Interventions for common mental health conditions
This section covers the support offered to people with common mental health conditions (anxiety and depression), including from primary care, Talking Therapies and the voluntary and community sector. Practical and social interventions are covered here.
Evidence-based interventions
- The following interventions should be available to support people experiencing mild-to-moderate anxiety and depression (Public Health England, 2019):
- individual facilitated self-help based on the principles of cognitive behavioural therapy (CBT)
- computerised CBT
- structured group physical activity programmes
- group-based peer support programmes (for those who also have a chronic physical health problem)
- People who present with more severe common mental health conditions, or who fail to respond to the above treatments, should be offered one of a range of more intense psychological therapies (such as face-to-face CBT or couples therapy), or a suitable medication, or both (Public Health England, 2019).
- Social factors contributing to the depression should also be addressed (Public Health England, 2019).
- Although depression and anxiety disorders respond well to evidence-based interventions, there are high levels of relapse. Services should therefore ensure that relapse prevention approaches are included in treatment episodes, as detailed in relevant NICE guidance (Public Health England, 2019).
The Adult Psychiatric Morbidity Survey (2014) found that 10.4% of all adults in England were receiving medication as treatment for common mental illness. This was the most common form of treatment, with 3% of adults receiving psychological therapy and 1.3% receiving both therapy and medication (NHS Digital, 2014). These figures may be out of date, due to substantial investments in Talking Therapies services since 2014.
Antidepressants
- Antidepressants are a type of medication used to treat depression. They can also be used to treat other conditions, such as generalised anxiety disorder and long-term chronic pain (NHS, 2021).
- Nationally, antidepressants prescriptions have increased since SSRIs (selective serotonin reuptake inhibitors) were introduced as a treatment for depression in the 1980s (Kendrick, 2021). Research suggests that this increase has been driven by both greater numbers of people receiving antidepressant treatment and prescriptions lasting for a longer time (Kendrick, 2021).
- In the UK, the median duration of antidepressant use is over 2 years (Kendrick, 2021). For some people, a long-term antidepressant prescription may be the best form of treatment and help to prevent relapse of depression symptoms.
- However, around 30 to 50% of patients on long-term antidepressants had no clear clinical reasons for continuing to take them (Kendrick, 2021). Long-term antidepressant use is associated with increased risk of side effects and withdrawal symptoms (Kendrick, 2021).
- It is estimated that around half of people who stop taking antidepressants experience discontinuation/ withdrawal symptoms, although there is not comprehensive data on this issue (Davies & Read, 2019). Patient-led groups have highlighted that these symptoms can be severe and/or long-lasting (LEAP for Prescribed Drug Dependence, 2023).
What do the guidelines say?
- NICE guidelines highlight that antidepressant treatment ‘might need to be taken for at least 6 months after the remission of symptoms, but should be reviewed regularly’ (NICE, 2022).
- British Association for Psychopharmacology guidelines state that ‘medication-responsive patients should have their medication continued at the acute treatment dose after remission with the duration determined by risk of relapse’ and that for patients at lower risk of relapse ‘the duration should be at least 6 – 9 months after full remission’ (Cleare et al., 2015).
- The Royal College of Psychiatrists state that ‘evidence does suggest the need for improved monitoring of patients’ long-term antidepressant use’ but that GPs will require better resources to undertake regular antidepressant reviews (Royal College of Psychiatrists, 2019).
Additional resources
- Optimising personalised care for adults prescribed medicines associated with dependence or withdrawal symptoms: Framework for action for integrated care boards (ICBs) and primary care
- Lived Experience Advisory Panel for Prescribed Drug Dependence, a group that have drafted a model for an integrated primary care service for prescribed drug dependence
References
Full list of references is included at the end of this chapter.