GPs urged to cut back on drugs for depression

Antidepressant drugs have been overprescribed to hundreds of thousands of people with mild depression in whom the risk of side effects outweighs the benefits, Britain's chief medicines regulator said yesterday.

Professor Kent Woods, the chief executive of the Medicines and Healthcare products Regulatory Agency (MHRA), said a safety review of the drugs, called selective serotonin re-uptake inhibitors (SSRIs), showed that in adults with moderate to severe depression they were effective as low-risk treatments if prescribed with caution.

But he warned they should not be used as a first-line treatment for mild depression where other approaches such as talking therapies or simple advice on sleep and exercise could be effective and was risk free.

"These drugs have been very widely prescribed and they are likely to have been overprescribed in patients with milder depression. [This report] has tilted the balance against their early use in mild depression," Professor Woods said at the launch of the largest safety review to date of SSRIs.

About 3.5 million people are estimated to take SSRIs in any one year and 19 million prescriptions for the drugs were issued in 2003. Two reports from the National Institute for Clinical Excellence on the treatment of depression and anxiety which were also published yesterday, recommend that "effective psychological treatments" be offered as an alternative to drugs.

But doctors said psychological treatments such as cognitive behaviour therapy were in short supply in many parts of the country, leaving GPs with no option but to hand out prescriptions for antidepressants. Graham Archard, of the Royal College of General Practitioners said: "Talking therapies are hard to come by in many areas. As a consequence chemical therapies are over-used because that is all that is left to the GP."

The popularity of the drugs, which include brands such as Prozac and Seroxat, has soared since they were launched in the late 1980s. They were heavily promoted by drug companies as safer and with fewer side effects than the older tricyclic antidepressants. But reports of patients committing suicide days after starting the drugs and suffering withdrawal symptoms when they stopped taking them came to light in the 1990s.

A BBC Panorama report on Seroxat in 2002 prompted 67,000 calls and 1,200 e-mails, the largest response in its history.

The 200-page report from the Committee on Safety of Medicines says there is no evidence of increased suicide risk in people taking SSRIs compared to other antidepressant drugs, although the possibility that they increase suicidal thoughts in some people "cannot be ruled out".

It warns, however, that any antidepressant can increase the risk of suicide and calls for strengthened warnings about the risk of withdrawal reactions at the end of treatment and advises that the lowest recommended dose should be used in most patients. The MHRA banned the use of all SSRIs except Prozac in patients under 18 last year after data came to light showing that the drugs were ineffective in the age group.