Media coverage: August 2003
Depression:
treatment matters
In modern healthcare, depression is treated in two broad ways - psychological therapy and anti-depressant medication. Many scientific authorities believe a combination of these approaches is the best option for most patients.
However, the BACP have two major concerns; doubts about the effects of anti-depressant medications and claims made by their Manufacturers; and the need to raise the profile of counselling and psychotherapy among GPs and the central role it can play in the treatment of depression.
Drug problems
Whilst drug therapy for depression is in general well validated,
there remain doubts about claims made by many manufacturers and
concerns from
patients about the potential side/withdrawal effects and claimed
links with suicide. Seroxat has been in the firing line after
a coroner was
reported asking for Britain's most popular anti-depressant to be
withdrawn until detailed national studies into its safety are
undertaken.2
Two TV investigations by Panorama brought concerns about the drug into the open and put increasing pressure on the manufacturer to alter the drug's safety warnings.
The Government has finally conceded to intense pressure to give patients input into a new inquiry on the safety of selective serotonin reuptake inhibitors (SSRIs) antidepressants.
On June 10 the Medicines and Healthcare Products Regulatory Agencies (MHRA) sent a high level warning to doctors and patients that children under 18 should not be treated with Seroxat, as there is an increase in the rate of self-harm and potentially suicidal behaviour in the under-18 age group.
BACP argue that perhaps the real learning point for health professionals is that drug intervention by itself offers only half a treatment. Drugs alone:
- Do not solve the patient’s problems.
- Do not provide insight into relationships.
- Do not improve communicate skills
- Do not teach new behavioural strategies.
- At best, pills buy that vital window of time during which the patient could TRY to solve their problems.
It would obviously be better to help patients understand their own depressive behaviour rather than just give drugs to dull the brain. Full treatment, claims BACP, means learning how to live differently.
Psychological
therapy
The BACP are calling on governing bodies within the health
service to recognise this problem at the heart of modern
mental healthcare
and ensure
that Primary Care Practices are in future fully supported
by qualified counselling and psychotherapy services and feel the
following issues
need to be addressed.
- Up to 60% of fund holding doctors chose to hire counselling practitioners.
- Doctors themselves must receive better mental health training.
- Funding is threatened and 40% of patients still do not receive the support evidence suggests they need.
Due to reorganisation of the NHS funding for counselling therapies has already been a withdrawn at Worcester and South Warwickshire. BACP claim it's a last in first out situation and psychological therapies are not considered a priority. However, based on the extensive body of international psychotherapy research, systematically reviewed and appraised, the Department of Health in their document ‘Effectiveness Matters’ states that: ‘’Psychological therapy should be routinely considered as an option when assessing mental health problems’’.3
The combination approach
Research in this area is very limited, but a brief review
shows this approach to be effective in the treatment
of depression. A Norwegian
study found that the combination of active drug and
psychological treatment (counselling, emotional support and close
follow
up) was more effective
than simple psychological treatment alone, particularly
for those with recurrent depression.4
At the same time, British studies explored efficacy and cost-effectiveness for counselling and psychotherapy. Results showed that psychotherapy is a more effective treatment in the short term for patients with depression than with GP care.5 Further results showed that both counselling and cognitive therapy were more cost effective than standard treatment after four months.6
The BACP and other organisations have been pressing drug manufacturers for a more honest appraisal of the pharmacology. Given the recent Seroxat inquiry announced by the Government and subsequent action taken by the manufacturer there at last appears to be some progress, although some may argue that it is overdue. Moreover, the BACP continue to argue that anti-depressant medication is only half the treatment, and maintain that when pharmacology supports the best talking therapies only then will patients get the help they truly need.
To achieve this, the BACP hope to see better training for GPs to enable them to understand the differences between the various types of psychological counselling when considering referral. More counselling professionals employed in primary care and more valid research into the effectiveness of psychological counselling in the treatment for depression. Unless the Government takes drastic action, the future of psychological therapies within primary care remains in a catch-22 situation.
Perhaps a timely reminder is that of the National Service Framework for Mental Health, which states: ‘Psychological therapies have an important role to play in helping people with mental health problems who should have access to effective treatment, both physical and psychological’ (Dept. of Health, 1999).
References
1. BACP press briefings April 2003
2. Ref 16 March, Guardian Newspaper 2003
3. http://www.dh.gov.uk/PolicyAndGuidance/fs/en
4. Malt U F et al. The Norwegian naturalistic treatment study of depression
in general practice (NORDEP)-1: randomised double blind study. BMJ
1999, 318: 1180-4
5. Ware E et al. Randomised controlled trail of non-directive counselling,
cognitive-behaviour therapy and usual general practitioner care for
patients with depression. 1: clinical effectiveness. BMJ 2000; 321:
1383-1388
6. Bower et al. Randomised controlled trail of non-directive counselling,
cognitive behaviour therapy an dusual general practitioner care for
patients with depression. 11: Cost effectiveness. BMJ 2000; 321; 389-1392
Extract Source: Primary Care Today, August 2003