Doctors must stop over-prescribing antidepressants to patients who are just lonely, demand leading experts

• In the last decade, antidepressant prescriptions have almost doubled in England
• Full version of the letter from medics, researchers and officials published below

Doctors must stop prescribing antidepressants to patients with mild mental health problems to curb the country’s overreliance on pills, experts said today.

Antidepressant prescriptions have almost doubled in England over the last decade with 85.6million dished out in the last year alone.

Experts blame ‘overmedicalising’ issues like loneliness for the steep rise, with unnecessary drugs putting patients at risk of harm while failing to tackle the root causes of problems.

Instead, lifestyle changes alongside greater use of social prescribing, such as gardening, walking groups and volunteering, must be used to turn the tide on unnecessary drug usage.

More than 8.6million people — one in five adults — are now prescribed antidepressants annually, despite poor outcomes and potential harms such as dependence.

Over the last decade, antidepressant prescriptions have almost doubled in England, rising from 47.3million in 2011 to 85.6million in 2022. Pictured: citalopram, a type of selective serotonin reuptake inhibitors (SSRIs), which are the most widely-prescribed antidepressants

More than 8.6million people — one in five adults — are now prescribed antidepressants annually (Stock Image)

This number is expected to rise between 5-10 per cent each year over the next decade, while unnecessary prescribing has been estimated to cost the NHS England up to £58million every year.

While not addictive, antidepressants can cause withdrawal symptoms in around half of patients who try to stop, and severe withdrawal symptoms in around a quarter.

Members of the new Beyond Pills All Party Parliamentary Group (APPG), experts and patient representatives are today urging health leaders to reverse the rate of antidepressant prescribing.

In an open letter to the British Medical Journal today, they said ‘a pill for every ill’ must stop and called for a national, 24-hour prescribed drug withdrawal helpline and website.

Reductions in antidepressant prescribing should be included in official NHS targets, they suggest, with GPs urged to follow Nice guidelines on safe prescribing and withdrawal management, including properly informed consent and regular review of harms and benefits.

What are antidepressants? 

Antidepressants are medicines that treat depression symptoms. 

There are around 30 different types that can be prescribed.

The NHS says that most people who have moderate or severe depression notice improvement when they take antidepressants. But it notes that this isn’t the case for everyone. 

Side effects vary between different people and antidepressants but can include nausea, headaches, a dry mouth and problems having sex.

Antidepressants aren’t addictive but patients may have withdrawal symptoms if they stop taking them suddenly or miss a dose. 

These can include an upset stomach, flu-like symptoms, anxiety, dizziness and vivid dreams.

Lord Nigel Crisp, co-chair of the Beyond Pills APPG, said: ‘The high rate of prescribing of antidepressants over recent years is a clear example of over-medicalisation, where patients are often prescribed unnecessary and potentially harmful drugs instead of tackling the root causes of their suffering, such as loneliness, poverty or poor housing.’

Dr Michael Dixon, a GP and Chair College of Medicine, said: ‘As GPs we are facing a tsunami of mental health problems — especially depression — and these can often be helped by changes in lifestyle, diet and a range of interventions offered through social prescribing, without reaching for pills that can have all sorts of undesired effects.

‘It is crucial that patients know about and are helped to try these alternatives so that pills become the last resort rather than the first. It is time to de-medicalise mental health and to liberate our patients to find non-drug solutions that work for them. Our most urgent priority now is to equip patients and medics with the means of achieving this.’

A Department of Health and Social Care spokesperson said: ‘We are committed to supporting people with their mental health and we’re going further and faster to transform our country’s mental health services.

‘Up to £2.3 billion in extra funding is being invested by the government until 2024 to expand services so that two million more people, including 345,000 children and young people, can get the mental health support they need.

‘The decision to prescribe a particular product is a clinical one and should always be based on the patient’s medical needs and best interests.’

A full version of the letter can be read below. 

Today a group of medical professionals, researchers, patient representatives and politicians call for the UK government to commit to a reversal in the rate of prescribing of antidepressants.

Over the last decade, antidepressant prescriptions have almost doubled in England, rising from 47.3million in 2011 to 85.6million in 2022. 

Over 8.6million adults in England are now prescribed them annually (nearly 20 per cent of adults), with prescriptions set to rise over the next decade. 

Additionally, the average duration of time a person spends on an antidepressant has also doubled between the mid-2000s and 2017, with around half of patients now classed as long-term users.

Scotland, Wales and Northern Island have similar rates of antidepressant prescribing.

Over 8.6million adults in England are now prescribed them annually (nearly 20 per cent of adults), with prescriptions set to rise over the next decade. Pictured: fluoxetine, a type of SSRI 

Rising long-term use is associated with many adverse effects, including increased weight gain, poorer long-term outcomes for some, sexual dysfunction, bleeding and falls. 

Additionally, withdrawal effects are experienced by around half of patients, with up to half of those describing their symptoms as severe, and a significant proportion experiencing withdrawal for many weeks, months or longer.

