Page last updated at 12:20 GMT, Wednesday, 25 November 2009

Scrubbing up: Your comments

In this week's Scrubbing Up, Dr Jennifer Wild, a senior lecturer at the Institute of Psychiatry says that GPs are still pushing drugs to people with depression despite more psychological therapies being available.

Dr Wild says doctors need to realise that therapies such as cognitive behaviour therapy (CBT) can work and should choose to offer them to patients.

What do you think? Here are some of the comments you have been sending in to this week's Scrubbing Up.

YOUR COMMENTS

What comes first? Does your low mood cause faulty thinking or does faulty thinking cause your low mood? I believe that it is the former. No amount of positive thinking can change your depressed state!!!
Lian McDade, Stirling

My GP is great but the local community mental health team are terrible. They promise things they cannot deliver and yes, there is CBT available but there is a waiting list of six months. There seems to be no parity between the standard of service offered in different areas as a previous experience of services in Carmarthenshire was really good.
Ben, Dartmoor

In my experience, based over the last 40 years - I am 50 years old - the GP's role has been transformed. Their primary function would now appear to be the collection and collation of data on behalf of the government. Their secondary role would appear to be to act as a sales force to the pharmaceutical industry. Consequently, it comes as no surprise to me that they are now being tasked with promoting psychological therapies, given the huge number of courses now available in the discipline. Who better to create the market in which to employ the next generation's psychotherapists? Personally, I lament the passing of the General Medical Practitioner.
Chris Neame, Bodrum, Turkey

Whilst I agree that therapy is more beneficial to someone suffering with depression in the long term, the fact that there is not therapy widely available enough means that drugs are vital for keeping people going. In the past I have been told the waiting list for my area for CBT is 18 months - which is far from acceptable given the increased level of suicidal thinking. The availability of immediate therapy needs to be addressed long before Doctors should be encouraged to stop prescribing medications.
Jane, York

I think it's easy to criticise GPs, and despite the recent introduction of IAPT, the reality is that mental health services are still limited, with many of these new workers still in training. There are still long waiting lists for CBT, and often GPs have little choice but to offer resources available to them. Antidepressants aren't an ideal solution for mild - moderate mental health problems, but until there is are shorter waiting lists for psychological therapies, the reality is that people will be prescribed antidepressants to stop them deteriorating.
Hannah Desmond, Bolton

As a GP, I agree that CBT is an effective and useful tool. The problem is accessing it in a timely manner. Current waiting lists are in the region of eight weeks for brief counselling and over six months for a clinical psychologist. It is obvious that we tend to reach for medication in these circumstances and to be honest drugs are generally effective. Mental health services would not be able to cope with increased demand for CBT.
Mark Wells, Brynmawr, Blaenau Gwent

Whilst I agree CBT should be offered, I see no issues with prescribing medication - even as a first port of call. For me, it got me back to work quickly, and despite what Dr Wild says - I learned under the influence of the medication methods to deal with it in the long term. Under the medication, I noticed how my thought patterns changed - how I'd no longer focus on the things getting me down, changing my train of thought before plummeting down that self-reinforcing spiral of gloom. Once off the drugs, I strive to continue to think the way I did under the influence. And I'm managing quite easily now, two years later with no reoccurrences.
Alex Davies, Perth, Australia

My GP put me on light medication and paid for a lot of therapy. After three months and no improvement, he referred me to a psychiatrist. All the psychiatrist wanted to do was put me on higher and higher doses of medication. The psychiatrist said he would put me on the waiting list for CBT but after nine months of waiting he then said CBT wouldn't be right for me and just increased my medication. Before being critical of GPs, maybe you should start with the psychiatrists.
Edward, Tavistock

I am a GP. I would love to be able to refer my patients for CBT. Dr Wild is quite right that this would be better for many patients than drugs. Whilst on paper CBT is available, the reality is that unless patients are actively suicidal, the waiting lists are many months long, despite the increase in provision of IAPT. My depressed patients, given a choice between medication now and CBT a few months ahead, make their own choices. Without wishing to criticise Dr Wild, the reality is that the resources available to a front-line GP are very different from those available in a university department of academia.
Alan Francis, Bridlington, East Yorkshire

My GP prescribed antidepressants when I asked for them. I didn't tell him the half of what was going on in my head, and I wouldn't have told a psychiatrist or psychologist either. The medications eventually got me to a point where I was amenable to counselling and where counselling could do some good. But on that day when I asked for medication, I wasn't ready for even CBT and wouldn't have gotten a thing out of it. I needed medication first.
Lisa, Las Vegas, Nevada, USA

While many psychotherapists believe that people can be treated for depression, especially where the antecedent of the depression was post traumatic stress disorder, by getting them to 'change their distorted thinking' patterns using CBT, there is a considerable, sometimes fierce, debate in the professional literature about the efficacy of CBT for a wider range of psychological problems. There are many other psychological conditions which remain stubbornly resistant to both CBT and pharmacology, however sophisticated, in the longer term.
Trevor Habeshaw, Bristol

After suffering depression when my wife left me with two young children I really struggled on my own and asked the doctor for help to which he prescribed 'Citalapagm' the non addictive drug, but one time when I ran out at a weekend I thought I was going to die. I was told these were mild anti-depressives but the effects of not taking them were horrendous. I would like to see more natural therapy than drugs that nobody really knows the long term effects of.
Andy, Liverpool

I was originally diagnosed anxiety with depression by the health centre based at my university and I was offered CBT, although for a limited time. I felt frustrated with this as at the time as it didn't really feel like it helped if I went every week. Only then did my doctor prescribe medication. Since then, I have seen GPs who have prescribed medication without pushing for me to try therapy again as I said I didn't feel it helped me. And my current GP has let me have an unlimited repeat prescription and has failed to request that I come in for a check up. I am managing my depression on my own now and gradually reducing my medication dose as I know how I react to it.
Laura, Stockport

I have had experience of the system and unfortunately I fear that nothing will change as long as GPs still have an "I know best, don't question me" attitude to patients. It is an attitude which all other professions have had to lose but unfortunately GPs retain. I have suffered from mild depression for the past few years and fear going to the doctors as they always try and push a new drug on me but never give in to my requests to see a psychiatrist about assessment for treatment.
Paul Moore, Luton

I disagree to an extent with Dr Wild. When my depression rose to the surface in March this year, I needed a quick fix to start the healing process. Once the anti-depressants had started working, I was ready to start CBT. I now feel well enough, and in control enough, to come off the anti-depressants. CBT without prior medication could be likened to operating without first anaesthetising the patient. You need the medication to be able to access the reasoning part of your brain.
Christopher, London



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