By Felicity Thomas
Nationwide, prescriptions for antidepressants are at an all time high – up by 100% since 2015, and 500% since 1992. It is estimated that half of all people on antidepressants in the UK have been taking them for two years or more (Kendrick et al. 2015), and that nationwide, a third of all people taking them long-term have no clinical reason to continue with their treatment (Cruickshank et al. 2008). So why does this matter? An increasing body of evidence suggests that rather than treat mental ill health, long term use of antidepressants can actually be significantly detrimental to mental health and wellbeing – and that in many cases, long-term use of psychiatric medicines not only exacerbates existing mental health conditions, but may also trigger new ones. Data from a recently published twenty year study for example, show that at each follow-up assessment, people who had taken antipsychotic drugs were significantly more likely to display psychotic symptoms that those who had never taken medications (Harrow et al. 2014). Others have argued that antidepressants not only have limited effectiveness over placebos but may also affect people’s vulnerability to depression in their future lives (Kirsch 2008).
Findings from the DeStress project indicate that long-term antidepressant use is disturbingly common amongst people in low-income communities. Many of the people we have interviewed have been taking antidepressants for years – even decades, with what they describe as little opportunity for review within medical consultations. In a situation in which GPs are encouraged by clinical guidelines to reassess treatment decisions only when side effects are palpably detrimental to patient health; when health providers are massively constrained by cuts to resourcing; and when people may assume that they are expected to continue treatment unless otherwise advised, the likelihood of people remaining on antidepressants in the long term becomes increasingly apparent. And despite the potential risks associated with withdrawing from antidepressants, few of those we have spoken to have found any support available to help them to come off the drugs. Those who have been able to withdraw have described the often horrific experiences of doing this without professional support, and the adverse impacts this had on them and their families.
There is an urgent need for health providers to reassess existing practice on antidepressant prescribing in the UK both to ensure that medications are being prescribed appropriately, and to guarantee that their use is monitored and regularly assessed in light of changing patient circumstances. A failure to do this is not only costly and wasteful in terms of resourcing but is morally and ethically dubious.