Medicalisation of young minds: new study reveals 28% rise in antidepressant prescribing amongst 6-18 year olds « Swansea University

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Antidepressant prescribing amongst children and young people has shown a significant increase of 28% in the past decade, even though recorded diagnoses of depression have gone down, according to new research published today.

One in ten children and young people suffer from some kind of mental health problem, including depression and anxiety. Concerns about under-diagnosis and under-treatment contrast with worries about over-prescribing and the medicalisation of unhappiness in young people.

The research, published in Psychological Medicine, and carried out by a team which included several Swansea University experts, was led by Ann John, associate professor at Swansea University Medical School, who is also a qualified GP. The team looked at data from 358,000 registered patients between 6 and 18 years old, living in Wales, UK, between 2003 and 2013. The data was drawn from GPs and other NHS primary care services.

The research found that:
• Antidepressant prescribing rose significantly, by 28%, mainly in older adolescents
• Depression diagnoses showed a steady decline by just over a quarter, while symptoms of depression more than doubled
• Unlicensed citalopram prescribing occurs outside current guidelines, despite its known toxicity in overdose
• Just over half of new antidepressant prescriptions were associated with depression. The rest were associated with diagnoses such as anxiety and pain

The findings led the researchers to call for new strategies to implement current guidance for managing depression in children and young people.

Dr Ann John, associate professor at Swansea University Medical School, said: “These findings add to the growing debate over increasing prescribing of anti-depressants to children and young people.

The main issue is whether they being prescribed with enough cause. The rise in prescribing may reflect a genuine increase in depression and its symptoms, or increased awareness and better treatment by GPs, or poor access to psychological therapies and specialist care, or even increased help-seeking.

Whatever the explanation it’s important that each individual young person is listened to and gets the right kind of help for their problem. We need to support those who support young people and their families, helping them to act in keeping with current guidance.”

Dr John underlined the importance of responding appropriately to the needs of young people:

“The teenage years are a phase of gaining independence, engaging with the world and testing boundaries. This can result in a normal developmental range of emotional responses- stress, loneliness, sadness and frustration. For others the mental health issues are more serious, and historically they were often not recognised, talked about or treated.

Teenagers may be moving into adulthood without many of the skills necessary to deal with these issues if we don’t manage them well at an early age.

It can be hard to distinguish between what is emotional turmoil and what warrants a mental health diagnosis in a young person.

We need to ensure GPs are trained to really understand the lives and moods of young people, as well as knowing what warning signs they should look out for. For some young people reassurance that this is within the range of normal human experience may be appropriate. For others, talking therapies may be the best option, as they have a proven track record of improving symptoms for those with mild and moderate depression.
In more serious cases, anti-depressants should be used together with talking therapies. Improving access to talking therapies is very important. Otherwise, if waiting times are too long, it’s more likely that a prescription will be given. If an antidepressant is required, fluoxetine should be the first option.”

via Swansea University – Medicalisation of young minds: new study reveals 28% rise in antidepressant prescribing amongst 6-18 year olds

The full paper, published in Psychological Medicine, “Recent trends in primary-care antidepressant prescribing to children and young people: an e-cohort study” by A. John, A. L. Marchant, D. L. Fone, J. I. McGregor, M. S. Dennis, J. O. A. Tan and K. Lloyd has been published Open Access and can be viewed here free of charge.

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Researchers find lifestyle link in depression

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Researchers following the progress of 1200 people for five years have found strong links between unhealthy lifestyles and depression.

Researchers at the University of Tasmania’s Menzies Institute for Medical Research studied the impact of lifestyle on depression and the impact of depression on lifestyle. This is the first time the association has been looked at from both sides.

The lead author of the study, Dr Seana Gall, said that people with healthier lifestyles at the beginning of the study were significantly less likely (22%) to develop a first episode of depression over the five years, while there was a tendency for those with a history of depression to lose points in a lifestyle assessment over the five years (46% more likely than those without a history of depression at the beginning of the study). Lifestyles were assessed through a score comprising body mass index, smoking, alcohol consumption, leisure time, physical activity and diet.

