New approach could provide more help for depression

With reports showing a woeful lack of mental health support in the UK, some good news for depression sufferers

There’s been quite a debate going on in the mental health sector and while it may appear a bit tribal to an outsider, it could have a significant impact on how the NHS deals with patients diagnosed with clinical depression.

Depression is a huge and growing problem.

It affects more than 350 million people across the globe and the figure is rising fast; the WHO has predicted that by 2020 depression will be the leading cause of disability in the world.

The sheer volume of pharmaceuticals taken for depression has been rising by 20% annually across the EU.

In 2015 the UK alone reported 57.1 million prescriptions for antidepressants and revealed that at least one in every eleven patients visiting a GP was diagnosed with depression.

All the health professionals agree, however, that drugs can only ever treat the symptoms and mask the causes of the illness. Without proper treatment there can be no cure.

Therein lies the cause of the recent debate.

The current ‘gold standard’ of treatment for depression is known as Cognitive Behavioural Therapy (CBT) and entails a reasonably lengthy process of identifying and challenging the negative thoughts and beliefs that are the root cause of depression.

CBT requires a highly trained therapist and costs around £1,235 per patient.

This high cost means that it is not offered as widely as it should be and the area has suffered under budget pressures in the last six years. Currently 1 in every 10 patients in England waits more than a year for the treatment, if they are referred at all.

We’re not alone in this predicament; experts estimate that in the US only a quarter of those suffering depression have received any treatment in the previous year.

An alternative treatment, different from but related to CBT, has been gaining support among mental health professionals for some time.

Behavioural Activation (BA) is described as a ‘third generation’ behavioural therapy.

It differs from its predecessor by focusing on helping the patient to recognise the link between their behaviour and their mood. By changing the behaviour, particularly habitual behaviour that reinforces or amplifies their depression, the patient can break the cycle of thought and activity that causes the illness.

It has been described as an ‘outside in’ approach as opposed to the ‘inside out’ methodology of CBT.

Essentially it suggests that patients stop doing things that make them feel bad, and do things that improve their mood instead.

Adherents to the new treatment are convinced of its effectiveness and many small scale studies have been produced providing evidence to support them.

The National Institute for Health and Clinical Excellence (NICE) however, the arbiter of standard treatment in the UK, has remained unconvinced so far and called for a more substantial study to fully benchmark the treatment against current practice.

Now a team of researchers from the Universities of Exeter, York, Kings College along with Tees Esk and Wear Valleys NHS Trusts have done exactly that.

In a multi-centre study 440 patients were split into two groups, one to receive the standard CBT and the other treated using BA; their progress was noted at six, twelve and eighteen month intervals.

The results at each stage were virtually the same for each sample and after a year both had achieved the same results; two thirds of each group reported a reduction of at least 50% in their depressive symptoms with similar totals of depression free days.

The only real difference was the cost; BA costs around 20% less than CBT at £975 per patient because it requires less training and staff who are less senior.

On the face of it, therefore, it seems to be a decision that makes itself.

The results have been published in The Lancet and the profession awaits the considered response of NICE once they have reviewed the study.

Perhaps we should be concerned, however, that yet another part of our public health provision is being driven by budgetary constraint rather than patient outcomes.

The BA treatment has proven to be ‘no worse’ than CBT, not better, and the bulk of the saving comes from the salaries and training costs of the providers rather than any genuine shift in the cost of medication or time taken.

Rather like the decision to allow senior nurses to prescribe medication I am sure that in most cases, maybe even 99% of the time, that would never be a problem.

But there is a reason why doctors’ training differs from nurses’ and there is a reason why CBT training is more intense and wide ranging than that for AB, because there is a danger in that 1%.

Depression is a terrible affliction that can lead to self-harm and even suicide, not to mention the potential harm to others around the patient.

I don’t think I’d be alone in thinking that those dealing with it should be more qualified rather than less, even if in most cases it seems unnecessary.

For the ones where it is necessary, it could be vital.

Dlux Spray


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