Sarah's Health Notes: Beyond Pills Campaign update

Some readers may know that I was the co-founder of the College of Medicine Beyond Pills Campaign, which launched formally in June 2022. It was a direct response to the Government’s National Overprescribing Review, which showed that, while some drugs do good, 10% of those dispensed in primary care were unnecessary, inappropriate or could do harm, including cause premature death.

It was a lightbulb moment for many health professionals. One leading GP told me: ‘We’d always known there was a problem but now we have government data and the Beyond Pills Campaign gives us a hook to hang our hats on’.

With impeccable timing, on the day the Campaign launched, the (about to retire) NHS Medical Director Sir Stephen Powis told an NHS conference that ‘pills should not be the first line of treatment’. (I saw him in Westminster recently and reminded him of that and said how useful it was, as the Campaign piggybacked on all his headlines. He seemed rather pleased.)

The Campaign leaders – senior politicians and doctors – had been impressed by the National Overprescribing Review and its 20 recommendations, which were all endorsed by the Department of Health & Social Care as well as NICE (National Institute for Health & Care Excellence, which rates clinical and cost effectiveness of drugs). But we were all worried that this vitally important Review would be rubber stamped by the DHSC and then end up gathering dust under a desk.

Today, far from gathering dust, the Review has stimulated a campaign that is going full steam ahead. In December 2023 we gained a lot of traction with policy makers in Westminster when we launched the Beyond Pills All-Party Parliamentary Group (APPG). You can see our Mission and Objectives here. Basically, it’s to help reduce overprescribing of pharmaceutical drugs by supporting non-drug alternatives so, rather than becoming dependent on pills, people can be helped to help themselves as much as possible through resources like social prescribing, which I’ve written about here and here.

Importantly, about half the work that social prescribers do is practical - with issues like money management, housing, legal and cultural problems. Minister of State for Care Stephen Kinnock explained this recently on BBC Newscast. ‘So often people in those difficult [life] situations – with social issues about debt, housing, employment status - come in to see their GP because they've … got real problems with mood, anxiety, depression. In many ways, the last thing they need is a diagnosis. The last thing they need is medication. They just need support, social prescribing, talking therapies.’

When we launched the Beyond Pills APPG, we made a specific call for a reduction in antidepressant prescribing for mild to moderate depression. One in five adults in England are prescribed antidepressants, mostly SSRIs (Selective Serotonin Reuptake Inhibitors), despite the evidence for effectiveness being very low while the side effects of taking them can be very distressing: some people say they’re worse than the original reasons they took the drugs. Scandalously, one in eight 12–17-year-olds have also been prescribed SSRIs.

Research shows that, together with sorting out practical problems, non-drug alternatives can be far more effective than drugs or CBT (cognitive behavioural therapy) and even give people long-lost glimmers of joy through exercise such as dancing (see my report here), gardening, joining a choir, or being in Nature. The Government-funded ‘Green Social Prescribing Programme to Tackle and Prevent Mental Ill Health’ showed that helping people to engage in nature-based activities can significantly improve their mental health. Importantly, more than half the participants were from the most deprived areas and 21 per cent were from ethnic minorities. Do click on this link to see an extraordinary video where Mehbooba, who suffers from depression and fibromyalgia and has two children diagnosed with autism, learn how to swim and how cold water – ‘wild’ – swimming changed her life.

But it’s not just the side effects when people are taking antidepressants that can profoundly affect their lives. It is also when people try to withdraw from the drugs. Many thousands of people in this country and millions worldwide testify to severe adverse reactions, particularly if they’ve been taking medication longer term (six months and over), as many people have. There is a list of possible symptoms of withdrawal on the MIND website here.

Recently, a new, self-professed ‘gold standard’ study hit the headlines claiming that, for the majority of patients, antidepressant withdrawal is largely mild, brief and overstated. This is plain wrong and the paper has drawn robust criticism worldwide with many leading experts pointing out the unreliable assumptions.

To explain: the study draws its findings from mostly short-term clinical trials (most lasting only eight to 12 weeks) with patients’ withdrawal experience followed up for one to two weeks. But at least half the 8.7 million adults in England prescribed these drugs have been taking them for longer than two years, many for much longer. Multiple studies clearly show that longer-term use (six months and more) correlates with greater incidence of a range of withdrawal effects.

By excluding most of the real-world data on antidepressant use, the paper delivers a dangerously distorted picture, which denies the experience of millions of sufferers, risks misattributing withdrawal symptoms to relapse of depression (so doctors may put patients back on the drugs that are causing the problem, sometimes at higher doses), and threatens the very limited support for people in withdrawal.

By offering ‘reassurance’ that withdrawal symptoms are negligible, this paper also risks harm to others in the future who may be prescribed antidepressants where non-drug support would be much more helpful, as I’ve explained above.

Many patients say that if they’d known about the risks, they might not have taken these drugs. Many people say they don’t like to question their doctor but medical experts agree that everyone must feel able – ‘empowered’ is the buzz word – to ask their doctors about any drugs they are offered, using the acronym BRAN: ask about the Benefits and Risks of medication, the Alternatives and what happens if Nothing is done.

One last thing, which is very important. Anyone who chooses to withdraw from an antidepressant should never go cold turkey. Careful monitoring and tapering is essential, especially if people have been taking the drugs for six months or more. The Maudsley Deprescribing Guidelines by Mark Horowitz and David Taylor (published by WILEY Blackwell) gives all the details.

Beyond Pills website here