10th October 2013
World Mental Health Day
This year the World Mental Health Day is focused on highlighting the importance of quality of life and later years.
As my contribution to the world Mental Health Day I want to ask a question of the world at large.
Why is mental health deteriorating?
There is a fairly constant stream of data showing that 1 : 6 to 1: 4 of the population will suffer from a mental health problem at some point in their lives. To me this seems far too high a figure to be a valid representation of the population. Especially as it seems that depression and anxiety are seen to be increasing. Depression is now the largest source of disability in the USA and the Second largest in the world. Furthermore antidepressant prescriptions are increasing with over 46,000,000 prescriptions per year in the UK alone.
Yet, depression is a curable disorder. With a few minor exceptions I see no reason why anyone should remain depressed. There is no viable biological explanation for depression (despite what you may have been told) and yet the grip of depression reaches further and further afield.
One explanation for the increase in mental health problems is that the pharmacological treatment used actually makes long term outcomes worse. This argument is very coherently captured in the book Anatomy of an Epidemic. By Robert Whitaker isbn 978-0-307-45242-9. I recommend this as a bed time read.
My concern and that expressed by Robert Whitaker is that psychiatric medications are at best mildly effective in the short term for some condition s but tend to make conditions such as depression, anxiety, bipolar disorder and psychosis much worse in the long term. In fact, so much worse that the pharmacological medications may themselves have created the increase in mental health problems seen over the past 50 years.
My own evidence for this really hit me when I was talking about the effects of CBT on medicated patients in my recent report of the Blues Begone randomised controlled trial.
In my trial NHS patients were stable on medication albeit at a high moderate to severe level of depression and anxiety. They had been stable for many months (21 months on average) making the word antidepressant a misnomer! Following computerized CBT their depression and anxiety scores dropped like a stone with 72% making big changes.
For me this chimes with the idea that antidepressants don’t treat depression but they may make the symptoms of depression more tolerable.
I think that if we want to take the psychological health of the population seriously then we need to investigate this problem and lay it at the feet of those who are paid to be the guardians of public health.