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Antidepressant prescriptions in the UK have
increased by 9.6% from 2010 to 2011, to 46 million
prescriptions. Does this reflect overmedicalisation
or appropriate treatment? Two experts debate the
issue on bmj.
Glasgow GP, Dr Des Spence, thinks that “We use
antidepressants too easily, for too long, and that
they are effective for few people (if at all)”
He acknowledges that depression is an important
illness, but argues that the current definition of
clinical depression (two weeks of low mood – even
after bereavement) “is too loose and is causing
widespread medicalisation.” He also points out that
75% of those who write these definitions have links
to drug companies.
National Institute for Health and Clinical
Excellence (NICE) guidelines do not support the use
of antidepressant medication in mild depression, nor
necessarily as first line treatment of moderate
depression. Instead, they promote talking therapies.
“But even if we accept that antidepressants are
effective, a Cochrane review suggests that only one
in seven people actually benefits. Thus millions of
people are enduring at least six months of
ineffective treatment,” he writes.
He is unconvinced by research showing that
depression is undertreated and that antidepressants
are being used appropriately, saying “the only
explanation is that we are prescribing more
antidepressants to ever more people.”
He also questions the view that depression is a mere
chemical imbalance and concludes: “Improving
society’s wellbeing is not in the gift of medicine
nor mere medication, and overprescribing of
antidepressants serves as a distraction from a wider
debate about why we are so unhappy as a society. We
are doing harm.”
But Ian Reid, Professor of Psychiatry at the
University of Aberdeen, says the claim that
antidepressants are overprescribed “needs careful
consideration.”
He argues that the rise in prescriptions is due to
small but appropriate increases in the duration of
treatment, rather than more patients being treated,
and that increased use of antidepressants in other
conditions “has compounded misunderstanding.”
He refutes the idea that GPs are handing out
antidepressants “like sweeties” and points to a
survey showing “cautious and conservative
prescribing” among GPs in Grampian. He also points
to “methodological flaws and selective reporting” of
data showing that antidepressants are no better than
placebo except in severe depression. Instead, he
says, practice is supported by evidence.
Finally, he dismisses reports that limited
availability of psychological therapy leads to
inappropriate antidepressant prescription, saying
there is no consistent relation between the
availability of psychological therapies and
antidepressant use.
“Antidepressants are but one element available in
the treatment of depression, not a panacea,” he
writes. “Like 'talking treatments' (with which
antidepressants are entirely compatible), they can
have harmful side effects, and they certainly don’t
help everyone with the disorder. But they are not
overprescribed. Careless reportage has demonised
them in the public eye, adding to the stigmatisation
of mental illness, and erecting unnecessary barriers
to effective care.”
For more information
http://www.bmj.com/content/346/bmj.f191
(MDN)
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