The drugs do work: as long as you take them!

A recent study, published in the Lancet and widely reported in the media, has concluded that using drugs for the treatment of depression is effective. And the study generously concluded that, overall, drugs and the ‘Talking Therapies’ are equally effective.

But there is a detail that many commentators conveniently failed to draw out. On the one hand the best-known antidepressant of them all, Prozac – was among the least effective of the drugs but was the best tolerated and had the lowest rate of patient drop-outs. Conversely, the most effective drug scored much lower for patient tolerance. ‘Tolerance’ here meaning there were fewer side-effects.

So, it seems an issue faced by those dealing with depression and other seemingly intractable conditions is how to ensure that, in the longer term, the treatment of the condition is sustained. It’s easy to think the answer is to get a course of pills, and advertising by the large pharma certainly aims to spread that belief, but that is not always the best route to take. Given the relatively high rates of drop out and the high cost of medicines, the responsibility or accountability for compliance over an extended period is always going to be a sticking point.

This supports the case for the ‘Talking Therapies’, which are acknowledged to be not only effective but also, because the client takes on greater responsibility for the direction of the work done, are less likely to have drop out. These benefits over a longer period tend to outweigh the apparent cost issue compared with repeated use of expensive pharmaceuticals. Making an agreement about the programme of session has long been a core principle in Coaching, although less so in Counselling and Psychotherapy. The psychological contract and the relationship between coach or therapist and client is what can encourage and support the client to keep up the programme and not to drop out.

In the case of coaching, a well-formed outcome may be that a client identifies and moves towards their personal or career goals, or some other longer-term objective. In this context, setting in place a schedule of check-ins and progress reviews is one of the ways of supporting and keeping the client on track. It’s what McChesney, Covey, Huling in The 4 Disciplines of Execution call the ‘Cadence of Accountability’.

A coach is not a doctor but the regular sessions can be like a client/patient electing to have the doctor standing over them while they take their pills. There is a possibility of intolerance – the coach/coachee relationship doesn’t always work – and there may be drop out before the programme of sessions is complete. However, the benefits of coaching, like the other talking solutions, are that the client is more in control and has a greater involvement over the constituent ‘ingredients’.

Of course, there is a proper time and place for pharmaceuticals – drugs do work – but if they remain in the bathroom shelf, unused, the cost and the overall value have to be questioned.