Depression and Drugs

Well. I am more surprised than anyone to be writing on here again so soon. My inspiration for todays ‘blog’ is again something that occurred whilst I was lying in bed this morning, minus the cream and brown furball who was literally in the doghouse and was made to sleep on the floor last night. That, again, is a whole other rant. I like to check the headlines before getting up and whilst doing so I saw the and then read the following article:

Despite this article being ostensibly positive, stating as it does that there may be an effective ‘fast acting’ drug for depression on the market soon, my reaction to it was what I can only compare to an experienced oncologist reading an article about a new treatment for cancer based on homeopathy and heroin.

Ketamine was developed in the 1960’s and intended for use as an anaesthetic. It was effective enough for use in the Vietnam war where other forms of anaesthetic were impractical. However, Ketamine has many side effects (as most drugs do) including in the short term:

  • Hallucinations
  • Dissociation
  • Double vision
  • Breathing difficulties
  • Slow or fast heart rate

To name but a few.

I first came across Ketamine when working with a client who was taking it for non-medical reasons. Ketamine is a class B drug in the UK and similarly classed all around the world, so it is something that is generally accepted is not good to ingest on a regular basis. This particular client who was considerably younger than me, faced a lifetime wearing adult nappies because of the urinary incontinence that his Ketamine use had caused. Every day for the rest of his adult life, having to wear a nappy because he cannot control his own bladder. To say this chap was depressed when I met him was an understatement, yet Ketamine was the cause and not the cure.

Whenever I read or hear about Ketamine being used to treat depression, I remember this chap and become extremely frustrated. That clients face and his experience of Ketamine are etched permanently into my mind and as such, Ketamine use and its consequences will forever be associated with my memory of him.

Ketamine actively impacts on the physiology of the brain in ways we surely cannot be completely sure of. It can cause hallucinations and dissociation; how helpful will that be to the estimated 10-20% of people who take it for medicinal purposes who experience them. You are depressed and then on top of that the medication you are taking makes you see things that aren’t there. Brilliant. That will help!!

I have no doubt that it has helped some depressed people during the trials, it must have done. Drug companies in general have the ethical standards of your average sewer rat, but even they cant get away with putting something that has absolutely no positive effects onto the market. Well, they have done that before, but it is not so easy to get away with it now. Drug companies are businesses. They exist to make profit, the fact they might make a few people feel less depressed or anxious is a by product of their main aim which is to keep their shareholders and the hedge funds that have hold of their stock happy.

That is why the above article is so frustrating to me. It reads more like an advert for the drug company than providing the reader with an objective overview. There is no mention of the NICE guidelines for the treatment of adults diagnosed with depression (I have added a link to their webpage below) which clearly states that anti-depressants should be prescribed initially (if the patient wishes to take them) and following this the patient should be referred for talking therapy (CBT initially, then different modalities if the CBT is ineffective).

There is no mention of talking therapies in this article. It can be read as an advert for this amazing new drug that gives people and quick and easy fix for something that can be horrible and debilitating. No mention of adult nappies, brain lesions and the other possible side effects. Just a nice trip to the psychiatrist who will hook you up to a drip and monitor you in case you pull a whitey or start seeing pink elephants climbing up your leg.

The drug company and the psychiatrists it pays for or employs believe Ketamine is a long term curative treatment for depression? Really?

I read the article largely despairing, but it was something I had heard about and was expecting and not particularly worked up about. It was the last paragraph that made me want to write this blog though.

The psychiatrist (maybe?!? drug salesman? Who can tell?) interviewed is quoted as saying:

The biggest challenge psychiatrists will face, Dunn said, is much the same as the one they face now: keeping patients in treatment.

“The challenge we’ve all faced in psychiatry is keeping people on their medications,” he said. “Patients have gotten better, they don’t have symptoms anymore, so why take the medication?”

