Anti Depressants- do they really work?

“Pain could be killed. Sadness could not, but the drugs did shut its mouth for a time.”  Colson Whitehead, Zone One

There is currently a debate around whether Anti depressants are being overused for treating Depression and if there is really a strong enough evidence base for them.

Statistics show that at least 1 in 10 people in the UK suffer from depression, it’s prevalence being slightly higher in women, with 1 in 20 of sufferers being as a result of clinical depression.  Anti depressant prescriptions in the UK have increased by 9.6% in 2011, to 46 million prescriptions and continue to rise.

There is no question that most people with Depression report a reduction in their symptoms though research shows that improvement appears to be due to psychological factors, i.e., the placebo effect.  Evidence is currently inconclusive about how much the Placebo effect is involved. We could ask, how much of the effectiveness of medication is due to the active ingredients and the non Placebo effect?

From my own experiences of working with hundreds of clients with Depression, both Clinical (i.e. from a chemical Serotonin imbalance) and ‘Reactive’ (as a result of a response to an event or stressor), Anti Depressants do have their place.  Many initially report an improvement using Anti Depressants though often, alone they aren’t enough to resolve the underlying factors that cause it in the first place and that help maintain it.  For instance, taking a pill when experiencing work stress may buffer against some of the negative emotional effects though unless the underlying triggers are addressed, things may not change long term. With some clients, Anti Depressants have little effect or in some cases, cause a worsening of symptoms as a result of unpleasant side effects.

Dr Ian Reid, Professor of Psychiatry at the University of Aberdeen, says "Antidepressants are but one element available in the treatment of depression, not a panacea,"…they can have harmful side effects, and they certainly don't help everyone with the disorder. But they are not overprescribed. Careless reportage has demonised them in the public eye, adding to the stigmatisation of mental illness, and erecting unnecessary barriers to effective care." 

The National Institute for Health and Clinical Excellence (NICE) guidelines doesn’t promote the use of Anti depressants as a first port of call for treating moderate depression though instead advocates talking therapies such as CBT (Cognitive Behavioural Therapy) and Interpersonal Therapy initially. Often however, long NHS waiting lists prevent individuals accessing services.  GP’s only option then is to prescribe medication to patients when there are few alternatives available.

Posing my question at the beginning, is there enough evidence to support the widespread use of Anti Depressants; one might argue, if it makes people feel better, why worry about how that happens? Perhaps the individual’s belief in the pill as well as the scientific base causes the improvement.  Often, the therapeutic benefit of talking about our problems and expressing our feelings to a professional such as a GP is part of the healing effect;  ‘It’s good to talk’ as BT says.

The promotion of medication alone however, dismisses the wider implications of creating a culture of ‘pill popping’ rather than addressing underlying causes and socioeconomic factors.   We should be asking why has depression become endemic, not only in the UK but worldwide and how can we change it? In our modern ‘quick fix’ society, we are prone to avoiding the real issues when we need to take a move in the direction of change and start doing something differently. 

How to Stay Resolute this Year

“How few there are who have courage enough to own their faults, or resolution enough to mend them” – Benjamin Franklin

Change can sometimes be very daunting, especially when it comes to sticking to a resolution you have decided upon yourself. We don’t always adjust well to change, and it can be challenging and stressful to keep up willpower or reach targets we set ourselves. It can also be very distressing when we fail, so here we offer all the help we can to assist your achievement, and give advice on what to do when things don’t quite go to plan…

Top Four resolutions (source: University of Washington):

-          Increase exercise

-          Be more conscientious about work or school

-          Develop better eating habits

-          Stop smoking, drinking, or using drugs (including caffeine)

Tips for Sticking to your Goals:

Be Realistic – When setting yourself a resolution, you have to be realistic. You are only human, and trying to achieve something completely out of reach will no doubt put you under a lot of stress and even affect your esteem. Start small if you can, and increase your targets if all goes well! It is great to dream and have a vision of where you want to be eventually, but break it down; goal at 3 months, goal at six months, at nine, and finally at a year.

