Medicalisation of misery to blame for soaring use of antidepressants, say GPs — (The Guardian)

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The Guardian

Mark Rice-Oxley and Carmen Fishwick

Thursday 21 November 2013

Doctors across Europe warn limited time and resources leads many to prescribe pills for less-urgent cases of depression

Doctors across Europe are warning that the soaring use of antidepressants is down to growing pressure to “medicalise” unhappiness, complaining that a lack of time and meagre availability of other therapies meant that physicians reach for the prescription pad far too often.

In response to a questionnaire devised by the Guardian and five leading European newspapers, the vast majority of almost 100 European doctors and psychiatrists who replied said there was a “prescribing culture” in their country because other help for people with depression was inadequate.

Many of the doctors – from the UK, France, Italy, Germany, Spain, Luxembourg, Belgium and the Netherlands – said they believed antidepressants were an effective treatment for cases of severe depression. But dozens expressed frustration that limited time and even more limited resources mean that they often feel pressured to prescribe pills in less-urgent cases.

“We are medicalising common situations: conflict, separation and the vicissitudes of life,” said Gladys Mujica Lezcano, a Barcelona-based hospital doctor.

“They are prescribed much too easily,” added Alain Vallée, a psychiatrist from Nantes in France. “If you take an antidepressant and it doesn’t work, you don’t think it’s because you might not be depressed, but that you need to take a stronger one.”

Not everyone agreed. Ricardo Teijeiro, who practises in the Netherlands, said the Dutch system had figured out that antidepressants might not be appropriate for milder forms of depression. “Dutch family doctors prescribe very little,” he said. “They have learned that mild depression is iatrogenic and prescribe pills when they encounter a severe depression.”

Data from the Organisation for Economic Co-operation and Development more or less bears this out: in the Netherlands antidepressant usage has risen by less than 25% since 2001 and has flatlined in the past five years. In Germany, the UK and Spain, by contrast, prescriptions have doubled over the past decade.

Doctors and psychiatrists say the pressures are manifold: from patients desperate for resolution and families eager for reassurance, from schedules that leave them with too many patients and not enough time and from the lack of available alternatives.

Fareedoon Ahmed, a trainee psychiatrist from Essex, said the illness had long since outstripped the resources available – in the UK at least. “Depression is a common mental health problem with a large number of sufferers, of which only the most severe can be supported within this health system.”

But continental doctors expressed the same view.

“It’s inadequate,” said Simone Schliermann, from Erbach in Germany. “There’s a lack of psychotherapy. My waiting list is one year.”

José Luis Ballesteros Ramos, a psychiatrist from Granada, added: “The fact that primary care physicians prescribe antidepressants is linked to the inability to spend more time with the patient, because they get to see 40 patients in the morning.”

The financial crisis has certainly squeezed health budgets across the EU, and in Germany, consultants say that the state cannot afford the appropriate treatment for the large numbers of depression patients who present.

“There is a payment problem for the dedicated psychiatrist,” said Jörg Madlener, a Frankfurt-based neurologist. “For €40 [£34] a quarter, and with the huge inrush of patients, I can only treat depression with medication.”

This is a frustration for many clinicians, because experience broadly shows that while antidepressants can be effective at treating symptoms of depression, it is talking therapies that will help patients understand what is happening to them – and how to avoid relapse. The chances of a recurrence of depression are far higher in people who do not have some form of psychiatric therapy than for those who do.

UK-based doctor Hannah Hudson said access to talking therapies was poor unless the patient was severely depressed. “Otherwise it is scanty,” she said. “There are few support groups and often the only professional who provides support is the GP.”

More broadly, there is concern that common human afflictions – sadness, melancholia, ennui – are being turned into medical conditions and then treated with pills. “Psychiatric care is becoming a consumer good in a society in which there is a low tolerance for frustration and adversity,” said one Spain-based doctor whose identity has been verified but who wanted to remain anonymous.

“Trivial problems are being psychiatrized. There are people who want antidepressants because ‘the boyfriend left me’.”

José García-Valdecasas Campelo, a Tenerife-based psychiatrist, added: “Sadness is a normal human emotion that should not be medicalised. Social problems should be treated at a social level, and not at a psychiatric one.”