These associations occurred regardless of other predictive factors such as socio-economic position, parental and marital status, social support, major life events, cardiovascular disease history and self-rated physical health.

Participants were aged 26-36 years at the beginning of the study (2004-2006) and 31-41 years at follow-up (2009-2011).

Dr Gall said the study’s grouping of health behaviours (i.e. the overall lifestyle) rather than looking at individual risk factors was significant. “This is the first study to consider the association between this number of health behaviours and risk of developing depression over time,” Dr Gall said. “Studying individual risk factors and their relationship with depression ignores the fact that risk factors often cluster as unhealthy lifestyles.

“Our findings have implications for reducing the higher risk of cardiovascular disease that is seen in those with depression and also potentially reducing the risk of developing depression in young people” Dr Gall said. “The study highlights the need for holistic management of young adults in terms of their mental and physical health, including health behaviours.

Dr Gall said the results suggested that a healthier lifestyle may protect against the first onset of depression and therefore the findings were relevant for those managing the physical and mental health of younger adults.

 

via University of Tasmania – Researchers find lifestyle link in depression

 

The full paper, published in Psychological Medicine, “Bi-directional associations between healthy lifestyles and mood disorders in young adults: The Childhood Determinants of Adult Health Study” by S. L. Gall, K. Sanderson, K. J. Smith, G. Patton, T. Dwyer and A. Venn can be viewed here free of charge until 30th August 2016.

 

Early screening spots emergency workers at greater risk of mental illness

Ambulance

Study offers new direction for preventative interventions to increase mental resilience to stress and trauma

Emergency services workers who are more likely to suffer episodes of mental ill health later in their careers can be spotted in the first week of training. That’s the conclusion of a Wellcome Trust funded study carried out with trainee paramedics.

Researchers from the University of Oxford and King’s College London wanted to see if they could identify risk factors that made people more likely to suffer post-traumatic stress (PTSD) or major depression (MD) when working in emergency services. Their results are published in the journal Psychological Medicine.

Dr Jennifer Wild from the University of Oxford explained: ‘Emergency workers are regularly exposed to stressful and traumatic situations and some of them will experience periods of mental illness. Some of the factors that make that more likely can be changed through resilience training, reducing the risk of PTSD and depression. We wanted to test whether we could identify such risk factors, making it possible to spot people at higher risk early in their training and to develop interventions that target these risk factors to strengthen their resilience.’

The researchers followed a group of around 400 new ambulance staff through the first two years of their three-year training period. During the initial six-week classroom phase of the training, the students were given a number of assessments to establish their thinking styles, coping behaviour, psychiatric history and personality traits.

Follow up sessions were carried out every four months for the next two years to see if any of the participants had had PTSD or depression. After two years, a final assessment looked at quality of life, as well as smoking, alcohol and drug use, days off work, weight change, burnout and insomnia.

Professor Anke Ehlers said: ‘While just under one in five experienced PTSD or depression in the two years, most got better by the next four-month follow-up.

‘However, there were still lasting effects. Those who had reported mental ill health were more likely to have sleep problems at 2 years. They were also more likely to have days off work. Paramedics who developed an episode of PTSD were also more likely to report gaining weight and smoking.’

The team found that even accounting for past psychiatric history, people were more likely to experience PTSD and depression if they had lower perceived resilience to trauma, or if they dwelled on stressful events from the past before they started their training.   Significantly, the number of traumatic incidents they experienced could not be used to predict PTSD but was relevant to predicting MD, suggesting a cumulative risk of different exposures to trauma for depression.

Dr Wild said: ‘This is not about screening out particular people in training. Early assessment means that those who are more at risk can be offered training to improve their resilience to stressful and traumatic experiences. That has the potential to reduce episodes of PTSD and major depression and improve the long term health of a valued and essential workforce.’

The full paper has been published Open Access in Psychological Medicine, ‘A prospective study of pre-trauma risk factors for post-traumatic stress disorder and depression’ by  J. Wild et al. can be viewed here free of charge.

