Family Physicians Must Change Antidepressant Prescribing Practices

A new article highlights the changes needed in primary care to reduce the overuse of antidepressants.

6
1924

A new article, published in the Australian Journal of General Practice, examines antidepressant prescribing practices by primary care physicians. The authors highlight the adverse effects and ineffectiveness of antidepressants and call for changes in how these drugs are prescribed in Australian general practice.

The authors, led by Katharine Wallis, General Practitioner and Associate Professor at the University of Queensland, write:

“There is general agreement that antidepressants are no more effective than medication placebo in less severe depressive disorders, and there remain questions regarding whether antidepressants have any useful effects against more severe depression over and above the placebo effect. It has never been substantiated that antidepressants reverse an underlying chemical (serotonin) deficiency or other brain abnormality, yet they modify the brain in ways that are not fully understood, with potentially harmful consequences.”

Female family doctor listening carefully to woman patient.Antidepressants continue to dominate treatment for depression, despite research demonstrating that antidepressants are not effective for those struggling with mild or moderate depression, which raises questions as to whether they are effective for persons experiencing severe depression. Moreover, research elsewhere has demonstrated that not only are antidepressants largely ineffective, they also worsen long-term outcomes.

In Australia, antidepressants are most often prescribed by general practitioners. Unfortunately, however, the ways that antidepressants are prescribed often are not supported by clinical guidance.

“Clinical guidelines recommend psychological therapies for mild depression and anxiety, and 6–12 months of antidepressant therapy for a single episode of moderate-to-severe depression,” Wallis and colleagues write. “Yet in Australia, the average duration of therapy is now approximately four years, and half of the users are long-term users.”

Additionally, the authors call attention to the differences in who is prescribed antidepressants. For example, individuals from lower-income areas are prescribed the drugs at higher rates than those from wealthier areas, and elderly adults are prescribed antidepressants at nearly double the rates of younger persons.

Further, prescribing antidepressants does not address possible underlying social issues, such as grief, loneliness, or poverty. They can also cause adverse side effects such as emotional numbing, lethargy, sexual dysfunction, weight gain and are associated with higher rates of severe COVID-19. Also, long-term antidepressant use can lead individuals to feel as if they are dependent on it and can increase reliance on mental health services which can inhibit individuals’ resilience.

Withdrawal symptoms like anxiety, irritability, dizziness, headache, low mood, among others, can prevent individuals from stopping long-term antidepressant use, as the symptoms are often misunderstood as a depressive relapse, which in turn causes fear and results in the practitioner continuing to prescribe the medication.

Available research suggests that about half of people attempting to stop their antidepressants may experience withdrawal symptoms. These withdrawal symptoms can last weeks or even months, with the severity and time period of symptoms likely correlating with how long the person was on antidepressants.

Despite antidepressant withdrawal symptoms affecting half of those who take them, the occurrence, severity, and length of withdrawal symptoms have only recently been given more attention, prompting changes in clinical guidelines to recommend individuals to slowly taper antidepressants to reduce withdrawal symptoms. In addition, psychotherapy is crucial to preventing depressive relapses when stopping antidepressants.

The authors offer several recommendations to reduce unnecessary and long-term antidepressant use. They suggest that general practitioners be supported to prescribe antidepressants less frequently and stop antidepressant use more frequently. Support with stopping medication should also be extended to patients, given the complexity of the withdrawal process and the clinical recommendation for slow tapering. Additionally, providing access to social, financial, and psychological supports is key to assisting individuals with stopping and staying off of their medication.

 

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Wallis, K. A., Donald, M., Moncrieff, J. (2021). Antidepressant prescribing in general practice: A call to action. Australian Journal of General Practice, 50(12), 954-956. (Link)

6 COMMENTS

  1. “Available research suggests that about half of people attempting to stop their antidepressants may experience withdrawal symptoms. These withdrawal symptoms can last weeks or even months,”

    Personally, I have had the common symptom of antidepressant discontinuation syndrome of “brain zaps,” since 2001. So withdrawal symptoms can last for years, perhaps forever.

