Long term treatment of depression with selective serotonin reuptake inhibitors and newer antidepressants

The introduction of fluoxetine in 1987 marked the arrival of the selective serotonin reuptake inhibitors (SSRIs) for the treatment for depression. In the United States antidepressant prescriptions accounted for 2.6% of primary care visits in 1989, rising to 7.1% in 2000.1 This pattern was reflected across Europe, where SSRIs are now the most commonly prescribed antidepressants. Newer antidepressants, such as the serotonin norepinephrine reuptake inhibitors, including venlafaxine and duloxetine, also contributed to the remarkable increase in antidepressant prescribing.2

Several reasons were put forward for this trend: improved tolerability; reduced lethality in overdose; the aggressive marketing of newly patented drugs; the wider range of available antidepressants; and ease of prescription. An analysis of the UK general practice research database showed that prescriptions almost doubled from 1993 to 2005.3 However, the increase in antidepressant prescribing was not accounted for by new diagnoses but rather a rise in the number of prescriptions given for long term treatment: although the proportion of patients receiving short term treatment declined, the proportion of patients receiving continuing prescriptions for over five years increased. Another primary care study found that …