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One Illness, 74 Tablets: And all they need is six...
How the NHS could be wasting 14 million a year:
Britain's doctors are accused of wasting millions
of pounds on anti-depressant drugs

Sunday Mirror
March 1, 1998
by Sharon Collins

Britain's doctors have been accused of wasting millions of pounds on anti-depressant drugs. As many as 74 different pills are being prescribed to treat depression and its symptoms. But some experts say that only six types are necessary. They claim that around 14 million a year could be saved if prescriptions of the most expensive anti-depressant, which costs 95p per tablet, were replaced by the cheapest, which costs just 0.006p.

'Not everyone with depression needs a pill to treat it,' says Dr Ian Rodin, a lecturer in psychiatry at Southampton University. 'Doctors need to be familiar with around only half a dozen or so different types.'

And consultant psychiatrist Nick Kosky says: 'Ninety per cent of the time I prescribe the same six anti-depressants to my patients.'

But with one in 20 of the public, and one in ten women, complaining to their doctor of depression, it is not only Britain's most common psychiatric disorder, but also a golden opportunity for pharmaceutical firms. Around 15 million anti-depressant pills were dispensed in England alone in 1996, the last year for which official figures are available, at a cost of 191 million.

Mr Kosky, commenting on the high number of anti-depressants on the market, said: 'Neither doctors nor patients need this many drugs to treat depression.'

'There is a vast difference in the cost of some of them to the NHS. There is probably a case for about half the number that there is on the market. Some of the newer, more expensive drugs are probably no more efficient than some of the older types but their side effects are better tolerated by patients.'

'We know that some GPs are using drugs like sedatives and tranquillisers to treat depression but they are not what most psychiatrists regard as effective anti-depressants,' added Mr Kosky, who is based in Dorset. Experts fear that the NHS, and ultimately the taxpayer, may not be getting value for money for the vast numbers of anti-depressants being prescribed. Dr Joe Collier, editor of the Drug and Therapeutics Bulletin, said: 'What is the point of using expensive medicines when cheaper ones that are just as effective will do? There is certainly a case with anti-depressants for reducing the numbers of drugs available. We have to keep an eye on the cost of drugs to the NHS otherwise, in the end, the patient loses out. In general, there is an over-provision of medicines and we could do with fewer of them. Then we would be better able to understand them and their side effects and use them properly.'

He added: 'Hospitals and the Department of Health are keen to reduce the numbers of useful drugs.'

A cut-back on the number of drugs prescribed would be a blow for the pharmaceutical firms who can spend between 10 and 12 years and 300 million putting a new drug on the market. Depression is thought to be caused by a reduction in the level of certain chemicals in the brain called neuro-transmitters that affect moods by stimulating brain cells. Anti-depressants increase the level of these chemical messengers.

There are four types of anti-depressants: Tricyclics, such as Tryptizol (the cheapest, as you'll see from our guide on the right) and Anafranil; Mono amine oxidase inhibitors (MAOIs), such as Nardil and Parnate; Selective Serotonin Reuptake Inhibitors (SSRIs) such as Prozac and Lustral (the most expensive); and Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs), such as Efexor. Tricyclics, often given to people with sleeping difficulties, are also used for the relief of pain and anxiety.

They should be avoided by sufferers of epilepsy, diabetes, glaucoma, heart complaints, liver or kidney problems and prostrate trouble. MAOIs are not widely used because they have a reaction with certain foods, including cheese.

Some experts urge sufferers of depression to try drugs-free ways to ease their problem. Depression linked to bereavement and redundancy may respond to counselling and psychotherapy. Supporters of alternative therapies say that yoga, meditation, aromatherapy and massage can be effective.

Dependence on smoking, illicit drugs and alcohol are damaging. Despite giving a temporary lift, alcohol can worsen depression. Regular exercise reduces stress, and changes to a hectic lifestyle can also have beneficial results.

