New guidelines for prescribing anti-depressants are being issued amid concerns that too many people are taking them.
Health agencies are expected to tell doctors to limit the amount of times they prescribe anti-depressant drugs know as SSRI's which include Seroxat and Prozac.
The guidelines are likely to advise doctors that patients with mild to moderate depression would benefit from a combination of counselling and exercise, rather than prescriptive anti-depressants.
Do you think anti-depressants are over-prescribed? Why is there growing concern over some drugs? Have you experienced depression? How did you tackle the illness? Send us your comments.
This debate is now closed. Thank you for your comments.
It's all very well saying that doctors should get people into counselling instead of anti-depressants, but its virtually impossible to get counselling when you need it especially on the NHS! Generally you have to wait months which in some cases could well be too late!
Rob MacNab, Hants, UK
In my work, I deal with people who have or are on anti-depression drugs and in my opinion they should never have been offered them in the first place. Once on these drugs, it is very difficult to wean people from them as they dull the senses of all reality. I find that mostly folk need to be helped to face reality and help to handle the problems and issues of everyday life. We had to take a person and encourage them to reduce the drug over a long period of time. This process was done with the doctor's supervision and a year this person has completely changed.
Terry McGovern, Watford England
I am sixteen years old, weigh seven and a half stone and am currently taking 60mg of Prozac a day. Whilst I understand the concerns of others, mine is that it is being prescribed and then people are being left to deal with the underlying issues alone. People do not want to be taking tablets to feel better; they want to be better. Surely alternatives should be looked into at whatever cost, because the dangers with the medication and its side affects can over-ride the positive effects of the drug.
If I suggested that a diabetic replaced daily medication with counselling and exercise, there would be outrage. The same applies to sufferers of clinical depression. A chemical imbalance cannot be corrected with anything apart from regular medication.
The truth is that counselling and exercise are not "lame" - they just won't work for all people, just as anti-depressants won't work for all people. I think it is positive that doctors are being encouraged to think of alternatives, and it does not mean that those who do require anti-depressants will not get them.
It's all very well recommending counselling instead of anti-depressants, but what happens whilst people are waiting for counselling? An NHS waiting list for counselling can be up to 12 months. In the meantime, mild depression can become severe depression.
Carolyn, St Albans, Herts
Anti-depressants are of great help to people suffering from clinical depression, but much of the unhappiness and misery that people feel has other more straightforward causes due to life-style and life-choices. For these latter problems, feelings of anxiety, unhappiness and anger should act as natural triggers telling us that something is wrong and impelling us into taking action to rectify the situation. By suppressing our feelings with drugs thoughtlessly prescribed we suppress these natural reactions and become stranded within our unhappiness, unable to move on and blaming others for our situation.
Martin Smith, England
I have been taking antidepressants for about 7 years and I feel that they have helped me to survive and function in both my family duties and my job. Clinical depression is a real disease of chemical imbalance in the brain. It just won't go away after a few chats with a person who knows nothing about you and cares even less. The underlying reasons for depression are not necessarily concrete things, and even if they are, these things often cannot be changed. If I have to stay on anti-ds for the rest of my life, that's ok. Just like I have to take an ace-inhibitor for my high blood pressure. I just don't want to be told "It's all in the mind" or "Pull yourself together". It is condescending and naive. And I don't want to go back to being permanently tearful, suicidal and unable to enjoy life.
Mary, Modena Italy
Anti-depressants are essential for some people but I definitely agree that they are vastly over-prescribed. I accept that they're quicker and much cheaper than other forms of treatment, but they merely mask the symptoms, rather than actually addressing the problems that lead to depression in the first place. I was seriously depressed a few years ago, but didn't want to go on medication because a couple of friends had been on them and it didn't seem to have helped. Through counselling, I got to the root of my problems and now feel completely different about my life. I used to regularly wake up in tears, and suffered from chronic anxiety, melancholy, low self esteem and panic attacks. A couple of years on, I've totally changed my lifestyle and feel like a different person!
