Antidepressants; a GP ponders the urban myths…

I’m writing this blog purely as a GP who, every day, sees patients who take antidepressants. So these are my thoughts, based on experience, as well as evidence.

I also see patients every day who should consider taking antidepressants, because they clearly have all the signs and symptoms of significant clinical depression, anxiety, obsessive compulsive disorder or social phobia. Up to one in three of my consultations is for a mental health problem, and I suspect most of these people have finally come to see a doctor because they have reached a crisis point, or no longer know how to cope. They do not come lightly, and I understand that. They will often have already tried sensible measures, though we usually discuss those anyway, such as minimising alcohol or drug use, better sleep and eating routines, and exercise.

I always suggest counselling or other talking therapies, though again, many have had unsuccessful experiences of these. I will probably mention giving them another go…a different approach or technique perhaps?

But finally we come to medication, always approaching the subject gently, knowing that everyone comes with preconceptions and concerns.

“But they’re addictive”

“I don’t want to feel like a failure, needing medication”

“They’ll make me fat”

“They’ll make my acne worse”

“My parents won’t approve”

“I’ll be on them forever”

 

I have heard all of these, and many more, hundreds of times in the 15 years I’ve been a GP.

And it takes time and patience to pick my way through the concerns, which are mainly based on hearsay/myth (especially because they are NOT addictive or dependency inducing, and only one specific antidepressant is classically associated with possible weight gain. They have no effect on acne!).

 

But it’s worth the time, and listening to the concerns, because often a patient will then agree that it might be worth ‘giving them a go’, and that there is little to lose by trying them. Side effects are usually minimal for most people, especially if started at a half or low dose, and we always like to review how things are going at 2-3 weeks. And then when they have given them a go, and they return 4-6 weeks later, I have lost count of the number of people, but it is the vast majority, who have noticed an improvement, and as time goes on, at 8-12 weeks, say “I wish I’d tried these sooner”.

 

So all I would say is this; if you’re struggling and unsure about medication, then talk to a GP, sooner rather than later, and discuss your concerns, so we can see if antidepressants might help you too. And if they’re not right for you, we will still support you, and meet with you, to discuss other options and therapies.

You are not alone, and we are here to help.

 

Mental Health Awareness Week 12-18 May 2014; Anxiety

As a GP I really like it when a student comes to see me about their anxiety. Not only because it means they are keen to get help and get better, but also because there are so many things we can offer to ease their symptoms. In the last few years, here at Students’ Health Service, we have tried really hard to provide a variety of treatment options for what is the commonest mental health problem that we see; anxiety.

Anxiety affects people differently (about 1 in 20 people will have it at some time), but in general it makes you feel afraid and tense. It can lead to physical symptoms, as your adrenaline rushes around more than usual. People complain of palpitations (fast heart beat), sweating, nausea (feeling sick), chest pains, and shaking. You can also get headaches, and feel out of breath. It can be normal to feel like this, eg before an exam, but when it starts to interfere with everyday life it can become very challenging. Some people get panic attacks, where the symptoms feel overwhelming, and it can feel like the world is closing in on you, or that you might die. Please ask for help if this is happening. Ideally, please see a GP before it gets this bad.

So what can we offer you?

A variety of psychological (talking based) therapies are available. Relaxation techniques and Mindfulness can be learnt, and the Student Counselling Service provides very regular groups. Just sign up on their website.

http://www.bristol.ac.uk/student-counselling/

Self Hypnosis has been shown to be effective, and a GP can refer you for this; a one off free session provided by Matt Edwards in a confidential environment. Here is a blog written by a student who saw Matt last year;

I tried self hypnosis for my anxiety! You could too… a student writes…

 

Online CBT (cognitive behavioural therapy) is available for those who would prefer this method; sign up via the SCS website.

