Experiences of antidepressants

Talking therapies and antidepressants

Current government policy aims to make talking therapies more easily available on the NHS. Guidelines for the treatment of depression advise doctors to refer patients with a new diagnosis of mild to moderate depressive symptoms for talking therapies before prescribing antidepressants.
 
There are a number of effective talking treatments for depression. Counselling is useful in mild depression. Psychotherapy is a more in-depth form of therapy than counselling, which can be used to address a wider range of issues. For mild to moderate depression the GP may suggest Cognitive Behavioural Therapy (CBT). This can help people manage their problems by changing the way they think and behave. The Improving Access to Psychological Therapies (IAPT) programme aims to improve access to talking treatments, which may be offered on a one to one basis, in groups, or through online materials. It may be possible to self-refer through this programme instead of going through the GP.
The people we interviewed had accessed a range of different types of talking therapies, as well as taking antidepressants. Some said their GP had suggested counselling or therapy at the time when they were prescribed an antidepressant. Emily’s doctor ‘was very clear on the fact that he believed, you know, some sort of therapy... the medication shouldn’t be used, shouldn’t be by itself, you need to look at the reasons for it’. People felt strongly that it was important to have this type of help, as well as being prescribed an antidepressant. Many believed that although medication can help relieve symptoms you must ‘get to the root of the problem’ in order to recover, Charlotte echoed this view ‘I don’t have a problem taking antidepressants, but it’s just masking the problem, it’s not actually addressing the underlying problem’. 
Often people used the terms ‘counselling’ or ‘therapy’ interchangeably and not everyone knew what approach their counsellor or therapist took. Where talking therapy had been suggested by the GP generally it was either CBT or counselling. Some people had undertaken longer term psychotherapy, although often this was at their own expense, or through workplace schemes, because there is limited availability for this type of therapy through the NHS. Some people with more deep-rooted or serious depression saw a psychologist or other mental health specialists on a regular basis through the community health team, or in hospital. Some saw a therapist or counsellor on a one-to-one basis, but others had attended groups, had telephone consultations, or used internet resources. Andrew (below) was dubious about going to a group for CBT at first, but after a while he found it really helpful. 
Views about the potential benefits or otherwise of talking therapy varied widely. People described positive benefits including: gaining new perspectives; helping them cope with difficult life events; developing a better understanding of themselves; helping them develop new ways of thinking and taking responsibility for their lives. Some said that it was helpful just having an impartial and non-judgemental person taking an interest. Lucy Y said, ‘It’s good to have, you know, that sort of private knowledge of non-judgemental space to talk stuff over. Michael said, ‘I’ve always felt that talking to people is the best therapy for everybody, sharing and talking, honest talking one to, you know, heart to heart talking’. Some people had tried different types of therapy over several years but were resigned to being prone to depression. Even so, some said it had helped them find ways to cope or recognise signs or symptoms and to manage things more easily when they felt themselves ‘slipping’.
 
People varied in when they thought was the best time to access talking therapies. Some had not felt ready or able to talk openly about things when they first sought help and felt an antidepressant helped them to feel more stable and able to engage with therapy eventually.
 
Some people we spoke to would like doctors to be more willing to suggest talking therapies before prescribing an antidepressant, but they felt that there were constraints on what they could offer. A common complaint was that the availability of therapeutic services was limited and most people who would have liked to have the option said they had not been able to access services immediately. Some people felt let down by the lack of options. Melanie was prescribed an antidepressant and wanted to have counselling, but was told there was a waiting list ‘I was lucky enough to get the private counselling that’s helped me through. If I had still had to have waited to see the counsellor through the GP surgery I don’t know how I would have felt’. Others also felt it was unacceptable to have to wait a lengthy period for an appointment, and that if you were in crisis it could feel as though nobody cared enough to help you. Some expressed concerns that without someone to talk to, people who were seriously depressed could be at risk of harming themselves. 
Counselling sessions, or therapy such as CBT was sometimes available through workplace schemes or occupational health departments. Others had paid to have therapy privately, but it can be costly and out of reach for people with lower incomes.
 
