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Self-help 'is ineffective'

By Nerys Nairon

Self-help is not a clinically effective add-on treatment in patients prescribed antidepressants, a new study has found.

The 'disappointing' findings further reduce the options for GPs trying to manage patients with depression while waiting months for access to psychological therapy.

Researchers found no significant differences in depression scores for standard GP treatment with antidepressants plus or minus a self-help programme in patients with moderate to severe depression.

Patients on the self-help programme filled in questionnaires and received individually tailored workbooks.

The study, published in Psychological Medicine last month, showed patients and GPs were highly satisfied with the self-help programme, and patients reported improvements in know- ledge about depression compared with the control group.

But the researchers concluded the individualised self-help package did not have any 'identifiable beneficial effects' on trajectory of improvement, symptom change, medication adherence, social adjustment or self-reported global functioning.

Study leader Professor Paul Salkovskis, professor of clinical psychology and applied science at King's College London, said the trial showed 'really, really disappointing results' for clinical improvements with self-help.

'In the more severe cases self-help may be insufficient and more research needs to be done. None of the packages are getting anywhere near the effect sizes that therapists deliver.'

'The depressing reality is that all these people should have been having CBT but there was not any on offer.'

The study, involving 96 patients with moderate to severe depression in GP practices in Oxford, found both groups improved by a similar amount over the six-month study period.

Dr Ian Walton, chair of Primary Care Mental Health and Education and a GPSI in mental health in Tipton, West Midlands, said: 'The problem with self-help packages is that humans are designed to need interaction.

'We need feedback and direction, in the same way CBT packages on computer work better if there is someone to direct you.'

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