wellness

What I did during National Depression Awareness Week

Now I no longer have a wonderful communications team to keep me briefed, awareness weeks like this one can pass me by. It was serendipity that I saw my GP yesterday and we agreed that I would start the final reduction of my antidepressants prior to stopping them altogether.

There are side effects to reducing modern antidepressants, also known as SSRIs, as well as significant risks. Reduction should be done carefully, with expert supervision. My GP has specialist mental health training and experience, which is also serendipity, as I didn’t know this when I shuffled into her consulting room at an acute stage of my last depression. She listens carefully to her patients, and works closely with us and secondary care staff including my psychiatrist. I am confident that I don’t get special treatment; she is equally compassionate and skilled with everyone. I do know that I am lucky.

It is shocking how many people think that you can go on the internet and become an expert in the treatment of mental illness. Without me asking for their advice, someone suggested that now we know that mindfulness works just as well as antidepressants, maybe I should try that instead? This made me smile to myself. I have given a presentation about the importance of access to mindfulness as a treatment option for anxiety and depression with the report author Professor Willem Kuyken to the Permanent Secretary of the Department of Health, Una O’Brien, and her senior team. So I do know a bit about it. But even so, with my own treatment, I need help.

As my dear friend @BiPolarBlogger said on Twitter, telling someone they should have a go at mindfulness is a bit like telling a person who can’t swim that doing the butterfly stroke is good for you. Such psychological techniques need to be taught with skill and practised regularly. And they are not for everyone. Mindfulness can be increase problems for someone with a trauma-related illness such as PTSD.

Actually, once I got over the hiding-under-the-bed-stage of my last depression, I found mindfulness to be a great help, and I use it most days. Yesterday I looked into a top-up course because, like all exercises of the body or the mind, repetition and building mastery are essential. Which isn’t the same as taking a tablet.

I have to confess to feeling anxious about coming off my little pills. There is something about putting them out before I go to bed, and then taking them on waking in the morning, that helps me remember my own fragility. It is a little daily act of self care. I might forget to floss my teeth, but I have never forgotten to take my medication.

People like me who experience depression have a tendency to be extremely hard on ourselves. I’ve written about this here and here. Medication prescribed by a doctor that you cannot buy over the counter is a reminder that someone who knows what they are doing believes that you need and deserve help – even if you don’t believe it yourself.

As well as upping my game on mindfulness, I am also doing more work (paid and voluntary) and preparing for a gruelling bike ride. And I’ve bought a new book called Reasons to Stay Alive by the wonderful @MattHaig.

Reasons to Stay Alive

Reasons to Stay Alive

And finally, I am using CBT techniques – facing the thing that frightens me and through this, allowing the fear to subside naturally – to help me. My blog is part of this.

Thank you for reading it. I hope it helps you or someone else xxx

 

Let’s stop being mean about people who are fat

This is an update on a blog I wrote earlier this year. I’m reprising it because of the fuss this week about Public Health England’s report into obesity and the Prime Minister’s apparent refusal to consider a possible tax on sugar.

Fat-shaming is a recent phenomenon. People who do it include doctors, nurses, NHS managers, politicians, journalists, comedians and ordinary folk like you and me. And it is weird, because according to statistics, over 60% of us in the UK fall into the category of people being vilified for our weak will, stupidity, greediness and for costing a lot of money in unnecessary healthcare.

I write as one who has done it as well as had it done to me.

I always liked the beach

I always liked the beach

Here’s me as a baby. Fully breastfed, I grew bigger than my tiny mother almost before I could walk. I take after my father. I am robust. I love my food.

Humans are built for survival. Some are wiry and can run fast for long distances. Others have staying power. In an emergency situation, chunky people like me can cope with cold and hunger because we can survive on our fat stores. We are the polar bears and the Arctic seals of the human race.

But our modern Western world has played havoc with these survival characteristics. As long as you have money, food is plentiful. The least nutritious, most fattening sorts of food are often the cheapest. And the combination of sugar, fat and salt in many processed foods such as cakes, biscuits, chocolate, ice-cream, crisps, milkshakes and even bread is, apparently, addictive.

This Ted Talkthis Ted Talk is enlightening. It helped me understand why losing weight is so hard. When you have gained weight, your body quickly adapts to being bigger, and adjusts your metabolism accordingly. Resetting the metabolic rate is extremely difficult. Once you have lost weight, you will probably have to eat fewer calories for the rest of your life to maintain your reduced size, even with regular, vigorous exercise. So you are fighting not only an addiction, but also your own nature.

And there is another factor. Many modern medications, particularly those used to treat various sorts of mental illness, have the unfortunate side effect of increasing one’s appetite. People taking them find they feel hungry all the time, and not surprisingly they eat more. I finished my antidepressants six months ago. Yet I have at least half a stone to shift, and despite extensive motivation and knowledge, it is proving a struggle. I know from chatting to others how distressing it is to gain four or five stone very quickly, with all the disability and stigma that goes with being overweight to add to the burden of the mental illness for which you have to keep taking the medication that leads to the weight gain.

