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It's essential patients get SSRI choice

As someone who has had major depression successfully treated with an SSRI since 1990, I was encouraged to read the paper by Cipriani et al demonstrating variation in SSRIs ('Sertraline and escitalopram "better than NICE-recommended antidepressants"').

Perhaps we can now move on from dismissing patients' varying experiences of antidepressants as merely anecdotal?

It might be convenient for prescribing advisers and cash-strapped PCTs to push us all down the same hill, but these medicines are now demonstrated to be different. When I am a patient I expect to be offered choice in such matters. I hope urgent thought will now be given to giving a life to the new findings so people with depression can get the optimal treatment for them and not the most convenient for their PCT.

Since most of the SSRIs in question are now off patent, there is absolutely no excuse for prevaricating. The principle also extends to those that are not - if the first-line generic is not kicking in, it has to be unacceptable now to deny people the first-line branded product, rather than the next-line and weaker generic.

Alternatively, patients can do what some of them already do - not bother to see a GP at all and self-prescribe off the internet, with all the risk and quality-control issues implicit in such practice.

From Dr Chris Manning, UPstream Healthcare Ltd and former GP

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