Is rising antidepressant use among Singapore youth a path to better health or a sign of wider angst?

As for adults aged 25 and above who take antidepressants, several large-scale studies have found no significant increase in suicide risk.

However, the global medical community has expressed mixed opinions on the efficacy of these warnings being front and centre.

In a systemic review published in October on Health Affairs, a healthcare policy journal by a global non-profit called Project Hope, it was stated that the US FDA warnings were associated with “unintended reductions in physician visits for depression, depression diagnoses, antidepressant treatment and use” as well as increased suicide deaths.

“The overwhelming evidence suggests that the ongoing use of these warnings may result in more harms than benefits,” the review’s authors wrote.

Dr Rajesh Jacob, senior consultant psychiatrist at Promises Healthcare clinic, noted that suicidal risks and suicides can occur in severe depression, and the direct causal link between antidepressants and increased risk of suicide has not been proven.

Therefore, a routine black box warning for antidepressants is “not the way forward”, he added.

Having said that, doctors should exercise caution when prescribing antidepressants to young children, adolescents and young adults, with regular follow-ups once the antidepressant is initiated and whenever the dose is increased.

All patients should also be informed of antidepressants’ potential risks, doctors said.

INDIVIDUALISED, HOLISTIC APPROACH STILL THE BEST

Ultimately, doctors who spoke to CNA TODAY agreed that the best plan of care for people suffering from mental disorders always depends on the individual.

For instance, Dr Kwok of Private Space said that some patients may not be as articulate and expressive as others during therapy, which limits its effectiveness. In cases where such patients display more severe symptoms of depression, a prescription of antidepressants is highly necessary.

Dr Rajesh said that some patients prefer to have only psychological therapy and are not keen to take medications because they are worried about its side effects and becoming dependent on them.

However, both serve different functions when it comes to improving a patient’s condition.

Dr Huang of DTAP Clinic said: “Medication helps to stabilise symptoms, while psychotherapy addresses the root causes, coping mechanisms and emotional resilience. For many, the combination of both is ideal.

“That said, a personalised treatment plan, guided by a professional, ensures the most effective and appropriate care for each patient.”

The one-hour special Talking Point episode on antidepressants can be viewed on CNA Insider’s YouTube channel. The programme airs on Channel 5 every Thursday at 9.30pm.

WHERE TO GET HELP

Samaritans of Singapore Hotline: 1767

Institute of Mental Health’s Helpline: 6389 2222

Singapore Association for Mental Health Helpline: 1800 283 7019

You may also find a list of international helplines here. If someone you know is at immediate risk, call 24-hour emergency medical services.