Monday, 28 January 2013

Anti Depressants- do they really work?

“Pain could be killed. Sadness could not, but the drugs did shut its mouth for a time.”  Colson Whitehead, Zone One

There is currently a debate around whether Anti depressants are being overused for treating Depression and if there is really a strong enough evidence base for them.

Statistics show that at least 1 in 10 people in the UK suffer from depression, it’s prevalence being slightly higher in women, with 1 in 20 of sufferers being as a result of clinical depression.  Anti depressant prescriptions in the UK have increased by 9.6% in 2011, to 46 million prescriptions and continue to rise.

There is no question that most people with Depression report a reduction in their symptoms though research shows that improvement appears to be due to psychological factors, i.e., the placebo effect.  Evidence is currently inconclusive about how much the Placebo effect is involved. We could ask, how much of the effectiveness of medication is due to the active ingredients and the non Placebo effect?

From my own experiences of working with hundreds of clients with Depression, both Clinical (i.e. from a chemical Serotonin imbalance) and ‘Reactive’ (as a result of a response to an event or stressor), Anti Depressants do have their place.  Many initially report an improvement using Anti Depressants though often, alone they aren’t enough to resolve the underlying factors that cause it in the first place and that help maintain it.  For instance, taking a pill when experiencing work stress may buffer against some of the negative emotional effects though unless the underlying triggers are addressed, things may not change long term. With some clients, Anti Depressants have little effect or in some cases, cause a worsening of symptoms as a result of unpleasant side effects.

Dr Ian Reid, Professor of Psychiatry at the University of Aberdeen, says "Antidepressants are but one element available in the treatment of depression, not a panacea,"…they can have harmful side effects, and they certainly don't help everyone with the disorder. But they are not overprescribed. Careless reportage has demonised them in the public eye, adding to the stigmatisation of mental illness, and erecting unnecessary barriers to effective care." 

The National Institute for Health and Clinical Excellence (NICE) guidelines doesn’t promote the use of Anti depressants as a first port of call for treating moderate depression though instead advocates talking therapies such as CBT (Cognitive Behavioural Therapy) and Interpersonal Therapy initially. Often however, long NHS waiting lists prevent individuals accessing services.  GP’s only option then is to prescribe medication to patients when there are few alternatives available.

Posing my question at the beginning, is there enough evidence to support the widespread use of Anti Depressants; one might argue, if it makes people feel better, why worry about how that happens? Perhaps the individual’s belief in the pill as well as the scientific base causes the improvement.  Often, the therapeutic benefit of talking about our problems and expressing our feelings to a professional such as a GP is part of the healing effect;  ‘It’s good to talk’ as BT says.

The promotion of medication alone however, dismisses the wider implications of creating a culture of ‘pill popping’ rather than addressing underlying causes and socioeconomic factors.   We should be asking why has depression become endemic, not only in the UK but worldwide and how can we change it? In our modern ‘quick fix’ society, we are prone to avoiding the real issues when we need to take a move in the direction of change and start doing something differently. 

Wednesday, 2 January 2013

How to Stay Resolute this Year

“How few there are who have courage enough to own their faults, or resolution enough to mend them” – Benjamin Franklin

Change can sometimes be very daunting, especially when it comes to sticking to a resolution you have decided upon yourself. We don’t always adjust well to change, and it can be challenging and stressful to keep up willpower or reach targets we set ourselves. It can also be very distressing when we fail, so here we offer all the help we can to assist your achievement, and give advice on what to do when things don’t quite go to plan…

Top Four resolutions (source: University of Washington):
-          Increase exercise
-          Be more conscientious about work or school
-          Develop better eating habits
-          Stop smoking, drinking, or using drugs (including caffeine)

Tips for Sticking to your Goals:

Be Realistic – When setting yourself a resolution, you have to be realistic. You are only human, and trying to achieve something completely out of reach will no doubt put you under a lot of stress and even affect your esteem. Start small if you can, and increase your targets if all goes well! It is great to dream and have a vision of where you want to be eventually, but break it down; goal at 3 months, goal at six months, at nine, and finally at a year.

Reward Yourself – Positive reinforcement, the giving of rewards when things go well, will encourage you to succeed time and time again, and makes it easier on you to accept the changes you are undergoing.
DO NOT punish yourself – this can have a negative effect and make you feel like a failure. Learn to forgive yourself. 

Talk to Others – Getting support and encouragement from those around you can greatly improve your success with a resolution. They might even join in, which can increase your performance – e.g. going for a morning run twice a week, or cutting down on how much you smoke. Chances are others will want these changes too, and so you can support and motivate each other.

Track Your Progress – Keep an eye on how you’re doing. This can increase your motivation, as you’ll see how well you’re doing, or which areas you need to improve. It is important to do this so that your progress and the changes you are going through are clearly set out in your mind.

Good luck, and stay positive. This isn’t the be all and end all of making the changes that you want in life. A new year is a fresh start in many ways, not just resolutions. And if you’re having trouble thinking of resolutions, look back over last year and think of things you might want to have changed or done differently if you had the opportunity. Don’t regret what’s in the past – use it to create yourself a better future.

A useful website in which you can select a resolution and track your progress: