This correspondence with Professor Ian Reid is from 2014. This is the first time that I have shared it in the public domain. In my opinion, narrative is no less important than data:
From: Gordon Peter (NHS FORTH VALLEY)
Sent: 30 January 2014
To: Reid, I.
I still wonder what duration of treatment with antidepressants is “appropriate”?
6mths, 6yrs, or longer … what is “appropriate duration of treatment”?
aye Peter
From: Reid, I.
Sent: 31 January 2014 12:34
To: Gordon Peter (NHS FORTH VALLEY)
At least 6 months. I’m guessing you haven’t actually read the Moore paper, and think that prescribing long term is the issue?
Ian Reid
From: Reid, I.
Sent: 31 January 2014
To: Gordon Peter (NHS FORTH VALLEY)
With respect to the rise in prescribing volumes, which is accounted for by ultra-short prescribing converting to ‘just a wee bit too short’ prescribing, the use of ‘appropriate’ is entirely… appropriate. Long term prescribing is not really part of this issue. That doesn’t mean it doesn’t merit attention, but it doesn’t really have anything to do with this argument.
Ian
From: Gordon Peter (NHS FORTH VALLEY)
Sent: 31 January 2014
To: Reid, I.
Okay. but how many people are on “appropriate” treatment longer than 6 months?
aye Peter
From: Reid, I.
Sent: 31 January 2014
To: Gordon Peter (NHS FORTH VALLEY)
Remember that evidence base for antidepressant use is strongest in relapse prevention in the longer term. There are quite a few studies e.g. Frank’s work showing that recovered recurrent depressives randomly allocated to continuation antidepressants; IPT or placebo over 5 years (which I guess you would call long term therapy) have relapse rates of 20%; 40%; and 80% respectively. So for those patients 5 years looks pretty appropriate… but this is a different story.
Ian
From: Reid, I.
Sent: 31 January 2014 21:33
To: Gordon Peter (NHS FORTH VALLEY)
Not sure what your issue is with all this. Can you say?
From: Gordon Peter (NHS FORTH VALLEY)
Sent: 01 February 2014 08:21
To: Reid, I.
I am simply interested in how many folk are on antidepressant treatment beyond 6 months.
It occurs to me as a doctor prescribing we have struggled to give clear guidance to patients, though I fully agree with you that advice for each patient has always to be mindful of their individual presentation.
Does the question I ask matter? Well surely the answer is yes. When we as doctors initiate antidepressant treatment we should at least have thought about this matter so that we can help inform choice for our patients.
Of course long-term antidepressant treatment may be necessary for recurrent depression, but there are surely other possible explanations?
I guess, like you, that the science that I really wish to follow, is open-minded, questioning and attempts to look objectively at data. Equally I am of the view that this same science must never stop listening and considering the voices of those with experience (in this case those receiving long term treatment with antidepressants)
ever aye Peter