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Medicalising unhappiness: new classification of depression risks more patients being put on drug treatment from which they will not benefit

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f7140 (Published 09 December 2013) Cite this as: BMJ 2013;347:f7140

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Re: Medicalising unhappiness: new classification of depression risks more patients being put on drug treatment from which they will not benefit

We support the broad thrust of Professor Dowrick’s paper on trends in antidepressant prescribing(1), but add the qualification that UK data since the millennium do not support an unvarying increase in antidepressant prescribing and use.

The National Psychiatric Morbidity Surveys (NPMS)(2)(3)(4) provide population-based nationally representative information on trends both in the prevalence of depression, as assessed by the Revised Clinical Interview Schedule, and in anti-depressant use. We have previously reported that there was no change in the prevalence of depression, between 2000 and 2007, apart from an increase in women aged 44-50 years(5). While the use of common antidepressants increased markedly between the 1993 and 2000 surveys(6), unpublished data from the NPMS do not support a further rapid increase in use between 2000 and 2007. Point prevalence of antidepressant use in those aged 16 to 64 years remained at 2.8% in both 2000 and 2007 in men (95% confidence interval for difference -1.0% to 0.9%), and increased by a percentage point in women, from 5.9% in 2000 to 6.9% in 2007 (95% confidence interval for increase -0.3% to 2.3%).

These results are broadly consistent with routine database(7) and prescription data(8)(9) that also show a slowing of the increase in prescribing in the UK in the early 2000s, after the rapid increases of the 1980s and 1990s, which were in part due to a move away from the use of benzodiazepines. This evidence suggests that pressure on Primary Care Physicians to medicalise and prescribe may not be the only driver of trends in antidepressant use.

Prescribing data show a resumed increase since 2006(8), despite the Improving Access to Psychological Therapies initiative, but the impact of the economic recession is unquantified. English population-based data from NPMS 2014, currently underway, will enable examination of the extent to which the more recent increase in prescribing is due to these or other factors.

References
1. Dowrick C, Frances A. Medicalising unhappiness: new classification of depression risks more patients being put on a drug treatment from which they will not benefit. BMJ 2013; 347: f 7140.
2. Meltzer H, Gill B, Petticrew M, Hinds K. OPCS surveys of psychiatric morbidity in Great Britain, report 1: The prevalence of psychiatric morbidity among adults living in private households. Her Majesty’s Stationary Office, 1995.
3. Singleton N, Bumpstead R, O'Brien M, Lee A, Meltzer H. Psychiatric morbidity among adults living in private households. Her Majesty’s Stationery Office, 2000.
4. McManus S, Meltzer H, Brugha T, Bebbington P, Jenkins R. Adult psychiatric morbidity in England, 2007 results of a household survey. The NHS Information Centre for Health and Social Care, 2009.
5 .Spiers, N., Brugha, T. S., Bebbington, P., McManus, S., Jenkins, R., & Meltzer, H. Age and birth cohort differences in depression in repeated cross-sectional surveys in England: the National Psychiatric Morbidity Surveys, 1993 to 2007. Psychol Med 2012; 42(10):2047-2055. doi:10.1017/S003329171200013X
6. Brugha TS, Bebbington PE, Singleton N, Melzer D, Jenkins R, Lewis G, Farrell M, Bhugra D, Lee A, Meltzer H. Trends in service use and treatment for mental disorders in adults throughout Great Britain. Br J Psychiatry 2004;185:378-384.
7. Moore M, Yuen HM, Dunn N, Mullee MA, Maskell J, Kendrick T. Explaining the rise in antidepressant prescribing: A descriptive study using the general practice research database. BMJ 2009;339:b3999.
8. Ilyas S & Moncrieff J. Trends in prescriptions and costs of drugs for mental disorders in England, 1998 to 2010. Br J Psychiatry 2012;200:393-398.
9. Lockhart P, Guthrie B. Trends in primary care antidepressant prescribing 1995-2007: a longitudinal population database analysis. Br J Gen Pract 2011;61(590):e565-72. doi: 0.3399/bjgp11X593848.

Competing interests: No competing interests

28 March 2014
Nicola Spiers
Research Fellow in Medical Statistics
Traolach S Brugha, Paul Bebbington
University of Leicester
Department of Health Sciences, 22-28 Princess Rd Leicester LE1 6TP