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zinnithOkay, this entry is sort of personal, but I'm going to make it public anyway. If you don't want to know very private things about me and my pet depression, the black beast, don't read.
Anyway, apparently the Swedish National Board for Health and Welfare wants Cognitive behavioural therapy to replace medication for patients with depression and anxiety-related illnesses.
It seems like the reason for this is that the current guidelines for depression and anxiety disorders are to prescribe medication. Not all patients are offered the choice of CBT, a treatment that doesn't have the side effects the medication can have.
Sure, it sounds like a good idea. I'm definitely not opposed to the idea of therapy. Therapy rules, and I know from personal experience that it can be very helpful as a tool when dealing with your emotional problems. What I am opposed to is the idea of changing the guidelines to consistently prescribing therapy instead of meds.
I can say without a doubt, and without being overly dramatic, that SSRI saved my life. Twice.
I have a long history of depression and dysthymia, and in the past five years, I've had three really rough periods. The first time, the Student Health sent me to a CBT therapist, and you know what? It didn't help me at all.
Don't get me wrong here - I'm not saying that CBT doesn't work. I know it does. I'm saying that, and this goes for all forms of therapy, in order for it to work, the patient must have the will and the energy that is neccessary to actually get something out of the therapy. At that point of my life, I didn't have that energy. I also didn't click at all with the therapist. I interpreted CBT to mean that 'If you pretend that you're not depressed, you won't be', and she did not correct me.
Do I have to say that I'm very good at pretending that everything is fine? Two months later, the therapist thought I had made excellent progress and declared me 'cured'. I was definitely not cured, but I had perfected my acting skills so I could at least make people believe I was healthy.
Two years later, I just couldn't keep up that appearence any more. I had a breakdown at work, passed out in the middle of a meeting and just sat there shaking until the ambulance came.
This was the first time I got a prescription for SSRI (Selective serotonin reuptake inhibitors). And I won't lie, the first few weeks were filled with hellish side-effects and all sort of weird tics, but in the long run, it helped. That was probably the first time since I was seventeen that I actually looked forward to waking up in the morning.
To make a long story short, I felt better, stopped taking the meds, only to get worse again about a year later when I was working at the soul-killing dungeon of doom. This time however, I recognised the signs in time to prevent another breakdown and went looking for help in time. Again, SSRI, in combination with some major life adjustments, (i.e. quitting the damn job and moving closer to my family) helped me get my wonky brain chemistry under control.
Both times, I was offered therapy in combination with the meds. The first time I declined, because I really didn't believe it would do me any good. The second time, I waited until the meds had had some time to start working and then went to a few sessions with a therapist. We agreed that I already knew how to get my life back on track, all I needed was to not feel like shit anymore so I could find the energy to start working on getting better.
And that's my whole point, actually.
When you're so deep down in that black hole that you spend hours staring at your wrists thinking about razor blades, or find yourself with urges to step out in front of moving cars, or research lethal doses of various chemicals online, therapy shouldn't be the first choice. At that point, therapy is useless at best, and downright counter-productive at worst. When you can't even find the energy to get out of bed in the morning, you do not need to be told that you have the power over your own emotions. That will just make you feel worse, because hey, apparently it's your own fault that you're feeling like this and you're a big fat failure!
On a different note, I hate the use of the word 'happy pills' That implies that medication is some kind of magic solution, that once you start eating them you automatically get well. That's not true. Recovering from depression is hard work and it takes a long time. Therapy can certainly be a big help, but therapy is hard work too, and for it to do any good, you need to have the energy to do that work.
It's my firm belief that the best way to treat depression and anxiety disorders is medication and therapy in combination, not just one or the other. You can't put these illnesses into neat little boxes. Every patient is different and has different needs, and it's important that the doctor takes the time to look at each individual case to determine what the best treatment will be for the specific patient. If I had been sent directly to therapy again without any meds to help, I'm pretty sure I would not be alive today.
Okay, I was so not planning to write this entry, but the news just pissed me off. WTF desk monkeys? It's not that simple! Come back when you've actually had the illness in question!
(On an even more personal note - feeling fine now! For real! I'm finally off the meds and everything!)
Anyway, apparently the Swedish National Board for Health and Welfare wants Cognitive behavioural therapy to replace medication for patients with depression and anxiety-related illnesses.
It seems like the reason for this is that the current guidelines for depression and anxiety disorders are to prescribe medication. Not all patients are offered the choice of CBT, a treatment that doesn't have the side effects the medication can have.
Sure, it sounds like a good idea. I'm definitely not opposed to the idea of therapy. Therapy rules, and I know from personal experience that it can be very helpful as a tool when dealing with your emotional problems. What I am opposed to is the idea of changing the guidelines to consistently prescribing therapy instead of meds.
I can say without a doubt, and without being overly dramatic, that SSRI saved my life. Twice.
I have a long history of depression and dysthymia, and in the past five years, I've had three really rough periods. The first time, the Student Health sent me to a CBT therapist, and you know what? It didn't help me at all.
