Talking therapy for depression…

According to a newsletter, yesterday, from NetDoctor.com, which I’ve been unable to verify, the government has announced that it is rolling out, to 32 areas across the country, “talking therapies” for people with depression. The funding is to be £33 million in total, and you can bank on most of it going on training, admin and salaries before the patients even enter the equation – we’ve seen this happen for many years in hospitals.

The key points are these:-

Over the next three years, 3,600 extra therapists will be trained and offer treatment to 900,000 people.

In the first year at least 700 therapists will be trained and see around 100,000 people.

Extrapolating from that last, the training course is a year, or less, and the 700 newly-qualified therapists will get around 150 patients each on average.

Let’s focus on, though, the 3,600 new therapists/900,000 patients equation, which is where it gets scary. This gives an average of 250 patients to each shiny, new, therapist, all of whom they are expected to tackle with the benefit of zero experience. A recipe for disaster right there.

So, on these figures, just how much time will each patient get? Let’s say therapists work a 40-hour week, which is probably over-generous as there are lunch breaks and other breaks to be considered – a 30-hour “actually working” week is more like it, so 30×52 gives you the annual hours, divide that by 12 to get hours per month, and divide again by 250 to get hours per patient per month or, in this case 52 minutes per patient per month. Even if they do actually work 40 hours a week, that figure is improved only a little. Considering the fact that talking therapies are immensely time-consuming, just what benefit is a severely depressed patient going to get from a 52-minute chat (and by the time preliminaries and goodbyes are out of the way, they’ll be lucky to get 45 minutes), once a month?

And which talking therapy is it to be? No-one seems to be saying, but given that CBT seems to be very much in favour with NICE, I’d put my money on that – and my view of CBT is that, for the most part, it’s a crock. Some years ago, briefly, I had a social worker (I can’t, for the life of me, remember how I acquired him), and he’d just qualified as a CBT practitioner. Proudly, he let me read his thesis – and what I read was 5,000 words of the most egregious psychobabble. That put me off CBT for life – I wouldn’t willingly confide in someone who could write such tripe, never mind obtain a qualification for having done so.

Anyway, I don’t need a therapist to tell me why I’m depressed – I already know. Life’s crap, I have an illness that’s gonna kill me, I’m pretty sure I have vascular dementia, and I’m mostly housebound – and I need to get laid! It’d be a sodding miracle if I wasn’t depressed to some degree. I’m not suicidal – I found out what was causing that – see the Drugs for COPD post – and I’m not depressed all the time, but it is a sizable part of my life. What I certainly don’t need is some oik, with the ink still wet on his diploma (This is to certify that the undersigned is now qualified to talk absolute bollocks to unsuspecting victims!), trying to figure out what I already know.

Still, I digress… Something else not made clear is where they are going to recruit 4,300 new therapists. One thing that concerns me is that, for a post as sensitive as this, they need to be highly intelligent people, and are sufficient numbers of such people, with the requisite life experience and empathy, going to be available? Also they need to be native-born English speakers (i.e., from a country where English is the first language).

I don’t care what colour they are just as long as they speak, understand and think in colloquial English, as well as received English. What would be unacceptable is a foreign national with no more than basic English – a depressed person doesn’t need someone who has to translate every word into Polish, Punjabi, or Estonian, in their heads, before they can understand, and maybe get it wrong. I’ve encountered this in general medicine (try explaining to a Greek orthopaedic nurse with about 50 words of English how you were knocked off your Honda by a dog, if you don’t believe me!), where it can be a huge communication problem – someone who’s depressed really doesn’t need a therapist who, quite literally, doesn’t understand them. Nobody does.

Taking all of the above into account, I fear that this is doomed to failure. It would fail on the time factor alone, the rest is just overkill. Sadly, though, the genius(es) who came up with this hopelessly inadequate scheme won’t be the ones to suffer – that’ll be the patients, as always…

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Prozac…

One piece of recently-published research suggests Prozac may not work, and everybody jumps on the bandwagon. Almost any research of this sort, though, is pretty worthless unless its results can be independently replicated (so it’s too soon to write off Prozac), but I do have to wonder if they may be on the right track (though I think saying Prozac doesn’t work for some would be rather more honest that simply claiming that placebos are as good).

I’m prone to drug-induced depression – one of my meds, Aminophylline, causes a deficiency of vitamin B6, which is involved in maintaining stable serotonin levels, and a deficiency causes depression. I have taken Prozac several times and, the first time, it worked fine, until the horrendous side-effects kicked in- it made me cough uncontrollably, until my lungs haemorrhaged – and caused me to stop taking it after a couple of months. Subsequent courses did nothing for me at all, causing me to think that the initial benefits were nothing more than the placebo effect.

