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.

R D Laing pops up again

“Madness need not be all breakdown. It may also be break-through. It is potential liberation and renewal as well as enslavement and existential death.”  R D Laing, 1927 - 1989

Yesterday morning I heard the Scottish psychiatrist’s son, Adrian Laing, speaking on BBC Radio 4’s Saturday Live programme (about 30 minutes in if you listen again). He recalled life with his father, a bittersweet combination of experiences also documented recently in The Daily Telegraph, and then outlined his participation in one of Laing’s more unconventional therapies – a “rebirthing”.

The story reminded me of a comment in Laura’s recent post on Thomas Szasz, where a reader made the link between Szasz and Laing. The Anti-Psychiatry page on Wikipedia pulls them both into the same camp, but as Laura pointed out – Szasz was not anti-psychiatry, it was the coercive nature of psychiatry as practised that he opposed. Nevertheless, the two psychiatrists are often lumped together in the political debate over psychiatry, and in pushing the view  “that psychiatric treatments are ultimately more damaging than helpful to patients”.

The debate, which was particularly vocal in the 60s and 70s, is regarded by some to have been “of its time” and no longer relevant. After all, mainstream psychiatry (relying heavily on drugs in its attempts to treat what are regarded as medical problems) seems to rule the roost, certainly in the developed world. However, it appears as if the debate is gaining renewed momentum of late...

I unexpectedly discovered a copy of Laing’s “The Politics of Experience and The Bird of Paradise” on a bookshelf here at home. (It’s not mine – G is also more well-read than me!) Yesterday after listening to Adrian I read the chapter on “The Schizophrenic Experience.” Here are a couple of, what I believe, are relevant quotes:

“It seems to us that without exception the experience and behaviour that gets labelled schizophrenic is a special strategy that a person invents in order to live in an unlivable situation.” (Following research studies made by Laing and two colleagues. His emphasis).

“’Schizophrenia’ is a diagnosis, a label applied by some people to others. This does not prove that the labelled person is subject to an essentially pathological process, of unknown nature and origin, going on in his or her body.”

Dr Joanna Moncrieff, a practising psychiatrist and critic of pharmaceutical drugs, said that “I was reading Thomas Szasz and R.D. Laing when I was at medical school – they were the only ray of interest I could find in the subject area.” With like-minded colleagues she set up the Critical Psychiatry Network which aims to debate issues such as “scepticism towards the evidence base, the biological basis to psychiatry, the efficacy of biological treatments, and an objection to the emphasis on coercion and medicalisation and the issues of social control.”

So... the debate does seem to be very much out there and current. What do you think?

PS: You can watch an intriguing 1989 Channel  4 documentary on R D Laing here. It’s 1.5 hours long (but absolutely worth it), so make sure you are sitting comfortably...

Mental Health: The Myth of the Chemical Cure

Last week my colleague Glynis Luke attended a really interesting event organised by Lewes Skeptics down in East Sussex. She was very lucky to get a ticket at all, as they sold out in 24 hours! Dr Joanna Moncrieff, Senior Clinical Lecturer in psychiatry at University College London, spoke to a packed audience at The Elephant & Castle pub in Lewes. As it said in the publicity blurb:

"Joanna Moncrieff challenges the view that drugs like ‘antidepressants’ and ‘anti psychotics’ remedy mental disorders in the same way that medical drugs treat asthma or diabetes. She argues that psychiatric drugs cause rather than cure chemical imbalances, and change the way we normally think and feel."

Glynis felt that Dr Moncrieff spoke with real passion and knowledge about her subject, and asked me to share a podcast of the event with a wider audience. The podcast concludes with a very robust question and answer session.

You can link to the podcast on the Lewes Skeptics blog page.