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GPs cut back on antidepressant prescribing in recent years, study shows

GPs are prescribing fewer antidepressants to patients with newly diagnosed depression than ten years ago, despite the overall rise in antidepressant use, new research shows.

GP prescribing of antidepressants in people with a first bout of depression fell by 12% between 2003 and 2013, from around 73% to 61%.

However, the overall rate of antidepressant prescribing stayed at roughly 70%, because of increase in treatment rates among patients with recurrent episodes, which went up from around 74% to 78% over the same period.

As a result more people are being prescribed antidepressants long term - the mean number of prescriptions given to each patient doubled from two to four per year over the study.

Antidepressant prescribing in primary care has increased markedly in recent years, particularly since the financial crisis hit in 2008.

However, the study authors, led by Professor Tony Kendrick at Southampton University, said their findings showed GPs had responded to the introduction of NICE guidelines and QOF measures that encouraged more targeted use of antidepressants – they found significant ‘step change’ reductions of around 4% in the rate of antidepressant prescribing for first-ever episodes after each of these initiatives were introduced, in 2005 and 2006.

Professor Kendrick told Pulse: ‘GPs did try and follow NICE guidelines to reduce antidepressant prescribing, and that was reinforced by QOF, although it was only for new cases of depression.

‘The reduction in prescribing for new cases was cancelled out by increased longer-term prescribing for recurrent cases, and overall prescriptions went up due to longer courses being prescribed.’

The study was not able to look at the appropriateness of prescribing, and the authors said more research is needed into ‘the potential benefits of reviewing patients with a view to discontinuing treatment’.

However, Professor Kendrick said it was likely some patients who were taking antidepressants long-term could be reviewed and taken off the drugs.

Professor Kendrick said: ‘I think the SSRIs have become like the benzodiazepines, and we need to start taking people off inappropriate long-term antidepressants.’

Readers' comments (9)

  • John Glasspool

    Well, Tony, that's fine, but what happens if we find the suicide and DSH rate rises as less ADs are used? Who shall we blame for that? Presumably NOT the GPs (for once) if they really are following NICE guidelines?

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  • I agree John, withdrawal needs to be monitored and some patients might relapse and need to restart antidepressants but they'll be a minority. Studies have shown that more than 50% of people on antidepressants have been on them for more than two years and between a third and a half have no indication for continuing use.

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  • John Glasspool

    Hey! This is good! Almost like instant messaging!

    I've now retired. I was probably a relative high prescriber of ADs. However, I always used to offer people the chance of reduction/stopping. A surprising number didn't want to risk it if they had relapsed twice or more.
    (DOI- treated depressive with strong FH. 3 attempts at weaning off in 7 years have always triggered a relapse. Fortunately I am insightful about it, and can increase dose, after running it past my GP.)

    I find your comment about Benzos interesting. Every generation seems to have something like this:-

    1800's- laudenam.

    1940s- Barbiturates.
    1950's/60's- Purple Hearts- remember them? I can, just (as a child hearing them mentioned.) An amazing "antidepressant" consisting of a barbiturate and something like amphetamine!!!!! But nothing better at the time. It is known that Anthony Eden was on them at the time of the Suez crisis, though he was also bloody ill physically with cholangitis.
    1970's-80's. Benzos- a Godsend! I remember Panorama doing a programme saying they should not be used for acute crises, but for long-term problems! Yes, journalists were just as dangerous for our health then!
    Then the 1990's SSRIs. What will the the next latest "wonder-drug" family that big pharma will do its best to get us to shove down people's throats at vast expense?????
    Having said that, I think SSRIs, and probably SNRI's are less damaging than anything that went before. I guess time will tell?
    Nice to talk with you.

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  • Always a pleasure John!

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  • Have a look at UKs suicide rate according to ONS. Hasn't changed a great deal for men despite SSRIs. Women's rate dropped signifcantly and has now plateaued out

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  • These drugs simply do not work! Does anyone out there realise how much evidence there is linking serotonin levels to depression - none/zero - it's an hypothesis which has never been provent. The best metanalysis of ssri effectiveness by Irving Kirch - no better than placebo. We have been brain washed as a profession and now it is coming back to haunt us. My only dilemna is that I may be depriving my patients of the placebo affect that prescription offers. As for withdrawl symptoms - has anyone actually seen any that couldn't be explained by the nocebo affect?

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  • Interesting comments about every generation of doctors finding that they have been prescribing and over prescribing drugs that have major long term issues, including addiction and withdrawal issues like the benzodiazepines.
    However I don't think that is the SSRIs but pregabalin and gabapentin especially when given for none specific pain syndromes like fibromyalgia.

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  • Vinci Ho

    (1) I think GPs are more 'sensible' in dealing with new cases of depression these days . Clearly , mild to moderate depression should not be dealt by antidepressant as first choice . (Personally I still use PHQ9 and GAD7 to grade anxiety and depression despite QOF points are removed now)
    (2) The cases of persistent and/or chronic recurrent depression are genuinely existing . The psychosocial effects of the financial crisis and the subsequent austerity lasting to today , have been underestimated in my opinion and that is deliberately ignored by politicians and policy makers . This also represents a group of patients where more research is necessary.
    (3) The argument of most antidepressants (apart a few) do not actually work , is well documented . Better designed studies are necessary to verify the evidences.
    (4) Is antidepressant e.g. SSRI causing dependence? One can argue all drugs can cause psychological dependence but I am not certain about physical dependence with SSRI , for instance .

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  • I have found after many years practice that they definitely do work! But not for everyone,and often I had to swap from one to another,either in the same group or a different group.In many cases patients have come to thank me and told me their life has been turned around,and how well they feel,how they have become more active and productive ,often after existing in a "semi- coma " or a black emotionless hole for years. However some people in spite of anti- depressants ,with or without cbt / counselling,or even psychotherapy have not made progress.I suspect they have more difficult personalities,possibly personalities disorders,or simply no support from friends and family,or any mixture of these situations.However to say they never work and are a placebo ,I feel is damaging,because for many people they have been wonderful.In fact some patients told me they never believed they would work,they felt: "it's all a lot of nonsense to make drug companies money" But these same people came back to say that indeed they felt so much better and even could pin point a moment when they realised that they were no longer thinking of death and dying but of going shopping. I have known many such text book cases.

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