I now take a B6 supplement (100 mg daily), which has stabilised my serotonin levels and I’m no longer depressed – last Christmas was the first in nearly 20 years that I haven’t felt almost suicidally depressed.

Could that be the placebo effect, though? No, I don’t believe so, as I have a lot of experience with that. I have ME, as you may know, for which there is no treatment (note for NICE – Cognitive Behavioural Therapy and Graded Exercise Therapy are unproven and dangerous for those with ME), so like many in the ME community, I put my faith in supplements to try and ease my symptoms. Some of these work fine the first time, but subsequent batches do pretty much nothing at all – these are the ones I put down to the placebo effect and stop buying them. Oddly, it seems to be the more expensive and heavily hyped supplements that this happens with.

I have a hard-core range of supplements, which are cheap, and have proven to be effective over many years. For me there is one proof of efficacy for a supplement – do I deteriorate without it, and improve with it. In the case of my current range, this has been demonstrated repeatedly over a long period. They are, in no particular order:-

Zinc, 30mg

Magnesium, 300mg

Vitamin B6, 100mg

Soluble Vitamin C, 1000mg

Vitamin E, 400mg

Ginseng, 500mg

A multi-vitamin and mineral supplement

That’s my standard daily intake. If I feel the need for a boost, I’ll add a Mega B-complex supplement (which turns pee an alarming shade of yellow!). And a note about ginseng – for years I insisted on the genuine article, Korean ginseng (Panax ginseng), however, the cost prompted me to try Siberian ginseng (Eleutherococcus senticosus), and I found it to be just as effective, so I stuck with it. It’s about 50% cheaper than Korean ginseng.

Note re vitamin C. If you take 1000mg all at once, your body will take what it needs at that point and promptly excrete the rest. There are two ways around this – slow-release tabs/caps, which are expensive, or you can use a 250ml water bottle, fill it with water, and dissolve the C in it (leave the cap off!). Once it’s dissolved, you can cap it, stick it in the fridge and drink it throughout the day. Oh, and don’t cut costs by using ascorbic acid powder. True, it’s still vitamin C, but it’s entirely without any of the buffering agents that stop the soluble versions irritating the hell out of your stomach. The cheapest source is Tesco or Sainsbury’s – or you can buy Redoxon from the chemist at twice the price.

Given my success with B6, I would have no reservations about suggesting that anyone who is depressed gives it a try, as it’s very cheap and, even if it does no good, it’ll do no harm either. After all, if you present to your GP with depression, he won’t order a blood test to check for B6 deficiency, he’ll just scribble a scrip for happy pills which, in the process of fixing your depression, have a very good chance of fucking you up in so many ways.

I buy my C at the supermarket, but all the rest I get here. I buy the PowerHealth brand, which is at the cheap end of the market – why pay maybe 4 or 5 times the price for, say, the Solgar brand, which is ferociously expensive and no more effective than the cheaper ones (I’ve tried them to be sure)?

Footnote:- one of the search criteria that brought people to this post today was “vitamin C as good as Prozack (sic)”. Let me state, categorically, that there is not the slightest evidence that vitamin C does anything for any mental illness. It provides a boost to the immune system (though even that’s controversial), and, of course, stops you getting scurvy, and that’s pretty much it.

Oh, you can Google it ’til you go blind, and you’ll find a wide and varied selection of fruitcakes telling you C is good for almost every conceivable illness – there are even some 24-carat psychos who insist it’ll cure AIDS and cancer – no it bloody won’t!

Here’s a tip – ask these people in which journal their research was published and peer-reviewed, and watch them slink back under their stones. Quacks don’t publish, because their deranged theories will be kicked to death by people far more qualified than they are – they depend entirely on the gullible not asking too many questions. Sadly, the ME community is beset by legions of these vultures, who, for reasons that elude me, find rich pickings.

OK, people with ME are, almost without exception, desperate for a cure, and many can’t get their heads around the cast-iron fact that there isn’t one, nor is there going to be until someone finds a definitive cause. Many, also, will seize upon any “remedy” offered and, to them I will say just this – check it out by all means, but, for pity’s sake, don’t leave your brains at the door!

I seem to have digressed, but there is zero evidence that vitamin C cures anything at all, though it does make my bread rise nicely!