Perhaps if individuals at risk of developing depression or anxiety disorders were identified earlier, there would not be such a need to prescribe anti-depressants. I developed problems with anxiety in my teenage years, and had this been recognised I may have got better with therapy alone. Unfortunately this was not the case so I now rely on a combination treatment of drugs and cognitive behavioural therapy. No one likes to rely on medication, especially for mental stability, but sometimes the damage has been done and tablets are required.
J, Brighton, England
I have suffered from recurring bouts depression for years, finally seeking treatment when I was 18 (I'm 26 now), after years of self-harm. When I was 18 I was referred to a CPN, but was not happy talking through everything at the time - I was still coming to terms with being diagnosed with depression and what it meant. I have since asked my doctor about trying a "talking treatment", as I hate the thought of spending half my life taking tablets without trying alternatives. However, I was told that it wouldn't help - even though there has been very little discussion about the causes of my depression. I think that medication has become a way of fobbing people off. That's not to say that it doesn't help people, but more needs to be done to explore other ways of dealing with mental health problems.
I have been on anti depressants for the last two years after my wife left me. I would not be here today without the support of counselling, my GP and the drugs. Anti depressants should be seen as part of a package of support available however many people still make you feel that you should be able to cope without them. I for one cannot
Michael, West Yorks
My father was immediately prescribed anti-depressant when first suffering post op depression. Some weeks later, he suffered what was termed a 'heart incident' as a possible side effect of the drug, resulting in him collapsing into a shallow ditch and drowning- all as an unnecessary consequence of a hastily prescribed drug. I am sure his illness, which was a temporary result of surgery, could have been treated by a totally different method.
Ben Lambert, Hope Valley, Derbyshire
When I started to suspect I was suffering from depression, I was prescribed Prozac after been read a list of symptoms taken from some sort of handbook, to which I said yes to. It was as formulaic as that. Admittedly, Prozac did help, but when I returned to see a different doctor at the same practice, she was alarmed at how quickly the first doctor prescribed them without exploring other avenues initially. On retrospect I agree with her, but that said I did find the counselling I was offered on the NHS hopeless: my counsellor forgot that she had met me in the second week I met with her!
Dan, London, UK
No medicines are entirely 'safe'. It is just a question of whether the 'cure' carries an acceptable risk compared to the ailment. I know many people who, without antidepressants, would not be here now. I don't know any of who are not here because of SSRI's.
When I went into my doctors with continual tiredness and slight depression, I was prescribed an anti-depressant. The side-effects were horrendous. The doctor then tried 2 other anti-depressants, both causing the same side-effects (one making me suicidal and having visions of slashing my wrists - very scary). Now, it has been discovered a year later that I have pernicious anaemia (body not able to absorb vitamin B12) and that was what was causing the tiredness and depression.
I told the doctor that I thought it was a physical problem at the start...I was not listened to, TOLD that I was depressed and was dished out highly addictive, and no doubt expensive anti-depressants with horrendous side-effects. I welcome these new guidelines as GPs as a whole have no idea how to diagnose depression and tend to just jump to the conclusion that 'you are depressed, here's some Prozac' rather than first excluding any other causes of the symptoms.
Katie , Herts
Religion is no longer the "opium of the masses" ... it's been replaced by Prozac, Celexa, and Ritolin.
Ian, Brit in USA
I was prescribed a 6 month course of anti-depressants about a year ago and can honestly say that without them I don't think I'd be the same person I am today. I was really depressed and found it difficult even getting up in the morning, let alone going out with friends etc. I was prescribed anti-depressant along with a course of counselling and together they really put my life back together. I totally understand why the drug was prescribed to me, but would agree that sometimes doctors are a little too happy to give it out. Maybe if more doctors recommended counselling as well more people would stop taking them quicker.
Anon, Norwich, Norfolk
This is the first time ever I have felt compelled to write a comment on one of your articles. People who believe depression is a luxury illness and the people should just work more or do more sports have no idea what they are talking about. I have spent years hating every day of my life before I finally met a doctor who prescribed Prozac, rather than recommend that I talk about issues or 'do more sports'. I am not happy about taking medication every day, but it makes my life worth living!
Annette, New York, USA
You can't put a limit on the number of people who have depression. If you've got it, you've got it. It's no good doctors saying I've reach my depression quota, sorry, go away.
