‘In my life antidepressants have been…’: a qualitative analysis of users’ diverse experiences with antidepressants

BACKGROUND: While mental health professionals have focused on concerns about whether antidepressants work on a neurochemical level it is important to understand the meaning this medication holds in the lives of people who use it. This study explores diversity in the experience of antidepressant users. METHODS: One thousand seven hundred forty-seven New Zealand antidepressant users responded to an open-ended question about their experience of antidepressants. This was analysed using content and thematic analysis. RESULTS: There was considerable diversity in participants’ responses including positive (54 %), negative (16 %) and mixed (28 %) experiences with antidepressants. Those with positive experiences saw antidepressants as a necessary treatment for a ‘disease’, a life saver, a way of meeting social obligations, dealing with difficult circumstances or a stepping stone to further help. Negative themes described antidepressants as being ineffective, having unbearable side effects, undermining emotional authenticity, masking real problems and reducing the experience of control. Mixed experience themes showed how participants weighed up the unpleasant side effects against the benefits, felt calmer but less like themselves, struggled to find the one or dosage and felt stuck with continuing on antidepressants when they wished to stop. CONCLUSIONS: Mental health professions need to recognize that antidepressants are not a ‘one size fits all’ solution

A voyage of discovery: From fulfilling funding criteria to revealing a clearer vision for music therapy in a special needs school

Στην εποχή της ερευνητικά τεκμηριωμένης πρακτικής, οι μουσικοθεραπευτές καλούνται ολοένα και περισσότερο να προσκομίζουν αποδεικτικά στοιχεία στους χρηματοδότες τους. Συχνά, αυτό σχετίζεται με την απαίτηση για «αξιολόγηση των υφιστάμενων υπηρεσιών ή για τη δικαιολόγηση δημιουργίας νέων υπηρεσιών με τα ‘κατάλληλα’ τεκμήρια» (Pavlicevic, Ansdell, Procter & Hickey 2009: 3-4). Ο φορέας Youth Music Initiative│Creative Scotland (YMI) χρηματοδότησε τον μουσικοθεραπευτικό οργανισμό Nordoff-Robbins στην Σκωτία για να υποστηρίξει τις υπηρεσίες μουσικοθεραπείας σ’ έναν αριθμό σχολείων μιας περιοχής τοπικής αυτοδιοίκησης στη Σκωτία. Ως μέρος της διαδικασίας χρηματοδότησης ο φορέας ζήτησε την αξιολόγηση της υπηρεσίας που προσφέρθηκε σ’ ένα απ’ αυτά τα σχολεία. Το πρώτο μέρος του παρόντος άρθρου περιγράφει την αξιολόγηση (που πραγματοποιήθηκε το 2013) της μουσικοθεραπευτικής υπηρεσίας σ’ ένα σχολείο για μαθητές με σύνθετες ανάγκες. Η αξιολόγηση στόχευε στην εκτίμηση της επίδρασης που έχει η μουσικοθεραπεία στους μαθητές και στο σχολείο, και στη διασφάλιση της ποιότητας της υπηρεσίας. Το δεύτερο μέρος του άρθρου αναλύει τη διαδικασία αντιμετώπισης ενός επιπλέον αιτήματος που ανέξυψε από τους χρηματοδότες μετά την ολοκλήρωση της αξιολόγησης. Αυτή τη φορά, όλα τα σχολεία που χρηματοδοτήθηκαν από τον φορέα κλήθηκαν να παράσχουν πληροφορίες για ν’ αποδείξουν ότι πληρούν τις προϋποθέσεις ώστε να διασφαλίσουν την ανανέωση της χρηματοδότησης. Οι μελέτες περίπτωσης και τα πορίσματα της αξιολόγησης χρησιμοποιούνται για να διευκρινιστεί ο τρόπος με τον οποίο η μουσικοθεραπεία ανταποκρίνεται στους στόχους του χρηματοδότη. Η διαδικασία αυτή οδήγησε στην ανάπτυξη ενός μοντέλου για τη συνεχή παροχή μουσικής στο σχολείο. Αυτό το άρθρο έχει ως στόχο ν’ αναδείξει πώς αυτό το ταξίδι χρηματοδότησης δεν εξασφάλισε μόνο τη συνέχιση της μουσικοθεραπείας, αλλά στην πραγματικότητα είχε ως επακόλουθο ένα σαφέστερο όραμα για τον ρόλο της μουσικοθεραπείας στο σχολείο.In the era of the evidence-based practice (EBP) movement, music therapists are increasingly asked to provide evidence for funders. Often this has been the requirement to “evaluate existing services, or to justify the creation of new services with ‘appropriate’ evidence” (Pavlicevic, Ansdell, Procter & Hickey 2009: 3-4). Youth Music Initiative│Creative Scotland (YMI) awarded funds to Nordoff-Robbins Music Therapy in Scotland to support music therapy services for a number of schools in a local council area in Scotland. As part of this funding, they requested a service evaluation of one of these schools. The first part of this paper describes this evaluation (conducted in 2013) of the music therapy service in a school for pupils with complex needs. The evaluation aimed to assess the impact of music therapy on the pupils and the school and to ensure the quality of the service. The second part of the paper discusses the process of meeting an additional request from the funders which came after the completion of the evaluation. This time, all of the schools under the umbrella of this funding block were each asked to provide information to prove eligibility to access this funding to ensure funding renewal. Case studies and the evaluation findings are used to help illustrate how music therapy meets the funder’s goals. This process led to the development of a model for a continuum of music provision in the school. This paper aims to demonstrate how the funding journey not only ensured the continuance of music therapy but actually resulted in a clearer vision of the role of music therapy in the school

