What is it about?
Middleton and Moncrieff1 made a good case for being cautious about prescribing antidepressants in primary care in a previous edition of BJGP. The discussion was, however, somewhat one sided. The responsible GP will be aware that there is always a suicide risk if a severely depressed patient is sent away without an antidepressant. Being on the waiting list for cognitive behavioural therapy will not necessarily prevent suicide and there is evidence for low levels of serotonin in postmortem studies on the brain of suicide victims. This, and recent evidence for a role for omega-3 in treatment of depression encouraged me to try this approach. There is growing evidence that a combination of an SRRI antidepressant and high dose omega-3 is synergistic which has been borne out by my experience of treating major depression.
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Why is it important?
If GPs stop prescribing antidepressants and more patients commit suicide as a result, this would be a very tragic outcome.
Perspectives
I saw a young woman who had been on a SRRI antidepressant for several years when she told me she was getting breakthrough symptoms of depression. I increased her SRRI dose and added in a OTC high dose omega-3 supplement. At follow-up two weeks later she said "I feel normal for the first time in three years."
Dr John Anthony Alvan Nichols
Royal Society of Medicine
Read the Original
This page is a summary of: Antidepressant prescribing, British Journal of General Practice, March 2011, Royal College of General Practitioners,
DOI: 10.3399/bjgp11x561276.
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