As our use of antidepressants DOUBLES in a decade, experts say thousands are being given dangerous drugs they don't neeed

Clare Morgan was going through a rocky patch: her long-standing relationship had hit difficulties and she was struggling financially. But the self-described 'optimist' felt she was managing to cope.

Then the 35-year-old biologist started experiencing unusual symptoms. 'Out of the blue, I felt really agitated - I couldn't concentrate, I couldn't sleep, and I felt very shaky,' she recalls. 'I'd been under some stress. But my symptoms seemed too odd for that to be the whole explanation.'

After about six weeks she went to see her doctor, who diagnosed depression and anxiety. 'I asked him if he was sure, because there were other symptoms such as diarrhoea, weight-loss and vomiting. But he confirmed his diagnosis and prescribed an antidepressant.'

Increasing numbers of Britons are taking antidepressant drugs, with prescriptions doubling over the past ten years, according to a report this month

Unfortunately this only made her feel worse; she developed the shakes as well as suicidal thoughts. In an attempt to remedy this, her GP changed the medication three weeks later. But nothing changed.

And after mentioning her suicidal thoughts to her doctor, she was put under the supervision of a mental health team.

Six weeks later, Clare was put on yet another antidepressant, along with a tranquilliser and an anti-psychotic drug. She was now sleeping 14 hours a day; unable to work, she had to rely on her boyfriend for support.

'I was zombified, but still felt the anxiety and the terror, and that didn't seem right. However, my doctor simply increased my dose.'

After six miserable months, Clare's doctor admitted the drug treatment wasn't working and suggested electric shock treatment. 'I said "no way" and decided to come off the antidepressants,' she says. This proved 'fantastically hard - worse, actually, than being on them'.

'The only good part was a brilliant nurse, who took me seriously when I said I'd always felt that something physical had caused my symptoms and put me in touch with a sympathetic private doctor,' she says.

A year-and-a-half after her symptoms began, Clare was diagnosed with an overactive thyroid and a problem with her adrenal glands. 'That was why I had been so bizarrely agitated, had diarrhoea and had lost weight.'

Clare's story is extreme, but it is far from unique. Increasing numbers of Britons are taking antidepressant drugs, with prescriptions doubling over the past ten years, according to a report this month. In 2000, there were 20 million prescriptions - this rose to 39 million last year.

While this rise is partly being blamed on the recession, experts are concerned that misdiagnosis is a major factor. Indeed, a study published recently in The Lancet found that the average GP will wrongly diagnose 16 out of every 100 patients they see with depression and anxiety.

As Dr Alex Mitchell, consultant psychiatrist at Leicester General Hospital, explains: 'A busy GP sees about 100 patients a week. Out of those, 20 will be suffering from depression, but he will spot only ten of them and treat five, usually with drugs.'

Not only are the depressed missing out on treatment, 16 of those 100 patients will be told they are suffering from depression when they aren't.

One of the reasons this happens is because the official test GPs use to check if you're depressed involves two very basic questions: During the past month, have you been bothered by feeling down, depressed or hopeless?

During the past month, have you been bothered by having little interest or pleasure in doing things?

'Ideally, GPs shouldn't just rely on these two questions, although they are a NICE-approved way of diagnosing depression,' says Dr Mitchell.

'It's not really GPs' fault,' he adds. 'They haven't got enough time to give longer questionnaires. We did find that serious cases were less likely to be missed than milder ones.'

But Dr Mitchell's research shows that at least two patients a week will walk out from an average surgery with a prescription for a totally unnecessary and possibly damaging antidepressant. That adds up to hundreds of thousands of patients in the UK every year.

most commonly used drugs for depression are SSRIs, or selective serotonin reuptake inhibitors - they come with a range of nasty potential side-effects.

Those for Seroxat, for instance, include loss of appetite, severe mental/ mood changes, uncontrolled movements, irregular heartbeat and a raised risk of cataracts.

As well as side-effects from a drug you possibly shouldn't even be taking, coming off such drugs can be extremely difficult, as Clare Morgan found.

