Tag Archives: depression

Treating mental illness is trial and error

The Locum psychiatrist looked enraged when I pointed to the BNF and said with a heavy heart “I’ve tried everything in there.”

(The BNF is the British National Formulary for medicines used in the UK by all doctors, pharmacists etc as the medicines bible. It has all tried and tested drugs listed with their uses, dosages and side effects.)

I was experiencing another dip in my depression, my current anti-depressant was not working and I’d checked my copy of the BNF, there wasn’t really much else to try unless I was prepared for almost certain weight gain (which I most definitely was not – I was on a waiting list for treatment at an Eating Disorders Unit for my anorexia – I did not have any support at the time!)

The psychiatrist didn’t like a) that I knew what I was talking about (they like to hold the power and control and sadly some feel threatened by my medical degree) and b) I was presenting with “treatment resistant” depression. This phrase is used when it is felt that various treatment avenues have been exhausted and the depression remains. Looking back at this particular appointment, a short admission would have been useful but it seems this psychiatrist decided that would be too much hassle. Despite me having spent the entire appointment in floods of tears, I was sent home with no change in drug regime, no additional support and no further plan. The negligence of this psychiatrist aside, treatment resistance is an incredibly difficult phenomenon to tackle and the spiral of hopelessness can be disastrous!

There is, however, research currently being undertaking into the genetics of mental illnesses. For example, the Genetic Links to Anxiety and Depression* (GLAD) study is based at King’s College London. Therapygenetics is using genetics to predict treatment response in mental health conditions. While I’d heard of research into the trying to find genes “responsible” for various mental illnesses (a hunt that’s proving to be futile), this shift to looking at what our genetics can tell us about what treatment options are more likely to work is relatively new.

Recent research* showed 80% GPs admitted they treat mental health problems as a progress of trial and error. They try one approach after the other, based on what is available in their area and their own experience. This is not just frustrating but could be fatal for some who’re suffering with suicidal thoughts, they might not have time to try one drug after another until they find the right one. New research could enable doctors to finesse their prescribing so the patient can get the most effective treatment, for them, as soon as they are diagnosed.

My story did not end with being let down by a Locum psychiatrist – fortunately, on this occasions I had a good friend scrape me off the floor and supported me over the next couple of days until I could see my GP, and I eventually got to see the eating disorders team, then the psychotherapist who changed my life, and the rest, as they say, is history. To date, I’ve been on, maybe 10 anti-depressants, a few anti-psychotics and a couple of mood stabilizers; I’ve also worked with about 15-20 psychologists and therapists who all believed their approach was right for me. Fortunately, my current anti-depressant has been working for about 8 years (I did come off it, but went back on it!) and I continue to use skills gained from various therapies but it was individual systemic therapy from someone with specialist knowledge and experience in eating disorders that was right for me.

Just imagine if I’d been able to give a sample of saliva 20 years ago and from that, I’d been able to access the right drug and therapy treatment immediately!

Some research is finding genes that implicate how we respond to both negative and positive environments. It is noted that people with a particular gene variant are found to be highly sensitive to adversity, they also respond particularly well to social support and positive life events. This research, with children, looked at different outcomes of individual CBT, group CBT and parent-led CBT. Being highly sensitive to environmental influence led to a good response to individual therapy, whereas those who were less sensitive had similar outcomes to each course of therapy. This is just one example of where a generic variant could possibly predict outcomes to different therapies.

Biological, social and psychological Venn diagram with mental health a the the centre.

But let’s hold fire a minute. We’ve always known all mental illnesses have a bio-psycho-social cause; that is, there are elements of nature and nurture, our genetics and our environment that can lead to development of a mental illness, so doesn’t it follow that we need to take all of this into account when treating an individual? If we run off into the genetics trap, thinking we can pinpoint the ideal treatment with a mental illness, we’ll forget that they will bring with them a whole host of environmental and psychological factors that will influence their ability to engage and benefit from any given treatment.

