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Docs Disagree on Overuse Of AD's For Depression

Posted by Phillipa on January 27, 2013, at 18:24:59

I guess even docs in other countries disagree on the best treatment for depression & when "low" mood meets the criteria for using meds for this. Phillipa

Physicians Go Head to Head in Antidepressant Overuse Debate

Caroline Cassels
Jan 22, 2013

Antidepressants are prescribed too easily, for too long, and have few, if any, beneficial effects.

That's one side of a head-to-head debate over rising prescription rates for antidepressants put forward by general practitioner Des Spence, MB, ChB, and published online January 22 in BMJ.

On the other side of the argument, psychiatrist Ian Reid, PhD, professor of psychiatry, University of Aberdeen, Scotland, maintains that the claim that antidepressants are overprescribed requires "careful consideration," asserting that the increase in prescriptions is due to small, but appropriate, increases in duration of treatment rather than more patients being treated.

For his part, Dr. Spence points out that the current definition of clinical depression, defined in both the fourth and the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders as 2 weeks of low mood, is "too loose and is causing widespread medicalization."

He also claims that 75% of those who write the definitions have links to drug companies.

"Mental illness is the drug industry's golden goose: incurable, common, long term, and involving multiple medications. This relation with industry has engrained a therapeutic drug mindset to treat mental illness," he writes.

Dr. Spence notes that guidelines from the National Institute for Health and Clinical Excellence do not support the use of antidepressants for mild depression or necessarily for moderate depression, favoring instead psychological talk-based therapies.

"But even if we accept that antidepressants are effective, a Cochrane review suggests that only 1 in 7 people actually benefits," Dr. Spence writes.

Dr. Spence believes there is a lack of evidence to show that depression is undertreated and that antidepressant medications are used appropriately.

The only explanation for the rise in antidepressant prescriptions, which increased by almost 10% in 2011, is "that we are prescribing more antidepressants to even more people."

Lack of Evidence

But Dr. Reid disagrees. The idea, he writes, that GPs are handing out antidepressants "like sweeties" is not borne out by research.

He notes that a study conducted by his team that screened 1000 general practice patients for depression and that examined antidepressant prescription decisions of 33 GPs showed that physicians were "cautious and conservative In their prescribing for those that they did diagnose. We found only 3 patients for whom the indication was unclear."

He noted that the study's finding was instrumental in persuading the Scottish government to withdraw a target to reduce prescribing by 10%.

He notes that talk therapies are "at best" as effective as antidepressant medications but are not superior to them, adding that "effect sizes for psychological therapies may be smaller."

"Antidepressants are but one element available in the treatment of depression, not a panacea. 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," Dr. Reid writes.

Dr. Spence has disclosed no relevant financial relationships. Dr. Reid reports that he has received payment to deliver presentations at meetings organized by AstraZeneca and from Sanofi to attend an advisory board.

BMJ. Published online January 22, 2012




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