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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by jclint on December 6, 2004, at 8:00:44
From http://news.bbc.co.uk/1/hi/health/4071145.stm
GPs get new anti-depressant rulesDoctors have been issued with new guidance on the prescribing of antidepressants.
The National Institute for Clinical Excellence called on doctors to exercise more caution in prescribing the drugs.
Separate advice from the Medicines and Healthcare Products Regulatory Authority demanded stronger warnings on drugs such as Prozac and Seroxat.
It says advice on potential withdrawal symptoms should be reinforced.
The group of people who will benefit from these drugs is smaller than some GPs think
Andrew McCulloch, Mental Health Foundation
One woman in 15 and one man in 30 are affected by depression each year.And around 44 adults in every thousand are estimated to have an anxiety disorder.
The NICE guidelines say no type of antidepressant should be used in the initial treatment of mild depression.
But for patients with moderate to severe depression who are deemed to need antidepressants, drugs such as Prozac and Seroxat should be favoured above other types because they are less likely to be discontinued due to side-effects.
Other options
Both belong to a family of drugs known as Selective Serotonin Reuptake Inhibitors (SSRIs).
Around 13 million prescriptions are written for SSRIs in Britain annually.
HAVE YOUR SAY
Counselling and exercise are a lame panacea for a very real malady
Amanda, Paris, France
They have become increasingly popular over the last decade, as doctors considered them safer than the older tricyclic drugs which carried a high risk of overdose.The NICE guidelines say all patients prescribed any antidepressant must be warned of possible side-effects when they stop taking the drugs, or reduce their dose.
For those patients with anxiety disorders, NICE recommends therapy, such as counselling or cognitive behavioural therapy (CBT), are the ideal treatment, with SSRIs as second-choice.
Andrew Dillon, Chief Executive of NICE, said: "These guidelines recognise that whilst medication has an important role to play in treating these conditions, there are also many effective alternatives."
Prescribing trend
The MHRA said the analysis of both published and unpublished data by experts on the Committee on Safety of Medicines (CSM) showed "a modest increase in the risk of suicide from SSRIs compared to placebos [dummy pills]" in adults.
KEY RECOMMENDATIONS
Antidepressants should not first choice for mild depression
People with moderate to severe depression who require antidepressants should be given SSRIs (such as Seroxat and Prozac)
Anxiety disorders should initially be treated with therapy
Stronger warning of withdrawal symptom risk on SSRIs
The lowest dose possible should be prescribed
But it added that there was good evidence that there was "no clear increase" in the risk of suicide associated with SSRIs compared to other antidepressants.However, the MHRA said there should be offered greater monitoring as a precaution - particularly younger adults (aged 18 to 30) taking SSRIs.
Last year, it advised no SSRIs, except Prozac, should be given to under 18s after concerns the drugs were linked to suicidal thoughts in some patients.
The MRSA has also called for the lowest recommended dose to be prescribed in the majority of cases.
But people who are on SSRIs are advised not to stop taking them, or reduce their dose, without speaking to their GP.
Professor Kent Woods, Chief Executive of the MHRA, said: "The benefits of SSRIs in adults are still considered to outweigh the risk of adverse drug reactions."
Professor Louis Appleby, National Director for Mental Health, welcomed both sets of guidance.
Paul Farmer, of the mental health charity Rethink said antidepressants could give people space to tackle the issues underlying their condition, but were "not a cure".
"People should instead have access to psychological treatments and support underlying issues that lead to the anxiety," he said.
But Marjorie Wallace, Chief Executive of the mental health charity Sane, added: "Unfortunately, trained and experienced therapists are currently like gold dust and those needing therapy may have to wait many months.
"It is heartening that the newer medications - the SSRIs - which have had such a bad press, have been shown on the whole to have benefits which outweigh their risks and side effects. "
A spokesman for GlaxoSmithKline, which makes the biggest-selling SSRI, Seroxat, said the new guidance clarified the use of such drugs, and added they had revolutionised the treatment of depression.
Posted by jclint on December 6, 2004, at 8:06:06
In reply to New UK guidelines for anti-depressants..., posted by jclint on December 6, 2004, at 8:00:44
I don't know what to think about this.
On one hand I'm glad the withdrawal problems are being acknowleged, but on the other I'm deeply worried about Britain's increasing anti-med mentality. Looks like councelling is becoming the treatment for EVERYTHING now. It seems the existance of 'mental illness' as a serious and urgent physical problem is not being acknowledged at all. The benzophobia is bad enough over here, now SSRIphobia? I feel very uneasy about the whole situation.
