PROBLEMS remain with rising prescriptions of antidepressants (“Campaigners in plea to address prescription pill ‘health scandal’” & Herald View, The Herald, December 4). My sympathies go to those who have suffered because of treatments.

Dr Des Spence is correct to raise awareness of issues associated with the level of prescribing of psychoactive drugs such as the “modern” antidepressants.

As he points out, GPs, despite working at speed, do need to observe the mantra – first appointment, diagnose, do not prescribe.

Reassessment after a short interval, having provided a listening ear and some information on the condition and non-drug options for treatment, can mean different shared decisions. Patients should expect no less.

Prozac (fluoxetine) was the first of the new breed of anti-depressants to be prescribed in quantity after its launch in 1986.

It remains the most widely used antidepressant in history, prescribed to millions of people worldwide, and many feel they owe their lives to it.

It is prescribed for depression, obsessive compulsive disorder, panic disorder, eating disorders and premenstrual dysphoric disorder (formerly known as PMT).

That does not mean that it and other commonly used similar drugs such as citalopram and sertraline do not have side effects nor withdrawal effects; they do.

Many previously used antidepressants were dangerous and often fatal when there was an overdose.

An opportunity was missed when, in the 1980s and 1990s, such prescriptions cost the NHS £22 per month (in today’s terms, £63).

Cognitive behaviour therapy (CBT) and similar approaches had by then been more or less established as an effective intervention for mild to moderate depression or anxiety disorders.

It would have cost a lot less then for a course of such treatment than a six-to-12 month course of the drugs.

But this was not explored as a cost-effective alternative, this despite the fact that mental health became a Scottish NHS priority alongside cardiovascular disease and cancer.

In more recent years, health psychologists (honours psychology graduates with a year’s CBT training) began working in NHS clinical psychology departments and deliver such talking therapy courses to individuals.

Health psychologists cost on average around £23 for an hour’s treatment.

Out of patent since 2001, in contrast, fluoxetine now costs the NHS just under £1 for a month’s prescription at standard dose.

Waiting times for psychology treatment tend still to run to several months with small reductions since targets were introduced.

Online treatment courses such as Beating the Blues do suit some and can be offered promptly in my own health board area to those who have computers and printers at home.

The drugs are cheap but other options are not. That said, private CBT is available from around £55 per session which, for many, is an affordable and successful treatment often requiring fewer than 10 sessions.

It is time for GPs and the NHS to do better.

Philip Gaskell, GP,

Woodlands Lodge,

Buchanan Castle Estate,