Antidepressants are under attack. Two programmes that take a very negative line with respect to these drugs, particularly Seroxat, won prizes at last month's Mental Health Media Awards (one programme was broadcast on HTV West, the other was one of Panorama's two documentaries on the subject in the past year). I have a vested interest here as I take my low dose of Seroxat every morning. I cannot face another depression, and having had three severe episodes the chances of another are high, so this is a preventative measure and seems to be working .
The line taken by the Panorama programmes was that Seroxat can cause a patient to become suicidal, and the withdrawal effects are terrible. I thought the programmes irresponsible as thousands of depressed patients are on Seroxat and not only did these programmes make them anxious but also fuelled the fears of those with depression that if they took medication they would become more disturbed and addicted. The positive, life-saving effects of antidepressants were barely mentioned, and the programmes provided anecdotal evidence with no science base for the negative effects.
Dependence is defined in terms of a strong desire to continue to take a substance even though the adverse effects were clear. Evidence for dependence is largely anecdotal, and personal stories have no scientific validity. Severe depression is unspeakable and I claim that if you can describe such an episode you have not been seriously depressed. One in five people in Britain will have a depressive episode sometime in their lives, and similar figures are found worldwide.
A recent report now claims that depression is being over diagnosed by GPs, and that antidepressants are being given out almost like sweets. About two million people are estimated to be taking antidepressants every year, costing the NHS £380m. There are concerns that doctors are prescribing drugs too readily for patients who may just be stressed. Are we, it is being asked, becoming a nation surviving on happy pills and is this not a very unhealthy situation? I find the term happy pills applied to antidepressants offensive as it carries with it the stigma of having a depression, and that if only the individual would pull themselves together they would get better without pills. But what is the real evidence that they are being prescribed just when someone is feeling low? Note that this view is in contrast to the number of patients with depression who fear taking the antidepressants because of the fear of side effects and dependence.
Depressives are totally self-involved and negative about everything, which makes it very hard for those carers who have to look after them. For the doctor it is no joy to have another depressive on the books. Worse still, given the 10 minutes an NHS GP has for each patient, the chances of any kind of psychotherapy with the GP is out of the question. It is not hard to imagine that the simplest solution is to prescribe antidepressants. But what are the alternatives? There is cognitive therapy which can be very successful provided one is not too severely depressed. But the problem is that the waiting list on the NHS is months and months.
Before the Government takes any policy decisions on controlling antidepressants, they should consider the evidence from the World Health Organisation that depression now and in the future causes more lost working days than almost any other illness. So the Government may save on the cost of prescriptions but should consider the impact on patients and a possible increase not only in days lost but an increase in the suicide rate and general misery. Yes, perhaps GPs should be restrained a little, but not too much. The stigma of depression should not determine how it is treated.
Lewis Wolpert is professor of biology as applied to medicine at University College, London
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