help mild to moderate depression and should not just be used in bad
cases, researchers say.
Current guidelines urge doctors to avoid antidepressants as an initial
treatment in mild depression.
But an NHS-funded study of 200 patients from across England found the
drugs, called SSRIs, were more effective than GP advice and support
The team hope national
advisers will look at their findings, reported on the Health Technology
Study leader Professor Tony Kendrick, a GP and researcher at the
University of Southampton, said although the National Institute of
Health and Clinical Excellence wants doctors to restrict SSRIs to the
most severe cases, GPs frequently prescribe them for milder cases.
"Just because someone has mild depression does not mean it is a mild
illness, because it can cause them to be off work for months," he said.
"And often you don't have psychological treatments to offer because
they're not available so you end up prescribing quite frequently."
In the latest study, researchers looked at patients across 115 practices
who had depression for at least eight weeks and had not had any
counselling or drug treatment.
Half of them had usual care of four follow-up consultations with their
GP over 12 weeks to talk about how they were coping and half received
the same GP support plus antidepressants.
Those who had the drugs had better quality of life at the end of the
trial and for every seven patients treated, one showed significant
improvement by 12 weeks.
Professor Kendrick said although the benefits of the drugs were small,
the results showed prescribing them for mild to moderate depression was
helpful and "good value for money".
He said the findings would help GPs decide when to prescribe the drugs
by assessing how long they had had symptoms and by scoring them on a
"GPs are criticised a lot for missing depression, putting too many
people on antidepressants and not putting enough people on
antidepressants so they can't win," he added.
Professor Andrew Tylee, an expert in primary care mental health at
King's College London, who took part in the study, said the results
showed that that it was often worth prescribing SSRIs for people with
mild to moderate depression
"The team do hope that NICE will take this finding into account in their
current revision of their depression guideline."
But Dr Tim Kendall, joint director of the National Collaborating Centre
for Mental Health, threw doubt on whether the guidelines would alter.
"I think using drugs for mild to moderate depression doesn't make much
sense because you're risking a lot of side effects," he said.
"Self-help approaches improve people's self-reliance."
He said the evidence base suggested psychological therapies were best in
mild to moderate cases of depression and the latest research may have
picked up a placebo effect.
"Access to psychological therapies has improved hugely, in Sheffield
where I work GPs say there has been a noticeable difference."