Letters Antidepressant use and cardiovascular risk

Antidepressant use and cardiovascular risk: moving from emotive rhetoric towards evidence based care

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2145 (Published 26 April 2016) Cite this as: BMJ 2016;353:i2145
  1. Vlad Schlezak, psychiatrist1,
  2. Kripalani Mukesh, consultant psychiatrist2
  1. 1Early Intervention Team, London N9 0PD, UK
  2. 2Royal College of Psychiatrists, London, UK
  1. Vlad.Schlezak{at}beh-mht.nhs.uk

When many psychiatrists are struggling to engage patients with protocols for physical health monitoring, we welcome the idea that antidepressant prescribing is safe when indicated.1 These findings counter media claims about increased numbers of prescriptions for antidepressants in the UK2 and suggestions from psychologists that antidepressants do more harm than good.3 An evidence based article analysed this last study and concluded that antidepressants work.4

A recent paper (requested as a consequence of regulatory authorities clarifying use of antidepressants with suicidal thoughts) clearly shows that suicide attempts dropped after the introduction of antidepressants—rates were significantly lower in patients with treated depression than in those with untreated depression. It studied 128 111 participants (52 355 from the incident depression cohort and 75 756 from the general population sample).5

Recent findings of a national survey of patients’ experiences of the negative effects of psychological interventions cannot be overlooked.6 Of 14 587 respondents, 763 (5.2%) reported experiencing lasting negative effects. Experiences varied across the spectrum of therapies, with cognitive behaviour therapy and solution focused therapy accounting for 4% of negative reports and psychodynamic psychotherapy peaking at 9%.

We believe this paper changes the balance towards antidepressant prescribing in appropriate patients.1 Although we adhere to the biopsychosocial model, we need to move away from sources that use emotive rhetoric to change the balance away from evidence based treatments.



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