The results of a recent study published in the in The Lancet last week, comparing the use of Mindfulness Based Cognitive Therapy (MBCT) with conventional drug treatment for recurring severe depressive episodes, recognised the equal value of physiological therapies (specifically MBCT) when compared to drug treatment for depression. (PREVENT was a randomised controlled trial examining MBCT-TS versus maintenance antidepressants.)
In fact the results were slightly more positive for MBCT over drugs, with a lower recurrence rate for depression (44% relapse compared to 47% for those on drugs) and greater cost effectiveness (£112/patient to £124/patient). Cost effectiveness was achieved through group therapy sessions rather than one-to-one treatment and though the difference in cost seems small, spread over hundreds of thousands of patients the choice of MBCT over drugs could be a huge saving for the NHS.
PREVENT found evidence ‘to support MBCT-TS as an alternative to maintenance antidepressants for prevention of depressive relapse or recurrence at similar costs. It allows such individuals to stay well and maintain good quality of life. In patients who report childhood abuse, MBCT-TS might confer greater benefit than maintenance antidepressants in prevention of depressive relapse or recurrence.’ Other benefits of MBCT over drugs are avoiding becoming addicted to prescribed medications (many of which are recommended for use over short time periods only) and avoiding what can be the debilitating side effects of maintenance antidepressants such as:
- Drowsiness or confusion
- Feelings of panic or dread
- Increased thoughts of suicide
- Loss of libido, difficulty achieving erections, inability to reach orgasm
- Nervousness and agitation
- Weight gain
- Dry mouth
- Liver failure
- High blood pressure
- Risk of seizures at high doses
to name a few…
It has become increasingly unpopular to buck the trend for relying on drug treatment for anxiety, stress and depression, or speak out against the use of drugs for treating these increasingly common problems in our current cultural climate. So many people have been shepherded down the ‘drug’ route that it is almost impossible not to cause offence in some quarter. In my own experience the modus operandi for treatment at GP’s surgeries is focussed on ‘getting you back to work’ rather than making you well. When one considers the side effects of antidepressants this might indicate that the oath to ‘first do no harm’ is being firmly pushed aside. My own experience at my GP involved being put under quite a bit of persuasive pressure to take the drug option, as the waiting list for counselling or CBT is so long. In September 2014 Mind revealed that ‘one in ten (9.6 per cent) are waiting over a year between referral and assessment, while four in ten (41 per cent) wait more than three months.’
I do not mean to imply that doctors do not care but that they are under budgetary and cultural pressure to take the faster, cheaper option (funding for NHS trusts to provide mental health services has fallen by more than 8% in real terms since 2010). I was suffering from stress and the persuasive pressure was an extra burden at time when I was seeking support.
The current ‘quick fix’ solution is not right for all cases and it is hoped that in view of PREVENT’s findings, that there will soon be a sea change in health professionals’ approach to the care of the increasing number of us who are suffering from anxiety, depression and stress. The results of the study confirm what many of us know instinctively: that when people suffer from anxiety, stress or depression, they generally need human contact and community support rather than a bottle of pills.
The frenetic pace of modern life combined with the breakdown of the extended family and community is having hugely detrimental effects on an increasing number of adults and children alike. A recent YouGov survey for Mind found that 20 per cent of participants said workplace stress had put a strain on their marriage or relationship and the Mental Health Foundation report that 1 in 4 people will suffer some sort of mental problems over the course of a year.
Talking through problems one-to-one or in groups, benefiting from the support of family or feeling supported and valued by one’s close community are basic human needs. We are social animals and it is essential for us to share our highs and lows in order for us to feel fulfilled. Our cultural focus on money and possessions may be good for our governing bodies but it is not healthy for people, nor for Earth’s finite resources. I hope PREVENT will encourage people to insist on being offered a choice of resilience building therapies in their treatment and enable GP’s to be funded to proactively give that choice to patients.
It often takes a long time to approach one’s GP when beginning to suffer from anxiety, depression or stress. Many of us turn to other stimuli such as food, alcohol, or recreational drugs (such as nicotine, caffeine or illegal substances) as a means of coping with the pressures of modern life. The results of our compensatory actions are constant front page news; increased incidence of diabetes; obesity explosion; alcoholism and binge drinking on the rampage!
If we felt more able to seek help earlier, and the value of therapies which empower patients becomes fully recognised, the first steps toward treating the symptoms of our unhealthy culture without doing more harm may be taken. What we must begin to address if we are to heal ourselves is our toxic way of life. Recognising the importance of interpersonal relationships, getting a healthy perspective on what we ‘need’ to own, improving our work-life balance and re-connecting with the natural environment are all paths towards healthful living. Whilst it is not always possible to live close to extended family, we can focus on valuing our immediate families and building our community of friends. This natural support network is an important first port of call when we feel overwhelmed by modern life: a port of call which the health system can never truly replace.
I know that some of you will feel offended that I should suggest you begin to value your family and friends but I do not mean that you don’t already do so: only that it is beneficial to practice gratefulness daily; to act out your appreciation practically and to be proactive in building and maintaining your community. The same community will be there to support you when your burden becomes too heavy to carry alone.