8/21/2003 • Research challenges role of antidepressants

8/21/2003 • Research challenges role of antidepressants

Professor Joe Collier, editor of DTB

Drug and Therapeutics Bulletin (DTB)

The DTB said that most patients with mild depression fell below the threshold of severity used in clinical trials for antidepressants.
Research challenges role of antidepressants

http://www.societyguardian.co.uk

Professor Joe Collier, editor of DTB

Drug and Therapeutics Bulletin (DTB)

The DTB said that most patients with mild depression fell below the threshold of severity used in clinical trials for antidepressants.

People with mild depression are being prescribed antidepressants despite a lack of proof that it is the best treatment for them, according to a report published today.

Antidepressant prescriptions issued by family doctors doubled between 1975 and 1998 to 23.4m per year, research by the Drug and Therapeutics Bulletin (DTB) found.

Yet few clinical trials have studied the effectiveness of the drugs with regards to GP patients, with the vast majority focusing on severely ill patients in hospital. The DTB investigation questioned whether prescribing antidepressants was the best way to treat mild depression when other therapies were available and preferred by patients.

Professor Joe Collier, editor of DTB, said: “Serious questions must be asked as to whether there is any real benefit from the routine early use of antidepressant drugs in patients with the sort of mild depression seen in UK general practice.”

Ike Icheanacho, deputy editor of DTB, published by the Consumers’ Association, said: “Most of the trials of antidepressants have been done in hospital settings rather than general practice.

“This calls into question whether people should be rushing to prescribe antidepressants in so-called mild cases of depression.”

The DTB said that most patients with mild depression fell below the threshold of severity used in clinical trials for antidepressants.

The study noted that surveys suggested many patients would prefer psychological therapies such as counselling instead of medication.

But Mr Icheanacho said there were complex reasons behind a GP’s decision to prescribe antidepressants.

He said there was increased awareness of depression among both doctors and patients, leading to greater use of antidepressants.

The pharmaceutical industry had also intensively promoted new antidepressants.

Mr. Icheanacho said: “There has also been increased pushing of antidepressants by the pharmaceutical industry.

“They are very heavily marketed as a good treatment for depression.”

“The level of prescribing might be appropriate but we haven’t got the evidence that to say conclusively.

“That makes us question if that is the right thing for patients to have immediately when there are sometimes alternatives available.”

But Mr. Icheanacho said that in many areas, services such as counselling were not available or had long waiting lists so GPs were unable to offer patients an alternative to medication.

The report said it was not necessarily wrong for GPs to prescribe antidepressants, but questioned whether they should be given as a routine treatment for mild depression.

It stated: “For many patients with depressive symptoms seen in general practice, a supportive ‘watchful waiting’ approach is reasonable.

“An immediate prescription for anti-depressant medication is not usually justified.”

The report added that GPs needed to look out for any major depressive illness that might need more urgent treatment and those with milder symptoms would need to be followed to ensure they did not deteriorate.

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