Leading article: The search for the right medicine
Tuesday, 8 July 2008
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For too long, the issue of clinical depression barely figured on the radar of mainstream public debate. So it is welcome to see that this mental illness, which affects the lives of an estimated one in six people in Britain, is at last becoming a political issue. But with scrutiny, inevitably, comes disagreement.
Last year, the Government earmarked about £170m to increase the number of cognitive behavioural therapists in the NHS. Yet this week, a group of practising therapists has used the occasion of an international counselling conference at the University of East Anglia to criticise this official emphasis on cognitive behavioural therapy (CBT) as a remedy for depression.
The therapists want equal weight to be given to "person-centred" and "psychodynamic" psychotherapies. They argue that the only reason the Government and its advisers at the National Institute for Clinical Excellence are so keen on CBT is because there has been more research on this branch of psychotherapy than on others. In their view, this has led to a misguided assumption in Whitehall that CBT is the only show in town.
This critique has some force. These therapists are right that more research is needed into other psychotherapies to perform a proper, comparative evaluation of their effectiveness. At the moment, we do not have the evidence to make that evaluation. There should be no official dogmatism over which form of treatment is best. Government decisions must be guided solely by the clinical evidence.
But we should also put the objections of this group of therapists in context. They are not saying the CBT is ineffective, rather that other treatments might be just as good, or perhaps better. Moreover, we should bear in mind that the Government was right to look for alternatives to the mass prescription of drugs, such as Seroxat or Prozac, which has been the NHS's basic response to depression in recent years.
A credible recent study by Hull University suggested that the effect of these anti-depressant drugs, known as SSRIs, on a great many patients is indistinguishable from that of a placebo. When the evidence suggests that, for many patients, talking therapies can be more effective, it is the responsibility of the NHS and the Government to increase the availability of that service. Talking therapies do not come cheap, of course. But training therapists will, over time, be far less expensive than paying the £120m-a-year bill for anti-depressant drugs.
We need a proper discussion about which form of therapy is most effective. But we should not allow disagreement to stampede our health service back into the stifling embrace of anti-depressant drug manufacturers.
If you just treat depression with ANY antidepressant and CBT therapy here and there, chances are you will spend a good 20 years or more on the disorder. The depressed must learn the ins and outs of her disorder and to act upon. Certainly, there is some sort of brain chemistry dysfunction that needs to be treated pharmacologically. In addition, a comprehensive mental and physical program aimed to restore the 3 daily life cycles, rest/activity, sleep/wake and diet/metabolism must be implemented. Depression is an illness for the long haul and the patient must battle depression day in and day out, relentlessly. It took me almost 10 years of my life to beat it but I finally did it. I became a full blown neuroscience researcher just to learn the ins and outs of brain chemistry in order to cure
Posted by tangledsynapses | 12.07.08, 03:25 GMT
I have suffered from several periods of depression caused by work related stress and marriage breakup. In each case I was prescribed anti-depressants. To say that these medications are as effective as a placebo is misleading to say the least. They have profound effects on the personality, flattening or altering emotional responses, many unpleasant side effects, including alterations to libido, rash or impulsive behaviour and even mania. It is also extremely difficult to stop taking these medications because of the unpleasant withdrawal symptoms. In my opinion they are far too readily prescribed and downright dangerous.
Posted by Anthony Field | 08.07.08, 19:20 GMT
It's good to see depression getting an open discussion, and The Independent is to be congratulated for promoting it.
It's fair to point out, however, that for some of us no lasting 'cure' has emerged, and learning to live with the condition has been the name of the game.
I have received, courtesy the NHS, a useful period of psychotherapy - which I would not get today - and a range of drugs, most of which have been unhelpful, and in two cases downright alarming.
I have also had behavioural counselling - a complete failure - and talking therapy at the local Methodist church. This ended in farce when I was told (a) I was too ill for their kind of treatment, and (b) there was, in any case, nothing wrong with me!
I urge everyone to google David Smail and read his 2001 paper on the wider social implications of mental illness. It's not necessarily the patient's job to adapt to a sick society, is the thrust of his very detailed argument.
Posted by Tom MacFarlane | 08.07.08, 12:28 GMT
I believe that it is right to highlight the Governments situation at this time. Government relies upon advisors in the field to provide direction and those advisors can have personal and professional agenda's. Counselling has always suffered from it's lack of academic status in the arts category; existing as it does in the scientific world of medicine. CBT has captured the imagination of the science based NHS decision makers; lending itself easily to research and evaluation. I would like to see a range of models available in the NHS so that clinicians can suit models to patient needs. I also believe that the Person Centred and Psychodynamic practitioners should follow the example of their CBT colleagues by devising models of scientific evaluation to demonstrate their results.
Posted by Richard Mason | 08.07.08, 10:34 GMT