Types of antidepressants

Antidepressants have been on the market for decades.  The newer SSRI (selective serotonin reuptake inhibitors) and SNRI (serotonin-norepinphrine reuptake inhibitors) drugs are now preferred to the older type drugs such as monoamine oxidase inhibitors (MAOIs) and tricyclics which had more side effects and were more dangerous in overdose.

Withdrawal symptoms

Almost two-third of patients experience withdrawal symptoms

The withdrawal symptoms for benzodiazepines and antidepressants have been found to be similar.

A literature review reports that withdrawal symptoms can occur with any SSRI but were more frequent with paroxetine. Symptoms can persist for up to a year or more.

Withdrawal Symptoms after SSRI Discontinuation: A Systematic Review.  Fava G et al, Psychotherapy and Psychosomatics, 2015, 84: 72-81

Withdrawal symptoms after SSRI discontinuation

New Classification of SSRI Withdrawal. G Chouinard, V Chouinard, Psychotherapy and Psychosomatics, 2015, 84: 63-71

SSRI Withdrawal New Classification 2015

Are antidepressants effective?

Research has shown that antidepressants are largely ineffective for mild depression.  The RCPsych states that 50-65% of patients who take antidepressants will benefit compared to 25-30% who take a placebo pill.   In other words, only 25-35% will derive some real benefit.

Rates of prescribing in Scotland

In Scotland, as in the UK as a whole, the prescribing of antidepressants has been increasing year on year, while the issuing of benzodiazepines has been on the decline.

The number of items prescribed in Scotland rose from 3.5 million in 2004/5 to 5.8 million items in 2014/15.  The Scottish Government attempted to curb prescribing but had to abandon its target in 2010. In 2014/15, a total of 814,181 patients in Scotland were prescribed at least one antidepressant, an increase of 28.5% since 2009/10 (633.791 patients).  In 2016, this had risen to 877,453 patients, about 17 per cent of the population.  Nearly 579,000 prescriptions were given to female patients, compared with 299,000 male patients.

Why are prescribing rates increasing?

The mean score for adults on the Warwick-Edinburgh Mental Wellbeing Scale has changed little between 2008 and 2016.  The mean score fell from 51.0 in 2006 to 50.0 in 2008, and has remained at a similar level since (ranging between 49.7 and 50.0).

General Health Questionnaire (GHQ-12) scores have remained stable since 1995 with only minor fluctuations over time.  Adult life satisfaction levels have not changed significantly since 2008.

The adult population (over 16) of Scotland is around 4,259,600.  Consequently, around one in five adults were prescribed at least one antidepressant in 2014/15. Yet, in 2012, 74% of adults described their health as good or very good.  This suggests that most adults who have some sort of health problem is being prescribed an antidepressant.

Research studies of antidepressant prescribing by GPs in Scotland and England confirm that the rise is not due to an increase in the number of new cases of depression.  The study in England showed that an increase in long-term prescribing was largely responsible for the overall increase in antidepressant prescribing.

Antidepressant prescribing rates across Europe.

Some countries have higher prescribing rates compared to the UK.  France, Germany and The Netherlands have lower prescribing rates.

Misrepresenting harms in antidepressant trials, Editorial, Dr Joanna Moncrieff, 2016

Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports, Cochrane Collaboration, Denmark, 2016