DR MAX THE MIND DOCTOR on depression


What has happened? Has some dreadful plague suddenly afflicted the nation? You’d be forgiven for thinking so when you hear that government figures show 48 per cent of the population are on prescribed medication.

It’s mind-boggling. Half of the entire population of this country take at least one tablet, while a quarter take three or more. We’re a nation of pill-poppers.

Buried in this data was one statistic that really stuck out for me. One in ten of us is on antidepressants. In fact, the greatest rise in the number of prescriptions was for antidepressants.

Some of the highest rates of depression under-diagnosis occur in older men, who also have the highest rates of suicide (stock image)

Some of the highest rates of depression under-diagnosis occur in older men, who also have the highest rates of suicide (stock image)

As a psychiatrist, I prescribe these medications daily — but 10 per cent of the population needing to take a chemical to improve their mood? That struck me as astonishing. It’s a sad indictment of our society that so many people are apparently having such a miserable time.

Of course antidepressants are prescribed for a variety of conditions, such as anxiety, OCD or post-traumatic stress disorder, so some prescriptions will be for conditions other than depression.

But even so, when one in ten of us is being prescribed one of these medications, I think that warrants some thought.

There’s no doubt that society has become more understanding with regard to mental illness, and increased awareness is bound to mean that more people seek help.

Yet there is often a charge that prescriptions for antidepressants are being given out needlessly. And it is true that, in some situations, harassed GPs faced with patients who have complex social problems and eight minutes to sort them out inevitably reach for the prescription pad.

But there is no pill on Earth that is going to make your screaming children be better behaved or your bored wife love you.

Toxic toll of energy drinks 

There is a nasty and noxious substance that thousands of children are exposed to on a daily basis, yet no one is doing anything about it. It’s not an illegal drug; not cigarettes or alcohol. It’s energy drinks.

Talk to any teacher and they’ll tell you that these sickly-sweet drinks, laced with huge amounts of caffeine — often many times more than in a cup of coffee — are consumed in vast quantities by their pupils.

When I worked in A&E, I saw several children brought in with palpitations caused by drinking them. One girl had drunk eight cans and needed to have her heart monitored.

Caffeine is a drug that’s toxic in high quantities. It increases the heart rate and can make people agitated and anxious.

The problem is that youngsters aren’t drinking vast quantities because they don’t realise the effects. They’re drinking them precisely because of the effects.

I don’t think it’s a coincidence this is happening in the age of the smartphone. With perma-access to social media and video consoles, I fear sleep-deprived children feel they need these drinks to get through the day.

This week, there were calls by one of the teaching unions to restrict the sale of energy drinks to children, describing them as ‘readily available legal highs’.

As a libertarian I almost hate to say it, but I agree. It is extraordinary we are allowing children to buy a potentially toxic and dangerous substance totally unfettered. There should be no place for energy drinks in the school playground. 

That’s not to say these situations aren’t awful — but in truth feeling down about these sorts of things is normal, not pathological. It isn’t an illness.

Certainly social situations can trigger a depressive illness, but all too often people who are just responding to stressful and awful situations in a perfectly normal way are given a prescription and pushed out the door.

I think the rise is linked to cash-strapped mental health trusts having to cut back on talking therapies, leaving little alternative but to use medication.

But the flip side of this is that while antidepressants are being overprescribed in some quarters, in others depression is woefully under-treated.

Research by the London School of Economics a few years ago showed that while mental illness accounts for nearly half of all ill health in the under-65s, only a quarter of people in need of treatment actually get it.

Further research conducted by Aberdeen University showed that GPs failed to diagnose major depression in half their patients, meaning they went untreated.

Organ donation is meant to be a gift 

There are 6,500 people waiting for a transplant in this country. Many will, tragically, die before an organ becomes available.

This week, the Government announced a public consultation on changing the rules around organ donation. It is proposed that there will be ‘presumed consent’, which would mean that everyone is entered on the organ donation register and that people have to actively opt out.

It makes me feel deeply uneasy that the Government feels at liberty to presume what I would want done with my body and that the wishes of families could be over-ridden. But perhaps most importantly, there’s no good evidence that the policy works.

There are 6,500 people waiting for a transplant in this country (stock image)

There are 6,500 people waiting for a transplant in this country (stock image)

There are 6,500 people waiting for a transplant in this country (stock image)

Since Wales adopted an opt-out system two years ago, there has been no increase in donations. The same happened in Spain. For the first ten years after they introduced an opt-out policy, there was no rise in organ donations.

The thing that improved the numbers was introducing highly trained transplant teams who would meet with families to discuss donation and answer their questions. This is the way to do it.

But there is another dimension to this, too. The very fact that organ donation is a gift, and one that the loved ones are involved in, has real psychological benefits for grieving friends and family. While nothing will bring the person back, many have said to me how they feel it is what the person would have wanted, and there’s a sense that the family are involved in keeping their loved one’s memory alive.

But presumed consent strips all this away. It’s no longer a powerful and generous gift that brings families together, but an assumption by the State that it can do what it wants with your body.

That’s not a gift in any sense of the word.

In other words, there are large swathes of the population who are suffering in silence.

Some of the highest rates of under-diagnosis occur in older men, who also have the highest rates of suicide.

An inquiry into suicide published a few years ago showed that fewer than 10 per cent of people who killed themselves had been referred to mental health services in the previous 12 months.

So while on the one hand we are over-prescribing antidepressants to some people, we are failing to reach others altogether.

Middle-aged to older men are the least likely to be on anti-depressants yet have some of the highest rates of mental distress.

It shows that for all the advances that have been made recently with people feeling emboldened to talk about their mental health problems, for a lot of men, the revolution has yet to happen. They’re still keeping a stiff upper lip.

We urgently need to rethink the way that services reach out to these men. I think many find the process of going to their GP to broach the subject a humiliating experience. It jars against social ideas of masculinity and feels akin to a weakness. So they don’t go.

Our mental health services are failing men – but where is the furore? Where is the outcry. 

Prescribe pets on the NHS! 

Pets have been credited with conferring all sorts of health benefits on their owners, from lowering blood pressure and reducing the risk of stroke to decreasing stress and anxiety.

Yet a study this week in the BMJ claims that, in fact, they don’t help people stay healthy: the finding was that pet-owners have the same levels of physical and psychological health as non-pet owners.

I don’t believe this for a second. As far as I’m concerned, doctors should be able to prescribe pets on the NHS. Time and again, I’ve seen how someone’s dog or cat utterly transforms them.

When I was working in a nursing home, a kindly woman who lived in the area would bring her dog in. She’d stop off on the way back from their afternoon walk and the friendly – but rather excitable – German shepherd would run amok in the lounge. He’d upset teacups, knock over side tables and generally have a great time rushing from one person to the next.

What astonished me was the way the residents responded. No longer sitting half asleep, chins on their chest, they would laugh, scold the dog, or try to stroke him as he dashed past. People who hardly said a word were suddenly talking.

Long after the dog left, you could still feel the sense of excitement in the air.

Pets might not make you stay younger, but they make you feel alive. And that’s even better. 

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