New draft guidelines from the National Institute for Health and Care Excellence (NICE) recommend people with depression should first be offered exercise before medication
People with lived experience of mental health conditions have welcomed new draft guidelines that recommend patients with “less severe depression” should be offered exercise classes and counselling first before they are prescribed anti-depressants.
The advice from the National Institute for Health and Care Excellence (NICE) encourages patients to have access to a menu of options including cognitive behavioural therapy (CBT) and psychotherapy as part of the first line of treatment.
For father-of-two James McWilliam, 26, who was diagnosed with depression with anxiety three years ago, anti-depressants were his GP’s first port of call.
Mr McWilliam, who found himself “feeling low and sad all the time”, sought help from his doctor after he started having suicidal thoughts.
“I didn’t know how to control my feeling of sadness and low mood. I tried some apps and speaking to people but nothing seemed to help. I decided maybe I needed a new start, so I ended my relationship, I quit my jobs and I moved out of the family home. Little did I know this would make me feel much much worse. I then waited a few months because I thought it would pass and then the thoughts of suicide started to cross my mind. I plucked up the courage and I went to my doctor, who straight off the bat decided to offer me antidepressants,” Mr McWilliam told i.
The medication initially made him feel worse. He was then prescribed another kind of anti-depressant and began to feel better but the benefits didn’t last long.
While he was given details to self-refer for CBT, it would be months before he was assigned a mental health worker.
Mr McWilliam said: “I was thinking suicide every minute of every day. I called my doctor and he said, ‘What do you want me to do? You’re already on the maximum dose I can give you’.”
His GP eventually referred him to a mental health worker, Kay, who spent 10 weeks supporting him.
“[Kay] helped me more in those weeks than everything I had ever been offered in the three years I had been struggling,” he said.
Mr McWilliam came off his medication three weeks ago and says he’s never felt better.
He said: “My life is now where I want it to be and I’m finally happy. It’s been a long journey and I couldn’t be prouder of myself. I think offering someone a distraction would be a great first step.”
“If I was offered the 10-week programme with [a mental health worker] in the first instance, I probably would have been off the medication a long time ago. I think if a GP tailored the support that they can offer to someone with regards to what is making them feel the way they do, [the impact] would be massive.”
John Durrant, 33, who blogs about his mental health, agrees that patients with mental health conditions would benefit from being offered alternative treatments before medication.
“I’ve been on antidepressants probably from the age of 12 and up, on and off, and I’ve never been offered any kind of therapy before or after,” he said.
Mr Durrant said the draft guidelines were “a brilliant idea”.
“It should already be happening. There’s projects out there that could benefit people without giving them meds. Meds don’t always work for a long time,” he said.
He added that he felt a lack of communication between services and organisations was behind why many patients were not being offered alternatives.
Dr Nishant Joshi, who works in a GP surgery in Luton, is among the medical professionals who endeavour to provide patients with access to non-medication treatment for depression. But he feels unequal access to such options is the reason many patients are offered medication first.
“One of my most successful tools to help my patients who have been suffering from mental health issues is is yoga, so through Total Wellbeing and what we call social prescribers, we actually have a team of people who are able to link up our patients with the latest non-medication treatments. I’ve had so many patients of mine, especially this year, go via these services for yoga – either free of charge, or at heavily reduced prices – and it helps them,” he said.
Dr Joshi added that the stumbling block in implementing the proposed approach is likely to be poor access to more holistic treatments for depression.
He said: “The issue is that there’s still a lack of equity within the country when it comes to availability for depression treatments.
“I think the issue is actually making sure that’s consistent throughout the country.”
Jenny Bell, 46, from Romsey, Hampshire, believes people should dismiss the positive impact anti-depressants can have.
She said: “My venlefaxine has kept me on the straight and narrow for a number of years now.
“I have tried CBT over the phone, but this didn’t work for me.
“My depression is purely the chemicals imbalanced in my brain and as I’d had it for so long and it’s hereditary – my parents have both suffered with depression – I will have it forever and the medication is counter acting the imbalance.”
She added: “I do know people that don’t want to be on anti-depressants for a long period of time, others who don’t want to take any and I’ve had numerous people tell me that I’ll get addicted and shouldn’t be on them all my life. My reply is always, ‘if I had diabetes, would they tell me to stop taking insulin?’ Then it does make people think about it.”
Dr Paul Chrisp, director of the centre for guidelines at NICE, said: “The Covid-19 pandemic has shown us the impact depression has had on the nation’s mental health. People with depression need these evidence-based guideline recommendations available to the NHS, without delay.”