And for those who can afford it, a good holiday in the sun can work wonders. For more information, contact the Depression Alliance answerphone on 0171 633 9929. It has produced a booklet. Myths and Misunderstandings About Depression, which can be obtained by sending 50p in stamps to its office at 35 Westminster Bridge Road, London, SE1 7JB. What they are, what they cost:

  1. Asendis 100 tablets, 25mg, 10.89.

  2. Lexotan 60 tablets, 1.5mg, 5.47.

  3. Molipaxin 84 capsules, 50mg, 17.31

  4. Surmontil 28 tablets, 10mg, 4.02.

  5. Zispin 28 tablets, 24.

  6. Oxazepam 100 tablets, 10 mg, 1.16.

  7. Atarax 84 tablets, 10mg, 1.52.

  8. Stelazine 100 tablets, 1mg, 2.80.

  9. Triptafen 100 tablets, 20.24.

  10. Nitrazepam 20 tablets, 5mg, 14p.

  11. Amytal 500 tablets, 50mg, 45.90.

  12. Mogadon 30 tablets, 5-10mg, 1.87.

  13. Lustral 28 tablets, 50mg, 26.51.

  14. Propanix LA 28 capsules, 160mg, 4.98.

  15. Seroxat 30 tablets, 20mg, 20.77.

  16. Motipress 28 tablets, 30mg, 2.83.

  17. Lormetazepam 20 tablets, 500 micrograms, 53p.

  18. Nardil 100 tablets, 15 mg, 6.65.

  19. Tofranil 84 tablets, 10 mg, 1.60.

  20. Soneryl 56 tablets, 100mg, 10.65.

  21. Isocarboxazid 50 tablets, 10 mg, 9.20.

  22. Triptafen M 100 tablets, 18.

  23. Allegron 100 tablets, 10mg, 11.93.

  24. Lorazepam 20 tablets, 1mg, 25p.

  25. Nytol 20 tablets, 25mg, 1.39.

  26. Vivalan 100 tablets, 50mg, 6.17.

  27. Sominex 8 tablets for 20mg, 1.53.

  28. Stilnoct 28 tablets, 5mg, 3.36.

  29. Frisium 30 tablets, 9.98.

  30. Temazepam 20 tablets, 10mg, 66p.

  31. Edronax 60 tablets, 4mg, 19.80.

  32. Prozac 30 capsules, 20mg, 20.77.

  33. Inderal 100 tablets, 10mg, 89p.

  34. Heminevrin 60 capsules, 192mg, 4.34.

  35. Buspar 100 tablets, 5mg, 31.20.

  36. Imipramine 20 tablets, 10mg, 19p.

  37. Amitriptyline 20 tablets, 10mg, 14p.

  38. Librium 100 capsules, 5mg, 1.41.

  39. Dothiepin 20 tablets, 25mg, 78p.

  40. Diazepam 20 tablets, 2mg, 6p.

  41. Camcolit 100 tablets, 250mg, 2.89.

  42. Trasicor 56 tablets, 20mg, 1.29.

  43. Litarex 100 tablets, 564mg, 3.60.

  44. Priadel 100 tablets, 200mg, 2.50.

  45. Tuinal 100 capsules, 100mg, 19.40.

  46. Valium 100 tablets, 2mg, 1.88.

  47. Parnate 28 tablets, 10mg, 1.27.

  48. Fluanxol 60 tablets, 0.5mg, 2.95.

  49. Parstelin 28 tablets, 10mg, 1.30.

  50. Tranxene 20 capsules, 7.5mg, 2.66.

  51. Ludiomil 28 tablets, 10mg, 98p.

  52. Welldorm 30 tablets, 2.54.

  53. Prothiaden 100 capsules, 25mg, 5.53.

  54. Xanax 60 tablets, 250 micrograms, 2.75.

  55. Sodium Amytal 100 capsules, 60mg, 17.16.

  56. Liskonum 60 tablets, 450mg, 2.82.

  57. Cipramil 28 tablets, 10 mg, 12.77.

  58. Loprazolam 28 tablets, 1mg, 4.46.

  59. Tryptizol 30 tablets, 10mg, 20p.

  60. Manerix 30 tablets, 150 mg, 10.50.

  61. Lentizol 56 capsules, 25mg, 2.58.

  62. Dutonin 56 tablets, 100mg, 16.80.

  63. Concordin 30 tablets, 5mg, 66p.

  64. Efexor 56 tablets, 37.5mg, 23.97.

  65. Faverin 60 tablets, 50mg, 19.00.

  66. Rohypnol 30 tablets, 1mg, 4.41.

  67. Motival 100 tablets, 10mg, 3.50.

  68. Sinequan 56 capsules, 10mg, 1.21.

  69. Anafranil 84 capsules, 10mg, 3.23.

  70. Lofepramine 56 tablets, 70mg, 9.60.

  71. Dalmane 30 capsules, 15mg, 2.92.

  72. Gamanil 56 tablets, 70mg, 9.84.

  73. Ativan 100 tablets, 1mg, 2.63.

  74. Seconal 100 capsules, 50mg, 26.49.


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