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.

I'm sorry BabyDubs that sounds rubbish (the response from MH). No reason therapy wouldn't help, some of the people I feel I've worked best with have been acutely psychotic, there's (ime) always been something for us (me and the person) to learn about why they feel the way they do.

Also if you wanted you you could challenge it. Therapy is in NICE guidance and you're not getting it and other people will be. I know the system can be crap and makes people feel powerless though.

Ill always suggest docs first. It depends on what the problems are to what therapy is needed or whether medication is needed.
The wait times for therapy are also appalling.
Therapy doesn't always work for everybody either.
Some people arent comfortable with therapy or therapists like they are their doctors.

Iv suffered with depression and anxiety since i were 16/17.
I was very ill. If i hadn't have been given medication i would not be here now.
I have had therapy and cbt. Nothing has helped apart from medication.
I'm very thankful my gp could see how ill i was and didn't send me down the therapy route at that time.
I don't think they give out ad to everybody ( i have friends who have been ill) just people who clearly need them.

I would have killed myself if my GP hadn't put me on Efexor. Because I had a physical condition and it helped straight away.
With the greatest respect op, please take your silly armchair psychology and pop it up your arse.

lem read my posts, I agree with you!

I am Mentally ill. I had a 6 week course of CBT, completely useless. Frustratingly pointless! They offered me either more CBT, or said I could go on the waiting list for counselling which I have to pay for. I cannot afford to pay for councelling, or to take any more time
Off work for therapy.

Therapy is all well and good, but it is practically very difficult - what am I supposed to do with my kids while I am there? Not to mention my loss of pay everttime I can't go to work.

GOOD psychological therapy has good outcomes. Depending on type of therapy... It gets people to examine and work with unhelpful patterns of thinking... Ie it focuses on treating the roots of the problem. It should give the client a toolbox of strategies if things get worse.

Medication just doesn't do this... It is a sticking plaster.. .hence why some people end up on meds for years at a time.. It also has very variable effects... Some antidepressants have beem implicated in making people worse. Oh yes there is no decent evidence that biochemical changes cause depression...

Good therapy is always a good thing, IMO. But finding a good therapist is hard. Therapy is expensive and time-consuming. And it isn't a cure: therapy generally requires you to then take action to improve your life circumstances.

Not everyone is ever going to be able to do this.

I'm in therapy (counselling) after refusing antids from my gp. I have previously been prescribed antidepressants which led to psychosis and me being sectionned. Tentative diagnosis of bipolar. The drugs they gave me whilst on section messed with my head, but after a couple of months they realised I was hallucinating and prescribed anti psychotics which were wonderful. I got myself back and had the hospital managers discharge me. I weaned myself off the anti psychotics and after such a bad experience with antids have always refused them since. I can alter my mood withwith sleep, diet and exercise. My counselling is in my own time and I was taking the whole day as leave as going straight into work after is hard. I am going to have to just go to the appointments soon as I am running out of leave. Coming off meds suddenly is obvs a bad idea, but gaining insight into what works for you is important. I have been mostly well since coming out of section, my depressions have been reactive and I have not experienced a full blown mania since. It took me over a year of 'faking it' to finally feel normal, but for 14 years I have avoided medication for my mental health though I would hope that I would accept meds if I was psychotic again.

As a therapist, it's really frustrating when people talk about therapy not working and it turns out what they had was a couple of weeks of CBT with a "therapist" who did a two month training course to be able to offer NHS talking therapy.

Therapy does take time but that does make sense when you are often dealing with problems the client has experienced for decades. Unfortunately the NHS only wants to fund what they see as the cheapest interventions and those tend to be short term. In some cases this is a false economy because the cost of crisis services much higher and many people go from crisis to crisis without ever being given a chance to make sense of what is happening.

Psychiatric medication does help many but it also has many harmful side effects. People on long term anti-psychotic medication are at a greater risk of many serious physical illnesses, for example diabetes.

Wouldn't it be good if we could see mental illness in the same light as physical illnesses? Like it's not all in the mind, it's a physical problem with our brains.

Imagine suggesting therapy to someone with diabetes

Diabetes is actually a good example. Some people (eg some type 2 or gestational diabetes) might be able to control it with diet and exercise, other people need medications (type 1 and those with more severe type 2/GD).

No one would tell an insulin dependent diabetic that they just didn't try hard enough with diet, surely?

A therapist blaming a client rather than looking at themselves for failure of therapy is like a poor workman blaming his tools. I question if they should look at an alternative career, away from the vulnerable.

I am always amazed at the number of people who think mental illness should not be treated with medication.

Perhaps I should suggest to my husband that he "talk" his way through an asthma attack instead of using his medication? Or would that be reckless and silly?

HTH

I'm a psychiatrist.
There is no one size fits all answer to this question.
Meds are not better than therapy in every situation but nor is the reverse true.
I get quite a lot of families who ask why their relative is not getting 'intensive therapy' on the inpatient ward. Why are we 'just drugging them up'. The answer is usually because they are so very psychotic/ suicidal/ agitated that they are not able to concentrate and think straight enough for therapy to be effective. They need meds to get to a place where they can engage in therapy at all.
Psychotherapy is not just turning up to sit in a room for an hour you need to actively participate and practice outside sessions. Some people are too ill for that, some aren't able to do it and some don't want to.
Research evidence shows that whilst CBT can be equally as effective as antidepressants for mild to moderate depression it is not effective for severe depression.
It is not necessarily the case that therapy will preclude the need for long term medication. It definitely helps but some people need long term meds to stay well.
Quality and waiting lists are also valid issues. My excellent secondary care psychology colleagues are brilliant. Some of the IAPT workers I'm sorry to say not so much.

