Archive for Depression

On drugs (and off them)

Posted in Mental Health with tags , , , , , , on July 11, 2017 by telescoper

I came across an interesting piece in the Guardian the other day written by Deborah Orr, who had just taken antidepressants for the first time (with unpleasant consequences). This was followed by an explanatory article by blogger and author Dean Burnett who explains that nobody really knows how anti-depressants work, and why it is not surprising that they can have unexpected side effects. I hope that the articles I mentioned above help make it clearer what is involved being on medication of this sort. These drugs are in widespread use, but ignorance about them is spread even wider.

I remember a while ago, when I was working at the University of Sussex, sitting on a bus in Brighton with two people behind me talking – in a very unhelpful and ill-informed way – about depression, and how anti-depressant drugs were a `soft option’. It made me quite angry listening to some of the comments they made but I didn’t intervene. I toyed with the idea of writing a blog then but I didn’t get round to it, partly because I didn’t really want all the staff and students in the School of which I was Head to know I was taking heavy medication for much of the time I was working there.  I only told a handful of people at the time. Now I am no longer in that job I think it’s safe to be a bit more open, and add a little bit here from my own experience to the articles mentioned above.

The most widespread anti-depressant drugs currently available are called Selective Serotonin Reuptake Inhibitors (the best-known of which, Fluoxetine, is known by the trade name Prozac). Deborah Orr’s article concerned her experience with an SSRI called Citalopram, which I was using about five years years ago. More recently, for much of the time I was at Sussex I was taking Paroxetine (trade name: Seroxat). The latter is not available on the National Health Service through a General Practioner, but must instead be prescribed by a consultant psychiatrist.

Anti-depressants are not only prescribed for the treatment of clinical depression but also for, e.g., anxiety disorder, panic disorder, and post-traumatic stress disorder. Nobody really knows why anti-depressants work against depression (although there is clinical evidence that they do), and there is even less understanding why (and, in some cases, evidence that) they are effective for these other conditions. Like many treatments they seem to have been discovered empirically, by trial and error.

As Dean Burnett explains in his article, SSRIs work by increasing the level of Serotonin (a monoamine neurotransmitter). However, taking an SSRI increases the level of Serotonin almost immediately whereas the effect on depression takes weeks to register. While low Serotonin levels may play a part in depressive illness, they’re clearly not the whole story.

My experience contrasts a bit with Deborah Orr’s, in that I have never experienced significant problems going onto this sort of medication – the worst by far has been when I’ve tried to quit. I had awful problems in the summer of 2012 largely as a result of trying to come off the medication I had been on since the previous autumn. The withdrawal symptoms then included shaking fits, insomnia, visual and auditory hallucinations, nausea, and hypervigilance.

The effect of this extreme collection of withdrawal symptoms was that I didn’t eat or sleep for a couple of weeks, and ended up in a high-dependency unit at a psychiatric hospital under sedation while they figured out what to do with me. Fortunately, I recovered well enough to return to work after a couple of months.

At the end of the summer of 2012, I was offered the job of Head of the School of Mathematical and Physical Sciences at Sussex University. I moved from Cardiff to Brighton in early 2013 to take up this new position. I hadn’t been there for long when my old problem returned. The stress of the job obviously played a role in this, and I soon realised that I couldn’t keep going without help from medication. It was then that I was tried out on Paroxetine, the dose being gradually increased until I was at the maximum recommended level (60mg daily).

While this medication was effective in controlling the panic disorder, it had some unpleasant side-effects, including: digestive problems; dizziness; difficulty in concentrating; fatigue; and the weirdest of all, a thing called depersonalisation. Deborah Orr describes the latter very well in her piece but she seems to have experienced it as soon as she started taking medication, whereas in my case it came on  gradually.

 I found myself living a kind of half-life, functioning reasonably well at work but not having the energy or enthusiasm to do very much else outside of working hours. Eventually I got fed up with it.  I felt I had to choose between staying in my job as Head of School (which meant carrying on taking the drugs indefinitely) or leaving to do something else (which would mean I might be able to quit the drugs). I picked the latter. The desire to come off medication wasn’t the only factor behind my decision to stand down from my job, but it played a big part.

I knew however that Paroxetine  is associated with notoriously difficult withdrawal symptoms so, mindful of my previous experience in 2012, I followed the medical instructions to the letter, gradually cutting down my dose over a couple of months during the course of the Autumn in 2016. I still had significant withdrawal symptoms, especially the insomnia, but not as bad as five years ago. I’m hoping that my current (part-time) job allows me to manage for the foreseeable future without the need for any medication – apart, perhaps, from the odd glass of fine wine!

