Dr Tim on medication, mental health therapies and a couple of book tips

Dr Tim Anstiss, health and wellbeing improvement specialist at The Academy for Health Coaching will be joining us on BlackDogTribe.com every day this week between 4pm and 5pm to answer questions around depression, mental health and wellbeing from the community.

Below are Dr Tim's answers to the questions sent in by the BDT community on Tuesday 24th April:

Q: I wanted to ask Dr Tim whether he thinks being in a high pressure sales role for ten years could impact on my already preexisting depression and anxiety - Charley

A: Quite possibly, but so might working in other jobs, or being unemployed. Some people thrive in high pressure sales. I, personally, just couldn’t do that work. It comes down to ‘person-environment fit’. Whether or not what you are doing is suited to your values, strengths and skills. How well you are managed will also make a HUGE difference to your wellbeing. I know people who love nursing, but because their managers have poor styles they become disengaged, unmotivated and anxious. Studies have shown that being exposed to autocratic, authoritarian management style influence heart disease risk, not just risk of mental health problems. So many things can impact a person’s wellbeing at work – including commuting, paperwork, performance indicators, and friendliness of colleagues – sometimes it can be hard to pin down. And, of course, people’s interests change over time – so a job you once enjoyed doing may become dull and uninspiring. Sounds like you might want to a) become more resilient and keep brushing up and developing those coping skills and helpful thinking styles and b) talk with someone about your job / career and whether or not you want to stay in that sector and field.

Q: In brief I suffered a sudden onset of Panic Attacks... after 9 months I noticed they seemed to be linked to my periods (pre-period) and also my periods went a bit haywire (Mirena coil was getting to the end of it's life) and happening every week for months then gone for 3 months then a 20 day period etc… When the Marina coil was replaced they seemed to disappear again but every now and again I'll get one pre-period. Also comes with a visual disturbance that seems to be set off by dim lighting? Or am I just mad? Started at age 45 now 47. So, in summary are Panic Attacks something that is associated with a drop in Progesterone levels during peri-menopause and what is this thing with dim lights? - Anon.

A: Women are more likely to experience panic disorder than men, suggesting a possible hormonal aspect. And a range of hormones are associated with how the body regulated stress, but these interactions are complex. Certainly progesterone and its metabolites may influence anxiety sensitivity. We also know that thinking patterns and styles can influence a person’s vulnerability to anxiety and panic, and that for some women, thinking styles and patterns can change markedly with their monthly period. How one copes with feelings of anxiety and panic also makes a difference to how long these feeling last and how severe they might become. Accepting the feelings whilst using active, problem solving coping strategies and seeking social support can be better for emotional wellbeing than what are called ‘avoiding’ coping strategies. Best to chat with your GP about these things, and can’t answer the question about the dim lights thing, sorry.

Q: I have had episodes of depression since I was eighteen, I'm now 33 (I believe they started since I had been taking Roacutanne for acne at the age of seventeen/ eighteen) I spoke to the dermatologist at that time saying I felt down, he said ‘I’m a skin doctor, if you feel down go and see your GP'. I felt desperate and ran from the room crying. Over the years I have been on Fluoxetine off and on, starting at 20mg daily up to my current dose of 60mg daily (currently on it 2 and a half years). I have has suicidal thoughts on and off and took an overdose last year. I have received one full year of cognitive behavioral therapy prior to the suicide attempt. I understand the connection between life style choices and depression and I’m currently in a fairly good place by taking my meds, eating well, exercising, drinking less and avoiding drugs. I attend the local mental health team for relaxation sessions and to 'check in'. I’m due to meet with the medical team soon to review my medication. So my question to you is, what would be the best anti depressant to try, how will I cope with the weaning process and why is one anti-depressant different to another? (Ok so that’s three questions...I’m greedy)

Hopeful of your help. - Anon.

A: I’m afraid I can’t really comment on which antidepressants may be best for you, since people vary and I’m not a specialist in the drug treatment of mental health problems. But different anti-depressants have slightly different chemical formula and physiological effects – so some might also help with feelings of anxiety, some might help people to sleep better, whilst some might be slightly more energizing. But what I would like to say is that sounds like you are doing a number of things right, including meeting with a team, having reviews, practicing relaxation skills, looking after your physical health, staying away from drugs and having some cognitive therapy. Well done, and keep these things up. Your mental health team will be able to answer your questions much better than me – so make sure you ask them. Some people find it helpful to have their questions written down before they meet with their GP or specialist, to ensure they get asked, and hopefully answered!

Q: Guess the question I am left with after my experiences is: why are so many health professionals so crap at dealing with depression?

