Low down – Mental Health Treatments

The aim of this article is to take the reader through the bamboozling array of treatments available for Mental Health problems. It is not meant as an in-depth study of each treatment and doesn’t by any means cover every treatment available. It is meant as an overview of what is on offer, so that the vast array of treatments can be better understood, along with the benefits and disadvantages of each treatment. I will try to unravel the technical jargon prevalent in mental health and present you with clear overview in layman’s terms. I am not an expert on any of these treatments and so they are only meant as very rough guidelines.

I will also offer my personal opinion as to the way forward with mental health treatment, but it is to be noted these conclusions are my own personal opinion and should be taken as such. Every individual is unique and what may work for one person, may not for another.

I have written this article to once and for all bring all the treatments available for depression together in one easily accessible place.

Medication

Medication is very much the frontline of mental health treatment and is usually what is offered first. This is unfortunately the case, due to the power of the pharmaceutical companies and their big marketing budgets. It is also due to the narrow-mindedness of governing bodies who mistakenly see it as the cheapest and most effective solution. This is far from always the case and will discuss this in more detail later.

I will split these medications into three basic groups. Although this is very much a generalisation, it will give a good overall insight into the different types of medication available.

• Antidepressants
  
  Prescribed to help lift the mood of depressed people.
  
  SRRI
  
  The most common type of antidepressant in use today is that of the SSRIs (Selective Serotonin Reuptake Inhibitors)
  
  These include:
  
  
  • Prozac (fluoxetine)
  • Paxil (paroxitine)
  • Lexapro (escitalopram)
  • Celexa (citalopram)
  • Zoloft (sertraline)
    
    
  How SRRIs work
  
  SRRIs work on the basis that there is not enough serotonin produced in the brain of depressed people. Wow, this is complicated, but I will try to put this as simply as possible, skip the next 15 steps if you just want a summary of what it does:
  
  
  1. The brain has approximately 10 billion brain cells.
  2. Each brain cell has up to 25 thousand connections to other brain cells.
  3. These connections are called synapses.
  4. Simplified, a synapse consists of a transmitter and receptor.
  5. There is a gap between the transmitter and receptor.
  6. When a brain cell passes a message to another brain cell, an electrical impulse is sent down the nerve fibre to the transmitter.
  7. A chemical message is then passed from the end of the transmitter to the receptor.
  8. The chemical message arrives at the receptor and fits like a key in a lock.
  9. The message has now been receive at the next brain cell.
  10. The receptor changes shape with the arrival of the chemical transmission.
  11. This triggers off an electrical impulse in the receiving cell, which then transmits to the next cell and so on until the network of synapses is complete.
  12. When each transmitter has done its job it is either broken down by enzymes or recycled in a process call re-uptake.
  13. Serotonin is a chemical transmitter that is said to be in low quantities in depressed people and thought to be important to mood.
  14. Where serotonin is low, the synaptic connections slow down and are considered to cause depression.
  15. SSRIs (Selective Serotonin Reuptake Inhibitors) block the re-uptake process of the serotonin transmitters, therefore keeping the transmitter in place and providing a stronger signal to pass the serotonin transmitter across the receptor on the next cell.
      
      
  This effectively is a way of increasing the amount of serotonin signals active in the brain that are said to be low in depressed people and therefore an increase should improve mood.
  
  Does it work?
  
  Yes it does for approximately 50 to 70% of those taking it. It usually takes between two and four weeks to kick in. Most people have to try two or three different SSRIs before they find one that works.
  
  Who else can benefit?
  
  People suffering from the following can also benefit from SRRIs:
  
  Anxiety, panic disorders, post-traumatic stress disorder, social phobia, obsessive-compulsive disorder and bulimia nervosa.
  
  Common Side effects
  
  Sickness, insomnia and sexual dysfunction.
  
  Dangers
  
  There have been possible connections with suicidal tendencies, especially with young people. I don’t believe this is high risk in adults and whether this is founded in fact or not, I am also not sure.
  
  Pregnant women should not take SSRIs, as there is a possible risk to the foetus and newborn babies.
  
  NaSSA
  
  A more recent type of antidepressant and one that I am currently taking is NaSSA (Noradrenergic and specific serotonergic antidepressants). Unfortunately that doesn’t qualify me as an astronaut or a rocket scientist, but is more effective for me than SSRIs that I have tried in the past. The main NaSSA drug in use is Mirtazapine, the one I am on.
  
  How does it work?
  
