Two million antidepressants for five years – BBC News

More than a quarter of patients taking antidepressants in England – around two million people – have been on them for five years, the BBC has found.

This is despite the fact that there is limited evidence of the benefits of taking the drugs for that time period.

A doctor who runs an NHS clinic that helps people stop taking pills says withdrawal symptoms can make it difficult for some to stop taking their medicines.

The picking guide was updated in 2019, but says little has changed.

More than eight million people in England take antidepressants, prescribed for depression, anxiety, OCD and other conditions. That’s a million more people than five years earlier, NHS prescriptions figures show.

The new long-term usage data – covering the period 2018-2022 – was provided to BBC Panorama by the NHS, following a Freedom of Information request. The data provides a big picture but does not reflect the circumstances of individual patients, some of whom may be taking long-term antidepressants for good reason.

The investigation also uncovered evidence that a major pharmaceutical company attempted 27 years ago to hide possible withdrawal effects a drug could cause.

Modern antidepressants — called Selective Serotonin Re-Uptake Inhibitors (SSRIs) — have been around since the late 1980s, including Prozac. They were quickly heralded as wonder drugs compared to previous drugs, some of which had serious side effects.

They were thought to treat depression by fixing an imbalance of the mood-regulating chemical serotonin in the brain. Researchers are now unclear on how they work. One theory is that they simply change the way you think or feel, rather than correcting an underlying problem.

The NHS recommends antidepressants as a treatment for more severe depression. Talk therapy, exercise, and lifestyle changes might be recommended instead of or in combination with the drug.

“Throughout my long and extensive career, I have seen people benefit from antidepressants,” said Professor Wendy Burn, former president of the Royal College of Psychiatrists.

“I see them working in my clinical practice, I see lives being changed by them.”

But he added: “People are taking antidepressants longer and we don’t have any long-term studies to support that.”

There has long been a debate about how effective antidepressants are. The most comprehensive research, from the University of Oxford, suggests that antidepressants help some people, at least in the short term.

But on average, their benefits are relatively modest and how people respond varies, with some not responding at all, according to the researcher who led the study.

And there’s some evidence to suggest that long-term use of antidepressants may be linked to some health risks, such as heart problems and diabetes. It’s also thought that long-term use may lead to a higher risk of withdrawal symptoms in some people.

Withdrawal can occur when you stop a drug that your body has become accustomed to.

Taking that drug off too quickly, before the brain has had time to adjust, can lead to symptoms, including low mood and feelings of anxiety. Some symptoms overlap with the original condition for which the drug was prescribed, meaning withdrawal can sometimes be confused with relapse.

Symptoms depend on the individual, what medication they were taking, and for how long. Many patients can stop taking antidepressants without experiencing any problems.

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Panorama uncovered evidence suggesting that a major pharmaceutical company that manufactured SSRI antidepressants had become increasingly aware of a full range of withdrawal symptoms since the mid-1990s, but was reluctant to share this information with the public and authorities. of drug regulation.

A copy of a confidential 1996 memo from the firm Pfizer – which originally sold sertraline, now the UK’s most common antidepressant – shows employees discussing what the drug company allegedly told regulators in Norway.

“We shouldn’t volunteer to describe withdrawal symptoms, but prepare an agreed list in case they insist,” the memo says.

Some of the withdrawal reactions referred to in the memo include sensory disturbances, sweating, nausea, insomnia, tremors, agitation, and anxiety.

Pfizer no longer makes sertraline. In response to Panorama’s findings, a spokesperson said the company “has monitored and reported all adverse event data” to licensing authorities, “in line with its legal and regulatory obligations, and has updated labeling.” of sertraline as required”.

He added, “Public health organizations and professional medical bodies around the world have recognized sertraline and other SSRIs as the treatment of choice for adult depression.” The company said the drug’s label warns of the recall and has been updated “as requested.”

The Royal College of Psychiatrists published updated information on the retreat in 2019, under the supervision of Prof Burn, who was its president at the time. He arrived after hearing testimony from patients who had experienced severe withdrawal effects.

Until then, the guidance used by the NHS and the college maintained the withdrawal was mostly mild and short-lived, no more than a week or so.

Now NHS guidance reflects that it can be severe and long-lasting for some, and withdrawal can last many months.

About stopping antidepressants

A spokesperson for the Royal College of Psychiatrists told the BBC: ‘Medicine is constantly evolving, and so is our understanding of the treatment of mental illness. As a result, the college updates its guidance as new evidence comes to light.’

A lack of awareness about withdrawal difficulties has meant that even medical professionals prescribing the drugs have struggled to stop taking the antidepressants themselves.

Dr. Mark Horowitz, who tried to stop antidepressants he’d been on for 15 years in 2015, said: “It’s led to complete chaos in my life,” he says. “I used to wake up in the morning in a panic, like I was being chased by an animal.”

The panic she felt would last well into the evening and she started running around as a distraction.

“I ran until my feet bled, because it gave me a slight respite from that panicky feeling.”

He said it was worse than the symptoms that led him to take antidepressants in the first place.

Panorama examines whether the current generation of antidepressant drugs has lived up to its promise, following patients who have suffered severe side effects.

Watch The Antidepressant Story on BBC One at 8pm Monday 19 June (8.30pm in Wales and Northern Ireland) and on BBC iPlayer later (UK only)

He is concerned that much more work has been done on how to start patients on antidepressants and much less on how to stop them.

“To me, it’s like allowing cars to be sold without brakes,” he said.

“We should know how to start the car and how to stop it.”

Now Dr Horowitz runs the only NHS antidepressant prescribing clinic in England, a pilot scheme set up in London in 2021 to help people struggling to get off their medication.

He is currently seeing about 25 patients.

Although the pickup guide has been updated, Dr. Horowitz believes patients are still struggling to get tailored advice. The guide for doctors now recommends people gradually reduce the dose of their medications, but doesn’t specify how long it should take. It’s different for everyone.

The Royal College of GPs told Panorama that GPs were “highly trained to have frank and sensitive conversations” with patients about the risks and benefits of antidepressants.

“Between the intense workload and pressures of the workforce,” she said it was “increasingly difficult to give patients the time they need within the confines of a standard 10-minute consultation.”

The companies behind the most widely used antidepressants told Panorama that many studies and clinical trials, including those conducted by independent researchers, have proven their drugs’ effectiveness.

They said the drugs had been taken by many millions worldwide for potentially devastating and sometimes life-threatening conditions.

As with all drugs, they said, antidepressants have potential side effects that are clearly stated in the prescribing information. They added that their drugs are considered safe, with a positive benefit-risk ratio by doctors, patients and regulators around the world.