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GPs criticised for prescribing unnecessary antidepressants

GPs are prescribing antidepressants unnecessarily to patients with mild depression despite only 'weak' evidence that they are effective in primary care.

The Drug and Therapeutics Bulletin accused GPs of 'loosely' diagnosing mild depression in patients who failed to meet the criteria for major depression.

It also claimed GPs were too ready to prescribe anti-

depressants instead of psychological therapy even though most trial data for the drugs relates to major depression.

The bulletin investigated the approach GPs used in treating adults with depression because GP prescriptions in the UK have more than doubled between 1975 and 1998 to 23.4 million a year, mainly due to increased prescribing of SSRIs.

The evidence for prescribing antidepressants in primary care was 'weak' and surveys showed patients preferred counselling or cognitive behavioural therapy, it added.

Bulletin editor Professor Joe Collier said GPs should adopt a 'watchful waiting' approach as an immediate prescription for an antidepressant was 'not usually justified'.

Professor Collier, professor of clinical pharmacology at St George's Hospital Medical School in London, added:

'Serious questions must be asked as to whether there is any real benefit from the routine early use of antidepressant drugs in patients with the sort of mild depression seen in UK general practice.'

RCGP mental health spok-esman Dr Alan Cohen, chair of the forthcoming National Institute for Clinical Excellence guidelines on anxiety, said: 'For a long time GPs were told they weren't prescribing enough antidepressants and now we are doing it we are told it's wrong. GPs can't win.'

Dr Cohen, a GP in south London, called for research to establish whether treatments such as cognitive behavioural therapy were as effective as medication.

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