Antidepressant prescribing is out of control. Why?

The prescribing of antidepressant drugs is now out of control. Antidepressant drug prescribing has risen year-on-year for two decades or more. Almost 60 million antidepressant prescriptions are now written annually in Britain, equivalent to one prescription a year for every UK man, woman and child. The inexorable rise in antidepressant prescribing has similarly continued in virtually all developed – and many developing – countries.

Counselling and psychotherapy is “prescribed” far less that antidepressants by mental health doctors – psychiatrists and GPs (family physicians) – despite counselling’s proven effectiveness in the treatment of depression (see NICE guidelines).

This major discrepancy cannot be explained by antidepressants perhaps being far more effective treatments for depression than counselling. Studies have found that the difference in effectiveness of antidepressants and active placebo is not clinically significant. (An active placebo is a substance that has no direct effect on the condition itself but does cause some effects, so the person knows they have taken something, as opposed to an inert or inactive placebo, which does not cause any effects at all).

Psychiatrists and GPs repeatedly tell us that the major discrepancy between antidepressant prescribing and other modalities is down to economics – to underfunding. This claim is not the whole story, far from it. The fundamental problem is not a funding issue at all; it is the mindset that drives mental health health services, and the priorities that arise from that mindset.

This mindset is largely the creation of those who lead mental health – psychiatrists and GPs, mental health doctors, society’s appointed foremost experts on depression. These doctors like to see depression as an illness, as fitting primarily into their familiar model of illness. It is therefore second nature for doctors to prescribe, since that is what doctors are trained to do. Their indoctrination into the medical system begins the first day they enter medical school.

This is a deluded view. Depression does not fit into medically-accepted definitions of disease. In his excellent book The Body Keeps the Score, psychiatrist Bessel Van der Kolk correctly states that depression is a form of learned behaviour.

There is an obvious cognitive dissonance about counselling for doctors. Counselling does not easily fit into the disease model as a “treatment”. It is not prescribed as a treatment for medical conditions generally, rather as a support for the person in dealing with their disease, but not as a treatment in itself. Therefore the idea that counselling can actually be a treatment in itself is a great deal more challenging for doctors to get their head around than prescribing.

Many doctors do in time become comfortable with the idea of counselling as a “treatment”, but by then, the horse has bolted. Most doctors have little training in counselling, don’t really understand it, don’t know how to practice it. So counselling remains somewhat “out there” for many doctors, whereas prescribing antidepressants is very much within their worldview, their personal toolkit, their modus operandi.

I have not heard any doctors calling for a cap on antidepressant prescribing in order to make more funding available for other therapies and approaches such as counselling. I am not suggesting that counselling is the only other valid option to antidepressants.

In my next book, working title Depression: Its True Nature (expected publication date April 2016), I will set out a far more accurate way of understanding depression than that provided by the medical model.

This understanding will present quite a challenge to the established medical view.

If you would like to be informed of developments regarding my next book and other updates, you can sign up for updates at my website https://doctorterrylynch.com/ and receive two free chapters, one from each of my two most recent books, Depression Delusion Volume One: The Myth of the Brain Chemical Imbalance and Selfhood: A Key to the Recovery of Emotional Wellbeing, Mental Health and the Prevention of Mental Health Problems.

 

 

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