Health experts in Devon have expressed concerns about prescribing antidepressant (AD) drugs in patients who may be suffering from mild symptoms amid figures showing that AD use in the country has soared in the last 20 years.
AD drugs are licensed to treat major depression, and according to NHS guidelines they are not recommended to treat milder symptoms “unless other treatments like talking therapy have not helped”.
A depressive episode differs from regular mood swings as it can last for at least two weeks. Other symptoms may include a low self-worth and thoughts of suicide.
Jacqueline Thomas, clinical practice lead with the Devon Partnership NHS Trust, said that in the right conditions ADs worked “exceptionally well”, particularly with people with neurological disorders, but feared that their use had become too common.
“ADs are meant to be used for moderate and severe depression, but not necessarily mild depression,” she said, suggesting that patients with mild symptoms should instead be offered alternative treatments, such as the NHS’s Talking Therapy scheme.
However, according to the OECD (Organisation for Economic Co-operation and Development) the UK is the third biggest user of AD drugs in Europe. In 2000, the UK ranked sixth.
More recent NHS data shows that AD drugs were prescribed to 6.7 million patients across the UK between April and June this year, and although this represented a small decrease compared to the previous quarter, the number of patients being prescribed stimulants and ADs to treat ADHD (Attention Deficit Hyperactivity Disorder) increased to 200,000 (up by 5.6 per cent) compared to the previous period.
Thomas claimed some GPs did not have enough training on how to prescribe ADs, and that there were better ways to diagnose depression levels.
She said a nine-question patient health questionnaire (the PHQ-9), which is designed to rate the severity of depression, as well as GAD (Generalized Anxiety Disorder scale), were “very useful tools” to help doctors make a more accurate diagnosis.
“You need to make a clinical decision on the level of depression (patients) have,” she said. “GPs are prescribing ADs not just to people with depression but also potentially (those who) have ADHD or ASD.”
A recent BBC report also found that adults in Devon were struggling with waits of up to five years for an autism diagnosis, with average times between referral and an appointment about 18 months instead of 13 weeks – a delay which could see patients being prescribed ADs as a stop-gap measure.
Devon’s antidepressant hotspots
Regarding Devon, Thomas said AD drugs were being prescribed more heavily in Torbay and parts of East Devon, while in South Hams their use appeared to be considerably lower.
She said the extent of AD drug use was directly proportional to the severity of socio-economic factors, adding that the Covid pandemic and the subsequent lockdown had aggravated the problem.
“We have hugely deprived areas in Torbay. It needs to be funded like an inner city, but it’s not. There is a huge transient community which has moved away from all social support networks, and people have also developed a kind of agoraphobia and a fear about going out.”
Another mental health practitioner, who wished to remain anonymous, said there was often a tendency in mental illness cases to treat the person rather than the conditions around the individual.
“AD drugs don’t help with the problem if you’re giving someone (these drugs) and they’re going back to the same relationships at home and at work,” she explained. “They often tend to medicate the symptoms but they’re not healing a (mental) illness the way antibiotics heal (physical) illness.”
She cited a group in Torquay, called Open Dialogue, which involves a type of therapy that directly involves a person’s family and friends in addition to medical professionals.
The scheme, which originated in Finland but has not been broadly implemented in the UK, involves arranging face-to-face meetings with all affected parties as often as needed at a place chosen by the patient, who largely decides who should be invited.
The Royal College of General Practitioners (RCGP), the body representing GPs in the UK, was asked to comment.
Earlier this year the RCGP published a paper acknowledging that ADs could be effective “when prescribed appropriately” but added that access to alternative mental health treatments “needs to be improved”.
Professor Kamila Hawthorne, RCGP Chair, said: “When prescribed appropriately, antidepressants can be an effective treatment for many patients suffering from mental health conditions, such as depression and anxiety.
“But wherever possible we don’t want patients to have to rely on medication long term, and most patients don’t want that either.
“GPs are highly trained to have frank and sensitive conversations with our patients. Outlining the benefits and risks of different treatment options, when developing a treatment plan, will always consider clinical guidelines and the various factors potentially impacting on an individual patient’s health.
“We will also have regular medication reviews with patients to ensure their treatment plan is still optimal. If a patient wants to stop taking medication or reduce their dose, they should never do this before speaking to their GP or the clinician who has prescribed them their medication.
“More generally, what we do need to see improved is access to alternative mental health treatments in the community right across the country – and for staffing in general practice to be addressed, including increasing numbers of mental health therapists.”