Letter: Other ways to treat depression

Sir: It is not often I am persuaded to use the adjective "irresponsible", but I fear I must for the article written by Oliver James on SSRI antidepressants and their use ("The blue Nineties", 11 February), and in particular the suggestion that any other pharmaceutical management of depression should not be tolerated.

Let us examine the proper facts, as outlined in The Treatment of Depression in Primary Care. This document reviews 162 worldwide research papers on depression.

Fact 1: Cognitive therapy has been shown to be as effective as other treatments of depression in primary care.

Fact 2: There is no significant difference in efficacy or compliance with treatment between tricyclic antidepressants and SSRIs. Compliance is clearly related to acceptability by patients of the effect of the drugs.

Fact 3: Shift to use of SSRIs as first-line drugs for depression would cost the NHS an additional pounds 100m per year for no greater clinical outcome.

SSRIs do have a place, but not the one advocated by Mr James. They are highly effective where phobic symptoms are a feature and in eating disorders. However, if Mr James and his ilk were to have their way, there would be far fewer resources to employ the therapists and mental health staff he also advocates using.

There is also one further fact he omitted. Paroxetine, one of the SSRIs, produces withdrawal reactions on cessation. This implies dependency can occur. I remember similar newspaper articles in the 1970s to that of Mr James's, talking about the wonder drugs of Valium and Librium . . . and we all know where that sorry episode ended.

Dr JOHN OLDHAM

Glossop, Derbyshire