It’s rash to rank antidepressants in a Top 10

SIR – The inference taken in the recent widespread media coverage of a report in The Lancet is that antidepressants should be much more widely prescribed (“Anti-depressants should be given to a million more Britons, largest ever review claims,” report, February 22).

The report’s authors conducted a complex statistical re-analysis of more than 500 clinical trials covering 21 antidepressants, old and new, and ranked them on the basis of benefit and acceptability. They concluded that the controversy over whether these drugs “work” has been finally settled and that many more people should be receiving them. There are serious problems associated with any uncritical acceptance of this message.

The conclusions are based on a highly sophisticated statistical re-working of other people’s original findings; to draw from this any clinically useful conclusions, especially a “Top of the Pops” antidepressant ranking, is rash.

Furthermore, since these trials were published a vast amount of information has been gathered on their respective safety in everyday clinical practice – information not included in the report.

Taken uncritically, the findings may well prompt demands from patients to be given an antidepressant, and those already on one to be switched to an alternative nearer the top of the ranking. Encouraged by the media coverage and the bold conclusions of the authors themselves, non-specialist practitioners might be forgiven for submitting to pressure and reaching more readily for the prescription pad.

Already, 20 per cent of adults in Scotland were taking an antidepressant last year – a figure that continues to rise. Please let us take a cautious approach to any new message about these widely used medicines, whether it be positive or negative. Professor Angus Mackay

Ardrishaig, Argyll