Do you live in an antidepressant pills hotspot?
Prescriptions up 5pc — despite efficacy fears
Judging by the volume of antidepressants prescribed by GPS, Britain has become a depressing place to live. Antidepressant use in the UK is soaring – earlier this month, it was revealed that the number prescribed had risen by more than 5 per cent in the year to May 2022.
And as good Health has discovered, there is a huge postcode lottery in antidepressant prescribing – meaning that in certain areas you’re more likely to end up on medication, that some research suggests may be no better than a placebo when it comes to mild or moderate depression, yet can cause side-effects.
Scotland’s prescribing rate rose from 112 to 187 items per 1,000 people over the past decade. And women are more than twice as likely to be medicated for anxiety than men, with drugs including antidepressants, reported the British Journal of general Practice.
And yet research published last week raised serious questions about the prescribing of antidepressants on such a scale.
it showed the widely held belief that depression is caused by a ‘chemical imbalance’ in the brain – something doctors have been taught and have repeated to their patients for years – is a myth.
‘For decades, people have been led to believe that depression is caused by a chemical imbalance due to a deficiency of the brain chemical serotonin,’ Joanna Moncrieff, a professor of psychiatry at university College London, said.
Serotonin transmits messages between the body’s nerve cells and a lack of it has been blamed for causing depression.
Professor Moncrieff was the lead researcher on the study, which looked at 17 major international reviews that had documented the findings from more than 260 studies, involving 300,000 patients.
She said: ‘We can safely say that after a vast amount of research conducted over several decades, there is no convincing evidence that depression is caused by serotonin abnormalities.’
THESE new findings undermine the basis of decades of dishing out the most commonly prescribed antidepressants, specifically, Selective Serotonin Reuptake inhibitors, or SSRIS.
Furthermore, as with any medication, these drugs have potential side-effects. These include ‘feeling agitated, shaky or anxious, feeling or being sick, indigestion and diarrhoea or constipation’, according to the NHS. Coming off them can also be problematic.
And figures show that women are more likely to end up on these pills. As Professor Moncrieff explains: ‘One theory is that women internalise their difficulties, whereas men externalise them – i.e. women get depressed and they “blame” themselves, while men get angry and blame other people or things.
‘Related to this, women are more likely to go to the doctor for help while men go to the pub.’
Research published this year in the British Journal of general Practice found that women were more than twice as likely to be diagnosed with anxiety and prescribed antidepressants, and were ‘more comfortable seeking help for mental health conditions’ than men, who were more affected by ‘the stigma associated with poor mental health’.
But if this helps explain the difference between the sexes, when it comes to the postcode lottery the picture is more complicated.
Take the region with the highest prescribing rate, the NHS Sunderland Clinical Commissioning group area, with 286,855 patients (with 248 antidepressant items per 1,000 patients in May).
By contrast, north West London, where GPS have a total of 2.7 million patients on their books, has the lowest rate, just 53 items for every 1,000 patients.
What lies behind the wide disparity? The north West London commissioning group said the capital ‘has the lowest prevalence of depression in the Uk’.
But it added that ‘the expansion of mental health services, including the improving Access to Psychological Therapies programme, plays a role’. This scheme, which began in England in 2008, aims to improve access to talking therapies, such as counselling and cognitive behavioural therapy (CBT).
Professor Martin Marshall, chair of the Royal College of Gps, told good Health that while ‘antidepressants are often an effective treatment that can help patients manage mental health conditions’, GPS report that ‘access to appropriate, alternative therapies in the community, such as talking therapies and CBT is patchy across the country.’
Professor Marshall suggested the patchy provision is ‘a likely factor as to why there are some regional differences in numbers of antidepressants prescriptions’.
But the increasing rate of antidepressant use might reflect a lack of funding, leaving GPS with no alternative treatments other than medication – the cheapest, easiest option. And yet this is at odds with what experts see as the root of depression.
‘it’s not what’s wrong with us but what’s happened to us,’ says consultant psychologist Heather Sequeira. ‘depression and anxiety have a clear association with factors such as poverty, inequality, unemployment, social deprivation, childhood trauma, childhood neglect and emotional neglect.’
South of the Border, Sunderland saw a 3.2 per cent reduction in the number of patients prescribed antidepressants after local health chiefs issued ‘deprescribing guidance’, to support GP practices ‘in therapeutic conversations with patients’. The question remains, however: are antidepressants the answer for many of the others?