UK Doctors Prescribe Books For Mild Depression

The American Psychological Association reports on an article originally carried by the Sunday Gazette-Mail on the use of bibliotherapy by UK doctors.

According to the article, most cases of depression and anxiety are diagnosed at the general physician’s office, where the average visit in Britain lasts just seven minutes. Under a new programme in more than a dozen counties across the United Kingdom, doctors now send mildly to moderately depressed patients down the hall to a mental-health worker, who will ask a short series of questions and then may prescribe a self-help book. Patients take the prescription to their local library, where they check out reserved titles such as Overcoming Depression [Amazon-US | Amazon-UK] and The Feeling Good Handbook [Amazon-US | Amazon-UK].

(Note that the mental-health workers are not trained therapists or counsellors, but have undergraduate degrees in psychology or a related field and take an additional one-year training course that qualifies them to administer bibliotherapy.)

Doctors say they began prescribing books out of concern that too many depressed people were either being medicated too hastily with antidepressant drugs like Prozac or going untreated. They also saw it as a cost-saving strategy. The state-run health-care system cannot afford one-to-one counselling for everyone — waiting lists can run up to 18 months — leaving medication or no treatment the remaining options.

The programmes, called “bibliotherapy” or “guided self-help”, were endorsed by the National Institute for Clinical Excellence, the British health agency, in December. The agency warned of “overuse” of antidepressants in patients with mild depression and recommended that doctors try guided self-help or other kinds of counselling before medication.

Bibliotherapy raises some concerns. Some patients fail to check out or read the books and fall through the cracks. And, in a few cases, severely depressed people have been directed to the self- help program when more serious treatment was needed, counsellors say.

Concerns about overuse of antidepressants — and about how to treat the growing depression burden in general — have been voiced in many countries, including the US, making the British experiment a test case for others to watch.

“Until recently the only thing available to a physician was to write a prescription for a drug. What this does is give the physician two prescribing pads”, says Neil Frude, a Cardiff University psychologist who started the self-help-book trend by setting up a program in Wales three years ago. Bibliotherapy, he adds, also frees up busy counsellors to deal with more seriously depressed or mentally ill patients.