The Antidepressant Era: Is England a nation on antidepressant meds?

In England a nation on anti-depressatns

Anti-depressant prescribing is far too high

This has been described as the antidepressant era. And you might well wonder if England is a nation on antidepressant meds.

Well, the National institute for Health and Clinical excellence (NICE) have recommended that GP s should only prescribe antidepressant medication for severe cases of depression because it is not cost effective otherwise.

Indeed, the research data do not support the use of antidepressants in mild to moderate cases of depression because they are not very helpful at all.

But clearly GPs feel the need to give a patient something that may have the potential to be useful which has led to this being dubbed the antidepressant era. But of course hope of a treatment through placebo effects is not the best clinical strategy. The NICE guidance is that a talking therapy or a self help tool such as Computerised Cognitive Behavioural Therapy (CCBT) be offered.

The Antidepressant Era: How common is depression

I looked into the whole issue of the antidepressant era a bit further so I could lay the bigger picture before you. The lifetime prevalence of mixed anxiety and depression for men,aged between 16 – 74  is estimated to be 9.1% of the population while for women it is 13.6% of the total population (source: Depression: The treatment and management of depression in adults: National Clinical Practice Guideline 90 NICE 2010, p.22).

Yet the level of antidepressant medication prescribing in some cities and towns is far above what might be expected based on these data. GPs are massively over-prescribing antidepressants we know this because the NICE guidance says don’t prescribe unless the depression is severe and we know from the data collected by the National Comorbidity survey that there are many less severely depressed people that prescriptions for anti depressants issued monthly.

Therefore GPs are prescribing antidepressants in preference to the treatment that is supposed to be offered. That is either computerised CBT or talking therapies. I hold the view that GPs are well meaning and committed to the well being of their patients. Therefore they must be over prescribing because they feel they need to, probably through lack of effective alternatives.

The Antidepressant Era: Is the doctor always right?

Is your doctor always right?

Is your doctor always right about the best psychological treatment?

As a member of the general public I rely on my doctor to know what to do if I have a medical problem! I am generally a well informed person (especially about matters psychological) but when it comes to skin problems, or cancer, of heart problems then I am no better informed than the general layman. I reply on my GP. But if the GP cannot offer what is recommended and known to be effective then this reliance is misplaced.

Some primary care trusts in the UK have tiny levels of therapists trained and ready to offer you CBT therapy should you want that as an alternative to antidepressant meds. If you live in one of the poorly provided zones for face to face therapy such as Hillingdon, Croydon, Stockton on Tees, Heywood, Middleton and Rochdale, Luton and many others then you need to take a degree of control over your own mental health issues. There is no alternative if you want to feel better any time soon.

Suppose your GP was doing their best but only had poor options to choose from! In some places in the country there is very little in the way of face to face talking therapies. There are no viable alternatives on offer from the NHS other than a long waiting list. Not a very attractive option when you have a pressing need for help with depression and anxiety.

The Antidepressant Era: Take responsibility for your own mental health

I believe that it is time to take more responsibility for your own mental health care. For cancer I probably say leave it to the doctors and the same with broken bones. But where your own well being, happiness and satisfaction with life are concerned; take more control.

My research, some of which is recently published in the journal Primary Care Today (Autumn 2013, pp28-29 Treating Depression – Are Therapists Out of Date?) shows that when you take control over your own depression or anxiety treatment you can finish with antidepressants, achieve good mental health and remain well.

Data from the article showed that Blues Begone was able to remove  60% of users from the clinical depression category (they were cured) and 50% of users from the clinical anxiety category (cured of anxiety). In addition it helped others make substantial clinical gains.

When we use the broader definition of clinical outcome favoured by the IAPT Talking Therapies organisation then we can state that with Blues Begone 70% of depressed users achieved clinically significant change and 60% of anxious users achieved clinically significant change.

There is a power in committing to and taking control over your own well-being that puts your efforts into stellar orbit. What you can achieve is only limited by your commitment to the process of feeling good again.

