Ecotherapy UK
Recently Published Research Adds Fuel To The Debate On The Value Of Anti-Depressants..
Research by a group of experts, led by Professor Kirsch of the University of Hull, has concluded that the majority of patients suffering from depression receive no benefit from the prescription of antidepressant medication.
The paper, Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the FDA (US Federal Drug Administration) was published on Feb 26th 2008, in the journal PloS Medicine. The study examined data from 47 clinical trials, used to support the licensing applications for 4 of the most commonly prescribed antidepressants.
The analysis of the data revealed that most patients suffering from depression, ranging from moderate to severely depressed, received no clinically significant benefit from the antidepressants they were prescribed, when compared to those patients who took a placebo. In the small group of very severely depressed patients where there was a clinically significant result, the analysis revealed that this was as a result of this group’s lower response rate to the placebo, rather than an increased response to the antidepressants.
This research focused on 4 of the new generation of antidepressants, which work by boosting the levels of the mood changing chemical Serotonin in the brain. Selective Serotonin Reuptake Inhibitors (SSrI’s) have been licensed for use in the USA and the UK as well as many other countries around the world.
This latest research highlighted the fact that patients who received placebos (pills with no active ingredients), recorded significantly higher levels of positive response, than those who received placebos in other clinical trials e.g. Trials of painkillers. In such trials, a placebo effect of approximately 50% of that experienced by those taking the drug is the norm. In the trials of the SSrI’s, of those taking the placebo, 80% reported improvements duplicating the groups who took the actual drugs.
The implication of this is that the majority of those taking the placebo were experiencing a psychological benefit, simply from taking a pill that they believed was helping them.
That being the case, the majority of those suffering from anything less than very severe depression, can improve without the prescription of antidepressant medication.
This latest research comes against a background of mounting concern regarding the apparently unstoppable wave of patients taking antidepressant medication.
In the UK alone, prescriptions for antidepressants exceeded 31 million in 2006, of which 16.2 million were for SSrI’s. These record figures represented a 10% increase over the previous year and come in spite of the guidelines from NHS drugs advisers, that antidepressants should not be the first line of treatment for depression.
Many experts agree that talking therapies, such as Cognitive Behavioural Therapy (CBT), offer a better starting point and improved response rates, in the early stages of the treatment of depression. The problem in the UK is that there are insufficient numbers of trained therapists to cope with the demand for this type of treatment. As a result, access to this type of treatment is severely limited with long waiting lists in most areas.
Faced with this situation, most GP’s have little or no alternative but to prescribe antidepressants. Even in those cases where an alternative exists, many patients are so severely depressed that, in order to be able to engage in the talking therapy, they require the use of antidepressants to maximise its effectiveness.
So how have we arrived at the situation where an estimated one in six of the population are receiving treatment for depression?
Previous generations recognised that we were likely, at one time or another, to experience sadness as a result of bereavement, jobs or love affairs. They had strategies to cope with the disappointments of life, not the least of which was a ‘stiff upper lip’. They were also taught that discussing these disappointments in public was ‘not the done thing’. In those days, depression was seen a ‘malingerer’s ailment’ and, as such, not a genuine medical condition. Since the 1960’s, when the first antidepressants became available, the subject of depression has become increasingly acceptable as a topic for discussion.
The early antidepressant medications often had side effects that meant that patients often had to be prescribed a number of different medications before finding one which had no, or minimal, side effects.
The latest generations of antidepressants have far fewer side effects than their predecessors, and can be prescribed to a wider range of patients as a result.
The subject of depression is now accepted as a genuine medical condition and, as a result, the populace as a whole are more likely to accept a diagnosis of depression from a GP. Having been diagnosed as ‘depressed’, the patient also expects to be treated for that condition. With the lack of alternative therapies, GP’s often have little choice but to issue a prescription for antidepressant medication.
In order to tackle the lack of alternative therapies, the UK Dept. of Health has announced its intention to train an additional 3,600 therapists, to provide much wider access to talking therapies as a preferred alternative to the prescription of antidepressant medication, for the majority of patients.
In addition to talking therapies, there is a growing acceptance that ecotherapy can play a significant role in the treatment of depression.
Ecotherapy involves the patient in close interaction with a natural environment, such as working on a farm, or even something as simple as taking a walk in a park or the countryside.
In a study done by the University of Essex where one group of patients had such a walk in the park and another group walked around a large shopping mall, 71% of the group who took a walk in the park reported feeling less depressed as a result, as opposed to 45% of those who walked around a shopping complex. Of those who walked round the shopping centre, 50% reported increased tension as a result and 44% reported feelings of reduced self-esteem.
In a separate study of 108 people conducted by the mental health charity MIND, 90% of those taking part said that the combination of exercise and nature had the greatest effect on them, with 94% of those who took part regularly in green activities reporting that it had been instrumental in lifting their depression.
Many European countries prescribe agricultural work as a treatment for those diagnosed as suffering from depression. Holland, for example, has 600 farms attached to their Health service to which patients can be sent to help in the treatment of their depression. The NHS by contrast has just 43 such farms available and none of them are used in the treatment of mental illnesses.
So where does all this leave us?
There doesn’t seem to be any doubt that there is a significant placebo effect associated with antidepressant medication and even the Association of the British Pharmaceutical Industry acknowledges this.
There is a considerable body of evidence that indicates that the alternatives to the prescription of antidepressant medication may well offer a more effective treatment of depression, especially in the initial stages of that treatment.
The inclusion of some form of exercise in a natural environment may very well offer benefits that have up to now been overlooked. A walk in the park or the countryside doesn’t cost anything and is unlikely to do any harm. GP’s may increase the effectiveness of medication, if they included an element of ‘ecotherapy’ along with the prescription of antidepressant medication.
The current lack of available alternatives has created a situation where GP’s have little choice in the treatment they offer to patients in the early stages of depression.
Until these alternative therapies are more widely and readily available, the current level of prescription of antidepressant medication looks unlikely to diminish.
The good news is that there does appear to be a consensus that current levels of medication prescription are unacceptable. Also, there does appear to be action being taken to tackle the lack of alternative therapies available.
A wider awareness of therapies involving the natural environment would offer an even greater number of alternatives to those that currently exist, and at a cost which is much more acceptable.
Therefore, there are reasons to believe that, in the future, the levels of prescription of antidepressant medication might fall as alternatives become more widely accessible. To find out about, help or support an organisation working in alternative mental health therapies - please view our courses, resources, ganisation working in alternative mental health therapies - please view our courses or directory.
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