In 2006 there were more than 31 million prescriptions for drugs such as Prozac issued - a rise of 6% on the year before. In 2004 the National Institute for Health and Clinical Excellence issued guidance recommending that antidepressants should not be used as first-line therapy for mild to moderate depression. Instead they suggested that patients should be offered guided self-help and psychological therapies in the first instance, however the rise in antidepressant prescriptions seems to indicate that this advice has not been followed.



In particular prescriptions for a group of drugs known as SSRIs, which include Prozac, rose by 10% last year from 14.7m to 16.2m, despite fears that that the drugs could be linked to suicidal thoughts and self-harm in some cases. In 2003, experts said SSRI antidepressants should not be given to teenagers after experts' concerns they made some patients suicidal. However, Prozac is still recommended for under-18s, as it is thought that the benefits of taking this particular drug outweigh any potential risk, but only for those with severe depression.

Mind, the mental health charity, say the UK is trailing behind other countries in the use of other therapies, and that GPs should consider "ecotherapy" as a valid alternative. In the Netherlands, Italy, Germany, Austria, Belgium and Slovenia, patients with depression are prescribed agricultural work. In a report on ecotherapy, described as getting outdoors and getting active in a green environment, Mind said 93% of GPs have prescribed drugs due to lack of alternatives, and therefore ecotherapy should be considered as a treatment option.

Paul Farmer, chief executive of Mind said ecotherapy was a credible, clinically-valid treatment option and needs to be prescribed by GPs especially as access to treatments other than antidepressants was extremely limited. "We're not saying that ecotherapy can replace drugs but the debate needs to be broadened."

In a similar study researchers at the University of Essex compared a walk in a country park with a walk in a shopping centre in a study of 20 people. They found that 71% reported decreased levels of depression after a country walk compared with 45% after a shopping centre walk.

Marjorie Wallace, chief executive of the mental health charity SANE, said: "GPs are now encouraged to diagnose depression yet without the availability of qualified counsellors and therapists they have little choice but to hand out a prescription - or send the patient away empty-handed, leaving them with less hope of treatment and recovery."

Supporting this, Professor Mayur Lakhani, chair of the Royal College of GPs, said: "We reject the suggestion that GPs prescribe antidepressants too readily. GPs consider the need for antidepressants only after a careful assessment of the patient's clinical condition. The real story is the lack of access to services such as talking therapies and the long waiting lists for these. GPs find themselves in a difficult position because of limited services."