Rising antidepressant prescribing is not associated with an improvement in mental health outcomes at the population level, which, according to some measures, have worsened as antidepressant prescribing has risen. 

Questions remain about the extent to which poor outcomes are fuelled by such adverse effects, and the poor efficacy of antidepressants for many groups.

Multiple meta-analyses have shown antidepressants to have no clinically meaningful benefit beyond placebo for all but the most severely depressed patients, which is why NICE guidance states that they should not be routinely prescribed as first-line treatment for less severe depression, while still respecting the importance of shared decision making.

WHAT IS DEPRESSION? 

While it is normal to feel down from time to time, people with depression may feel persistently unhappy for weeks or months on end.

Depression can affect anyone at any age and is fairly common ¿ approximately one in ten people are likely to experience it at some point in their life. 

Depression is a genuine health condition which people cannot just ignore or ‘snap out of it’.

Symptoms and effects vary, but can include constantly feeling upset or hopeless, or losing interest in things you used to enjoy.

It can also cause physical symptoms such as problems sleeping, tiredness, having a low appetite or sex drive, and even feeling physical pain.

In extreme cases it can lead to suicidal thoughts.

Traumatic events can trigger it, and people with a family history may be more at risk.

It is important to see a doctor if you think you or someone you know has depression, as it can be managed with lifestyle changes, therapy or medication. 

Source: NHS Choices 

Despite this, rates of prescribing to patients with mild and moderate depression remain high. 

One study shows 69 per cent of diagnosed depression in older people was of mild severity, and another that of those taking antidepressants 26.4 per cent reported mild depressive symptoms. 

Furthermore, one UK study showed that 58 per cent of people taking antidepressants (2> years) failed to meet criteria for any psychiatric diagnosis.

Additionally, there are now evidence-based objections to prescribing antidepressants for sufferers of chronic pain, where efficacy is very low, alongside evidence of disproportionate prescribing to women, older people and those living in deprived areas. 

This raises questions about the extent to which we are wrongly medicalising and medicating the impact of disadvantage and deprivation.

As well as the human costs of unnecessary antidepressant prescribing, there are now significant unnecessary economic costs being incurred by the NHS in England of up to £58million annually – money that could be better spent boosting non-pharmacological provision. 

The problem has been recognised by the NHS in its National Medicines Optimisation Opportunities 2023/24 statement.

We believe a reversal in the rate of antidepressant prescribing can be achieved by following through with various public health recommendations, in line with the NHS National Medicines Optimisation Opportunities 2023/24.

These include:

1) Stopping the prescribing of antidepressants for mild conditions

2) Adhering to the 2022 NICE guidance on safe prescribing and withdrawal management including properly informed consent and regular review of harms and benefits

3) Funding and delivering local withdrawal services integrated with social prescribing, lifestyle medicine & psychosocial interventions

4) Including the reduction of antidepressant prescribing as an indicator in the NHS Quality and Outcomes Framework (QOF)

5) Funding and delivering a national 24 hour prescribed drug withdrawal helpline and website

Finally, we hope other countries with high levels of antidepressant prescribing will also commit to a reversal in prescribing rates.

Lord Nigel Crisp (Co-Chair, Beyond Pills All Party Parliamentary Group)

Professor Sir Sam Everington (Vice President BMA, Deputy Chair, College of Medicine)

Baroness Professor Sheila Hollins (Professor of Psychiatry, St Georges, University of London)

Professor Joanna Moncrieff (Professor of Critical and Social psychiatry, University College London)

Dr James Davies (Associate Professor of Medical Anthropology and Psychology, University of Roehampton)

Professor John Read (Chair, The International Institute for Psychiatric Drug Withdrawal)

Danny Kruger MP (Chair, Beyond Pills All Party Parliamentary Group)

Dr Michael Dixon (Chair, College of Medicine)

Dr Bogdan Chiva Giurca (Global Lead and Clinical Lead National Academy for Social Prescribing)

Prof Guy Chouinard (Professor of Clinical Pharmacology, McGill University)

Michael Dooley (Treasurer, College of Medicine)

Dr Anne Guy (Secretariat, Beyond Pills All Party Parliamentary Group)

Dr Mark Horowitz (North East London NHS Foundation Trust, UCL (honorary))

Professor Peter Kinderman (Professor of Clinical Psychology, University of Liverpool)

Dr Lucy Johnstone (Consultant Clinical Psychologist, Bristol)

Luke Montagu Secretariat (Co-Founder, Council for Evidence-based Psychiatry)

Professor Antonio E. Nardi (Professor of Psychiatry, Federal University of Rio de Janeiro)

Sarah Stacey (Co-Founder, College of Medicine Beyond Pills Campaign)

Dr Andrew Tresidder (Clinical Lead for Medicines Management NHS Somerset)

Jo Watson (Psychotherapist, Worcestershire)

Stevie Lewis (Lived Experience Advisory Panel for Prescribed Drug Dependence)

Professor Marcantonio Spada (Professor of Addictive Behaviours, London South Bank University)

Chris van Tulleken

Norman Lamb (Former Minister of State for Community and Social Care)

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