To suggest therapy over meds for MH problems?

[AliceScarlett]

Maybe it's just me but it feels like when people talk about mental health problems, (depression in particular) the default position in response seems to be suggesting medication. Or seeing their GP. All very useful and helpful suggestions don't get me wrong. But I wonder why the general trend isn't to suggest therapy? Is it seen as something to be ashamed of? A friend of mine told me she was suffering from anxiety and when I suggested CBT she got pretty defensive and said "I don't need my head looking at thanks". Maybe the insult "you need your head looking at" is causing people to think therapy is somehow wrong?

If anyone asks for my advice in the future I'll still suggest therapy because I think it could be more/as beneficial as meds, but I'm kind of worried people will be insulted

I see it to be the same as, idk, physiotherapy. You hurt your back, you go get some treatment as well as take painkillers. I feel like I'm missing something here.

They don't need to do that - the drugs work!

Is your friend's diagnosis recent? Maybe she hasn't yet realised that there are multiple approaches to treating mental health issues.

Access to therapy on the NHS is patchy. Private is expensive. Lots of people who might benefit from it can't access it. So suggesting it might be insensitive in some contexts.

CrohnicallyAspie - i get what you are saying, but i do think it is wrong to say that anxiety and depression don't need meds. They don't always need meds, but very often they do. Therapy is by far the best solution however often someone needs to stabalize on meds before they can get to a point where therapy is something they could cope with. Therapy in itself is stressful and if you are too anxious and depressed it isn't always right at that time.

I do however think that meds are over used because the waiting lists for counselling and in all honesty EFFECTIVE counselling are ridiculously long. The fact of the matter is, you have to wait, ages before you get seen and you are often seen by a trainee/volunteer counseller. It took me five years before i got to see a fully qualified counseller that i gelled with. By this time i was having thoughts of suicide.

I would find it completely bewildering if anyone I knew decided to suggest I should have therapy rather than medication for a MH illness.

Your opening posts did indeed say suggest, but it didn't indicate that anyone had actually asked for your input, merely that someone had told you they were ill.

I really do think it's an area where, unless you are qualified and have all the medical history, it is best to be supportive with things like "I hope you can find something that makes you feel better, if there is anything I can do to help let me know".

The first port of call for most people is the GP, to look at either therapy or drugs, or both.

But to be fair, I do also get annoyed with dp when I have backache and he tries to tell me how to make it better - my method is to take brufen and rest. His seems to be to "stretch it the other way", whatever the fuck that means (he has backache far more than I do so I don't think his method is really working).

Therapy is also expensive.

Alice what are IAPT services?

I'm VERY sceptical about therapy. I have known it help very few people.

www.iapt.nhs.uk/ primary care NHS mental health services.

TheoriginalLEM Yeah I don't suggest therapy right left and centre. I'm one of those annoying problem solving people, I will validate and empathise but then tend to say something like "have you considered x,y,z".

Haven't read the thread (not even the op just the title but the counselling I received recently (last year) (Yr9) for my anxiety disorder made me want to kill myself. I did not have depression or suicidal thoughts before this. It also made me take twice as long to get back to school (now going into yr10 at higher levels than people who did the entire year in my class).

Therapy can make things better but it can also make things FAR FAR worse.

Forgot, I also didn't get mess just dealt with it on my own for over half the year then got cabin fever so my desire to not got crazy was stronger than my anxiety and depression (from therapy)

I've had therapy and medication and also tried just therapy on its own. I sink like a stone without meds, even with weekly therapy so I think you are slightly naive in your thinking. Even my counsellor was alarmed how quick the spiral down was, so I dont feel bothered re taking them any more, as he used to be of the opinion that medication isnt the answer but now realises its not a good idea to go without in my case. If I wasnt on them I wouldnt be here is my take.

*meds! Shouldn't be typing at 22:30 with sleep deprivation!

I know what you mean OP, and I agree in some circumstances.

Of course schizophrenia /dementia etc won't be cured with therapy.

However, sometimes I think it would help for things like anxiety and depression.

I am a very anxious person. I'd rather not be but I wouldn't take medication for it as I think that would just "mask" it. I think (if it gota lot worse) I'd need to find a way of coping with it or dealing with it so therapy would probably be better.

Having said that, I can see why someone who had depression would probably want something to mask it, to help them get through the day.

Horses for courses.

And don't forget the part where you finally make it through the months and months long waiting list and your therapist turns out to be unprofessional and inappropriate. So you ask to see someone else and end up waiting the months and months and months again. Great stuff. Meanwhile you have the drugs in your hand minutes after your initial GP appointment.

Plenty of people with anxiety disorders need to medicate to get through the day too AyeAmarok. Depression and anxiety can be mild, moderate, severe, life-threatening...

I love the way people that come out with this shit never have MH issues.

Therapy can take years and years to work (if it ever does). Anti-depressants take a month.

The assumption that therapy will always work also assumes that it is not an illness and is just because of trauma which is often not the case.

