Dependency Britain: We're in a major drugs crisis. Why it may be better to talk

Kate Langley did not know where to turn after battling depression for more than seven years. Doctors had prescribed her a variety of drugs to help her anxiety and depression but they had left her feeling not quite "100 per cent".

On bad days, the 27-year-old was so anxious even about going to see friends that she would spend hours trying to summon the confidence to meet people.

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Her desperate situation is one shared by millions across Britain who are being turned into pill-poppers because of a desperate shortage of therapy on the NHS.

More than three million adults and young people are dependent on powerful anti-depressants. Prescribing of drugs such as Prozac and Zoloft has more than doubled over the past decade, with over-worked GPs handing them out as an instant remedy. Between 1995 and 2004, the number of prescriptions for mood-enhancing pills soared from just over 13 million to 29 million. Last year, 30,000 "scripts" were signed by doctors for adults suffering mild depression, a rise of 2,000 on the previous year.

Experts warn that handing out drugs may offer short-term relief, but such drugs do not treat the underlying causes of anxiety disorders, phobias and mild depression. They compare drug treatment to using a sledgehammer to crack a nut.

Ms Langley eventually had her life turned around by a revolutionary treatment where therapists teach patients how to think positively. Cognitive behaviour therapy (CBT) is widely believed to be more effective in the long term than drugs, because people suffering from depression and phobias are given skills they can use outside their therapy session. A typical course lasts from eight to 16 weeks.

But the communications consultant from London ended up paying for CBT, which she says was like "gold dust", because she faced a two-month waiting list.

A severe shortage of trained counsellors and therapists, and a woeful lack of investment in therapy, means many GPs feel they have no alternative but to prescribe a drug. The demand for cognitive therapy is far outstripping the rate of recruitment of therapists, according to a study by Pulse, a magazine for doctors.

Monthly referrals have nearly quadrupled over the past five years, from 1,155 in January 2001 to 4,375 in December 2005, but the number of clinical psychologists has only risen by around 47 per cent. Its research also reveals that nine out of 10 doctors have been forced to prescribe drugs because of a lack of funding for therapy. The average wait, according to the survey of 1,300 doctors, was over eight months for a hospital appointment.

The doctors on the front line describe access to talking therapies as "appalling". David Spiers, a GP in Devon, says that drugs are the only solution available. "We have no choice but to prescribe anti-depressants for anybody who is feeling low because they are just not going to get any sort of psychological help in a reasonable time," he said.

Whitehall officials admit that some patients face a wait of up to two years to access therapy. More than one in five NHS healthcare providers do not offer CBT despite the fact research has shown it is the most effective non-drug treatment for depression.

The over-prescribing of drugs also shows that official guidelines promoting the benefits of therapy are being ignored. In 2004, the National Institute for Health and Clinical Excellence (Nice) advised GPs that psychological treatments are more clinically and cost effective than drugs for mild depression.

The news that ministers are planning to launch pilot centres offering CBT and a range of therapies has been welcomed by mental health campaigners and doctors, but others dismiss this as a cynical attempt to reduce the Government's benefits bill.

Their proposals are based on those drawn up by Richard Layard, emeritus professor of economics at the London School of Economics and the Government's happiness tsar, who has called for an army of 10,000 therapists to help treat the record numbers of people who suffer from phobias, anxiety and depression.

In an interview with The Independent on Sunday, Professor Layard, who is a Labour peer, said investing in talking therapies was more cost effective and that improving the nation's well-being should be part of every political parties' election pledge. "Therapy is a form of empowerment in the way drugs are not," he said.

There is no doubt among psychiatrists and medical experts that anti-depressants are effective in helping people out of their mental despair in the short term. The British Association for Behavioural and Cognitive Psychotherapies, which represents 5,000 therapists, says it is not against drugs such as Prozac. But it says the danger is that people spend years taking them without any major benefit.

"Some people do need respite from the traumas they are going through, and you can appreciate that busy GPs don't have the time to sit down with patients. But CBT is very effective for mild to moderate depression, which is the biggest area for treatment," said Rod Holland, a spokesman.

Campaigners also warn that GPs are often ignorant of alternatives to anti-depressants and that patients should be given a wider choice of treatments.