Posted by ed_uk on December 6, 2004, at 8:19:41
In reply to New UK guidelines for anti-depressants..., posted by jclint on December 6, 2004, at 8:00:44
Hi John,
I think that it's somewhat ridiculous for NICE to state that psychological therapy should be the first line treatment for anxiety disorders on the NHS because they know full well that the resources are not available. I once had to wait well over a year for 3 sessions with an NHS psychologist.
I agree that it's very important that GPs and patients are told the risks of SSRIs (such as withdrawal symptoms) but I fear the day when the pharmacist will look at me like a drug addict when I collect my citalopram.
Regards,
Ed.
Posted by jclint on December 6, 2004, at 8:41:06
In reply to Re: New UK guidelines for anti-depressants... » jclint, posted by ed_uk on December 6, 2004, at 8:19:41
> I think that it's somewhat ridiculous for NICE to state that psychological therapy should be the first line treatment for anxiety disorders on the NHS because they know full well that the resources are not available. I once had to wait well over a year for 3 sessions with an NHS psychologist.
I sympathise totally. I remember waiting several months to see my local surgery's councellor, then several more weeks after they messed up the admin (they realised I was a few weeks under 16). The end result was 1 (one) session with this councellor, who sent me off with a couple of 'breathing techniques'. It was very patronising. Needless to say, within a week or two I was desperate enough to see a private doc, who diagnosed my depression and anxiety and recommended an immediate course of Efexor. I was angry about how the system treated me, and felt that my deperation was being fobbed off with a safe, but extremely under-aggressive treatment. I hope these new rules don't mean this will become an increasing pattern.
Posted by ed_uk on December 6, 2004, at 9:02:10
In reply to Re: New UK guidelines for anti-depressants..., posted by jclint on December 6, 2004, at 8:41:06
Hi John :-)
It would probably be very useful if techniques such as CBT were more widely available on the NHS but in the current situation, how is it possible for medication to be a second line treatment? What will first-line treatment for severe anxiety consist of? ..... A few encouraging words from a GP once a month?
NICE is supposed to provide realistic guidelines for NHS practice. Perhaps they have lost sight of reality and retreated into the world of fantasy! Have they not noticed the miniscule number of psychologists employed by the NHS?
Regards,
Ed.
Posted by cubic_me on December 6, 2004, at 9:07:16
In reply to Re: New UK guidelines for anti-depressants..., posted by jclint on December 6, 2004, at 8:41:06
On the whole I think that these guidelines are pretty sound, apart from using just councelling as a first line treatment for anxiety - they don't seem to recognise that there are degrees of anxiety, some of which require more agressive treatment.
I think that part of the trouble here in the UK is that doctors know that it will take many months for a person to get an appointment with a councellor, and even then they may not be very good, so they put them on meds to tide them over.
Another problem is diagnosing what is serious enough to warrent drugs. A little transient depression may be able to be treated will a little talk therapy, while suicidal depression can't. I've been seeing my NHS pdoc for 3 now and have not once been asked whether I am suididal or SI. I think he thinks that because I am high functioning I have very mild depression. These new guidelines suggest I wouldn't be prescribed meds, when in all honesty I probably wouldn't be around if I hadn't had them.
Posted by glenn on December 6, 2004, at 17:31:55
In reply to New UK guidelines for anti-depressants..., posted by jclint on December 6, 2004, at 8:00:44
This is no real suprise, doctors were told in this country a few years ago that they were underdiagnosing and undertreating depression.
So they went crazy with SSRIS, sounds a bit like the situation with Benzos many years ago, first they were marvellous and non addictive, not like those naughty barbituates.
Then they were awful, addictive and "you can't have them even if you beg"
The British medical establishment suffers from "splitting" that is when something turns out to not as good as they originally bought, they take the opposite view!
The way they are going it will be back to Trycyclics soon.
Then again there is of course the wonderful CBT, a pity its theoretical basis has just been shown to be wrong by Le Doux as a lot more people will be getting it (or at least they will be on a waiting list!)Glenn
Posted by Daky on December 9, 2004, at 20:12:41
In reply to Re: New UK guidelines for anti-depressants..., posted by jclint on December 6, 2004, at 8:06:06
" I feel very uneasy about the whole situation."