Julia, West Midlands
Without the use of anti-depressants, my wife would not be here today. It may be in some cases that anti-depressants are over prescribed but as has been mentioned previously then there are long waiting lists. It would help, of course, if these were actually mentioned to patients. It was only after a particularly bad period over a year ago as my wife tried to come off her medication following discussions with her GP that we were told of some of the support services.
7 years ago or so, when my wife was first prescribed anti-depressants, no mention was made of these nor was my wife referred to a Community Psychiatric Nurse for support. My wife is still on anti-depressants but you wouldn't know. We hope that she will be able to come off them in the future but we don't know when that might be. At present she is running the equivalent of 3 businesses, is one of the strongest people I know and is full of enthusiasm. She certainly isn't "a weakling".
AN, Glasgow, UK
Following the end of my marriage i was on anti-depressants for some months. They helped considerably in getting though the first few months of my new life and, although I am no longer taking them, I feel they contributed to helping me get through what was a very difficult time.
I owe my life to antidepressants. My son was killed by a drink driver, after struggling for life for 13 days. Had I not had the help of Prozac I could not have survived.
Mary A., Alabama, USA
True depression is different from sadness or unhappiness. The criteria for diagnosis are clear cut in most cases. Clinical depression, however mild, is a systemic illness which should be treated with the appropriate drugs without delay. Like any drug therapy for a systemic illness it should be monitored.
Dr Yousef Abdulla, Orpington, UK
I had a friend who at 14 was put onto Prozac after seeing her GP once about feeling down. She has a number of issues with self esteem and all he did was try to medicate her, not help with her very real problems. I was very glad when the guidelines for these drugs were changed for under 18's and would welcome any changes the government makes towards offering support as well as medication. I do however acknowledge these drugs are useful and necessary for some people, we just have to be more specific about how they are prescribed.
Katy, Southampton, England
If I hadn't been prescribed anti-depressants at the age of 18 I wouldn't be here today. I am 20 now and am still taking them. I would rather be alive and on anti-depressants than dead.
I have never suffered from depression, but I know that depression is most certainly not due to weakness or simply feeling low. Everyone feels low at some point in their lives, maybe even at some point in their week, but depression is a very real, debilitating illness. To say that antidepressants shouldn't be prescribed because negative experiences make us better at dealing with future problems is ludicrous. Whilst it is important that GPs and psychiatrists prescribe antidepressants responsibly, the enormous benefits that antidepressants bring to so many people simply cannot be ignored.
From having experienced an ex-partner being a manic depressive it is needed in such circumstances, however hearing from a friend who doesn't have half the symptoms of a manic depressive I find it shocking that doctors gave her anti-depressants. If a person has a chemical imbalance then absolutely, but for someone who is having to deal with a bad few months I don't believe it is the solution!
I know plenty of people who have been on anti depressants, some for years on end and I am yet to meet anyone for whom they actually help. The only effect I can see from anti depressants is that they are difficult to come off of as they can be quite addictive.
Laura, Herts, UK
Yes, anti-depressants can help some people. But all too often the doctor prescribing such medication does not explain the possible side effects or follow up with follow on appointments. I don't think it's because GPs don't care. I think it just highlights another failing in our NHS and how doctors are overworked.
Like so many who have responded I too would never have imagined that I would need to 'resort' to Prozac. I had no money worries, no job problems, great family etc but I fell down a long dark hole and until you have suffered depression - real depression - you have no idea just how desperate you can feel. For me, Prozac, gave me my life back and I came off them once cured within 4 weeks with NO problems. If anyone reading this needs them I would say do not hesitate to take the help they undoubtedly give.
I've had depression for 22 years on and off and I've learnt to think of anti-depressants as being a bit like pain killers. They don't take away the problem but they take away the symptoms.
Ted Aylmer, Bristol
Counselling helps in the long run but anti-depressants are excellent in the interim as waiting times can be unbearable.
Angela, Glasgow, Scotland
Without anti-depressants I would not be here today. They are not for everyone but everybody needs a little help at some point in their life. When you are depressed it's hard to see a clear path and anti-depressants help make the path.
