Antidepressant Usage Challenges CBT Treatment

CBT clients often wish to discuss discontinuation of their antidepressants or take precipitous action to do so. But CBT training rarely addresses such issues. The matter has been  given an extra urgency by a recent paper by James Davies and John Read which found that that half of antidepressant users have significant side effects when they attempt withdrawal., see link

https://www.dropbox.com/s/rs6x0hapwduccgz/antidepressants%20Davies-Read%202018.pdf?dl=0

But these withdrawal symptoms can be labelled as a return of anxiety/depression, a misdiagnosis and the GP then increases the dosage or switches the person to another antidepressant. Clients often then complain of being ‘zonked out’ and an increase in symptoms particularly impaired concentration, making CBT more difficult. The danger is that the CBT therapist can feel that they are on uncertain ground, marginalise the client’s medication concerns and hurriedly revert to whatever protocol was being followed. Unfortunately the therapist and GP are most likely located in different laces with no opportunity to chat about such matters.

The NICE guidelines for GPs states that withdrawal symptoms for antidepressants last a week or two after gradual withdrawal. but this advice was based on studies where patients had been on antidepressants for just 8-12 weeks.  Davies and Read point out that over half of those on antidepressants have been taking them for more than 2 years and suggest that this is a very different ball game, with withdrawal symptoms beginning some time after discontinuation. They call for more real world studies of the discontinuation of long term antidepressants.

In the light of the Davies and Read paper NICE is reconsidering its guidance to GPs.

 

Dr Mike Scott

Clinical Commissioning Groups Not Listening To GP’s on IAPT – The Chaos of Liverpool

Earlier this month Pulse reported ‘In Liverpool, Dr Barnett (GP) says services last year ‘couldn’t have been much worse’ and ‘GPs did not bother to refer patients [to IAPT] because nothing would happen’. Yet the Liverpool Clinical Commisioning Group in its report ‘Talk Liverpool Contract’ dated July 10th 2018 talked of a steady improvement of IAPT’s performance such that it fell just short of the target 50% recovery rate!  Via my MP Maria Eagle I complained that my own independent study of 90 former IAPT clients showed an overall 9.2% recovery rate. https://www.dropbox.com/s/flvxtq2jyhmn6i1/IAPT%20The%20Need%20for%20Radical%20Reform.pdf?dl=0

The Chief Operating Officer,  for Liverpool CCG, Mr Ian Davies replied simply re-iterating IAPT’s national claims.

It is clear that when CCGs talk to IAPT Managers the discussion is about operational matters e.g number of client’s seen, waiting times etc and never about whether the Service makes a real world difference to patient’s lives. CCG’s have blindly taken on board IAPT’s own metric of recovery and its’ assessment of meeting targets, there would never be such incredulity about a drug. NHS Foundation Trusts ought to be challenging this naivety.

Dr Mike Scott

Unannounced Visits To IAPT Reveal……..

The Care Quality Commission (CQC) pay unannounced visits to establishments for vulnerable people and have thereby revealed tragedies such as Winterbourne View in 2011.  But the clients of IAPT are no less vulnerable, yet there is no inspection on their behalf.  I wonder what the CQC would make of a lady on the autistic spectrum accepted into IAPT for management of her anxiety,  catered for by a high intensity therapist who is allowed only 6 sessions, with no knowledge of autism or of the grey are between OCD rituals and aspects of autism.  The CQC would surely cry foul, but this is not an isolated example.

If IAPT practitioners are to be based in GP practices they could fall within the CQC’s orbit of ‘people with poor mental health’.  Had they visited the establishment where   the would be Bake Off winner,          Kim-Joy https://www.theguardian.com/tv-and-radio/2018/nov/12/i-was-preety-much-mute-at-school-the-bake-offs-kim-joy  worked they would have heard her tell, that she has a Master’s in psychology, she could provide only up to 6 half hour sessions in low intensity and was heading off to other pastures.  If they needed an independent window on what is going on in IAPT I would have given them the following comments from amongst the 90 clients that I saw:

https://www.dropbox.com/s/flvxtq2jyhmn6i1/IAPT%20The%20Need%20for%20Radical%20Reform.pdf?dl=0

There are valuable TV programmes such as ‘GPs Behind Closed Doors’, I wonder what the public would make of ‘;IAPT Behind Closed Doors’ but such a programme would have to escape censorship by NHS England (and IAPT leadership)  something GPs would not tolerate.

Dr Mike Scott

IAPT Half Baked

IAPT dominates mental health provision, so you have to be free of its’ clutches to voice dissent.  The        Guardian reported on a  dissident (see link below) ” Before Bake Off, Kim-Joy was a psychological wellbeing practitioner, having done a master’s in psychology………but I’m at a point where the clinical side of mental health isn’t for me. You do a questionnaire with each person when they come in. So they tell you how many times that week they’ve felt low, which is a really weird question. It’s not real. Professionals need it for their data, to see who’s recovering. A lot of people just make up their answers, because they want to sound like they’re feeling better.”
We need an ever rising chorus of dissidents for clients not to continue to suffer in silence. There has to be a commitment to honesty and not fake news e.g ‘51% recovery’. The silence over the true                    functioning of IAPT clients is eerily reminiscent of the silence over ‘shell shock’ in the two world wars.
Dr Mike Scott

IAPT’s Bonfire Night

Yesterday Pulse published its’ investigation of IAPT, it was the effigy on the bonfire despite NHS England’s protestations, see link below:

https://www.dropbox.com/s/f19vxn1h4kd37bf/IAPT%20Bonfire%20%20Night%20Revealed_%20How%20patients%20referred%20to%20mental%20health%20services%20end%20up%20back%20with%20their%20GP%20_%20Article%20_%20Pulse%20Today.pdf?dl=0

It follows close on the heels of the BBC investigation., see link http://www.bbc.co.uk/news/health-45895541

What is still not properly recognised is that despite over £1billion being spent on IAPT there has been no independent assessment and my work suggests just a 15% recovery, it is a scandal.

 

Dr Mike Scott