It's one thing to be treated with incomprehension by friends and family, who are understandably thrown by having to deal with a friend or family member's depression. But in my experience, a large proportion of health professionals have an appalling attitude. Last summer, for example, my wife had to called an ambulance when I became suicidal after two months of severe depression; I was admitted to a psychiatric hospital later that day, so I don't think I was faking it. But when the ambulance came, one of the two medics treated me with scorn, refusing to do anything for me until begged to do so by his colleague. When we got to A&E, he had to be asked to sit with me whilst his (very understanding and supportive) colleague went off to talk to the A&E staff. Despite the state I was in, I can still sense his hostility. What's that about? - Anon.

A: Healthcare professionals vary in their interest in mental health problems and also in their levels of empathy. And even though they are in the caring professions, some healthcare workers can be judgmental – towards people with obesity, towards smokers, towards people who drink too much, towards people with depression, etc. It’s a shame, but it’s a fact. It’s is also the case that many health professionals receive far too little training in empathic, non-judgmental listening and ways of being with patients. Some just consider themselves biological technicians and are more interested in the mashed up ankle than the person on the other end of it. Sorry about your experience. Complaining about rude healthcare staff can sometime be helpful in bringing about a more patient-centered healthcare system. Of course, most healthcare professionals are dedicated and caring and always want what is best for their patients. And of course, some will be depressed themselves.

Q: Dear Dr Tim, I had a breakdown around 18 months ago and to be honest I think I have been treated pretty badly by the health service and have changed GP's only to find my new GP much the same. Anyway that is another story.

Because of this I have investigated a lot of different self help techniques. One of these is Mindfulness and CBT or MCBT and have also read a book called The Happiness Trap by Russ Harris which is a similar thought pattern in that it is Acceptance etc. The mindfulness books I have read are Mindfulness and Depression by Mark Williams and others, and also Mindfulness again by Mark Williams.

What do you advocate as a self help therapy or any therapy come to that, I have had talking therapy i.e. a counsellor and have done online CBT. - Anon.

A: Sorry about your experiences with the healthcare system. Glad you have come across the recent Mindfulness self help book by Professor Williams and Dr Danny Penman. I think this is the best book on the subject I have come across and have now done all the mindfulness exercises on the accompanying CD-rom. Repeatedly. The Happiness Trap is also very good. If you find mindfulness approaches helpful, then A Mindfulness Based Stress Reduction Workbook (with CD) by Bob Stahl and Elisha Goldstein is also very good. Many people find Christine Padesky and Dennis Greenberger’s ‘Mind over Mood’ book helpful in understanding why they think and feel and behave the way they do, and what to do about it. An emerging approach to helping people with stress, anxiety, depression and other problems is called compassion focused therapy. Many people spend far too long with their brains in self-criticism and threat mode. Learning to become more compassionate towards oneself can be very helpful in slowing down thinking and self-soothing.

Here are a couple of books that can help you on any journey towards becoming a more compassionate and self-compassionate human being: Self-Compassion: Stop Beating Yourself Up and Leave Insecurity Behind by Kristin Neff, and The Mindful Path to Self-Compassion: Freeing Yourself from Destructive Thoughts and Emotions by Chris Germer and Sharon Salzberg

Q: I have been on antidepressants since I was 12, nothing happened to me to make me depressed I just am, then when I had my first child I had post natal and by the time my second came I was near to being sectioned. I have been on pretty much everything they have tried chucking at me but nothing works, not properly any way it just makes me numb I’m not happy but I’m not sad and I hate being like that, I’m a very creative person but when on the tablets I can’t draw and I have no drive so recently I have taken myself of them and although some days I am high as a kite and some days nothing can make me smile I feel better than being on the medication. Is there anything I can try other than tablets or tablets that don’t slow you down so much? - Anon.

A: You describe very well the feelings, and the mixed feelings, of many people. If you look at my answers to other people’s questions, I hope you well be able to see the kinds of non-drug approaches which other people find helpful and which are supported by science. But to summarise: psychological therapies, including cognitive-behavioural therapy, becoming more active, improving your diet, and self help approaches including mindfulness and compassion focused methods. Many people also find St John’s wort helpful. And for tablets that may help with the depression but have a less sedative effect, best to chat with a mental health professional – either a GP with a special interest or a psychiatrist. There are lots of people who would like to help you feel less numb, less flat, more engaged, motivated and creative. You just may have to keep looking before you find them. Perhaps ask your GP or practice nurse about local therapies services.

Q: I have suffered from depression for many years now, and this question has always concerned me: if I have children in the future, is my depression likely to be passed on to them? - Anon.

A: Many people become depressed without having had parents who were depressed. So even if your future children became depressed, that may not be because you passed anything on to them. There are many more important things which contribute towards depression than any genetic tendency. And we don’t even know if you have a genetic tendency to be depressed anyway – so there may not be anything to ‘pass on’! And……for many conditions which show a tendency to run in families, the offspring only develop the condition if the environment brings it out - e.g. diabetes, back pain, some cancers. So I wouldn’t be too concerned, but I would make sure they grew up feeling loved and accepted.