Free NHS groups, and 1 to 1 therapy are accessed via the LIFT Psychology service; no GP referral required, just contact them on

http://lift.awp.nhs.uk/bristolandsglos/

However, if psychological approaches are not enough, or might take too long and your symptoms are too challenging to manage daily, then medication can be extremely helpful, and can work within a few days of starting it. Any of the GPs will be happy to discuss this option with you.

So remember, anxiety is normal and common, but sometimes it can become overwhelming or a daily stress, so get help and talk to us soon!

I tried self hypnosis for my anxiety! You could too… a student writes…

When I approached the Students’ Health Service to seek help with my study-related anxiety, night-time panic attacks and insomnia, I was really not sure what to expect. Although I knew they would have heard it all before, I did not anticipate such swift and effective support. Dr Grant, who I was able to see within a couple of hours of my panicked phone call, suggested a number of helpful options including referring me to a colleague in the Centre for Sports, Exercise and Health who introduced me to a range of approaches, including neuro-linguistic programming (NLP). In just an hour Matt Edwards had taught me a simple method of recalling a desired mental state: in my case, a state of calm and focused concentration on the task at hand. I had never attempted anything like this before, largely due to a deep suspicion of such techniques. I like to think of myself as a ‘rational’ person, not usually drawn to ‘alternative’ medicines or therapies. I felt nervous and a bit silly, but prepared to give it a try. In a private and comfortable office I explained that I was hoping address study-related anxiety and improve my concentration and focus. To my relief this was all the detail I had to give: this was not a counselling session! Matt outlined a range of approaches and we agreed to try a certain NLP technique. He told me to close my eyes and imagine a situation when I had felt calm, focused and in control: the mental state I wanted to be able to recall. He then talked me through a process of cementing in my mind what I could see, hear and feel in this situation. This took about ten minutes or so, but after imagining and magnifying that feeling in my mind’s eye, I felt that I really could return to it any time. Matt explained that in NLP this process is often accompanied by associating this mental state with a physical ‘anchor’: for me, this became a single word. Now, when I say that word to myself, I am able to recall that feeling of being calm and in control. I have used it several times since in class presentations and at home, particularly in the evenings, when my workload seems too much.

Apparently NLP is about being able to visualise what you want to achieve, and then re-create it for yourself by placing yourself mentally in that situation. I am being honest when I say I can’t believe it works, but it really does. I really would recommend anyone else at the end of their academic tether to give it a go – it can’t hurt, and if you believe in it even a little bit, it works wonders.

For a discussion about a referral to Matt Edwards book an appointment with a GP at Students’ Health Service.

Self Injury; a paradox…

It is a strange truth that people self harm to make themselves feel better.

Some people have a glass of wine after a bad experience, some eat a huge bag of crisps or a bar of chocolate. But some people cut themselves, or burn their skin, take an overdose, or punch a wall. All of these options are a human way of coping with stress, though not a healthy way.

Most days at Students’ Health Service we see male and female students who have recently harmed themselves. Our nurses are very sympathetic, brilliant at wound care and completely non judgmental. The GPs would like to help you too, and discover what’s behind the self injury and distress. We are not easily shocked and we have seen many unusual ways that students harm themselves, secondary to depression, anxiety, obsessive thoughts or psychosis.

Alcohol usually makes self harm more frequent, or the injury worse.

Nationally self harm is thought to affect about 5% of people, though this is likely to be an underestimate (Meltzer et al 2002). In a school survey 13% of young people aged 15/16 reported having self harmed at some time in their lives, and 7% in the previous year (Hawton et al 2002).

It is important to assess and treat those who self harm, as the behaviour is often related to an underlying mental health condition, which, if treated, may lead to improvement not just of the depression/ anxiety/ schizophrenia etc but also of the self injury.

If you would like help with self injury, or would like to talk about your mental health in general, please come and see us soon. Don’t forget that the Student Counselling service is also there to help, and the team is very experienced in supporting students with such issues.

 Other support in Bristol;

Contact the Self Injury Self Help Bristol organisation, who provide services for men and women with self injury issues. They run support groups, and also run workshops related to achieving good mental health in general.

