Sweet Lemons

Dr Clare Gerada, chair of the Royal College of General Practitioners, said doctors were right to prescribe more antidepressants to patients, in higher doses and for longer.

“Antidepressants make patients better,” she said. “Depression is a biological disorder caused by a deficiency of chemicals in the brain.”

From ‘GPs prescribe soaring numbers of drugs for depression’

Hunger is also a biological disorder caused by a deficiency of chemicals in the brain/body, but most of the time it is ‘cured’ by this fantastically simple and normal activity called eating.

My point is that our body naturally strives for biochemical homeostasis in a changing world. We have experienced thousands and thousands of years of evolution to be able to adapt to most things this world can throw at us. Everyone has a right to access all of the resources possible to recover his or her balance in the world and that includes anti-depressants. I’ll say that louder: I am NOT anti-medication!

Unless there is adequate training and support in the ‘other stuff’ (self-management, ‘good enough’ parenting, physical and mental well-being)… what is the point of prescribing anti-depressants? There are considerable risks, not all of them biochemical, when taking medications. And in the end, relying on anti-depressants alone means you are putting off the inevitable: that is, the (often complex) assessment of and interventions for one’s individual risk factors for mental illness.

The truth is, Type 2 Diabetes also requires incredibly complex management, and there are billions of pounds poured into improving the prevention and management of diabetes. No doctor would ever say that diabetes is merely a biological disorder, implying that it can and should be managed entirely by a range of medications (including insulin). Why is the chair of RCGP making such a comment about depression, then?

I appreciate GPs often feel helpless in providing appropriate care to patients who present with depression or anxiety (up to a staggering 1/3 of their caseload). There are problems with accessing psychological therapies that are not under their control. So, many often resort to prescribing medications in lieu of any other intervention, despite conflicting with NICE guidance. It may be all that they can do, and they have to do something. They are doctors, and their patients are suffering. It’s a difficult situation for everyone, and I empathise with the RCGP for having to manage it.

But really, anyone with minimal training in psychology could call out Dr Clare Gerada’s comments as the “sweet lemon” rationalisation it actually is: a post-hoc justification that this over-prescribing of anti-depressants is actually the right thing to do. I hope it has worked to reduce Dr Gerada’s cognitive dissonance, but I’m left with a sour taste in my mouth.

A lemon is still a lemon, even with sugar poured on it.