Prescribing antidepressants for depression: time to be dimensional and inclusive

Abstract

The article by Middleton and Moncrieff questions the role of antidepressants in treating depression on both philosophical and practical grounds; namely that depression isn't a brain disease to be treated by a drug and that antidepressants are ineffective except as placebos. We argue that their stance is unhelpful and factually incorrect and that a more dimensional and integrative approach is needed in order to be able to best tailor treatment to individual needs. This involves a personalised assessment of the likely benefits and risks of both psychological and drug approaches when recommending treatment for someone with depression.

Improving Access to Psychological Therapies and antidepressant prescribing rates in England: a longitudinal time-series analysis

“…9 Despite clear NICE guidance based on current scientific evidence, 10 there is a divergence of opinion among GPs about the clinical effectiveness of prescribing antidepressants. 11,12 An economic argument for the establishment of IAPT was based on a cost-benefit analysis that mainly focused on the benefits of increased employment, in terms of the increased revenue gained from returning people to work. 13 Evaluation of clinical and employment outcomes are central to the IAPT programme, and have shown some positive early results.…”

An end to depression in primary care?

“…24 In a counter-point to the article by Middleton and Moncrieff cited above, 'patient-centred treatment' was put forward as one of the reasons to consider antidepressant treatments. 25 Similarly, a recent editorial on the subject of antidepressant prescribing advised 'shared decision making'. 15 But being patient-centred does not mean working from a diagnosis, it means working from the reason for encounter.…”