We all know what it’s like to feel seasick in our mind at some point in our lives. It is a pain in the arse, but part of what it means to be a human being with an exceptionally complex brain.
Not everyone is mentally “ill”, of course, but things like bereavement, relationship breakdowns, periods of physical illness, work stress, loneliness, new parenthood, sleep disturbance and our menstrual cycles are just some of the myriad factors that can unsettle even the most psychologically resilient of us, affecting moods and anxiety levels. The ways in which we manage the discomfort are as individual as those grey blancmanges we’re carrying around inside our skulls.
For the one in four of us who suffer with our mental health in a way that breaches these appropriate, ie “normal”, responses to the undulations of life – those of us who live with problems like anxiety disorders and depression – that word “manage” means something else.
Living with a mental-health problem means, at times, tasting desperation. That desperation can be transient or enduring. It can be a whisper, a shout or a deafening scream. Either way, we need interventions and techniques to help us feel better. Some people are able to manage their mental health on their own with things like exercise, diet, meditation and a commitment to good sleep. A great many of us aren’t. If we are struggling, it can be daunting to think about asking for help. Not just because of any self-stigma we may have, but because there is so much information – and misinformation – out there about what is “best”.
Broadly speaking, we know that the two main treatment options for problems like anxiety and depression are psychopharmacological (medications like antidepressants) or talking therapies like Cognitive Behavioural Therapy (CBT). We know – in the UK, at least – that if we go to our GP and say that anxiety or low mood has made it difficult to function how we want or need to, these are the options that will likely be presented to us. But which is best? Will I become dependant on antidepressants? Are some better than others? Which kind of talking therapy is best? Is it better to do therapy and medication together? What if I am already having treatment and still haven’t had a eureka moment of feeling cured?
The above are all questions I have heard from people during my book research and beyond. Since writing it, I have been approached many times, online and offline, at book signings and talks, by people asking if I had discovered an optimum approach for dealing with anxiety. I absolutely bloody wish.
I am not a clinician – although I am retraining as a psychologist – and only know that my own turning point in living with anxiety was much more prosaic than finding a “perfect” therapy. It was accepting that anxiety is as much a part of me as the way my hair grows and, like my (often Michael Bolton-like) hair, needed to be managed. Not cured. Not fixed. Because of the infinitely variable and complicated ways our brains work, much of which is still a mystery to scientists, empirical “cures” for mental-health problems are not possible. However, there are a great deal of options to help us manage our mental health and a great deal of people live with problems like anxiety or depression in a way that is indiscernible. They – we – are functioning highly like “everyone else”.
There is a big problem when the public are being sold the idea that antidepressants are dangerous or interchangeable
Thankfully, the concept of otherness that surrounds mental-health problems is gradually dispersing. One look at mental-health statistics puts the boot on the idea that, if you’re suffering, you’re different. But if we go back to the main treatment options available, things can feel quite confusing.
First, let’s look at antidepressants. We are being told all the time that far too many of us are on them. Last month, speakers at a meeting of the All Party Parliamentary Group for Prescribed Drug Dependence said we are “in the midst of a great public health disaster”, grouping antidepressants with strong painkillers and anxiolytic medication like Valium. The evidence is unequivocal that there is a problem with addiction to prescribed medications in the UK, but the issues surrounding antidepressants are quite complicated.
People considering taking an antidepressant when it’s suggested to them may feel put off by the language we’re reading so much in the media at the moment; words like “hooked”, “dependence” and “addiction” stick to our skin like midges. As psychoactive substances, antidepressants do subtly change the way the brain works, but dependency on them is not the same as dependency on an opioid painkiller, for example. They are long-acting and you don’t take them for a “fix” or a high. The brain gets used to the medication, of course, and withdrawal can be difficult for some. This is where misinformation is rife and our services aren’t quite up to speed. It’s imperative we look at the bigger picture.
As a psychologist recently pointed out to me, we desperately need pharmacists and GPs to have more awareness of the side effects when people are coming off antidepressants because the effects are often labelled as a relapse. Of course, this keeps people and their doctors stuck, but this kind of “dependence” is a compound problem. Also, the over-subscribing we hear about is, in a large part, due to GPs having no other option. When the mental-health system has been stripped to ribbons by funding cuts, in the face of poor housing, benefits withdrawal and zero-hour contracts GPs are forced to prescribe them because it is often the only thing they can do.
There is a big problem generally right now, too, with the public being sold the idea that antidepressants are dangerous or interchangeable. We’re not informed properly about the different types of therapy, either – it’s too often just “therapy”. The fact is that there are multiple options of both medications and talking therapies. What we need to focus on is providing as much clear information as possible, so people can make informed choices on their treatment. We should also remember that terms like “evidence-based” are subjective, too. You can make a great argument for antidepressants either being fantastic or potentially detrimental to long-term recovery, and for therapy being better. You see where we get to with this.
Ultimately, the only evidence that really matters is what works for you. There is no panacea for mental distress. What’s important is that we accept that trying something out is just that – trying. It’s all we can do. If a medication doesn’t agree with us or we don’t get along with a particular type of therapy, there are options. There should be no floating hierarchy of what is better or worse for us.