Our service was set up to provide the people of Rhondda Cynon Taff and Merthyr Tydfil with courses that are designed to teach ways of managing depression, anxiety and stress.
Antidepressants work. They?re essential for some people but unfortunately, they?re not the whole story. Those of us who struggle with anxiety or depression usually need to make changes ourselves to manage all the effects of these issues.
The courses teach people how to make changes to the way they think and what to do so as to feel better. So far we have lots of feedback from people who have completed the courses saying how much they have helped do just that.
At Valleys Steps we would like people to feel able to attend a course when they first start noticing stress building up rather than, as many of us tend to do, wait until they are really struggling before getting help. We hope that this option might be used alongside antidepressant medication so that we might combat all the effects of these common mental health problems. It also provides the tools for the longer term and effective skills to replace medication.
So here are our views of the recent discussions. One from Sue Nam, Chair of Valleys Steps and a retired consultant clinical psychologist and the other from Professor Jonathan Richards, retired local GP, and Valleys Steps Trustee and Volunteer.
Are antidepressants the answer?
Sue Nam, Chair of Valleys Steps and a retired consultant clinical psychologist
“Valleys Steps? aim has always been to reduce prescriptions for antidepressants and to promote a better approach to overcoming depression. Now suddenly there are reports in the media that antidepressants are beneficial – so what?s the truth?
These messages may appear to contradict one another but in reality they don?t.
Leaving aside illnesses such as Bipolar Disorder, both everyday anxieties and feelings of depression are rooted in thinking habits. It?s our thoughts that cause our emotions.
You only have to imagine how you?d feel if you won the lottery tonight or you were told you were about to be made redundant. You can probably predict exactly how each of these events would make you feel. Those feelings would develop as a direct result of the way you?d be thinking about the event. What will you spend the winnings on? Or how will you survive without a job?
This was a message that I found people were very reluctant to accept in my lifetime?s work as a clinical psychologist. Nearly everyone wanted a pill to take away the problems. But a pill can?t change what?s happening in your life and it can?t change how you?ll feel about it for good.
Anyone who?s ever had a drink to ?drown their sorrows? will know only too well that whilst under the influence you can forget your troubles? But then when it wears off, you feel even worse than you did before.
It?s not what happens to us that causes the way we feel. It?s how we THINK about what has happened. Two people can have exactly the same experience. One will be devastated whilst the other will just shrug it off. It?s all down to the ways we have grown up viewing our world.
For many of us these ways are not always helpful. Although we don?t intend to learn them, we do. Negative thinking habits are far more damaging to our mental health than the events that trigger them.
The only long term answer for a happier life is to learn different ways of viewing the world that are more helpful. That?s where the techniques taught by Valleys Steps come in.
Sometimes someone is feeling too low to be able to focus on learning something new. That?s where antidepressants can help. But they?re not a long term cure.
Antidepressants are really beneficial in order to provide a temporary lift so that you are in a position to make more permanent changes.
Sometimes they might lift the person?s mood enough for them to forget whatever it was that caused the low mood. That?s all well and good but the unhelpful thinking habits will still bother ready to strike again the next time something goes wrong.
Antidepressants are a great short term solution but they are not the long term answer.
If you have headache that?s preventing you from doing what you need to do, you take a pill to get rid of it. Once in a while that?s ok. If, on the other hand, you are needing to take headache tablets every day in order to function that suggests something more serious is going on and bigger changes are needed.
So, there?s no contradiction really. If mood is so low that there?s no ability to focus or concentrate on other things then a short term antidepressant prescription can be useful – but the important words are ?short term?. Only a change of thinking habits and understanding of their power will provide a more permanent solution.
That is why often a GP will only prescribe antidepressants for a short while and will expect you to also participate in a course of some kind (such as mindfulness) that will teach you techniques that will help avoid such low mood episodes in the future as well as increasing your ability to enjoy every day”
What about medication for depression?
Professor Jonathan Richards, retired local GP, and Valleys Steps Trustee and Volunteer
“I worked for more than thirty years as a general practitioner serving a community in which depression, anxiety and other mental health problems were very common.
I have had three episodes of low mood and depression that would have ?qualified? as being ?clinical depression? using a well-known depression rating questionnaire.
I used medication as a way of helping people and did not ask for medication for myself.
Another report has been published to much publicity with the headlines that
- antidepressants do work,
- their side effects are not as bad when balanced out against their potential benefits and
- people are missing out on their benefits because they are not taking them.
Social media has carried opinions about these conclusions; people are asking questions, especially those living with a mental health and well-being difficulty and their families, colleagues and friends. What is true? What should I do for myself? What should I do for someone I care about? I shall try to summarise what you would have heard if you had consulted with me and asked these questions.
There are a number of controversies and disagreements about the issues with strong and opposing opinions on each side; therefore you may not find one, clear answer to your questions.
I find it helpful to remember that most, if not all, questionnaires to ?diagnose? a mental health problem were developed by people funded by drug companies to maximise their sales. Each person?s experience is unique, in that moment and depends on all sorts of things like their social support, their resilience, their experience of how family members would deal with stress and worries and their knowledge of and ability to use coping strategies. In my case, I could vary my questionnaire score from ?mild depression? to ?severe depression? by changed answers to just a few questions asking how often I had experienced the feelings.
In my experience a depression questionnaire often did not match someone?s lived experiences. Some people had a high score and were coping whilst others were poleaxed with a low score. I was very fortunate as I was able to immediately take time off work and drop commitments that I was juggling. I also have a strong history of depression running in my family and it helped to think: ?I am not as ill as my mum was, or her dad was.?
There are different theories about why people experience low mood or become depressed ranging from biological (changes in brain chemicals) to social (how you cope with bad things that happen to you). In my experience each theory helps me to understand what is happening in your life at the moment. Some people can cope well with all sorts of life experiences whilst others can be plunged to hopeless depths.
Some people do need medication to be healthy When I judged that someone did need medication in this way we would discuss side effects and duration of treatment, after all they are the experts in what is happening to them, what their responsibilities are in this moment and how they can manage their complex lives. Most people who I talked with did not fit into this category.
Everyone can benefit from Mindfulness and the wisdom of the lessons in the Valleys Steps courses. Applying them in my own life during a recent episode made a big difference. Everyone can benefit from taking more exercise, especially people with anger difficulties. (One interesting insight that helped me to understand people is that depression is often ?anger turned in on yourself?). Depression causes poor sleep patterns and impaired sleep causes depression so it is very important to pay attention to ?sleep hygiene?. This is covered with great practical advice in Session 6 of the Stress Control Course.
I do have a concern about the recent research findings for people in Wales. They confirm a study some ten years ago that reported on which medications were thought to be the most helpful with the lowest risk of side effects. I hope that someone who asks to try the medications highlighted in the recent reports will be able to make use of them”.