That's true Robinson

I suppose I think someone at the "mild" end of either illness, that didn't have a trauma event of some sort that was triggering it, would maybe benefit more from therapy than drugs.

I do think some GPs are too quick to prescribe ADs, when they aren't the best treatment in every case (I say this as someone who was once prescribed them btw). But I do appreciate they may be a quick fix when the patient would otherwise face a long waiting list for therapy and needs help urgently.

I have mood disorder - it's not especially severe but can at times be utterly disabling. I've had CBT which was excellent - not dissing it at all because I still use the techniques etc. However I still have the mood disorder and low moods can have me on my knees - I would much rather take a low dose of an SSRI than go through that. I know what causes my depressions, I have some psychological tools at my disposal but sadly whatever it is in my brain that buggers me up simply won't listen to my reasons.

Much much happier on ADs, though I can't discount the idea that the placebo effect could be in play.

Maybe it's just me but it feels like when people talk about mental health problems, (depression in particular) the default position in response seems to be suggesting medication. Or seeing their GP.

Well at least they get the right advice then. Unless you are in some way medically qualified to diagnose somebody, then why wouldn't you be telling them to contact their doctor? A GP appointment does not necessarily mean medication.

You do know people can take their own life when depressed? How will you know who is that low when you telling them to get therapy? What if you tell someone to get therapy and they are dead the next day? Just say oops?

YABVU.

I waited 18 months for CBT. The meds stopped me wanting to drive my car into a wall in the meantime. I was having panic attacks every week and distraught with them

I was put on medication but it took quite some time to get find the right one.

I was referred for therapy as well. Appointment came through after waiting patiently for it for weeks. Attended and it was with a social worker who carried out an assessment which took almost 2 hours. The vast majority of this time (at least 1.5 hours) was spent discussing the fertility issues of the social worker's friend and how she might apply to the local NHS board for funding (I shit you not- I had been in he field for many years at the time). Oh, and then I had a follow up phone call that afternoon telling me to stay on the same medication (follow up letter after their MDT meeting was completely different) and that I'd be sent an appointment to see the psychiatrist. Guess what? Appointment never materialised and 4 years on I've not yet been seen. I've not chased this as, frankly, what's the point?

So if it's a choice between medication (which works) and therapy (which in my mind is fucking pointless even pursuing) I know what I'm happiest with!

I was put on medication but it took quite some time to get find the right one.

I was referred for therapy as well. Appointment came through after waiting patiently for it for weeks. Attended and it was with a social worker who carried out an assessment which took almost 2 hours. The vast majority of this time (at least 1.5 hours) was spent discussing the fertility issues of the social worker's friend and how she might apply to the local NHS board for funding (I shit you not- I had been in the field for many years at the time). Oh, and then I had a follow up phone call that afternoon telling me to stay on the same medication (follow up letter after their MDT meeting was completely different) and that I'd be sent an appointment to see the psychiatrist. Guess what? Appointment never materialised and 4 years on I've not yet been seen. I've not chased this as, frankly, what's the point?

So if it's a choice between medication (which works) and therapy (which in my mind is fucking pointless even pursuing) I know what I'm happiest with!

YANBU. DH has suffered from depression and has never taken medication. Therapy brought him on leaps and bounds and he believes that exercise and diet change also helped. He just didn't want to take anything.

He hasnt been diagnosed with depression now for maybe 3 years. I think what put him off meds is that his mum sister and brother have been on them for years and are no better than they were before they began them. His sister is still on anti depressants for PND - her youngest is 14. That just can't be good!

I'm an NHS clinical psychologist, so this is my bread and butter. My frustrations are:

I think the 'stepped care' model fails a lot of people. You rarely get to see someone with a significant amount of training further down the ladder. This does impact on the quality of therapy.

Counselling (imho) has a lot of people practising within it who are poorly trained, and not very self aware of their own motives for going into counselling. There are also some fantastic and well trained counsellors but it isn't always easy to spot who they are.

At my end (secondary care) IAPT can look like a bit of a waste. It often seems that people need the level of therapy up from what they get offered on the NHS.

General point- meds can change your chemical composition which allows people to manage in the short/ medium term, but doesn't allow you to look at unhelpful patterns of thinking or behaviour, understand what drives some of this, recognise relational patterns in the past/ present that impact on MH, unpick negative self image and develop self care skills etc...etc... Good therapy can do this and can make the world of difference to the trajectory of someone's life.

I have Bipolar, I have rapid cycles, schizophrenic tendencies and permanent psychosis. In 8 years of intensive medications my psych team have tried repeatedly to find someone, anyone, who could offer me counselling to lessen the effects of my illness on my daily life. In 8 years I have met with one wonder woman of psychoanalytic counselling who after 1 meeting decided she also didn't feel qualified to work with someone like me. I cant afford private, though tbh the team have tried to pull in private specialists, no one is willing to offer me counselling! I couldnt even get someone to agree to work with me in CBT for the anxiety my illness causes. They wouldn't (couldn't?) touch someone with 'the big three' in their diagnosis.
Praise the pink unicorns for anti psychotic medication that allow me to life some semblance of a life!