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NHS antidepressant prescribing: what do we get for £266m a year?

BMJ 2018; 360 doi: (Published 06 March 2018) Cite this as: BMJ 2018;360:k1019

Re: NHS antidepressant prescribing: what do we get for £266m a year?

What indeed do we get? In my own case, many years ago, after the break-up of my first marriage, nothing. Only the Samaritans saved me from suicide. What I needed and was not offered was talking therapy. I had no close relatives in the UK: my parents were dead. But after several years my brother came over for a holiday from Australia, and I talked to him non-stop for a whole week. This did the trick, and I came off all my medication cold turkey. But three months later I discovered a lump in my breast, which turned out to be cancer. Since I was no longer depressed I was able to cope, in spite of the lack in those days of Macmillan nurses, breast-care nurses and so on. I received expert help including counselling from the Bristol Cancer Help Centre, now Penny Brohn Cancer Care. Though I did not have a good prognosis I have survived thirty-one years since then.

It seems that the possible connection between depression and subsequent cancer is now being properly researched, with the aid of the UK Biobank, though it has long been suspected. (1) 'Depression and despair make their registrations not just in the mind but in the body . . . Contemporary medical researchers have been able to make correlations between emotional disturbances and malignancies.'(2) Think of how much money and misery would be saved if our cancer incidence could be reduced. One way might be to improve our mental health services.

I should like to suggest that counselling or psychotherapy, which can often be accessed through voluntary groups in the community, must be offered as an alternative to antidepressants. It needs to be said that Cognitive Behavioural Therapy is not necessarily the answer: CBT focuses on the present, whereas in my experience depression has its roots in the past. The fact that the recent paper on antidepressants in the Lancet (3) made no mention of psychotherapy except to write it off as unavailable 'because of inadequate resources' is to my mind shocking. Surely it should be possible to research its efficacy versus that of antidepressants rather than or in addition to using a placebo? I doubt very much if the cost of eight sessions per patient would exceed £266m a year.

I have to declare an interest: after my recovery from cancer, thirty years ago, I trained as a counsellor and worked in the community for thirteen years in the south of England before coming to Scotland in 2003 to join family members. Here again I find that the waiting list for talking therapy is as much as six months: this has to change.

Heather Goodare
(retired counsellor)

1. Patrice Guex. An Introduction to Psycho-Oncology, translated by Heather Goodare, with an introduction by Karol Sikora (Routledge, London 1994)

2. Lawrence LeShan. You can fight for your life: Emotional Factors in the Treatment of Cancer: Foreword by Carl Simonton, p. xii.

3. Andrea Cipriani, Toshi A Furukawa, Georgia Salanti, Anna Chairmani, Lauren Z. Atkinson, Stefan Leucht et al. Comparative efficacy and acceptability of 23 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. The Lancet published online 21 February 2018.

Competing interests: No competing interests

07 March 2018
Heather M. Goodare
Retired counsellor
Cochrane Collaboration Consumer