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Postcode lottery is 'forcing GPs to overuse SSRIs'

Postcode rationing of psychological services is forcing GPs to overprescribe antidepressants to patients with mild depression and anxiety, according to a new report.

A survey of 250 GPs showed 81 per cent admitted overprescribing selective serotonin reuptake inhibitors to patients with depression, anxiety and stress, with 72 per cent saying they wrote more prescriptions for the drugs now than five years ago.

Some 26 per cent of GPs blamed the lack of psychological therapies available for patients with mild depression or anxiety, in the survey carried out on behalf of Norwich Union Healthcare.

GPs came under fire for soaring levels of prescriptions for antidepressants ­ up from 10 million in 1992 to 26 million in 2002 ­ in a report in the Drug and Therapeutics Bulletin last year.

Professor Joe Collier, editor of the bulletin and a professor of clinical pharmacology at St George's Hospital Medical School in London, said GPs were prescribing the drugs to patients with mild depression when the evidence did not support it.

He said: '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.'

But the GPC said poor access to counselling was to blame. Deputy chair Dr Ham-ish Meldrum said: 'GPs are

often forced to prescribe antidepressants to their patients when they would rather use non-drug treatments because other options have been clos-ed down to them.'

Dr David Tooth, a GP in Sheffield, said GPs opted for SSRIs because medication was the only option available in some parts of the UK.

'The approximate two-year wait to see a clinical psychologist round these parts leads us to dismiss cognitive behavioural therapy as a treatment,' he said.

Dr Neal Jolly, a GP in

Huddersfield, West Yorkshire, agreed.

'We have a one-year waiting list for psychotherapy and no access to NHS-funded counselling. I know other areas have far better provision than this but this is postcode rationing in action again.'

Dr Alan Cohen, RCGP mental health spokesman and a GP in south London, said GPs were in a no-win situation. '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.'

He added that NICE guidelines on depression and anxiety, due in June, would highlight access to these services as a key priority.

·The Committee on Safety of Medicines' review into SSRI safety is ongoing. Warnings have already been issued on dosage and use in children.

By Brian Kelly

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