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Long‐term antidepressant treatment: time for a review?

Poor targeting In the early 2000s we found evidence of poor targeting of antidepressant treatment – GPs were prescribing inappropriately for patients with mild symptoms, yet failing to treat some patients with more severe depression.6,7 Subsequently, the 2004 NICE depression guideline emphasised the need to assess severity, and advised against treating mild depression.8 Then a performance indicator was introduced in the GP quality and outcomes framework (QOF) rewarding the use of symptom questionnaires to assess depression severity, aimed at improving targeting of treatment.9 Following the introduction of the QOF indicator, we found that decisions to prescribe antidepressants were more appropriately related to greater severity at diagnosis,10 and a study of GPs’ initial prescribing decisions found them justified in most cases, against the 2004 NICE guidance.11 However, antidepressant prescription numbers have continued to rise year on year. To investigate the cause, we recently analysed anonymised data from 142 English practices contributing to the Clinical Practice Research Datalink (CPRD) from 2003–2013.12 We found that GPs were not diagnosing many more people with depression. There was a small increase in consultations for depression following the economic recession (around 4 per cent between 2008 and 201312) but antidepressant use increased by 48 per cent during the same period.3