They are among the most prescribed drugs on the NHS and have spawned a multi-billion-pound worldwide industry. However, a study of clinical trials published today concludes some anti-depressants are no better than placebos.
They are among the most prescribed drugs on the NHS and have spawned a multi- billion-pound worldwide industry.
However, a study of clinical trials published today concludes some anti-depressants are no better than placebos.
It is expected to put the desire for alternative ways to deal with depression firmly back on the agenda.
Anti-depressants have been under the microscope since Prozac appeared on the market more than 20 years ago.
The newest, which are provoking medical debate, are Cymbalta and Efexor.
Cymbalta, which has only just started to be prescribed in the UK, was developed by the drug company Eli Lilly after its patent on Prozac ran out in 2001. It is expected to turn over £1.5bn next year.
Having been around for a decade, Efexor has been the focus of an online petition from people claiming they were never warned of significant side effects or risk of dependency. The drug has its supporters - many doctors who say it can be effectively controlled for the benefit of patients.
Some say the new report shows trials by drug companies with a financial interest should be subjected to more independent scrutiny.
More than 3.6 million scripts for anti-depressants are issued each year in Scotland alone - and the number continues to rise in spite of government attempts to turn patients and doctors off them.
Last year an estimated 30 million scripts were signed in the UK for the best-known of the drugs, Prozac.
Brokeback Mountain actor Heath Ledger did not die from cocaine and heroin, despite his previous skirmish with illegal drugs. The inquiry into the death of the 28-year-old Oscar-nominated actor concerns legally prescribed sedatives, painkillers and anti- anxiety drugs found in his Manhattan apartment. Some were prescribed in the UK.
When, in 2006, it emerged that Scottish doctors had been prescribing three times what they were handing out 13 years previously, the then Scottish Executive launched a campaign to offer alternative treatments in an attempt to limit, and eventually reverse, the trend.
According to official figures, in 1992-3, Scottish GPs issued 1.16 million prescriptions, costing £12.28m. By 2005, this had risen to 3.52 million prescriptions. Scotland was estimated to be spending 40% more per head of population on anti-depressants than the rest of the UK.
The executive's report, Delivering for Mental Health, included 14 commitments to improve services, including providing more access to psychological therapies, with £2.5m funding. It pledged to halt the rise in anti-depressant prescriptions by 2009-10.
But at the end of last year, figures showed 3.65m batches of pills were prescribed for depression in 2006 - a rise of 3.7% on the previous year. It is estimated almost 9% of Scots aged 15 and over take anti-depressants daily, which is nearly 370,000 people.
Alison Cobb, policy officer at Mind, the mental health charity, said the latest study provides a "serious challenge to the predominance of drugs in treating depression".
She said: "Anti-depressants do help many people but by no means all. Nine out of 10 GPs say they've been forced to dish out drugs because they don't have proper access to talking treatments' such as cognitive behavioural therapy.
"We're asking GPs to consider alternative therapies. Exercise, for example, particularly outdoors rather than in the gym, has been shown to be very effective."
Dr Tim Kendall, deputy director of the Royal College of Psychiatrists Research Unit, said it was important that drug companies were forced to publish all their data on trials.
While regulators would receive both unpublished and published data, this was not all publicly available. Dr Kendall said: "I think it's too dangerous to allow drug companies - where profit is a key factor - to withhold data which shows that a drug is ineffective or harmful."
