‘They won't do any harm and might do some good’: time to think again on the use of antidepressants?

Middleton, Hugh

doi:10.3399/bjgp11x548983

Cited by 36 publications

(33 citation statements)

References 13 publications

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Sreeharan

Madden²,

Lee³

et al. 2013

Br J Gen Pract

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BackgroundAntidepressant prescribing rates in England have been increasing since the 1970s. The impact of the Improving Access to Psychological Therapies (IAPT) initiative on antidepressant prescribing rates is unknown. AimTo investigate the impact of the establishment of IAPT services on antidepressant prescribing rates in primary care trusts (PCTs) in England. Design and settingA longitudinal time-series analysis, using PCTlevel data from 2008 to 2011 set in England. MethodA time-series analysis was conducted using PCT-level prescription data, dates of establishment of IAPT services, and covariate data for age, sex, and socioeconomic status. Statistical analysis was carried out using analysis of variance and a random-effect negative binomial model. ResultsAntidepressant prescribing rates in England increased by 10% per year during the study period (adjusted rate ratio = 1.10, 95% CI = 1.09 to 1.10). The implementation of IAPT services had no significant effect on antidepressant prescribing (adjusted rate ratio = 0.99, 95% CI = 0.99 to 1.00). ConclusionIntroduction of a large-scale initiative to increase provision of psychological therapies has not curbed the long-term increased prescribing of antidepressants in England. Keywordsantidepressive agents; cognitive behavioural therapy; depression; general practice; primary health care.

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Section: Introductionmentioning

confidence: 99%

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

Sreeharan

Madden²,

Lee³

et al. 2013

Br J Gen Pract

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“…In England, some 25 million prescriptions for a course of antidepressants were issued in 2000. That figure had risen to nearly 40 million by 2009 [13], and it has continued to rise at a rate of some 10% per annum [14]. What is more the percentage of incapacity Benefit claimants with mental health problems has not decreased either [15].…”

Section: Therapy As a Pathway To Happinessmentioning

confidence: 99%

Sociological Conceptions of Happiness and its Implications for Psychotherapy and Public Policy

Shaw

Middleton²

2015

J Nurs Care

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This paper critiques the usefulness of cognitive-behavioural therapy, which is often seen as a means of redressing the loss of community and friendship networks within society. Therapy in this context they runs the danger of becoming an Iatrogenesis at worst and just another `technology of mood' at best. In this paper we develop the critiques made elsewhere and provide a more nuanced argument that considers a wider range of psychological therapies. While all psychological therapies operate at an individual level, there are wide differences in the epistemological stances taken by differing therapeutic schools. Cognitive-behavioural therapy focuses on the idea of dysfunctional thinking within the individual, psychoanalytic therapy focuses upon developmental legacies, whereas person-centred therapy focuses on currently active social influences. In this form one to one therapy can be a route to change which is compatible with our sociological critique. However, the broader criticism that psychological therapies attempt to compensate for breakdowns in friendship and social networks remains. Furthermore reviews of psychotherapeutic outcome data and qualitative enquiry both point to the experience of authentic relationship rather than psychotherapeutic technique as the major determinant of outcome. Preventing social dislocation rather than trying to repair it post hoc should be the goal.

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“…This is a different, more meaningful, and more inclusive formulation of the relationship between depression and the brain than the term 'brain disease' set up as an 'Aunt Sally' by Middleton and Moncrieff. 1 We agree, however, that it is important to avoid using this term as a careless shorthand that can reinforce an 'either-or' mentality about causation and treatment.…”

Section: Ian M Anderson and Peter M Haddadmentioning

confidence: 99%

“…To caricature, if only slightly, the position of Middleton and Moncrieff, 1 the case is put forward for 'antidepressants bad, psychological treatment good' based on two main arguments. First, that the use of antidepressants is based on the erroneous medical model that 'depression is a reversible, or partly reversible, brain disease that can usefully be treated by drugs', and secondly that antidepressants work through the placebo effect and therefore their risks outweigh their benefits.…”

Section: Introductionmentioning

confidence: 99%

Prescribing antidepressants for depression: time to be dimensional and inclusive

Anderson

Haddad

2011

Br J Gen Pract

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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.

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‘They won't do any harm and might do some good’: time to think again on the use of antidepressants?

Cited by 36 publications

References 13 publications

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

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

Sociological Conceptions of Happiness and its Implications for Psychotherapy and Public Policy

Prescribing antidepressants for depression: time to be dimensional and inclusive

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