Friday, 30 May 2014

English unemployment and poverty - and the landscape for antidepressants

New research, published as a part of QualityWatch, a joint initiative of the Nuffield Trust and Health Foundation reveals a stark trend in the incidence of antidepressant prescribing in England.

Between 1998 and 2012 (the last year for which data was available), the number of antidepressants dispensed in the community each year rose from 15 million to 40 million, with almost half the increase occurring in the four years following the 2008 financial crisis. That's an exponential increase, with at least the suggestion that unemployment and financial hardship/insecurity may be part of the picture.

Digging down deeper into the research, we encounter some interesting findings:

  • A 1% rise in unemployment typically resulted in one-and-a-half more tablets dispensed per person on a GP list per year
  • There is significant variation in the rates of prescribing across England; for example, patients in Blackpool collected more than four times as many antidepressants as those in Brent in London
  • GPs who prescribe large numbers of antibiotics also prescribe large numbers of antidepressants, suggesting that doctors vary, in general, in their propensity to prescribe for any condition
  • Younger female GPs, who qualified in the UK were more likely to prescribe antidepressants to their patients
  • Areas with poor housing tended towards significantly higher antidepressant prescribing

Senior Research Analyst at the Nuffield Trust, Adam Roberts, said:
"It's striking that GPs were prescribing an extra 2.7 million antidepressants in 2012 compared to the trend we saw during the years of economic growth. The acceleration in the use of these drugs raises some difficult questions about the impact that poverty and unemployment have on peoples' health."
He also highlights that differences in antidepressant prescribing between different regions of England may suggest particular underlying problems in mental health for people in areas suffering from unemployment and poor housing.

Nick Barber, Director of Research at Health Foundation, while acknowledging the dramatic increase in antidepressant prescribing, also draws our attention to the real variation in prescription rates across GP practices. He notes that the differences in propensity to prescribe could suggest that not enough attention is being given to patients' individual needs.

No matter what we speculate, the figures tell their own story - a radical increase in prescription rates over not so many years. The use of antidepressants is accelerating, which presumably means so is depression, though, as we see from this report, the relationship is far from simple. Unemployment and poverty are clearly implicated, which won't come as a surprise to anyone, but are they the only factors? Would we have seen this trend in the absence of a financial crisis? Conversely, will we see a reversal in this trend now that we are (allegedly) on the road to recovery?

We welcome your thoughts on this vexed subject - please drop us a line in the comments below.

Written by Jacqui Hogan

Friday, 23 May 2014

New research on which to meditate

We hear a lot about meditation these days, mostly as an antidote to stress. But it has also been associated with improving mood and sleep quality, enhancing memory and reducing some of the risk factors for cardiovascular disease.

Far from being a definitive technique, meditation takes many forms, from mindfulness (whose marketing machine seems to have been in overdrive in recent years), to mantra-based meditation, to guided visualisation, to plain old navel-gazing. Distinguishing between the varieties is bound to reward the effort, not least by providing an opportunity to evaluate the different effects.

A new study conducted at the University of Oslo goes some way towards doing this, by dividing meditation into two basic categories - concentrative and non-directive.

Concentrative meditation techniques focus on the breath or on certain thoughts, which, in turn, serve to eclipse other thoughts. Non-directive techniques focus on breathing or a certain sound, and allow the mind to wander. With these latter techniques, only when one becomes aware of the wandering mind does one steer back to the breath or the sound.

Participants who were highly experienced in non-directive meditation underwent magnetic resonance imaging (MRI) under three conditions: while resting, as they were practising non-directive meditation and as they were practising one concentrative meditative technique.
The researchers found that when non-directive meditation was being practised, brain activity was greater in areas associated with processing self-related thoughts and sensations than when resting. But during concentrative meditation, brain activity was virtually the same as as when they were resting. 
This would suggest there is something about allowing the mind to wander which confers psychological benefit; according to Svend Davanger, one of the researchers, it is possible that non-directive meditation allows for more 'space' to process memories and emotions than concentrative technique.

What's interesting is that the area of the brain which demonstrates increased activity during meditation is normally at peak activity when we are at rest. It represents a kind of default which takes over when external tasks do not require our attention. That non-directive meditation results in even higher activity in this region is quite remarkable.

So I don't know about you, but if I'm going to meditate (jury's out, for no other reason than chronic inertia), I'm going to choose the non-directive brand - and in the meantime, I'm happy to note there's nothing wrong with a wandering mind!

Do you practise or work with meditation? Do you find it of benefit? Perhaps you know of specific techniques that have helped you or a patient. Let us know of your experience by commenting in the area below.

Written by Jacqui Hogan

Friday, 16 May 2014

Don't panic: it's Mental Health Awareness Week

Did you know it's Mental Health Awareness Week? Don't panic if not; you have two more days to get your head around this year's theme, anxiety, now one of the most common mental health problems here and in the rest of the world.

The Mental Health Foundation (MHF) is a key driver of Mental Health Awareness Week and its growing success in reaching out to sufferers and those who support them is largely down to the work of organisations and individuals throughout the UK, who help by promoting the week, hosting events and generally spreading the word.

This year, the MHF has produced a series of eye-catching posters, an easy-to-read guide to anxiety and a report entitled Living with Anxiety, based on some excellent field work conducted in April 2014. This survey of 2,330 adults (aged 18+) was implemented online and results were weighted to render them representative of the British population as a whole.

