Medical Journalism, and anti-depressants.

You have to love The Daily Mail. It's a better option than insanity, which, when faced with the fallout of its sensationalist reporting of most healthcare issues, is the only other option open to me. Love seems the sensible choice.

The British Medical Journal this week published this article about the rising incidence of anti-depressant prescribing by GPs in the UK over a period of several years. It's a good article - one that I hope many GPs will read and take to heart. In the study period (1993-2005) the number of new cases of depression remained fairly static, if anything dropping slightly, but the number or prescriptions for anti-depressants doubled. The conclusion (in the abstract) states:

 "The rise in antidepressant prescribing is mainly explained by small changes in the proportion of patients receiving long term treatment. Previous clinical guidelines have focused on antidepressant initiation and appropriate targeting of antidepressants. To address the costly rise in antidepressant prescribing, future research and guidance needs to concentrate on appropriate long term prescribing for depression and regular review of medication."

This sort of article would often lead to discsussion with colleagues about our review processes, perhaps an audit of our own figures, maybe an alteration in the advice we give when initiating a prescription and certainly an entry in our learning diaries for revalidation. All good science-driven medicine, with patient outcomes being directly altered by current research. 

However, the conclusion translates into The Daily Mail's preferred language, Fearspeak, as:

"Prescriptions for anti- depressants have soared despite fewer patients being diagnosed with depression, research shows.
It reveals the number of prescriptions issued by GPs for drugs including Prozac and Seroxat has more than doubled over the past 11 years.
And it warns the dramatic rise is largely down to more than two million patients taking antidepressants for years at a time  -  many of them young women."

Stricly speaking, of course, most of what the Mail has said is true. The difference is not in the facts that are being reported, but in the language used to report them. Prescription numbers haven't risen, they have "soared". The article states prescriptions "nearly doubled"; this translates into "more than doubled". "Small changes in the proportion of patients receiving long term treatment" becomes "the dramatic rise is largely down to more than two million patients taking anti-depressants for years at a time". While the BMJ article promotes a sober reflection on practice, and generates useful change, the Mail article generates such a fear of these medications in their users, many of whom, of course, already have pathological levels of anxiety as part of their illness, that the trust in one of the few useful tools that can help them is destroyed.

The Mail rightly points out that non-pharmaceutical therapies are recommended for the treatment of depression. It fails to note that access to those therapies in most areas of the UK is abysmal. It fails to note that the impact on the lifestyle of a patient of psychotherapy (an hour a week for weeks at a time) can make its use unfeasible, when compared to a simple tablet treatment. It fails to note that the lead in time to benefit is longer with psychotherapy when compared with SSRI treatment. These factors mean that when I prescribe anti-depressants, it is after a balanced discussion of the relative merits of all available treatments, and of no treatment at all. In fact, it is a patient's choice, made holistically, taking into account physical and social needs of the patient and based on a great deal more experience of a complex and misunderstood disease than most journalists could ever hope to get.

And yet, sometime this week, a patient will come into my office, clutching a clipping of this article, saying they want to stop their fluoxetine because they've read how dangerous it is in the Daily Mail.

And they wonder why it takes two and a half weeks to get an appointment with me.