Talking therapies could be ‘as effective’ as antidepressants, claim researchers
New research published by the BMJ indicates that psychotherapy or talking therapies may be ‘as effective’ as antidepressants when treating depression in adults.
Researchers analysed data from 11 separate trials which compared the use of antidepressants with a psychological treatment approach, including counselling and cognitive behavioural therapy (CBT), among more than 1,500 patients.
The analysis, led by Austria's Danube University, found the latter approach to be “as effective” as medication in treating mild to moderate depression, with an improvement of around 45% reported across both treatment groups.
However, many experts still recommend a two-pronged approach to treatment for depression, with importance attached to patient preference when it comes to arranging treatment.
According to a YouGov study from last December, almost one in 10 adults are currently taking antidepressants in the UK and 55 million prescriptions were issued in 2014. 54% of respondents diagnosed with depression or anxiety said they were offered antidepressants alongside other therapies, while 34% said they were just offered medication.
The Royal College of Psychiatrists currently advise the talking therapy route when treating mild depression, and already recognise that talking treatments can be as effective as antidepressants when treating moderate depression. Despite this, mental health charities have previously expressed concern that drugs may be too often prescribed as a first line treatment as opposed to talking therapies.
Critics say five consecutive years of funding cuts have left many mental health services stretched to the limit, with counselling and CBT waiting lists of many months or even years in some areas. But budget cuts, say experts, are just part of the reason for the increase in prescriptions. Other factors cited include the economic climate, more people coming forward for help and also varying approaches to treatment from GPs.
Professor Simon Wessely, President of the Royal College of Psychiatrists and Professor of Psychological Medicine at King’s College London, says: “This confirms what many have been saying for some time. Both antidepressants and talking therapies such as CBT should be offered for patients with depressive illnesses. Both seem equally effective, and like all interventions across the whole of medicine, both have side effects. So the decision is going to be made on issues such as patient preference and of course availability. This study will reassure GPs that it is reasonable to prescribe antidepressants as a first line treatment for patients who wish it, whilst also arranging for talking treatments where available. In this country we have made major strides in making CBT more available but there is still more to be done. Finally, we should remember that it’s not either/or here – the evidence repeatedly shows that the best outcomes comes from both together. If I were to develop depression I would want both antidepressants and talking therapies.”
Half of depression sufferers “go untreated”
Professor Anthony Cleare, Professor of Psychiatry, King’s College London’s Institute of Psychiatry, Psychology & Neuroscience says that arguments over which course of treatment is most effective “should not obscure the fact that too many patients are currently not getting adequate treatment”. He says that, according to recent information from the Royal College of Psychiatrists, more than half of people suffering with depression go untreated. He adds: “The good news from this study is that patients can be reassured that both antidepressants and psychological therapies like CBT are likely to be effective treatments for depression.
“Some patients tell us they would prefer antidepressants and some psychological therapies. We know from other work that this is very important: patients show substantially higher recovery rates if they can have their preferred treatment.”
Dr Michael Bloomfield, Clinical Lecturer in Psychiatry, MRC Clinical Sciences Centre and UCL, says of both treatments: “It is not an exaggeration to say that for many people these treatments are life-saving. As a field, we should be moving away from a repeated debate about medicines vs. psychotherapy, and move towards research looking at how to predict who will respond to what type or combination of treatments.
“In clinical practice today one of the biggest barriers to recovery is a toxic combination of sustained funding cuts together with a fractured dismantling of services, particularly for patients with more severe and long-term mental illnesses. Outcomes for patients with mental illnesses will remain challenging unless this is urgently addressed.”
Dr Bloomfield recommends that future research should include other types of psychotherapy and combinations thereof, particularly for patients with severe or complex illness. He stresses: “No one should stop either a medicine or psychotherapy without discussing this with their doctor or therapist first.”
Rachel Boyd, Information Manager for mental health charity Mind, says: “Although the two treatments covered in the analysis are antidepressants and cognitive behavioural therapy (CBT) these should not be seen as the only options available for treating depression. In fact, Doctors should work with patients to find out what works for them. This should include having adequate information to make informed choices, timely access to health professionals to review and discuss treatment, as well as availability of appropriate treatment beyond antidepressants and CBT. Other options could include other forms of talking therapy, as well as advice on exercise and diet.
“Research by Mind, as part of the We Need to Talk coalition, found that people who were given a full and informed choice about treatment options were considerably more likely to feel that therapy was effective. Health professionals have to be able to provide this meaningful choice, but to do this they need to have the time and resources to draw on.”
What are antidepressants?
Antidepressants are said to rebalance neurotransmitter chemicals in the brain commonly affected by mood, including serotonin and noradrenaline. As with all medicines antidepressants can have side-effects and these can vary considerably from person to person, however many milder side-effects, such as nausea, headaches and appetite changes are said to be short term and often settle after persevering for the first few weeks of treatment.
Any concerns about medication, including side-effects or dose should be discussed with your GP.
What is cognitive behavioural therapy (CBT)?
According to NHS Choices, CBT is a talking therapy that helps people learn to self-manage problems by addressing the way they think and behave, by helping them understand how thoughts, feelings and actions are interconnected, and how patterns of negativity can become habitual.
CBT aims to help people deal with the problems they are facing presently, as opposed to problems they may have experienced in the past. It has been found to be effective in treating a range of mental health problems, including depression, anxiety disorders, obsessive compulsive disorder (OCD), eating disorders, phobias and post-traumatic stress disorder (PTSD).
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