Clare Morgan was going through a rocky patch: her long-standing relationship had hit difficulties and she was struggling financially. But the self-described 'optimist' felt she was managing to cope.
Then the 35-year-old biologist started experiencing unusual symptoms. 'Out of the blue, I felt really agitated - I couldn't concentrate, I couldn't sleep, and I felt very shaky,' she recalls. 'I'd been under some stress. But my symptoms seemed too odd for that to be the whole explanation.'
After about six weeks she went to see her doctor, who diagnosed depression and anxiety. 'I asked him if he was sure, because there were other symptoms such as diarrhoea, weight-loss and vomiting. But he confirmed his diagnosis and prescribed an antidepressant.'
Increasing numbers of Britons are taking antidepressant drugs, with prescriptions doubling over the past ten years, according to a report this month
Unfortunately this only made her feel worse; she developed the shakes as well as suicidal thoughts. In an attempt to remedy this, her GP changed the medication three weeks later. But nothing changed.
And after mentioning her suicidal thoughts to her doctor, she was put under the supervision of a mental health team.
Six weeks later, Clare was put on yet another antidepressant, along with a tranquilliser and an anti-psychotic drug. She was now sleeping 14 hours a day; unable to work, she had to rely on her boyfriend for support.
'I was zombified, but still felt the anxiety and the terror, and that didn't seem right. However, my doctor simply increased my dose.'
After six miserable months, Clare's doctor admitted the drug treatment wasn't working and suggested electric shock treatment. 'I said "no way" and decided to come off the antidepressants,' she says. This proved 'fantastically hard - worse, actually, than being on them'.
'The only good part was a brilliant nurse, who took me seriously when I said I'd always felt that something physical had caused my symptoms and put me in touch with a sympathetic private doctor,' she says.
A year-and-a-half after her symptoms began, Clare was diagnosed with an overactive thyroid and a problem with her adrenal glands. 'That was why I had been so bizarrely agitated, had diarrhoea and had lost weight.'
Clare's story is extreme, but it is far from unique. Increasing numbers of Britons are taking antidepressant drugs, with prescriptions doubling over the past ten years, according to a report this month. In 2000, there were 20 million prescriptions - this rose to 39 million last year.
While this rise is partly being blamed on the recession, experts are concerned that misdiagnosis is a major factor. Indeed, a study published recently in The Lancet found that the average GP will wrongly diagnose 16 out of every 100 patients they see with depression and anxiety.
As Dr Alex Mitchell, consultant psychiatrist at Leicester General Hospital, explains: 'A busy GP sees about 100 patients a week. Out of those, 20 will be suffering from depression, but he will spot only ten of them and treat five, usually with drugs.'
Not only are the depressed missing out on treatment, 16 of those 100 patients will be told they are suffering from depression when they aren't.
One of the reasons this happens is because the official test GPs use to check if you're depressed involves two very basic questions: During the past month, have you been bothered by feeling down, depressed or hopeless?
During the past month, have you been bothered by having little interest or pleasure in doing things?
'Ideally, GPs shouldn't just rely on these two questions, although they are a NICE-approved way of diagnosing depression,' says Dr Mitchell.
'It's not really GPs' fault,' he adds. 'They haven't got enough time to give longer questionnaires. We did find that serious cases were less likely to be missed than milder ones.'
But Dr Mitchell's research shows that at least two patients a week will walk out from an average surgery with a prescription for a totally unnecessary and possibly damaging antidepressant. That adds up to hundreds of thousands of patients in the UK every year.
most commonly used drugs for depression are SSRIs, or selective serotonin reuptake inhibitors - they come with a range of nasty potential side-effects.
Those for Seroxat, for instance, include loss of appetite, severe mental/ mood changes, uncontrolled movements, irregular heartbeat and a raised risk of cataracts.
As well as side-effects from a drug you possibly shouldn't even be taking, coming off such drugs can be extremely difficult, as Clare Morgan found.
'The problem is that antidepressants have side-effects and can increase the risk of suicide when given to children or young adults,' says Professor Kirsch
'The doctors said there were no withdrawal problems, but when I tried to stop taking them, the panic and horror became so great I wanted to kill myself. I even searched for details on the internet about hanging myself. I didn't want to live like that.'