  It is thought to work by blocking presynaptic alpha-2 adrenergic receptors that normally inhibit the release of neurotransmitters norepinephrine and serotonin, thereby increasing active serotonin levels in the synapse. It also blocks post-synaptic receptors 5-HT2 and 5-HT3 which is thought to increase serotonin synaptic connections.
  
  Effectiveness
  
  In limited trials Mirtazapine has proved just as effective as SSRIs, with less side effects. It also proved t be effective quicker than an SSRI, effective within 14 days.
  
  Common Side Effects
  
  
  • Weight gain
  • Drowsiness
  • Dizziness
  • Mild hallucinations
  • Vivid dreams
    
    
  My findings
  
  Mirtazapine has been particularly good for me because of its sedative properties, helping me sleep. Before taking mirtazapine I was unable to sleep, even with sleeping tablets, which can be addictive. I use it in conjunction with the mood stabilizer, valporate semisodium, which is a combination that works for me.
  
  Dangers
  
  It has not been tested enough to ascertain what dangers, if any, it may have, but pregnant women should be cautious about taking it and also lactating mothers as it is passed on in the milk.
  
  
• Mood stabilizers
  
  Prescribed for people who suffer from mood swings e.g. Those with bi-polar disorder (otherwise known as manic depression), where the mood can swing dramatically from high to low, or people with Borderline Personality Disorder(BPD) where mood swings also occur.
  
  Lithium
  
  This is the oldest mood stabiliser and is still in common use.
  
  How does it work?
  
  It is thought to regulate the serotonin and dopamine neurotransmitter levels in the brain, keeping them at a steady level, without peaks or drops.
  
  Effectiveness?
  
  It is thought to be effective in %50 of cases.
  
  Common side effects
  
  Trembling of hands, nausea, increased thirst.
  
  My findings
  
  I didn’t find Lithium very effective when I was prescribed it in the past and I also suffered badly from side effects, especially badly trembling hands. It is not thought to be as effective with people who have rapid cycles of moods. This is possibly the case with Borderline Personality Disorder, which fits my symptoms most accurately. This does not however mean it will not work for all BPD sufferers; it just didn’t in my case. I have known many people for whom this drug is extremely effective and is the only one that will work for them.
  
  Dangers
  
  Lithium levels in the blood have to be closely monitored and regular blood tests taken. This is very important as too high levels can be dangerous.
  
  Valporate Semisodium (depakote) - Anticonvulsant
  
  There are a few anticonvulsants on the market, but the one in most common use is Valporate Semisodium.
  
  How does it work?
  
  It is thought to work by increasing the amount of the brains nerve calming agent GABA, when the brain becomes over-stimulated with electrical nerve activity GABA is supposed to calm this activity down and prevent mania. It is also thought to stabilize moods. Valporate Semisodium helps prevent the chemical breakdown of GABA in the brain and thus increase its levels. It is thought to be effective for people with rapid cycling of moods.
  
  Common side effects Nausea, indigestion, dizziness, vertigo, double vision, rash, headache, hallucinations, hyperactivity.
  
  My findings
  
  I currently take Depakote and have found it the only drug that is effective in stabilizing my mood. I take it alongside mirtazapine mood stabilizer, which may increase its effectiveness.

• Antipsychotics (neuroleptics)
  
  These are used to treat schizophrenia, mania and delusional disorder. They are used to treat many diagnoses that have psychosis in them. They are also sometimes used to treat mood disorders where no psychosis is present. Antipsychotics are grouped into two different categories, the older or Typical antipsychotics and the newer or atypical antipsychotics.
  
  Typical antipsychotics include:
  
  
  • Chlorpromazine (Thorazine)
  • Fluphenazine(Prolixin)
  • Haloperidol(Haldol)
  • Loxapine(Loxatane)
  • Molindone(moban)
  • Perphenazine(Trilafon)
  • Pimozide (Orap®)
  • Prochlorperazine(Compazine, Compro)
  • Thiothixene(Navane)
  • Thioridazine(Mellaril)
  • Trifluoperazine(Stelazine)
    
    
  How do they work?
  
  Typical antipsychotics work by reducing the dopamine neurotransmitter levels in the brain, which scientists believe are overactive in people suffering from psychosis and hence they reduce psychotic symptoms.
  
  Common side effects
  
  Movement disorders, loss of control of muscles causing stiffness, shaky hands, arms, legs or face muscles and general restlessness. There are other drugs that can be taken to counteract these muscle problems, but you can end up on a drug cocktail, not always advisable.
  
