The Wellbeing Magazine
In this issue: New Year Willpower Challenge Disease-Mongering Doctors? News Round-up What Flu Can Tell Us About Depression Mental Health First Aid Fails to Deliver Food for Mood: Zinc and Depression Food for Mood Recipe Five Quick Ways to De-stress (without alcohol) Breathing for Calm
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Winter Willpower Challenge
What will get you out on a cold Winter morning? If good intentions were enough, there would be no smokers, alcohol consumption would be low, and every one of us would be confident about getting into our swimming costumes when Summer comes. But good intentions are not enough. To succeed, you need to overcome stress and to build your willpower. Stress is the enemy of willpower. Stress will cause you to focus on instant gratification instead of thinking about the future. As you lose focus on future goals like losing weight, getting healthy or giving up smoking, so it is much easier to reach for the quick fix - to eat that cake, stay in bed on a cold morning or have “just one” cigarette. Unfortunately, most of us find that “just one” lapse in our intentions makes us feel so bad that we get even more stressed, and so reach for even more instant gratification. How many dieters end up consuming tubs of ice cream because they feel so bad after having “just one” scoop to begin with? How many people give up exercise altogether because they spent “just one” cold morning under the duvet? The bad news is that this stress-instant gratification response is like a muscle - the more you use it, the stronger it gets. So fat people get fatter, unfit people get more unfit, and smokers smoke more.
The good news is that willpower is also like a muscle. The more you exercise it, the stronger it becomes. Each time you feel the cold of a Winter morning but exercise anyway, the more you are likely to keep doing it. The more times you eat healthily, the less tempted by unhealthy food you will become. The biggest problem is to overcome the stress that leads to instant gratification in the first place. There are three helpful approaches to this. First, damage limitation! When you lapse - and let’s face it, we all do - instead of beating yourself up (and making yourself even more stressed) just remember that we all lapse sometimes. There is nothing wrong with this, so long as you get back on track afterwards. Second, remember that the quick-fixes that we are tempted by never give satisfaction - they make you feel bad and always leave you wanting more. Third, and most important, stay focused on the future. When you notice that you are getting stressed, remember why you wanted to diet, exercise, give up smoking, etc. Remember that each time you avoid temptation, your willpower grows in strength.
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Disease-Mongering Doctors?
Total Cost of Antidepressants
Once a year, it is traditional for the BBC and the newspapers to run a story about how disease-mongering doctors are turning us into a nation of antidepressant junkies. The story, based on the annual release of government statistics, is part of the stigma that surrounds common mental illness. It implies that many - perhaps even a majority - of the people prescribed antidepressants are not really ill, and that doctors are writing out millions of unnecessary prescriptions just to get these “heart sink” patients out of the surgery.
Cost Per Item
Total Antidepressant Prescriptions
There is no doubt that the number of prescriptions is rising. But it would be wrong to simply assume that this is because more and more people are seeking treatment and/or that doctors are happy to dole out pills to people who will not benefit from them. Indeed, an examination of the total spend on antidepressants together with the cost-per-
item suggests that something else is going on.
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NHS Wales is spending £10 million a year less on antidepressants today than it was spending in 2005. And the average cost of a prescription for antidepressants has fallen from £11 in 2005 to just £3.70 in 2012. This is the opposite of what would happen if doctors were disease-mongering and over-prescribing.
One reason for more prescriptions but lower costs is that doctors have shifted from quarterly to monthly repeat prescriptions. The number of patients remains the same, but the number of prescriptions increases threefold while the cost of each prescription falls dramatically. The other main reason for the increase in the number of prescriptions is that patients are staying on antidepressants for longer sometimes for life. Since longer term patients are more likely to use older and cheaper antidepressants, this may also explain some of the falls in price. There is a story here - but it is not the one that the media choose to run. The prognosis for depression is excellent. This is as true today as it was in the 1990s when antidepressant use began to take off. Indeed, 80 percent of people with depression recover without ever using medical services. Most of the remaining 20 percent recover within six months. When drugs like Prozac first appeared, we were told that they would play a similar role to a plaster cast for a broken bone. They were not a cure, but they would provide support while the patient healed. However, from the mid-2000s, doctors began to use antidepressants to prevent depression recurring in patients who had recovered. Instead of congratulating patients on their recovery, doctors began to scare them into staying on antidepressants in case the depression returned. But, clinical trials have shown that antidepressants are completely ineffective even in mild-moderate depression, let alone as a preventative measure. In almost all cases, depression is “reactive”. That is, it follows unpleasant or traumatic life events such as bereavement, divorce, redundancy, financial problems, etc. Insofar as
antidepressants help at all, it is because they raise people’s mood and energy to the point that they can address these wider concerns. However, it is now widely accepted that social support, adopting a healthier lifestyle, and talking therapies to address the way people respond to life events are all much more effective than antidepressants alone, and - crucially - are much more likely to prevent further episodes of depression. “Let them eat Prozac… it’s cheaper!” But antidepressants are much cheaper. So politicians, NHS managers, doctors and even mental health charities turn a blind eye to the millions of people left to languish on ineffective antidepressants. Indeed, a recent Welsh Government report states that the new primary care mental health service would be totally overwhelmed if all of the people who are entitled to social and psychological support were to try to access their service. The real scandal is not that we prescribe antidepressants to people who are not ill. The real scandal is that we fail to help millions of people to overcome a condition where recovery should be the norm.
