THE BLOG

What's Wrong With Anti-Depressants

17/01/2017 16:21 GMT | Updated 17/01/2017 16:21 GMT

Radio 5Live chose to mark "Blue Monday" by questioning the prescription of antidepressants and whether or not they are overused.

Anyone who has lived with depression (and let's be clear, that's a very generic term for a host of conditions and experiences) knows that even when you feel better and life starts to sense again, you are not cured. There is always the possibility of another episode and many people work very hard at managing their recovery through taking better care of themselves in a myriad of different ways. One of these is ongoing medication to manage what is a chronic condition.

Current research and understanding points to depression being linked to the insufficient or sluggish activity of various chemicals (neurotransmitters) in our brain, which pass signals from one cell to another as part of the process of feeing emotions. Antidepressants help increase this activity, effectively, to boost what our brain is struggling to do naturally. The analogy with diabetes is therefore correct, if your body struggles to produce insulin, you take insulin. And in the same way as you wouldn't suggest that someone with diabetes comes off their insulin so you can't jettison your antidepressants and put a brave face on things.

Depression usually responds best to a variety of interventions; studies which have compared drugs to talking cures (therapy) have generally concluded that gold standard treatment would be a combination of both. Which brings us to the availability of therapy from the NHS - it's actually quite hard to come by. The guidelines in primary care are for GPs to refer to CBT in the first instance, firstly delivered via a web based computer programme, then group therapy if no better and finally to individual sessions, if really need them. Under these constraints, finding a therapist in private practice is the only way to ensure access to one to one therapy of your choice. This also has the advantage of being within a reasonable timeframe, something else the NHS does not deliver.

The average waiting time in January 2016 (Improving Access to Psychological Therapies (IAPT) Executive Summary January 2016) was 28.4 days, effectively a month, which is a very long time to wait for help when you're struggling to remember the point of life, and each day can seem interminable. 3% of referrals waited over 18 weeks - four and a half months, which is impossible to comprehend. But even if you hang on in there for your appointment, a course of treatment can be as little as two sessions according to IAPT definitions. It is well known that talking to someone who is empathic and available is essential to treating mental ill health and most people are likely to feel some improvement after experiencing two sessions of this, I'd be amazed however if they were significantly better after such a short time. Even insurance companies offer six sessions as a standard and NICE Guidance is for 6 - 8 sessions minimum.

We're not really providing a service for mental health patients in a primary care setting (nor are we in secondary for that matter), and the ever-present requirement to focus on short term (political) goals, along with the failure to plan across sectors does not bode well for the future, despite Theresa May's recent assurances. Failing to respond to depression leads to an escalation of the illness with costs everywhere. The cost to the patient, their family, and already stretched crisis services. Against this background we should probably be grateful that GPs are seemingly able to prescribe antidepressants freely, whilst acknowledging that this alone is not the answer.