Mind, the mental health charity, emphasises that people need access to a combination of therapies and medication. "What everyone needs is to have access to the treatments that work best for them," said Sophie Corlett, Mind's policy director.

However, not everyone is convinced that CBT is the way to cure depression anxiety. Oliver James, a clinical psychologist and broadcaster, said offering CBT on the NHS was a "cynical ploy" by a Government whose sole motivation was to save money and to get people back to work.

"CBT ... is aimed at getting people back to work ... with a smile on their face. [It] is hostile to emotions and phobic about childhood causes of mental illness, which I think are very important," he said.

Virginia Ironside, writer and agony aunt, said the benefits of therapy were unproven, although she is supportive of the use of pills and CBT. "CBT I did find more useful," she said. "Often people just want someone to talk to, and knowing that you have an appointment booked and a Valium in your handbag is enough to stop you killing yourself."

Additional reporting by Megan Waitkoff

PILLS vs THERAPY

Linda Gillard developed severe side effects, including hair loss and a compulsive need to spend money, as a result of the anti-depressants she was prescribed.

The drugs were meant to help her overcome the anxiety and stress she experienced working as a primary teacher at a rough school in Norfolk. Instead, the 53-year-old, who had also been the victim of an attack by a pupil, found medication made her moods worse.

It was only when she moved to a remote part of the Highlands in 2001 that the local doctor put her on a six-week course of cognitive behaviour therapy (CBT), which turned her life around.

"It [therapy] is good for people who are stuck or on anti-depressants for a long time," says Mrs Gillard, who is now a writer. "The real ticket is getting diagnosed correctly, getting the right medication and doing CBT."

CBT is considered by many experts to be one of the most effective treatments for depression and anxiety. Therapists use it to teach a patient how to change the way they think, training them to replace negative feelings with positive ones. Instead of dwelling on reasons in the past for someone's depression, the therapy, which typically lasts for between eight and 16 weeks, is focused on the present. Patients are made to challenge everyday scenarios, such as a row at work or being ignored by a friend, which make them feel rejected or worthless.

In Mrs Gillard's case, the treatment helped her to manage her feelings of anxiety. During the weekly, hour-long sessions, she completed worksheets, one for each negative feeling or experience. "The mantra was 'What's the evidence that everyone's going to hate me? What's the evidence that you're going to fail?' And, of course, there is no evidence," she explains.

"It's very client-centred. The therapist does very little. You have to do all the work. You have to be very self-motivated."

Mrs Gillard still has feelings of panic, fear and low self-esteem, but she mentally fills out the CBT worksheets to calm herself down. For example, the day before she left for a recent literary workshop, she says she was overcome with nerves but used CBT to calm herself.

"I thought, OK, I'm going to be useless and helpless, but then, what's the evidence?" she said. "It's like a broken record, really, but then that's the nature of depression."

Interview by Megan Waitkoff

Prozac

FIGHTS: depression, bulimia nervosa and obsessive-compulsive disorder

POSSIBLE SIDE EFFECTS: diarrhoea, nausea, headache, sleep disorders, anorexia, hair loss

COST: for 28-day treatment (1x20mg capsule/day) £1.37

Efexor

FIGHTS: anxiety disorder

POSSIBLE SIDE EFFECTS: tiredness, dizziness, low blood sodium levels, tingling and sweating, shortness of breath

COST: for 28-day treatment (1x75mg capsule/day) £23.41

Zoloft and/or Lustral

FIGHTS: obsessive-compulsive disorder, post-traumatic stress disorder, depression

POSSIBLE SIDE EFFECTS: dry mouth, dizziness, indigestion, tingling

COST: for 28-day treatment (1x50mg tablet/day) £17.82

Paxil

FIGHTS: obsessive-compulsive disorder, social anxiety disorder and post-traumatic stress disorder

POSSIBLE SIDE EFFECTS: nausea, weakness, insomnia, tremor, sweating, decreased appetite

COST: unavailable

Celexa or Cipramil

FIGHTS: panic attacks, depression

POSSIBLE SIDE EFFECTS: abdominal pain, diarrhoea, drowsiness, dry mouth, insomnia, painful menstruation, sweating, tremor, vomiting, confusion

COST: for 28-day treatment (1x20mg tablet/day) £2.59