BACP sets outs to press home the 'problem with anti-depressants'

May 3, 2003

The British Association for Counselling and Psychotherapy is pushing for an increased role for psychotherapists and counsellors in primary care services.

A new press release has outlined why the organisation believes anti-depressants have limited efficacy.

The release read: "The British Association for Counselling and Psychotherapy calls on the BMA, The Royal College of Psychiatry and the Department of Health to... ensure that primary care practices are in future fully supported by qualified counselling and psychotherapy services"

Below is the press release in full.

...........

The problem with drugs

"In modern healthcare, depression is treated in two broad ways - psychological therapy and anti-depressant medication. Many scientific authorities believe a combination of these approaches is the best option for most patients.

However, very few (apart from the experts) understand the differences between the various types of psychological counselling. According to recent research in a forthcoming report for the London Mayor's office and the GLA GPs are probably the least well informed. They fail to diagnose more than half of all cases of depression correctly. Even so, 90% of people with mental health problems are treated in primary care and one third of people with serious mental health problems are treated in primary care.

A key area of concern, says the report, is the 'lack of (availability of) psychological therapies' . There is a real need to increase the profile of psychotherapy and counselling and the central role it can play in mental health. But for more reasons than you might suppose.

Whilst drug therapy for depression is in general well validated, there remain doubts about the claims made by many manufacturers. There are also anxieties from patients about the potential side and withdrawal effects of these products.

For instance, claims for overall efficacy rates of the most popular anti-depressants have never exceeded 70 per cent. That means 30 per cent of all patients - treated by drug-care alone in General Practice - can gain no benefit whatsoever. It is sometimes claimed that overall efficacy rates are lower than 70 per cent.

There is also criticism that anti-depressant trials are NEVER genuinely "double-blind" so long as the 'control' agents are sugar pills (almost invariably the case). The reason: drugs cause a physical response, unlike the sugar, so guinea pigs can always TELL when they are taking an anti-depressant and respond with a strong placebo effect.

It is argued by some that much of the effectiveness claimed for anti-depressants is attributable to placebo effect (e.g. Dr Irving Kirsch, Psychologist, University of Connecticut, www.apa.org/releases/debate.html). If atropine (which causes anti-depressant-like side effects but has no other activity) rather than a sugar pill is used as the placebo, he suggests the effectiveness of most anti-depressants would fall.
Some commentators claim the original evaluations of Prozac show that it has CAUSED depression (www.garynull.com/documents/prozac2.htm) (www.namiscc.org/News/2002/Fall/ProzacSuitSettled.htm)

There is evidence that some of the most popular anti-depressants interfere with levels of sexual desire, which may also cause depression. Seroxat is in the firing-line: "A coroner has called for Britain's biggest-selling anti-depressant to be withdrawn after a retired headmaster who was prescribed the drug was found dead with slashed wrists. Colin Whitfield, 56, died just two weeks after he began taking Seroxat… The coroner said 'I have grave concerns that this is a dangerous drug that should be withdrawn until at least detailed national studies are undertaken'". (Daily Mail, page 17, 14 March 2003).

Despite these concerns, perhaps the real learning point for health professionals is that drug intervention by itself offers only half a treatment. Drugs alone:

1. Do not solve any of your problems
2. Do not provide insight into relationships
3. Do not improve your communicate skills
4. Do not teach new behavioural strategies
5. At best pills buy you that vital window of time during which you could TRY to solve your problems

It is worrying for instance, that a substantial proportion of patients who recover from depression will have at least one subsequent episode, and many will have an average of five to six subsequent episodes. (Keller MB, Diagnostic issues and clinical course of unipolar illness, Review of Psychiatry, American Psychiatric Press, Washington DC, 1988). It would obviously be better to help patients understand their own depressive behaviour rather than just give drugs to dull the brain. Full treatment means learning how to live differently.

The British Association for Counselling and Psychotherapy therefore calls on the BMA, The Royal College of Psychiatry and the DoH to recognise this problem at the heart of modern mental healthcare and ensure that Primary Care Practices are in future fully supported by qualified counselling and psychotherapy services.

Up to 60% of fundholding doctors chose to hire counselling practitioners. However, funding is threatened and 40% of patients still do not receive the support evidence suggests they need. Doctors themselves must receive better mental health training.

As far as relevant counselling research goes, Professor Michael King's £500,000 double blind trial (BMJ 2000) showed that counselling is more effective, and cost effective, in treating depression than doctors with drugs in the first 12 months of the illness (which would cover the majority of depressions).

On the basis of such research, it is the opinion of the Department of Health in their document 'Effectiveness Matters' that: "Psychological therapy should be routinely considered as an option when assessing mental health problems" - www.doh.gov.uk/mentalhealth/treatmentguideline

"Counsellors do not claim to possess a panacea. It is time the drug companies were equally candid. It is when pharmacology supports the best talking therapies that patients get the help they truly need" Alan Jamieson, Deputy CEO, The British Association for Counselling and Psychotherapy.

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