NHS - Too little, too late?

A link was sent to me from one of my readers that points to the NHS page on depression.

Ruth, who often sends me various links, added, 'Oh how times have changed' to the body of the email. She's right.

The NHS now point to N.I.C.E. guidelines regarding SSRi treatment. Some interesting points are:

Patients should have access to accessible information about treatments and self-help and support groups.

Mild depression: further assessment, usually within two weeks. The patient may recover without intervention. Antidepressants are not recommended for the initial treatment of mild depression. Guided self help, such as computerised cognitive behavioural therap, should be considered.

Mild and moderate depression: psychological treatments (such as CBT or counselling) should be considered.

Antidepressants: selective serotonin reuptake inhibitors (SSRIs) should be considered over tricyclic antidepressants because of better safety and fewer side effects. All patients should be informed that withdrawal symptoms may occur when stopping, missing doses, or reducing the dose.

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It's good to see that N.I.C.E. are recognising the SSRi withdrawal problem and it's good to see that the NHS are now highlighting it on their page. It's also refreshing to see the MHRA are now taking this matter seriously - a meeting they have with David Healy later this month should prove very interesting.

Personally, I'd like humungous changes to the packaging. The Americans have black box warnings, so why can't we?

Maybe the Patient Information Leaflet [PIL] should start with:

"Your doctor has prescribed you this medication because you have depression. Your depression has been deemed to be worse than mild to moderate by your doctor. If you need to ask your doctor why he feels your depression is worse than mild to moderate then we suggest you go back to see him/her and ask him/her how they arrived at their diagnosis."

They may even wish to add:

"By taking this medication you could possibly make your depression worse. We don't know how this medication works, we just go on theories and not facts. If at any time you feel suicidal or have homicidal thoughts then please go back to your doctor. He/she will then have to play a guessing game of whether or not your dosage needs to be increased or if it is the actual medication that is making you have these thoughts. At no point will we intervene or show you or your doctor any negative trial results from your medication. We don't have to because we are covered by the EU Law so na na na na na."

Maybe some sort of literature for parents too?

"Your son, daughter has been prescribed this medication 'off label' by their doctor. This basically covers our ass as the medication is not meant for minors. The onus is on your doctor and any lawsuits you may bring against us in the future will be defended by our highly paid law team, using the 'off label' decision by your doctor as our defence. If your son/daughter takes their own life our law team will either blame the illness or state catagorically that our medication is not approved for children - thus putting the onus on the person who prescribed our drug to your child."

Finally, the PIL could carry the disclaimer:

"This medication has been granted a licence by the MHRA, they think it is suitable after shifting through all the evidence that proves efficacy. We never provided the MHRA will all the data, in particular the data that showed that this medication is about as effective as a placebo [dummy pill] - Again, we are doing nothing illegal, we are protected by EU Law."


It would certainly make a change from the current literature on patient information leaflets wouldn't it? You know, the bog-standard:

"This medication may cause dizziness, nausea, headaches."

Yeh right.

Now who was it that once said, "Education, education, education?"

Fid

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