This attitude is archaic and just plain wrong. I wish as a psychotherapist; my biggest challenge was keeping people coming into my office and talking to me. The actual biggest challenge I and my clients face is dealing with the outdated and grossly ineffective systems and organisations that exist at this time for the treatment of people with mental health issues. The attitudes and services that strip each and every person with any and all mental health diagnoses of their individuality, humanity and dignity, prescribing them pills after labelling them and then leaving that person to stagnate as they do not know there are more effective alternatives available, or tell them there is help available but they have to wait a year to receive it.

My attendance rate over the last year for clients is in the high 90’s. I have no problem keeping my clients ‘in treatment’ to use the psychiatrist’s word. They come back because I offer them long term support and hope that at some point in the future, they will be able to manage their depression themselves, without the need for drugs. Certainly not drugs designed originally as an anaesthetic, with horrendous side effects and is most famous for its use in the veterinary world as a horse tranquiliser or as a party drug that might damage your bladder so much, you pee yourself as you wait for the bus to go see your psychiatrist.

I don’t just offer my clients a course of snake oil and tell them they will feel better forever if they keep taking it. I am honest with them. I tell them that making a full recovery will involve hard work and emotional graft. That they will need to commit to a process that they might not fully understand yet can take them where they wish to be. That they can heal, but that I cannot tell them exactly why they have healed. I offer a client reality, humanity, hope and support when they walk into my office. Not a quick and easy fix that just makes depression disappear like magic.

This kind of medication and this kind of research is designed for a society that now demands ‘instant gratification’ and is in my opinion lazy and dangerous.

Mental health treatment is still too reliant on the opinions and beliefs of those who wholeheartedly believe in the medical model of treatment. In short, they believe that everything to do with mental health, anxiety, depression, personality disorders, psychosis, everything a person can be diagnosed with is a ‘brain disease’ and purely due to a defect or damage in the brain. To me, this is patently absurd. To dismiss as irrelevant a persons whole experience of life, themselves, their family/friends, other people, their social situation, their gender, their cultural background, their beliefs, their traumas, their highs and lows, their conscious and sub conscious mind, is arrogant, illogical and just plain daft.

Surely it makes more sense to look at the person as a whole. Bio-psychosocial theory states that a person’s overall health is influenced by not just one thing, but several. The way that our experiences of:

  • Social pressures/experiences
  • Mental health
  • Physical health

combine, influence our overall sense of wellbeing and any one of the above can have a positive or negative impact on the others. If someone has a physical illness such as cancer, they are more likely to experience anxiety or depression. If someone is depressed following the loss of a family member, they may develop physical symptoms that co-exist alongside the depression and if someone is being bullied at work or school they are likely to experience both mental and physical health issues as a result.

This makes much more sense to me. That human beings are complex and unique. No two people experience things in the same way, and we can have the same experience as someone else and respond to it differently physically and emotionally. Therefore, one person may experience fewer or even no depressive symptoms when taking Ketamine, whereas another person may lose the ability to control their bladder after taking it.

Our ability to think and to process and internalise experience and thought are what make us unique and special on this planet. I believe that any person motivated enough can make positive changes to their patterns of thinking and behaviour with the right support and access to talking therapies. I just wish that the world of counselling and psychotherapy had the billions of pounds that the drug companies have, so we could do more research and develop new and more effective counsellors and psychotherapists to help people change and grow as they wish. But whilst those trained in the medical model have more influence and control of politicians and the money, there is little hope in me that things will change any time soon. To see every client as an individual and treat them as such would be expensive and require a lot of hard work behind the scenes to get things in place as they would need to be.

Therefore it is not going to be an attractive option as there will be little to no profit in that for the hedge funds, politicians, investors and even the psychiatrists behind the scenes, why spend money on services you personally will never need which would be only of use helping people you will never know or care about? That is madness surely?!?

Should these kinds of institutions and people be making decisions that impact directly on millions, likely billions of people worldwide? I will leave that one for you to think about, whilst those of us who have been depressed can also now ponder whether a quick and easy way to relieve the symptoms of depression is worth brain damage and the inability to wee when we want to.

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