GPS told to avoid offering antidepressants
DOCTORS will be told not to offer antidepressants to those with mild illness, and instead suggest options such as meditation, mindfulness and talking therapies.
The new NHS guidance follows a doubling in the number of pills prescribed for depression over the past decade, and an increase in the condition since the pandemic.
England has one of the highest rates of antidepressant use in the world, with one in seven people estimated to be taking the pills.
The draft guidance from the National Institute for Health and Care Excellence (Nice) says patients with symptoms of mild depression should be offered a “menu” of options. These include cognitive behavioural therapy (CBT), exercise, mindfulness, meditation, counselling or psychotherapy. If patients express no preference, then the first option offered should be a group class in CBT, which focuses on trying to break a cycle of negative thoughts and beliefs.
The guidance also suggests that patients could be offered group behavioural activation which aims to recognise negative patterns and focus on behaviours that are linked to improved mood.
GPS are urged not to offer antidepressants to those with mild or borderline depression.
The draft guideline, which is subject to consultation, states: “Do not routinely offer antidepressants as a firstline treatment, unless that is the person’s preference.”
Latest NHS data show more than 79million antidepressant drugs prescribed in England 2020-21 – up from 43million in a decade.
Some 7.87million people in England were prescribed the drugs in 2020-21, one in seven people.
Latest UK statistics show that 17 per cent of adults suffer symptoms of depression, compared with 10 per cent before the first lockdown.
Dr Paul Chrisp, director of the centre for guidelines at Nice, said: “People with depression deserve and expect the best treatment from the NHS which is
why this guideline is urgently required. The Covid-19 pandemic has shown us the impact depression has had on the nation’s mental health. People with depression need these evidence-based guideline recommendations available to the NHS, without delay.”
Last month, the Royal College of Psychiatrists said that mental health referrals were forecast to rise by a third in the wake of the pandemic, resulting in an extra 1.8 million cases.
The NHS is already facing the biggest backlog of those waiting for help in its history. Currently, there are about 5.4million referrals annually in England, a figure which is projected to rise to 7.2 million by 2023.
The Nice draft guidance is the first in 12 years to identify, treat and manage depression in adults. Nice said the menu of treatments should allow patients to pick the one that was right for them, as a result of “shared decision-making” discussion with their medical practitioner.
For those with more severe depression, a similar range of options should be offered, with the option of antidepressant medication, the guidance says.
Nav Kapur, professor of psychiatry and population health at the University of Manchester and chairman of the guideline committee, said: “We’ve emphasised the role of patient choice – suggesting that practitioners should offer people a choice of evidence-based treatments, and understanding that not every treatment will suit every person.”
Prof Martin Marshall, chairman of the Royal College of GPS, said: “Decisions about a treatment plan should be shared between patient and GP, as a result of a discussion about the risks and benefits and taking into consideration an individual’s circumstances and preferences, and this guideline should help facilitate that.
“However, access to some treatments are patchy across the country and it is vital that GPS have access to a wide variety of treatments for their patients.”
The Royal College of Psychiatrists said that it supported offering a range of treatments.
Earlier this year, an independent review found a tenth of prescription medicines doled out by GPS are unnecessary, pushing the NHS drugs bill to more than £9billion. The review, led by Dr Keith Ridge, said patients were routinely being harmed by a “culture” of overprescribing, and too often patients felt unable to question medics.