The Rise of Antidepressants

The BBC ran a news piece today about the massive rise in use of antidepressants in England and Wales over the last 10 years. And depending on which study you believe between 1 in 11 and 1 in 6 people in England are now on an antidepressant (though we must remember, that antidepressants can be used for other conditions like pain management and irritable bowel syndrome – IBS). In the USA, antidepressants are now the second biggest group of prescribed drugs.

 

So, what should we conclude? Well, firstly, it is good news that it has become much more acceptable for people to talk about struggling with depression, anxiety and other mental health issues. It is good that people are going to see their GP when they feel depressed and anxious, rather than just trying to cope with it. So, we mustn’t now necessarily insinuate that the increase in prescriptions is a bad thing, because firstly, that can heap shame on those who are taking them, which is unhelpful at so many levels and also, we need to remember that there is actually a good evidence-base behind anti-depressant medication. They really do work – I’ve seen that again and again for my patients, who choose to go on them, and for sure, I would love to see more psychological therapies available on the NHS, as an alternative or as an adjunct to medication. Waiting lists are currently far too long for such therapeutic interventions and many people choose medication because they cannot afford to pay for therapy or indeed to wait several months for the help they need. We don’t report the use of antihypertensives to control blood pressure negatively and so we need to be careful about taking a dim view of medications which help improve mental health.

 

However, when so many in our society are struggling with anxiety and depression to this extent (and it’s really positive that we’re talking about it and that people are getting help), we need to ask ourselves some big questions about the root causes of this and what we can do as a nation to improve our mental health. One of all time favourite quotes is that of Archbishop Desmond Tutu, when he says:

 

“There comes a point, where we have to stop just pulling people out of the river. We need to go upstream and find out why they are falling in.”

 

So, in the rest of this blog, I’m going to explore some root causes, whilst recognising that for many people, endogenous depression (i.e. a neurochemical cause in the brain) IS the root cause, and therefore their depression may not have any other roots to it.  I’ve also done this vlog (which I did for mental health awareness week) about what depression is and some of the things that can help.

 

But in looking for root causes, let’s start at the beginning. I’ve written on this blog a number of times about the impact of Adverse Childhood Experiences and the impact of Trauma on our lives. So many of us live with unhealed pain, which over time eats away at us and makes it harder for us to remain mentally well. Many of us go through trauma and are able to survive it better than others, but that is because we’ve had other things in our lives at the time which have helped us navigate the storm. However, we need to recognise more the massive reality of trauma in our lives, so that we can face it, and find healing together. This is one of the reasons why I’ve co-written ‘The Little Book of ACEs’ with some friends and colleagues, here in Morecambe Bay. There is a free PDF version of it, if you click here. You may also find this inspiring talk by Jaz Ampur-Farr, herself a survivor of significant trauma, really helpful. Jaz is joining us in Morecambe Bay very soon, to explore some of these issues.

 

We must also be brave enough to recognise that we have a complex corporate history, which shapes our identity and we have a society, which is by no means equal or fair. Prof Bev Skeggs, and Prof Imogen Tyler, two of the foremost sociology professors in the UK/world right now, are writing so powerfully about this. It’s well worth digging into their work, and I am so excited that they are here at Lancaster University, in Morecambe Bay, and will be exploring some of these issues with us in more depth over the next few months. We cannot underestimate how injustice, poverty, and inequality impacts our mental health.

 

Stress has a hugely negative impact on our mental health. Our work patterns have become so manic and busy and our weekends often so full, that we have forgotten how to rest, how to stop, how to switch off and take notice of the beauty all around us – of the things which really matter. This takes a huge toll on us. The girl guides took part in a fascinating survey about what causes them stress and feeds mental health issues. The number one factor was the pressure they feel to do well at school. Our very systems and the treadmill of the exams are making our young people unwell. The idea of slowing down and learning to switch off from our ever faster, consumerist world, seems laughable to so many of us – and yet I would argue that this is one of the greatest causes of our ill-being. We have created an economy which treats people like fodder for the economic machine and is literally killing the planet around us – another underlying huge but often unrecognised cause of our stress. We must rebuild an economy based on wellbeing. It’s why I’m so excited that we’ll be welcoming Prof Katherine Trebeck to Morecambe Bay in the next few weeks.

 

Another causative factor of our growing mental illness in society, perhaps caused by all the busyness, is loneliness and isolation. Despite our many frantic activities, and social networking, 20% of the UK population say they feel lonely, but that jumps to between 50 and 75% of people over 75. We were made to be in relationship. When we are disconnected from community, we become sad and low. We need to remember how to love people, and also to be loved. Our disconnection is leading to increased separation, suspicion of others and a rise in racism and hatred. This is in no way good for our mental health. Valerie Kaur explores this so powerfully in her incredible TED talk on revolutionary love. We need to reimagine a society in which relationship is at the core of our being together. Hilary Cottam’s work is so vital in helping us recover this. Again, Hilary is coming to the Bay in the coming months to help us dig deeper as a community into these ideas.

 

I am so glad that we are talking about mental health so much more seriously. I am glad that people are able to take medication that can help them and that the stigma is being broken. I am hopeful though that we can recognise together just how broken our society is, and how our current political and economic systems (including our beloved health system) cannot fix this. Perhaps, in learning to be together in the dark, when we cannot see the light, wrestling with the complexity of our pain, healing our trauma and reimagining our future, we might find that our need for medication decreases.

