Since the beginning of the pandemic, there has been a growing demand for mental health services, with an estimated 1.6 million people in England waiting for specialist support, and another 8 million who would benefit but deteriorate. of whose mental health is not considered serious enough to even enter the waiting list. It has been reported that anxiety rates increased significantly between 2008 (the year of the financial crisis) and 2018, with increases in all age groups under 55, but tripling in adults. teens.
The number of prescriptions for anxiety medications has also increased. Earlier this year, research was published showing that between 2003 and 2008 the use of drugs to treat anxiety was constant, but by 2018 it had increased considerably. During this previous period, new prescriptions for anxiety increased by 25 or 26 per 1,000 person-years at risk, a measure of the prevalence of anxiety, to 43.6 in 2018. Almost twice as many women are ‘ls prescribe drugs that men.
This increase could be due to several things. “I think GPs are improving a lot when it comes to detecting anxiety,” says Charlotte Archer, a senior associate researcher in primary mental health at the University of Bristol, who led the study. Before, he says, there were concerns “not being diagnosed. I think that’s starting to change. And that will have an impact on prescription rates.” He also believes that patients are more aware, not only of anxiety, but of how it can be treated. “They know they want a recipe. I don’t think it’s always been that way.”
When people see their GP, says Dr Trudi Seneviratne, a consultant psychiatrist and registrar at the Royal College of Psychiatrists, treatment “is very much about what people want”. “How serious is it and how would you like to handle it better?” it is often the conversation. If it is mild to moderate, would you like to follow the path of talking therapies? Would you like a combination of psychological therapies plus a medication? What other lifestyle changes can you make to manage this anxiety? “
Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs) such as sertraline and citalopram, are the most widely used. “Anxiety and depression can go hand in hand,” says Seneviratne. “You don’t necessarily have someone just anxious, even if you can.” Antidepressants, such as the SNRI group, can be used if an SSRI has not worked. “The other group we use is benzodiazepines, which are sedative drugs like lorazepam or diazepam, but they should only be used in the short term because they can be addictive.” Others include beta-blockers, medications used for epilepsy, and antipsychotic drugs. Depending on the drug, side effects can range from headaches and nausea to a reduction in sexual desire and even an increase in anxiety. The latest reflection on medication suggests that in general it should not be considered “for life,” as Seneviratne says, and should be monitored and reviewed approximately every three months.
With milder forms of anxiety, people should initially be offered psychological therapy such as counseling or CBT.
Medication tends to be prescribed, says Seneviratne, “when anxiety is becoming weaker … when it has a serious impact on quality of life: not being able to sleep, work, work, even struggle to do simple things like get out of the house, or keep self-care. ” At this time, someone with anxiety may not be able to participate effectively in therapy.
With milder forms of anxiety, he says, people should initially be offered psychological therapy such as counseling or cognitive-behavioral therapy (CBT). The latest guidelines from the National Institute for Health and Care Excellence (Nice) for Depression recommend that patients be offered other treatments such as therapy, mindfulness, and exercise before taking medication.
For some people, it may simply involve making their own lifestyle changes, improving their diet, sleep, and exercise. If that doesn’t work, “then mild to moderate, and for the most severe anxiety, speech therapy should always be offered.” However, Seneviratne adds, “access to speech therapies is very erratic and there are huge waiting times depending on where you are.” What is unclear is whether medications are prescribed where there are long waiting lists for talking therapies. For people who need more urgent help and do not want to take medication, private therapy can cost more than £ 40 per hour.
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“There is a dizzying variety of therapies, which can be confusing for those who suffer from it,” says Dr. Stephen Blumenthal, a clinical psychologist and psychoanalyst. “In general, they are grouped into two types: one, which is more exploratory, which treats anxiety as a symptom of something underlying, which is to be understood. And on the other side of the spectrum, there is [therapies] The latter are usually behavioral therapies such as CBT and CBT (dialectical behavioral therapy, which is based on cognitive therapy but also incorporates an element of acceptance) which are, he says, “basically strategies for dealing with fear is not mutually exclusive with a more psychodynamic approach, which would be to try to explore what it means. “
For many people, medications cover the symptoms during the time the person is in a state of anxiety and can undermine the natural coping mechanisms.
He added: “Of course, there are times when you need to take medicine.” But be wary of it being considered a quick fix. “Anxiety can be so paralyzing that you want to resolve it as soon as possible,” he says. And our mental health service, “under great stress, is extremely action-oriented. When someone goes to a GP, you’ll have seven minutes, and the poor GP is under a deluge of people, in the about 40% of them involve mental health problems of one kind or another. ” He believes that for many people, anxiety medications “do not solve anything, they only cover the symptoms during the time that the person is in a state of anxiety, and in fact they can undermine our natural coping mechanisms.” Coping strategies, he says, “should be supported by psychological therapies.”
In July last year, Hannah Duran’s depression and anxiety, which had been going on for years, began to get worse. “I felt like I needed a little more help,” he says. He referred to the Improving Access to Psychological Therapies (IAPT) service, which operates in England, but found out nothing. In February, unable to cope, she was discharged. “Coincidentally, the day after I got sick I got a call from a talking therapy local to give me an appointment,” she says. Then, that appointment was canceled, and so was the reordered date. Nine months after her first contact, she says she has not been offered treatment yet. The NHS recently reported that almost 90% of IAPT referrals for speaking therapies in England were seen on average in six weeks, but it varies by area and people have reported long waits.
Duran cannot afford private therapy, but he did access counseling, which began in March, through the mental health charity Mind. “They’ve been great,” she says, but she’s frustrated because the IAPT service wasn’t available. “I think there’s a good chance I wouldn’t have gotten sick if I had had access to therapy before. Things got worse until I got to the breaking point.”
Speech therapy may work for some people but not for others, and the same goes for medication. For Duran, a combination of both has been effective. For others, the medication has not been effective. Freya Jenkins has been suffering from anxiety for most of her life and was recently hospitalized for a week after her mental health declined rapidly last January. He has been taking beta-blockers, a short course of diazepam and, for the past two months, venlafaxine, an IRSN. “I haven’t noticed any difference,” he says. He would prefer to receive therapy but needs specialized and long-term treatment, under the care of a psychologist, and is now facing a wait, although he is clearly struggling. “Someone told me [it could be] up to a year, “he says.” It’s not the fault of the NHS. There is not enough funding and a review is needed. “
Some names have been changed.