Camilla Kong*, a Senior Researcher specialising in psychiatric genomics at the University of Oxford has a background in moral and political philosophy and an interest in the ethical issues raised by genetic research in mental health. She has concerns about us focusing entering on a genetic level, she says “It is quite a reductive explanation…that diverts our attention from the person as a holistic being who is impacted by relationships, life history, structural inequalities and environment and social issues.” She is also concerned with stigma and the assumption that diagnoses are life long and incurable. The biogenetic explanation lends itself to fatalism and works against the therapeutic alliance and hope. Of genetic research she says “I think researchers over-promise – they have to, to attract funding – but even if academic institutions pay for the research, and the results are more measured, public expectations are still very high and the more nuanced findings are ignored.”

Whenever we talk about genetic research, there’s the shadow of eugenics. Kong wisely warns us, as we learn more about genetics, “It’s not that we shouldn’t do it, but we need to be very critically aware of the reasons why we are doing it.”

Perhaps what we can learn from my story is that sometimes finding the right medication and therapy takes time and this time is valuable, I learnt a lot as I went along, some things can’t be rushed! It saddens me that (in the UK) there’s a such a push for everyone to travel on the conveyor belt that is IAPT (Improving Access to Psychological Therapies) – now there’s a service that only partially living up to its name. Access has been improved, no matter what your symptoms or history, if you present with mental health problems, you qualify for 6 sessions of CBT in IAPT, this will be the answer for some but there’s no room for flexibility or individualisation. I was involved in some work to train therapists to recognise when the basic IAPT programme wasn’t going to be enough and how/what treatment to refer patients onto but NHS funding for tertiary mental health services is still floundering; scarce resources mean long waiting lists, leading to people with moderate mental illness becoming people in mental health crisis.

For every cancer patient, £225 is spent on research. For every mental health patient, the equivalent figure is £9**. It’s great that some money is being spent on research but so much more is needed. It concerns me that to attract funding outcomes are being over promised and we all know that the media always sensationalise research results. What we really need is some down to earth longitudinal studies that will back-up the need for particular groups of patients to have long term therapy while others may benefit from shorter, specialised therapies. We then need the funding to train GPs and enough tertiary services to provide appropriate support.

*Information and quotes from Therapy Today Volume 29, Issue 10 – Nature and Nurture, Catherine Jenkins.

** MQ Mental Health

Woman looking out the window calmly

Should we be normalising mental illness?

Awareness around mental illness is certainly getting better, reducing stigma and discrimination is important but are we doing the general population a disservice?

1 in 4 mental health awareness. 4 silhouettes, 3 are blue and 1 is has words such as “there’s too much to do” and “why does it always happen to me?”

The figure is 1 in 4 people will suffer with a mental illness at some point in their lives. There are also statistics out there about how many anti-depressants are prescribed each year or the number of sick days mental illness costs companies. Some say “mental illness is on the rise”, perhaps due to the state of our economy, social media or life stresses from other sources.

But, perhaps we need to stop and think. Not coping is different from mental illness.

Talking recently to someone working in Child and Adolscent Mental Health, she said she is seeing a rise in children being referred to her service but this is not due to a rise in mental illness, she is seeing a rise in children not coping and a decrease in resilience.

This seems to be the same across all sector of the population.

The phrase “panic attack” has become synonymous with feeling anxious. Now, I do not want to diminish anyone’s anxiety but if you’re stood in a queue in the supermarket “having a panic attack” but you “kept it in” – you did not have a panic attack. You may have experienced extreme anxiety, and I’m not saying that is ok, you may need to learn some techniques to manage feeling anxious but please do not use a medical phrase for a normal emotion.

An outline head and shoulders with thought bubbles saying, “worry”, “anxiety”, “fear”, “tension” and “panic”.

The language around mental illness is diffciult because they’re standard English words. You can feel depressed without being diagnosed with depression, you can feel paranoid without suffering panaroia (a symptom of mental illness), you can feel anxious without having a diagnosis of anxiety. By raising awareness, we’re making all these words more accessible and they’re falling into common use. But bandying medical words around in common parlance diminishes their meaning in the context of illness.

If you suffer severe fluctuations in emotions that feel uncomfortable, please do talk to someone, you are allowed support, I do not want to take that away from you. After all, apparently Socrates said “The unexamined life is not worth living”. You do not have to be ill to access support, explore yourself and your life and to develop better coping strategies. Nor do you need to justify your struggles by using medical terminology.