The Antidepressant Era: Blues Begone

Blues Begone

Blues Begone is an effective treatment for depression and anxiety

Blues Begone is a computerised CBT program that delivers 30 sessions of CBT therapy to you over a periods of 8 – 12 weeks. Blues Begone is usually delivered on a DVD that holds the program. You install it once and then it starts to learn about you. Blues Begone creates a unique treatment Roadmap to Recovery that takes you all the way from depression to wellness.

All you have to do is a little bit every day. Furthermore Blues Begone is engaging and interesting. See the comments of users who were interviewed after completing the program. They really enjoyed using Blues Begone while at the same time recovering from depression and anxiety.

Blues Begone offers a unique money back guarantee. Feel better or your money back.

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References used in this article


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Clinical depression treatments: Your soul has a cold (Kokoro no Kaze)

Clinical depression treatments vary tremendously depending on where you live. This comes from the fact that attitudes to depression can be very different across the globe.

Japan traditionally suffered twice the suicide rate of the USA. However, talking about depression in Japan had always been a very different matter from talking about it in Western countries. In our language, the word for depression is interchangeable with dips in landscape, economy or mood. But in Japanese the word for depression (utsubyo) was used only to describe major depressive disorders and/or mania. Indeed it was seldom heard outside psychiatric circles.

In Japan, to talk about or express feelings, people relied on the word ki or ”vital energy.” When describing low mood people might use the word ‘Ki’ and couple it with expressions of sadness because their Ki was sluggish, blocked or leaking.

Moreover there had always been a keep it to yourself (KITY) social norm in Japan where there was merit in not burdening others with your problems. And for both cultural and religious reasons people with mental health problems like depression were likely to suffer stigmatization, in addition, to the burden of their psychological problem.

Traditionally the major pharmaceutical companies had bypassed Japan when marketing anti depressants because there was not a disorder of depression recognized in Japan to treat and therefore no market for antidepressants. Until that is a new phrase was coined that linked the traditional Japanese notion of Ki and low mood. Kokoro no kaze (your soul has a cold)

Clinical depression treatments: Your soul has a cold

The effect of this clever combination of traditional word and understanding coupled with the new way to talking about something that was an unspoken problem for Japanese society started slowly but with gathering pace to change the status of depression. Depression became defined as a ‘real’ problem. And real problems have real solutions!

Clinical depression treatments: Antidepressant meds

So far so good. The problem I have with this story is not that depression in Japan was under reported and under treated, I think that is self evident.  And clearly the changing force needed to bring this problem into awareness against a strong and established cultural norm was very substantial. All of that I believe was to the common good. No, the problem I have with this overall approach is that in Japan depression has been characterized as an entirely biological problem that is therefore can only be solved by the use of antidepressant drugs.

Clinical depression treatments:  How the Japanese viewed low mood

To put the problem into an historical context the traditional way of thinking about suffering in Japan may shed some light on why depression was never considered a disease. ‘Melancholia, sensitivity, fragility were not considered to be negative experiences for Japanese hence they were not considered to be problems in need to a solution. They were not considered bad in and of themselves.

Clinical depression treatments: The medical model of depression

In contrast the medical model of depression categorizes suffering as pathological and a problem that requires an intervention. Normally this is a pill. It is the case that the treatment of diseases in more easily understood and funded by health insurance companies and national health agencies and of course the classification of something as a disease helps remove some of the potential for stigmatization. But it also creates a market for the solution where previously none existed. Some critics of this approach have argued that it leads to the pathologisation of normal emotion; the tipping point where moods become medical problems and as such it turns normal human experiences into commodities to be managed.

Clinical depression treatments: A Little history

Eli Lilly had decided in the late 1980s against selling Prozac into Japan as there was virtually no demand for antidepressant meds. Even though throughout the western world Prozac and other selective serotonin reuptake inhibitors, or SSRI’s were becoming a virtual cultural phenomena – the antidepressant era!

In 1999, Meiji Seika Kaisha a Japanese company began selling the SSR Depromel. Meiji was among the first users of the phrase kokoro no kaze.

