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At the heart of general practice since 1960

Defeating depression, now the drugs don't work

Copperfield's all for talking therapies - if only there was someone properly qualified to talk to

Copperfield's all for talking therapies - if only there was someone properly qualified to talk to

I'm old enough to have played my part in the outstandingly successful 'Defeat Depression' campaign of the 1990's. I use the words 'outstandingly successful' in the sense that if you were the head of a multi-national pharmaceutical company then you were raking in enormous profits from the sales of antidepressant drugs of dubious benefit.

As for playing my part, I use that to mean that I did anything and everything I could to persuade people that antidepressants weren't usually the answer, especially if the presenting symptoms were more suggestive of anxiety. Whatever drugs you took, if Granny really was in the jailhouse, Daddy was on his death bed and Old Shep had taken to mauling the children rather than herding the sheep then nothing I could do with a prescription pad was likely to help.

A fleeting glimpse of the sales figures for SSRIs, MAOIs, NARIs and GTis around that time will demonstrate just how successful I was. The only fun I had was beating patients around the head with their copies of 'Listening to Prozac'.

Fast forward a decade. Talking therapies are now the flavour of the month. I find them a lot more palatable than chucking psychoactive medication around the place but it's hard to persuade someone who's got a PHQ-9 score in the high teens that they really ought to wait around for a couple of months on the counselling waiting list when they could start popping pills the following morning.

Tellingly one of the more popular replies to that suggestion is, 'Two months? I'll be better by then anyway...'

The Department of Health have jumped on the 'Talking rather than Taking' bandwagon big style. Down my way, Improved Access to Psychological Therapies (IAPT) has been re-branded as 'Time For Talking' and there has been a quantum leap in the number of 'therapists' available to listen to people talk their problems through.

The same people who were lambasting GPs for not prescribing enough antidepressant drugs in the '90s are now lambasting us for prescribing too many.

Last year there were three CBT therapists serving my practice, I now have access to thirty-six. They say they'll take on anyone who's a PHQ point short of self-harming or actually hearing voices. So far, so good.

But where do you conjure up thirty-three qualified CBT counsellors? The answer is, of course, that you don't. There are a lot of CBT therapists 'in training'. Patients might find themselves being assessed by a 'Psychological Well Being Practitioner' (in training) or a computerised 'virtual' therapist online. Only the really sick ones will get through to the CBT trained staff for some face to face banter.

And before they'll even consider taking the patient on they must have suffered significant symptoms for at least three months. Just in time, some might say, to catch the patient as they complete their recovery and to claim an assist.

The figures will show that patients subjected to counselling by microprocessor or trainee Well Being Practitioner will get better – simply because they were going to get better anyway. Money spent on retraining hairdressers and social workers to be fluffy quasi-psychotherapists would be better spent on setting up a fully qualified CBT service.

Copperfield

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