Is a pill really the answer to your blues?
The number of prescriptions for antidepressants has doubled in the last 10 years, but other treatments can work just as well. By Karen Evennett
Your job's on the line, you're stressed, sleeping badly, and life seems a struggle. You can't remember the last time you had a really good laugh, and most days you feel like bursting into tears. You know that something's got to change so you go to your doctor for advice. And, before you know it, they are writing out a prescription for antidepressants...
You probably think this couldn't possibly happen to you; if so, think again. For many GPs, reaching for the prescription pad is the easy option, says Jane Harris of the mental health charity Rethink. Most are short of time (the average consultation takes 11 minutes), few are trained in mental health, and 78 per cent* admit to prescribing antidepressants, even when they think an alternative such as psychotherapy or even exercise would be better.
Shockingly, there were 36-million prescriptions for antidepressants in 2008, compared to just 18 million 10 years earlier. By 2020, experts predict depression is going to be the UK's biggest health problem, above cancer and heart disease, and ‘the recession is bound to make things worse,' says Jane.
How do you know if you need drugs?
Signs that you're depressed include a persistent feeling of infinite sadness, waking up very early every day, and constant tiredness. If you're a patient at a large practice, ask if you can see a GP with a special interest in mental health. Before diagnosing depression, your doctor should work out how many symptoms you have from a list. It's called the ICD-10 diagnostic criteria ask if that's what he's used, and whether it shows you're mildly, moderately or severely depressed. Ask about psychological therapies, too. ‘The Government health watchdog NICE has said for years that people with all kinds of depression also need psychological therapies. If the waiting list's too long, your local depression support group (Rethink has 140 nationwide) will know of GP practices with their own counsellors,' says Jane.
If you accept the prescription...
You need your GP to give you a long-term plan so you know how long to expect to be on the drugs, and how he will help you come off them. They're not addictive, but sudden withdrawal can cause horrible side effects. It normally takes four to six weeks for antidepressants to start working, but you should have your first review with your doctor after two weeks. Keep a list of any side effects so he can find you a more suitable drug if the first one's not right for you. Some can cause insomnia, nightmares and loss of libido. The newer drugs (selective serotonin reuptake inhibitors or SSRIs, such as Prozac and Citalopram) are supposed to have fewer side effects than the old ones (tricyclics such as Amitrip and Aventyl). And few people are prescribed the old ones these days, as they're more dangerous if you overdose. If you suffer side effects on one SSRI, you could take another and be fine.
How do they work?
Antidepressants were developed in the 1950s and there are now about 30 to choose from. Twice as many women as men take them. Psychiatrists aren't entirely sure how they work but they're thought to increase the activity of key mood-boosting neurotransmitters in the brain. After three months, 50-60 per cent of patients feel a great improvement - according to the Royal College of Psychiatrists - but so do 25-30 per cent of those taking a dummy pill.
What are the alternatives?
Antidepressants shouldn't be prescribed for mild depression, and rarely for moderate depression. St John's Wort (from health food shops) is widely prescribed for depression in Germany, and is recognised by the Royal College of Psychiatrists. Research shows that exercising for 30 minutes a day also significantly improves depression symptoms, while even 10 minutes a day will boost your mood. If your doctor can't refer you on to an exercise programme or personal instructor, charities such as Mind (www.mind.org.uk) and Rethink (www.rethink.org; 020 7840 3188, open 10am to 1pm Monday to Friday) can put you in touch with walking groups, gym buddies and even boxing clubs, depending on where you live. Both charities also offer cheap or free counselling (such as cognitive behavioural therapy, or CBT, which helps you to change negative thought processes without constantly dragging up the past).
*Survey by the Mental Health Foundation
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