Source: Early screening spots emergency workers at greater risk of mental illness- University of Oxford/News

Mental health implications for older adults after natural disasters

cyclone yasi_earthquake2

The January International Psychogeriatrics Article of the Month is entitled “Mental health implications for older adults after natural disasters – a systematic review and meta-analysis” by Georgina Parker, David Lie, Dan J. Siskind, Melinda Martin-Khan, Beverly Raphael, David Crompton and Steve Kisely. This blog piece was written for us by one of the paper’s authors, David Lie.

Our interest in the susceptibility of older adults to disaster arose in the context of an unprecedented spate of natural disasters and dramatic events affecting the Australia- New Zealand region between 2009 and 2011.

New Zealand was affected by an air crash, earthquakes (notably Christchurch) and the Pike River Mine accident. A number of bushfires affected most regions of Australia notably the Black Saturday fires, which itself had followed a heatwave. Flood and cyclone preoccupied other parts of the country (e.g. Cyclone Yasi) amidst economically disruptive events such as volcanic ashclouds. Taken together these events killed hundreds of people and injured or displaced thousands more.

The broad psychological impact of the Tohoku earthquake, tsunami and nuclear disaster complex was the closing parenthesis for a period that demanded we knew more about the psychiatry of extreme events and particularly for older adults. Very little seemed to have been written as overview with the exception of a narrative review by Cherniak (2008) and a book on geriatric aspects of disaster psychiatry (2010).

As we explored the literature, contradictory themes emerged suggesting that older people were as likely, more likely or less likely than younger counterparts in their susceptibility to serious mental health sequelae after disasters.

Four broad theories to explain age-related resilience or vulnerability are outlined in the introduction to our paper which can be summarised as:

  • Experience counts
  • You don’t react emotionally as much as you age which is protective
  • The middle aged are stressed most, caring for their children and parents
  • As you age you become more vulnerable

We chose to analyse the highest quality research to determine broad patterns but much more needs to be learned. Our research (Parker et al., 2016 this issue) showed increased relative risk for PTSD and adjustment disorder but is based on particular disasters in particular contexts and only on natural disasters. Our included studies were characteristically events which were sudden, unheralded and producing significant physical destruction comprising four earthquakes and two tsunamis.

It could be that older adults actually have better outcomes in disasters where evacuation and/or preparation are possible or in areas where natural disasters such as hurricanes or cyclones are recurrent and an eventual part of life for those who live long enough.

We would certainly recommend further development of standardised, validated tools and research protocols for deployment in future disaster psychiatry studies to expedite our understanding. Whatever the reality of climate change, the world is indisputably ageing and increasingly living closer to shorelines and other places that put people “in harm’s way”.

The full paper “Mental health implications for older adults after natural disasters – a systematic review and meta-analysis” is available free of charge for a limited time here.

The commentary paper “Natural disaster, older adults, and mental health–a dangerous combination” by Meaghan L. O’Donnell and David Forbes is also available free of charge here.

References:

Cherniack EP.. The impact of natural disasters on the elderly. Am J Disaster Med. 2008 May-Jun;3(3):133-9.

Parker G, Lie DC, Siskind DJ, Martin-Khan M, Raphael B, Crompton D and Kisely S. Mental health implications for older adults after natural disasters – a systematic review and meta-analysis. Int Psychogeriatrics 2016 (2016), 28:1, 11–20

Geriatric mental health disaster and emergency preparedness. John A. Toner,
editor ; Therese M. Mierswa, associate editor, Judith L. Howe, associate editor.

The Relationship Between Sleep and Alzheimers

Oregon Health & Science University in Portland has begun a research project to better understand the how relationship between sleep and Alzheimer’s disease. The research will focus on a “key process” in the brains of sleeping humans which will be the first of its kind and will hopefully illuminate the ways in which sleep and Alzheimer’s are intertwined.

In the early stages of Alzheimer’s sleep problems are very common for patients. Sometimes even years before patients develop more noticeable cognitive problems or memory loss they will suffer from disrupted sleep.

In the last five years studies have found that people, and mice, that were suffering from poor sleep patterns had a buildup of beta amyloid plaque in their brains. Beta amyloid plaque, a sticky mixture of proteins, collects in synapses. It is also a key characteristic in people with Alzheimer’s disease.