'The problem is that antidepressants have side-effects and can increase the risk of suicide when given to children or young adults,' says Professor Kirsch

'The doctors said there were no withdrawal problems, but when I tried to stop taking them, the panic and horror became so great I wanted to kill myself. I even searched for details on the internet about hanging myself. I didn't want to live like that.'

Then she came across a charity which specialised in withdrawal from prescription medication. The Liverpool-based Council for Information on Tranquillisers and Antidepressants is one of the few such centres in the UK.

'We are seeing an increasing amount of people who have a serious problem coming off SSRI antidepressants,' says Pam Armstrong, a nurse consultant and co-founder of the charity. 'Doctors are happy to put people on them, but they haven't a clue about getting them off.'

For the majority of people, misdiagnosis and withdrawal problems are not, however, an issue. For them, the real question is whether the drugs are actually effective. Many say antidepressants have really helped them.

But now, one dogged researcher has found the drugs are no better than a placebo - and that the drugs industry has tried to hide this.

Professor Irving Kirsch, a psychologist at Hull University, used the Freedom of Information Act in the U.S. to get access to all the data the pharmaceutical companies had submitted when their drugs were licensed.

As well as finding that the negative results were not published, when Professor Kirsch combined the results from the published and unpublished trials, all brands of SSRIs showed up as little better than a placebo.

Even worse, Kirsch says that both the drugs companies and the U.S. regulators knew this, but chose to keep it from doctors and their patients.

He quotes an internal Federal Drug Administration memo saying it was 'of no practical value to patient or physician' to reveal that SSRIs are no better than placebos.

But if people do get better on antidepressants, what's the problem? 'The problem is that antidepressants have side-effects and can increase the risk of suicide when given to children or young adults,' replies Professor Kirsch.

There are safer and more effective alternatives,' he says, referring to talking therapies.

In fact, officially these are precisely the sort of treatment Clare Morgan and many others should be getting, instead of 'harmful' drugs. Since 2004, NICE has recommended that patients with mild to moderate depression or anxiety should be offered a talking therapy.

The one with the best evidence is called cognitive behaviour therapy (CBT), which concentrates on changing the thoughts that go with negative feelings.

The benefits are clear: those getting this treatment are less likely to relapse than those on antidepressant medication. In one study, the relapse rate was 5 per cent on therapy, 40 per cent on the drugs.

Even patients who feel they have benefited from antidepressants often appreciate help from a therapist as well, as Louise Luxton, a 36-year-old make-up artist living in London, discovered.

She'd suffered from anxiety and was put on Prozac, ­but 'felt terrible'.

She says:­ 'Seroxat worked better for a while. ­But years later when things got really bad, ­Seroxat didn't help at all.'

What did help was medication in combination with a talking therapy.

'The therapist taught me techniques to use when the anxiety gets too bad and he found the right drug for me. I wish I'd been able to see him a lot earlier.'

She's now happily married and planning to have a baby.

But talking therapy is infamously hard to find. Nearly three-quarters of GPs say they hand out pills becasue therapy just isn't available, a recent study by the Mental Health Foundation found.

Indeed, Louise had to pay for treatment privately. 'If you don't have that sort of money, your prospects can be pretty grim,' she says.

Three years ago, the Government announced it was spending £173million on training an army of 3,600 extra therapists which could be rolled out across the country by 2011 to provide CBT to all those suffering from depression and anxiety.

Professor David Clark, who heads up the scheme, is optimistic about reaching this target: 'By 2011, we are due to have all the therapists in place and we will have provided treatments to an extra 900,000 patients over the three years,' he says.

So far, 115 out of 154 primary care trusts in England have agreed to set up a centre.

But as Good Health has discovered, the roll-out of the scheme nationally may be having the effect of actually reducing the number of therapists in some areas.

Mariam Kemple, of the mental health charity Mind, explains. 'We've been getting reports that when the money to set up one of the new centres comes through, the primary care trust cancels contracts with existing therapists, saying the centre will be providing treatment for depression and anxiety in future.'

Similar reports have come in from the British Association for Counselling and Psychotherapy.

'The whole point of the project to roll out new therapy centres was to make up for the serious shortage of talking treatments,' says Paul Farmer, chief executive of Mind. 'We would be extremely worried if some trusts are axing existing services and using the new one as a replacement.'

