The Fix has an article on antidepressants which, amongst other things, tackles the problems a significant number of people have when trying to stop them. Officially called ‘discontinuation syndrome’ these are arguably withdrawals by any other name. When you consider that there is little evidence of effectiveness of antidepressants for mild to moderate depression and they are often prescribed instead of effective ‘talking therapies’ then it’s arguable that undue harm is being caused.
Antidepressant prescribing grows year on year in the UK. One in seven Scots is now on an antidepressant. A BBC report last year, outlined that in some areas of England prescribing significantly exceeds the number of people estimated to suffer from depression. I’ve often thought how easy it is to shoehorn unhappiness into a diagnosis of depression. If we think that we ought to be happy all the time, it’s easy to pathologise negative affective states. I know in saying this I will offend some folk. Des Spence wrote in the BMJ:
As a generalist prescribing antidepressants daily in primary care, I think that we use antidepressants too easily, for too long, and that they are effective for few people (if at all). But even questioning current care is considered “stigmatising” towards mental illness and “populist” anti-medicine rhetoric.
I have no interest in stopping anyone getting appropriate treatment, but I am staggered by how many of us are on antidepressants, how shaky the evidence base is for them in mild depression, how often patients are actually reviewed, and worry about the struggles some folk have to come off them. Although most tolerate them well, they are not without risks and side effects, some of which are serious. So how often are people on antidepressants reviewed?
A Scottish study found:
Review of antidepressant regimens declines over time for patients receiving long-term antidepressant therapy through primary care clinics, according to a new study by researchers at the University of Aberdeen, Scotland, and published online May 21 in Family Practice…”This study shows that many patients on longer term courses of antidepressants are not being appropriately reviewed in primary care,” the authors emphasise.
One problem is that there are no good guidelines for long term review and to And discontinuation symptoms? The Fix lists them:
SSRI discontinuation symptoms include nausea, headache, dizziness, chills, body aches, paresthesia (tingling), insomnia, and electric shock-like sensations; psychological symptoms; and in rare cases, auditory and visual hallucinations, extrapyramidal symptoms (problems with movement), and mania/hypomania
To be fair, most people don’t get these and for most that do, they are mild and short lived. Antidepressants need to be readily available to those who the research says will benefit from them.
At the end of the day it’s important that folk are informed about the potential benefits and the risks. But are they fully up to speed? As Dr Spence writes:
…some meta-analyses suggest antidepressants may not work at all in mild to moderate depression. 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. People who do not respond fare worse, with switches of medications and often multiple drug combinations. How often do we tell patients these undisputed facts?