The news that 70.9 million antidepressant prescriptions were dispensed in England last year – almost double the figure in 2008 – is an admission of failure.
Some medical and mental health organisations have speculated that this rise reflects increased awareness of mental health problems and greater willingness to seek help, and others have even blamed Brexit. Others have implied that our collective reliance on psychotropic drugs is benign, or even welcome, reflecting greater access to medical support.
Such comments are speculative at best.
The research clearly shows that the rise in antidepressant prescribing is in fact primarily the consequence of more people taking the drugs for longer, with prescriptions per patient doubling over the past ten years. This is partly due to the underestimation of the incidence, severity and duration of adverse reactions to antidepressant withdrawal. Many withdrawal reactions are being misdiagnosed as relapse (with drugs being reinstated as a consequence) or as failure to respond to treatment (with either new drugs being prescribed or dosages increased). But it is also because many people find themselves dependent on these drugs, and are unable to come off without debilitating symptoms, leading to long-term use.
We also know that rates of antidepressant prescription are highest in socially deprived areas, strongly suggesting that people are being given antidepressants for social problems. This is particularly worrying, because antidepressants, for most people, work no better than placebos, and long-term antidepressant use is associated with increased severe side-effects, increased risk of weight gain, the impairment of patients’ autonomy and resilience (increasing their dependence on medical help), worsening outcomes for some patients, greater relapse rates, increased mortality and the development of neurodegenerative diseases, such as dementia.
Research shows that most people consulting a GP for help do not want antidepressants, but some kind of psychological or social support. In the absence of alternatives, prescriptions fill the gap. Pressure on NHS services, short GP appointments (which allow little time for exploration of people’s difficulties and the discussion of solutions), shortages of psychological therapies and cuts to local authority budgets (restricting the availability of social and community services) all mean that inappropriate medical solutions are more likely to be used.
We therefore call for:
- Urgent revision of clinical guidelines, especially NICE guidelines, to take account of research showing withdrawal is more common, long-lasting and severe than previously indicated
- A focus on alternatives to antidepressant medication, including social prescribing and greater investment in social and psychological alternatives
- Changes to doctor training and medical syllabi, including greater awareness of the severity and duration of antidepressant withdrawal reactions
- Support for people wishing to withdraw from antidepressants, including a national telephone helpline and website, and dedicated withdrawal support services
- Research into long-term outcomes and harms of antidepressant use