Professor Clark blames the way funding is going into the local trusts' general pot - 'some may have been deciding to save money on existing provision'.

Although the Government has just pledged to spend £70 million over the next year providing more therapists and centres, this is not going to be ring-fenced.

This provision matters, as Clare Morgan knows only too well.

'If I'd been able to see a therapist initially, everything might have been different. Someone might have spotted that my symptoms weren't necessarily depression,' she says.

Now taking steroids for her condition, she is training to become a science teacher.

'Lots of people say they benefit from antidepressants, but doctors need to be more responsive when patients say they are having a bad time with them. Increasing the dose is often not the answer.'

Visit backtolife.uk.com, mind.org.uk and bacp.co.uk for more information.

THE FIVE TYPES OF DEPRESSION

By top psychologist Dr Cecilia d'Felice

REACTIVE

SYMPTOMS: Inability to face the day and cope with routine situations. You feel tearful, overwhelmed, angry and lacking in any options to make things better. For example, you're convinced you'll never get another job and that your life is over.

CAUSES: Major life events such as divorce, death of a loved one, or losing your job.

CHANCES OF BECOMING LONG-TERM DEPRESSION: Feeling this way after a major event is normal and the unhappiness should start to dissipate after several weeks.

But a single trauma can also be the straw that breaks the camel's back if you have other things in your life that are causing agitation, such as stress at work. This can lead to long-term depression. If you've been down for several weeks with no improvement, seek help.

SOLUTION: Talking with friends, family or a counsellor is very important to give an outlet. Or see your GP about taking medication.

PHYSIOLOGICAL

SYMPTOMS: Fatigue, feeling weak, overwhelmed and exhausted even if you have had a good night's sleep.

CAUSES: Health issues such as thyroid problems or symptoms relating to the menopause and ageing.

CHANCES OF BECOMING LONG-TERM DEPRESSION: This is a situation where health changes can affect mood, and therefore mimic depression. an under or overactive thyroid can, for example, produce symptoms that are very similar to depression, such as low spirits and excess fatigue.

SOLUTION: To rule out an underlying health problem, see your gp, who can carry out blood tests to see if a cause can be identified. Look at other factors in your life. For example, it's natural to feel emotionally vulnerable after having a baby. If you still do a month after the birth, it could be depression.

STRESS-RELATED

SYMPTOMS: Feeling agitated, uptight and wound-up all the time, unable to focus or remember simple things. Finding even normal actions irritating. A constant feeling of being under pressure.

CAUSES: Taking on too much at work, moving house, caring for parents or children, relationship break-up.

CHANCES OF BECOMING LONG-TERM DEPRESSION: Stress is a normal part of life and there is research to suggest that limited amounts can be beneficial. However, cumulative stress can lead to long-term depression.

SOLUTION: If feelings persist for several weeks, or if you feel you can't cope with them sooner than that, go to see your GP. Acknowledging the problem is part of the issue and may help identify what is triggering your stress. It will also be a chance to examine ways to relax and take on more exercise to help you cope with stress.

EXISTENTIAL

SYMPTOMS: You are tearful, restless and perhaps sleeping badly. nothing seems to give you any pleasure. There is also a sense of feeling you aren't good at what you do.

CAUSES: Feeling rootless, directionless, empty or even trapped, as well as unsure of your place in the world. often triggered when between relationships or jobs.

CHANCES OF BECOMING LONG-TERM DEPRESSION: We all have phases when we feel negative and worthless, but if this goes on for more than two weeks, then such feelings can lead to chronic depression. Insomnia can worsen or you can suffer with hypersomnia - a desire to sleep all the time to avoid confronting reality.

SOLUTION: Counselling or psychotherapy will help you get to the root of your problem and feelings. If you lack motivation, or have low self-esteem, then CBT is helpful.

DYSTHYMIC

SYMPTOMS: Feeling burnt out, hopeless, as if nothing has any point. A feeling of being numb.

CAUSES: No particular trigger - many people say they feel born this way. They constantly feel negative and gloomy.