So those are my experiences. All I can say that I hope I’ve convinced you that anti-depressants are not a `soft option’!

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It’s Time to Change: Don’t Demonize Depression!

Posted in Mental Health with tags , , , , , on March 27, 2015 by telescoper

Like everyone else I was shocked and saddened on Tuesday to hear of the crash of an Airbus 320 (GermanWings Flight 4U 9525 from Barcelona to Dusseldorf)  in the French Alps.  That initial reaction turned to consternation and confusion when it appeared that flying conditions were good and no “Mayday” signal was sent for the eight minutes it steadily lost altitude until it hit the mountains., and then to complete incomprehension yesterday as evidence emerged that the crash, which resulted in the deaths of 150 people, appeared to have been the result of deliberate action by the co-pilot, Andreas Lubitz.  It seems that the co-pilot waited for the pilot to leave the cockpit to use the lavatory, then locked the door and proceeded to put the plane on a descending trajectory designed to take his own life along with everyone else on board. The horror of these events is beyond imagining. It’s also beyond imagining what could have possessed Andreas Lubitz to do such a terrible thing, for this was an act of mass murder.

Although it seems a paltry gesture, I’d like to take the opportunity to express by deepest condolences to the families, friends and loved ones of everyone who lost their life on that day, including Andreas Lubitz whose family must be experiencing pain on a scale the rest of us are completely unable to contemplate.

I’m not going to speculate at all about what drove this man to behave the way he did. I’m not qualified to comment and it would obviously not be helpful to anyone for me to do so.

That has not stopped the gutter press, however, who have seized upon the fact that Andreas Lubitz had a history of depressive illness to sell copies of their rags by labelling him “a madman” and splashing lurid details about his private life. A Daily Mail article (to which I refuse to link) clearly implies that anyone who has ever suffered from depression is potentially a psychopathic killer. Not for the first time, I am ashamed that people exist with so sensitivity that they could think this sort of journalism could ever be justified.

What this tragedy says to me is that only a better understanding of mental illness will help prevent similar things happening in future and that will not happen if the media continue to demonize those who suffer from depression and/or other mental health problems because the stigma that causes makes it so difficult to seek treatment. I know this for a fact. It is difficult enough to ask for help, even without  headlines screaming in your face from the front page of the Daily Fail or the Sun or even the Daily Telegraph.

I agree completely with Professor Sir Simon Wessely, President of the Royal College of Psychiatrists who is quoted in today’s Guardian as

The loss of the GermanWings Airbus is a ghastly horror. Until the facts are established, we should be careful not to rush judgements. Should it be the case that one pilot had a history of depression, we must bear in mind that so do several million people in this country.

It is also true that depression is usually treatable. The biggest barrier to people getting help is stigma and fear of disclosure. In this country we have seen a recent fall in stigma, an increase in willingness to be open about depression and most important of all, to seek help.

We do not yet know what might be the lessons of the loss of the Airbus, but we caution against hasty decisions that might make it more, not less, difficult for people with depression to receive appropriate treatment. This will not help sufferers, families or the public.

A conservative estimate is that about one in every four people in the UK suffers from depression at one time or another, many of whom struggle with mental illness without either asking for or receiving medical help. Help is there, but we need to much more to encourage people to use it.

Here’s another quote from Time to Change, for whose organization in Wales I wrote the piece linked above,

The terrible loss of life in the Germanwings plane crash is tragic, and we send our deepest sympathies to the families. Whilst the full facts are still emerging, there has been widespread media reporting speculating about the link with the pilot’s history of depression, which has been overly simplistic.

Clearly assessment of all pilots’ physical and mental health is entirely appropriate – but assumptions about risk shouldn’t be made across the board for people with depression, or any other illness. There will be pilots with experience of depression who have flown safely for decades and assessments should be made on a case by case basis.

Today’s headlines risk adding to the stigma surrounding mental health problems, which millions of people experience each year, and we would encourage the media to report this issue responsibly.

It is Time to Change attitudes to mental health, and a good place to start is to realise that it’s Time to Change how the media approach the subject. If you would like to complain about inappropriate reporting of mental health issues in the media then please follow the link here.

A bit of CBT…

Posted in Biographical with tags , , , , , , on October 12, 2012 by telescoper

Up early because a busy day lies ahead, I thought I’d just post this video produced by the National Health Service on the subject of Cognitive Behaviour Therapy.  I’m posting it just in case there might be someone out there who has been recommended for such a treatment and is reluctant to try it, like I was at first, thinking that it is just a load of psycho-babble.

Well, it isn’t psycho-babble. It works. So if you need it, go for it!