Prozac nation: alarm at huge rise in anti-depressants’ use

From the Herald, in Scotland

Government efforts to cut the number of anti-depressants prescribed by GPs were thrown into doubt yesterday after new figures showed they had increased four-fold over the past decade.

A report by NHS Quality Improvement Scotland (QIS) found that the number of prescribed daily doses of the drugs had gone up from 19 per thousand to 85 between 1992 and 2006.

Medical experts at QIS, a health board established to oversee improvements in the NHS, said the record level of prescriptions may be due to the popularity of newer anti-depressants such as Prozac, which had fewer side effects, and patients being given more drugs over a longer period. But it was not clear whether there had been any increase in the number of people diagnosed as depressed.

Mental health charities expressed alarm at the latest figures, saying they showed an overdependence on medication to treat mental illnesses and highlighted a lack of available alternative treatments such as psychological therapy.

Faced with a rise in prescriptions, the previous Scottish Executive imposed a target of reducing the increase in anti-depressants being prescribed to zero by 2009. But while there were some signs that prescription rates were levelling out, there was scepticism over the SNP's manifesto commitment to cut them by 10% over the same period.

Dr Dorothy Muir, chair of the QIS clinical outcomes group, said that, though there were signs prescription rates were levelling, it was "probably unlikely" they could be reduced.

Dr Geraldine Bienkowski, lead clinician for psychology at NHS Education for Scotland, said there was "limited" evidence that providing alternative therapies led to a cut in prescription rates. But there was also evidence that, in some situations, increasing the provision of psychological therapies had a knock-on effect of increasing the rate of prescriptions, as it increased awareness of depression among GPs, she said.

Prescription rates for anti-depressants are strongly linked to deprivation, with Greater Glasgow having the highest rate in the country, according to QIS's figures.

Women are more likely to be diagnosed with depression and the condition was most common in the 25 to 44 age group, its figures show.

However, research undertaken by Glasgow University has found wide variations in prescribing levels between GP surgeries and that factors such as deprivation, gender, and age only account for 50% of these.

Dr Philip Wilson, a Glasgow GP involved in the research, said that different prescribing cultures within GPs surgeries may account for some of the variation. He also questioned whether simply cutting levels of prescriptions was in patients' best interests.

"There's a lot of evidence that people's depression relapses if they stop them too soon. In the case of a second or subsequent episode of depression the guidelines are now telling us we should be prescribing for a period of two years," he said.

Shona Neil, chief executive of the Scottish Association for Mental Health, said the figures betrayed a medical culture in which there was a "pill for every ill". She said: "People are being prescribed these pills for problems which are far beyond mental health issues. If you're living in poverty, are unemployed and without a good social support network, a pill isn't going to improve any of that. We have pathologised suffering to a level that isn't helpful."

Dr David Steel, chief executive of NHS QIS, defended the use of a target but conceded it was unlikely the new goal could be met. He said: "One of the great advantages of a target like that is it gets us talking about it, even if we don't meet it."

Shona Robison, Health Minister, said the Scottish Government was committed to the previous administration's goal of "levelling off" the prescription of anti-depressants and had invested £4.5m in developing alternative treatments for people with depression.

But she made no mention of the SNP's previous manifesto commitment. "We are striving to drive down the prescribing of antidepressants by offering a range of other effective interventions," she said.

Last night a Scottish Government spokeswoman denied that the manifesto commitment had been dropped saying it was "still committed to the reduction over the next two years".