CHANCE OF BECOMING LONG-TERM DEPRESSION: People who feel this way say it has been going on since they were young, but it can get out of control. If you feel yourself having thoughts such as 'I'd be better off dead', seek help immediately.

SOLUTION: Cognitive behavioural therapy activates the mind to change thought processes and therefore patterns of behaviour. Sessions involve encouraging you to get out and do more for yourself and become more involved with other people. You will need a referral from your GP.

US manufacturing growth slows: ISM

The US manufacturing sector grew for the 11th consecutive month in June, but at a slower clip than expected, an industry survey said Thursday.

"The manufacturing sector continued to grow during June; however, the rate of growth... slowed when compared to May," said Norbert Or of the Institute of Supply Management (ISM).

The firm's manufacturing index, also known as the purchasing managers index, stood at 56.2 percent, down from 59.7 percent seen in May.

The reading -- which compiles managers' reports on everything from new orders to stock inventories -- was well below market expectations of 59 percent.

A reading above 50 percent indicates an expanding manufacturing sector.

The ISM's Or said the slowdown was to be expected after months of robust growth.

"The sector appears to be solidly entrenched in the recovery," he said.

"Comments from the respondents remain generally positive, but expectations have been that the second half of the year will not be as strong in terms of the rate of growth, and June appears to validate that forecast."

BP Oil Disaster Solution: 'Just Blow It Up'?

Is it time to blow up the gushing BP oil well? Much like the oil spill itself, it's an idea that keeps spreading despite efforts by the Obama administration to contain it. Most recently, former president Bill Clinton voiced his support for the "just blow it up" solution.

The tropical storm threatens oil cleanup efforts along the Gulf Coast.

It may become necessary to "send the Navy down deep to blow up the well and cover the leak with piles and piles and piles of rock and debris," Clinton said at a weekend forum hosted by several news organizations. "...Unless we're going to do that, we are dependent on the technical expertise of these people from BP."

Clinton's comments came weeks after government officials dismissed the explosive solution.

"I think we'd have to run out of a lot of things before we'd consider something like that," Coast Guard Adm. Thad Allen told "Good Morning America" earlier this month. He later said that even a non-nuclear explosion -- considered by some to be less controversial and less dangerous -- could also prove more hurtful than helpful.

Some who have floated the idea agree that it's risky, but ask whether explosives would be any worse than the status quo -- up to 60,000 barrels of oil are leaking into the Gulf of Mexico each day and BP's efforts to drill relief wells to plug the leak are more than a month away from completion.

"At what point do the real damages that pile up outweigh the potential risks of something like weapons use a couple of thousand feet below the sea floor?" said Michael E. Webber, the associate director of the Center for International Energy and Environmental Policy at the University of Texas at Austin. Webber was among the first to publicly raise the possibility of using explosives to seal the BP well; he says that he does not necessarily support the idea, but maintains that it's worth consideration.

Here's how he and others say the explosives proposal could work: Near the failed BP Macado oil well, another hole would have to be drilled some 3,000 feet down. Explosives would then be lowered into that hole. Detonating those explosives would create a cavity below the sea floor that would envelop a section of the neighboring BP well and plug it with rubble.

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Baltic Dry plunges

The Baltic Dry Index (BDI), a basket of shipping rates closely watched as a leading indicator of economic growth, has lost over 40 per cent since late May. While the BDI is infamously volatile, the parallel with 2008, when late May turned out to be the peak before a 95 per cent decline that presaged the September banking crisis, is unsettling. Should investors be worried?

The BDI tracks spot freight rates for dry bulk cargos such as iron ore and coal. It recovered sharply last year because China's post-crisis efforts to pump-prime its economy required a huge inflow of raw materials. But now that the economic needle in China has swung towards inflation, the government wants to slow production. Demand for the so-called 'capesize' vessels that transport iron ore has slackened in particular. Heavy manufacturing is under pressure in China because the authorities have a long-term objective of rebalancing the economy towards greener, more local sectors.

But the spot rates behind the BDI are also driven by the supply of ships. The mining boom of 2008 sparked a flurry of vessel orders that turned sour when demand collapsed. Yet the Asian recovery meant there were fewer cancellations than expected, so this year the industry faces a whopping 17 per cent expansion in dry bulk tonnage, estimates Henriette van Niekerk at the ship broker Clarksons. If that's not matched by demand, basic economics suggests rates should plunge.

