Antidepressant prescribing and “fully informed consent”

I have submitted the following letter to the Herald:

21 January 2018.

Dear Sir,
I have now witnessed the Scottish Government’s Department of Health seeming to disbelieve the evidence presented in three separate health-related petitions and the experience of those who have petitioned. These included the petition by the Mesh survivors (PE1717); my petition for a Sunshine Act for Scotland (PE1493); and now Marion Brown’s petition on prescribed drug dependence and withdrawal (PE1651). The latest evidence session to the Scottish Parliament’s Petitions Committee once again would seem to demonstrate the Scottish Government’s starting position that its statements carry greater value than those made by individuals and groups challenging the status quo. This defensiveness may be understandable in terms of politics but does nothing to help advance the matter under consideration. Senior Scottish Government officials should not be considered more “credible” just because of they are in more powerful positions. The underlying research evidence in long-term prescribing of antidepressants is particularly poor.

I support the appropriate use of antidepressants. However, we all share in the Scottish Government’s determination for there to be “fully informed consent” between doctor and patient and it is my view, in terms of antidepressant prescribing, this is not routinely happening in NHS Scotland. I have been a Scottish NHS psychiatrist for 20 years and it has never been routine practice to discuss with patients the possibility, when commencing antidepressants, that they may be on them for life. The potential for severe withdrawal effects with antidepressants needs to be recognised and without listening to a range of patients’ experiences we are unlikely to develop our scientific understanding.

Dr Peter J. Gordon (writing in a personal capacity)

I have also submitted the following to the BMJ in response to this research news: Large meta-analysis ends doubts about efficacy of antidepressants

In Scotland, it is estimated that 1 in 5 adults are taking antidepressants, and it seems that the majority are taking them either in the long term or indefinitely. This meta-analysis does not help us evidence the basis for such prescribing. Indeed, it is surely a concern that there is such a dearth of long term studies on antidepressants. This is an indictment against the scientific community given that antidepressants have been in use for well over 50 years.

Scotland has had a number of parliamentary inquiries into medical treatments in recent years and our Chief Medical Officer has, as part of her Realistic Medicine campaign, repeatedly stressed the importance of “fully informed consent”.

I welcome this meta-analysis. I hope that it will act as a “wake up call”. When prescribing antidepressants, as part of fully informed consent, we should be explaining to patients that they may find that they will be taking antidepressants in the long term or perhaps indefinitely and that there is a lack of evidence to support this practice.