My daughter spent a year in London when she was a junior in college. It was so difficult to find a pdoc who would deal with her need for medication. Finally, though this board, I got some info that lead me to a US trained pdoc there who helped her. Of course, we were private paying so that helped. NHS is a mess. Mental health issues in the UK are largely ignored. As flawed as our current system of healthcare is in the US, I'll take it any day over what we saw in the UK.
Posted by SadMum on December 28, 2004, at 7:59:40
In reply to Re: New UK guidelines for anti-depressants..., posted by jclint on December 6, 2004, at 8:41:06
After years of being fobbed off by my GPs, I'm now under the care of a consultant psychiatrist - not following a referral from my GP but at the insistance of my CPN. Even now, with a fax from my psych in his hand, my GP refuses to prescribe what he calls dangerous combinations and too high a dose for my "mild depression", of course, he prefixes his statement with, "I'm no expert, but in my opinion"...
Rant over, but question remains - do GPs prescribing ads do more harm than good through their lack of experience.
Posted by cubic_me on December 28, 2004, at 9:19:48
In reply to Re: New UK guidelines for anti-depressants..., posted by SadMum on December 28, 2004, at 7:59:40
Some GPs are good, some are not, and others are somewhere in the middle. Is there any way you can see another GP to get a second opinion? Any good GP wouldn't mind you doing this at all.
Personally I think that for real cases of mild depression GPs are generally good at what they do - most people begin to feel better without having to see a psychiatrist,(and over 1/5 of GP consultations are about mental health) but when you have been feeling this way for a long time, or it is more serious, it is definatley best for a specialist to get involved. They are usually more up to date with medications and are more confident prescribing combinations.
I'm sorry you haven't had a great experience so far - my GP passed me on to a psychiatrist after a few weeks as she wasn't very confident with treating mental illness, but every doctor is different. Another GP I went to had some very valid points to make about long term effects of the meds the psychiatrist had prescribed to me, which subsequently lead to me coming off that combination - so some are good, you just have to find one.
Posted by dancingstar on December 29, 2004, at 16:43:16
In reply to Re: New UK guidelines for anti-depressants... » SadMum, posted by cubic_me on December 28, 2004, at 9:19:48
I don't mean to disagree with most of what you are saying, but I think that England has got it right. Now that I am off Effexor which was incorrectly prescribed to me by a GP, not a Pdoc, and is one of the four most prescribed drugs in the US, I can say that I feel much healthier in every way. I have more energy, my pain is gone, I am no longer depressed, I have lost weight, I am beginning to heal from the neurological problems caused by the withdrawal as if I have had a moderate stroke and I am finally starting to pick up the pieces of my life after sleeping for nearly three years straight. I feel that GPs, Gynos, internists -- are not the doctors that should be prescribing this, as my current internist says, "poison." If it is one of the four most prescribed drugs, I can pretty safely say that most of us do not need to be taking it.
Only since I have stopped taking EffexorXR do I realize that my body has been caused neurological damage, that that is, in fact, the way Effexor works in the first place. Because it works on the central nervous system, it is possible that many people may be affected in a way similar to the way that I was affected by the drug, and from what I have read so far, the long-term affects of Effexor on depression aren't as good as they are in the first few months. The withdrawal problems, weight gain problems, stomach problems, fatigue problems...all highly under-reported. Trying to rebuild my neural pathways and to decrease the level of anxiety to live my life calmly after I stopped taking Effexor was sheer hell. I imagine that the 2 percent rate reported is more like 20 percent to 65 percent, but at this point we don't really know the statistics because of the more recent increase in the number of people taking Effexor that haven't any idea of the havoc it is wreaking on their bodies. When you stop taking it, it leaves huge gaps in the body and mind that take months to repair. It is for that reason that I feel that it is a dreadful, horrid drug. It had me thinking all kinds of things were wrong with me that weren't, and I hadn't a clue -- not even a glimmer that any of these problems were caused by Effexor until I stopped taking it, and then, through the nausea and headaches and vomiting, and colitis, shivering and pain...each one of the health problems that I had developed over the course of the three years that I had taken EffexorXR slowly began to evaporate, one by one. It's blown me away. I'm still amazed as each day I continue to regain my health.
I say Hooray for England's new therapy and exercise policy. Everyone is too quick to simply take a pill. With pages and pages of side effects that never seem to make it to the attention of our doctors, those pills are more likely to kill us than cure us.
Oh, goodness, was this yet another not civil post?
This is the end of the thread.
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