    “with the severity and time period of symptoms likely correlating with how long the person was on antidepressants.”

    I did not find this to be true, since I’d only been on the antidepressant for a month or two. Prior to being abruptly taken off it by my PCP, since it did not function as the “safe smoking cessation med” my PCP had claimed it to be.

    I also don’t agree “psychotherapy is crucial to preventing depressive relapses when stopping antidepressants.” Since it was a psychologist that misdiagnosed my “brain zaps” as “bipolar;” then she demanded I take a bunch of drugs from a psychiatrist, which resulted in a bunch of anticholinergic toxidrome poisonings. In the States, the psychologists tend to function as partners of the psychiatrists.

    But I absolutely agree, “Family Physicians Must Change Antidepressant Prescribing Practices,” here in the United States as well. Same is true of the ER doctors. For goodness sakes, one cannot go into an ER in the States, with a pulled muscle, without being asked – out of the blue – “Are you depressed?”

  2. Now I wanted to mention something. I have an incredible sense of balance, love music and dancing, and love athletic and gymnastic type of stuff that uses my incredible sense of balance. And I’m somewhat of a natural performer.

    At the gym, I do one set of exercises that are challenging in terms of balance. Then I get used to them and they are no longer challenging so I like to do another that’s challenging, so I am always challenging myself.

    Now here is something I want to note. Any kind of balance exercise is like learning to ride a bike. Once your brain has set down those pathways, they are permanent. But that does mean, your brain has to “grow” each time and develop a new set of connections each time.

    What if I am someone who simply has to always be active and doing a lot of athletic stuff? (I note, I have had other relatives who were the same and felt obliged to remain very active into their late 90’s, never stopped being active until they died.)

    Would I perhaps be more prone to depression, had I not been allowed to develop my athletic and musical side? Because there would be all this brain that “wants” to be exercised and develop doing that stuff — and, if it can’t do that, it won’t do anything. Or it won’t do much. But it would be prone to depression, I think.

    Because it’s meant to have that constant stimulus.

    Would academics have thought of that? I do think they are a sedentary bunch. Those who are more like me would not have gotten very far there. So they aren’t going to even think of that in the first place.

    I was also thinking about psychotherapy — there is a headline I see that says psychotherapy has an enduring effect on depression unlike pills.

    I sort of always felt that psychotherapy isn’t really that good for me. Because, sitting down in an office like that, it’s as if I’m not exercising most of my brain while talking to a psychotherapist. I sort of wonder if, having a psychotherapy session walking around outdoors or doing some activity at the same time besides talking, might that impact me better? It might even making me think of things I wouldn’t think of sitting still indoors.

    I wonder about that, because I do think there is human variety. And what’s good for some isn’t good for everyone.

    By the way, I happen to be a gay man who is — well, were I a woman and like that, the best way to describe me would not be a compliment and not permitted on here. OK, so I get around lots.

    And, at the same time, I am a very curious and intellectual person. And, also, if you are talking to someone who is a member of some profession, after you sleep with them, they will trust you more and are willing to tell you all sorts of inside information they would never tell.

    OK, so first of all, I met one gay guy in this cruisy video store — very sleazy place, I might add. With little booths big enough so two or three guys can share them. He was a nurse and from a family of nurses. Guess what he told me?

    “Zyprexa and similar drugs MAKE YOU INCOMPETENT. I know that because I am from a family of nurses. It’s a scam. Everyone knows it’s a scam.” He also told me all about how abruptly withdrawing causes temporary symptoms of psychosis, even if you didn’t have psychosis in the first place and it was inappropriately prescribed, and “in order to get off of zyprexa or the other neureleptics, you need to be on valium for a whole entire year, and then taper off the valium too, but most doctors aren’t taught about this.”

    In other words, all the key opinion leaders out there? They are liars. They all know it’s a scam and they all are lying through their teeth and, at the same time, privately to themselves, or amongst each other and those they trust, they all openly agree it’s a scam, “but the money.”