This is a problem for ship owners like such as Goldenport. The company's exposure to volatile spot rates is limited because its ships are contracted out many months in advance, but contract rates will follow longer-term trends in the spot price. That said, ship owners also make money by buying and selling ships, and with ship values low but rising Goldenport has announced a £24m placing in late June to fund vessel purchases. Clarksons and its rival Braemar have also both reported strong performances, having brokered purchases by cash-rich shipping magnates sniffing out bargains.

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IC VIEW:

China's hunger for iron ore and coal may be abating, but growth is still strong and rebalancing the economy will take years. It's more likely that excess supply of ships is behind the latest plunge in the BDI. That's bad news for parts of the shipping industry, but less so for the economy as a whole. No one yet expects wholesale demand erosion on the scale of 2008.

UK export slowdown sparks concerns

• Exports show weakest increase since August 2009
• Analysts fear European debt crisis may affect trade

UK manufacturing growth has slowed after reaching a 15-year high last month, with export orders the hardest hit. Photograph: Lewis Whyld/PA

A sharp slowdown in British export orders last month has sparked concerns that the recovery in manufacturing could soon run out of steam. The fall suggests that a stronger pound, coupled with the European debt crisis and signs of a slowdown in China and the rest of Asia, are starting to damage British sales overseas.

The Markit/CIPS manufacturing survey, a monthly snapshot of the sector, showed that a measure of export orders plunged to 50.7 last month from 56.7 in May, marking the weakest growth rate since last August. A reading of 50 indicates growth; below 50 signals an overall decline.

Overall, manufacturing recorded strong growth in June, down slightly from a 15-year high in May. The headline index edged down to 57.5 from 58.

"Looking three to six months ahead, manufacturers don't have a high degree of confidence," said Jeegar Kakkad, senior economist at the manufacturers' trade body EEF. "What happened in the last quarter of 2008, when within weeks orders melted away and the market fell off a cliff, made them a lot more cautious than maybe the statistics suggest."

He said that export growth earlier this year had been driven by shipments to Asia and the Middle East, while sales to Europe were also growing but not as fast.

Manufacturers are worried about the volatility of the pound against the euro in the wake of the Greek debt crisis. Sterling has strengthened to about €1.20 from €1.16 at the time of the election. This is affecting British exports of mechanical parts, such as machine tools and components for machine tools, to Germany.

A series of economic figures from China this week has sparked concern that its economic boom is running out of steam. Factory output in China is now falling, while Japan, South Korea, India and Taiwan have seen manufacturing growth slow.

UK exports to the US, especially consumer electronics, are also lacklustre, with American consumer confidence still weak, said Kakkad.

City economists said the recovery in British industry remained pretty robust – for now. Some were concerned that the European debt crisis was starting to affect trade. Peter Dixon at Commerzbank said it was having a "significant impact on demand".

Philip Shaw at Investec said: "The headline index has held up very well, it's not far off a 15-year high and ostensibly implying very strong growth in the manufacturing sector.

"But we're a little bit sceptical. The one obviously negative point is the large decline in the export index, which may be the first indication that the European debt crisis is impacting negatively on trade. It could be a one-off or it could be something more fundamental. We'll have to gauge next month's survey and other evidence to determine if this is the case."

Ross Walker at RBS concurred: "The big worry, of course, is still the euro area sovereign debt crisis damaging credit conditions and derailing the recovery." But he added: "It's still far too early to expect any of that to show up in the real economy."

On a more positive note, the survey suggested that manufacturers are hiring again. The measure of employment grew at the sharpest rate since February 1995.

US jobless claims surge more than expected

WASHINGTON (AFP) - New claims for US unemployment benefits jumped more than expected last week, official data showed Thursday on the eve of the key June jobs report.

Initial claims for jobless benefits rose to a seasonally adjusted 472,000 in the week ending June 26, an increase of 13,000 from the previous week's upwardly revised level of 459,000, the Labor Department said.

The leap was sharply higher than the consensus analyst forecast of 458,000 claims.

