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Thursday, 3 November 2011

Most popular post Oct 2011 - Is Seroxat the Worst Drug in the SSRI, SNRI Class

Is Seroxat the Worst Drug in the SSRI, SNRI Class - Chronic Long Term and Intermittent Repeat Prescribing ?

original here -

The following research study "Explaining the rise in antidepressant prescribing: a descriptive study using the general practice research database" was led by Tony Kendrick, professor in Primary Medical Care at University of Southampton's School of Medicine and investigates the chronic long term and intermittent repeat prescribing which accounts for 90% of increases in SSRI, SNRI prescriptions.

The study centred on the UK Government, Prescriptions Cost Analysis (PCA) Statistics and the General Practice Research Database (GPRD) anonymous computerised records, the research team analysed all new cases of depression between 1993 and 2005 from 170 GP general practice surgeries and 1.7 million registered patients.

In the British Medical Journal (BMJ) published paper, scientists found the continual annual increases in GP issued antidepressant prescriptions was caused by a number of people taking the drugs on a long term basis.

The research scientists also found that despite a drop in new patient diagnoses of depression over eleven years antidepressant prescription numbers doubled, estimating more than 2 million people are now taking antidepressants long term or repeat intermittent course treatment to patients with multiple episodes of depression.

The researcher's state data from the Prescription Cost Analysis (PCA) statistics shows that antidepressant prescribing in England between 2000 and 2005 increased by 36% to 7.3 million items per quarter, during this period prescribing of selective serotonin reuptake inhibitors increased by 45% and accounted for half of all prescriptions.

The following is from the Science Daily review of the study published Oct. 23, 2009, "Increase In Long-Term Antidepressant Drug Use, UK Study Reveals"

"………. Researchers at the University of Southampton found 90 per cent of people diagnosed with depression are now taking SSRIs either continuously or as repeated courses over several years.

Professor Kendrick adds: "Our previous research found that although these drugs are said not to be addictive, many patients found it difficult to come off them, due to withdrawal symptoms including anxiety. Many wanted more help from their GP to come off the drugs. We don't know how many really need them and whether long-term use is harmful. This has similarities to the situation with Valium in the past." "

The following information, chart and conclusion are from the University of Southampton Study.

"To address our study questions and examine more closely trends occurring within the cohort, we divided patients into five pre-defined treatment pattern groups on the basis of treatment in the five years following first diagnosis (five year follow-up was possible only for those diagnosed between 1993 and 2001)."

"Table 1 + shows an overall increase in prescription duration from just under 2.9 million days in the patients studied between 1993 and 1997 to more than 4.3 million days in the those studied between 2001 and 2005. Chronic and intermittent prescribing together accounted for approximately 90% of the total prescriptions (for example, 270 005/288 249 in 1993). Although the number of prescription days increased over time for all treatment groups, small changes in the constitution of the chronic treatment and intermittent treatment groups were responsible for most of the increase in antidepressant prescribing over the duration of the study."

"Total prescription days for each of the five treatment pattern groups is summarised in figure 7 . The volume of prescriptions attributed to long term prescribing (that is, the proportion of prescriptions in the chronic and intermittent groups) contributed the majority of the change in overall prescribing volume.


".........There was also an increase in the average number of prescriptions per patient in the chronic treatment group: from 34 over five years to 36 over five years in the period studied which equates to approximately 60 days more treatment over the five year period in 2001-5 compared to 1993-7. Bearing in mind the increase in the proportion of patients in this group (from 8.4% to 10.2%), the increase in the duration of prescriptions in the chronic treatment group is responsible for a substantial increase in the overall prescribing volume. A similar pattern was seen in the other treatment groups, but with a smaller impact on overall volumes."


Antidepressant prescribing is much higher compared with 10 years ago. This increase is not because of an increase in the incidence of new cases of depression, a lower threshold for treatment, an increase in the proportion of new cases of depression for whom antidepressants are prescribed, or an increase in the duration of the prescriptions written for new cases of depression. Rather, the dramatic changes in antidepressant prescribing volumes between 1993 and 2005 seem to be largely because more patients are on long term medication and this group consumes the most drugs. In order to better understand the rise in antidepressant prescribing, research needs to focus on chronic prescribing and policy needs to focus on encouraging appropriate high quality monitoring and review of those patients who become established on long term prescriptions,"

Other than the issue of discontinuation problems, no other reason appears to have been found or proffered by the study researchers to explain the consistent and continual increase in Antidepressant, SSRI, SNRI drug class prescriptions. Although there will also be a percentage of patients content with the treatment they are receiving - whether encompassed by the chronic and intermittent treatment groups or not.

The study concluded in 2005, and found no anomaly –favourable or otherwise-- associated with the decline of Seroxat prescriptions. Since 2005 total annual SSRI, SNRI drug class prescriptions have increased from 18.88 to 26.94 million, an increase of 8.5 million or 43% before taking into account the negative Seroxat increase of 402.5 thousands of prescriptions for the same period. Seroxats' total prescription decline of 1.74 million during the period 2001 to 2005 does not appear to be reflected in the overall prescription increase trend or numbers in the chronic and intermittent treatment groups.

Impartially, the discontinuation phenomenon is known and acknowledged to affect the whole drug class - this does not reflect negatively or otherwise on anyone being treated with any SSRI, SNRI drug – including those who have had or are having problems withdrawing from Seroxat, those still being issued prescriptions for the drug and the percentage who will have swapped or been swapped from Seroxat to other brands of SSRI, SNRIs only to find they have similar and in the case of Efexor -- because of its shorter half life -- worse problems associated with discontinuation.

This research study does and should officially raise concerns over the recognised possibility of iatrogenic illness caused by short, intermittent and long term treatment with the SSRI, SNRI drug class. The suggestion for a policy focusing on high quality --more stringent-- monitoring and review of long term patients established on antidepressant prescriptions and reference to similarities to the past situation with Benzodiazepines does indicate how serious the SSRI, SNRI drug class problem is – so can Seroxat be considered worse than any other drug in that class?


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