“I need medication, the problem is in my brain”: Should GPs offer therapy before prescribing anti-depressants?

When she began suffering from mental health issues at age 12, Lily was prescribed the same dosage of anti-depressant medication as her mother at the time. She is now 21 and still on prescription tablets.

With an estimated one in every seven taking anti-depressants in England, the rise in mental health medication has gone up significantly in recent years. The NHS responded to this data last week, with new guidelines suggesting GPs offer therapy before prescribing anti-depressant medication to minor mental health cases.

“It’s hard because not everyone has a set way of how they’re going to get better,” Lily said.

“Some people can do it without medication, some people can’t. Some people benefit from therapy, some people don’t. I don’t think GPs can put a strict way of doing things by always offering therapy and then medication after.”

“If someone came in with kidney problems, they wouldn’t say ‘try going for a run first.’ You need [medication], it’s in your brain.”

Lily is grateful for going on medication when she did, even though she agrees she began taking them at a very young age. Her anxiety had gotten so severe that she wasn’t able to leave the house and credits anti-depressants for giving her the push she needed to go out again.

“In order for me to be able to do things to help myself, like go out, I needed to get that initial anxiety under control. The medication helped take the edge off there.”

The NHS will be looking at offering initial cognitive behavioural therapy (CBT) to patients, a type of therapy that aims to challenge self-defeating thoughts and unhelpful behaviours. CBT works more with problem-solving and teaching new ways of thinking and behaviours rather than just talking therapy.

Rhiannon Spicer, who specialises in cognitive behavioural therapy, said: “Using CBT therapy, I would not focus on the past events or childhood development, but instead would focus on the client’s negative current thoughts and behaviours, so I would work very much with the present difficulties.”

“With the NHS planning to use CBT as the main theory, I feel that it’s mainly because it’s easier to track. You can see changes and can easily see the scale of change, whereas with theories like talking therapy you are just talking and the client is sharing their thoughts, it’s more of a relational partnership. With CBT you are teaching them new ways of thinking, advising better ways for them to cope.”

Even with a focus on more problem-solving therapy for those with mental health issues, Lily has doubts about whether the NHS can uphold counselling and therapy for some of its patients. As someone who has experienced the CAMHS system, she said it can be disheartening to receive a short-term therapy plan and then restart the cycle of getting more help again through the months-long waiting list.

“You only scratch the surface by the time you’re in your sixth week and then you’re not allowed another block of sessions for another four months. You’ve dug up all of this stuff and then you’re just left with it until you can get re-referred. That’s why I ended up paying for it privately.”

Emma Brand has been a private counsellor for three years and said many of her clients came to her once waiting lists for free NHS therapy had become too long. She agrees with Lily that whilst therapy is a great way of tackling minor and major mental health problems, the NHS needs to be able to supply the demand of appointments needed.

“Being offered therapy is fantastic because there’s a choice. Some people want to explore medication, and some want to explore therapy, so I think having that choice is brilliant, but I would agree that for some people it needs to be long-term,” she said.

“Sometimes, clients can feel pressure or anxiety around only having six sessions. There can be a lot of pressure to hurry up and deal with the things going on but actually, for some people, it’ll take a longer time, going back into the system, back in the queue, back on the waiting list. For some people that might turn them off and they may choose not to engage and that could put their mental health at risk.”

Emma has seen from her clients that taking anti-depressants alongside seeing a therapist can be a successful way of tackling more serious mental health conditions.

“Therapy can work alongside medication really well because for me with my experience in counselling is very much a holistic approach to the person. (…) As counsellors, we are not doctors. We have to refer them back to their GP if we have any concerns, but I think there’s definitely value in having both running alongside each other”

More than 20 million anti-depressants were prescribed in just 3 months last year, a 6% increase from the same three months the year before. Whilst the decision to offer therapy to patients seeking mental health advice is welcomed, it is clear that there is still much to be done in the NHS for those struggling with anxiety and depression.