Experts Debate Use and Misuse of AntidepressantsA jump in antidepressant prescriptions of 10 percent in 2011 alone in the UK has fueled the debate about whether such medications are over-prescribed.

Two experts confront this topic in the online version of the British Medical Journal.

According to Des Spence, M.D., a Glasgow, Scotland general practitioner, “we use antidepressants too easily, for too long, and that they are effective for few people (if at all).”

He acknowledges that depression is a serious 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 medicalization.”

He also asserted that 75 percent of those who write these definitions have links to drug companies.

In the UK’s nationalized health system, the National Institute for Health and Clinical Excellence (NICE) provide guidelines to direct cost-efficient medical care. Those guidelines do not support the use of antidepressant medication in mild depression, or even as first-line treatment of moderate depression. Instead, they promote talking therapies.

Yet physicians continue to prescribe medication as a first line of intervention.

“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,” writes Spence.

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.”

Spence also questions the view that depression is a mere chemical imbalance and concludes: “Improving society’s well-being 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, Ph.D., professor of psychiatry at the University of Aberdeen, said 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.”

Reid 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.

Reid also refuses to join the argument that the limited availability of psychological therapy leads to inappropriate antidepressant prescription.

Rather he believes there is not a consistent connection 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.

Reid believes inappropriate media coverage has given antidepressants a bad rap in the public eye, and has added to the stigma of mental illness by adding unnecessary barriers to effective care.

Source: British Medical Journal