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David Baxter

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Warning on depression treatments
19/4/2006

At the start of National Depression Week, DA Cymru, an independent charity run by and for people affected by depression, together with the Centre for Mental Health are calling for better regulation of complementary and alternative medicines offered in the treatment of mental illness.

There is particular concern around the use of over-the-counter ?food additives? such as St. John?s Wort and Passiflora, which are used to self-medicate.

Tim Watkins, Director of DA Cymru said, "The active ingredients in these preparations are not alternatives to antidepressants, they are antidepressants. St. John?s Wort contains an SSRI (from the same family of drugs as Prozac); Passiflora contains a Mono-Amine Oxidase Inhibitor (a family of drugs that are rarely prescribed because they have dangerous interactions with common foods such as bread, cheese and red wine."

DA Cymru and Centre for Mental Health are calling for proper clinical trials into the active ingredients of herbal remedies so that these can be offered to patients in a safe manner, rather than leaving patients at risk of side effects and overdose.

Tim Watkins said, "We don?t doubt that these substances work as antidepressants. However, using the raw plant rather than the active substance means that there is no way of controlling dosage, leaving users facing the prospect of both overdose and withdrawal within the same box of tablets. Kava, a herb used for stress, was withdrawn from sale two years ago because it causes liver damage. St. John?s Wort has been banned from sale in Eire because it has dangerous interactions with other medicines. Research into St John?s Wort has shown that users experience the same side effects as users of other SSRIs. It may be that these substances have a part to play in the treatment of depression. However, when people pick up herbal antidepressants, they need to know that these preparations are safe and effective. As it stands, this assurance can?t be given.?

DA Cymru and Centre for Mental Health are calling for a safer market place in which these approaches are delivered to people who can be highly vulnerable as a result of their condition.

About complementary therapies, Tim Watkins said, "As with every other market, we need to know that the products and services on offer are safe and fit for purpose; we need to know that practitioners are appropriately qualified; and we need a system of redress when things go wrong. At present, the multi-million pound complementary and alternative therapy market is unable to offer any of these basic guarantees."

DA Cymru believes that self-regulation should be the preferred option, but that if this does not prove possible; there should be legislation to guarantee minimum standards for consumers. Tim Watkins explains, "Many of the people who use these therapies ? particularly those with mental health problems ? are very vulnerable. They have often been denied NHS services, and are desperate to find relief for their condition. In this state, many people will believe some of the outlandish claims made by the less scrupulous practitioners in this area. With some of these therapies costing over ?100 per hour, this cannot be acceptable."

Relationship with medicine
DA Cymru and Centre for Mental Health are concerned about the lack of communication between complementary and alternative medicine and the NHS. Tim Watkins explains, "Depression can be a serious and dangerous mental illness. Depression accounts for more than 75 percent of suicides and 85 percent of homicides by people with mental illnesses. It would be irresponsible to give the impression that depression can be treated without contact with a doctor. There is also good reason to see a doctor in order to rule out conditions such as diabetes, thyroid problems and liver disease that can have similar symptoms to depression. While we fully understand that someone would want to avoid contact with a doctor because of the problems associated with being diagnosed as 'mentally ill', self-medication using approaches for which there is no clinical evidence base for safety or efficacy is likely to result in precisely the severe depression that all of us would wish to avoid."

DA Cymru is the only Welsh charity dealing specifically with depression. A user-led organisation, we have more than 600 members and 20 Branches in Wales.

Over two million people are being treated for depression at any one time in England, and around 250,000 people in Wales.
 

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