Recently, Dr Des Spence submitted, after more than a decade, a follow up to his 2013 ‘Head to Head’ debate in the BMJ with Prof Ian C Reid [see here and below]
I have taken the opportunity to submit this rapid response:
I agreed with Dr Spence when in 2013 he first put forward his argument that antidepressants were overprescribed [1]. More than a decade later, I still agree with Dr Spence. I am one of the nearly 1 in 5 Scottish adults who is taking an SSRI antidepressant. In my case I was prescribed this for anxiety in 1997, just as the 5 year long, largely industry funded, Defeat Depression Campaign was ending. I have found that I am unable to “discontinue” my SSRI antidepressant, however slowly, without severe withdrawal effects including akathisia and suicidality. So here I am, nearly three decades later still taking an SSRI that I do not want to be taking and which has harmed me [and as a consequence has harmed my family].
As an NHS psychiatrist I worked through the rapidly increasing medicalisation of life. Partly this is due to societal demand but the medical profession must also take responsibility for encouraging this. More and more people are seeking medical interventions for emotional distress that is part of normal life and for a number of reasons, these interventions commonly include prescribed drugs. I am not against medical treatments but I am aware of the potential harms related to their overuse. The consequences of “Too much medicine” [as the BMJ refers to overmedicalisation] include opportunity costs for those who are most in need of help as services become ever more stretched.
In 2013, it was Professor Ian C Reid who put forward the counter argument to Dr Spence, namely that antidepressants were not overprescribed [2]. More recently a senior psychiatrist and elected official of the Royal College of Psychiatrists [RCPsych] re-promoted Professor Reid’s argument, stating “it was good to refresh my memory of this given some recent discussions”.
It concerns me greatly that the Royal College of Psychiatrists has made such little effort to consider overmedicalisation and the harms associated with it. Indeed the College has not even responded to the general issues included in the recommendations of the Cumberlege Review: First Do No Harm [3]. The RCPsych needs to resist the urge to defensiveness and show leadership in addressing this problem.
[1] Are antidepressants overprescribed? Yes, Des Spence, January 2013, BMJ 2013;346:f191
[2] Are antidepressants overprescribed? No, Ian C Reid, January 2013, BMJ 2013;346:f190
[3] Cumberlege Review: First Do No harm, July 2022, https://www.immdsreview.org.uk/downloads/IMMDSReview_Web.pdf