Richard, Cardiff, South Wales
I used to believe that an anti-depressant was as rational a treatment for depression as insulin is for diabetes. No longer. I now realise it to be unmitigated drug-company propaganda. I took these drugs for years, with ever-increasing psychiatric symptoms, until I realised that the doctors just really didn't know what they were doing.
Denise Dewald, St. Louis, Missouri, USA
I agree that counselling and support should be first line treatment but it is very difficult to get this therapy due to underfunding and lack of resources - more investment in mental health services is needed to support these guidelines. (FYI I am a GP and face this common problem daily in my surgery).
Dr Richard Try, Gosport, Hants
As a strong, motivated man you would think that nothing could touch me. But twice in May past events have for a time completely overcome me and nearly stopped me functioning. I have had success, especially with the control of panic attacks, through counselling and I learnt some good techniques. Depression is entirely different. What would be perfect is a loving extended family on your. Our society and ambition to search for jobs has us moving away from this. I found as a man the very nature of the problems leads to further isolation. The drugs just kick you back enough to begin sorting yourself out again. An earlier period with a pre-SRI drug led me to try one of the "latest" improved drugs but I ended up with permanent side effects of twitching and mood changes.
Dave, West Midlands
I was diagnosed with OCD 3 years ago, and after researching the condition myself and discussing it at length with a counsellor, I made a conscious decision to start taking Prozac. It is by no means a cure-all, but what it does do is help you to gain enough clarity to address the actual issues. The problem I see with these drugs is that they are too often relied on as a magic source - "Prozac will sort me out" etc. It wont, that's up to you. I am now in a position where my dosage is one-third of what it was 6 months ago, and I will stop taking them altogether in the next few months. But I certainly couldn't have got this far without talking to someone about it.
I have suffered prolonged depression for nearly 15 years now, and I am quite certain that if I had not been prescribed Prozac I would not be here today. My father was old school, he believed in a stiff upper lip. He died of cancer 5 years ago, but 6 months before he died he was diagnosed by his GP with severe depression, understandably. When he came home from the surgery, he came to me and said, 'I am so sorry for how I have dealt with your depression. If you have felt only half as bad as I do now, I do not know how you have pulled through. You have my utmost admiration.' I find it very insulting hearing people who have never suffered such a debilitating disease, saying we are a society of weaklings. I hope if that person is ever diagnosed, they find a sympathetic ear, because it is very real.
I was the victim of an assault back in May and have been on anti-depressants ever since. I also suffered panic attacks and the medication I am on treats this too. I would not be without them. They have helped me through one of the most difficult times in my life. I know I will need them to see me through the court case.
I may be one of those GPs who 'hands them out like smarties'. Doctors are using these medications so frequently because they are available and patients are demanding them. CBT is undoubtedly better as a treatment for depression and anxiety. When I suggest this to my patients and say that the waiting time is 24 months, do they wait or choose the tablets? Patient Choice Rules.
I can speak from personal experience; the Seroxat I take for my anxiety disorder has been of much greater help - at least in the short-term - than the counselling I have received. While SSRIs won't work for everybody, they are wonderful when prescribed responsibly to those who need them.
Yes they are. I suffer from IBS went to the doctor to see if there was anything available to help me and was palmed off with Prozac. I didn't take them as I saw that as the first step on a slippery slope that I did not want to be on. I felt as if he were giving me them just to get rid of me.
Matt, Norwich UK
After the end of my marriage, which coincided with losing my job, I was very depressed and in a bad state. Anti-depressants helped me to shelve my problems long enough to sort myself out and get myself moving in a new direction again. Without them I would probably be unemployable now - but I made the decision to come off them as soon as possible. They are like a crutch - helpful to a point, but they actually inhibit your recovery beyond that point.
Iain Howe, Amsterdam, Netherlands
A friend of mine suffers depression in bouts, as does her father. She has been medicated on and off for years. I was interested to hear her father's perspective, who has never been medicated. When she asked him how he has coped with his depression, the sense of disquiet and unhappiness, his reply was refreshingly honest; "I don't expect to walk around happy and content all the time...being unhappy, being sad and upset...I just figured that was life!"