  Other common side effects include a dry mouth, weight gain, sexual problems, dizziness, increased sensitivity to sunburn, constipation.
  
  Atypical antipsychotics
  
  These include:
  
  
  • Aripiprazole (Abilify)
  • Clozapine(Clozaril)
  • Olanzapine(Zyprexa)
  • Risperidone(Risperdal)
    
    How do they work?
    
    These also affect the dopamine levels in the brain, but include serotonin neurotransmitters in their action as well. They are thought to have fewer side effects than typical antipychotics, but recent evidence disputes that. Problems associated with typical psychotics are historically based on the much higher doses that used to be prescribed; the side effects are much less prevalent at lower doses.
    
    Common side effects Much the same as typical psychotics, but supposedly less likely, although as previously said, this is open to debate.
    
    My findings
    
    I have tried a few different types of atypical antipsychotics and found myself numb to the outside world and unable to concentrate; I also had bad shakes, although this was probably partly caused by the lithium I was on at the time. I find it hard to write accurately on the effects of these medications, as I was on a cocktail of five different drugs at the time, all interacting with each other. A mixture of too many medications is not generally a good idea, as it is hard to pinpoint what works and can have all sorts of side effects.
    
    

• CBT (Cognitive Behavioural Therapy)
  
  This is the most common and most studied form of therapy.
  
  How does it work?
  
  Put simply “Cognitive” addresses the way you think and “behaviour” tackles the way you behave. It focuses on the here and now. It looks at problems and changes negative thoughts and behaviour surrounding the problem, to positive thoughts and behaviour, thus improving your state of mind.
  
  Does it work?
  
  Yes it does, it proves effective for two thirds or more people undergoing treatment.
  
  My experience
  
  I have yet to undergo CBT treatment, but I am scheduled for some form of psychotherapy starting in January. This has been a long wait due to the lack of resources put into psychotherapy in this country, more on that later.
  
  As far as the concept is concerned I try to practise positive thoughts and thinking. I also try to concentrate on the here and now and not dwell on the past or worry about the future. I find both these techniques help me a great deal. New research shows that the happiest people are in fact those who live for the moment; there is a lot to be said for this.
  
  Other resources
  
  Although it is better to undergo CBT with a trained therapist, there is an alternative through following books or online CBT, a link to a free online CBT course is below, I cannot vouch for its effectiveness, but will be giving it a try myself.
  
  http://moodgym.anu.edu.au/
  
  
• IPT(Interpersonal psychotherapy)
  
  Relationship therapy
  
  How does it work?
  
  This focuses on relationships with other people and communication difficulties, or coping difficulties, as in the case of bereavement.
  
  Does it work?
  
  There is not enough research to give clear indications, but there is some evidence that it is as effective as medication or CBT.
  
  
• NLP (Neuro-Linguistic Programming)
  
  An owner’s manual for the brain!
  
  How does it work?
  
  It teaches you to use your mind, body and motions to have a more successful and positive life. It is good for depression because if you are more successful and positive, your overall mood is enhanced.
  
  My experience I am part of the way through a book “The Ultimate Guide to Well Being”, written by Jason Pegler of Chipmunkapublishing. I am already benefitting from it, gaining control of my life and improving my outlook. For more information a link to the book is below:
  
  chipmunkapublishing
  

• Alternative medicines
  
  There are many alternative medicines used to help with mental health problems, St John’s Wort is the most well know, used by many to ease depression. There is a whole list of them, but I do not know much about them. Please consult your doctor before taking St John’s Wort or any other alternative medication, especially if you are already taking some kind of medication.
  
  My findings
  
  I have tried St John’s Wort, but found no benefit from it. It is used with success by a lot of people though.
  
  
• Aromatherapy
  
  Aromatherapy oils can be used to lift or calm the spirit. It is used most effectively when combined with massage, as in aromatherapy massage, easing tension within the body and mind.
  
  My findings
  
  I find both the aromatherapy oils and massage very helpful, depending on the oils, this can be calming or uplifting.
  
  
• Indian Head massage
  
  Massaging of the scalp and shoulders, usually done with relaxing background music. Lets the mind drift off, as your troubles are soothed away.
  
  My findings
  
  I found the Indian Head massage very therapeutic, lifting me out of a state troubled thoughts and away on a carefree breeze.
  
  
• Reiki
  
  The channelling of energy in to key power points within the body, again usually done with gentle background music. Can relax and calm, also rejuvenate.
  
