Anti Depressants don’t work

Well, the shocking (or maybe not) news of the day for anxiety and depression sufferers is that antidepressant drugs of the SSRI (Selective Serotonin Re-uptake Inhibitor) class don’t actually work.

Scientists today revealed a study that looked at many other studies including some that, under extremely dubious auspices, have never been published before. What did they find exactly? That antidepressants like Prozac and Citalopram don’t work any better than a placebo pill (normally a sugar pill; always with absolutely no medical value).

That leaves a lot of people with red faces. The drug companies have been pushing these pills for decades with very thorough marketing campaigns. Doctors have bee prescribing them as if they are going out of fashion and online pharmacies have been flogging them to anyone who will pay. What’s worse is that clinical guidance bodies, such as NICE (National Institute for Clinical Excellence) in the UK and the FDA (Food and Drug Administration) in the USA have listed SSRI’s as at least an important part of the treatment of choice for anxiety, depression, panic disorder and GAD etc for years. They now would seem to have egg on their faces.

But what of the most important people in all of this? The patient? Well, firstly the advice has to be don’t do anything rash. Even if these pills have no medical value stopping them cold turkey can be very dangerous and very unpleasant. Don’t make any changes until you have spoken to your doctor.

The second thing is to remember science is always wrong! And I don’t mean to sound like one of those terrible pop-psychologists on US TV and just claim my theories are correct. What I am saying is that scientific research has been mixed over the years. Some studies have been good and some studies have been bad. Many people, and I include myself in this category, have been helped immensely by taking SSRI antidepressants (or at least we think we have, which more or less amounts to the same thing!). My personal feeling is that when taking antidepressants my sleep improved immensely, and I was much less anxious in situations that used to provoke anxiety and in daily life. If a placebo pill can do that with no side effects then great, buy I suspect it can’t. I believe that antidepressants don’t work for plenty of people, but do work for some, and can be well worth a trial. Remembering of course that they are not a long term solution.

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Using an elevator to overcome anxiety

Many people have lift or elevator anxiety. They panic when they enter, or think about entering an elevator. For the purpose of this blog I will refer to elevators as "lifts" as I am English and lift is the English word.

Lifts commonly cause phobias for various reasons. On the one hand they can aggravate claustrophobia. The small enclosed space is the nearest most of us get to prison. Often the walls are metal and the doors are several inches thick. Not much hope of getting out of there, we think, if the lift gets stuck.

Lifts also go beyond claustrophobia. Lifts do not leave us fully in control, which is often where the anxious mind wants us to be. And lifts are obviously associated with tall buildings, hospitals and work. So there are many possible subconscious considerations to a lift phobia.

Worst of all, lifts are easy to avoid, and evasion is the arch enemy of a phobia sufferer.

But a lift is also a gift. There are a few reasons why lifts are so great for helping you overcome anxiety and phobia issues.

Although they appear scary to some, lifts are incredibly safe! It is basically impossible for a lift to plummet to the ground, the chances are millions against.

Lifts are easy to find, there is more than likely one in your local shopping centre you can use.

Lifts give you a very short dose of what you are afraid of. You can go on a lift for as little as twenty seconds.

As time goes by you can stay in lifts for longer, getting used to not being able to see out, not being able to get a reference point from which to orientate yourself.

And will they lift get stuck? The chances are very remote, but if you do get stuck what is the worst that can happen?

Assuming the lift you use is in a building used by others, people will be aware of the problem strait away. People will be called and restarting the lift rarely takes long. You might think that you would die if you got stuck in a lift, but you would be wrong. In fact you would probably have a panic attack, but after some short time the panic would give way to reasonable concern and boredom.

So don’t delay, start using elevators or lifts to get a feel for surrendering control!

Cognitive Behaviour Therapy – the truth?

The more I research therapies used to treat anxiety and depression the more cynical I get. I recently was told about an excellent article by a UK Art Therapist which looked at the official guidelines for using CBT (Cognitive Behaviour Therapy) to treat anxiety and depression.

