What do you do when you just can't beat the blues? (From Worcester News)

What do you do when you just can't beat the blues?

9:14am Wednesday 13th January 2010 in

• Skip social links
• Print
• Email
• Comments(2)

‘‘PULL yourself together” or “get over it” are the phrases well-meaning people often use to try and wake people from the nightmare of depression.

This epidemic of insensitivity still infects attitudes to depression and the hackneyed mantra of positive thinking tends to be the province of those fortunate enough not to suffer from this unpleasant illness.

Depression can leave sufferers isolated, unable to hold down a job and can lead them to take their own lives, tearing families apart.

Forty-two people committed suicide in Worcestershire in 2008, the latest available figures supplied by NHS Worcestershire, and while the country wrestles to free itself from the iron grip of recession, it is likely many more have considered it.

Yet depression still draws with it the long shadow of social stigma and the view seems to persist that people can reason themselves out of this most unreasonable of illnesses.

The depression debate is also replete with arguments that the nation is too dependent on antidepressants, that pills are just a quick-fix solution and that such dark emotions are part of life, a natural response to bereavement, loss, change and stress.

There is some truth in this but it is not the whole story. Some people have what the doctors call endogenous depression which is not driven by changes in circumstances such as divorce or death in the family but by a chemical imbalance in the brain.

Redditch GP Dr Simon Parkinson, secretary of the Worcestershire Local Medical Committee, said some forms of therapy, such as cognitive behavioural therapy (CBT) – which is based on new ways of thinking and approaching life situations – were often not practical, with some patients waiting up to a year to access it.

Some depression may be lifestylerelated but sometimes lifestyle changes alone are not enough to bring it under control.

Dr Parkinson said: “Many GPs have access to counselling but even for that there is a waiting list of several months and for cognitive behavioural therapy we have to refer people to the mental health trust where the waiting times are appalling. Most patients aren’t prepared to wait 12 months. That’s why GPs need to use antidepressants.

So often GPs are criticised over this but this is the real world. CBT is time-consuming and there are not enough therapists. I don’t see that getting much better in future. There’s not going to be the money to employ and train more therapists. There is no doubt it works. There is also no doubt that anti-depressants work.

They do what they say on the tin.”

Patients can complete a questionnaire called PHQ-9 which asks them about their interest levels, whether they feel depressed or hopeless, tired or have little energy, have trouble concentrating or have have suicidal thoughts.

The questionnaire also asks patients how often they have these feelings, which helps doctors to judge how depressed their patient is on a scale ranging from mild, through moderate to severe.

Dr Parkinson said: “Patients are usually on anti-depressants on average for between five and six months but for some people it is better for them to continue taking them in the long term. GPs are doing the best they can with the tools available.”

Mother-of-two Trudy Burge, aged 40, of Church Street, Pershore, has battled severe depression for the last 15 years, beginning in 1995 when she suffered from post-natal depression. Since then she has suffered recurrent bouts of the illness, some of which have triggered a total mental breakdown, the most recent last May.

Trudy backs a combination of medication and cognitive behavioural therapy which she has accessed at Studdert Kennedy House in Worcester since July, provided by Worcestershire Mental Health Partnership NHS Trust.

The one-to-one sessions with a psychologist have in part allowed her to reduce her dose of the anti-depressant Sertraline from 200 milligrams to 100, although it took nearly a year on a waiting list before she could access the therapy.

Trudy, who has been off work since 2003 because of depression, said: “People say, ‘Pull yourself together’. If someone had a heart condition you wouldn’t say that to them. The mind is such a powerful thing. You can’t survive without your brain. The heart is another organ that keeps us alive but people often have sympathy for someone with a heart condition but not for someone who has a problem with their mind.”

The former Wychavon district councillor, describing the advantages of cognitive behavioural therapy, said: “It was worth waiting for. I had hit rock bottom and other forms of group therapy had not worked. I did not feel well enough to listen to other people’s problems. CBT has calmed me down. I was physically getting into such a state about things but now I feel I am finally taking some baby steps forward.”

This month, national charity the Mental Health Foundation released a report calling for people who suffer repeated episodes of depression to be offered mindfulness-based cognitive therapy (MBCT), a clinically approved treatment based on meditation techniques which combines CBT and breathing meditations and yoga stretches.

National Institute for Health and Clinical Excellence (NICE) guidance for the NHS has recommended MBCT for recurrent depression since 2004. However, the Be Mindful report reveals that five years on, just one in five GPs say they can access the treatment for their patients and only one in 20 prescribe MBCT regularly.

MBCT is proven to cut relapse rates in half for those who experience more than two episodes of depression.