Changing our minds (Jan/Feb 10)

Friday, 01 April 2011 08:05

Don't get depressed in Alaska

My son Edward spent September in Alaska, exploring the glaciers and reading the local papers. He texted me to say that in the Anchorage Daily he’d read about Sarah Palin’s autobiography which she had written (with the help of a professional writer) in just four months. A spokesman from her publishers, HarperCollins, said that Sarah had worked very hard. She was, he said, ‘very hands on.’ Edward then expressed the hope that I had been very hands on with my new book, Why We Lie that I had just delivered to HarperCollins.

Edward also sent me a bundle of Alaskan newspapers, choosing ones that had articles on mental health. On September 20, the Fairbanks Daily News published a magazine called Parade in which ‘Top Doctors Solve Your Medical Problems’. One of these doctors,  Ranit Mishori, told readers how to ‘Cope with Depression’. Often, she said, people are depressed without realising that they are. However,

'The good news is that there are many effective treatments. More than 27 million Americans take some form of antidepressant. Most of these work by affecting the brain’s levels of serotonin, dopamine, and norepinephrine – chemicals that influence mood. The most popular are SSRIs (selective serotonin reuptake inhibitors), of which Prozac is the best known example. But there are dozens of drugs that work in different ways. Talk therapy or counselling also helps. Studies have shown that, for most people, combining medicine and talk works best. For those whose depression is very hard to treat, there are other alternatives, though most are experimental.'

She went on to list four treatments: vagus nerve stimulation, where ‘electric currents stimulate the vagus nerve, which is located in the neck, via a generator implanted in the chest’; transcranial magnetic stimulation where ‘magnets are applied to the scalp to create electric fields’; deep-brain stimulation where ‘a pace-maker-like device implanted in the chest sends electric currents to electrodes connected to mood centres in the brain’; and electroconvulsive therapy in which ‘electric currents are sent to the brain to trigger a small seizure has changed dramatically since it was first introduced decades ago. The major side effect is temporary memory loss.’

Here in the UK some psychiatrists would see  Mishori’s article as being quite reasonable, but others, those who keep up with the research and follow the advice on the treatment of depression as given by the National Institute of Clinical Excellence (NICE), would see that article as being quite out of date. NICE divides depression into mild, moderate and severe, and advises that medication should be used only with severely depressed people. However, all levels of depression require psychotherapy. The system that the government is developing to provide different kinds of therapy for different degrees of unhappiness and depression has many teething problems, but at least it recognises that depression is one of the ways we can manifest our severe mental distress. Unfortunately, the most popular therapy, CBT, uses the language of medicine to talk about mental distress. This is as sensible as talking about music but using the language of playing golf.

Many people contributed to this important change in how we understand ourselves, not least those who were depressed. One professional who contributed to this change was David Nutt, the psychiatrist who so angered Alan Johnson with his research into recreational drugs that showed that cannabis is less harmful than alcohol or nicotine. In 1999 David Nutt and his colleague Sam Forshall published a short report on their work of reviewing ‘current evidence and opinion with regard to the long-term treatment of unipolar depression’. Here they wrote, ‘Of those who have suffered one episode of depression 50–80% will have a subsequent episode, while of those who have two episodes, 80-90% will develop a third. With each recurrence a further recurrence becomes more likely and the period of remission tends to become shorter.’[1] 

This short paper might have upset those psychiatrists who wanted to continue believing that antidepressants cured depression, but eventually most of them had to admit that depressants don’t cure depression but simply reduce people’s awareness of their emotions. Some depressed people find this helpful but many do not. Painful emotions, like physical pain, tell us that something is amiss and we have to acknowledge this in order to put it right.

How is it that depression is seen so differently here from the way it is seen in America? American psychiatrists and the pharmaceutical industry work closely and profitably together in a system based on the belief that depression is a physical illness. They cannot afford to change their minds. Whereas in Britain the system allows professionals to change their minds. This is the system that many Alaskans assured Edward was a version of Nazism, the wicked NHS.

Published in openmind 161 January/February 2010

[1]Psychiatric Bulletin, 1999, pp.370-3)