From Mr J. M. Donoghue, MRPharmS
SIR,—I feel I should comment on "Onlooker" (PJ, January 8, p42) and the article on understanding depression. Clearly "Onlooker" does not understand depression well, and one gets the impression that much of the article was based on a textbook of psychiatry from at least 25 years ago. The attitudes, knowledge and understanding conveyed by "Onlooker" are a poor reflection on pharmacists, bearing in mind the significant advances made in the past two decades in the development of pharmacy practice in psychiatry to a specialist level.
I was privileged to be invited to speak at the conference referred to by "Onlooker", which, incidentally, was organised by the World Health Organisation. One of the central concerns addressed by the conference was not, as "Onlooker" would have it, that there is a problem of over-prescribing of and dependency on antidepressants, but rather the reverse. The overwhelming evidence is of the massive under-treatment of depression: of failure to recognise depression and prescribe effective treatments; of patients not being prescribed adequate doses of antidepressants; of failure to take treatment for long enough.1 Physical dependence on antidepressants is so rare as to be virtually unknown, although public misconceptions, confusing antidepressants with benzodiazepines, are thought to contribute to an all too common reluctance to take antidepressants for long enough for the treatment to make an appreciable difference to the course of the illness.
The evidence is that many patients remain depressed, and their doctors (and pharmacists) do little to optimise antidepressant therapy despite the lack of response.2 "Onlooker" is right to say that we must change our attitudes to depression. Let us hope this article will, at the least, make some contribution to that change.
John Donoghue
Liverpool