DOROTHY ROWE - " The iconoclastic wisdom of David Nutt," This is not the first time Professor Nutt has challenged dearly held beliefs – as many sufferers of depression will gladly testify

The iconoclastic wisdom of David Nutt

This is not the first time Professor Nutt has challenged dearly held beliefs – as many sufferers of depression will gladly testify

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• • Dorothy Rowe
  • guardian.co.uk, Tuesday 3 November 2009 

In the late 19th century the German psychiatrist Emil Kraepelin described depression as a long-term illness that returned frequently and would become chronic – a definition that was accepted by British psychiatrists. And when the first antidepressants were created in the 60s, psychiatrists were delighted that they now had what seemed to be a cure for depression.

However, it soon became clear to depressed people – and to many of us working in the psychiatric system – that antidepressants did not prevent recurrence and chronicity. Psychiatrists did not wish to admit this, because the only other treatment that we had for depression was ECT (electroconvulsive therapy).

The pharmaceutical companies then advised psychiatrists to prescribe antidepressants as prophylactics that would stop the person getting depressed again. The DSM-IV (Diagnostic and Statistical Manual, Revision Fourth Edition) contains the diagnosis "Major Depressive Disorder in Full Remission". Once depressed, always depressed, no matter how well you feel.
In 1999 David Nutt – who was forced to step down last week as chairman of the Advisory Council on the Misuse of Drugs after saying that cannabis was less harmful than alcohol or nicotine – and his colleague Sam Forshall published a short report on their work of reviewing "current evidence and opinion with regard to the long-term treatment of unipolar depression" (Psychiatric Bulletin 23, 1999, pp.370-3).

"Of those who have suffered one episode of depression," they wrote, "50–80% will have a subsequent episode, while of those who have two episodes, 80-90% will develop a third. With each recurrence a further recurrence becomes more likely and the period of remission tends to become shorter."

They also wrote: "In trials, 20-70% of patients have a recurrence despite prophylactic treatment."
In short, antidepressants did neither cure nor prevent depression. Many psychiatrists refused to accept Professor Nutt's findings. However, as time passed, the evidence mounted that a good therapist, irrespective of the kind of therapy, could help a depressed person find a way of seeing themselves and the world that ensured that the person would not become depressed again.

An increasing number of psychiatrists followed the practice of evidence-based methods. They preferred truth – however inconvenient – to dearly held fantasies. Nice – the National Institute for Health and Clinical Excellence – now advises doctors to prescribe antidepressants only for severely depressed patients, while mildly, moderately and severely depressed patients should receive psychotherapy.

Over recent years many once depressed people have good reason to thank David Nutt.