Leading article: The search for the right medicine

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The Independent Online

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.

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