In our infant mental health service we find depression among vulnerable mothers to be so common that we are in danger of taking it for granted.
When we go into the pressures that all these mothers are under, and the trauma that is an aspect of their past, then this is small wonder. If I was in their shoes not only would I feel depressed, but I would be coping less well. However, only because it is not something taken for granted in my background, the difference would be that I would resist taking prescribed anti-depressants.
There is an acceptance that pills are the answer, and we have to ask where this comes from. Well, for a start it means the 'problem' can be located within the individual and so avoids trying to understand the hard grind, hopelessness and victimisation so many suffer. Heaven forbid that another reason might be the drug companies that target both those that write the prescriptions and those who cash them in.
I am not saying that anti-depressants do not work, although there is a huge variation in effectiveness and tolerance, and getting the right drug can be hit and miss sometimes. At the same time, the patient has to put up with the side effects. In the short term, the most common are nausea, diarrhoea, nervousness and insomnia; and in the long term, sexual dysfunction and drowsiness.
However, there is a treatment that has been shown to be as effective as anti-depressants and it has no side effects at all - psychotherapy. Not only that, but the drop-out rate for treatment is under half, as is the relapse rate when treatment has finished. Studies on cognitive behaviour therapy and interpersonal psychotherapy show the best improvements here, and encouraging results seem to be coming in from short-term psychodynamic therapy and client-centred therapy as well.
The comparative costs work out as about the same, so the only real barrier to redressing the balance of available treatment for depression is the lack of qualified psychotherapists working in the public sector who have the time and skills to offer understanding as an alternative to drugs.
- Robin Balbernie is a consultant child psychotherapist in Gloucestershire.