Much of this focus has been on increasing the availability of psychological services, but pharmacological therapies are still a core component of treatment for both conditions, particularly for more severe presentations or when psychological treatments have

been ineffective. The mainstay of pharmacological treatments for depression and GAD are antidepressants, and in the UK 95% of all prescriptions for antidepressants are scientific research issued #new post keyword# by GPs [Henry, 1993; NICE, 2010]. In the UK, prescribing of antidepressants in primary care has been increasing steadily over the last decade, which has been explained mainly by an increase in the proportion of patients receiving long-term treatment [Moore et al. 2009]. In England during the 3 months to September 2011, over 11 million prescriptions for antidepressants were prescribed in primary care [National Health Service Business Services Authority, 2011] making them one of the most Inhibitors,research,lifescience,medical commonly prescribed classes of drugs [National Health Service

Information Inhibitors,research,lifescience,medical Centre for Health and Social Care, 2010]. Selective serotonin reuptake inhibitors (SSRIs) are recommended by NICE as first-line pharmacological treatment for both depression and GAD and the dual action antidepressants serotonin and noradrenaline reuptake inhibitors (SNRIs) are among the second-line treatments [NICE, 2010; 2011]. Drug safety is one of the key considerations when prescribing in primary care and this is particularly applicable in conditions such as depression and anxiety when there is a risk Inhibitors,research,lifescience,medical of suicide by antidepressant overdose among other means and the disorders are often accompanied by other psychiatric and medical comorbidities. However,

the safety of antidepressants Inhibitors,research,lifescience,medical has been called into question over the last decade. The UK Medicines and Healthcare Products Regulatory Agency (MHRA) has issued guidance on a Entinostat number of safety issues, including suicidal behaviour [MHRA, 2007], discontinuation reactions [MHRA, 2004], use in pregnancy [MHRA, 2010a, 2010b], risk of fracture [MHRA, 2010c], cardiotoxicity and toxicity in overdose [MHRA, 2004, 2011] related to antidepressants. These warnings have applied to some of the most commonly prescribed antidepressants in primary care. For example, the most recent guidance regarding QT prolongation [MHRA, 2011] relates specifically to citalopram, the most commonly prescribed SSRI in the UK [National Health Service Business Services Authority, 2011], and its related compound escitalopram. These recommendations are potentially alarming for GPs and patients and may undermine the confidence in antidepressants in general.