UK: Guardian: "NHS to give therapy for depression before medication under new guidelines"

[Arvo]

Not a criticism Arvo but I seemed to pick up somewhere that they'd identified genes re eating disorders.

Seems to be a bit counterintuitive that CBT overrides your genes.

I'd be content with a well conducted study which shows it woks though.

That would indeed be quite implausible to be helped with CBT...! I was speaking about what it was originally used/developed for. (Late 80's/early 90s)

 

[hibiscuswahine]

This has been the standard treatment for Major Depressive Disorder of mild severity and other depressive disorders in NZ for 20 odd years. People are given a choice at what they would like. Most people don’t go for antidepressants first because of it’s known side effects eg. numbing of emotions, sexual SE’s etc. Some people opt for a short term course of sleeping tablets via their GP while working on precipitants with supportive therapy (which range from counselling to a trained provider of psychological treatment), most not available for free…or you get three sessions max via our Public Health Service. Often not enough. Exercise, financial/work support, improving social networks through support groups, family education/engagement, nature and cultural activities are actively promoted. Also you can’t be referred to mental health services until you are in the moderate-severe severity category or have risk to self or other due to lack of resource in community mental health services.

 

[Esther12]

Guideline committee:

https://www.nice.org.uk/guidance/gid-cgwave0725/documents/committee-member-list-2

Just posted as there were some familiar names like Tony Kendrick. Not sure why there were resignations.

Chair Prof Navneet Kapur

Members
GP Prof Carolyn Chew-Graham
Counsellor Jeremy
Psychiatric Nurse Prof David Ekers
Psychiatrist Dr Satheesh Kumar Gangadharan - Appointed September 2020
Commissioner Dr Tarun Gupta - Appointed September 2020
Primary Care Prof Tony Kendrick
Psychologist Professor Peter Kinderman - Appointed September 2020
Psychiatrist Dr Neil Nixon
NHS Service Manager and Commissioner Jennifer Speller
Counsellor Toby Sweet - Appointed September 2020
Pharmacist Prof David Taylor Director of Pharmacy and Pathology
Psychologist Prof Ed Watkins
Psychiatrist / Old Age Specialist Dr Philip Wilkinson

Lay members :

Lay member Louise O’Connor Lay member
Lay member Catherine Rouane Lay member
Lay member Prishah Shah Lay member

Resigned members:

Commissioner/ Social care practitioner Sinead Dervin Resigned in Dec 2018
Psychiatry Prof Simon Gilbody Resigned in Feb 2019
Psychology Dr June Brown Resigned August 2019
Counsellor Dr David Hewison Head of Research Resigned in May 2020

 

[Esther12]

I was also thinking about those complaining about how many people on the ME/CFS committee had some personal connection to ME/CFS, (though it was always a clear minority). How many people on the depression committee would need to have had a personal experience with depression, or a family member who had done so, before those people would make similar complaints?

 

[Arnie Pye]

From Post #23

Counsellor Jeremy

This sounds a bit weird without a surname. Is he shy or trying to hide or trying to avoid taking responsibility for any decisions that might be made?

 

[Esther12]

From Post #23

Counsellor Jeremy

This sounds a bit weird without a surname. Is he shy or trying to hide or trying to avoid taking responsibility for any decisions that might be made?

Sorry, that was just my poor copy\paste. The full name, along with everyone's affiliations is at the link.

 

[Sean]

With more and more conditions being treated as psychogenic, and doctors being told not to treat anyone with medicines, I foresee a huge increase in the number of people being left untreated for invisible diseases. I imagine that number is already quite high, and that many of the ignored are female or children.

I foresee massive malpractice bills and loss of credibility looming over the horizon for the profession if it doesn't stop this crap.

I think I had real depression once which fit the usual description as mood disorder fairly well. Then I experienced despair as my life was falling apart due to ME/CFS and I was being blamed for it rather than being understood and helped. This was an injustice.

In the second case, I'm sure it would have been terrible to apply any sort of therapy that didn't involve a lot of attentive listening and trust building.

The first depression was a biological thing. The second was adverse life events plus unfavorable social context and a lack of maturity to handle such terribly difficult situations well.

Despair, frustration, anger, etc are not depression, and psychs are not helping anybody, not even themselves, by conflating them.

I was also thinking about those complaining about how many people on the ME/CFS committee had some personal connection to ME/CFS, (though it was always a clear minority). How many people on the depression committee would need to have had a personal experience with depression, or a family member who had done so, before those people would make similar complaints?

Not to mention that not having any personal experience of or connection to a condition is no guarantee of neutrality or objectivity either, not even of being less prejudiced than those with that experience. Which is the whole point of requiring robust methodology and controls (i.e. adequately blinded and/or objective outcome measures).

 

[CRG]

Succinctly put:

 

[Andy]

The Government’s New Depression Treatments Are a Scam

"Last week, the National Institute for Health and Care Excellence (NICE) announced its new treatment guidelines for depression. From now on, it says, there will be fewer antidepressants, more treatment options and more talking therapy.

