Enough of these disasters – wind up the GPC now
Commentators are missing an obvious cause for the increase in antidepressant prescribing, one that has nothing much to do with lack of psychotherapy or drug company promotion (News, August 9).
Could it be that we are simply taking depression more seriously? And treating it better than we used to?
Before SSRIs I used to have a struggle with treating depressed patients. I had to start a tricyclic at a low dose and build it up in the hopes that the side-effects would be tolerable that way, wait weeks before getting to a therapeutic dose, wait weeks more for an effect, and still have patients feeling awful on the stuff.
Then along came Prozac and suddenly I could start patients on a therapeutic dose, I could promise them the side-effects would be minimal, I could tell them that most likely they would start to feel better within weeks. And now, after years of experts telling us we miss depression and don't treat it adequately, the expert zeitgeist has changed to: 'SSRIs bad, pharmaceutical companies bad, talking therapies good.'
Now, don't get me wrong about talking therapies. CBT works incredibly well and should be as readily available as a year's prescription for any SSRI.
But I find it naive, to put it mildly, of ivory-tower pundits to give not-so-subtle messages about prescribing fewer SSRIs when they know damned well that it will be years, if ever, before I can prescribe even limited CBT as easily as an antidepressant.
Dr Declan Fox