 

 

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Cuts and More Cuts – a Disaster for our Population’s Health and Wellbeing

It amazes me, in this 24-hour news world that we live in, that a further £1 BILLION of cuts to our county councils doesn’t remain on the BBC front page until much past lunchtime! It feels a bit more important than some of the stories being picked by the editorial team instead!

 

https://www.bbc.co.uk/news/education-45573921

 

Anyhow….these cuts will be utterly devastating for our population’s health and wellbeing and the “extra funding” for the NHS is simply not going to be enough to undo the damage. Local government will have lost 60% of it’s budget by 2020, with devastating consequences and no amount of local taxation will replace the difference, especially in poorer areas of the country. And just look at what will be cut:

 

  • 58% of councils said highways and transport (including road improvements, streetlights, pothole filling)
  • 47% said libraries
  • 45% said early years and youth clubs.
  • 44% ear-marked public health services like smoking cessation, sexual health, substance misuse
  • 36% said children’s services.

 

 

So:

  1.  We will have far higher risk of road traffic accidents, especially for cyclists/motorcyclists (I’ve seen the effect of people hitting potholes and fracturing their spine).
  2. there will be less access to shops and leisure facilities for our poorest communities, meaning a worsening of the obesity epidemic.
  3. We will have increased social isolation and reduced learning opportunities for our elderly (therefore increasing risk of dementia and depression).
  4. We will have decreased social support for our young people, leaving them far more vulnerable to gangs and substance misuse.
  5. We will have less support for young families, struggling to cope and so less opportunity for parental support and an increase in Adverse Childhood Experiences – with devastating long term consequences for physical and mental health.
  6. Smoking continues to affect 1 in 5 people in a hospital bed, and is still the biggest cause of death in many parts of the country – yep good idea to cut that.
  7. Our drug crisis is rising exponentially, and we’re seeing an increase in STIs and yet councils will not be able to provide services to help.
  8. Children’s services, those vital safety nets that work to prevent serious safeguarding incidents will have to be reduced also!

 

WHAT?!

 

There isn’t a council in the country that wants to make these cuts and the lack of foresight by the government to drive these further cuts through when the ones we’ve had already have been so deep, is utterly ludicrous. I’ve sat with council officers in tears over the choices they are having to make – these are people who love the communities they serve and are trying to do as much damage limitation as possible, whilst being left to take the blame.

 

What does it tell us? It tells us a few things. Firstly, there is a serious lack of joined up thinking about the long term consequences of these cuts. Save money now, but pay for it 5-fold in the future. Secondly, there is a genuine lack of concern for the poorer communities in our country. Thirdly, our current political model is broken and more than ever we need a politics of love/compassion. Fourthly, our current economic model is caput and cannot give us the regenerative and distributive future we need for humanity and the planet. I feel so despairing, sad and am grieving what this is going to mean for so many of our communities. We need to feel this pain and face up to this and find hope in reimagining how we might do things radically but necessarily differently.  This piece in the Guardian is worthy of serious reflection:

 

https://amp.theguardian.com/politics/2018/sep/16/the-eu-needs-a-stability-and-wellbeing-pact-not-more-growth?__twitter_impression=true

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Mental Health Help

Tweet Here is a series of 5 videos I did for Mental Health Awareness Week this year. Mental health is SO important and struggling with mental health issues, is NOTHING to be ashamed of. These videos cover, depression, anxiety, exam stress, suicide and getting to the roots of stress. There has been really positive response [Continue Reading …]

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A-Z of Health and Wellbeing

Tweet Happy New Year!   We often start a New Year with resolutions, things which we would like to change for the better. so, I thought I’d start this year of blogging with a vlog about my perspective on the A-Z of what affects your Health and Wellbeing the most.   It’s longer than most [Continue Reading …]

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Our Nation’s Biggest Public Health Problem

Tweet The subject of this blog is sensitive and difficult. It may stir up some difficult issues or memories for you, as you read. If this happens, then please take time to seek the help you need. I believe this blog and ones to follow might be some of the most important I have written to [Continue Reading …]

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Solutions Focused Thinking for the NHS

Tweet One of the main headlines in the news this morning is that without extra funding, the NHS is in dire straits and patients are beginning to suffer as a result of less financial provision than is needed.   http://www.bbc.co.uk/news/health-38019771   One of the things I have trained in, during my career is Solutions Focused [Continue Reading …]

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Learning to Celebrate Success

Tweet The NHS really is amazing. Today, I have been at the NHS confederation (confed2016), a conference which helps to set the pulse and rhythm of the health system over the following 12 months. I heard Dame Kelly Holmes speak movingly about her own experiences, help she received from across the NHS and how grateful [Continue Reading …]

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5) GIVE (5 Ways to Wellbeing)

Tweet Here is my latest vlog on using the 5 ways to wellbeing to help change the culture of the NHS.   Share This:

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Reconnecting Clinicians to Healing

Tweet In the USA, doctors have the highest rate of suicide of any profession. In the UK, a similar picture unfolds. Why is it, that 69% of all physicians suffer with depression at least one time in their career? It could be because of the high workload, high stress, high demand, an increased sense of professional [Continue Reading …]

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Love – It’s a Two Way Street

Tweet There is a lie that has been told, to clinicians in particular, that it is wrong to get too close to patients. One is told to keep a healthy separation, perhaps to make the tragedy we often deal with somewhat more bearable. We have shaped medical ethics around the four core principles of beneficence (do good), [Continue Reading …]

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