Reward Yourself – Positive reinforcement, the giving of rewards when things go well, will encourage you to succeed time and time again, and makes it easier on you to accept the changes you are undergoing.

DO NOT punish yourself – this can have a negative effect and make you feel like a failure. Learn to forgive yourself. 

Talk to Others – Getting support and encouragement from those around you can greatly improve your success with a resolution. They might even join in, which can increase your performance – e.g. going for a morning run twice a week, or cutting down on how much you smoke. Chances are others will want these changes too, and so you can support and motivate each other.

Track Your Progress – Keep an eye on how you’re doing. This can increase your motivation, as you’ll see how well you’re doing, or which areas you need to improve. It is important to do this so that your progress and the changes you are going through are clearly set out in your mind.

Good luck, and stay positive. This isn’t the be all and end all of making the changes that you want in life. A new year is a fresh start in many ways, not just resolutions. And if you’re having trouble thinking of resolutions, look back over last year and think of things you might want to have changed or done differently if you had the opportunity. Don’t regret what’s in the past – use it to create yourself a better future.

A useful website in which you can select a resolution and track your progress:
https://www.resolutions.change4life.co.uk/

Men and Depression: The Internal Conflict

“Depression is rage spread thin” - George Santayana

Depression affects 6 million men every year in America alone.  Reasons for depression that men have reported include: trouble in an important relationship, unemployment, pregnancy or childbirth, separation/divorce, retirement, and work stress.

There is a lot of pressure upon men in our society to maintain a sense of “masculinity” and being a “real man”. Sometimes this means that when a man feels desperate, lonely or depressed – he will hide his feelings and keep things bottled up. Because of this, men are three times more likely to commit suicide than women (statistic from the Royal College of Psychiatrists).

There is a common misconception that women are the more body conscious, the more emotional and the more soulful of the sexes – but this is not true. A man may look into the mirror and hate his appearance, doubting himself for not being muscular enough, for being short, not having much chest hair etc. Similarly, men feel the same emotional range as women and can also suffer from depression or anxiety. They just tend to keep it much more hidden.

If you think you know a man who is suffering with depression, be sensitive about it. He may not want to admit to himself or you that he is out of his depth. Men traditionally see themselves as having a lot of responsibility; earn the wage, be the protector, be man of the house. And when they start to struggle they see it as a failure. A crisis of masculinity, if you like.

Things you need to know and look for concerning Male Depression:

·         Coping Mechanisms – Male coping mechanisms differ a lot from female coping strategies. A man might throw himself into an activity, focussing a lot on work or sport to avoid dealing with his problems or distract himself. Also, the man in question might resort to impulsive strategies such as alcohol or drugs to cope with the feelings they are experiencing.

·         Downplaying signs or symptoms – Men are much more likely to ignore or justify the feelings they are experiencing than females.

·         Reluctance to discuss things – Men probably wont want to discuss they feelings with anyone, let alone a mental health professional. It’s better to reach out to your man in a caring, casual way when encouraging to seek help, e.g. “It’s probably nothing darling, but it might be worth just popping to see Dr Smith in case he has any suggestions” than “You are depressed and I’m taking you to see a Psychiatrist on Monday!”.

·         Emotions – Men are likely to feel anger, violence or frustration rather than sadness when they are depressed.

·         Physical vs Emotional – Males are likely to report feelings of physical pain such as headaches, backaches, dizziness, chest and joint pain rather than emotional discomfort.

If you think that your partner, son, brother, father or male friend is suffering from depression, try to encourage them to seek help from a Doctor or Psychotherapist without pressuring them or making a big “fuss” about it. The Royal College of Psychiatrists offers helpful information here:

http://www.rcpsych.ac.uk/expertadvice/problems/depression/mendepression.aspx

 

From Angry to Assertive in 10 Steps

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“Holding on to anger is like grasping a hot coal with the intent of throwing it at someone else; you are the one who gets burned." Buddha

It’s National Anger Awareness week this week- an opportunity for us to increase our understanding of and get more savvy with ways of managing our anger.  In my experience as a Therapist, Anger is one of the most misunderstood emotions; either one to be feared or revered- allowing a gain or loss of control over situations. 