Email; sishbristol@yahoo.co.uk

 Phone; 0117 927 9600

Or, Bristol Crisis Service for Women; 07788142 999

Runs a text support service for managing your self injury and emotional distress.

Reflections on Body Image

Last month the Students’ Health Service had a visit from our local MP Stephen Williams, a member of the All Party Parliamentary Group on Body Image. He was interested to hear about our work with students with eating disorders, but we also talked through the challenges of being a student with a condition such as Body Dysmorphic Disorder, and the misuse of body building drugs such as anabolic steroids in some parts of our population.

Negative body image underlies much of the mental health work we do, whether it leads to low self esteem (which can itself lead to depression or self harm), anxiety, social phobia, and more obviously anorexia and bulimia.

The report highlights more positive ways to view ourselves and our bodies, such as the Health At Every Size movement, which focuses on health rather than weight/ Body Mass Index. This movement tries to encourage us to eat healthily and engage in appropriate amounts of physical activity and has been shown to lead to higher levels of self esteem, and better blood pressure and cholesterol levels.

Anecdotally the medical community is certainly becoming increasingly wary of using BMI as a ‘one size fits all’ measure, as we watch the generations increase in height and muscle mass. Even traditional children’s measurement charts have had doubt thrown over them, with a current study from the University of Worcester identifying healthy children as being incorrectly labelled ‘obese or overweight’ by the National Child Measurement Programme. This could then lead to those children developing neuroses about their height and weight in the future, in our ‘weight obsessed society’.

Fixating on a particular weight may not be the best approach for us, and it might be better to take a more holistic approach  with better health being the best outcome measure to aim for; focus on Fitness rather than Fatness, if you like.

If you are worried about your weight/ shape or health, then please do come and see us to talk it through. We are very used to discussing these issues, and I hope you will find us good at listening and keen to help.

 

http://issuu.com/bodyimage/docs/reflections_on_body_image

 

 

Dealing with Exam stress part 2

Hi, my name’s Rick and I work at Students’ Health two days a week, delivering cognitive-behavioural based talking therapies to students struggling with difficulties such as anxiety and depression.

 As the dreaded exams loom, the people I see often find that their problems become more difficult to cope with. This is because, frankly, there are various aspects of studying at a University that are psychologically downright unhealthy:

 The perfectionism, the isolated nature of the work, the unrealistic amounts of work expected, the competitive nature of the whole thing, the lack of instant reward for the hours and hours of hard slog put in, the uncertainty about what the future holds beyond University… etc etc etc

 I still vividly remember my own struggles with all this; and anyone who was in the vicinity of the Psychology department at Exeter University in 1989 will maybe recall my own less-than-ideal attempts to cope with it.

 The good news is that 23 years later, I’m full of good ideas about how to deal with the stress of University work, most of which I’ve learned fairly recently from working here with you.

 Here are 5 top tips for psychological wellbeing at this difficult time:

 

1.   Use a diary/ schedule to plan your work and your revision

     By planning work you can break it down into manageable chunks and hopefully find it less overwhelming. Try not to plan unrealistic amounts; 5-6 hours a day is realistic for most people. Plan breaks and relaxing/ fun activities as well and try to start as early as you can: If you’ve already done 3 hours work by lunchtime, you’re less likely to get stressed as the day wears on.

     Above all, see what works for you.

 2.  Try not to compare yourself with other people

 There are always going to be people who seem to get up at 6.00am and spend their whole day in the library, working for 14 hours without a break. Do not compare yourself with these people and on no account try to compete with them. Work at a pace that suits you, and try not to pick up on other people’s stress.

 3.   Try to avoid falling into spirals of negative thinking

     There are various unhelpful styles of thinking people can fall into when under pressure. These include predicting the future, catastrophising, and  black and white thinking, among others. There’s a link to 12 of these and what to do about them attached below.

