GP antidepressant prescribing: caution in the face of uncertainty

Ten years ago concern was expressed about a lack of recognition and undertreatment of depression in primary care. More recently concern has been raised over GPs’ overprescription of antidepressants and the medicalisation of problems of living. The number of prescriptions issued is increasing each year – last year over 26 million prescriptions were issued in England, costing almost £400 million. 1. There is uncertainty about whether antidepressants are beneficial to patients with mild depression or anxiety. Most clinical trials have been carried out in secondary care and there is also concern about the possible serious side-effects (including suicidal behaviour) of some, and possibly all, antidepressants in a subgroup of patients. NICE recommends that antidepressants should no longer be used as first-line treatment for people with mild depression. 2. Concern about overprescribing of antidepressants has led to a need to understand how GPs make decisions about prescribing and what influences their decisions.