While this should, in theory, be the cue for a warm welcome to more talking therapy on the NHS, it won’t work like this in practice for a number of reasons. "

https://novaramedia.com/2021/12/03/the-governments-new-depression-treatments-are-a-scam/

 

[Jonathan Edwards]

The Government’s New Depression Treatments Are a Scam

Bound to be an advert from a Jungian psychoanalyst sooner or later.

 

[chrisb]

‘Evidence-based’ means random control trials

That sounds about right.

 

[DigitalDrifter]

Anecdotally I have a friend who told me he was very harmed by it and that he now strongly believes CBT "doesn't work" for mental health issues either.

CBT is probably just a con to get people changing their questionnaire taking behaviour. It robs vital money from proper research.

the idea that millions of people, in the UK alone, live with mild depression needing "cognitive rehabilitation" or treatment is absurd

See my thread here (https://www.s4me.info/threads/how-o...changed-thread-title.22366/page-3#post-377092). I think depression is a quack diagnosis 90% of the time.

 

[Ash]

Interesting that CBT is described as “high intensity psychological intervention”, which seems to clarify that it would have the potential to harm if inappropriately applied.

I think they are saying “high intensity psychological intervention” to make CBT sound like more of a substantial and serious offer than it actually is. A precious and valuable resource to be coveted. To make it something someone would consider queueing for. Rather than the short term budget basic that it really is.

It is clever to refer to it as intensive because all the work is on the patient so yeah intensive. But like a heavy work out at the gym, not intensive like some actual psychological care from a professional with higher training in the medical system.

You're right anti depressants were often inflicted on people rather than offered. CBT is awful. Full stop. So it’s probably a blessing if there’s less of it.

But I am not optimistic about any of this being taken off the table. It was a poor offer, place holding for no offer at all. The falling out of favour of the only two remaining offers, would seem to signify we have arrived at the no offer at all phase. RIP NHS treatments one and all.

 

[Simbindi]

Interesting that CBT is described as “high intensity psychological intervention”, which seems to clarify that it would have the potential to harm if inappropriately applied.

I think CBT is described as a 'high intensity treatment' if it is being delivered by a therapist who has done the year's IAPT postgraduate training and supervision course in CBT. People with severe depression are supposed to receive this level of CBT. However, mild and moderate depression can be delivered via the IAPT 'step up' method, so can be treated [sic] by a Wellbeing Practitioner , i.e. a psych graduate with little experience or formal therapy training.

 

[Ash]

I think depression is a quack diagnosis 90% of the time.

Umm. I don’t think depression is an illness/disease. I think it’s a collection of symptoms that can arise from a multitude of different causes. Diseases so many we know about and so many we don’t. Environmental pollution and nutritional deficiency due to many causes.
C/PTSD and ongoing abuse oppression and impoverishment. Grief that your harsh society and life circumstances don’t allow you to process.

 

[hibiscuswahine]

There is a rapid commercialisation of CBT and mindfulness in the mental health sphere both within the public system (in NZ and worldwide). It is a concern to me because of it’s quick fix and forget mentality.

I disagree that depression is a quack diagnosis. I have seen people with a range of depressive disorders as a psychiatrist.

To get into a Public Mental Health Service in NZ is very hard, you have to be in the top 10% of clinical severity or there are significant diagnostic issues a GP does not have training in. You need to have had a range primary care interventions including, firstly ruling out medical disorders that cause depression.

GP’s usually offer people the choice of counselling or possibly 3 sessions (up to 6) publicly funded psychological treatment which is predominantly CBT for depression (and sometimes with some dimensions of CBT anxiety) depending on depression type. There is a big demand for this and unfortunately long waiting lists so is it is triaged for severity.

This is provided by a range of MH practitioners like psychologists, nurses with mental health training, occupational therapists. They are also offered antidepressant therapy which would be highly recommended for moderate severity and there is good evidence it is effective.

So people that have “therapy” or antidepressants and not recovered; they would be referred to community mental health services for psychiatric assessment to review if the diagnosis is correct and medical disorders have been properly excluded. Then a formulation would be developed and discussed with the client and reviewed frequently with them and their families (if consent given) and recommendations given to them based on current psychiatric knowledge and pertinent to their cultural preferences.

No, we do not have the power to fix environmental problems but are proactive in gaining good social support for people within their community and families.

I am aware that GP’s are part of your public system in the UK but general principles are the same.

 

[NelliePledge]

However, mild and moderate depression can be delivered via the IAPT 'step up' method, so can be treated [sic] by a Wellbeing Practitioner , i.e. a psych graduate with little experience or formal therapy training.

And this is the generic approach you get for any long term condition as well. Mine was a 30 minute session every 2 weeks for 6-8 sessions, here’s your worksheet do you understand it, please fill in these questionnaires, bye, sausage machine style.

 

[Andy]

 

[Sly Saint]

sausage machine style

"new menu"
maybe it'll be a bit more a la carte? CBT, ACT, side order of mindfulness