I started training to be a counsellor because I want to help people diagnosed with mental illness but the more I learn, the more I see how incredibly helpful it can be for people who’re struggling with life’s ups and downs. It’s ok to seek counselling or other support when things just don’t feel right.

Words on a rainy back ground, “it is perfectly okay to admit you’re not okay”

It’s great that people are getting more comfortable in talking about their emotions but we need to be able to differentiate between people who’re struggling and people who’re ill. It’s ok to say “I’m having a bit of a tough time” or “I’m not feeling so great today” – the #hashtag #itsoknottobeok is falling into common use and this is helpful for everyone’s mental and emotional wellbeing.

If you’d sprained your ankle, you wouldn’t say you’d fractured it, put it in a cast and use crutches would you? A sprained ankle needs appropriate support. If I had a sprained ankle but I acted as though it was broken and treated it as such, i.e. immobilised it etc, it would get worse, not better.

By normalising mental illness and by normalising the language, we risk normal struggles being treated as illness. Since recovering from mental illness, I’m not immune from normal life struggles but I’m acutely aware they are just that.

By raising awareness of mental illness, we need to be careful we don’t label all emotional struggles as “illness”. We need to make sure we’re also raising awareness of the differences between illness and not coping.

Quote “The unexamined life is not worth living” accredited to Socrates. On a black and White Sea scape background

World Mental Health Day: Young people in a changing world

Young people today face very different pressures to the ones I experienced. I cannot say whether it is better or worse to be a teen these days without experiencing them both first hand. I think the biggest difference is technology and it’s having a great impact on everyone, not just our young people.
It’s social media in particular that has revolutionised the way we interact with each other and the world at large. I can barely keep up with the number of platforms from Facebook and Twitter to LinkedIn and Aloqa to various online dating sites! My grandmother, bless her, even tried to “Facemail” me the other day, I’m assuming that was a mistake, not another networking platform!

YouTube wasn’t even a thing as I grew up, now we have someone whose identity is as a ‘YouTuber’ appearing as a ‘celebrity’ on Strictly Come Dancing (I think he’s amazing and might actually win!)

Anyone in the public eye and how the media portray them, influence young people as they grapple with issues such as identity, morals, ethics and personal boundaries. If you want to be successful and ‘liked’ there is a certain body shape we should have, a certain way to dress and a specific way to talk and behave – most of this for the average Jo is unobtainable. While these ‘ideals’ have always been there, perhaps with a different emphasis, they are now more accessible and almost invade our lives in a way never experienced before.

The speed of technological change is such that instead of us designing technology to meet a particular need, technological advances are now telling us what we need! As a young person, growing up, never did I think “I wish I had a device in my pocket that alerted me the minute a [insert reality TV star] goes up or down a dress size”!

Questioning the amount of screen time a young person should or shouldn’t have is just the tip of the iceberg. How their real relationships are impacted by their virtual relationships is complicated.

Technology has advanced before we’ve decided what we want and, as with any change, it’s open to abuse. Social media is great at enabling us to make positive connections, it’s also there if people want to make negative connection such as cyber-bullying and trolling.

Cyber-bullying has been named as a key factor in young people dying by suicide. Being bullied at school is bad enough, but when it flows beyond the school gates and into the private space of the individual, being told “you’re different and that’s a problem” would take its toll on anyone, there is no escape. People are trying to develop tech to tackle this problem, to support young people when they’re targeted but as one solution is found, a different problem will occur, we’re running to keep up!

Rates of self harm, depression, anxiety and eating disorders in young people are all on the rise – this is very worrying and mental health services are not able to keep up with demand. The government target is for any young person presenting with mental health symptoms to be seen within 4 weeks, this target just isn’t being met. Listen to BBC Radio Berkshire on Monday at 7am for more on this!

I did, however, have a very positive experience with social media while on the road to recovery. Berkshire Eating Disorders Service piloted a Support, Hope and Recovery Online Network (SHaRON) – an internet based forum for people suffering with eating disorders and their affected family members. Anonymous online support could never replace the important face-to-face therapy necessary to re-build a life destroyed by illness. However, the forum was very well designed and I would not have managed the multiple challenges I faced during recovery, if I hadn’t had the incredible support I received from fellow sufferers and professionals day and night at the touch of a button.

Young people these days do not have an easy job navigating changes as they happen. We all have a responsibility to support each other.