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Treatment resistant depression: what are the options?

BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k5354 (Published 18 December 2018) Cite this as: BMJ 2018;363:k5354

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Re: Treatment resistant depression: what are the options?

Dear Sir,
As a lay person who has suffered from debilitating withdrawal from venlafaxine, I find this article deeply worrying. The fact that patients are being subjected to a merry go round of medications in a primary care setting, where pressures on GPs time is huge, is probably the worst outcome for someone suffering from a depressive illness. As I'm sure many of your readers would agree, the second generation AD medications have some horrible side effects and people can easily be put off by them. Having to try drug after drug without success and being switched between medications in an often haphazard manner (this happened to me, so I speak from experience), is enough to push many suffers away from the system all together. I found the process to be a frightening one.

Whilst I cannot entirely blame doctors for this, they must shoulder some of it. That said, like many modern 'systems' primary health care is not well set up for dealing with this issue. However, secondary psychiatric services are even more pressed due to constant government cuts and other factors.

These time and funding constraints are also compounded by the inability of psychiatry to see the flaws in the drugs administered. Many chronic sufferers will be drugged and released from the system without further help. The drugs are not designed or tested or in any way proven for long term use, which is now resulting in patients becoming long term trial participants with no one collecting the data. I am one of them and I worry constantly about how I am going to get off these drugs safely. Granted, they provided help in the short term, but I should not have been left on them long term by my GP. I feel mislead and betrayed by that process and there are many thousands more in the same or worse situation than me. It is only my own tenacity that prevents the psychiatric service I was referred also discharging me whilst taking unneeded medications. I am insisting they see me safely off the drugs as well. How long their patience will last, I don't know.

I am sure there are many desperate long term sufferers who would be willing to try ketamine or psilocybin, but they too are psychotropic and recreational drugs with no long term use data. What is really needed are proper services to support sufferers with talking therapies, dietary advice and investigative options to get to the root cause of their illnesses. More drugs are not the real answer.
Yours faithfully
Dr Ed White

Competing interests: No competing interests

19 December 2018
Edward M White
Global Solutions Architect (IT)
None
Pewsey, Wilsthire