Healthy Skepticism Library item: 46

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Publication type: news

Britain overdoses on anti-depressants
The Daily Mail 2004 Dec 6

Full text:

Anti-depressants are frequency over-prescribed and should not be given as the first treatment for patients with mild depression, experts said today.

The possibility of side-effects including suicidal thoughts and self-harm prompted the largest ever review of the class of anti-depressants known as Selective Serotonin Re-uptake Inhibitors (SSRIs).

As many as 3.5 million people in England have been prescribed SSRIs for the treatment of depression and sometimes anxiety.

Today the Medicines and Healthcare products Regulatory Agency (MHRA) and the National Institute for Clinical Excellence (NICE) issued a raft of recommendations for doctors to make sure the drugs are only used where most appropriate.

NICE said that for patients with mild to moderate depression psychological treatments, such as counselling, could be as effective as drug treatments.

But doctors voiced concerns that these therapies were in short supply in many parts of the country. As a consequence, GPs were erring on the side of caution and prescribing anti-depressants where they thought it was in the best interests of their patients to avoid the possibility of suicide.

Andrew Dillon, chief executive of NICE, said: “These guidelines provide an important step forward in improving the diagnosis, treatment and care of people with depression and anxiety.

“The guidelines recognise that while medication has an important role to play in treating these conditions, there are also many effective alternatives.”

19m prescriptions

In England in 2003 there were 19 million prescriptions handed out for SSRIs, which include drugs such as Prozac and Seroxat.

It is estimated that as many as one in five adults will have depression at some point in their lives and 30% of patients entering primary care have either depression or anxiety problems.

The review of SSRIs by the Committee on Safety of Medicines began in May 2003 to investigate concerns about the drugs, particularly concerning suicidal behaviour, withdrawal symptoms and dependence.

Last year the committee warned that the majority of SSRIs should not be prescribed to under-18s because of the possibility of an increased risk of suicide which outweighed the benefits.

As a result of the completed review, which involved data from 600 published and unpublished clinical trials, new guidance has been sent to doctors covering both adults and children.

The experts said that warnings about the risk of experiencing withdrawal reaction when finishing a course of treatment should be strengthened.

They also said that in the majority of cases the lowest recommended dose of SSRIs should be prescribed.

The experts said the clinical data did not show any extra benefit from increasing the dose above the recommended daily level, which can happen in some patients where the GP believes it will be helpful.

After looking at all the data, the review concluded that a slight increase in the risk of suicidal thoughts and self-harm for SSRIs compared with dummy pills “cannot be ruled out”.

But it said there was good evidence that there was no clear increase in the risk of suicide from SSRIs compared with other anti-depressants.

The experts said that there should be “careful and frequent” monitoring of patients using SSRIs in the early stages of treatment.

They said in particular young adults should be closely monitored as a “precautionary measure” because they may be at an increased risk of experiencing adverse effects.

Prof Kent Woods, MHRA chief executive, said that patients needed to be informed about all aspects of their treatment and the possible risk of side effects and withdrawal symptoms, such as headaches and vomiting.

“SSRIs are an important group of medicines, which help patients who suffer depressive illness.

“The benefits of SSRIs in adults are still considered to outweigh the risk of adverse drug reactions,” he added.

The committee also recommended that the SSRI venlafaxine (Efexor) should only be prescribed by specialists, alongside close monitoring. They also said patients with heart disease should not be given the drug.