More people should be offered medication when suffering from mental health problems, according to a new study
Research from Oxford University and published in The Lancet, concluded that at least a million more people in Britain should be prescribed antidepressants.
The research examined 522 trials involving 21 types of medication over nearly forty years. All were found to be effective, but its authors warned that only one in six patients suffering from depression are receiving treatment.
The Telegraph reports: Researchers said too many GPs were “squeamish” about offering medication for depression, when they would not hesitate to ensure patients received treatment for cancer or heart disease.
The findings also constitute the first ever league tables comparing different antidepressants.
Some of the best known antidepressants in Britain – such as Prozac – and the most widely prescribed drug, citalopram – were found to be among the least effective.
Less well-known drugs, such as amitripytline and mirtazapine were found to show far greater effect in reducing symptoms of depression.
Scientists urged GPs to consider the new evidence, with a “shift” towards the drugs shown to be most effective, following the trials involving almost 120,000 patients, most of whom had moderate to severe depression.
The UK already has the fourth highest levels of antidepressant prescribing in the Western world, with a tripling in prescription levels since the millenium.
Prof John Geddes, University of Oxford head of Psychiatry said: “The access to treatment is really bad. Only about one in six people with depression receive effective treatment in high-income countries.”
“If you recognise that people are suffering from a disorder you should expect to get access to effective treatment”, he said. “Let’s make the number 6 out of 6.”
Too many GPs were reluctant to suggest drug treatment, he suggested.
“What would we think if [patients with] high blood pressure or cancer if people simply werent getting access to available treatment?” he said, suggesting that some GPs were reluctant to prescribe drugs for mental health problems.
“I think we do tend to be a bit squeamish about it, it’s more stigmatised,” he said. “Some people don’t think they are illnesses or disorders.”
Lead author Dr Andrea Cipriani said he was “very excited” about the findings, which he said provided a “final answer” to controversy over the effectiveness of the drugs.
The researcher suggested much of the opposition to prescribing of such medications came from an “ideological” standpoint rather than an assessment of the evidence.
The study analysed 522 double-blind, randomised controlled trials, including previously unpublished results, comparing 21 types of antidepressant against placebos, and against each other.
All were found to be more effective than a placebo, and researchers stressed that all might be the best drug for some patients.
But they urged GPs to consider the evidence, and shift towards the most effective drugs.
The treatments agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine and vortioxetine were found to be most effective, while fluoxetine (Prozac), fluvoxamine, reboxetine and trazodone were found to make the least difference.
Drugs were deemed effective if symptoms were reduced in at least half of patients over two months.
Dr Cipriani said the “big challenge” was to increase uptake of the drugs, and to ensure those suffering from depression did not give up on treatment too soon.
“Eighty per cent of people stop anti-depressants within a month,” he said, when effects normally took at least two months, he said.
Professor Helen Stokes-Lampard, Chairman of the Royal College of GPs, said: “This research should reassure patients who are taking or are contemplating commencing antidepressants, and the doctors that prescribe them, that they are an effective treatment for depression in the short-term.”
But she said GPs should try to offer patients talking therapies, so they did not end up becoming “reliant on medication”.