Due to faulty conditioning as children and living in a culture of suppression, rather than expression of feelings, anger can often become a toxic rather than empowering emotion.  We characterize it with the person that loses control at the wheel, the man who beats his wife- it is bad to have anger we say as it can do so much harm.  I always say to my clients that every emotion is a valid one and anger can be more positive than most if channeled in the right way.

For example, if none of us felt any anger, would we ever fight injustice or stand up and be counted?  I doubt it.  The problems come when we choose to repress our feelings and allow them to fester until they transform into something else that can do harm.  The solution? Quite simply, learn to be assertive and say it like it is! 

Being assertive or congruent with your feelings may feel foreign to you at the moment.  Though, it can be learned, like any skill and you may be assertive in some situations more than others.  Think back to times at work or in your personal life when you exhibited more assertive behaviour, what was the difference?  Perhaps there is a certain context such as with your partner where you struggle with being assertive. To begin with, try these steps for learning new ways of changing your communication:

1.    Create some space around the argument before mentally scripting what you need to say using positive language: “I want to clear the air between us and discuss this..”

2.    Use 1^st Person Language and own your point of view- “I feel…”

3.    Get out of the Blame/Shame game: Remember, you have choices as to how you feel, no one can make you angry!

4.    Be specific on what triggered your anger and the degree of it- slightly annoyed- rage?

5.    Acknowledge your part in the situation- own responsibility for anything you did- remember this is a strength, not a weakness.

6.    At the same time, avoid self put-downs or criticisms.  Backing down from an argument in order to please only gets you into the passive role.

7.    Get out of Mind reading what the other person is thinking or feeling.  You need to have evidence based on fact not assumptions!

8.    Focus on the Behaviour, not the person.  i.e. “That was a selfish thing that you did.” rather than “You’re a selfish/angry person.”  

9.    Offer a positive for changing the behaviour- i.e. “We will be able to feel more able to communicate in future and get our needs met.”  

10. Finally, always use Assertive rather than passive or aggressive language: “I feel”, “I would like”, “In my opinion..” 

Remember, assertiveness also encompasses your voice tonality, body language and posture- this is supposed to be 55% of how we communicate so it is key to how others receive your communication, not just the words.

If you feel anger is something that is controlling your life, take a look at the beating anger website or consider speaking to a Therapist in confidence. 

Jingle Hells- How Avoid the Christmas Stress

 

“Next to a circus there ain't nothing that packs up and tears out faster than the Christmas spirit!” – Frank McKinney Hubbard.  

Christmas can be a very stressful time of year – so much planning and organising, living up to expectations, spending time with that Uncle you hate, making sure everything is perfect…There are lots of things you can do to prevent the Christmas stress from getting to you.

Some top tips are:

Give up unrealistic Internal Demands: Too many people at Christmas think “Everyone must have a good time” or “I must organise things perfectly”.  Therapist Yvonne Wildi  says that “Magazines, shops and television programmes create an almost impossible to achieve level of perfection which often bears little in relation to reality but many of us still feel driven to try and achieve the fantasy.” To set yourself such idealistic targets is surely going to add to your stress greatly. It’s much better to think of things in a more flexible way. You’re not responsible for other people’s enjoyment – they are. Stop hoping to reach the impossible levels of expectation, as it’s not going to happen. 

Try not to Pressurise yourself: This is closely related to the internal demands, but on a more basic level. If you don’t reach your targets, never mind. Try again tomorrow. 