In some instances it had been a counsellor who had suggested the GP should be consulted about whether an antidepressant might help. Flora saw a counsellor through the occupational health department at her workplace. The counsellor was concerned about her when she filled out a depression questionnaire and recommended that she should see her GP. Melanie had some telephone counselling sessions provided by a workplace scheme before she decided to consult her GP.
 
Not everybody wanted to access talking therapies straight away, or at all. It’s not uncommon for people to feel that they just want to take medication to alleviate the symptoms they are experiencing. Some people hadn’t wanted to talk to anyone about their lives or problems, or felt reluctant to talk to anyone for fear of being judged. Others said they had felt numb and detached and incapable of engaging on a meaningful level with talking therapy. Collette reflected that although she had seen a counsellor she hadn’t felt able to ‘open up’. ‘I play games... dance around subjects I would throw questions back at them instead of answering the questions that they want me to, I don’t always mean to, I don’t always want to I just seem to do it as a, I suppose a self- defence’. Charlotte had been offered an appointment for group counselling but said, ‘I didn’t want to talk about my situation in front of lots of people so I didn’t go’. Victoria commented that although she thought it was something worth looking into, ‘it’s one of those things when everything’s going fine you don’t think about it, you only really think about it when you’re having a bad day’. Lucy Y had been referred for counselling when she was younger but had cancelled the appointments beforehand because she felt too anxious about it. It’s only more recently as she’s become older that she’s felt less overwhelmed and has benefitted from seeing a therapist. 
Some had tried talking therapies in the past and not found it useful, but as they got older or their circumstances changed they said they had felt more willing or able to give it a try. Another type of therapy sometimes suited them better. Tim (below) tried CBT but didn’t take to it, but later tried psychotherapy and said it changed his life. Dina had experienced a breakdown when she was postgraduate student and felt that it was psychotherapy that had ‘saved my life’, ‘Well perhaps the antidepressants worked to start with and, you know, kind of lifted my mood but I think it was, the work that I did in therapy that helped me to be able to finish my studies’. Gerry was clear that although antidepressants had helped with the symptoms of depression that ‘you still think depressed thoughts’ and CBT had helped him to think differently about things. 
Sometimes people felt that the reason a particular therapy had been successful was because of the relationship they had developed with the counsellor or therapist. Several said that their therapist was the only person who knew them really well. Max commented that whilst the doctor who prescribes his medication knows about his physical health, it’s the counsellor who ‘knows most about my story’. But some said had found it difficult when their therapy finished. Michael described it as ‘a big loss… like a rejection’ and said he felt really let down when he stopped seeing his therapist. Sonia also felt a strong connection with her therapist and that she had become very attached to her. She also commented on the lack of ‘joined up thinking’ between the therapist who she saw on a private basis, and the mental health team and psychiatrist who were responsible for prescribing her medication and providing care on an ongoing basis. Thomas felt there were conflicts of interests between his psychiatrist and GP, and the therapist he had been seeing, who had different opinions about medication. 
Several people spoke of the benefits of attending courses or working with therapists who taught mindfulness techniques. Mindfulness is a ‘mind body based training’ that uses meditation techniques. It encourages people to develop strategies that help them to attend to the present moment instead of focusing on the past or worrying about the future. Sharon was sceptical about it when she was referred. ‘I thought it was all tree hugging hippy stuff to be honest when they first told me about it but I went and I engaged and it was really good, really, really helped, really helpful’. 
People who had been in hospital sometimes benefited from therapeutic support as well as antidepressant or other medicines. It could help to be in therapy groups with other people who had similar experiences and to realise that you were not alone. But mixing with others’ with serious mental health problems could also be distressing. Some people were critical about the type or standard of therapeutic provision that had been made available in hospital, or said that they had just been given medication with no therapeutic support. 
(See also ‘Treatment in hospital’, ‘Taking other medicines with antidepressants’ and ‘Being prescribed an antidepressant').

Last reviewed June 2016.
Last updated June 2016.

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