Researchers think that sleep might sweet toxins in the brain which would prevent beta amyloid from collecting in synapses. However, it is still not clear if the disrupted sleep is caused by the beta amyloid buildup or the beta amyloid buildup causes the disrupted sleep, “It may be a vicious cycle,” Miroslaw Machiewicz from the National Institute on Aging told the AP.

In order to help further solve this mystery, the team at the Oregon Health & Science University plans to observe people’s brains in a hyper-sensitive MRI machine while they sleep. They hope to see when the sweeping in the brain occurs in the sleep cycle. This new study could further illuminate, and possibly highlight, the relationship between sleep and Alzheimer’s which could help find new treatments and preventative measures in the future. Despite this excitement, scientists do acknowledge that participants may have a hard time sleeping in a noisy and small MRI machine. Good luck sleeping!

Are You Stressed? Do You Suffer from Workplace Anxiety?

Name: Stress

Name: Stress

This year’s stress awareness day bases itself around workplace wellbeing and how this can be beneficial for your business. According to the Health and Safety Executive for Britain, workplace stress is responsible for the loss of 9.9 million working days or 43% of absenteeism and 35% of work related ill health in 2014/15.

In the right amounts, pressure can sustain motivation, and drive personal performance, but if the pressure is too much it can lead to demoralisation and under performance. Certain businesses have take much more criticism than others, indeed the banking industry and other city jobs often being singled out as high pressure environments with alarmingly high suicide rates. Long hours, work overload and highly competitive work relationships can all lead to workplace stress and poor mental health.

Social anxiety can also be a major cause of stress. The need to have a partner, a family, or even a large social media presence with lots of Facebook friends where one can advertise their successful social lives, all trigger stress and anxiety. The idea of maintaining or increasing your social status can create a stressful environment outside of work. Other causes of stress have been attributed to living in a city. Urbanisation with its loud noises, busy streets and general ‘hustle and bustle’ can also lead to higher stress levels.

Stress itself is not a medical diagnosis; however it can lead to depression, anxiety or more severe mental health issues and be a symptom of a more serious condition or disease. Even so, the majority of people do not see stress as a genuine illness and often do not take it seriously. General awareness around its symptoms and consequences can help prevent it from being a gateway to more serious health concerns.

Here you can find a general guide to identifying your personal stress symptoms, and useful tips for managing your stress.

– James Jarvis

http://www.stress.org.uk/Stress-at-work.aspx

http://www.independent.co.uk/life-style/health-and-families/features/national-stress-awareness-day-is-the-fear-of-social-failure-making-us-more-anxious-than-ever-9840395.html

http://www.bwcharity.org.uk/sites/default/files/How_To_Manage_Stress_A_Mind_Guide.pdf

http://www.businessinsider.com/why-wall-street-bankers-committ-suicide-2014-2?IR=T

Obsessive Compulsive Disorder Awareness Week

11-17 October was OCD awareness week, a week dedicated to educating the general populace about the true nature of obsessive compulsive disorder in order to challenge its relative trivialisation in contemporary culture. However this week kicked off with exactly the type of problematic stereotyping demonstrated in Michelle Mone’s interview on Good Morning Britain which drew a lot of criticism. Watchers were quick to take issue with her self-diagnosis, as well as her description of the disorder as merely reinforcing the trivial stereotype of being neat and organised, even suggesting that this has helped her in business.  What made the whole episode more controversial was that GMB consulted OCD UK about the piece only for their suggested interviewees to be ignored in favour of a more mild option.

