Deborah Hill Cone
Deborah Hill Cone is a Herald columnist

Deborah Hill Cone: Talk therapy, not drugs, is often what's needed

Photo / Thinkstock
Photo / Thinkstock

I've had a few episodes of melancholia. One episode began after giving birth to my first child. I was euphoric when my daughter was born. But the gloom descended at Birthcare the day after and then I crumpled into a black hole. I just couldn't stop crying.

I was prescribed an antidepressant - an SSRI - and it was astonishing how quickly I rallied. Within a week or two I felt normal again. Excuse my non-medical jargon, but I think my hormones were just wonky.

Another time I became depressed after my marriage ended and I found myself separated with two children, aged 1 and 4. This time, antidepressants did not help. My hormones weren't especially wonky: I was just miserable because my life had fallen apart.

"Simply being alive is the basic trouble," as Thomas Ligotti put it.

I tried different pills but all they seemed to do was stop me sleeping - there was a disconcerting sort of low-grade hum inside me like a swarm of evil bees - and even then, my low mood did not improve.

Eventually I stopped taking them but I carried on seeing a supportive therapist. I wrote about what I was going through; sometimes here, so thank you, kind readers.

I learned different ways to think about my situation using the reframing techniques of cognitive behaviour therapy (CBT) - and new habits of self-care which helped me get back on an even keel.

Both of those episodes of depression would be classed as mild, but I'm telling you about it because as this paper reported last week, funding for "talk therapy", the kind that really helped me, is drying up all over.

Government-funded therapy in the Family Court is being cut, as is insurance-funded therapy. I think this is short-sighted, wrong-headed and dangerous.

Naturally, health insurers prefer to prescribe a pill because it is cheaper than a course of CBT. But even the insurers sound muddled - simultaneously vague and adamant - when they try to justify this move.

Here is health insurer Sovereign's chief medical officer John Mayhew explaining why they won't fund therapy: "A guy whose wife has left him might be depressed and struggling to cope but it doesn't mean he necessarily has to see a counsellor. Antidepressants like SSRIs are proven to work."

Whoa, Dr Mayhew. In a case of depression which is a reaction to a traumatic life event such as a marriage break-up, I would venture that a counsellor or therapist is precisely what that person needs.

Hormonally-based depression, such as depression after an illness or post-natal depression, may be different.

It is complicated, but in addition I think there's more to the story when Dr Mayhew says antidepressants are "proven to work". In one analysis of data submitted to the FDA, 80 per cent of the treatment response to the six most common SSRIs was also seen in patients who were given a placebo.

Another meta-analysis in 2010 showed antidepressants had "non-significant" benefits over placebo in mild and moderate depression. Granted, they worked better with severe, more obviously hormone-related, depression. But that means for most people with mild to moderate depression, antidepressants didn't work any better than a sugar pill.

Other studies show SSRIs still work best if they are combined with a talking therapy such as CBT. You might think: so what, the drugs don't work, no harm done.

But each year there are more than 100 million SSRI prescriptions written in America and a growing number here, with some people on them for 10 years or more. (In my experience, the horrible withdrawal effects from stopping taking an SSRI are frequently played down by doctors.)

Such widespread tampering with our brains may have other effects. Anthropologist Helen Fisher, who studies the evolution of human emotion, says SSRIs raise your levels of serotonin, the happy neurotransmitter, but by doing that, they suppress another brain chemical, called dopamine.

Dopamine is associated with romantic love. SSRIs also kill your sex drive and disrupt the flood of brain chemicals we experience during human attachment and love.

Professor Fisher warns these things are connected in the brain; when you tamper with one brain system, you tamper with another. So we might save a bit of money by putting miserable people on SSRIs for year after year rather than letting them talk about their problems, but do we know at what price? As Professor Fisher says: "A world without love is a deadly place."

- NZ Herald

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