Andy Norris, Washington DC, USA
Anti-depressants are supposed to be a band aid, to assist you in functioning whilst you undergo therapy to fix the underlying problem. Most people with depression are not suffering the key chemical imbalance that requires lifelong medication, they need help assessing the underlying reasons for their sadness. Too much reliance is placed on social workers to provide this help in the form of your "little chats" when they are really hopelessly under-qualified to help, it takes a real psychologist to help most people.
Andy Norris, Washington DC, USA
In my experience, doctors are only too happy to hand out antidepressants. What else would you do if you knew you can't really help the person and have only 10 mins per patient? Its the easy way out, both for the doctor and the patient. When are people going to realise that treating the syptomns and not the cause is not the answer?
Nick, Reading, UK
Anti depressants are considered the first line in in problems such as depression and anxiety. The first line should be a more natural alternative such as St Johns Wort which for example is the first line in Germany for these kinds of problems. Nutrition is another more natural way of tackling these problems there is plenty of evidence to back up correcting chemical imbalances with diet & supplements, testing for hidden allergies etc. None of this is available from your GP, first line or not.
I am currently working with a nutritionist to improve my anxiety to allow me to come off Venlafaxine. In the last 3 months it has cost me in the region of £1000 in consultations, tests & supplements. None of which my GP had any understanding of let alone access to via the NHS. There is also the issue of GP surgerys accepting funding/sweeteners from pharmaceutical companies to encourage prescribing of their medications.
Mark, Nottingham, UK
There is a common misconception in this country that a stiff upper lip will combat depression. In fact - prior to suffering from post-natal depression and being prescribed Prozac, I have to confess this was broadly my view. Prozac enabled me to regain a life where pleasure in even the most simple things had gone. Depression is a chemical imbalance and as such requires drugs to cure it. I think the suggestion to just get some exercise and have a bit of a chat constitutes the stiff upper lip syndrome. People who make such suggestions have clearly never experienced how completely debilitated you feel with depression - and the equivalent of 'pull yourself together' would only seek to make things worse. Prozac saved me - and I know I am not alone.
I am 91. Having severe pain in my leg I was given Sertaline stating that it was "to raise the pain threshold. We shall not be making another appointment" The first week I had dreadful nightmares and spent days convincing myself they had not really happened. Three weeks later I began to hear voices, a multitude talking in the distance. The Sertaline leaflet states that these are for Schizophrenics and, although fed up with the lack of a reasonable diagnosis, I was not even depressed. I stopped taking them and returned to my normal self. (a consultant confirms that I have the biological age of 70, I live alone cope with my three bedroom house, and am computer literate ) I did not need treating for depression. Nobody warned me or showed any interest in side effects. GPs turn too easily to anti-depressants and pain killers without monitoring the side effects. The trouble is they have lost the art of diagnosis
Kathleen Ward, UK
About 6 years ago, I was prescribed a course of Prozac lasting 5 months - it alleviated all my symptoms and I have not suffered any recurrence since then. Coming off the medication was straightforward, under my GP's supervision, and I have really not looked back since! It would really be a shame if others were not able to benefit in the same way that I have.
Eleanor, Cambridge, UK
Having positive and negative experiences is all part of life. We all have them. Dealing with a negative one by resorting to antidepressants only lessens our ability to deal with the next negative event we will encounter.
Neil K, Swindon
Many depressed individuals may just have a nutrient deficiency. Many nutrients are important for nervous system function such as B vitamins. Additionally it is not always necessary to prescribe chemical medication which have side-effect since there are helpful natural products on the market which work in the same way as SSRIs and actually helps the body adjust and re-balance.
Nathalie Goulding, London
I would be the first person to say SSRIs have side effects, are addictive and hard to come off, but it boils down to two choices for me. Counselling didn't work, so it was either live happily with a few side effects, or live life wanting to jump off a bridge. Please consider how many lives these drugs have saved when prescribed properly.