    Someone really should do some kind of undercover investigation involving gay men who are attractive and charming simply trying to sleep with as many medical doctors as possible, relevant in the area of psychiatry, and see if they can get them to admit the truth. That would be interesting.

    However, I also once hooked up with a guy in biotech as well. Another interesting bit of inside information he told me was all about how, the whole business model of the one blockbuster drug that gets sold to the whole population and makes billions is profitable but also not the right way to do medicine.

    There is human variety, what works for one sub population doesn’t work for another. They should really be working to categorize people into various sub populations, and target specific remedies or treatments to each small sub population, one at a time. If they really want to make medicine more advanced, that’s what they need to do. But they won’t do it because of money interests.

    What’s even more disturbing is, maybe you can take a drug that works for one sub population, and if you pick your study subjects right, it looks to be a wonderful success — and then you can turn it into a blockbuster drug prescribed for everyone. And nobody knows, it’s only good for that one sub population and you should not take it if you are not part of that.

    At the time I was very interested in the subject of corruption in biotech and medicine, so I was asking such questions, is there systemic fraud? That’s one thing I was told.

    However, at another time, I also remember being told, when asking were they looking as hard as they should for an HIV cure, I remember being told that they are not really trying very hard to find a cure for HIV. (It’s so profitable not to cure that they don’t want to.) And he said, they are looking in the wrong direction, and then told me some esoteric stuff I didn’t quite understand.

    Something along the lines of how, those seeking a cure are looking to cure it via targeting one particular biological mechanism, “but that is never going to work,” he said. And that they should be looking for a cure via targeting a completely different biological mechanism, because that IS promising and that’s the only way a cure might be found, “but they all won’t do that.”

    And he said it looks like they don’t want to, and it’s probably because of Big Pharma funding. Or, I think, he didn’t quite want to say that, he forced me to speculate, isn’t that probably because of Big Pharma Funding, so he could cautiously and hesitantly admit “yeah, it sure looks like it.”

    Because there is a whole culture of intimidation in those circles where it’s politically incorrect to be “conspiracy theorists.” Except it has gotten so extreme, you have to tiptoe around their blatant and brazen corruption, all the while they feel no qualms about shoving such brazen unapologetic corruption down everyone else’s throats, with zero remorse as to the millions of people harmed by their research failures. Instead, you must feel like you are walking on eggshells, all ready to apologize to them for pointing out their failures or their lack of stamina and ambition. Not exactly an environment conducive to greatness in medicine — where I note this is people’s lives that are at stake.

    Isn’t it disgusting, the culture of the people who make it in those research circles, then? It looks to me like they do not allow anyone to succeed there unless they are scum. Or have been slowly programmed to become scum. I do know the way “ivory tower” thinking occurs. People slowly get brainwashed further and further away from the mainstream, so slowly that they do not even realize just how outrageous they have become.

    I say it that way because I really do think this whole notion of deliberately playing dumb and going on a deliberate wild goose chase in the wrong direction you know will never succeed, because you are not going to stand up to Big Pharma, is this kind of sneaky kind of submissive sort of “playing dumb” that is very annoying.

    They act like they have no backbones, except they could have backbones, they just don’t care and are greedy.

    • I think your athletic ability is wonderful, and as a mediocre swimmer I envy you! Been swimming for 55 years and do the breast stroke, but I feel great afterwards! I have thought for a long time that mental health medication has only gone in one direction, that being brain synapses misfiring serotonin or other bio chemicals, and few are exploring the endocrine system and the idea that mental illness is in some cases metabolic. The endocrine system principally controls hormone production and excretion, and is the Pitiuary gland in the brain, the thyroid, the heart, the pancreas, and the ovaries/testicles. There is now research into autoimmune disorders such as Polysystic Ovarian Syndrome, diabetes type 3, Hosomoto disease of the thyroid and the list goes on! Are ‘mental or emotional’ illnesses autoimmune disorders? I don’t know, but as we strive to end the stigma in the mental health profession, let us look at all the other systems in the body!

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