Antidepressant use rises as recession feeds wave of worry

The number of antidepressants prescribed by the NHS has almost doubled in the last decade, and rose sharply last year as the recession bit, figures reveal.

The health service issued 39.1m prescriptions for drugs to tackle depression in England in 2009, compared with 20.1m in 1999 – a 95% jump. Doctors handed out 3.18m more prescriptions last year than in 2008, almost twice the annual rise seen in preceding years, according to previously unpublished statistics released by the NHS’s Business Services Authority.

The increase is thought to be due in part to improved diagnosis, reduced stigma around mental ill-health and rising worries about jobs and finances triggered by the economic downturn.

But tonight doctors warned that some people are being put on the drugs unnecessarily, especially those with milder symptoms of depression, partly because there is too little access to “talking therapies”, which use discussion rather than drugs to tackle problems.

“I’m concerned that too many people are being prescribed antidepressants and not being given counselling and cognitive behaviour therapy, because access to those therapies, while it is improving, is still patchy,” said Professor Steve Field, the chairman of the Royal College of General Practitioners, which represents the UK’s family doctors.

“More people are being diagnosed with depression, but many of them would be treated better by having access to talking therapies, especially those with mild to moderate depression. I’m concerned that these people are being treated with medication unnecessarily,” he added.

GPs felt “cornered” into giving patients antidepressants because of a lack of alternatives, he said.

“Talking therapies are just a good [as medication] for treating mild depression, and CBT can be just as good for more serious depression. But the provision for these therapies hasn’t been good,” said Field. However, more GPs were gaining more of a choice between tablets and talking treatments, he said.

Peter Byrne, the director of public education at the Royal College of Psychiatrists, whose 12,450 members include the UK’s 6,300 consultant psychiatrists, echoed Field’s concern. It said it was unsurprising that prescriptions were rising after a decade of investment in mental health services. “The optimistic view is that more people are being uncovered and treated. My concern is that people with mild depression should not be put on antidepressants,” he said.

Consultant psychiatrist Tim Kendall, director of the National Collaborating Centre for Mental Health, which drafts NHS guidance on the drugs, said: “Antidepressants are offered too frequently in primary care because the waiting lists for alternative treatments are too long. Doctors need to think hard about putting people on these drugs because they can be hard to get off and have significant side-effects.”

The NHS does not record how many people take antidepressants, but up to one in six people suffers from some form of depression during their life. The recession has produced greater demand for NHS help with mental health problems.

“In 2009 all of us – whether we work in general practice, general hospitals or specialist services – are seeing an increase in referrals from the recession. The stresses of the downturn are the last straw for many people,” said Byrne.

The Labour government invested hundreds of millions of pounds in “talking therapies”, in an effort to help jobless people with chronic problems get back into work and couples negotiate relationship difficulties. The Lib-Con coalition has promised to continue prioritising such treatments. But Byrne disputed claims about long waiting times.

The falling cost of antidepressants may have an effect. Ten years ago each prescription cost £16, but this has fallen to just £6 today, which means the NHS spend has fallen, from £315m in 1999 to £230m last year.

Dr Hugh Griffiths, the government’s mental health tsar, said that while the causes of, and risk factors for, depression were complex “the recession can have an impact. A rise in prescriptions might also reflect a greater awareness and willingness to seek support and better diagnosis by GPs”.

“Psychological therapies, which can be offered alongside or as an alternative to medication, provide choice in treatment. We are closely looking at how we can improve access”, said Griffiths.

A survey in March for the mental health charity Mind, which asked people if they had sought help for work-related stress since the downturn began, found 7% had begun medical treatment for depression and 5% had started counselling.

A spokeswoman for Mind, Alison Cobb, said the fact antidepressants are now licensed for use in a wider range of conditions, such as social anxiety and post traumatic stress, was also a factor. Pregnancy-related diabetes: reducing the risk of complications

Pregnancy-related diabetes: reducing the risk of complications

If you’re pregnant, it can be worrying to find out you have developed diabetes. But new research has found that treating even the mildest form of pregnancy-related diabetes can reduce the risk of a caesarean delivery and other birth complications.

What do we know already?
If you develop diabetes during pregnancy, this is called gestational diabetes. It means that you have high levels of sugar (glucose) in your blood. As a result, your baby gets extra glucose as well. This may mean your baby is larger than average at birth, which can increase the risk of a caesarean section and other problems, such as injury to your baby’s shoulders during delivery. Women with gestational diabetes are also more likely to develop high blood pressure while pregnant, as well as a related condition called pre-eclampsia, which can lead to seizures and, in rare cases, death. Gestational diabetes has also been linked to infant deaths on occasion, as well as a higher risk of diabetes later in life for both mother and baby.

As a result, pregnant women in the UK are routinely tested for gestational diabetes if they have certain risk factors, such as being overweight or having a relative with diabetes. For women diagnosed with the condition, treatment usually involves changing their diet and exercising. If this doesn’t bring their blood sugar level back to normal, doctors then prescribe medicines such as insulin.

However, there haven’t been many studies looking at women who have only mild gestational diabetes and whether treatment is helpful if a woman’s blood sugar level is only slightly raised. Now, researchers have done one of the first large, good-quality studies to explore this question.

What does the new study say?
The study included 958 women with mildly raised blood sugar levels who were between 24 and 31 weeks of pregnancy. Roughly half received nutritional counselling and diet advice, and they monitored their own blood sugar daily. If their blood sugar stayed high, they were treated with insulin. The other women received usual pregnancy care from their doctor.

The study found that women with mild gestational diabetes were less likely to have a caesarean delivery and other pregnancy- and birth-related problems if they had treatment. They were less likely to have unusually large or heavy babies, and their babies were less likely to have shoulder damage at birth.

Women who had treatment also gained less weight during pregnancy and had fewer preterm births. They were also less likely to have blood pressure problems, with only 8.6 percent developing high blood pressure or pre-eclampsia, compared with 13.6 percent in the usual care group.

How reliable are the findings?
The findings should be fairly reliable, as the study was large and carefully done. This type of study is called a randomised controlled trial, which is the best type of study for finding out the effects of a treatment.

Where does the study come from?
The study was done at 14 medical centres around the USA and was funded by grants from the US government and research foundations. It was published in the New England Journal of Medicine, which is owned by the Massachusetts Medical Society.

What does this mean for me?
If you are pregnant and develop mild gestational diabetes, this study shows that treatment can help both you and your baby. There’s a good chance you’ll be able to lower your blood sugar level by making changes to your diet, without needing medicine.

What should I do now?
If you’re pregnant, you should have regular check-ups that may include a test for gestational diabetes. Your doctor is likely to recommend the test if:

  • You’re overweight
  • You have a parent, brother, or sister with diabetes
  • You belong to a high-risk ethnic group (South Asian, black Caribbean, or Middle Eastern)
  • You have had gestational diabetes before
  • You have had a large baby weighing more than 4.5 kilograms (about 9 pounds, 9 ounces).

If you do test positive for gestational diabetes, make sure you follow your doctor or midwife’s treatment recommendations, even if your blood sugar level is only slightly raised.

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