British health officials advised doctors yesterday not to prescribe antidepressants for about 70 percent of the patients who show up complaining of depression without first trying exercise, self-help, talk therapy or just waiting a couple of weeks to see if they got better.
In issuing new treatment guidelines for doctors, the British regulators and a standards-setting panel said patients with mild depression who are able to go to work and function normally, even if they complain of symptoms such as a lack of interest in things, low energy, dark mood, difficulty sleeping or difficulty concentrating, should avoid widely used antidepressants at first because of the possibility of side effects and withdrawal symptoms.
The regulatory panel is the same one that last year triggered a major reevaluation of the use of antidepressants in children after it concluded that the drugs were associated with an increased risk of suicidal tendencies in children. The recommendations that the drugs not be used as first-line treatment for mild depression are the latest evidence that some experts are reexamining the widespread enthusiasm for the medications.
Numerous studies have shown that antidepressants are among the fastest-growing sectors of the U.S. pharmaceutical industry. A government report last week said the latest figures indicated that one in 10 American women is taking an antidepressant.
"There are some cultural differences in that, in this country, medications are prescribed for many disorders and for problems in living," said Carol Goodheart, co-chair of an American Psychological Association task force on evidence-based practice. "It may be that the British are more conservative than the Americans in prescribing drugs."
Stephen Pilling, a British scientist who directed the development of the new guidelines, said he is aware of "shades of difference" between British and U.S. practices. "I am confident we have taken the right line," he said, adding that several international experts, including Americans, had contributed to the British recommendations.
"We are not saying 'Don't use drugs.' We are saying 'Use them appropriately,' " Pilling said.
The guidelines were issued by the National Institute for Clinical Excellence (NICE). A companion report issued by regulators at the British Medicines and Healthcare Products Regulatory Agency (MHRA) warned that some antidepressants carry risks of withdrawal symptoms and inner restlessness. The regulators also singled out the antidepressant Effexor "because of concerns about cardiotoxicity and toxicity in overdose."
Antidepressants such as Prozac, Paxil and Zoloft belong to a class of drugs called selective serotonin reuptake inhibitors. Following the lead of the British regulators a year ago, the U.S. Food and Drug Administration ruled in October that the risk of suicidal behavior among children taking the drugs was statistically significant. FDA now requires drug manufacturers to post a warning to that effect.
The British report found no clear evidence of risk of suicidal tendencies in young adults as a result of antidepressants but said that "young adults treated with SSRIs should be closely monitored."
