overprescribe them. When medications are used to treat depression they should be part of an overall treatment plan and shouldn’t be the treatment plan.

The falling effectiveness of antidepressants
Why are antidepressants becoming less effective? Partly because we haven’t always had all of the data. The clinical sciences have a problem with negative trial results – trials where the experimental treatments don’t appear to work. They are seen as uninteresting, and as undesirable by drug companies, and have often gone unpublished. Drug trials are, however, regulated and require registration with authorities before they begin. So, over the past
decade, researchers have tracked them down. Once they have found the registered-butunpublished trials, they have included the data in their overall assessment of the medications’ effectiveness. Unsurprisingly, the result has been that the recorded effectiveness of the medications has fallen. Early drug trials are usually conducted in highly controlled university research environments. The researchers, often working in partnership with the pharmaceutical companies, enroll uncomplicated, motivated, middle-class patients intothe trials in an effort to give the trial medications the best chance of success. Later, researchers are keen to see if the medications work in “real world” patients: the sorts of patients we see in mental health clinics and GP practices, who may not only be depressed but also anxious, drinking too much and distressed about their mounting bills. The medications
don’t work as well in these patients.

The increasing effectiveness of placebos
Perhaps the biggest reason for the declining effectiveness of the antidepressant medications is that placebos are becoming more effective. The gap between the medications and placebos is steadily narrowing. The placebo response is a complicated phenomenon. In part it illustrates the statistical concept of “regression to the mean”, where a measure that is extreme when first measured (depressive symptoms in this case) will tend to be less extremewhen remeasured.

Explainer: what is the placebo effect?
The other component of the placebo response is a positive expectation bias. When people expect to improve, this makes it more likely they will improve. This is particularly important for depression, because by providing someone with treatment, if only a placebo pill, we are directly addressing the sense of hopelessness that is one of depression’s core symptoms. The increasing placebo response rate in depression is likely driven by an increasing
expectation that treatment will work. Notwithstanding recent evidence about the declining effectiveness of antidepressant medications, there is a broad cultural belief – one that has been emphasized in recent decades – that taking a pill can help depression.

Combining treatments
Antidepressants might not be as effective as we once believed. But, overall, they are effective. Other treatments have similar problems with declining effectiveness. In fact, there are no well-studied treatments for depression that have consistently strong effects. This suggests combining treatments might be the best approach. And the evidence bears this out: combined treatment with medication and psychotherapy is more effective than either alone. We should be moving beyond a simplistic view of alternative treatments as competition for medications and consider whether they might be usefully combined to deliver even more effective treatment.

Treatment recommendations
When medications are used they should be part of a broader treatment plan. When therapy is available – and it isn’t always – there can be few good reasons for not recommending it. Medication should be considered when the depression is reasonably severe, when psychotherapy is refused (not everyone wants to see a therapist), or when psychotherapy hasn’t been effective. When medication is used, it should be used in a way that maximizes
its chances of being effective. This means not remaining on the same ineffective low dose for months and months. It means close monitoring by a doctor, so when the medication isn’t effective there is consideration of a dose increase or a change to an alternative medication. Other treatments can also be added. Improving diet and exercising more are good for depression, and combining antidepressants with nutraceuticals – food-derived nutrients
such as fish oil and vitamin D – has been shown to improve the effectiveness of the medications.

Future treatment approaches
It is unlikely we are going to see treatments with significantly greater effectiveness than existing treatments in the near future. Drug companies have reduced their investment in developing new drug treatments for mental illnesses, largely because they have been burnt by so many failures. And the psychotherapies, while requiring a lot of training and skill to deliver competently, essentially comprise two people in a room talking. It is difficult
to see how new therapies could be much more effective than existing ones. Our task as clinicians is to consider the broad range of treatments that are available, and how they might best be combined in treating the particular patient in front of us. Our task as researchers is to work out the characteristics of the patients who are most likely to respond to particular treatments, so that we provide evidence for delivering the treatments to those
patients. There is still much work to do.

