How we do (and don’t but should) treat depression
I’ve just been watching a fascinating programme on iPlayer called The Doctor Who Gave Up Drugs.
Dr Chris van Tulleken now wants to offer drug-free treatments to all the patients.www.bbc.co.uk
It examines over-prescription of medication in the NHS and the lack of attention that the health service pays to really, really important factors in recovery like exercise. In one case study, a woman was able to lower her dose of anti-depressants after going cold water swimming, and in another a group of people at risk of heart attacks lowered their cholesterol readings by going for walks.
As you all now know, I’m off work with anxiety and depression at the moment. Those two terms barely touch on the terror that these illnesses cause. I am glad that I’m taking the time to recover from an injury to my mind rather than trying to run on it, and I cannot wait to come back to doing a job that I love and that brings me so much joy. I’m fortunate that my boss has been so understanding and kind about my illness and has given me the time to get better.
I don’t propose to go into the detail of why I’m ill or what effects it’s currently having on me as I am ultimately a very private person. There are lots of journalists who make a living of writing beautifully about themselves, but I’m just not one of them. The piece that I’ve had to make the most edits to in my career was a short Thunderer for the Times on sixth form colleges, where they very politely kept asking for me to put a bit more of my own experience into each paragraph. I found that deeply uncomfortable: other people’s lives and ideas are just much more interesting than my own.
But I decided to go public about being depressed largely because in many columns and blogs I’ve always praised people who are as honest about their mental illnesses as they would be about physical afflictions. It would be a bit hypocritical if I didn’t then do the same when I had my own visit from the Black Dog. Because many people have been much braver than I have been by talking about their mental illnesses at a time when people were still rather less understanding (including my parliamentary hero and kind friend Charles Walker, who spoke about his OCD in a Commons debate that made a huge difference to the way mental health is regarded in this country and in public life). And the response from everyone proved that firstly speaking up was the right thing to do, and that secondly we have become a much kinder country when it comes to mental illness. And so many people who I have admired for many years got in touch to say that they have been where I am now — and they’ve recovered, or found ways to manage their illness.
But one thing has struck me afresh while being ill that I already knew as a journalist who tried to write about public policy around illness, particularly mental illness, as much as I can. We’re better at supporting colleagues, friends and family who have mental health problems. But we’re not very good at calling for the changes that are needed in the health care system to help those people who are sick.
I’m currently switching from one anti-depressant to another, as I’ve been taking it since June without any discernible effect, despite two dose increases. I’m also prescribed three other medicines which are working much better. But really, what has made far more difference has been what I’ve been doing on top of taking my prescribed medication.
I have a talking therapy once a week. I decided to go private as I have savings and couldn’t wait for the six months that the GP predicted I would be left hanging around for on the NHS. I needed that treatment straight away, just as people who break their legs need casts straight away, not after six months. It is not fair that someone who has money can get treatment straight away, but someone who may be far more unwell than me but just isn’t as lucky has to wait, and probably deteriorate.
I go running three times a week. I’ve been a runner since 2013 and before I was unwell, was doing quite fast hilly 10ks every Sunday night and regular parkruns and cheery runs with friends where we’d natter about books we were reading while pounding around the lovely London parks (I was even part of an informal running club for political journalists, which many lobby colleagues were slightly alarmed by as it didn’t fit in with the boozy lifestyle we are supposed to lead). I love the wonderful mind tunnel that you go into when you’re running. Few things beat it, and I know that it is good for my mental health. But recently I’ve been too unwell to motivate myself to do this, and so have booked a personal trainer to get me out of the house twice a week and push me further, even when I swear at her, until I’m able to do this myself. I don’t have to do this, but it helps my mental health so much to be running. I have friends to run with at the weekends, and if I wasn’t lucky financially then I could find a friend to shout at me as I ran around a park for free during the week too, so this is a luxury treatment in my view for depression.
Similarly, the horse riding that I’m doing twice a week is expensive but it gets me out of the house and into the beautiful countryside and gives me a peaceful hour with a lovely horse which is undoubtedly good for the soul. I’ve chosen to spend money on these things as I have savings and I think it’s worth it as I want to do everything I can to get better, and therefore I’m spending my money well.
But the wider point beyond the damage I’m inflicting on my own bank balance by choice is that depressed people need help getting going with exercise — it’s just not good enough for a doctor to say ‘go running’ as that in itself can feel far too much for a lot of patients. Some won’t have been exercising before they fell ill, and so don’t know that after a little while, you stop thinking you’re about to vomit or die and you actually start enjoying running. Worrying that you’re about to vomit or die when you have anxiety is not ideal. Similarly, while I am annoyingly evangelical about parkrun, and I know a lot of people regard it as a lifeline, equally I know some depressed people for whom a crowd of three hundred people talking happily at the start and panting happily at the finish is just too terrifying for words (the state I’m normally in at the finish line is also too terrifying for words).
But without talking therapies and exercise, patients can either deteriorate or plateau without much hope of recovering. And that costs more money to the NHS — and to patients who pay more for more prescription drugs.
And how can the NHS really respond to this? GPs have ten minute appointments and long waiting lists. They don’t have the time to take a patient to a running club. They don’t have the time or the resources to prescribe personal trainers or swimming lessons.
The Doctor Who Gave Up Drugs identified the problem in the NHS, but offered about a minute of talking about the challenge for the health service before the credits started to roll. I’m not really sure of the solutions either: a lot of them seem to lie in friends turning up on your doorstep and forcing you to go for that walk, or being a bit mean and dragging you off on a run. Perhaps this means that as a society we need to work out ways for depressed people to get exercise for free in a way that will ensure they actually do it throughout their illness, even when that illness is making it near impossible for them to do anything.
We do need to make it as unacceptable that you’d wait half a year for a talking therapy as it would be if someone waited half a year for doctors to treat their broken leg. This means more political pressure, more media outrage about long waiting times and missed targets, and — perhaps I would say this after the past few days — more people prepared to speak out about the fact that they too are ill. The more we realise that there is an epidemic of mental illness, and the more we realise how much our friends, mentors and colleagues are struggling with the poor treatments available for it, the more likely it is that the system will be forced to change.
P.S. if you’re reading this and you are sick too, I would really recommend Matt Haig’s book Reasons to Stay Alive. Here’s a lovely excerpt from it on another low-cost treatment for depression:
P.P.S I’m obviously feeling well enough to write this, which is fab. And I promise that once I’m back at work, I’ll write more and more about public policy on mental health. You shouldn’t have to be lucky to be able to get treatment for serious illnesses that take you away from work and life.