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

What Chance Effective Psychological Treatment?

“If You Have Heart Problems and Depression You Are Four Times More Likely To Die In The Next Year or Two Than Those With Cardiac Problems Minus Depression”

– All In The Mind, Radio 4 May 3rd 2017.

 But scarcely more than the ‘tip of the iceberg’ of those with mental health problems receive psychological help

Iceberg, Water, Blue, Ocean, Ice

Here are two examples of people that I have seen recently who have been drowning in the ‘frozen waters’

‘Sarah’ was made redundant and had a fall 3.5 years ago. She has suffered from depression since and the only help she has been offered is antidepressants by her GP. Psychological therapy which is the NICE approved first line treatment for depression has not been discussed.

‘Ivan’ recently had a serious road traffic accident two years ago, and was referred by his GP to his local IAPT Service. He said that had a few face to face conversations with the staff but they did not offer him a diagnosis and said that they did not have the funding to treat him. Ivan was referred back to his GP with a recommendation he be referred to secondary care. On examination I found that he was suffering from PTSD complicated by the back pain he had suffered in the incident. The Secondary Care Unit provided no diagnosis but suggested a group programme could cater for his needs but he was not keen on this.

Dr Mike Scott

 

Moving Forward

Perhaps this diagram may help us in how we can move forward from this:-

 

Ultimately we want to make a socially significant to client’s lives, a real world difference, [See Scott (2017) Towards a Mental Health System that Works: a guide for practitioners. London: Routledge], not just a questionable change on some psychometric test.