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Letter

The tide of prescribing for depression is turning

EDITOR—Hollinghurst et al report that opportunity costs indicate that the development of psychological therapies is a feasible alternative to antidepressants for depression.¹ A change in practice is long overdue.

I did as I was taught. I used a depression rating score and diagnosed depression. This often meant using my position of authority and knowledge to convince patients that they had an illness called clinical depression. I used fluoxetine (Prozac). To begin with, treatment was suggested for three months; later this was extended to six months; and eventually editorials suggested continuing treatment long term. I followed the evidence and expert advice and used selective serotonin reuptake inhibitors (SSRIs) to treat premenstrual tension, eating disorders, anxiety, postnatal depression, panic disorder, obsessive-compulsive disorder, and even social phobia.

Life, children, marriage, and time change your perspective. More importantly, eight years' of full time work in the same general practice gave me a longitudinal perspective of mood issues that short, skewed, and processed research could and will never elicit. We are at sea with uncontrollable emotional swells slowly lifting us up and down. We delude ourselves if we think we fight these forces of nature with modern medicine. The medical nirvana of emotional flatlining is neither attainable nor desirable.

Drug treatment helps in a very small and select group of patients with depression. The antidepressant and "everybody's depressed" message was spun by a greedy pharmaceutical industry and a myopic medical profession. Stop the widespread use of antidepressants as they are eroding our wellbeing and dismiss life as a simple spark of synaptic electricity. More talk therapies, please. Time for society to invest and recognise the role of friends, family, faith, music, art, exercise, and the maligned idea of community in managing mood. Making us happy is not in the gift of health care or drug treatment, of that I am certain.

Des Spence, general practitioner

Glasgow G20 9DR destwo{at}yahoo.co.uk

References

1. Hollinghurst S, Kessler D, Peters TJ, Gunnell D. Opportunity cost of antidepressant prescribing in England: analysis of routine data. BMJ 2005;330: 999-1000. (30 April.)[Free Full Text]

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