Skip to main content

Main menu

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • RESOURCES
    • About BJGP
    • Conference
    • Advertising
    • BJGP Life
    • eLetters
    • Librarian information
    • Alerts
    • Resilience
    • Video
    • Audio
    • COVID-19 Clinical Solutions
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers
    • RCGP e-Portfolio

User menu

  • Subscriptions
  • Alerts
  • Log in

Search

  • Advanced search
British Journal of General Practice
Advertisement
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers
    • RCGP e-Portfolio
  • Subscriptions
  • Alerts
  • Log in
  • Follow bjgp on Twitter
  • Visit bjgp on Facebook
  • Blog
  • Listen to BJGP podcast
Advertisement
British Journal of General Practice

Advanced Search

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • RESOURCES
    • About BJGP
    • Conference
    • Advertising
    • BJGP Life
    • eLetters
    • Librarian information
    • Alerts
    • Resilience
    • Video
    • Audio
    • COVID-19 Clinical Solutions
Letters

NICE guidelines on antidepressants

R. Hamish McAllister-Williams, Karin Foran, Steven Forrest, Graham Ingram, Lindsay McMahon, Michelle Taylor, Madhuri Rajwal and Lenny Cornwall
British Journal of General Practice 2006; 56 (531): 798.
R. Hamish McAllister-Williams
Roles: Reader in Clinical Psychopharmacology and Hon. Consultant Psychiatrist
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Karin Foran
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Steven Forrest
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Graham Ingram
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Lindsay McMahon
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Michelle Taylor
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Madhuri Rajwal
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Lenny Cornwall
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info
  • eLetters
  • PDF
Loading

In December 2004 NICE issued clinical guidelines regarding depression. These included restrictions on venlafaxine with baseline ECGs and prescribing by specialists only recommended. This was based on unpublished data regarding the cardiac effects of the drug and concerns of toxicity in overdose.

On 31 May 2006, MHRA released a statement following an appeal against the restrictions by the manufacturer, Wyeth. This conceded that baseline ECGs are unnecessary for most patients. Further, MHRA accepted data showing that venlafaxine is more likely than SSRIs to be prescribed to patients at risk of suicide. This leads to an increase in the ‘fatal toxicity index’ (deaths per million prescriptions) for the drug. The absolute risk of toxicity of venlafaxine is probably still higher than for SSRIs, though is far less than the risk from overdose with amitriptyline or dosulepin (dothiepin). MHRA concluded that venlafaxine was an appropriate second-line antidepressant (after an SSRI), and that it can be prescribed by non-specialists in doses less than 300 mg per day.

The original NICE recommendations have had a profound impact. We have examined antidepressant prescribing in three general practices in the North East of England (combined population: 23 217), both immediately before and 6 months after publication of the NICE guidelines. All patients newly prescribed an antidepressant in 3-month periods were identified (764 and 780) and their case notes screened to identify those with depression and/or anxiety. Prescribing of SSRIs significantly increased from 46.5% to 59.4% of patients (P<0.001). However, the proportion prescribed venlafaxine fell from 7.3% to 1.0% (P<0.05). This does not simply reflect practices who assiduously implement NICE guidance. Prescribing of dosulepin, which NICE also recommended for specialist use only, remained unchanged (3.7 versus 3.2%).

Our data raises concerns regarding the impact of NICE guidelines. Recommendations that are contentious and widely discussed, and followed up by industry as was the case with venlafaxine, lead to major changes in practice. However, recommendations that are not widely publicised, such as those regarding dosulepin, can easily get overlooked (especially when the name of the drug has changed). The major concern is that while the confusion over venlafaxine has been resolved, the most toxic of the commonly prescribed antidepressants, dosulepin, continues to be prescribed unchecked. There needs to be a concerted effort by all trust medicines management bodies towards reducing the small but significant numbers of patients prescribed dosulepin to prevent unnecessary deaths.

  • © British Journal of General Practice, 2006.
Back to top
Previous ArticleNext Article

In this issue

British Journal of General Practice: 56 (531)
British Journal of General Practice
Vol. 56, Issue 531
October 2006
  • Table of Contents
  • Index by author
Download PDF
Article Alerts
Or,
sign in or create an account with your email address
Email Article

Thank you for recommending British Journal of General Practice.

NOTE: We only request your email address so that the person to whom you are recommending the page knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
NICE guidelines on antidepressants
(Your Name) has forwarded a page to you from British Journal of General Practice
(Your Name) thought you would like to see this page from British Journal of General Practice.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
NICE guidelines on antidepressants
R. Hamish McAllister-Williams, Karin Foran, Steven Forrest, Graham Ingram, Lindsay McMahon, Michelle Taylor, Madhuri Rajwal, Lenny Cornwall
British Journal of General Practice 2006; 56 (531): 798.

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
NICE guidelines on antidepressants
R. Hamish McAllister-Williams, Karin Foran, Steven Forrest, Graham Ingram, Lindsay McMahon, Michelle Taylor, Madhuri Rajwal, Lenny Cornwall
British Journal of General Practice 2006; 56 (531): 798.
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
  • Mendeley logo Mendeley

Jump to section

  • Top
  • Article
  • Info
  • eLetters
  • PDF

More in this TOC Section

  • Two-tiered medicine: the increasing disparity in medical care in the UK
  • MRCGP Recorded Consultation Assessment — the hidden fourth construct
  • Prostate-specific antigen testing and opportunistic prostate cancer screening — CAP intervention
Show more Letters

Related Articles

Cited By...

Advertisement

BJGP Life

BJGP Open

 

@BJGPjournal's Likes on Twitter

 
 

British Journal of General Practice

NAVIGATE

  • Home
  • Current Issue
  • All Issues
  • Online First
  • Authors & reviewers

RCGP

  • BJGP for RCGP members
  • BJGP Open
  • RCGP eLearning
  • InnovAiT Journal
  • Jobs and careers
  • RCGP e-Portfolio

MY ACCOUNT

  • RCGP members' login
  • Subscriber login
  • Activate subscription
  • Terms and conditions

NEWS AND UPDATES

  • About BJGP
  • Alerts
  • RSS feeds
  • Facebook
  • Twitter

AUTHORS & REVIEWERS

  • Submit an article
  • Writing for BJGP: research
  • Writing for BJGP: other sections
  • BJGP editorial process & policies
  • BJGP ethical guidelines
  • Peer review for BJGP

CUSTOMER SERVICES

  • Advertising
  • Contact subscription agent
  • Copyright
  • Librarian information

CONTRIBUTE

  • BJGP Life
  • eLetters
  • Feedback

CONTACT US

BJGP Journal Office
RCGP
30 Euston Square
London NW1 2FB
Tel: +44 (0)20 3188 7679
Email: journal@rcgp.org.uk

British Journal of General Practice is an editorially-independent publication of the Royal College of General Practitioners
© 2021 British Journal of General Practice

Print ISSN: 0960-1643
Online ISSN: 1478-5242