The World Health Organisation has actually ranked OCD in the top ten of the most disabling illnesses of any kind, in terms of lost earnings and diminished quality of life. You can see why an enormously successful business woman talking openly about her self-diagnosed ‘struggles’ on TV, whilst simultaneously announcing her upcoming appointment as a baroness was branded as distasteful. Maybe Mone does have a mild form of OCD, and she would be right in speaking out about her own struggles.  However her self-diagnosis makes a lot of what she says seem invalid, especially as OCD is only actually diagnosed when the problem is either ‘causing them overwhelming distress, and/or when their compulsions take so much time that they can’t get to work or school or do the things they want to do in their daily life.’ (Telegraph)

OCD is a severe and specific anxiety disorder characterised by upsetting, unwanted and inappropriate thoughts. Linked to this is the urge to carry out repetitive actions in order to relieve the anxiety created by the unwanted thoughts. These thoughts can range from feeling dirty, irrational fears over your house being burgled, to graphic sexual contemplations. Following this, people suffering from OCD, might wash their hands so compulsively that they spend hours in the shower, or actually damage their skin in the process. For example, someone might check the locks in their house several times to prevent a burglary. Perhaps what is most frustrating for OCD sufferers is the conscious knowledge that what they are doing is irrational, but nonetheless they cannot control the compulsive urge because of the temporary relief it provides.

In response to the Twitter storm, Mone did allude to an OCD spectrum which certainly exists. However this spectrum is much more to do with the different types of OCD that exist. Often not included in the stereotypes and clichés is that OCD can manifest itself as ‘pure O’ as Rose Bretécher has recently spoken out about this particular form of OCD in a series of articles for the Guardian. Within this, people experience disturbing, unwanted obsessions without observable behavioural compulsions. This might be questioning your relationship and the value of your feelings towards another person, your sexual orientation, your religion, or the obsession of doing harm to others. Other parts of the OCD spectrum goes as far as including phobias, hypochondria and panic attacks.

The idea of an OCD spectrum, as well as ‘mild’ and severe cases, means that the line between real and stereotyped OCD behaviours becomes blurred. It’s certainly not helped by celebrities ‘coming out’ about their OCD. Other than Michelle Mone, Paul Hollywood of the Great British Bake Off, recently spoke out  about his problems, which included the compulsive cleaning of his brand new Aston Martin, which to anyone who has recently bought a new car, seems logical rather than obsessive or compulsive.  Even more high profile was David Beckham’s supposed OCD organisation of coke cans in his fridge.  While no one really knows the extent of their condition, the idea of a celebrity coming out about their struggles seems oxymoronic due to their professional success. There will always be that question of what OCD has done to debilitate their careers, and hence a question over the sincerity in their claims. On our TV screens there are mixed portrayals as well.  The Huffington Post has compiled a list of characters from TV shows with ‘OCD’, some are merely yet more stereotypes, however some are extremely accurate and thought provoking (it might be best to avoid Sheldon Cooper’s portrayal from the Big Bang Theory and concentrate more on Michael J Fox’s performance in Scrubs, or Leonardo Di Caprio’s portrayal of Howard Hughes in the Aviator).

So yes, Mone’s interview seemed to reinforce inaccurate stereotypes and quirks of OCD, but is this a case of ‘any publicity is good publicity’? There are no doubts that writers and the general Twittersphere have reacted by posting various articles and facts explaining what OCD really is. The interview from Mone has, at the very least, given OCD awareness week a focal point for discussion. Indeed even this blog post is a consequence of that, and what’s more the whole episode has probably allowed people to educate themselves on the issue. Although people have been quick to condemn Mone and Good Morning Britain, at least people are talking about it, which has saved it from being OCD unawareness week.

-Written by James Jarvis

Sources:

Rose Bretécher –  http://www.theguardian.com/profile/rose-bretecher

Camilla Tominey – http://www.express.co.uk/comment/columnists/camilla-tominey/612778/Camilla-Tominey-Celebrities-OTT-OCD

Jenni Goodchild – http://www.telegraph.co.uk/news/health/11935833/No-OCD-is-not-all-about-cleaning-and-believe-me-you-dont-wish-you-had-it.html

Linda Blair – http://www.telegraph.co.uk/wellbeing/mood-and-mind/mind-healing–how-do-you-know-if-you-have-ocd-/

Dr. Max Pemberton – http://www.dailymail.co.uk/health/article-3258316/DR-MAX-hate-stars-joke-having-OCD.html

OCD LA http://ocdla.com/ocspectrumdisorders

OCD UK http://www.ocduk.org/ocd; http://www.ocduk.org/good-morning-britain-ocd-feature

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