'Anxiety' in the context of the survey was defined as 'feeling worried, nervous or uneasy', and some of the findings make for interesting and sobering reflection:

  • Almost one in five people say they feel anxious a lot of the time or nearly all the time
  • Almost half (45%) of people say that money/debt/financial problems are they main cause of anxiety in their lives
  • Four in every ten people who are currently employed say they experience anxiety about issues associated with their work
  • Young people (aged 18 to 24) were twice as likely to feel anxious about being alone as older people (aged 55+)
  • Comfort eating is used by a quarter of people to cope with feelings of anxiety (most common in women and the young)
  • The most commonly used strategies to combat feelings of anxiety are talking to a friend, going for a walk or taking physical exercise
These are just a few of the nuggets and the report will reward your efforts to delve a little deeper, specially if you are involved with the treatment of anxiety and related disorders.

Are we, then, more anxious as a nation than we have been in the past? The report suggests that this is certainly the belief of those who participated in the survey, who say that they are more anxious now than they were five years ago. But equally, their current identification with the condition may be a function of the level of awareness that now exists among the population - thanks to the work of organisations like the Mental Health Foundation and initiatives such as Mental Health Awareness Week.

Still, it would seem prudent to take a common sense approach to what the figures are telling us - if the results are to be believed, work and money are potent triggers for problems with anxiety. Could it be there's something important going on in society at large?

Written by Jacqui Hogan

Friday, 9 May 2014

Relief for depression in spades

Getting out into the great outdoors is good for us all, especially at this time of year. And what could be more delightful than colluding with nature in a spot of gardening, to fully immerse oneself in the experience.

It seems that such a strategy may be more than just a good idea for people with depression and anxiety - it may turn out to be an invaluable therapeutic strategy, if a new pilot scheme by the NHS Vale Royal Clinical Commissioning Group (CCG) is anything to go by.

Run by Groundwork Cheshire, 'Grozone' is an existing community garden project that welcomes volunteers to help with gardening and other outdoor activities. What's new here is the CCG's decision to actively recommend that patients from local GP practices take up places on the project, with the aim of improving their social interactions and mental health.

Those signing up to beat the blues with a dose of green may find themselves involved in propagating, growing fruit and vegetables, garden maintenance and even cooking, as part of the 12-week programme. Their progress will be monitored by participating GP practices, who will use three short, confidential surveys asking patients to record any changes in the way they feel over the course of the term.

Dr Jonathon Griffiths, Chair of Vale Royal CCG is enthusiastic about the scheme and hopeful that Grozone could really help people to boost their mental wellbeing:
"The CCG wanted to provide something in the area that would support people with depression and anxiety. Grozone is a fantastic programme which is suitable for people with a range of physical capabilities and access needs."
Last year, the Health and Social Care Information Centre (HSCIC), a national provider of information, data and IT systems for health and social care, published figures showing that more than 50 million prescriptions for antidepressants were issued in the UK in 2012 - the highest ever number and 7.5% higher than the year before. With prescriptions at such an all-time high, is it time to consider prescribing a dose of pottering in the garden shed as a possible alternative?

Perhaps not for all and perhaps not a complete substitution, but let's train our eyes on work like this to see where it leads.

Do you have experience of working with patients using natural means of beating depression and anxiety? Or maybe you have a personal experience of relieving the symptoms with some form of outdoor pursuit? Either way, we'd love to hear from you - your feedback is always greatly welcomed.

Written by Jacqui Hogan

Friday, 2 May 2014

Gone fishing

Continuing on our diet and cognition theme (see recent post on the brain benefits of green tea), new research showcased at Experimental Biology 2014 (San Diego, California) has found that low consumption of fish may be a risk factor for cognitive decline. Which is good news for those of us who don't need much of an excuse to tuck into a good feed of smoked salmon or a basketful of fruits de mer.

Researchers from Tufts University in Medford, Massachusetts, conducted a longitudinal observational study among almost 900 participants, asking them to report on their dietary intake via questionnaires. They were concurrently put through a series of cognitive tests, including an attention test to repeat lists of numbers forward and backward, and tests of their organising and planning faculties. The tests were conducted as part of a two-year follow-up protocol.

What they found was that, overall, the study group had a low intake of the omega-3 polyunsaturated fatty acids, EPA and DHA, which are the ones associated with oily fish - and those with which previous association with cognitive benefits have been implicated. Less than 30% of the group were meeting the US dietary recommendations for consumption of oily fish - amounting to at least two portions per week (the official recommendation from the UK Department of Health is effectively the same).

Those participants in the lowest four quintiles of EPA and DHA intake were most likely to show signs of cognitive decline over the two-year study period.

Cognitive development and decline are obviously influenced by a wide range of factors, so it will always be difficult to establish a clear correlation. However, this research adds to the mounting evidence that greater intake of oily fish, such as salmon, tuna and trout in particular (which are rich in EPA and DHA) may be associated with a slower rate of cognitive decline. But it is necessary to concede that not all studies to date have revealed an association.

Identifying the causes of dementia seems to be at the top of the list for the new global world order - in today's news we hear of a new international study whose aim is to get to the bottom of the apparent growth in incidence of this debilitating disease. Whatever their agenda, it would seem prudent to keep  our brains in tip-top condition by whatever natural means available. Call it Lobster Thermidor washed down with a delicate infusion of green tea for me!

Written by Jacqui Hogan