News Release, 29 March 2005
Amid growing concerns about side effects and over-prescribing of antidepressants, on 29 March the Mental Health Foundation will release Up and Running? a research report that marks the beginning of year-long campaign calling for all patients with mild or moderate depression to be offered exercise therapy.
Mounting evidence shows that a supervised programme of exercise on prescription can be as effective as antidepressants in treating mild or moderate depression. However, GPs are still turning to antidepressants as their firstline treatment due to what they believe is a lack of available alternatives.
The cost of antidepressant prescriptions in England has risen by more than 2,000 per cent over the last twelve years. And whilst clinical guidelines promote the use of exercise for the treatment of depression, Up and Running? shows that only five per cent of GPs use it as one of their three most common treatment responses. 92 per cent of GPs surveyed for the report use antidepressants as one of their three most common treatment responses.
Many of the GPs surveyed for the report do not believe exercise is an effective treatment, despite advice from the Chief Medical Officer as well as a substantial weight of evidence. This suggests an information and knowledge gap that the Foundation hopes to close with its Up and Running? campaign.
Clinical guidelines now say that antidepressants should not be used as a firstline treatment for mild depression, and that all but one of the newer antidepressants (Selective Serotonin Reuptake Inhibitors) should not be given to under-18s.
The most common alternative approaches - psychotherapy and counselling - are often in short supply, and patients are asked to join long waiting lists.
Findings from Up and Running reveal that 78 per cent of GPs have prescribed an antidepressant in the last three years despite believing that an alternative treatment might have been more appropriate. Two-thirds of the GPs polled have done so because a suitable alternative was not available, and 62 per cent because there was a waiting list for the suitable alternative.
The report asserts that research carried out into other ways of treating depression may well fail to reach GPs. Exercise referral schemes, for example, will not be able to match the marketing or staffing power of pharmaceutical companies when it comes to communicating and investing in relationships with GPs.
Dr Andrew McCulloch, Chief Executive of the Mental Health Foundation, said:
"Patients with mild or moderate depression asking their GPs for help are currently being denied an effective treatment option - exercise referral. There are some obstacles standing in the way of exercise on prescription for all... but they're not insurmountable. Society needs to be educated about the benefits of exercise in treating mild or moderate depression, and GPs need to be made aware that exercise referral is available."
Paul Bates, Head of Mental Health And Disability Services, at South Tyneside Primary Care Trust, said: "For GPs, the cost of changing their practice is psychological, not financial. They're beginning to see that there are alternatives to writing a prescription, and that it's not their sole responsibility to deal with a person's problem - there are alternatives, and exercise referral is an example of that."
The Foundation makes a number of recommendations in the report. First among these is a call for the Government to invest £20 million in developing and promoting exercise referral as a treatment for mild or moderate depression across the UK. This represents around five percent of the annual spend on antidepressants in England.
Ends
KEY FINDINGS
Antidepressants
- Seventy-one per cent of GPs believe antidepressants to be 'quite effective' but 57 per cent say they are over-prescribed.
- Fifty-five per cent of GPs prescribe antidepressants as their first treatment response for mild or moderate depression, although only 35 per cent believe antidepressant medication is the most effective intervention for these conditions.
- Forty-two per cent of GPs feel that most patients given antidepressants would be as likely to get better if they were unknowingly prescribed a placebo.
- Seventy-eight per cent of GPs have prescribed an antidepressant in the last three years despite believing that an alternative treatment might have been more appropriate. Sixty-six per cent have done so because a suitable alternative was not available, 62 per cent because there was a waiting list for the suitable alternative, and 33 per cent because the patient requested a prescription for an antidepressant.
- GP attitudes may be changing - recently qualified GPs are less likely than those who qualified ten years ago to turn to antidepressants as their first treatment response.
- 60 per cent of GPs would prescribe antidepressants less frequently if other treatment options were more available to them.
Exercise therapy
- ·Only five per cent of GPs use exercise as one of their three most common treatment responses, compared to 92 per cent of GPs who use antidepressants as one of their most common treatment responses.
- It is estimated that there are now 1,300 exercise referral schemes across the UK.
- Less than half of GPs (42 per cent) report having access to exercise referral schemes.
- Only 15 per cent of GPs who say they have access to exercise referral schemes use them very or fairly frequently for patients with mild or moderate depression.
- Less than half of GPs (41 per cent) believe exercise therapy to be a 'very effective' or 'quite effective' treatment for mild or moderate depression.
- There is considerable variation between exercise referral schemes including their size, capacity, levels of promotion to healthcare professionals, types of activity offered, costs to clients and levels of support offered.
What GPs would do if they became depressed
- Forty per cent of GPs would try counselling/psychotherapy first if they became depressed, 38 per cent would try antidepressants first, and 11 per cent would try a programme of exercise first.
- Forty-two per cent of GPs would try exercise as one of their top three strategies if they became depressed (despite only 5 per cent prescribing it to their patients as one of their top three responses).
Return to news releases 2005
For further information and interview requests contact please contact the press office on 020 7803 1105 / 1128 or email the press office
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