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Large meta-analysis ends doubts about efficacy of antidepressants

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k847 (Published 22 February 2018) Cite this as: BMJ 2018;360:k847

Re: Large meta-analysis ends doubts about efficacy of antidepressants

As a member of the online prescribed dependent and withdrawal community and an active campaigner on prescribed drug dependence, I believe the publication of the meta-analysis by Cipriani et al, the associated media publicity and subsequent events have thrown up many very important issues around prescribed drug dependence in general and the prescribing of antidepressants in particular. The public was presented with misleading headlines extolling the virtues of antidepressants with no mention of the many harms associated with them. Many members of the public will have read no further than the headlines and will have no knowledge of the actual scientific paper to which they referred. It is no wonder that patients turn up in the GP consulting room believing that an antidepressant might be the answer to a period of mild or moderate depression. There is a tendency among some in the medical profession to blame patients for fuelling demand but surely this sort of publicity emanating from psychiatry simply exacerbates the situation.

Matters were made worse when Profs Wendy Burn and David Baldwin of the Royal College of Psychiatrists published a letter in the Times that withdrawal symptoms would last only two weeks for the vast majority of patients. This letter is now the subject of a formal complaint by 30 academics, clinicians and patients. (1) Most members of the public however will be unaware of this.
Patients in the online support community generally feel they were not informed about the associated risks with the drugs they were prescribed and recent events demonstrate just how difficult it is for patients to access accurate, evidence-based information on both the benefits and the risks of dependence and the nature and length of withdrawal. Dr Helen Stokes-Lampard, Chair of RCGP, is quoted as saying “no doctor wants their patients to become reliant on medication” and yet Public Health England has recently announced a year long review of prescribed drug dependence, welcomed by the BMA (2) and the University of Southampton has been funded to research effective ways of withdrawing from antidepressants, at a cost of over £2 million. (3) Clearly, there are very many patients dependent on prescribed drugs, many to the detriment of their health. Of course patients are going to keep taking the drugs when no-one has explained to them that there is no scientific evidence supporting this and the risks are in fact unknown.

Meantime those of us who actively campaign on the adverse effects of antidepressants are denigrated for doing so as alluded to by Dr Peter Gordon in his e-letter response. It seems that the issues of dependence, withdrawal and iatrogenic harm are not considered appropriate topics of conversation whilst the benefits of antidepressants clearly are. This leaves the patient to question what exactly is going on, how is it possible to access accurate and unbiased information and how is it possible to achieve informed consent when the “experts” so clearly cannot agree on any aspect of this subject. A few days ago the Daily Mail reported Prof Carmine Pariante as saying "research shows between 50 and 60 per cent of patients respond well; for them, the drugs really are life-changing and they can get back to normal over the space of a few months". (4) I am left wondering about the accuracy of this statement and the fact that no mention was made of the 25-30% who improve when given a placebo.

(1) http://cepuk.org/2018/03/09/patients-academics-psychiatrists-formally-co...

(2) https://www.bma.org.uk/news/media-centre/press-releases/2018/january/bma...

(3) https://www.southampton.ac.uk/news/2016/07/antidepressent-study-kendrick...

(4) http://www.dailymail.co.uk/health/article-5540281/Happy-pill-anti-depres...

Competing interests: No competing interests

28 March 2018
Fiona H French
Retired
Member of online prescribed dependent and withdrawal community
Aberdeen, Scotland