How much does it cost for a 6-month course of a typical SSRI?

How much does it cost for a 6-month course of counselling or similar therapy?

I suspect that the answers to the above questions may serve to illuminate the debate concerning over-prescription.

Rob Cheeseman, Derby, UK

Some patients really struggle to pluck up the courage to visit their local medical practice, if in the past they have had aggressive and dismissive treatment regarding other health concerns which leaves them weighing up where to go, or perhaps once there just to receive something whether pills or not is better than nothing. More acting on findings whether regarding mental health or physical concerns would highlight shortfalls in particular areas. Depression is very dangerous as is any community left wondering where or who to consult about even the most basic health needs. Most would like to be referred for talking therapies, how hard should they have to push in view of the governments much publicised drive to increase access to these effective therapies?

mary foord brown, suffolk coastal,

My sister had a breakdown and it took 6 months to get her 5 sessions of CBT. She was terribly ill and was also housebound, Nobody could come out to see her as that is not part of the health service so she had to suffer terrifying experiences to go and see a medical practictioner, Not good enough!

Amber Burrows, Holyhead, Anglesey, UK

It is typical (above) that a GP states it is the patient who is to blame for the over-prescription of anti-depressants by GPs. If patients expect a pill for every ill, it is only because they have been told this is the solution to their problems by health professionals they trust. Even to the point where they become addicted to them. As a user of complementary medicinefor over 20 years - initially to wean my mother from the 18 years repeat prescription of librium she was givne by her gp, without his even seeing her each time, I know that if a patient wants anything but drugs they have to press for it. Most doctors look amazed when asked what can be done without drugs. GPs must take responsibility for their over-use of anti-depressents rather than blame the patient, who unlike them, rarely has access to their side-efects and tens to trust the person who has been trained by the state for 7 years to know what they are doing! J.Poole. Chartered Psychologist

Dr J. Poole, Romsey, Hants

The research into the use of St John's Wort is, to quote a Cochrane review (the most objective review of the available evidence that we have) "inconsistent and unreliable" It's not a basis to argue that the drug has no effect - bad research is just as likely to miss a benefit as it is to demonstrate an unjustified one.

NICE guidelines advise doctors not to prescribe it or recommend its use at present because of concerns about the widely varying bio-availability between different manufacturer's products - as it's classed as a food rather than a drug the regulations about product quality are nowhere near as stringent.

This meta-analysis showed that if SSRI's do have a beneficial effect then they are more likely to help patients with profound and severe depression but even that finding may be a result of patients' differing responses to placebo.

And to answer your final point, I'm a GP with a special interest in both psychiatry and pharmacology with additional qualifications in both.

Martyn Lobley, London,

The meta analysis methodology itself enables “publication bias” in the sense of selecting which data sets not to include and also ignoring technical limitations of individual studies such as different sizes of drug and control groups. Meta analysis is altogether "iffy" statistically and bad science and its results at best suggest further lines of investigation rather than demonstrating effects....feeds only the "no smoke without fire", "big conspiracy" type thinking

BKriss, London,

St John's Wart is clinically ineffective in double-blind studies. How can you suggest people take it? For the placebo effect?

Having lived with someone that suffers severe depression, and knowing the effectiveness of the medication on their well being, I find it startling to discover the same witchhunt against SSRIs being dug up once more.

Why is a GP writing this article instead of a psychiatrist?

Brett Cox, London,