Health experts urge doctors to look for other ways to treat depression

Antidepressants are being overprescribed for mild depression,
according to the head of the government’s drugs regulator.

Professor Kent Woods’ comments followed this week’s publication of
a review into the safety of selective serotonin reuptake inhibitors
(SSRIs). It concluded that the drugs were suitable for use by
adults but may cause suicidal thoughts and self-harm.

Woods, chief executive of the Medicines and Healthcare products
Regulatory Agency, said milder forms of depression could be managed
in other ways.

The expert review concludes that, although the balance of risks and
benefits for the use of these antidepressants “remains positive” in
adults, “a modest increase” in the risk of suicidal thoughts and
self-harm cannot be ruled out. The review was carried out by a
sub-group of independent advisory body the Committee on Safety of
Medicines.

However, it says there is no clear increase in the risk of suicide
from SSRIs compared with other antidepressants.

It warns that the drugs can cause withdrawal reactions when
patients stop or reduce treatment, some of which are “severe and
disabling”.

The group recommends carefully monitoring patients, particularly in
the early stages of treatment, and making them aware of the risk of
the withdrawal reactions. The lowest recommended dose should be
prescribed and withdrawal should be managed gradually.

This advice is echoed in guidance to GPs from the National
Institute for Clinical Excellence published this week to coincide
with the review findings. The guidance on treating depression and
anxiety emphasises that cognitive behaviour therapy and counselling
can be as effective as medication and should be offered.

However, it recommends prescribing SSRIs for moderate or severe
depression over other antidepressants as they are likely to have
fewer side effects.

According to the review, SSRIs have become the most widely
prescribed group of antidepressants in primary care. Since their
introduction, the number of antidepressants prescribed has more
than doubled.

The expert working group was set up in May 2003 after fears about
the safety of SSRIs. In March, Richard Brook, chief executive of
the mental health charity Mind, resigned from the group over
concerns that it was failing to protect service users.

• Guidance from www.nice.org.uk