I know people who have been to the doctor and been encouraged to lose weight. And then they buy a newspaper and are told that if they also buy a monster size bar of chocolate (which contains more calories than they need to eat in a whole day but no protein, vitamins or roughage) the newspaper will be free. If it were cigarettes or drugs, we would be horrified.

Given the cost to the NHS of obesity, with its links to heart disease, strokes, Type 2 diabetes, cancer, arthritis and other long-term disabling conditions, not to mention depression, anxiety and agoraphobia linked to body image and self worth, you would think that investing in prevention and effective treatments for obesity would be the place to start.

There is mention of this in the NHS Five Year Forward View. But until this week, there has been no systematic appraisal of the best ways to help people achieve and maintain a healthy weight, nor is there a coordinated, evidence-based commissioning approach to weight-loss and healthy weight maintenance services. Public Health England have produced a report about sugar, but we have learned this week that it has been witheld. Who knows what the real story is about who did this? I don’t really care. I just know that leaving obesity to individuals to tackle is unfair, ineffective and helps mo-one but the commercial giants who sell us all the stuff we don’t need.

Our current attitude to obesity is bizarre. Let’s tackle the food giants who push processed junk food at us from every direction possible. Let’s publish the economic appraisal to prove that helping people rather than criticising and lecturing them would in the end save a lot of money and even more unhappiness.And most of all, let’s stop blaming people for doing what comes naturally.

 

What I have learned through recovery

An episode of clinical depression isn’t sadness. For me, it starts with brittleness and a growing sense of doom. I stop sleeping and become increasingly irrational and irritable. Beyond a certain point, I am unable to ignore or control it. Eventually, something snaps. I am smothered by a suffocating blanket of nothingness. The only feelings to permeate are deep guilt and self-loathing. All perspective is gone; I ruminate endlessly over things I have messed up and those I have hurt. I am frozen, unable to speak, or crying. The tears do not soothe. I detest myself.

Luckily I don’t feel like this all the time. Having been on my latest road to recovery for the best part of a year, I have learned a few things about looking after myself that I want to share.

  1. Choose to be all of me: having learned that it is so much better to be open about my experiences of mental illness, I now have to work hard at not allowing depression to become my defining characteristic. It is just one thing about me.

  2. Expect less: if someone likes something I have done, that’s lovely. But I need not feel disappointed if they don’t.

  3. Mindfulness: live in the world and be in the moment. Enjoy the little things – rinsing a cup, the warmth of the cat’s fur. Stop rushing.

  4. Going out: notice how exercise in the fresh air, even in wind and rain, makes me feel strong and alive. Embrace it and do more.

  5. Stop ruminating: I’ve wasted a lot of time going over and over things. It is important to learn lessons when something goes wrong – CBT has taught me to face the difficult stuff with less fear. But knowing when it is time to move on is a skill that needs frequent practice.

  6. Choose to forgive: This goes with number 5, and I like to think I am better at it than I was. Again, I have to practise every day.

  7. Create order from chaos: people think I’m tidy, but the more distracted I am, the messier I get. I have learned that, on a day when I am feeling low or anxious, I need to create order. Write a list, tidy a shelf, weed a flowerbed – completing a small task that brings order is soothing.

  8. Buy less stuff: I thought I loved shopping, but it made me feel guilty to spend money I couldn’t afford or could have given to someone more in need. Now I try to buy less. Except fresh vegetables.

  9. Make do: this goes with 8. I gain increasing satisfaction from mending things, making something from something else, or giving something of mine to someone who can make good use of it.

  10. Treating myself: on bad days, addictive substances such as alcohol, caffeine and chocolate can seem like treats. It takes some of us a lifetime to learn that they aren’t. A soak in the bath, a walk by the sea or some quiet contemplation in a sacred space can feed the soul rather than flooding the brain with dopamine.

  11. Competition: for me, best avoided, except with myself when trying to improve personal performance.

  12. Listen hard: I used to miss so much or misunderstand because I was too busy interpreting what people were saying and working out what response I should give. I am learning the value of listening really carefully. It is amazing what you hear when you listen properly.

  13. Don’t shy away from things that feel difficult or scary: it takes huge courage even to leave the house when you are in the early stages of recovery from depression. Standing up in front of 200 people in my first week back at work, I wanted to die. But I am so proud that I did it. I have found that, as I get better, I thrive from the boost to my endorphins that comes from feeling fearful yet excited about a new challenge, preparing carefully and managing my nerves so that I do a good job. I feel very lucky that in my new world, there are plenty of opportunities.

  14. Stop pretending: when someone asked me how I was, I used truly to believe it was a dereliction of duty to say I was anything other than great. I have learned to tell the truth about how I am – some days I am good, and some just OK. And when I am not OK, I am better at saying this too.

  15. Choose kindness: people have often said of me that I am kind and generous. This came at a cost. I have learned that to be truly and effortlessly kind, one must start with oneself. The love I feel for other people and the kindness that flows from me towards them has multiplied as I have let go of negative feelings towards myself. I am far from perfect and still have many faults, but I am worthy of love. This helps me to help others more than I ever could before.

These are just my thoughts; if they help someone else, that’s great. But please, don’t shout at me if you disagree. We are all different. And that’s what makes us so amazing xxx