Stop Catastrophising:  Something might go wrong and you think “This is awful! It’s the end of the world!” but really just sit back, relax and try to look at the situation. Be rational about the problem. Is it really “awful” or is it just an annoying hassle? Looking at things rationally will help you deal with things better and find a solution for these (often trivial) problems.

Look after Yourself: With everything going on, we might forget to eat or drink or take some time out. Make sure you eat well and healthily, drink enough fluid, and have time to relax. Meeting these criteria will keep your body at a normal level and help you concentrate better on the tasks ahead. 

When dealing with Teens: At Christmas some parents act in certain ways or say certain things that push their teenagers back into “Child mode”. Try to remember that they are young adults now, and will not want to do the same things as they used to. By treating them with respect and talking to them in a mature way, you can ensure that any conflicts or “Stop babying me!” situations will be avoided.

Dealing with Loss or Grief at Christmas: Christmas can be a dark and lonely place for those who are suffering loss. It will draw your attention to those who “Should be there but aren’t” and often make you feel sad and even guilty for continuing without them. The glaring happiness others feel can sometimes have a negative effect, but just try to remember that although loved ones are gone, loved ones still remain. Try to enjoy your time with your friends and family as much as possible, whilst fondly thinking of those who are no longer with you. It’s okay to feel sad at Christmas. 

Remember not to forget the main point of Christmas and allow any stress diminish from the pleasure of enjoying time with family and friends. As Calvin Coolidge says: "Christmas is not a time nor a season, but a state of mind. To cherish peace and goodwill, to be plenteous in mercy, is to have the real spirit of Christmas."

How to Change Your Reality in 4 Steps

“Reality is merely is merely an illusion, although a very persistent one"  Albert Einstein

The way we perceive the world is a guide to how we navigate our way through it via out filters of experience- our map.  You see, ‘reality’ as we see it is only an edited version of the ‘real thing’- the territory.  Most of us operate as if our map that we hold in our minds is the reality that everyone else uses.  We then make assumptions and deletions based on our perceptions, resulting in stress and conflict as we learn that others don’t think the same way!

We create a very limited view of the world which often leaves us feeling without choice, stressed and unhappy that others aren’t doing it right. Or, we feel we seem to be getting it wrong (depending on what our model says) !  The question I often ask my clients is, ‘would you like to change this view’?  Most of them say yes of course though with a having a map comes a certain amount of investment in that view of the world and a fear of what might happen if I change it?

As a therapist, I aim to challenge the ‘reality’ of a person’s experience whilst respecting their model of the world as being theirs and unique.  I do not wish to trample on what has been their foundation for years of experience though perhaps offer them a different perspective from a third person’s point of view.  This in itself can be liberating.

To begin shifting your reality, work through the following steps to begin editing your experiences:

1.    Bring a stressful or negative memory or thought to mind- make sure you make it as powerful as possible- sense and connect with the colours, feelings, sounds again.

2.    Check in with yourself- would it be okay to let go of any unpleasant feelings associated with it? If ‘no’ then ask yourself ‘what is the positive purpose of keeping it?  i.e. so you don’t do it again or so you can ‘punish’ that person or yourself? Be curious.

3.    Next, notice how you think about the thought or memory you’re accessing then:

a.    If you’re associated (in it), dissociate (see yourself in it like a movie)

b.    Turn it black and white if it is in colour.

c.     If it is in 3D, make the memory flat like you’re seeing it on a screen.

d.    Shrink it down in size until you have it about the size of a postcard, flat and black and white in front of you.

e.    Reach out in your mind, screw it up and throw it away or burn it.

4.    Test it- Think about the memory now and see how you feel about it now?  If it feels better, you’re finished.  If there is no change, try altering the other submodalities such as making the sound different or quieter or adding a funny soundtrack to the image or memory.  Using humour is very powerful for changing our perceptions of things.  Try it next time you are scared of something or anticipating an event like doing a presentation- imagine the most ridiculous thing or a commentary by someone who makes you laugh and see how it feels. Feel free to play with it, after all, it’s your reality!