Then she came across a charity which specialised in withdrawal from prescription medication. The Liverpool-based Council for Information on Tranquillisers and Antidepressants is one of the few such centres in the UK.
'We are seeing an increasing amount of people who have a serious problem coming off SSRI antidepressants,' says Pam Armstrong, a nurse consultant and co-founder of the charity. 'Doctors are happy to put people on them, but they haven't a clue about getting them off.'
For the majority of people, misdiagnosis and withdrawal problems are not, however, an issue. For them, the real question is whether the drugs are actually effective. Many say antidepressants have really helped them.
But now, one dogged researcher has found the drugs are no better than a placebo - and that the drugs industry has tried to hide this.
Professor Irving Kirsch, a psychologist at Hull University, used the Freedom of Information Act in the U.S. to get access to all the data the pharmaceutical companies had submitted when their drugs were licensed.
As well as finding that the negative results were not published, when Professor Kirsch combined the results from the published and unpublished trials, all brands of SSRIs showed up as little better than a placebo.
Even worse, Kirsch says that both the drugs companies and the U.S. regulators knew this, but chose to keep it from doctors and their patients.
He quotes an internal Federal Drug Administration memo saying it was 'of no practical value to patient or physician' to reveal that SSRIs are no better than placebos.
But if people do get better on antidepressants, what's the problem? 'The problem is that antidepressants have side-effects and can increase the risk of suicide when given to children or young adults,' replies Professor Kirsch.
There are safer and more effective alternatives,' he says, referring to talking therapies.In fact, officially these are precisely the sort of treatment Clare Morgan and many others should be getting, instead of 'harmful' drugs. Since 2004, NICE has recommended that patients with mild to moderate depression or anxiety should be offered a talking therapy.
The one with the best evidence is called cognitive behaviour therapy (CBT), which concentrates on changing the thoughts that go with negative feelings.
The benefits are clear: those getting this treatment are less likely to relapse than those on antidepressant medication. In one study, the relapse rate was 5 per cent on therapy, 40 per cent on the drugs.
Even patients who feel they have benefited from antidepressants often appreciate help from a therapist as well, as Louise Luxton, a 36-year-old make-up artist living in London, discovered.
She'd suffered from anxiety and was put on Prozac, but 'felt terrible'.
She says: 'Seroxat worked better for a while. But years later when things got really bad, Seroxat didn't help at all.'
What did help was medication in combination with a talking therapy.
'The therapist taught me techniques to use when the anxiety gets too bad and he found the right drug for me. I wish I'd been able to see him a lot earlier.'
She's now happily married and planning to have a baby.
But talking therapy is infamously hard to find. Nearly three-quarters of GPs say they hand out pills becasue therapy just isn't available, a recent study by the Mental Health Foundation found.
Indeed, Louise had to pay for treatment privately. 'If you don't have that sort of money, your prospects can be pretty grim,' she says.
Three years ago, the Government announced it was spending £173million on training an army of 3,600 extra therapists which could be rolled out across the country by 2011 to provide CBT to all those suffering from depression and anxiety.
Professor David Clark, who heads up the scheme, is optimistic about reaching this target: 'By 2011, we are due to have all the therapists in place and we will have provided treatments to an extra 900,000 patients over the three years,' he says.
So far, 115 out of 154 primary care trusts in England have agreed to set up a centre.
But as Good Health has discovered, the roll-out of the scheme nationally may be having the effect of actually reducing the number of therapists in some areas.
Mariam Kemple, of the mental health charity Mind, explains. 'We've been getting reports that when the money to set up one of the new centres comes through, the primary care trust cancels contracts with existing therapists, saying the centre will be providing treatment for depression and anxiety in future.'
Similar reports have come in from the British Association for Counselling and Psychotherapy.
'The whole point of the project to roll out new therapy centres was to make up for the serious shortage of talking treatments,' says Paul Farmer, chief executive of Mind. 'We would be extremely worried if some trusts are axing existing services and using the new one as a replacement.'
Professor Clark blames the way funding is going into the local trusts' general pot - 'some may have been deciding to save money on existing provision'.
Although the Government has just pledged to spend £70 million over the next year providing more therapists and centres, this is not going to be ring-fenced.