In the UK, a public body called the National Institute of Clinical Excellence (NICE) gives out guidelines for the use of prescription medication, surgical procedures and other non-medical treatments such as therapy. For some time the overwhelming opinion of NICE has reportedly been that CBT is the treatment of choice for anxiety and depression (with drug therapies also playing a major role).

The essayist, Malcolm Learmonth, describes how NICE guidelines come in two parts: the full report which hardly anyone reads, and an abridged version. It seems that the two are actually quite different, with the abridged version making a much better case for CBT as a valid treatment than the evidence in the full version would suggest is plausible.

It is worth following the link above to read the article.

Why then would NICE be "bigging up" this therapy if it is not in fact much good? Well, let’s not say it’s useless. For sure it does help some people. The problem is that it seems not to be the panacea that it has been allowed to be seen us. There may well be a time and a place for it, but NICE seem to want to say that it is really the only therapy worth using for anxiety and depression. This is not the case and other therapies are starting to become more popular as professionals and patients see shortcomings and disappointment from CBT. This causes problems in itself. All over the place alternative therapies, often expensive ones, pop up and promise the world. Many hours and pounds are wasted on them and the charlatan founders get rich. That is why we need NICE.

But we need NICE to be able to separate the wheat from the chaff, not just flog one therapy. It may well be that CBT is cost-effective, but patients and providers need to know what is clinically effective.

Relaxation Techniques

Being able to relax the mind and the body is very important for people who suffer from anxiety and panic attacks. If you can master the art of relaxation then you have (almost) won the battle.

There are a few points to remember when it comes to relaxation.

  • You do actually choose whether to relax or not.
  • It is a skill to be learned
  • Relaxing the mind is better than relaxing the body

People with anxiety often project responsibility for their discomfort onto other things or people. In fact we do, inside our own bodies, choose how to feel in terms of stress, negative thinking and physical tension. Half of the battle when learning to relax is to recognise this power you have over your body. It is your body and nobody else’s. The first step, and most important one, in learning to re-evaluate your relationship with your body is to practice Mindfulness Meditation. This form of meditation allows you to understand how your breathing works, how to accept your breathing and not be scared of it, and how it is actually under your control although your unconscious mind does a much better job of managing it all day every day than you would want to!

Like all the best things in life, Mindfulness Meditation is free (well, you will need to buy a book, a CD course, or join a local course – all very cheap. If you are really strapped then you could probably work it out for free by looking at web sites. Mindfulness is not rocket science).

Also, however, like the best things in life it is not something you can obtain in a flash. It is a skill to be learned and this requires commitment and practice. It does pay dividends, unlike too man of the miracle cures out there.

I would also stress that mental relaxation is the key. In fact, I think relaxation of the mind and body go together. I have often read that if you relax your body your mind will follow. I do not believe this to be true. I think that you will be able to relax your body much more easily with a relaxed mind, in fact it might well happen naturally.

Progressive relaxation can be a good way of relaxing the body. You can learn to do progressive relaxation in about 2 minutes, it’s easy. It does of course require commitment!

Basically, all you have to do is to tense and release the muscles in each part of your body, starting with your toes and ending with the muscles on your head that control your wiggling ears! You should tense each muscle or muscle group for 15 seconds and then release them gently and leave them relaxed for a further 30 seconds. Each muscle group should be tensed and relaxed twice before moving on.

There is a version of this called a "Body Scan" meditation which is practised as part of mindfulness meditation. It is a passive form of meditation and is done by simply observing each part of the body (not just the muscles) in turn. Instead of sticking rigidly to 15 or 30 seconds you should take some time in exploring the sensations you can feel in that part of the body, giving it all your concentration and escorting your mind back to it gently but firmly whenever it drifts off.

When it comes to learning relaxation techniques the key words have to be acceptance, practice and commitment.

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