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Don't get too down about depression treatments

CBT is over-rated. Antidepressants hardly do a thing. Counselling is no good in the long run. Copperfield was quite depressed by it all, before a revelation brought him out of slough of despond.

CBT is over-rated. Antidepressants hardly do a thing. Counselling is no good in the long run. Copperfield was quite depressed by it all, before a revelation brought him out of slough of despond.



Hey, it's not all bad. Worse things happen at sea. Mustn't grumble. Well, actually, it is, they don't, and I must.

Because first we had the news that antidepressants show little of the desired effect. And now we hear that the current psychological flavour of the month, CBT may be over-valued too.

Blimey, next they'll be telling us that counselling doesn't do any long term good. Oh - they have already.

Which leaves us where? Buggered, basically. We have a significant proportion of our practice population suffering a pathology that is fast becoming untreatable. And if the old adage is true about the patient who makes you feel depressed being depressed, for ‘significant proportion', read ‘all'.

The only shards of light in this slough of despond are those provided by two key facts. Well, OK, opinions of mine - so virtually facts.

One: I'll bet many of the patients who contributed to the negative trials and systematic reviews simply weren't depressed. They were teary, weary or grumpy, probably because their boyfriend had just dumped them, or because they didn't like their job. But that's not a neurochemical imbalance, it's normal – and normality always tends to be refractory to treatment.

And two: whoever makes these pronouncements about the uselessness of treatments for ‘depression' seems to be labouring under the misapprehension that we're trying to help patients. Doh! No: these psychological ‘therapies' are for our benefit.

They help us GPs get these patients out of our rooms without using up all of our Kleenex and consulting time.

Come back in a month for your next prescription, or go and book an appointment with the in-house counsellor, or I'll put you on the waiting list for CBT…they all amount to much the same thing.

Which is that I'll do something to get you off my back while we wait for you to find that new boyfriend or better job, when, hey presto, you'll be cured, and we can all pretend it never happened.

There. So all these treatments really are worthwhile, despite what the media and the meta-analyses say. Feel better now?

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