‘Antidepressant use: changing patterns, cost and clinical effectiveness’

More than 5 years ago, before I retired as an NHS doctor, I attended this RCPsych accredited Continuing Medical Education (CME) event:

The afternoon session was on antidepressant prescribing and had two speakers, both of whom advise the Scottish Government on the prescribing of antidepressants:

This was the written introduction to these educational talks given to attendees [most of whom were prescribers]:

Dr Christmas considered the prescribing of antidepressants and shared the official Scottish Government figures for 2015 which indicated that approximately 1 in 9 of the adult Scottish population were taking an antidepressant:

Dr Christmas then shared a number of slides of media reports on these figures which expressed their disquiet:

The following year, in the Scottish Parliament on the 26th April 2017, as an advisor to the Scottish Government, Dr Christmas stated:

Since this statement was made Scottish Government figures have confirmed a year-on-year rise  in antidepressant prescribing, such that today, nearly 1 in 5 of the adult Scottish population are taking an antidepressant.

Following the The Royal College of Psychiatrists in Scotland Winter Meeting of 29th January 2016 , I submitted a response to this BMJ article ‘Misrepresenting harms in antidepressant trials.

Dr Peter J. Gordon, 3rd February 2016

I recently attended the CME accredited winter meeting of the Scottish Division of the Royal College of Psychiatrists.

One of the topics presented was antidepressant prescribing which is rising year on year in Scotland. It is now estimated that 1 in 7 Scots are on antidepressants.

The presenters went on to give evidence that prescribing rates are rising because antidepressants are prescribed chronically. The accepted view is that that such prescribing is “appropriate” (1). However, I wonder how many patients who are first started on antidepressants might have been told that they may well end up taking these long-term and perhaps even for life? It would be interesting to know of the experiences and reflections of those who have been taking antidepressants long-term. Perhaps we should also reflect on how such long-term prescribing of antidepressants fits with the now widely adopted “recovery model”?

In the recent Royal College meeting I was surprised that the potential harms of antidepressant medication were not mentioned. There was no mention of “discontinuation syndrome” and no mention of potential risks such as suicide (2). What was repeatedly mentioned was concern about public “myths” about antidepressant medication and that as a profession we needed to counter these myths.

Interestingly, in a poll of cards, it was estimated, before the presentation, that 3/4s of the audience of Scottish psychiatrists felt antidepressants were overprescribed. The result after the presentation was unchanged. This would suggest that Scottish psychiatrists are not comfortable with such high prescribing rates.

(1) Cameron I. M, Lawton K, Reid I. C. Appropriateness of antidepressant prescribing: an observational study in a Scottish primary-care setting. Br J Gen Pract. 2009 Sep;59(566):644-9
(2) Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports Tarang Sharma, Louise Schow Guski, Nanna Freund, Peter C Gøtzsche. 352:doi 10.1136/bmj.i65

Conflict of Interest:
I have petitioned the Scottish Parliament for a Sunshine Act to be introduced

Following my submission, which was published online, a further submission was made by a retired UK citizen:

4 February 2016

Dear Peter Gordon,
If 3/4 of psychiatrists were at odds to say the least, with the presentations being given by the College of Psychiatrists, why did they not speak out? That they did not is quite shocking when 3/4 of the attendees could not have been silenced by the presenters. The card ballot was a rather crafty way of keeping the issue under wraps - it needs to be shouted out collectively. You are the only person so far who has highlighted how it was dealt with.

It begs the questions - what are psychiatrists afraid of if they do speak their truth at conferences? What actions could they take collectively to stop over prescribing? And how trustworthy is the information given by the presenters and representatives? Any possible conflict of interests? Including thoughts of career prospects.

When so many practising psychiatrists are in breach of the legal obligation to 'do no harm' - by knowingly going along with overprescribing - it could, hopefully, in time lead to a group legal action. People who have taken antidepressants have for decades been reporting adverse effects and been fobbed off. The College should have the humility to acknowledge they have been arrogant in over-riding reports both by those prescribing and those who have suffered the negative effects of powerful and harmful psychiatric drugs. Obviously the pharmaceutical industry is not the only big bad wolf in this.

Suzanne Stevens 

I shared these responses with the Chair of RCPsych Scotland and recieved this reply:

5 February 2016

Dear Dr Gordon
Winter Meeting of the RCPsych in Scotland 29 January 2016

Regarding your email with the link to the BMJ editorial “Misrepresenting Harms in Antidepressant Trials”, speakers were invited to the Winter event and given a brief about the topic, they were not given advice by the officers of the College on what to include in their talk and what to exclude. Speakers were given the opportunity to give a presentation that would provoke debate amongst the audience. We have not had time yet to analyse the delegate feedback for this meeting but initial review of the forms that were returned indicates a high level of satisfaction with all of our speakers.

Yours sincerely

Dr Alastair Cook
Chair, RCPsych in Scotland

A year later, in the Scottish Parliament on the 26th April 2017, Dr Christmas stated:

These statement were made on this occasion without acknowledging the on-going gap in research.

A further two years on and official Scottish Government figures indicated that approximately 1 in 5 of the adult Scottish population were taking an antidepressant:

This increase in prescribing of antidepressants in Scotland, along with many personal testimonies submitted to PE1651: Prescribed Drug Dependence and Withdrawal, has contributed to the Scottish Government’s decision to update the following document. A short-life Working Group is being set up to do this and will be chaired by Chris Johnson, Pharmacist for NHS Greater Glasgow and Clyde: