Scotland in the grip of depression

THE number of Scots prescribed pills to combat depression has soared to record levels, with more than one in ten people now regularly taking antidepressant drugs.
The number of prescriptions for antidepressants handed out by medical professionals in Scotland rocketed last year to 4.66 million – up 7.6 per cent from 4.3m in the previous 12 months.
Meanwhile, a report published today demonstrates a persistent east-west divide in the risk of dying of coronary heart disease in Scotland. The Scottish Health Survey (SHS) has painted a picture of a nation of overweight people who avoid fruit and vegetables and take too little exercise.
A report by Heart UK showed the Ayrshire and Arran, Lanarkshire and Greater Glasgow health board areas had the highest coronary heart disease mortality rates in the country, while Fife, Lothian and Tayside have far lower rates.
The SHS revealed only 39 per cent of adults were getting their recommended daily amount of physical activity and that only 22 per cent met the recommended daily intake of fruit and vegetables. 
The report into antidepressant use, released by the Scottish Government, showed 11.3 per cent of all Scots aged 15 and over take drugs such as Prozac or Cipramil on a daily basis. However, the cost of prescribing the drugs dropped by £1.6m compared with the previous year, to £30.6m. 
Figures released by the NHS Prescription Services earlier this year showed there were 0.76 prescriptions of anti- depressants per head of population in England and Wales, while in Scotland, the figure was 0.88, despite SNP targets to cut their use. 
Critics have called for therapies such as counselling or cognitive behavioural therapy to be tried before GPs resort to drugs – but medical experts claim a combination of “talking” therapies and pills can be more effective than therapies alone. However, there are often long waiting lists for talking therapies on the NHS.
Dr Alex Yellowlees, medical director at the Priory Hospital in Glasgow, said: “Are GPs overprescribing antidepressants? And are they prescribing them for conditions that may not require antidepressants and not be responsive to them? Or are they prescribing them because it is quick and easy?
“GPs have very limited appointment times and for them to assess somebody properly and make a diagnosis of whether this is a clinical depression which may respond to medication is remarkably difficult.”
Carolyn Roberts, head of policy and campaigns at the Scottish Association for Mental Health, said it was a “positive sign” that people were increasingly comfortable talking to GPs about mental health.
However, she added: “Once people have taken that step, we must ensure they receive the right treatment at the right time.
Official prescribing guidance says people with mild to moderate depression should be offered talking therapies before being prescribed antidepressants. 
“Many people would also benefit from other options, such as exercise referral schemes that encourage physical fitness. Antidepressants help many people, but they are most effective in people with persistent or severe depression.”
Stuart Valentine, chief executive of counselling service Relationships Scotland, said cases of “mild” depression linked to events in an individual’s life, such as a failed relationship – rather than an underlying mental illness – could often be treated successfully with talking therapies.
“In our area of expertise, which is helping people when they are having problems in their relationship, they often find it is beneficial to explore underlying issues through counselling, which may contribute to their being depressed,” he said.
Sheila Peaston, course co-ordinator at Pink Ladies 1st, which runs courses for women in the Lothians suffering from depression, said in many cases, conditions could be treated without the use of drugs.
“I think GPs are very much under pressure because they only have a short time to spend with their patients and cannot get a full history,” she said. “In many cases, going for a walk or to the gym can be beneficial for people with mild depression.”
In its 2007 manifesto, the SNP government set a target of cutting the number of drugs used to treat depression by 10 per cent, but the figure has still risen for three consecutive years. The target was scrapped in March 2010 and replaced with an “access to psychological therapies” target.
The Scottish Government yesterday claimed the increase could be linked to the same number of people staying on an antidepressant for longer, or the same number of people receiving a higher dose of a medication – and added that research had shown that in 98 per cent of cases, people on a prescriptions were receiving medication appropriately.
“The prescribing of drugs is a clinical decision taken by doctors in discussion with their patients,” said a spokeswoman. 
“Many of these medications enable people with mental health conditions to continue to live their day-to-day lives in the community, when this might not otherwise be the case.”
It is thought the number of people registered by GPs with a diagnosis of depression is increasing, although it is believed this is due to better recognition of depression rather than increasing numbers of people with depression.
“There are alternatives to antidepressants and I think GPs and mental health services often make good use of them,” said Nigel Henderson, chief executive of Edinburgh-based mental health charity Penumbra.
“It is believed that the number of people using these drugs will increase as more people come forward to be treated with mental health problems.” 
The percentage of the population using antidepressants varied across Scotland – from 8.3 per cent in Shetland to 12.9 per cent in Greater Glasgow and Clyde.
Five health boards – Glasgow, Lanarkshire, Ayrshire and Arran, Forth Valley and Tayside – had rates of use above the Scottish average.
While Prozac remains a common drug, Cipramil has taken over as the most commonly prescribed antidepressant medication north of the Border.
Dr Dean Marshall, chairman of the British Medical Association’s Scottish general practitioners committee, said there was medical evidence that a combination of drugs and talking therapies was most effective.
But politicians called for a crackdown on the prescription of the drugs. 
“The fact the number of Scots on antidepressants is the highest since records began is extremely troubling,” said Scottish Labour’s public health spokesman Dr Richard Simpson. “I know from my experience as a doctor that mental illness can be devastating for those who experience it. However, for all but the most serious cases, the daily use of drugs should be a last resort.”
Lib Dem health spokeswoman Alison McInnes said: “We need to be confident that doctors have the time to explore alternatives to antidepressants before reaching for the prescription pad.”