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You can find the current article at its original source at http://www.theguardian.com/commentisfree/2014/may/28/talking-therapies-better-than-pills-report-depression
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| Talking therapies are better than pills, but you have to find the right one | Talking therapies are better than pills, but you have to find the right one |
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| Can therapy make you depressed? According to a study by researchers at Sheffield University, talking therapies – hailed for the best part of a decade as the solution to the over-medication of depression and anxiety – can do more harm than good for some patients if they're misapplied, or of poor quality. Well, obviously. Letting someone poke around inside your car or laptop is likely to do more harm than good unless they're properly qualified to fix it; why wouldn't the same apply to a distressed mind? Any treatment offered to vulnerable people should, of course, be subject to scrutiny but it's worth unpacking these results before anyone panics. | |
| Therapy is far from an exact science; it's only in recent years, since the advent of cognitive behavioural therapy (CBT), that the phrase "evidence-based therapies" has entered common parlance. When I first sought help from my GP for depression in 2003, waiting lists for therapy could be a year or more, and the default prescription was antidepressants. Broad anecdotal evidence, as well as my own experience, suggested that these were offered widely on the NHS, often with little chance in a five-minute appointment slot to assess the severity of the patient's problem or their suitability for the drugs. Stories surfaced regularly in the press about certain SSRI (selective serotonin reuptake inhibitors) antidepressants causing addiction or making people suicidal – we were told we were a nation addicted to happy pills that didn't even work, as depression and anxiety grew to epidemic proportions. | Therapy is far from an exact science; it's only in recent years, since the advent of cognitive behavioural therapy (CBT), that the phrase "evidence-based therapies" has entered common parlance. When I first sought help from my GP for depression in 2003, waiting lists for therapy could be a year or more, and the default prescription was antidepressants. Broad anecdotal evidence, as well as my own experience, suggested that these were offered widely on the NHS, often with little chance in a five-minute appointment slot to assess the severity of the patient's problem or their suitability for the drugs. Stories surfaced regularly in the press about certain SSRI (selective serotonin reuptake inhibitors) antidepressants causing addiction or making people suicidal – we were told we were a nation addicted to happy pills that didn't even work, as depression and anxiety grew to epidemic proportions. |
| When the Depression Report was published by the Centre for Economic Performance's mental health policy group in 2006, it quantified the effects of that over-medicalisation for the first time. Talking therapies, particularly CBT, could be shown to be more effective than medication in cases of mild to moderate depression, both in getting people back to work and preventing recurrence. National Institute for Health and Care Excellence (Nice) guidelines already stated that talking therapies should be offered before drugs; the problem was that there weren't enough qualified therapists. The Depression Report showed clearly that investment in making CBT and similar therapies more widely available would be better for the economy in the long run than handing out pills. | When the Depression Report was published by the Centre for Economic Performance's mental health policy group in 2006, it quantified the effects of that over-medicalisation for the first time. Talking therapies, particularly CBT, could be shown to be more effective than medication in cases of mild to moderate depression, both in getting people back to work and preventing recurrence. National Institute for Health and Care Excellence (Nice) guidelines already stated that talking therapies should be offered before drugs; the problem was that there weren't enough qualified therapists. The Depression Report showed clearly that investment in making CBT and similar therapies more widely available would be better for the economy in the long run than handing out pills. |
| There is still a shortage of therapists on the NHS, despite increased investment – the latest statistics on a rise in antidepressant use since the recession perhaps reflect this. But even if there were enough counsellors to go around, no amount of economists' pie charts can gloss over the fact that the mind is a complex instrument, and each is unique; what helps one person's depression may have no impact on another's. Some people may not respond to therapy, just as some react badly to medication. There is also the fact that therapy is a relationship like any other; it's taken me almost 15 years, on and off, of trying different types of therapy to find the person with whom I feel most comfortable. That doesn't necessarily mean that my previous therapists were not good at their job, just that they were not the right match for me. | There is still a shortage of therapists on the NHS, despite increased investment – the latest statistics on a rise in antidepressant use since the recession perhaps reflect this. But even if there were enough counsellors to go around, no amount of economists' pie charts can gloss over the fact that the mind is a complex instrument, and each is unique; what helps one person's depression may have no impact on another's. Some people may not respond to therapy, just as some react badly to medication. There is also the fact that therapy is a relationship like any other; it's taken me almost 15 years, on and off, of trying different types of therapy to find the person with whom I feel most comfortable. That doesn't necessarily mean that my previous therapists were not good at their job, just that they were not the right match for me. |
| Psychotherapy can cover a bewildering number of variations and that, too, can put people off if they're steered towards a type that doesn't suit their temperament. The findings of the Sheffield study don't tell us much about these kinds of nuances. There's also no way of knowing whether the patients who reported feeling more depressed after a course of therapy might have felt worse regardless. | Psychotherapy can cover a bewildering number of variations and that, too, can put people off if they're steered towards a type that doesn't suit their temperament. The findings of the Sheffield study don't tell us much about these kinds of nuances. There's also no way of knowing whether the patients who reported feeling more depressed after a course of therapy might have felt worse regardless. |
| If anything, this research ought to be an argument for more investment in talking therapies rather than an excuse to dismiss them as overrated. Regulation to ensure high professional standards is vital – as in any medical treatment – but it's worth remembering that, for many people, one of the most crippling effects of depression can be the loneliness. Therapy may not be a magic bullet, but the chance to talk to someone – anyone – who might understand how you feel can often be a lifeline. What is needed is greater investment in mental health care overall, so that patients can feel confident they have been prescribed the treatment that will best address their needs – whatever form that may take. | If anything, this research ought to be an argument for more investment in talking therapies rather than an excuse to dismiss them as overrated. Regulation to ensure high professional standards is vital – as in any medical treatment – but it's worth remembering that, for many people, one of the most crippling effects of depression can be the loneliness. Therapy may not be a magic bullet, but the chance to talk to someone – anyone – who might understand how you feel can often be a lifeline. What is needed is greater investment in mental health care overall, so that patients can feel confident they have been prescribed the treatment that will best address their needs – whatever form that may take. |