‘In my life antidepressants have been…’: a qualitative analysis of users’ diverse experiences with antidepressants

BackgroundWhile mental health professionals have focused on concerns about whether antidepressants work on a neurochemical level it is important to understand the meaning this medication holds in the lives of people who use it. This study explores diversity in the experience of antidepressant users.MethodsOne thousand seven hundred forty-seven New Zealand antidepressant users responded to an open-ended question about their experience of antidepressants. This was analysed using content and thematic analysis.ResultsThere was considerable diversity in participants’ responses including positive (54 %), negative (16 %) and mixed (28 %) experiences with antidepressants. Those with positive experiences saw antidepressants as a necessary treatment for a ‘disease’, a life saver, a way of meeting social obligations, dealing with difficult circumstances or a stepping stone to further help. Negative themes described antidepressants as being ineffective, having unbearable side effects, undermining emotional authenticity, masking real problems and reducing the experience of control. Mixed experience themes showed how participants weighed up the unpleasant side effects against the benefits, felt calmer but less like themselves, struggled to find the one or dosage and felt stuck with continuing on antidepressants when they wished to stop.ConclusionsMental health professions need to recognize that antidepressants are not a ‘one size fits all’ solution

Do GPs and psychiatrists recommend alternatives when prescribing anti-depressants?

This study explores whether a partial explanation for high antidepressant prescription rates is the failure of prescribers to recommend alternatives. 1,829 New Zealand adults were asked which of six non-pharmacological treatment approaches were recommended when prescribed anti-depressants. The majority (82%) received at least one recommendation and 32% received three or more, most commonly ‘Counsellor/Psychologist/Psychotherapist’ (74%) and Exercise Schedule (43%). It cannot, therefore, be concluded that failing to consider non-pharmacological treatments is a major cause of high prescribing rates. Being younger and more severely depressed were both positively related to number of recommendations. Psychiatrists made significantly more recommendations than GPs

Parental responsibility beliefs: associations with parental anxiety and behaviours in the context of childhood anxiety disorders

Background: High levels of parental anxiety are associated with poor treatment outcomes for children with anxiety disorders. Associated parental cognitions and behaviours have been implicated as impediments to successful treatment. We examined the association between parental responsibility beliefs, maternal anxiety and parenting behaviours in the context of childhood anxiety disorders. Methods: Anxious and non-anxious mothers of 7-12 year old children with a current anxiety disorder reported their parental responsibility beliefs using a questionnaire measure. Parental behaviours towards their child during a stressor task were measured. Results: Parents with a current anxiety disorder reported a greater sense of responsibility for their child’s actions and wellbeing than parents who scored within the normal range for anxiety. Furthermore, higher parental responsibility was associated with more intrusive and less warm behaviours in parent-child interactions and there was an indirect effect between maternal anxiety and maternal intrusive behaviours via parental responsibility beliefs. Limitations: The sample was limited to a treatment-seeking, relatively high socio-economic population and only mothers were included so replication with more diverse groups is needed. The use of a range of stressor tasks may have allowed for a more comprehensive assessment of parental behaviours. Conclusions: The findings suggest that parental anxiety disorder is associated with an elevated sense of parental responsibility and may promote parental behaviours likely to inhibit optimum child treatment outcomes. Parental responsibility beliefs may therefore be important to target in child anxiety treatments in the context of parental anxiety disorders