Doctors nowadays seem far too eager to prescribe anti-depressants as the only solution. Here in Bristol, counselling isn't available at all on the NHS, and so you have to pay approx £40 per session. Maybe if the alternatives to happy pills were available to everyone on the NHS, doctors would have more choice, and sufferers, like myself would be able to try other options.
People should not be so weak and need to deal with life and whatever it throws at them. We live in a society full of weaklings.
Kate Kennedy, Cheshire, England
To Kate Kennedy, Cheshire - Thanks Kate, calling me a weakling makes me feel so much better about myself. I'm glad to see that you have a full understanding of depression and its causes.
Richard W, Worcester
Kate Kennedy from Cheshire: I've suffered from chronic depression for eleven years now, it's cost me a marriage, a job and several close friends. Over the last few years, I've managed to hold down a very stressful (but rewarding) job, as well as working on my physical fitness as a means of helping me cope. Does that still make me a weakling?
Depression medication has really changed my life. Now, I am able to live instead of thinking about dying everyday for a non-existent problem. I think that there is still too much taboo for a real problem. Depression is just as real of a disease as diabetes. No one talks about insulin dependency for diabetics, depression is caused by too little serotonin in the body. It is the same phenomenon.
Esha, Ann Arbor, USA
I had all the symptoms of depression and anxiety when I was in my final year at Uni. I begged my GP for antidepressants but she refused and sent me for counselling instead. The counselling didn't help and it was hardly surprising when I discovered that I was suffering from carbon monoxide poisoning. I moved out and have been fine ever since (15 years). I dread to think what would have happened if I had been on a combination of carbon monoxide AND anti-depressants and I count myself lucky that my GP didn't reach straight for the prescription pad.
Anon, Maidenhead, UK
I'm glad to see that many other people have had the same impression about doctors prescribing drugs too easily. I have never had a depression problem, but the few times I've been to my GP, as soon as I finished describing my problem the GP was ready to write a prescription. When I expressed doubts on the fact that maybe some tests would have been appropriate to rule out more serious reason for my sickness, I was suggested that if I was in a bad pain, I could take even more drugs. No doubts GPs are just following NHS guidelines, but maybe is time to find other solutions to cut waiting lists short. Doctors and decision makers shoud never forget that patients are human beings, and not drugs-eating machines.
Adriana Brancaleone, Cambridge, UK
What else are GP's meant to do when waiting lists for counselling are so long and then limited to 6 sessions. The government leave them no choice.
Yes. When my son was 16 he made a serious suicide attempt and went to hospital. On physical recovery he was referred to a child psychiatrist, had sessions with a CPN and was given Prozac. At no time did he or I feel that the minimal 'chats' were of any use at all, and the doctor and nurse just seemed baffled as to why an intelligent, fit boy should be so depressed. At no time did I feel we got real support, other than from one GP. My son felt the pills helped (and, several years later, still has all the boxes they came in), but, frankly, I wondered if the placebo effect and us being alerted to how depressed he had become, were the things which helped. Also, he was able finally tell friends how he felt. I was angry that he was fobbed off with medication alone.
I think this should be between the doctor and patient to decide what treatment is necessary. I have a brilliant doctor who without his help and care would not have got through the last few years. He is now helping me to gradually come off them. He was up front about possible side effects and I am happy at the rate I am coming off them. I know of other doctors in the same practise who quite willingly give anti-depressants out so perhaps guidelines would help.
Anon, Swindon, UK
My partner suffers from depression and yes, he has to take Prozac a couple of times a year. Living with someone who suffers from depression has convinced me beyond any doubt that this is a very, very real illness. I am appalled that "counselling" and "exercise" are a lame panacea for a very real malady. How horribly patronising - and how dreadful for sufferers.
Amanda, Paris, France
The worst thing I ever did was to take anti-depressants. Sure, I felt better for a while when I was on them, but they did nothing to rid me of the actual reasons that were causing the depression.
I had counselling for a while which helped, but the most successful treatment I have had has been hypnotherapy which changed the "record" that was playing, and got me out of thinking myself as a victim.
Antidepressants in a mild form may be okay for the short term so that you can get yourself to a level where you can take other steps, but relying on them completely is a big mistake.
Helen, Aylesbury, UK