Understanding Antidepressants & Psychotherapy
There has been a lot of misinformation in the general media regarding the efficiency of antidepressants. It is not a secret that medication such as antidepressants are being prescribed too freely and concentrated among people with less severe, poorly defined mental health illnesses.
It is estimated there are up to 1.5 million people in Britain alone on long-term prescriptions and up to 4 million in the USA. The psychopharmacology experts criticise that this increase of longterm prescription medications is as a result of lack of action by doctors, health authorities and governments.
There are many other ways to treat mental health disorders, one of which is psychotherapy. In fact, unless your depression is severe the National Institute for Health and Care Excellence (NICE) guidelines recommend that antidepressants should not be your main treatment.
NICE suggests that before prescribing you medication, your doctor should recommend exercise and a talking treatment, such as Cognitive Behavioural Therapy (CBT). You might also find it helpful to investigate an alternative therapy, such as complementary therapies, mindfulness and arts therapies.
Understanding Cognitive behavioural Therapy (CBT)
I had the chance to talk to Dr. Susan Byrne, a cognitive and behavioural therapist. Dr. Byrne is a qualified counsellor with the Addiction Counsellors of Ireland. She holds a degree in Psychology and Philosophy and a doctorate in Embodied Cognition; Cognitive Psychology and Philosophy.
Discovered by Dr. Aaron T. Beck in the 1960s, CBT combines basic theories about how people learn (behaviourism) with theories about the way people think about and interpret events in their lives (cognition). This therapy is now firmly established as the leading psychological treatment for many mental health conditions. Dr. Byrne described CBT as a talking therapy that refers to how our thoughts, feelings and behaviours and how they are all interlinked and are directly related.
For example, the thoughts we are having about a particular situation can influence our feelings about the situation and therefore how we act, react, respond or behave
Dr. Byrne explains how the therapy helps clients to address negative thoughts and thought patterns which are contributing to maladaptive or unhealthy behaviours. Also, how behaviours can only be understood when thoughts can be clearly explored along with various stressors. She provides homework for her CBT clients such as worksheets and journalling, which has proven extremely helpful for clients to record and breakdown their thoughts, emotions and behaviours.
Although Dr. Byrne does not practice mindfulness based cognitive therapy or mindfulness based stress reduction she always advises her clients how being mindful and present is, in itself, is an useful tool to use in any situation and should become a part of everyday life. She recommends particular apps to clients such as Headspace. The feedback from clients on this particular app has been clearly positive. There are of course limitations to CBT as there are limitations to most interventions.
CBT, as a therapeutic tool, is simple not suitable for some clients. No one ‘therapy’ will be appropriate for all clients. A client may respond well to a technique such as CBT but could also be receptive to another. Medication can also help a client, both short & long term, depending on this issues
Finding a therapy that suits you is the first step. When finding the right therapist, it is important that clients aren’t afraid to ask questions such as; what are your qualifications? have you worked with this particular issue before, or what interventions do you practice? Dr. Byrne explains that the link between the client and the therapist is vitally important.“Your therapist literally comes your best friend, albeit with boundaries”, Dr. Byrne.
Unfortunately people still feel uncomfortable talking about how they are feeling. Recent NCHS survey data found that rates of antidepressant use rose as self-reported severity of depressive symptoms increased. I discussed this issue with Dr. Byrne;
In my experience a huge majority of my clients would have been offered medication for mental health issues such as depression, anxiety, OCD and even bereavement. Talking therapies are particularly effective for depression, anxiety, OCD and addiction, where there is an emphasis on patterns of behaviour and stressors/triggers
However, Dr. Byrne explains how it is important to understand that sometimes a client, for example, may present with depressive-anxiety disorder and may need medication initially, in order that they are more receptive to therapy. She continues explaining how it is challenging for both the client and therapist to work together in therapy when a client has such a bleak and narrow view of the world. This makes it difficult to make progress.
An antidepressant gives the client the opportunity to interpret their mood level and have a more optimistic outlook. Therefore they can engage more in the therapeutic process. It is vital that the therapist monitors the clients progress and possible resistance to the intervention and revises treatment plans as necessary
After talking to Dr. Byrne it is clear that there is not one solution to mental health problems. It is important to know that if one therapy or if one medication did not work for you, there are always other options. When addressing your problems or when you are wanting to get help, it can be sometimes difficult to know where and who to go to.
The first step in getting treatment will normally be to visit your GP practice. Your GP can suggest or direct you to a specialist such as a mental health nurse, psychiatrist or psychologist if needed. This is not unusual so do not become alarmed if he suggest you see a specialist.
To find your nearest hospital health centre, GP and more, you can head over to the Health Service Executive (HSE) website at www.hse.ie/eng/services. The HSE website also provides information about your rights, how to access personal information, and how to make a comment or complaint about services you have used.
For more information on the issues discussed you can read more about CBT at www.psychcentral.com or www.mentalhealthireland.ie, which is a great source for all information and resources on your mental health.