 4.   When work stress and anxiety do start to get on top of you, take a look at what you do in response to this

      Do you dive under the duvet? Go to the pub? Switch on daytime TV? Phone a friend? Go for a brisk walk around the block? Surf the internet? Go to the gym? Jump up and down and scream?

      Try writing down what you do, and try to notice what’s helpful and what isn’t, in terms of keeping you calm and allowing you to complete what you need to complete.

 5.   Remember that the whole thing is time-limited: It will not last for ever and you can only do what you can do in the time you’ve got

Soon it will all be over…

 

If you are struggling with anxiety and/ or depression and would like help and support, you can contact Rightsteps Bristol on 0117 9431111 and self refer. It is a free service. Alternately you can e-mail me at

rick.cooper@turning-point.co.uk

 http://www.getselfhelp.co.uk/unhelpful.htm

 

Mental Wellbeing Week (20/02/12)

Look around you.

Wherever you are, whatever you are doing,  1 in 6 of the people around you will be struggling with a mental health problem at this time. 1 in 4 will have a problem at some time in their lives. Maybe it’s you, maybe it’s your flatmate or friend, partner or another student on your course.

The important thing is to know how and when to get help if you or your friends need it, or advice if you’re not sure what to do.

At the Students’ Health Service 1 in 4 of our doctors’ consultations is for a mental health problem.

Students, like anyone, can develop anxiety, depression, social phobia, obsessive compulsive disorder, eating disorders, bipolar and schizophrenic disorders, as well as rarer problems such as body dysmorphic disorder and borderline personality disorder. (For more information see www.patient.co.uk )

If you are thinking of harming yourself, we want to help you.
If you can’t leave the house because of fear or low mood, we would like to hear from you.
If you think that life’s not worth living please talk to us.

If you know someone who is suffering, please encourage them to make an appointment with a GP or bring them in yourself. We don’t judge, we listen. We really want to help you.
This is what we do, this is why we are here.

It is time we as a society started talking more openly about mental health issues and how to deal with them positively.
Less stigma would lead to quicker access to help and better long term health.
So look around you… 1 in 6 of us is suffering.

Can you act today to help that person feel better?

Talk to the Students’ Health Service or Student Counselling Service for guidance, support or treatment.

Mental Wellbeing Week starts 20th February, at locations around the precinct, especially between Senate House and the Library, with free activities and much more.

 Students’ Health Service; 0117 3302720

Student Counselling Service

Other good sources of info;

Mind

Living Life to the Full  (depression advice)

Moodgym  (depression advice)

b-eat  (eating disorders information)

Bipolar UK  (bipolar disorder support)

Relaxation techniques for anxiety

So there I was contemplating a raisin…

We were sitting in a circle with our eyes closed, trying to clear our minds of the daily maelstrom of thoughts and tasks. In our hands we each held a small dried fruit, and we were being asked to focus on it, touch it, smell it, listen to it (!) and finally taste it. The only problem was that I couldn’t switch off and I couldn’t stop making lists in my head…

Mindfulness based relaxation is a lot trickier than you might think!

As GPs we like to take time out to review what we offer to our students and we recently had the opportunity to try mindfulness (a type of relaxation technique) for ourselves. It is recommended for stress and anxiety and it is also offered by the Student Counselling Service, so it’s no bad thing for us to try it out. It was revealing to find that I was absolutely hopeless at relaxing and switching off! There’s a real skill to be learnt and I can see how this would be a fantastic life long technique for dealing with future stress and challenging times.

So if you find yourself lying awake at night because of worries, if you’re anxious on a pretty regular basis, or panicky when in certain situations, this could be for you.

The raisin is just the beginning, but peace of mind and the ability to take back control over your emotions lie ahead if you are able to invest some time and patience in learning something new, just for you.

If you need to talk to someone about anxiety then please contact us at the Students’ Health Service on 0117 3302720, or you could contact the Student Counselling Service.

Other good sources of info: