Do you live in a depression hot spot?

Judging by the amount of anti-depressants prescribed by his doctors, Sunderland must be the most depressing place in England.

In May this year, NHS Sunderland Clinical Commissioning Group (CCG) doctors prescribed 71,306 antidepressants to 286,855 patients on their books. That’s 248 points per 1,000 patients — the highest prescription in the entire country.

The overall average for the region: one practice – Bridge View Medical Group – dispensed 378 antidepressants per 1,000 patients, the highest rate in the region, which has the highest rates in the entire country.

And, as Good Health found, there’s a big postcode for anti-depressant prescriptions – in some areas of the UK (see table to find your area’s prescription rates in May), new data published last week show that when you have mild or moderate depression, some studies show no better than placebo, but more likely to receive drugs that may cause side effects.

Antidepressant use is on the rise in the UK – earlier this month it was revealed that prescriptions in England will rise by more than 5 per cent by May 2022.

Charlotte Brighton, 36, a nail technician, lives in Gosport, Hants, with her husband Gary, 36, and their children, aged ten and five. She says: When I was diagnosed with depression, I was told I had to take anti-depressants – there was no other option. “This is the best thing to do and the fastest,” my doctor said. Waiting times for counseling were months

And women are twice as likely as men to take medication, including antidepressants, for anxiety, the British Journal of General Practice reported.

Some of the increase in antidepressants is due to the impact of the pandemic on mental health. But it was the sixth consecutive annual increase: the number of prescriptions for antidepressants in England rose by a staggering 34 per cent in six years to more than 83 million a year in 2021/22.

But a study published last week raised questions about the use of antidepressants on such a large scale. The belief that depression is caused by an “imbalance” of the brain chemical serotonin is believed to be a myth.

Serotonin is a chemical messenger that transmits messages between nerve cells, and its deficiency has been implicated in depression.

Joanna Moncrief, professor of psychiatry at University College London, was the lead researcher on the project, which looked at the results of studies involving 300,000 patients.

“After many decades of research, we can safely say that there is no convincing evidence that depression is related to serotonin abnormalities,” he says.

This leaves the most commonly prescribed antidepressants for decades, namely selective serotonin reuptake inhibitors (SSRIs), or disrupts the foundation of anxiety, malaise, indigestion, and diarrhea or constipation.

Getting out of them can also be problematic. According to mental health charity Mind, it can cause sensory disturbances such as dizziness or lightheadedness, feelings of electric shock, movement or involuntary movements, strange dreams or smelling something that isn’t there.

Antidepressant use is on the rise in the UK - earlier this month it was revealed that prescriptions in England will rise by more than 5 per cent by May 2022.

Antidepressant use is on the rise in the UK – earlier this month it was revealed that prescriptions in England will rise by more than 5 per cent by May 2022.

A Public Health England review published in 2019 found that 20 per cent of people who stop taking antidepressants after just one month experience such “withdrawal episodes”.

At the same time, indicators suggest that women may be more exposed to the pill.

Professor Moncrief says: “One theory is that women internalize their problems, while men externalize them, ie. women suffer from depression; that is, they ‘blame’ themselves, men get angry and blame other people or things’.

Research published earlier this year in the British Journal of General Practice found that women were twice as likely as men to be diagnosed with stigmatized anxiety and to take antidepressants and to “seek mental health help”. with poor mental health’.

Professor Moncrief adds that women also often take on family responsibilities and “often lack the obvious social rewards associated with careers”.

But if this helps explain the gender difference, the picture is more complicated when it comes to why you’re more likely to end up with an SSRI if you live in Hampshire than if you live in Frimley, Surrey.

Take NHS Sunderland CCG, the highest prescribing area, with 286,855 patients (with 248 antidepressants per 1,000 in May).

By contrast, North West London, with a total of 2.7 million patients, has the lowest rate, just 53 cases per 1,000 patients.

Apparently people in London are less likely to suffer from depression – the North West London Task Force told Good Health that the capital has “the lowest prevalence of depression in the UK”.

But he added, “the expansion of mental health services, including the Improving Access to Psychological Therapy (IAPT) program, has a role to play here. [low antidepressant prescription rate]’.

The IAPT program, a nationwide initiative launched in 2008, was designed to provide counseling and talk therapy such as cognitive behavioral therapy (CBT) to patients with anxiety or depression.