This provision matters, as Clare Morgan knows only too well.
'If I'd been able to see a therapist initially, everything might have been different. Someone might have spotted that my symptoms weren't necessarily depression,' she says.
Now taking steroids for her condition, she is training to become a science teacher.
'Lots of people say they benefit from antidepressants, but doctors need to be more responsive when patients say they are having a bad time with them. Increasing the dose is often not the answer.'
Visit backtolife.uk.com, mind.org.uk and bacp.co.uk for more information.
THE FIVE TYPES OF DEPRESSION
By top psychologist Dr Cecilia d'Felice
REACTIVE
SYMPTOMS: Inability to face the day and cope with routine situations. You feel tearful, overwhelmed, angry and lacking in any options to make things better. For example, you're convinced you'll never get another job and that your life is over.
CAUSES: Major life events such as divorce, death of a loved one, or losing your job.
CHANCES OF BECOMING LONG-TERM DEPRESSION: Feeling this way after a major event is normal and the unhappiness should start to dissipate after several weeks.
But a single trauma can also be the straw that breaks the camel's back if you have other things in your life that are causing agitation, such as stress at work. This can lead to long-term depression. If you've been down for several weeks with no improvement, seek help.
SOLUTION: Talking with friends, family or a counsellor is very important to give an outlet. Or see your GP about taking medication.
PHYSIOLOGICAL
SYMPTOMS: Fatigue, feeling weak, overwhelmed and exhausted even if you have had a good night's sleep.
CAUSES: Health issues such as thyroid problems or symptoms relating to the menopause and ageing.
CHANCES OF BECOMING LONG-TERM DEPRESSION: This is a situation where health changes can affect mood, and therefore mimic depression. an under or overactive thyroid can, for example, produce symptoms that are very similar to depression, such as low spirits and excess fatigue.
SOLUTION: To rule out an underlying health problem, see your gp, who can carry out blood tests to see if a cause can be identified. Look at other factors in your life. For example, it's natural to feel emotionally vulnerable after having a baby. If you still do a month after the birth, it could be depression.
STRESS-RELATED
SYMPTOMS: Feeling agitated, uptight and wound-up all the time, unable to focus or remember simple things. Finding even normal actions irritating. A constant feeling of being under pressure.
CAUSES: Taking on too much at work, moving house, caring for parents or children, relationship break-up.
CHANCES OF BECOMING LONG-TERM DEPRESSION: Stress is a normal part of life and there is research to suggest that limited amounts can be beneficial. However, cumulative stress can lead to long-term depression.
SOLUTION: If feelings persist for several weeks, or if you feel you can't cope with them sooner than that, go to see your GP. Acknowledging the problem is part of the issue and may help identify what is triggering your stress. It will also be a chance to examine ways to relax and take on more exercise to help you cope with stress.
EXISTENTIAL
SYMPTOMS: You are tearful, restless and perhaps sleeping badly. nothing seems to give you any pleasure. There is also a sense of feeling you aren't good at what you do.
CAUSES: Feeling rootless, directionless, empty or even trapped, as well as unsure of your place in the world. often triggered when between relationships or jobs.
CHANCES OF BECOMING LONG-TERM DEPRESSION: We all have phases when we feel negative and worthless, but if this goes on for more than two weeks, then such feelings can lead to chronic depression. Insomnia can worsen or you can suffer with hypersomnia - a desire to sleep all the time to avoid confronting reality.
SOLUTION: Counselling or psychotherapy will help you get to the root of your problem and feelings. If you lack motivation, or have low self-esteem, then CBT is helpful.
DYSTHYMIC
SYMPTOMS: Feeling burnt out, hopeless, as if nothing has any point. A feeling of being numb.
CAUSES: No particular trigger - many people say they feel born this way. They constantly feel negative and gloomy.
CHANCE OF BECOMING LONG-TERM DEPRESSION: People who feel this way say it has been going on since they were young, but it can get out of control. If you feel yourself having thoughts such as 'I'd be better off dead', seek help immediately.
SOLUTION: Cognitive behavioural therapy activates the mind to change thought processes and therefore patterns of behaviour. Sessions involve encouraging you to get out and do more for yourself and become more involved with other people. You will need a referral from your GP.
No comments:
Post a Comment