Back on the couch?

There's been a lot of talk over the last couple of weeks over a new UK-US study concerning the effectiveness of new generation anti-depressants and whether "talk therapy" should be promoted instead.

An article about the issue in the Press ( "Depression experts take steps toward alternatives to anti-depressant drugs" Saturday, March 11) says that new-generation anti-depressants, such as Prozac, may be effective in treating only the most depressed patients, and that counseling may be more appropriate for mild to moderate depression.

The popular image of Prozac is of a kind of part Soma, part miracle cure, but in scientific circles the limitations of new-generation depressants have been known for some time. Contrary to popular belief, many doctors say older generation tricyclic anti-depressants (such as Imipramine, which was originally trailed for schizophrenia) as just as effective as modern designer drugs.

The latest drugs are only superior in the sense they tend to have fewer side effects.Not only are anti-depressants no more effective today than when they were first introduced in the 1950s, but scientists have little idea why people's responses to them are so idiosyncratic.

Some people respond very positively, while for others there is no effect whatsoever. It's the same situation with many other drugs such as Ritalin, which is used to improve attention in those with ADD/ADHD. That said, talk therapy isn't necessarily going to work any better. Mental health professionals calling for increased public funding of talk therapy forget that one of the reasons why drug therapy has become so popular is because psychotherapy, which was all the range in the 50s and 60s, is today seen as a spectacular failure.

Admittedly, counseling probably does help in some cases, particularly for those for acute problems, and with the decline of organised religion, many people today lack any sort of respected figure they can confide in. However, for those with chronic mood disorders it's highly questionable that the therapeutic liberal state can provide much help.

Depression is hardly a new phenomena, ans it seems to have increased over the last few decades as society's become more liberalised and atomised. In the 1930s and 1940s people had a lot more to be worried about that they do today, yet society was arguably happier than it is today. Certainly crime and suicide rates were pretty low considering economic problems were far more acute and anti-depressants had yet to be invented.

The atomisation of the individual arguably began in the 1960s, with the mistreatment of Vietnam vets being a classic early example of a group suffering mental ill-health, in this case thanks to a lack of communitarian spirit from anti-war baby boomers. However the breakdown in community spirit didn't really begin in earnest until the late 1970s as migration, immigration and economic liberalisation reached unprecedented levels, and modernist failures in town planning (think Britain's dysfunctional tower blocks of the 1960s) came home to roost.

From a mental health perspective, this atomisation process has helped robed the depression prone individual of any sense of purpose which may help them transcend their own personal problems.In modern western society nationalism is frowned upon, the wealthy lack any sense of noblesse-oblige, anti-social behaviour has risen, fewer people are willing or able to raise a family, and personal gratification is seen as the individual's primary goal.

Given such a narcissistic environment, it any wonder so many people are wallowing in their own personal misery?