Depression is the leading cause of disability worldwide and a major contributor to the overall global burden of disease. In the UK, mental health problems represent the largest single cause of disability, with estimates showing that one in every six people of working age will experience a mental health problem over the course of a year, with anxiety and depression the most common.
Despite this, depression consistently falls between the gaps in healthcare provision, as GPs struggle with workload and Mental Health Trusts prioritise more serious mental illnesses, due to funding cuts and a bed crisis.
At present, mental health receives unprecedented political attention. Some might say, ‘about time too’. For several years, three words, ‘parity of esteem’ have been viewed as a mental health priority across the NHS, relative to physical health. Indeed, it has become the emblem embossed into national policies, documents, reports and indicators.
The change in policy has mainly been driven by the excellent work of the Mental Health Taskforce and the Five Year Forward View for Mental Health, but it might be argued that its recommendations have led to the overall focus shifting to more serious mental illnesses, such a schizophrenia, and less on depression. There may even be a view among the public, and some NHS services, that common mental illnesses like depression might be cured by commissioning more psychological therapies.
While NICE are currently re-writing their guidelines on depression, in their last document, ‘Depression in adults: recognition and management’, they were clear that both psychological therapy and pharmacological therapy are useful in improving patient outcomes. Furthermore, it states that, for people whose depression doesn’t respond to either interventions, clinicians should combine treatments.
NICE, in the spirit of the parity of esteem agenda, also undertook their first single-technology appraisal of an antidepressant in 2015, approving vortioxetine as an option for treating major depressive episodes in adults whose condition has responded inadequately to two antidepressants within the current episode. This clearly reaffirms the importance of pharmacological therapy for depression.
Despite this positive psychological/pharmacological guideline environment, and encouraging press around parity of esteem, it appears all too regularly in print that the patient on an antidepressant is part of a rising group of ill who are ‘overprescribed’ pharmacological therapies, despite NICE’s view on their effectiveness.
Meanwhile, mental health professionals await the updated NICE clinical guidelines for depression, due for publication in January 2018, in the hope that they will help remove the stigma associated with mental illnesses like depression, and also encourage new effective treatments. Go to www.lundbeck.com