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Doing Well Against Depression Sharp Fall in the Number of Patients on Antidepressants

Posted on: Friday, 3 March 2006, 06:00 CST

DOCTORS have dramatically reduced the number of patients taking antidepressants as part of a project which could help transform the way the illness is treated in Scotland.

Amid growing concern about the soaring number of Scots prescribed drugs such as Prozac, clinicians in Renfrewshire have adapted a US system for dealing with depression.

Under the project, GPs use 10 standard questions to calculate the level of patients' depression. Those with milder illness are offered cognitive behaviour therapy instead of drugs.

Those with low scores are referred to a psychology assistant who will help them embark on a programme of self-help. Patients with higher scores will receive an appointment with a more highly experienced psychologist.

The proportion of patients involved in the scheme who are on antidepressants is half the level of those in conventional NHS care.

This, alongside the selection of cheap but effective drugs for those who do need them, has cut the bill for antidepressants to less than a quarter of comparable doctors' practices.

Dr Michael Smith, consultant psychiatrist and clinical lead on the Doing Well project, said: "When you provide thoughtful care in this way it turns out it is really efficient because people get better with minimal health service input and minimal spend on drugs."

The scoring systems the GPs have been using will today be launched on the internet, allowing people to check their own rating and keep track of their mental health.

Dr Smith said people with depression should monitor their Personal Health Questionnaire (PHQ) score the same way people with high cholesterol monitor their blood pressure.

Some reports have suggested that depression is becoming Scotland's major health burden because of the rapid increase in people taking tablets for the condition.

In 2004-5, 3.5 million antidepressant prescriptions were issued to patients in Scotland, compared to 1.2 million in 1992-3.

The annual gross ingredient bill for such medication has now reached GBP58.7m, compared to GBP12.3m in 1992-3.

Dr Smith said: "There are concerns that people are getting drugs that they might not need and our programme was designed to address that."

He said the National Institute for Health and Clinical Excellence (Nice), which provides guidance on treatment, has advised that neither drugs or counselling work for those who have mild depression, but equipping people to help themselves does make a difference.

However, Dr Smith said there was concern GPs, who see large numbers of patients with depression, would prescribe antidepressants because they knew a patient could wait a year to see a specialist.

Dr Smith added: "We thought what people need to know is if they have got mild depression or something else." PHQ swiftly pinpoints the level of illness.

Doing Well in Renfrewshire, which involves 13 GP practices, received GBP400,000 over two years from the Centre for Change and Innovation, which stimulates and spreads good practice in the NHS. They were able to recruit six staff, and patients have been able to meet with the right practitioner quickly, with those who score under15 seen within 10 days.

The first appointment is an hour long to allow the psychology assistant - a junior graduate - to get to know the individual and help them begin to use a set of self-help booklets which guide sufferers on how to address different issues such as assertiveness, unhelpful thoughts and solving problems.

Patients will then take forward their own treatment using the books, but will be supportedby the practitioner through e-mails, phone calls and further face-to-face meetings.

However, Dr Mairi Scott, chairwoman of the Royal College of GPs in Scotland, said cognitive behaviour therapy was time-consuming and those who practised it were a scarce resource.

"Everyone would say we have to expand the availability of cognitive behaviour therapy, " she said.

"It is a long-term investment. If people can understand and manage themselves into the future it is much more effective and efficient than giving them drugs."

The Scottish Association for Mental Health said that drugs alone are not the most effective way of tackling depression, but unless more resources are invested in alternatives and talking therapies the trend of antidepressant prescribing will continue to rise.

Other health boards have also launched new mental health projects under the Doing Well banner using funding from the Centre for Change and Innovation. Their impact is now being assessed.

Look after yourself. . .

Ten ways to help how you feel.

For more information refer to: www. livinglifetothefull. com

Do

Stop, think and reflect on your worrying thoughts - don't get caught up in them

Ask yourself what advice you would give a friend who was worried about the same thing

Keep active - do things that give a sense of pleasure or achievement

Face your fears and build your confidence step by step

Live reasonably healthily in terms of fitness, food and sleep

Say no - balance demands you put on yourself

Try not to

Drink too much

Let your thinking spiral out of control

Let problems build up unaddressed

Do things that end up backfiring and causing more upset

Source: Herald, The; Glasgow (UK)

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