A coalition comprising 31 medical professionals, researchers, patient representatives, and politicians, including members of the Beyond Pills All Party Parliamentary Group and former health minister Norman Lamb, is urging the UK government to reverse the decade-long surge in antidepressant prescriptions. In a letter published in The BMJ, the group argues that the widespread prescription of antidepressants, particularly for mild and moderate depression, lacks substantial evidence of improved mental health outcomes at the population level.
The authors contend that the £58 million spent annually on antidepressants in England could be redirected to bolster non-pharmacological interventions for depression, emphasizing a need for a more nuanced approach to mental health.
In the fiscal year 2022-23, a staggering 86 million antidepressant items were prescribed to approximately 8.6 million identified patients in England, marking a significant increase from 50.1 million in 2012. Comparable rates of antidepressant prescribing were observed in Scotland, Wales, and Northern Ireland.
The letter scrutinizes the disproportionate prescribing patterns, highlighting the potential medicalization of the effects of disadvantage and deprivation, particularly among women, older individuals, and those residing in deprived areas.
Concerns were also raised regarding the escalating trend of long-term antidepressant use, with nearly half of patients falling into this category, leading to adverse effects such as weight gain, sexual dysfunction, bleeding, falls, and diminished long-term outcomes. Withdrawal effects pose a significant challenge, affecting around half of patients attempting to discontinue use.
The National Institute for Care and Health Excellence advises against routinely offering antidepressants as first-line treatment for less severe depression unless it aligns with the patient’s preference. It emphasizes that any benefits should be felt within four weeks, with potential difficulties in discontinuation.
The coalition proposes a strategic shift, focusing on discontinuing antidepressant prescriptions for new patients with mild conditions and adhering to the 2022 NICE guidance on safe prescribing and withdrawal. They advocate for funding local withdrawal services, a national 24-hour prescribed drug withdrawal helpline, and support for patients coming off antidepressants through social prescribing, lifestyle medicines, and psychosocial interventions. The emphasis is on a comprehensive, patient-centric approach to mental health care.