Don't get me wrong here - I'm not saying that CBT doesn't work. I know it does. I'm saying that, and this goes for all forms of therapy, in order for it to work, the patient must have the will and the energy that is neccessary to actually get something out of the therapy. At that point of my life, I didn't have that energy. I also didn't click at all with the therapist. I interpreted CBT to mean that 'If you pretend that you're not depressed, you won't be', and she did not correct me.
Do I have to say that I'm very good at pretending that everything is fine? Two months later, the therapist thought I had made excellent progress and declared me 'cured'. I was definitely not cured, but I had perfected my acting skills so I could at least make people believe I was healthy.
Two years later, I just couldn't keep up that appearence any more. I had a breakdown at work, passed out in the middle of a meeting and just sat there shaking until the ambulance came.
This was the first time I got a prescription for SSRI (Selective serotonin reuptake inhibitors). And I won't lie, the first few weeks were filled with hellish side-effects and all sort of weird tics, but in the long run, it helped. That was probably the first time since I was seventeen that I actually looked forward to waking up in the morning.
To make a long story short, I felt better, stopped taking the meds, only to get worse again about a year later when I was working at the soul-killing dungeon of doom. This time however, I recognised the signs in time to prevent another breakdown and went looking for help in time. Again, SSRI, in combination with some major life adjustments, (i.e. quitting the damn job and moving closer to my family) helped me get my wonky brain chemistry under control.
Both times, I was offered therapy in combination with the meds. The first time I declined, because I really didn't believe it would do me any good. The second time, I waited until the meds had had some time to start working and then went to a few sessions with a therapist. We agreed that I already knew how to get my life back on track, all I needed was to not feel like shit anymore so I could find the energy to start working on getting better.
And that's my whole point, actually.
When you're so deep down in that black hole that you spend hours staring at your wrists thinking about razor blades, or find yourself with urges to step out in front of moving cars, or research lethal doses of various chemicals online, therapy shouldn't be the first choice. At that point, therapy is useless at best, and downright counter-productive at worst. When you can't even find the energy to get out of bed in the morning, you do not need to be told that you have the power over your own emotions. That will just make you feel worse, because hey, apparently it's your own fault that you're feeling like this and you're a big fat failure!
On a different note, I hate the use of the word 'happy pills' That implies that medication is some kind of magic solution, that once you start eating them you automatically get well. That's not true. Recovering from depression is hard work and it takes a long time. Therapy can certainly be a big help, but therapy is hard work too, and for it to do any good, you need to have the energy to do that work.
It's my firm belief that the best way to treat depression and anxiety disorders is medication and therapy in combination, not just one or the other. You can't put these illnesses into neat little boxes. Every patient is different and has different needs, and it's important that the doctor takes the time to look at each individual case to determine what the best treatment will be for the specific patient. If I had been sent directly to therapy again without any meds to help, I'm pretty sure I would not be alive today.
Okay, I was so not planning to write this entry, but the news just pissed me off. WTF desk monkeys? It's not that simple! Come back when you've actually had the illness in question!
(On an even more personal note - feeling fine now! For real! I'm finally off the meds and everything!)
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(no subject)
Date: 2009-03-04 02:24 pm (UTC)(no subject)
Date: 2009-03-04 03:10 pm (UTC)(no subject)
Date: 2009-03-04 02:28 pm (UTC)Therapy is great, but it's not for everyone. I firmly believe that for some people, mental illness really is a case of the psychological state being a physical one. I need medication to balance my seratonin in the same way as a diabetic needs insulin to have a level that is normal. Just as you wouldn't expect a diabetic to 'buck their ideas up and make more insulin' I can't snap out of it and make my brain deal with seratonin properly. My doctor is (fortunately) very supportive and I'm big enough and ugly enough that I would let my mental health be influenced by other people's neagative opinions on medication.
Medication isn't a cure all, it has to be suitably prescribed and taken for the correct condition (same as any other medication) but your positive or negative experience is not mine and I don't see why my medical situation should be influenced by what is considered the best treatment for an un-named and unknown majority.
My condition, My life. My decision. Is that really too much to ask?
(no subject)
Date: 2009-03-04 03:59 pm (UTC)I really like the diabetes simile and I use it frequently myself when I run into people who argue that I 'don't look sick' and should 'cheer up and get over it'. I think politicians should care less about guidelines and more about the right treatment for the right patient. Some might do perfectly well with just therapy, others need meds to get something out of the therapy, and some doesn't need therapy at all, they just need the meds.
And lets not even talk about doctors who take a look at your journal, note that you're on meds, and assume that everything you complain about is psychosomatic. Last year, I had a doctor ask me if I had troubles at home, when what I really had troubles with was the huge discal hernation that made it near impossible for me to walk...
