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Assist staff to blow the whistle

New guidance aims to curb antidepressant use, but GPs bemoan lack of alternatives ­ by Emma Wilkinson

Government advisers are clamping down on the use of antidepressants in mild depression amid warnings that the drugs are being significantly overprescribed.

NICE issued final guidance on depression and anxiety last week, advising GPs should not prescribe antidepressants first-line for mild depression.

For mild to moderate depression GPs should offer psychological therapies before prescribing drugs, NICE said.

In parallel, the Medicines and Healthcare Products Regulatory Agency released its final report on the safety of selective serotonin reuptake in- hibitors, warning GPs should prescribe the drugs at the lowest possible dose and closely monitor young adults.

But GPs claimed they were often left with little choice but to prescribe antidepressants because of acute shortages of cognitive behaviour therapy and counselling services on the NHS. They said the new guidance had to provide the impetus to improve provision of depression services.

Dr Graham Archard, vice-chair of the RCGP, said: 'A lot of therapies that we would like to be able to use are difficult to come by and in some areas of the country there are very long waiting lists.

'It's all very well saying we are using too many drugs but if the alternative is that a 19-year-old dies there's no defence. Suicide is the commonest cause of death among young men and we have to err on the side of caution.'

The MHRA concluded there was no evidence SSRIs increased the risk of suicide in adults compared with other antidepressants but that stronger warnings were needed on the risks associated with withdrawal.

It also recommended that GPs should no longer initiate venlafaxine (Efexor) and that arrangements should be put in place for supervising patients on the drug.

Dr Alan Cohen, chair of the steering group for the NICE anxiety guidelines and a GP in Kensington, said the guidance highlighted the effectiveness of alternatives to medication: 'We hope this will provide the evidence for PCTs to reassess how they use their resources and commission services.'

NICE Guidance on depression and anxiety

·Do not use antidepressants first-line for mild depression; in mild to moderate depression offer psychological therapies first

·Use SSRIs where drugs are indicated and continue for six months after symptom resolution

·In chronic depression continue for two years with or without other therapies

·Use psychological therapies alongside drugs in severe depression

MHRA Final report on safety of SSRIs

·No evidence SSRIs cause suicide ideation in adults

·Stronger warnings needed on withdrawal risks

·Taper doses over period of weeks during discontinuation

·Start patients on lowest possible dose and avoid increasing dose in non-responders

·Closely monitor adults up to age 30 as a precaution

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