Are Anti-Depressants Over-Prescribed?
ARE anti-depressants over-prescribed.
Stephen Lawrie, Head of the Division of Psychiatry, Professor of Psychiatry and Neuro-Imaging, Director of PsySTAR at University of Edinburgh, takes a view in The Conversation:
There is a persistent media hype surrounding the notion that the prescription of antidepressants is “at record levels”, and “on the rise”. Yet numerous studies have shown that most people with depression do not get any treatment. How can both be true?
To approach this question, we must begin by understanding what depression is. We need to appreciate how common, disabling, and yet stigmatised it can be. We should also consider what effective treatments are available for depression, what other conditions antidepressants are prescribed for, and how antidepressants are prescribed and monitored.
Depression is an ambiguous term, but when we speak of it as an illness there is a clear definition. The World Health Organisation (WHO) has diagnostic criteria for what is called “clinical depression”. Based on the WHO definitions, clinical depression affects about 5% of the population at any point in time, and lasts for an average of six months.
People who are pervasively sad or unable to enjoy their usual activities for two weeks or more can be diagnosed with clinical depression. They will also have a number of other symptoms such as loss of energy, restlessness, sleep and appetite disturbance, poor concentration, self critical thoughts, feelings of hopelessness, and suicidal ideas.
If a person has four of these symptoms in total for a fortnight or more, they can be diagnosed with “mild depression”. Six symptoms in total indicates “moderate depression”, and eight or more symptoms yields a diagnosis of “severe depression”. People with mild to moderate depression may be able to work, but will probably be less productive than usual. They may be able to “tough it out” and wait for spontaneous improvement if work colleagues, friends and family are supportive.
People with moderate to severe depression tend to be unable to work, and may be ill for a year or more. Depression also has a tendency to recur, and is associated with increased mortality from accidents, suicide, alcohol misuse, and physical diseases. According to the WHO Global Burden of Disease Study, depression is the single most disabling condition affecting humankind. To put this in perspective, depression causes as much misery and impairment as all cancers put together.
People often receive these figures with scepticism, and responses like, “But I don’t know anyone with depression!”. Unfortunately, all of us probably do know someone with depression – it’s just they may not have spoken to us about it.
Stephen Lawrie is Head of Psychiatry at the University of Edinburgh and an Honorary Consultant Psychiatrists with Lothian Health Board. As Director of the Scottish Mental Health Research network he has co-ordinated clinical trials of new drugs for schizophrenia, but none for depression. He has also spoken at educational events and done consultancy work for Janssen and Roche in connection with schizophrenia, but not for depression. He currently receives research funding from the Medical Research Foundation, the Medical Research Council, the Wellcome Trust and the European Union.