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Reduce antidepressant prescriptions, doctors urged

Tuesday December 21st 2021

Doctors should prescribe fewer antidepressants and when they do so, for shorter periods of time, experts say today.

A UK review of the evidence on antidepressant use suggests there are ongoing uncertainties about their effectiveness and suggests also there is risk of potential severity and durability of the withdrawal symptoms associated with them.

Writing in the Drug and Therapeutics Bulletin, Dr Mark Horowitz, from the Division of Psychiatry at University College London, and Michael Wilcock, head of the prescribing support unit at Royal Cornwall Hospitals NHS Trust, Truro, say the use of antidepressants is associated with a range of side effects.

They also point out that clinical trial data tend not to assess the outcomes that matter most to patients and add there is no clinically relevant difference between these drugs and placebo on depression.

Patients with severe depression might benefit from antidepressants but the cons may outweigh the pros in those with mild to moderate depression or among patients whose symptoms are not classed as depression.

An antidepressant was prescribed to one in every six adults in 2019-2020, with prescription rates 50% higher among women.

The authors say much of the evidence about the effectiveness of antidepressants in adults comes from placebo-controlled trials that last between six and 12 weeks and those results do not meet the threshold for a clinically important difference.

They add that while the number of 12 to 17 year-olds prescribed antidepressants more than doubled between 2005 and 2017, the effectiveness of antidepressants for this age group is “even less convincing”.

The authors also criticise many of the studies for focusing only on symptom measures and not including outcomes that matter most to patients, such as social functioning or quality of life.

As well as experiencing a range of common side effects, patients trying to come off their treatment often experience withdrawal symptoms, including anxiety, insomnia, depression, agitation and appetite changes.

Gradual dose tapering may best help patients to stop, although “there is no guarantee that patients will avoid consequences such as long-lasting sexual side effects or persistent withdrawal symptoms even with a cautious taper,” they write.

“The gradual reductions in dose and the very small final doses required for pharmacologically informed tapering will necessitate the use of formulations of medication other than the commonly available tablet forms.”

They conclude that because there is “considerable uncertainty” about the benefits of antidepressant use, clinicians should look again at the widespread – and growing – prescription of antidepressants.

Horowitz M, Wilcock M. Newer generation antidepressants and withdrawal effects: reconsidering the role of antidepressants and helping patients to stop. Drug and Therapeutics Bulletin 21 December 2021; doi:10.1136/dtb.2020.000080

[abstract]

Tags: Mental Health | Pharmaceuticals | UK News

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