  My findings
  
  Very much like the Indian head massage, a feeling of peace and rejuvenation enfolds me in a blanket of light.
  
• Acupuncture
  
  The placing of needles in precise healing and energy points on the body.Can be used to relieve pain, stress, tension and depression.
  
  My findings
  
  I have only had acupuncture in my ears. This I found however very uplifting, a feeling of detachment and light-headedness enshrouded me while receiving the treatment. I am on the list to receive full acupuncture treatment and I am hopeful that it will prove very beneficial.

• Distraction
  
  If you are feeling down or something is distressing you, one of the best ways of lifting your mood is by distracting yourself from it. This can be done in a number of ways:
  
  
  • Talk to someone; lose yourself in conversation about a totally unrelated subject.
  • Watch a film or TV.
  • Read a book.
  • Write.
  • Make something.
  • Cook.
    The list is endless ...
  • Go for a walk – Change of scenery, fresh air and exercise often help, particularly in the countryside. I will elaborate more on exercise later.
  • If it is sunny, sit in the sun, this often revitalises the body.
  • Take a shower, this also charges up the positive ions in the body.
  •  Break a problem down into smaller chunks, don’t tackle a problem as a whole, it can often be overwhelming.

Exercise and Diet

Depression and low mood can induce eating binges or sometimes the opposite and loss of appetite occurs. The correct diet can certainly help with mood. It is a highly complex area and one I won’t go into detail at this stage, but perhaps in future “low down” issues. My only suggestion at this stage is to try and keep a balanced diet and only eat each particular food in moderation. Also regular meals are supposed to be good for the body, little and often is thought best. It is not good to skip a meal. These are only rough guidelines and as everybody has individual dietary needs it is best to seek advice from your doctor or a nutritionist.

Exercise is also good for boosting the mood, what type of exercise and how much, again is dependent on the individual, so if in doubt professional advice should be sought.

I suffer from exhaustion a lot of the time, but I find if I can motivate myself to exercise, I feel better inside and less exhausted afterwards.

Conclusion

The evidence suggests that both psychotherapies and medication are equally effective. Psychotherapies are actually more effective in the long term, with dropout rate for medication two to three times as high as those for CBT. Once treatment has ended, patients on medication relapse at twice the rate of CBT patients. Despite this promising figure for CBT, about 50% of the patients who have responded to CBT still relapse within two years. An eight session booster treatment given in the year following the CBT treatment significantly reduces this figure.

Why most mental health patients are prescribed drug therapy?

There appears to be a misconception that medication is more effective and cheaper. This is untrue as drugs have to be used over a longer period of time and have higher relapse rates; the expense is the same if not cheaper for psychotherapy. There is also a misconception that because brain chemistry is thought to be at fault in the case of mental health, it needs to be addressed by medication. In fact brain scans have proved that imbalances in brain chemistry have been corrected by psychotherapy alone. For these reasons, more efforts should be put into psychotherapy.

The brain can heal itself if given the right cues! A combination of psychotherapy, diet and exercise I believe is the best answer to mental health problems, although medication does play a part. Ideally a combination psychotherapy and medication yields the best results with the response rate a staggering 85%.

Alternative therapy is also superb and should be used to supplement other therapies where possible. I have been lucky enough to receive alternative therapies as part of my healthcare in Walsall and believe more health authorities should adopt this as part of the treatment for mental health.

Future Therapies

• TMS (Transcranial Magnetic Stimulation)
  
  This is a newly developing technology and was stumbled upon quite by accident. Doctors noticed that depressed patients undergoing MRI (magnetic resonance imaging) scans on their heads, were coming out happy. The scan builds up a picture of the inside of the head using magnetism.
  
  The process has been developed into a magnetic coil that is placed around the head and targeted on the left frontal lobe associated with mood disorders. This is a therapy being developed for patients resistant to drug treatment and as an alternative to the severe ECT treatment. It has the benefits of being very cheap treatment, once developed and has a success rate of 50% to 70%. It is painless, although some patients experience mild headaches.
  
  I firmly believe this treatment should be researched further and if proven, developed and used as an alternative to medication, with ECT phased out altogether.
  
  I for one would gladly try TMS.
  
  
• Virtual simulations
  
  Virtual simulations are being used to help cure phobias such as fear of heights or flying, with high levels of success. More research into virtual worlds to create a calm haven for depression sufferers would be highly beneficial.