The following year, GlaxoSmithKline (GSK) the maker of the antidepressant Paxil joined Meiji by entering the Japanese market.  At this point people did not realize they were suffering from a disease and so GSK put substantial effort into the re-education of the normal Japanese doctor. GSK created a simply message: ”Depression is a disease that anyone can get. It can be cured by medicine. Early detection is important.”

In the early 2000s GSK sent 1,350 Paxil-promoting representatives to visit doctors on average of twice a week. With additional campaigns to teach GPs and their patients about the symptoms of depression: ”head feels heavy, cannot sleep, stiff shoulders, backache, tired and lazy, no appetite, not intrigued, feel depressed.”

Clinical depression treatments: Recognition of depression is useful

I have to acknowledge that recognition of depression is better than not recognising it. Depression is a problem that causes untold misery. Even today in Japan data suggest that 6.6% of Japanese have depression.

Clinical depression treatments: Depression is a psychological problem

To promote depression as a solely biological problem is to tell an incomplete story. As a psychologist I am not a dispassionate observer of the capture of  depression by the medical establishment. I treat depression every working day and most of the time my clients never use antidepressant meds. Therefore my experience of clinical depression treatments shows me that depression is more than adequately treated by psychological therapy and probably best by CBT Therapy.  Nevertheless most psychological therapies are likely to have value as depression treatments.

I cannot blame the pharmaceutical companies for doing what they do which is to sell pharmaceuticals. And I know it is a common meme to bash the multi national drug companies. I can see they do a lot of good in many areas. If you have malaria you should take an anti malarial medication. But if you have a psychological problem that is better treated by a psychological therapy than a drug treatment then I have an issue with the bias in the message. That’s all.

The moral question is this: are we only consumers or human beings who can also consume? To assert and promote that depression is only a biological problem without also stating that it is a psychological problem is obviously good business for pharmaceutical companies but it is ultimately misleading and I think in the end immoral. If there are better depression treatments even though they cannot be packaged and sold by pharmaceutical companies they have an obligation to inform the public because that is a morally good act. I don’t observe this happening right now. How have we sleep walked to this place in the world where the pursuit of commercial advantage and money takes precedence over honesty, integrity and the common good?

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Natural Treatments for Depression

The holy grail of natural treatments for depression surely has to be something without side effects, that’s easy to use and has long term benefits. We often assume that natural treatments for depression fit more easily into this category but do they?


The problem is that when we look at the claimed beneficial compounds of these treatments very few appear to have actual ‘active ingredients,’ although all will undoubtedly have placebo (psychological) effect benefits, to a greater or lesser degree.

In this section I’ll talk you through the effect of a number of natural treatments for depression by considering how the psychological aspects combine with the ‘active ingredient.’

You may be surprised to learn as you read on that in many cases the psychological effect of these treatments is greater than the active ingredient. This opens up the possibility for the determined investigator to figure out how to harness the psychological effects and use them without the active ingredient to yield the ultimate in natural treatments for depression!

But first there is a natural treatment for depression that appears to yield clinical benefits over and above the psychological effects that accompany it…

St John’s wort for depression

St-Johns-wort-for-depression-1You’ve likely heard that one of St John’s wort uses is to treat depression but do you know what it is? St John’s wort is actually an extract of the plant Hypericum perforatum and it has been used for centuries for medicinal purposes which includes the treatment of depression. As a preparation it is widely available in health food shops and over the counter in pharmacies.

Antidepressant meds: The most common treatment for depression

As this section is about natural treatments for depression I will not be commenting on antidepressants per se, but I wanted to show you that much of the benefits of antidepressants (many gain valuable benefits from them) are available to you without taking the antidepressant itself. Hence no side effects! But you have to acquire a little knowledge to unlock this mysterious power. The power of placebo!

The powerful placebo effect (psychological effects)

The Powerful Placebo EffectSurely the most natural treatments for depression are those that originate within your own body. They have no side effects, no toxicity, no autoimmune issues, no natural limit on effectiveness and no fundamental cost. Furthermore they have all the power you could possibly want or need to combat depression. The only admittance criteria to use these powerful treatments are you have to want to use them. I think it is quite possible to use some elements of any placebo response as part of your goal to good mental health.

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