Electronic Letters to:
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eLetters: Electronic letters published:
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Non=pharmacological Treatment of Depression in Primary Care- A Real Issue
- Alex E Jewkes (12 March 2009)
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Authors' response
- Amanda C Howe, Professor Helen Lester, University of Manchester (13 March 2009)
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Alex E Jewkes, Foundation Year 2 Doctor Manchester Royal Infirmary
Send letter to journal:
alexjewkes{at}gmail.com Alex E Jewkes
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Many thanks to Lester and Howe for their overview of current guidelines for the treatment of mild-moderate depression in primary care (1). Having recently worked in primary care, I also found difficulty in accessing non-pharmacological treatments for depression in a suitable timescale. Often patients were faced with a wait of many weeks to see the local practice counsellor or for a psychology referral to come to fruition, and it is clear how many patients with mild depression may resultingly be prescribed antidepressants unsuitably for "lack of other options". A recent large longitudinal study in the Netherlands, looking specifically at older age depression in a primary care setting, found no relationship between antidepressant treatment and the duration of depressive episodes (2). In light of such findings, it is ever more important we prescribe medication with well-recognised side effects with more caution. Yet viable alternatives must readily exist in a primary care setting- whilst they obviously are present in the NHS, rapid access to these services is often the major issue leading to overprescription of antidepressant medication. References- 1)H Lester and A Howe Depression in primary care: three key challenges Postgrad Med J 2008; 84: 545-548 2)E Licht-Strunk, H W J Van Marwijk, T Hoekstra, J W R Twisk, M De Haan, and A T F Beekman Outcome of depression in later life in primary care: longitudinal cohort study with three years’ follow-up BMJ 2009; 338: a3079 |
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Amanda C Howe, Professor of Primary Care University of East Anglia, Professor Helen Lester, University of Manchester
Send letter to journal:
amanda.howe{at}uea.ac.uk Amanda C Howe, et al.
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Jewkes highlights key issues in both diagnosis and management. Questionnaires in common use in UK primary care can help to support the decision to offer pharmacological treatments, but work in press suggests that the relationship between symptoms, scores, and treatment decisions are complex, especially in the elderly and those with co-morbidities(1). Patients find the use of questionnaires can be helpful in verifying the diagnosis of depression (2), but lack of access to evidence-based treatments may prolong symptoms and suffering. GPs can support patients with self- help in CBT and medication until referral services come into play, but expansion of psychological therapies is an important goal for health services. (1) Tony Kendrick,, Christopher Dowrick, Anita McBride, Amanda Howe,Pamela Clarke, Sue Maisey, Michael Moore, Peter W Smith. Management of patients assessed with depression severity questionnaires in UK general practice: analysis of medical record data. in press to BMJ March 2009. (2) Christopher Dowrick, Geraldine M Leydon, Anita McBride, Amanda Howe, Hana Burgess, Pamela Clarke, Sue Maisey, Tony Kendrick. Patients’ and doctors’ views on depression severity questionnaires incentivised in the UK quality and outcomes framework: a qualitative study BMJ 2009;338:b663, doi=10.1136/bmj.b663 |
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