Lack of therapies blamed for high antidepressant rates

A lack of psychological and social therapies for people with mental health difficulties is partly to blame for high prescribing rates for antidepressants. That’s according to doctors addressing the Oireachtas joint health committee on foot of recent media reports on overuse of prescription drugs.

Dr Mark Murphy, spokesperson for the Irish College of General Practitioners (IAGP), said the State spent €40m on antidepressants for GMS eligible patients in 2016 but just €10m on Counselling in Primary Care (CIPC). 

CIPC, a HSE service for people with mild to moderate mental health difficulties, has limited availability around the country.

“Prescribing rates of antidepressants reflect a lack of psychological therapies and a lack of social therapies and resources in society, including fragmented communities, isolation and austerity,” said Dr Murphy.

He said lifestyle changes and psychological/social therapies should be the first port of call in treating depression.

“But for a GMS patient, it can take six months to access psychological services.

“I had a 15-year-old patient who had to pay €1,200 to access cognitive behavioural therapy (CBT) privately. It would have been a lot cheaper to take antidepressants,” he said.

Committee member and pharmacist, Fine Gael TD Kate O’Connell, said she knew of a woman who spent €5,000 on CBT over six months because she did not want to go on antidepressants.

The committee, which gathered to discuss prescription pattern monitoring, heard all the evidence suggests GPs “prescribe extremely appropriately in the context of a severe capacity shortage in general practice and primary care”.

Professor Tom Fahey, RCSI Medical School, said he did not think Ireland “was that out of kilter with other countries” in terms of prescribing rates.

Dr Murphy said doctors were prescribing more now than 20 years ago, “but they are doing a better job of it”.

While the number of over-65s prescribed 10 drugs or more, (excessive polypharmacy) had jumped from 1.5% to 22% between 1997 and 2012, the odds of potentially inappropriate prescribing in 2012 (versus 1997) was 60% less, Dr Murphy said.

Professor Mary Horgan, president RCPI and consultant in infectious diseases, Cork University Hospital, said in terms of antibiotic prescribing, sometimes the courses “can be a bit too long”. “Shorter courses can cure a lot of the infections that we see”, she said.

Prof Fahey said a current challenge was that prescribing in many hospitals remains a paper-based activity.

“Handwritten prescriptions are prone to errors in terms of identifying the medicine, understanding its indication as well as making errors in dosage more likely.” This put patients more at risk of adverse drug events.

Prof Fahey presented anonymised handwritten prescription samples to the committee, one containing about 14 medicines with no indication of the patient’s conditions, and another in which the handwriting was illegible.

“The solution to all of these issues is to develop an eprescribing platform in Ireland with appropriate training and education for all health professionals involved in prescribing,” he said.


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