Patients are not being given full details about the safety and effectiveness of anti-depressant medications, a report suggests.

Health Which? magazine says that sometimes people are not told about issues such as withdrawal problems or side effects - including a possible risk of increased suicidal behaviour.

Much more accurate information is needed about the efficacy of anti-depressants

Sue Freeman

The magazine argues that people may consider alternatives to anti-depressants if they had more information.

More than 22 million prescriptions were written for anti-depressant medication in England in 2000, up from nine million in 1991. The drugs cost the NHS Ј310m a year.

However, some clinicians believe the increasing use of the drugs is not necessarily a good thing.

Placebo comparisons

Dr Joanna Moncrieff, senior lecturer at University College London's department of psychiatry and behavioural sciences, has conducted research suggesting that anti-depressants may not be much more effective than giving people dummy drugs.

Whenever new evidence comes along we will always look at it

Dr Mike McClure

She told the magazine: "On the basis of evidence far less solid than generally portrayed, more and more people are being put on these medicines."

Dr David Healy, honorary consultant psychiatrist at the North Wales department of psychological medicine, told the magazine there was evidence that some patients taking a common form of anti-depressant known as selective serotonin re-uptake inhibitors (SSRIs) are "significantly more likely" to attempt suicide.

He said: "These studies show that in all probability there is a direct link between anti-depressant therapies and suicide induction."

Warning

Sue Freeman, managing editor of Health Which?, said: "Anti-depressants do help in some cases.

"People should not suddenly reduce their dose or stop taking their medication.

"But current advice from the Royal College of Psychiatrists and other sources is potentially misleading patients.

"Much more accurate information is needed about the efficacy of anti-depressants, about the risk of withdrawal reactions and the possible increased risk of suicide for some people taking SSRIs."

Ms Freeman said the Medicines Control Agency should review the warnings it requires SSRI manufacturers to give both patients and prescribers.

The Royal College of Psychiatrists and others should also reconsider their advice about anti-depressants.

Review

An MCA spokesperson said the safety of SSRIs was continually monitored.

The Committee on Safety of Medicines (CSM) has examined a possible link between SSRIs and suicidal behaviour on several occasions.

It has concluded there was no conclusive evidence, but that the matter should be kept under review.

"Product information for prescribers and patients contains warnings that suicidal behaviour may increase in the early stages of treatment with any antidepressant," it said.

"SSRIs are recognised to cause withdrawal reactions in some people, as do most antidepressants and many other drugs acting on the central nervous system.

"Product information for prescribers and patients already contains relevant warnings."

Psychiatrists

Dr Mike McClure, of the Royal College of Psychiatrists, said the suicide rate for England and Wales had fallen by 15% between 1990 and 2000 since the advent of SSRIs.

This raised doubts about the theory that SSRIs carried an added risk of suicidal behaviour.

Dr McClure said the risk of withdrawal symptoms could be minimised by gradually weaning patients off their medication.

He said: "Our advice is updated continuously as new research comes through.

"Anti-depressants can be very effective, but the issue of withdrawal symptoms was not something that was discussed, because there was no evidence at the time.

"But whenever new evidence comes along we will always look at it."

http://news.bbc.co.uk/2/hi/health/1813990.stm