An NHS target to reduce the prescribing of anti-depressants in Scotland was set in 2006-07 ("Number of Scots prescribed anti-depressants at new high", The Herald, September 28).
This was a proxy measure for good quality depression care, but it quickly became evident that the relationship between prescribing rates and other effective interventions for depression, including psychological therapies, was not a simple one.
This is the reason The Royal College of Psychiatrists in Scotland supported the replacement of the prescribing target with the Psychological Therapies waiting times target in April 2010.
The findings from 2007 onwards include:
l Better use of clinical guidelines will lead to an increase in anti-depressant use, because it reduces the numbers of people prescribed inadequate doses for inadequate lengths of time.
l Improved identification will lead to more people being identified as needing treatment and for many of these, anti-depressants (with or without psychological therapies) will be the best approach.
l Experience in England, where there has been considerable investment through the Improving Access to Psychological Therapies Programme, is that there has been an increase in anti-depressant prescribing alongside rapid access to therapies. In clinical practice, the combined use of anti-depressants and psychological therapies is common and this practice is supported by National Institute for Health and Clinical Excellence. These interventions are best seen as complementary, not as alternatives.
Individual clinical decisions are complex and are influenced by a range of factors, including evidence- based guidelines, clinical comorbidity and patient choice, as well as the availability of other approaches to care and treatment.
Our members strongly support improving access to psychological therapies and are actively involved in improving the quality of mental health care through our day to day clinical work and research.
We look forward to contributing to a process of continued research and service development.
Our learning over the past four years is that better access to psychological therapies should not be expected to lead to a reduction in the number of people prescribed anti-depressants or a reduction in the overall use of these effective medications.
Dr Peter Rice,
Chairman,
Royal College of Psychiatrists in Scotland,
12 Queen Street,
Edinburgh.
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