The NHS says it has “transformed the treatment of anxiety disorders and depression in adults in England”, but it is only available to a fraction of the more than eight million adults in England who use antidepressants.

In 2019/20 there were 1.6 million requests for therapy, but the following year it was just 1.46 million.

Professor Martin Marshall, chair of the Royal College of Gynaecologists, told Good Health that “antidepressants are often an effective treatment to help patients manage mental health conditions”, but doctors “have access to appropriate, alternative therapies in the community”. Talk therapy and CBT – which many patients with mental health conditions find helpful – are not exactly the same across the country.

He said the uneven availability of talk therapy is “a possible factor in regional differences in antidepressant prescription rates.”

“We need to address this quickly so patients can get the treatment they need quickly,” he told Health.

But a lack of funding can leave doctors with the cheapest, easiest alternative to the drug.

But this contradicts what experts see as the root of depression. Heather Sequeira, a consultant psychologist and NHS specialist in CBT based in Milton Keynes, Buckinghamshire, explains: “It’s not what’s happening to us, but what we’ve become.”

Dr Mark Horowitz, clinical researcher in psychiatry at University College London and North East London NHS Foundation Trust and co-author of last week’s article.

“The link between depression and stressful life events like relationship breakdown, job loss and physical illness is incredibly strong,” she says.

A July 2021 analysis by the NHS Business Services Authority found a clear link between antidepressant use and withdrawal. He compared prescription statistics with multiple indices of deprivation (income, housing, crime and health) and found concrete evidence that antidepressants were prescribed in the poorest areas.

Professor Moncrief says: “Reception rates are strongly linked to social deprivation and are particularly high in areas where traditional industry has declined.” “It shows that we are addressing the effects of socio-economic change.”

Coping with the health implications of all this is the Bridge View GP practice in the Southwick area of ​​Sunderland, just a stone’s throw from one of the worst areas in Tyne and Wear.

Half of the antidepressants prescribed in Sunderland in May were SSRIs. A spokesman for the North East and North Cumbria Integrated Client System, which covers Sunderland, said good health outcomes were influenced by “a range of complex and social factors, including health inequalities”.

In a bid to wean patients off antidepressants, the Integrated Care Council has issued new ‘explanatory guidance’, a first in England, to support GP practices in ‘therapeutic conversations with patients about long-term treatment’.

This included a “low mood plan and depression status check” for every patient, leading to a 3.2 per cent reduction in the number of patients being prescribed antidepressants in Sunderland.

But the question remains: Are antidepressants really the answer for most others?

I really wish I had gotten advice sooner

Charlotte Brighton, 36, a nail technician, lives in Gosport, Hants, with her husband Gary, 36, and their children, aged ten and five. He says:

When I was diagnosed with depression, I was told I had to take anti-depressants—there was no other option.

“This is the best thing to do and the fastest,” my doctor said. Waiting times for counseling were months.

After nearly ten years of suffering, I felt I had no choice. But I spent 16 years on the pill.

It all came from being bullied at school, every day, for five years. My stomach started to hurt. I was diagnosed with irritable bowel syndrome (IBS) and given everything from relaxants to antispasmodics, but nothing worked. In retrospect, it caused all my problems.

After I got out of school, I went to my doctor—he tried every stomach remedy in the book. When I told him that I was restless and anxious, he said, “I think you have depression.”

So when I was 20, I was put on fluoxetine [Prozac], followed by citalopram. I started at 20mg a day and then went up to 40mg after over four years. Within a month of taking citalopram, I became less anxious and more interested in the world. But it left me numb and feeling; I was also tired and had little sex drive.

Still, I saw it as a necessary evil to escape depression. In 2019 I tried to find out about counseling but was told the waiting lists were even longer. Right after the pandemic, I had a bit of a hard time. I was hyperventilating and panicking. One day I fell on the floor crying.

I decided to seek personal counseling. Six sessions cost me £300, but I wanted to try talk therapy. I saw a psychotherapist who helped me open up.

There were many tears, but through counseling I learned that emotions are normal. These feelings are more than what I have felt for 16 years.

I feel very good now. I gradually weaned myself down to 10mg of the pill. I wish I had gotten advice sooner. It changed my life.

Interview by Julie Cook

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