White Rabbit Number Six: John Drake’s Mental Health Blog - 1

As the DIY Futures project comes to an end, the focus is on the stories in the book "It's the inside that matters," which have drawn some really positive feedback. But there are so many stories out there, and one book can never be long enough...  So when we heard about John Drake's experiences recently we invited him to write a guest post for the blog.  John soon came back to us with not one but three posts! Here is Part 1... with 2 & 3 due to follow shortly.

1: Down the Rabbit Hole

There is nothing so very remarkable about falling down that very deep well we call depression. What follows is just one man’s experience...

It was quite a relief when I was first diagnosed with depression. My initial reaction was: Thank God for that, I thought I was going mad! I was certainly getting fixated on some strange ideas and experiencing overwhelming feelings of dread which made it difficult to continue to work...and I loved my job.

My GP referred me to a Community Psychiatric Nurse. He assessed me as suffering from mild to moderate depression and recommended a short course of anti-depressants. But I was very resistant to the idea because I had heard so much about the bad side effects... Fortunately the nurse was very sympathetic to my attitude and suggested I instead try St John’s Wort (a herbal alternative to pharmaceutical medicine). My GP was also supportive of this and said that I should treat it like any antidepressant and use it regularly for six months.

After three weeks I felt well enough to go back to work and in fact, with the aid of St John’s Wort, I managed my condition for the next seven years, throwing myself into my work with renewed dedication. I still suffered from occasional bouts of anxiety but I knew that I had to just keep going...

Until one day I couldn’t... It was as if an abyss had opened up and I was about to fall into it.

I rang the surgery but my GP wouldn’t be available for a couple of weeks! I knew I had to talk to someone straight away and fortunately one of the other doctors had a cancellation and was able to fit me in. She listened to me for what must have been quite a long time (once the dam broke, the flood was overwhelming), signed me off work and referred me to the counselling service that was attached to the surgery.

And now that I was in safe hands, I could let myself fall...

I was offered what I understand to be the standard counselling service through the NHS, which is six sessions of Cognitive Behavioural Therapy. Towards the end of this period I was offered an extension of three further sessions, which I was happy to accept. When I first began therapy, my counsellor assessed me as having moderate to severe depression. By the time I finished the course, I felt ready to return to work. Although our sessions were coming to an end, the counsellor assured me that if I ever needed to see him again I could get a new referral through the surgery.

Throughout these first few months of illness, I had felt very well supported both by my counsellor and by the GP. At her suggestion, I continued to be seen exclusively by the same doctor who had been available on that crucial day – and I think that this continuity of service was very important in my being able to cope with day-to-day living, without being hospitalised – which, along with being forced to take antidepressants other than St John’s Wort, was my biggest fear. Rightly or wrongly, I believed that pharmaceutical antidepressants would take away my mind and that, once in hospital, I would never come out again.

The CBT sessions had taught me how to cope with going to shops and facing the dreaded ‘how are you?’ question from well-meaning acquaintances, but going back to work was another matter. Even though I had met with my boss and we had agreed a back-to-work strategy, it all fell apart when a personal crisis caused everything to unravel – and I was back almost, but not quite, where I started – still down the rabbit hole but resting somewhat precariously on a ledge – no longer falling, but not yet able to climb out.

This time my GP was adamant that I should take stronger antidepressants – but I was equally adamant that I wouldn’t. To her credit, my doctor accepted my decision and continued to support me in other ways. I was referred back to the counselling service and, this time, I was told that I could book a session whenever I needed it, through the appointments desk. I assume this was offered to me as my counsellor believed that I wasn’t the type to abuse the privilege – and in fact I only took advantage of it a handful of times.

Throughout this time I felt that I was being supported in the way that was right for me by everyone concerned in my welfare – and for this I will always be grateful.

Meanwhile, however, I was still being signed off work. Then one day I got a bit of a shock when the finance officer informed me that my sick pay had run out and that I needed to contact the Job Centre about claiming long-term sickness benefit.

And that’s when my problems really started...

Antidepressants in the headlines again

For what seems like the whole of August so far! There are features on news sites, blogs everywhere, the radio... and people are asking questions about the continuing rise in the use of these drugs – in Wales, in the UK, in the “developed” world generally...

You can read online articles by a British GP, in The Huffington Post online newspaper and on the Mad in America blog - here by Scottish writer Chrys Muirhead.

Lots of questions are asked and the debate is fast and furious in many cases, particularly where there are comments sections following the articles. Some of the issues which have arisen include:

• Could it be that the increase in prescription numbers is because people are often on these drugs for many months and even years, so it is the repeat prescriptions which push the stats up?
• The medicalisation of life’s many stresses and problems may mean that people actually just require time and space, and possibly therapeutic support, to recover, rather than a (supposed) quick fix.
• But... this leads many who have experienced and struggled with very serious depression to condemn the suggestion that this kind of debilitating distress can just be addressed with a shout to “get out and exercise,” “change your diet”, or “pull yourself together...” when some people cannot even face emerging from their bed or home for weeks.
• There is the usual debate about “the chemical inbalance” – whether there is one or not ...(evidence being virtually non-existent so far... although we are always encouraged to look to the future and a miracle medical discovery...)

