Yonder: COVID non-compliance, antidepressant withdrawal, probiotics, and GPs in China

It is disappointing that, in an issue of BJGP devoted to mental health, the only mention of the increasingly recognised problem of antidepressant dependence is in reference to an article published elsewhere.

I have been in practice long enough to recall the Defeat Depression campaign of the 1990s. I recently came across some of the material distributed to GPs in support of this campaign,¹ which was supported by both the RCPsych and RCGP, as well as the pharmaceutical industry. We were told that the then-new SSRIs were safe, effective and non-addictive, they corrected a chemical imbalance in the brain, and that GPs were massively under-recognising and undertreating depression. The professional consensus emerged that it was good practice to prescribe to anyone who had “biological symptoms of depression” for two weeks or more. The studies backing these assertions covered a standard 8 – 12 weeks.

Now we are faced with huge prescription numbers, driven at least in part by long term prescribing, for which there is a very flimsy evidence-base. Many people have developed discontinuation symptoms when stopping these drugs, been told by their doctors that these represent a relapse of their original condition and can now count the years over which they have been dependent on prescribed drugs.

The RCPsych has moved its position, as evidenced by its recent publication “Stopping antidepressants”,² endorsed by the RCGP. This is welcome after years of denial from both colleges that there was a significant problem with SSRI withdrawal. The recent past president of the RCPsych recently told Telegraph Magazine “that prescription figure is high. However, most antidepressants are started by GPs”.³

This is important now. Not only are there large numbers of people who need help in coming off their medications, but we risk adding to their number if the stress and exhaustion of COVID-19 and its aftermath are also subjected to the seemingly irresistible pressure to medicalise human distress. General practice, and the RCGP in particular needs to resist the urge to defensiveness, learn the lessons of experience⁴ and show leadership in addressing this problem.

References

1. Pitt B. Down with gloom! Or how to defeat depression.  1993.  Publisher: Gaskell 
2. Royal College of Psychiatrists. Stopping antidepressants. Available at: www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/stopping-antidepressants. 
3. Levy M. The rise of 'McMeds': Are antidepressants becoming a fast fix? 2021.  The Telegraph.  Available at: www.telegraph.co.uk/health-fitness/mind/rise-mcmeds-antidepressants-becoming-fast-fix.
4. The Independent Medicines and Medical Devices Safety Review.  First do no harm. 2020.  Available at: www.immdsreview.org.uk/Report.html.