It appears that we are in the midst of drug epidemic.  According to the Council for Evidence-based Psychiatry, in 2013 more than 53 million prescriptions were issued for antidepressants in England alone, an increase of 92% since 2003. We are not alone with this trend and the situation is even worse in the US. But why are we facing a similar problem with overuse with newer SSRIs (selective serotonin re-uptake inhibitors) as we did with benzodiazepines (tranquilisers) in the 1980s? It is unlikely that we have become less mentally stable, or that the increase reflects a genuine need. Peter Gøtzsche PC of the Nordic Cochrane Centre has recently published a paper in Lancet Psychiatry (1) in which he presents some theories behind this growth in the prescription of antidepressants:

  • Many healthy people are inappropriately diagnosed, due to unclear definitions of mental health disorders.
  • Withdrawal symptoms from antidepressants are frequently misinterpreted as a return of the disease, or even the beginning of a new one, resulting in more drugs being prescribed. Hence the incidence of drug-dependence in long-term users is increased.

Antidepressants can bring about the symptoms that they are supposed to alleviate. Unfortunately, in these instances there is a tendency for psychiatrists to increase dosage or prescribe another drug.

As well as problems highlighted above, studies suggest that many antidepressants do not work as people believe. For mild to moderate depression they are no more effective than placebo and only one in ten people with severe depression experience any benefit. (2) It appears that the vicious circle of antidepressant overuse is causing more harm than good and alternatives are required. A recent study carried out at the University of York suggests that acupuncture or counselling could provide an alternative solution for people with ongoing depression. A course of 12 sessions of either acupuncture or counselling are shown to be associated with longer term benefits, with no serious adverse effects. (3)

References:

1. Gøtzsche PC. Why I think antidepressants cause more harm than good. The Lancet Psychiatry. 2014 Jul; 1(2): 104–6.

2. Fournier JC, DeRubeis RJ, Hollon SD, Dimidjian S, Amsterdam JD, Shelton RC, et al. Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA. 2010 Jan 6; 303 (1): 47–53.

3. MacPherson H, Richmond S, Bland M, Brealey S, Gabe R, Hopton A, et al. Acupuncture and Counselling for Depression in Primary Care: A Randomised Controlled Trial. PLoS Medicine. 2013 Sep 24; 10 (9): e1001518. [Full text]

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