Politicians, experts, and patient representatives call on the Government to reverse the rate of antidepressant prescribing

Open letter signed by medical experts outlines a five-step process to achieving reversal

Leading medical professionals and politicians have today published an open letter in the British Medical Journal, calling on the Government for a commitment to reverse the rate of prescribing of antidepressants. The move follows the release of statistics that reveal:

• The number of antidepressant prescriptions has almost doubled in England over the last decade, with 85.6m prescriptions issued in 2022/23 
• One in five adults in England - over 8.6 million people aged 18 and over - are now prescribed antidepressants annually despite poor efficacy and the risk of adverse effects, including dependence
• The number of antidepressant prescriptions in England is expected to rise between 5-10% each year over the next decade
• Unnecessary prescribing of antidepressants costs NHS England up to £58 million annually  

The call for a reversal in prescribing will be made as part of the launch of the Beyond Pills All Party Parliamentary Group in Westminster today. The APPG is chaired by Danny Kruger MP and co-chaired by Lord Crisp, former CEO of the NHS. Its mission is to move UK healthcare beyond an over-reliance on pills through an integrated approach, combining social prescribing, lifestyle medicine and psychosocial interventions with safe deprescribing (gradually stopping medication) and a reduction in unnecessary and inappropriate prescriptions. 

This new body will combine the work of the APPG for Prescribed Drug Dependence and the College of Medicine Beyond Pills Campaign, which was launched after the Government’s National Overprescribing Review found that 10% of prescribed drugs are unnecessary, inappropriate and may cause harm.

This is true of a significant proportion of antidepressant prescribing, where multiple meta-analyses have shown antidepressants have no clinically meaningful benefit beyond placebo for all but the most severely depressed patients. In addition, antidepressants are now known to cause withdrawal symptoms in around half of patients who try to stop, and severe withdrawal symptoms in around a quarter.  

In today’s open letter, experts, patient representatives and members of the Beyond Pills APPG propose five key public health recommendations to address the issue:

1) Stopping the prescribing of antidepressants for new patients with mild conditions

2) Adhering to the 2022 NICE guidance on safe prescribing and withdrawal management, including properly informed consent and regular review of harms and benefits 

3) Funding and delivering local withdrawal services integrated with social prescribing, lifestyle medicine and psychosocial interventions

4) Including the reduction of antidepressant prescribing as an indicator in the NHS Quality and Outcomes Framework (QOF)

5) Funding and delivering a national 24-hour prescribed drug withdrawal helpline and website.

The signatories of today’s letter and the objectives of the Beyond Pills APPG can be found below.

Commenting on the launch of the Beyond Pills APPG, Lord Crisp has said:

“The high rate of prescribing of antidepressants over recent years is a clear example of over-medicalisation, where patients are often prescribed unnecessary and potentially harmful drugs instead of tackling the root causes of their suffering, such as loneliness, poverty or poor housing.  The Beyond Pills APPG is being launched to raise awareness of this public health issue. It will focus on promoting proven alternatives to pills such as social prescribing and psychological therapies, as well as local services to help people withdraw safely from these medicines. It will work alongside others to change the way we all think about health, and address these wider social determinants of poor health.”

Dr Bogdan Chiva Giurca, Clinical Lead for Social Prescribing at the National Academy for Social Prescribing and lead for the Global Social Prescribing Alliance, added:

“The Beyond Pills APPG represents a crucial turning point, signalling a clear need for a shift in values and beliefs among current and future healthcare professionals. This is a move from reactive sick care towards preventative and community-based care.

“Social prescribing is a practical tool that offers clinicians hope for the future. Link workers offer individuals the most valuable resource of today’s day and age: time – something we as clinicians can rarely offer. Time to listen and to dig deep in order to understand the root cause of the individual’s problem. Link workers are able to co-design and co-create a plan of action together with the individual and connect them to local community support.”

Dr Michael Dixon, GP, Chair College of Medicine, stated:

“As GPs we are facing a tsunami of mental health problems – especially depression – and these can often be helped by changes in lifestyle, diet and a range of interventions offered through social prescribing, without reaching for pills that can have all sorts of undesired effects. It is crucial that patients know about and are helped to try these alternatives so that pills become the last resort rather than the first. It is time to de-medicalise mental health and to liberate our patients to find non-drug solutions that work for them. Our most urgent priority now is to equip patients and medics with the means of achieving this.

“The Beyond Pills All Party Parliamentary Group heralds a sea change in public perception and medical practice from “a pill for every ill” to recognising that there is so much that we can do for ourselves which will not only help us to heal but also stop us getting ill in the first place.”

Dr Andrew Tresidder, Clinical Lead for Medicines Management in NHS Somerset, concluded: 

“As a longtime Somerset GP and current Clinical Lead for Medicines Management in NHS Somerset, I really welcome the Beyond Pills APPG.  While the de-stigmatisation of mental illness over the last 20 years is welcome, at the same time there has been a worrying growth in the medicalisation of normal distress. As prescribers, we aim to act wisely, and safely and use an evidence base in order to avoid the traps of overprescribing and potential dependence. There’s a rhyme that goes: ‘You’re well until you’re ill, then see the Doctor for a Pill’. In the real world, wise prescribing always looks at the whole picture of the person. The National Overprescribing Review shows us we have a problem and the Beyond Pills APPG encourages us to re-evaluate our therapeutic approaches in order to tackle this challenge.”