stripytees I hope your are exploring the frustration you feel as you are likely to see many clients who have had CBT

Therapy has a place it can take time that is not to say short term therapy is a waste of time it's not but to understand and change patterns people have, when they really have to delve deep and also look at their own actions takes time, there will be times when clients feel worse, resistance and so on

I have worked with a few counsellors who have little understanding of theory and worse little self awareness

I feel far too many people are on ad's that is not to say they have not needed them I have seen far too many clients who have been on ad's for years their dose increased and they have never seen a mh worker, psychologist or a psychiatrist this is worrying unfortunately ad's have been sold to us as a quick fix for less severe depression and anxiety all sounds so simple you have a chemical imbalance take a pill all will balance out and you will feel better it's not that simple but the NHS can offer very little more unless someone is really really unwell even then some people do not get the support they desperately need

I never got proper treatment until I left the UK. Instead of namby pamby counsellors I just an appointment with a shrink (UK trained) went to see him, had a battery of blood tests etc and 6 fortnightly follow ups. He prescribed on my first visit and I argued I didn't want to go back in anti depresses. He just sat and looked at me and said "it's quite plain you are unwell and you need treatment. tough." and after 3 days I woke up and felt a glimmer and realised just how bad it had gotten. I won't stop now although he says 7.5mg Cipralex which is what I take.is.practically homeopathic it works well for me.
bollocks to the op and their lecturing. and bollocks to the NHS mental health care.

They both have there place i,m an RMN and i spent over 20 yrs working on mental health wards pyschotherpy helps people with deep rooted issues i have known[before the cuts to mental health services] people have CBT for years but alternativley as others have said if somebody is presenting as acutley psychotic all the CBT In the world isnt going to help untill their psychosis has been treated with medication you can talk to somebody who is psychotic untill you are blue in the face but often get knowhere untill they are able to think clearly .

No one size fits all! Before ANY treatment is given-either meds or therapy or both, a decent assessment should be made... This should take more than 5 mins.

It is true up thread, that some people are currently, just to unwell to engage in therapy. This will often change, either through meds or natural maturation of the condition.
Journal article re bio bases of depression..
www.spring.org.uk/2014/08/long-held-belief-about-depression-challenged-by-new-study.php

'Good therapy is always a good thing, IMO. But finding a good therapist is hard. Therapy is expensive and time-consuming. And it isn't a cure: therapy generally requires you to then take action to improve your life circumstances'

Very much agree with all of this. And like stripytees, I always wonder what people mean when they say that therapy didn't 'work' - I want to ask them what they were expecting from therapy. Long term depression / anxiety is just not going to go away after 6 or 10 or 12 sessions. The NHS and their penny pinching (I'm an NHS clinician myself, though not in mental health) is infuriating and so short sighted.

I've been in therapy for over 6 years now and I still don't see an end point. It's been the hardest but the best thing I have ever done. I am extremely lucky that I can afford to see a private psychotherapist who I trust completely. I know that other people have dreadful stories about encounters with downright dangerous MH professionals.

I did take anti depressants for 6 months when the emotional pain was absolutely killing me. Going on them and coming off them was horrible, but I was grateful for those 6 months of stability in between. My depression is 100% reactive, its a response to emotional abuse in my childhood, nothing to do with chemical imbalances. My own feeling is that meds may be more relevant to people with a physical reason for their depression. In my case, staying on meds would have just meant that the root cause of my depression was being shoved further and further down, whereas for other people, I can see why they would be a lifeline.

I also think some people are given anti depressants when they are just sad - not minimising the impact of sadness at all, but its a normal healthy emotion and a very understandable reaction to many situations, not something that should be medicated away.

Lottapianos - i agree totally about good therapy. I have seen at least four different therapists, probably only two of those fully qualified. Only one of them even scratched the surface of my self esteem problems. As for my anxiety - the only thing that works for me is medication. My anxiety started as reactive, and stayed. On that point i have to pick you up on something you said about your own problems being reactive and not a chemical imbalance. reactive depression and anxiety actually results in a chemical imbalance though because the whole seretonin (and other neurotransmitters involved in mood etc) gets so thrown off kilter by repeated stress responses that it prevents you from dealing with anxiety etc as efficiently. Suposedly, some medications can help to reset this by the way they help the body to utilize things like seretonin more efficiently. Its like, the body gets deplete of seretonin when we are stressed, if this continues, the cells produce fewer receptors to mop it up and then this all feeds back and less is produced, its a vicious circle. Certain medications help to put this cycle back on track. So whilst your issues aren't genetically hardwired, over time, all the stress and upset will have affected the level of hormones you produce. Having therapy will of course help with this by helping you to feel happier and therefore produce more of your own "happy hormones" so that is a physical effect of therapy too. I hope that hasn't confused everyone, im not very good at explaining things.

'reactive depression and anxiety actually results in a chemical imbalance though because the whole seretonin (and other neurotransmitters involved in mood etc) gets so thrown off kilter by repeated stress responses that it prevents you from dealing with anxiety etc as efficiently'

OK, that makes sense. What I meant was that the origin of my depression is not biological, but I absolutely agree that being flooded with cortisol etc changes how you function and how you respond to stress. It means that I'm not terribly resilient - I get triggered into depression again fairly easily and I have to take very good care of myself physically and emotionally because of it.

From experience, I would avoid NHS counsellors now btw. There is a massively long wait and the ones I met had as many if not more issues than I did/had only just qualified and were nice people but nowhere near the level of the private one i see who has 30yrs experience, used to be a GP and just 'got' me/the problem within 2 sessions. He told me the average GP gets half a day in mental health issues training, no wonder mental health treatment in the UK is pot luck.