Antidepressants in the headlines again

For what seems like the whole of August so far! There are features on news sites, blogs everywhere, the radio... and people are asking questions about the continuing rise in the use of these drugs – in Wales, in the UK, in the “developed” world generally...

You can read online articles by a British GP, in The Huffington Post online newspaper and on the Mad in America blog - here by Scottish writer Chrys Muirhead.

Lots of questions are asked and the debate is fast and furious in many cases, particularly where there are comments sections following the articles. Some of the issues which have arisen include:

• Could it be that the increase in prescription numbers is because people are often on these drugs for many months and even years, so it is the repeat prescriptions which push the stats up?
• The medicalisation of life’s many stresses and problems may mean that people actually just require time and space, and possibly therapeutic support, to recover, rather than a (supposed) quick fix.
• But... this leads many who have experienced and struggled with very serious depression to condemn the suggestion that this kind of debilitating distress can just be addressed with a shout to “get out and exercise,” “change your diet”, or “pull yourself together...” when some people cannot even face emerging from their bed or home for weeks.
• There is the usual debate about “the chemical inbalance” – whether there is one or not ...(evidence being virtually non-existent so far... although we are always encouraged to look to the future and a miracle medical discovery...)

Perhaps one of the most interesting and relevant topics is – would a readily accessible and affordable talking therapy ensure an appropriate and viable alternative to taking antidepressants? Again, there is strong debate around this area – with many people insisting that drugs alone have contributed to their return to everyday life, whilst others are equally convinced that counselling, for example, is what really helped. Others wish to have access to both. And Mark Easton, in a recent BBC news story, pointed out that those areas of the UK with the lowest incidence of antidepressant prescribing do not actually have good provision of talking therapies either... so it’s a complex issue.

Here in Powys it does seem that there are issues around waiting times for counselling, with there being something of a postcode lottery. In recent years expectations have been raised around mental wellbeing, with national surveys, anti-stigma campaigns and generally increased awareness about mental health and wellbeing, with many famous people (comedians in particular, think Ruby Wax and Stephen Fry) speaking out about their distress (or various "diagnoses...").

Last week I was at a meeting of the Primary Care Mental Health team in South Powys, with counsellors and mental health practitioners (previously called mental health nurses) speaking about some of their frustrations. Generally they seem to be struggling to keep up with the increased demand for counselling, and in some areas of Powys there are long waiting lists (up to 6 months) to see a counsellor or take up another form of talking therapy such as Cognitive Behavioural Therapy (we posted about some of the issues here). Couple counselling and counselling for young people are two areas with a particularly growing demand.

Our own Powys Mental Health Information Service receives an increasing number of enquiries from people seeking counselling... Just recently I was told that there is a 6 month waiting list for bereavement counselling with CRUSE in parts of Powys (so what else could we suggest), and there is a cost implication for Relate counselling... Yet all the time people are becoming increasingly aware that they are entitled to source talking therapies through the GP surgery (see the Welsh Government legislation around this – the Mental Health Measure 2010). So... more and more people ask for help, they want it immediately, not 6 months down the line, and the GP prescribes an anti-depressant because a) it really might help and b) it can be prescribed now. Then, as in this recent BBC Wales video, people can spend not just months and years, but sometimes even decades reliant on these medications, with the prospect of painfully weaning themselves off at some point in the future or... staying on them for life, with all the mental and physical complications that this can involve...

What do you think? Are you on antidepressants? Do they work for you? Would you have preferred the option of a talking therapy? Was counselling or CBT offered by your GP, and if so could you start immediately or did you have to wait? We would be really interested to know.

Meanwhile, for a really interesting take on psychiatric medications, it is worth watching a video of consultant psychiatrist Dr Joanna Moncrieff, author of The Myth of the Chemical Cure, speaking earlier this year.