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Misrepresenting harms in antidepressant trials

BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i217 (Published 28 January 2016) Cite this as: BMJ 2016;352:i217

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Re: Misrepresenting harms in antidepressant trials

I recently attended the CME accredited winter meeting of the Scottish Division of the Royal College of Psychiatrists.

One of the topics presented was antidepressant prescribing which is rising year on year in Scotland. It is now estimated that 1 in 7 Scots are on antidepressants.

The presenters went on to give evidence that prescribing rates are rising because antidepressants are prescribed chronically. The accepted view is that that such prescribing is “appropriate” (1). However, I wonder how many patients who are first started on antidepressants might have been told that they may well end up taking these long-term and perhaps even for life? It would be interesting to know of the experiences and reflections of those who have been taking antidepressants long-term. Perhaps we should also reflect on how such long-term prescribing of antidepressants fits with the now widely adopted “recovery model”?

In the recent Royal College meeting I was surprised that the potential harms of antidepressant medication were not mentioned. There was no mention of “discontinuation syndrome” and no mention of potential risks such as suicide (2). What was repeatedly mentioned was concern about public “myths” about antidepressant medication and that as a profession we needed to counter these myths.

Interestingly, in a poll of cards, it was estimated, before the presentation, that 3/4s of the audience of Scottish psychiatrists felt antidepressants were overprescribed. The result after the presentation was unchanged. This would suggest that Scottish psychiatrists are not comfortable with such high prescribing rates.

References:

(1) Cameron I. M, Lawton K, Reid I. C. Appropriateness of antidepressant prescribing: an observational study in a Scottish primary-care setting. Br J Gen Pract. 2009 Sep;59(566):644-9

(2) Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports Tarang Sharma, Louise Schow Guski, Nanna Freund, Peter C Gøtzsche. 352:doi 10.1136/bmj.i65

Competing interests: Conflict of Interest: I have petitioned the Scottish Government for a Sunshine Act to be introduced: http://www.scottish.parliament.uk/GettingInvolved/Petitions/sunshineact I prescribe antidepressants in my job as a psychiatrist but I try to do so with discussion of the current evidence, where uncertainties are shared and risks and benefits are treated as equally important.

03 February 2016
Peter J. Gordon
Psychiatrist
NHS
Bridge of Allan