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NHS Will Soon Offer Therapy Before Prescribing Anti-Depressants

NHS Will Soon Offer Therapy Before Prescribing Anti-Depressants




Photo by Tim Mossholder


NHS doctors are now set to offer their patients who are experiencing mild to moderate symptoms of depression  alternatives to antidepressants, as a way to improve their mental health.

The National Institute for Health and Care Excellence (NICE) stated that patients should be offered a choice of therapy or exercise and suggested group classes in meditation or behavioural therapy may be a positive alternative.

The new draft guidelines, which are subject to consultation also call for the option of individual counselling sessions to be made available to all.

They stated that doctors should not: ‘routinely offer antidepressant medication as first-line treatment for less severe depression, unless that is the person’s preference.’

Nice are now urging doctors to involve patients in conversations about what treatment options would suit them best based on their individual needs and wishes, adding that group cognitive behavioural therapy (CBT) could be offered as an initial treatment rather than offering standard medication. The treatment focuses on how our thoughts, beliefs, attitudes, feelings and behaviour interact, along with importance of setting goals and developing better coping skills.

Barbara Sahakian, a professor of clinical neuropsychology at Cambridge University in the United Kingdom, indicated that talking therapies are ‘much better’ options for many patients, however, for them to be successful, patients must be ‘committed to them’ and said they require effort.

Speaking to the BBC’s Radio 4 Today programme, she stated that ‘Some people do prefer a quick fix, but it is better for you in the long run to be able to manage your emotions and depression rather than have to take drugs for it, especially if you have mild depression.’

Other interventions suggested by NICE include group behavioural activation (BA), which can help us to recognise negative thought patterns and focuses on behaviours that are linked to improved mood.

Individual BA or CBT may also be offered alongside group mindfulness or meditation, group exercise, bibliotherapy and counselling.

NICE indicated that people could be offered a ‘menu’ of treatments to choose from as part of a discussion about what may be contributing to their depression, and the person’s experience of any prior poor mental health and treatment. It said the new draft guideline is the first in 12 years to identify, treat and manage depression in adults. A similar range of interventions, along with the option of antidepressant medication, is available to those choosing a first line treatment for more severe forms of depression.

Dr Paul Chrisp, director of the centre for guidelines at NICE, stated that: ‘People with depression deserve and expect the best treatment from the NHS which is why this guideline is urgently required. The Covid-19 pandemic has shown us the impact depression has had on the nation’s mental health. People with depression need these evidence-based guideline recommendations available to the NHS, without delay.’

The guidance also tells GP’s to discuss mental health waiting lists with patients and how long they may need to wait for treatment particularly in relation to the Covid 19 Pandemic which has resulted in even longer delays that usual for mental health referrals.

Nav Kapur, professor of psychiatry and population health at the University of Manchester and chair of the guideline committee, said ‘As a committee we have drawn up recommendations that we hope will have a real impact on people who are suffering from depression and their carers. In particular we’ve emphasised the role of patient choice suggesting that practitioners should offer people a choice of evidence based treatments and understanding that not every treatment will suit every person.’

The guideline also suggests that discussions must also be made around what happens if an individual requests to stop taking their antidepressants, including that withdrawal may take weeks or months in some circumstances.

Figures from the NHS indicate that in excess of 20 million antidepressants were prescribed during the period between October and December 2020. This is a 6% increase compared with the same three month period in 2019. Antidepressant use has been shown to be steadily increasing year on year since 2015.

A study by the New England Journal of Medicine found that those who stay on antidepressants ‘long term’ are less likely to suffer a relapse in their mental health than those who withdraw from them. They also found that given the right support early on, many can come off their medication safely.

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