The four-week moving average, which helps smooth out weekly volatility, rose 0.7 percent to 466,500.

"The trend has generally been moving higher in recent weeks, suggesting that the labor market is perhaps starting to weaken," said Andrew Gledhill at Moody's Economy.com.

In the previous week ending June 19, the insured unemployment rate was 3.6 percent, unchanged from the prior week's revised rate, the department said.

The number of people collecting unemployment insurance benefits in the week to June 19 rose by 43,000 to 4,616,000, while the four-week moving average slipped 0.5 percent to 4,567,500.

Gledhill called recent moves in claims "troubling."

"In typical job market recoveries, claims would be much lower -- below 400,000 -- but in the current situation they have remained stubbornly elevated. Part of the explanation is that hiring is very low, potentially prompting a greater share of unemployed than is typical to file for benefits coming out of a recession."

The weekly jobless claims data came on the eve of the department's key June jobs report, widely expected to show worsening conditions.

Most analysts expect the data Friday will show the unemployment rate rose to 9.8 percent from 9.7 percent in May, and the economy shed 100,000 nonfarm jobs after adding 431,000 in the prior month, mainly temporary government jobs for the 2010 census.

Commodity Shipping Has Worst Streak in Five Years on Surplus

By Alistair Holloway and Alaric Nightingale

June 30 (Bloomberg) -- Commodity shipping costs measured by the Baltic Dry Index extended their longest losing streak in almost five years as an expanding fleet overwhelmed weakening demand for grain, coal and ore carriers.

Imports of coal and iron ore by China, the world’s biggest user of the commodities, fell for two consecutive months, customs data show. Grain shipments from South America slowed, leaving shipping lines with “the full force of vessel supply,” Martin Sommerseth Jaer and Erik Nikolai Stavseth, Oslo-based analysts with Arctic Securities ASA, said in a report.

The index fell 41 points, or 1.7 percent, to 2,406 points, the lowest since October 2009, according to the Baltic Exchange in London. That’s the 24th consecutive drop, the longest losing streak since August 2005. Daily rates for capesize ships, typically iron ore transporters that are three times the size of the Statue of Liberty, slumped 59 percent since reaching a 2010 high on June 2.

“The capes are the weakest element of the BDI and the capes are iron ore-” driven, Andreas Vergottis, research director at Tufton Oceanic Ltd., which manages the world’s largest shipping hedge fund, said by phone from London today. “Profitability of Chinese steel mills is zero now, we think.”

Chinese steelmakers are the biggest consumers of iron ore, more of which is transported at sea than any other dry-bulk commodity. Dry-bulk demand is also leveling off because of China’s moves to cool its property market, Vergottis said.

Measures taken by the Chinese government to restrain the Asian nation’s surging property sector have included raising mortgage rates and downpayment ratios, barring lending for third-home purchases and ordering tighter scrutiny of developers’ financing.

Fleet to Grow

Daily rates for capesizes were little changed today at $24,239. Rents for smaller panamaxes, the largest vessels able to navigate the Panama Canal, dropped 4.4 percent to $22,113 a day. They compete with capesizes for coal and iron ore cargoes and also carry grains.

The total number of ships waiting to transit the canal fell to 30 from 38 the previous week, according to a June 26 report from Truro, England-based Global Ports, which tracks congestion.

The fleet of dry-bulk carriers will grow 16 percent to 17 percent this year, Vergottis said. Ships that may have been ordered in 2008, when the Baltic Dry Index rose to a record before recording a 92 percent collapse for the year, may now be surplus to requirements without the demand to absorb them.

“At the moment you haven’t got that demand growth,” Vergottis said. “There are too many ships just when growth in demand seems to be decelerating.”

Shares of Nippon Yusen K.K. fell 0.6 percent in Tokyo trading today, dropping for a fourth day. Mitsui O.S.K. Lines Ltd. declined 1.5 percent and shares in China Cosco Holdings Co. retreated by the same amount in Hong Kong. The 12-member Bloomberg Dry Ships Index retreated 27 percent since reaching a 15-month closing high on Jan. 11.

--Editors: Stuart Wallace, Claudia Carpenter