New figures show that despite a drop in the number of people seeking help for depression the number of prescriptions being written for anti-depressant drugs continues to increase.
According to reports in the Scottish media at the end of last week new figures show that the number of people seeing their doctor specifically about depression dropped significantly between 2002 and 2005.
The figures show that In 2002-2003, for every 1000 trips that women took to the doctor, 84 were due to depression. By 2005-2006 the number had dropped considerably to 65. During the same period the rate for men also dropped, from 37 to 30.
At the same time a report by NHS Quality Improvement Scotland (QIS), a health board established to oversee improvements in the NHS, shows that the number of prescribed daily doses of anti-depressant drugs had shot up from 19 to 85 per 1000 between 1992 and 2006.
Many commentators have previously linked increasing anti-depressant prescription rates to an increasing acceptance of mental illness and people's increasing willingness to visit the doctor about depression. In light of the new figures showing falling depression rates this explanation no longer stands up.
A number of other factors could explain the rise however. New guidelines recommend that patients stay on anti-depressant medications for longer to reduce the risk of relapse. Coming off the drugs too quickly has long been known to be risky. Another factor may be that newer drugs have become household names and have fewer obvious side-effects than older generation drugs which left patients drowsy and dry mouthed or required strict avoidance of certain foods. In addition, low doses of older tricyclic anti-depressants are now being prescribed for conditions such as fibromyalgia and irritable bowel syndrome.
In response to the new figures mental health charities expressed their alarm and said that alternative treatments such as cognitive behavioral therapy (CBT) and and advice on exercise programs should be made more available to address an overdependence on medication to treat mental illnesses.
The increasing rates of anti-depressant drug prescriptions over the past decade are despite growing amounts of research demonstrating the effectiveness of many alternatives that are safer and often cheaper. Herbs such as St. John's Wort and nutrients such as SAMe have demonstrated effectiveness in depression and do not exhibit the serious side-effects such as increased suicide risk which come with anti-depressants such as paroxetine. These alternatives are routinely prescribed in place of drugs in many European countries. In addition, regular aerobic exercise and various forms of psychotherapy are known to be highly effective.
The Scottish Executive had previously recognized the issue and set a target of halting the rise in anti-depressant prescriptions by 2009. There were early signs that progress was being made but it's unclear what exactly is being done in the effort.
Health Minister, Shona Robison, said the Scottish Government was committed to the goal of "leveling off" the prescription of anti-depressants and had invested £4.5m in developing alternative treatments for people with depression.