(no subject)
Date: 2009-03-04 04:26 pm (UTC)There's also an inherent sexism at work here. Woman are more likely to suffer from mental illness for several physical and emotional reason linked to hormones, birthing, raising children, primary care-giving, societal expectation etc.. and look where they're playing god. Viagra and high-blood pressure medications are prescribed to men in equally huge amounts but we don't see lifestyle alternatives being pushed over medication there...
Our medical services are trying to reduce the option to have an epidural during birth because the pain is 'natural'. Well, hello, ALL pain is natural but I don't see the guy with gall stones or kidney stones being told to 'breathe through it' because pain-relief is 'un-natural'.
(no subject)
Date: 2009-03-04 05:28 pm (UTC)And 'natural' pain? Geez, when I give birth I want every painkiller known to mankind. I'm already in pain 24/7, it's not that fun. The guy who came up with that idea should be forced to shit out a watermelon. Without pain-relief.
(no subject)
Date: 2009-03-04 02:30 pm (UTC)But I do agree. When you feel like waking up is the worst thing that could happen, when you contemplate drowning yourself in the bathtub, CBT may not be the ultimate answer. It works for me that my therapist tells me "O RLY? Doesn't that seem a LITTLE drastic, don't you think? For THIS?" when I'm suicidal to jolt me back into my senses, but I daren't think what that would do to my BFF, for example.
I think, yeah, if you have a problem, go to therapy, talk about it, discuss your options and if medication is the way to go? Go for it. Maybe therapy at the same time would be great, but I don't think one of them should exclude the other.
(no subject)
Date: 2009-03-04 05:44 pm (UTC)I think the my problem was that my therapist was very young, just out of school, and I wasn't exactly the textbook case she'd expected. She didn't care all that much about what the root to my problems was, she just wanted to 'fix' me. I remember one session when I'd had a really shitty day and I just wanted to talk to someone about it. She told me right to my face that it wasn't important and that we should concentrate on my little schedules for how many hours I had to study before I was allowed to watch TV. She also told me that I was too self-centered and that I could control my own emotions. What a deeply depressed Zin heard was: 'you're weak, stupid and selfish, go home and die'. So, not really the best thing to do right then.
I wouldn't mind giving CBT another shot with a therapist who knows what they're doing, but first I want my meds so I'm in a fit emotional state to get something out of the therapy :)
(no subject)
Date: 2009-03-05 12:39 am (UTC)It mostly definitely shouldn't be an either/or situation when it comes to medication and therapy.
(no subject)
Date: 2009-03-05 09:33 am (UTC)I think that offering therapy as an alternative or in combination with meds is an excellent idea, but the way they've presented the proposion is that therapy should always be prescribed first, and if that doesn't work, the patient can try meds.
I'm sure CBT is more than enough for some depression patients. I just wonder how many people are going to have to sit through hours of therapy and feel miserable before they can get the help they need.
(no subject)
Date: 2009-03-05 02:48 pm (UTC)In the UK, CBT is offered as an option for mild and moderate depression, as the gold standard non-pharmacological treatment. Anti-depressants are not prescribed for mild depression, the belief being that, in these cases, the side-effects out-weigh the benefits and guided by the growing amount of research indicating that psychological treatments can be as effected as drugs in mild cases without the adverse side-effects. For severe depression, both medication and CBT are prescribed.
So, in the UK at any rate, what it then comes down to how accurately the doctor diagnoses you - whether your placed in the mild, moderate or severe category. It sounds like you were certainly diagnosed incorrectly & I'm just glad you were strong enough to keep going until you got the help you needed. Hopefully healthcare workers where you are will appeal against this decision, especially if it ends up adversely affecting patients, as I can well imagine it might!
*hugs*
cep xxx
(no subject)
Date: 2009-03-05 03:21 pm (UTC)Money is a big The county councils are going to have to hire a lot of CBT therapists and I wonder where they're going to find that money, given how their economic situation is today. The waiting period to see a therapist can be months today. I have no idea how they're planning to deal with this. In worst case, patients who really can't afford to wait for help are going to have to because there just aren't enough therapists.
I just hope the doctors will use their common sense instead of just going after the guidelines.
(no subject)
Date: 2009-03-05 03:27 pm (UTC)I do think doctors will use their common sense - after all, they became doctors to help people & I doubt they'll just bow down to government pressure when they see their patients in continuing pain.
cep xxx
(no subject)
Date: 2009-03-05 03:55 pm (UTC)In an ideal world... the way our healthcare system works right now, you very rarely get to see the same doctor two times in a row (unless you're rich enough to afford a private doctor). You get an appointment, the doctor write you a prescription or (if you're lucky) give you a referral. Then, you have to sit on your ass an wait for something to happen. If you're healthy enough, you can call around and complain and pester people until you get help, but with an illness like depression that's not really an option. Unless, of course, you're lucky enough to have someone willing to call around and pester people for you.
I think I will write that letter. Got to do the research first though. Hopefully they'll take me seriously and not dismiss me as another crazy person. Mental illness is still pretty stigmatic around here. :(