Perhaps one of the most interesting and relevant topics is – would a readily accessible and affordable talking therapy ensure an appropriate and viable alternative to taking antidepressants? Again, there is strong debate around this area – with many people insisting that drugs alone have contributed to their return to everyday life, whilst others are equally convinced that counselling, for example, is what really helped. Others wish to have access to both. And Mark Easton, in a recent BBC news story, pointed out that those areas of the UK with the lowest incidence of antidepressant prescribing do not actually have good provision of talking therapies either... so it’s a complex issue.

Here in Powys it does seem that there are issues around waiting times for counselling, with there being something of a postcode lottery. In recent years expectations have been raised around mental wellbeing, with national surveys, anti-stigma campaigns and generally increased awareness about mental health and wellbeing, with many famous people (comedians in particular, think Ruby Wax and Stephen Fry) speaking out about their distress (or various "diagnoses...").

Last week I was at a meeting of the Primary Care Mental Health team in South Powys, with counsellors and mental health practitioners (previously called mental health nurses) speaking about some of their frustrations. Generally they seem to be struggling to keep up with the increased demand for counselling, and in some areas of Powys there are long waiting lists (up to 6 months) to see a counsellor or take up another form of talking therapy such as Cognitive Behavioural Therapy (we posted about some of the issues here). Couple counselling and counselling for young people are two areas with a particularly growing demand.

Our own Powys Mental Health Information Service receives an increasing number of enquiries from people seeking counselling... Just recently I was told that there is a 6 month waiting list for bereavement counselling with CRUSE in parts of Powys (so what else could we suggest), and there is a cost implication for Relate counselling... Yet all the time people are becoming increasingly aware that they are entitled to source talking therapies through the GP surgery (see the Welsh Government legislation around this – the Mental Health Measure 2010). So... more and more people ask for help, they want it immediately, not 6 months down the line, and the GP prescribes an anti-depressant because a) it really might help and b) it can be prescribed now. Then, as in this recent BBC Wales video, people can spend not just months and years, but sometimes even decades reliant on these medications, with the prospect of painfully weaning themselves off at some point in the future or... staying on them for life, with all the mental and physical complications that this can involve...

What do you think? Are you on antidepressants? Do they work for you? Would you have preferred the option of a talking therapy? Was counselling or CBT offered by your GP, and if so could you start immediately or did you have to wait? We would be really interested to know.

Meanwhile, for a really interesting take on psychiatric medications, it is worth watching a video of consultant psychiatrist Dr Joanna Moncrieff, author of The Myth of the Chemical Cure, speaking earlier this year.

Study links recession to rising suicides

A recent study published in the British Medical Journal, Suicides associated with the 2008-10 economic recession in England: time trend analysis, has found that a painful double-dip recession, rising unemployment and biting austerity measures may have already driven more than 1,000 people in the UK to commit suicide in the past two years.

Study lead David Stuckler from Cambridge University explained:  "Much of men's identity and sense of purpose is tied up with having a job. It brings income, status and importance. There's also a pattern in the UK where men are three times more likely to commit suicide than women, while women are much more likely to report being depressed and seek help."

The analysis found that between 2008 and 2010 there were 846 more suicides among men in England than would have been expected if previous trends continued, and 155 more among women.

Between 2000 and 2010 each annual 10 percent increase in the number of unemployed people was associated with a 1.4 percent increase in the number of male suicides, the study found.

These findings suggest that about two fifths of the recent increase in suicides among men (increase of 329 suicides, 126 to 532) during the 2008-10 recession can be attributed to rising unemployment.  

The study provides evidence linking the recent increase in suicides in England with the financial crisis that began in 2008. English regions with the largest rises in unemployment have had the largest increases in suicides, particularly among men.

You can read the full study here.

Earlier this month data from the government's Health and Social Care Information Centre showed the number of prescriptions dispensed in England for antidepressants rose 9.1 percent in 2010.

A study published last July, also by Stuckler, found that across Europe, suicide rates rose sharply from 2007 to 2009 as the financial crisis drove unemployment up and squeezed incomes.

More on this report here

The countries worst hit by severe economic downturns, such as Greece and Ireland, saw the most dramatic increases in suicides.

World Health Organisation estimates suggest that nearly a million people die from suicide every year at a rate of one every 40 seconds.

Review into the use of antidepressants

Platform 51 research shows that 33% of all women have taken antidepressants and more than half were not offered any alternative to drugs at the time of prescription. 24% currently taking antidepressants have been on them for 10 years or more and 24% have not had a review of their treatment for a year or more at some point. Antidepressants have a role to play in treating poor mental health but they are not the whole solution. We call on the Department of Health to commission a review into the use of antidepressants. It should investigate the rate at which antidepressants are prescribed as the only option for mild to moderate mental health problems, and the frequency at which people taking them have their treatment reviewed. The review should include health experts, mental health charities, GP representatives and organisations such as Platform 51 who work with thousands of people affected by mental health problems. Click to sign the petition or to learn more about women and mental health and read briefing.

Safety warning over Britain’s most common antidepressant

The Sunday Telegraph today published an article relating the results of a study into the effects of a widely prescribed antidepressant, Citalopram.
You can find out more here.