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GPs face pressure to reduce antidepressant prescribing

GPs will come under increasing pressure not to prescribe antidepressants, after new NHS guidance urged a reduction in antidepressant drug use to save money.

The new guidance - published by the National Prescribing Centre - is designed to maximise efficiency savings in 2012/13 and calls for commissioners to focus on prescribing costs for treatments for depression.

The QIPP document states: ‘NICE advocates a stepwise approach to the management of common mental health disorders, offering or referring for the least intrusive, most effective intervention first.'

‘Therefore, for many people with depression or general anxiety disorder, non-drug interventions (such as cognitive behavioural therapy) should be the mainstay of treatment, with drugs generally being reserved for more severe illness or when symptoms have failed to respond to non-drug interventions.'

The guidance also encourages commissioners to ensure that generic SSRIs are the preferred treatment for patients with depression or anxiety.

But Dr Jonty Heaversedge, a GP in south east London with a special interest in mental health, said the first line treatment of patients with depression should depend on severity and patient choice.

He said: ‘Some patients do not want non-pharmacological treatment and request medical treatment specifically.'

He added: ‘If the guidance comes into practice it could lead to a significant increase in patients referred for psychological treatment, services need to have resources to meet the demand. I am not sure they would.'

Professor Dick Churchill, clinical associate professor at the University of Nottingham, said the guidance was well supported by evidence, but the lack of availability to psychological therapies would hamper its application.

‘Patients with depression can, in practice, sometimes find it difficult to initiate the contacts with psychological services before they have had pharmacological interventions,' he said.

The document also recommends commissioners ensure GPs use minocycline less for treating patients with acne. However, Dr Stephen Kownacki, executive chair of the Primary Care Dermatology said although he was in favour of the recommendations, there were few alternatives.

He said tetracycline and oxytetracycline were ‘absorbed very badly' and ‘have problems with compliance' due to their twice-daily regimen.


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