We keep on taking the pills

orange_medication_bottle_blue_white_pills_1600_wht_1953I’ve previously written about the fact that prescriptions for depression, anxiety and sleeping problems had increased dramatically over the last few years.

I’ve also posted about psychotherapy or talking therapies being as effective as medication (see original post below).

Now there’s more evidence that that is true. See this post “Psychotherapy just as effective at beating the blues”

Original post from August 2012

According to data from the NHS Health and Social Care Information Centre more than 43 million prescriptions were dispensed in 2010, a 28% increase from the previous 3 years. Prescriptions for anxiety were also up by 8% and up 3% for sleeping problems.

And things haven’t improved. Last year total prescriptions for anti-depressants alone increased to around 47 million, almost 10% up on the previous year, at a cost of £2 billion.

The NorthWest has the highest use of anti-depressants and sleeping medication. It may be no coincidence that this has been a period of economic downturn with many job losses – which contribute to mental health problems.

The mental health charity MIND points out that there has been a steady increase for the last decade as people are more open about their mental health problems and GPs have become more adept at spotting the symptoms.

Unfortunately doctors may see medication as a quick fix because waiting lists for talking therapies are so long – 20% of patients wait for up to a year.

The Chief Executive of the Mental Health Foundation said; “Doctors may just be relying on anti-depressant prescribing rather than offering patients alternative evidence-based interventions such as psychological therapies or exercise prescriptions”.

Psychotherapy beats medication

Talking therapies are better for you than medication if you suffer from anxiety or mild to moderate depression. But their effectiveness depends largely on the relationship with the therapist.

Sounds a bit obvious perhaps but a professor of counselling psychology, Bruce E Wampold, says his research show that, in addition to having a customised treatment plan, this is what makes a good therapist:

  • a sophisticated set of interpersonal skills
  • building trust, understanding and belief from the client
  • an alliance with the client
  • an acceptable and adaptive explanation of the client’s condition
  • a treatment plan that is allowed to be flexible
  • is influential, persuasive and convincing
  • monitors patient progress
  • offers hope and realistic optimism
  • is aware of client’s characteristics in context
  • is reflective
  • relies on research evidence
  • continually improves through personal development

So with an effective therapist psychotherapy can work better than medication and with anxiety and moderate depression has better outcomes in the long-term with fewer relapses. This has been the argument for using psychotherapy in the UK NHS for these conditions and now Norway has issued guidelines saying psychological interventions should be tried before medication.

Of course GPs and medics are under pressure from the pharmaceutical companies and there aren’t enough therapists available in the NHS leading to long waiting lists but talking therapies should be the first intervention to try.

And the evidence is that people are now more open about mental health problems and more prepared to discuss it rather than try and maintain a stiff upper lip.