Adapted from www.businessinsider.com.au


Ex. 1 Find the words or expressions in the text which mean the following:

1) trying to cure a disease: __________
2) trying to cure the patient with a particular drug: __________
3) seeming to be: __________
4) to issue to many prescriptions for a particular drug: __________
5) a treatment that hasn’t been approved yet: __________
6) subject to rules and requirements: __________
7) sth confirms a theory: __________
8) very serious: __________
9) food that is supposed to cure a disease: ___________
10)a manner in which to solve a problem: __________
11)mostly: __________
12)not complicated: _________



Ex. 2 Match the expressions from the two columns into logical collocations:

1) the rate of                                             registration
2) an overall                                             narrowing gap between
3) falling                                                   about mounting bills
4) negative                                               anti-depressant use
5) sth requires                                        effectiveness of sth
6) highly controlled                               treatment plan
7) to be distressed                                  trial results
8) a steadily                                             symptom of depression
9) a core                                                   strong effects
10)consistently                                       research environment


Ex. 3 Provide English equivalents of these expressions:

1) zbytnio na czymś polegać
2) niepożądany
3) wyśledzić coś
4) ogólna ocena czegoś
5) udokumentowana skuteczność
6) z chęcią coś zrobić
7) reakcja na placebo
8) tendencyjność
9) bez względu na …
10)baczny nadzór lekarski
11)zwiększenie dawki
12)zmniejszyć nakłady na rozwój czegoś

Grammar corner…

Journalists rarely want to reveal who the source of their information is. That’s why they often use impersonal passive structures. It essentially boils down to two options: „somebody argues that” becomes either „it is argued that” or „something is argued to be”, e.g. „people believe that herbal medicines are effective” can be either „it is believed that herbal medicines are effective” or „herbal medicines are believed to be effective”. If you’re talking about the past you’d say something like „herbal medicines WERE / USED TO be believed to HAVE BEEN effective.


Ex. 4 Rewrite the sentences so that they beginning as indicated.

1. People believe that Kennedy was killed by the US government. (past) => It …
2. People thought that Apollo never actually landed on the Moon. => Apollo …
3. People are sure AIDS was invented in military laboratories as a biological weapon. (past) => AIDS …
4. People claim that somebody has seen the Loch Ness Monster. => It …
5. People maintain that computers will eventually turn against mankind. => Computers…



to comprise sth – składać się z
treatment with sth – leczenie czymś
treatment of sth  – leczenie czegoś
apparent  – rzekomy
to overprescribe – zbyt często przepisywać (lek)
experimental treatment  – leczenie eksperymentalne
regulated  – podlegający regulacjom
sth bears sth out  – coś potwierdza coś
severe – poważny
nutraceuticals –  nutraceutyki
an approach to sth  – podejście do czegoś
largely – w większości
simplistic –  w uproszczeniu
the rate of anti-depressant use – poziom stosowania antydepresantów
an overall treatment plan  – całościowy plan leczenia
falling effectiveness of sth  – spadająca skuteczność czegoś
negative trial results  – negatywne wyniki badań
sth requires registration – coś wymaga rejestracji
highly controlled research environment – wysoce kontrolowane środowisko, w którym przeprowadza się badanie
to be distressed about mounting bills – martwić się nagromadzającymi się rachunkami
a steadily narrowing gap between  – ciągle zmniejszająca się dysproporcja między
a core symptom of depression  – główny objaw depresji
consistently strong effectiveness  – nieprzerwanie wysoka skuteczność
to become too reliant on sth  – zbytnio polegać na czymś
undesireable  –  niepożądany
to track sth down  – wyśledzić coś
overall assessment of sth  – ogólna ocena czegoś
recorded effectiveness  – udokumentowana skuteczność
to be keen to do sth  – z chęcią coś zrobić
placebo response –  reakcja na placebo
bias –  tendencyjność
notwithstanding  – bez względu na
close doctor monitoring –  baczny nadzór lekarski
dose increase  – zwiększenie dawki
to reduce invesment in developing sth – zmniejszyć nakłady na rozwój czegoś


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Ex. 1
1) treatment of sth
2) treatment with sth
3) apparent
4) to overprescribe
5) experimental treatment
6) regulated
7) sth bears sth out
8) severe
9) nutraceuticals
10)an approach

Ex. 2
1) the rate of anti-depressant use
2) an overall treatment plan
3) falling effectiveness of sth
4) negative trial results
5) sth requires registration
6) highly controlled research environment
7) to be distressed about mounting bills
8) a steadily narrowing gap between …
9) a core symptom of depression
10)consistently strong effects

Ex. 3
1) to become too reliant on sth
2) undesireable
3) to track sth down
4) overall assessment of sth
5) recorded efficiency of sth
6) to be keen to do sth
7) placebo response
8) bias
9) notwithstanding
10)close doctor monitoring
11)dose increase
12) to reduce investment in developing sth

Ex. 4
1) It is believed that Kennedy was killed by the US government.
2) Apollo was thought to never actually have landed on the Moon.
3) AIDS is sure to have been invented in military laboratories as a biological weapon.
4) It is claimed that somebody has seen the Loch Ness Monster.
5) Computers are believed to eventually turn against mankind.Centrum Języków Obcych Archibald poziom B1/B2