Views And Reviews

NHS antidepressant prescribing: what do we get for £266m a year?

BMJ 2018; 360 doi: (Published 06 March 2018) Cite this as: BMJ 2018;360:k1019

Our darkest hour.

Depression - or what ever you want to call it - is a deadly disease claiming thousands of young lives every year. The morbidity and mortality associated with "it" is enormous. What is it? It is a constellations of symptoms and signs of varying degree and manifestation occurring in otherwise fairly healthy people. There is no blood test or x-ray and no signature except what the patient says and does. It is a diagnosis of history and observation. Its prevalence is of the order of 7-10% of the population.

If you didn't have anti-depressants (as in the 1950s and before) what would happen? Would everyone be more resilient and stiff-upper-lip as Dr Summerfield suggests, and just "get over it?" If you stopped them would the incidence of clinical depression rocket? It is impossible to answer. We are where we are, and whether medication dependence and pharma opportunism has made us into softies relying on pills to cope with the slings and arrows of life, is a possibility as he suggests. However, the horse has bolted and viable alternatives need to be available before taking away a very useful treatment (anti-depressants). Lithium and Clozapine definitely reduce suicidality and psychotic symptoms and mood swings (for their respective illnesses). Medications do work in mental illness and to say that anti-depressants are placebo may be wrong. Talking therapy is effective in mild/moderate depression provided you have medical cover if things don't go right.

To say that 10% of a countries population are on psychiatric medication is a stark acknowledgement that there is a need in this area. Why it is happening and what the root causes are is a topic for another time, but what we do have to cope with it right now are anti-depressants and talk therapy, and before throwing out the baby with the bath water, Dr Summerfield needs to give us another baby (treatment). What is his suggestion for this epidemic of depression?

Competing interests: No competing interests

08 March 2018
Eugene G Breen
62/63 Eccles St Dublin 7, Ireland