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News round-up Talking Therapies Don’t Work For Schizophrenia
Number of new depression cases decreases
New figures from NHS Scotland show a 50 percent reduction in the number of new patients with depression being seen by GPs since 2003. Over the same period, the number of prescriptions for antidepressants rose from 3.4m to 5.2m.
A meta-analysis of over 50 studies of Cognitive Behavioural Therapy (CBT) worldwide has found that patients with schizophrenia do not benefit from CBT, despite official guidance that these patients should receive it.
Critics of the data argue that GPs may be under-recording the number of new patients with depression to avoid the paperwork required by NHS Scotland.
At a time when millions of people with conditions like anxiety and depression that do benefit from CBT cannot access it due to a lack of resources, the research adds weight to calls to review and amend the official guidance.
Stress Costs Wales £219 million
Acupuncture is as Good as Counselling
Research by BUPA has found that a combination of sickness absence and “presenteeism” (sick workers coming into work) cost the Welsh economy more than £219 million last year.
Research by a team from the University of York has found that acupuncture is as good as counselling for treating people affected by depression. Both counselling and acupuncture were significantly better than “treatment as usual”.
More than half of the workers in the study reported an increase in stress, anxiety and depression. Worryingly, 40 percent said that while their employer claimed to support staff wellbeing, little practical support was actually available.
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The study’s authors suggest that both acupuncture and counselling should be made available as an additional treatment where antidepressants alone have failed to bring about improvements.
News round-up One in Six of us Phoned in Sick With Stress Last Year
Never Mind the Workload, it’s the Management that Matters
Research by the insurance company Friends Life found that 16 percent of UK employees took time off work as a result of stress last year.
A Danish study of more than 4,500 Danish public sector employees found that heavy workloads are not a cause of workplace depression. However, poor and unfair management, and a poor work environment are good predictors of depression.
The research found that employees in the 18-25 age group were particularly susceptible.
The study’s authors suggest that more emphasis should be placed on examining employees’ perception of their work environment as this will be more effective than attempting to lessen their workload.
The main causes of stress were job security (52%) fear of redundancy (36%) low wages (35%) and workload (22%). Every Patient with Depression to Have A Personal “Care Manager”
Employees Stress in Silence
Research by the charity MIND found that nearly half of us are expected not to mention workplace stress, while 42 percent of us feel unable to talk to a manager about our stress levels.
NICE are to review a personal care model for treating people affected by depression. If the new model is adopted, more than 6 million people in the UK could have access to a care manager who would coordinate their treatment and care. While there is good evidence that the model is significantly more effective than the current IAPT programme in England, critics argue that there are insufficient resources to make the service widely available.
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The research found a big discrepancy between policy and practice, with 68% of managers saying that they had procedures in place to address workplace stress, but just 22% of employees saying that managers would step in to help them address stress at work.
What Flu Can Tell Us About Depression are twice as likely to have depression as the general population. This had been though to be the result of pain, impaired mobility and difficulty remaining socially active. However, scientists are now examining the possible link with inflammation.
It is that time of year when the flu virus spreads. Those affected experience common symptoms such as fever, a sore throat, headaches, and a blocked nose. Flu also comes with psychological symptoms such as a loss of energy, slowed thoughts and action, poor concentration, apathy, and loss of interest in previously enjoyable activities. This group of symptoms has got researchers interested because they are also the symptoms of depression. Of course there are differences. The symptoms of flu seldom last more than a week, whereas depression would only be diagnosed if the symptoms lasted for more than a fortnight. But nobody is suggesting that flu and depression are the same thing. Rather, the common symptoms have got scientists wondering whether inflammation may play a key role in both conditions. More than 100 studies have demonstrated a clear link between inflammation and depression. For example, a Danish study of 73,000 adults found a link between above average inflammation and depression in 21 percent of those studied. Another clue to the link between inflammation and depression comes from studies of people with osteoarthritis, who
In a recent study of 1,500 adults with osteoarthritis by Mount Sinai School of Medicine in New York, researchers found that Non-Steroidal Anti-Inflammatory Drugs (NSAID) such as Ibuprofen commonly used in the treatment of arthritis resulted in lower rates of depression. It is too early to say whether there is a causal link between inflammation and depression - it may be that depression causes increased inflammation; it could be that the symptoms of diseases associated with inflammation also cause depression; or it could be that each is a causal factor in the other. Similarly, it is too early to tell whether antiinflammatory drugs have a direct antidepressant effect or whether improvements in depression are the result of the lower levels of pain and greater mobility that come from using NSAIDs. However, scientists have begun to study the antidepressant properties of a range of drugs that are commonly used to treat diseases where inflammation is a major symptom. It is nearly thirty years since the SSRI family of antidepressants was discovered, and no new classes of antidepressants have been discovered since. So these early Inflammation studies have caused a ripple of excitement through the psychiatric research community. This might be a new treatment waiting in the wings.
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Courses from Life Surfing Willpower Workout our 1-day course for anyone who is frustrated by their lack of willpower, and who wants to learn how to build “willpower muscle” in order to achieve a more fulfilling lifestyle. Banish Your Blues our 1-day selfmanagement course for anyone affected by or at risk of developing depression. Learn how to recover without the use of antidepressants or therapy. How to Help our 1-day course for anyone who wants to learn how to help a friend, relative, colleague or client affected by mental health problems or common mental illness. Distress to De-stress our ½ -day stress management course for anyone who wants to learn how to manage and
overcome stress in a healthy and sustainable way. Getting to Sleep our ½ -day course for anyone who wants to learn how to get a good night’s sleep… night after night! For more information about our courses, please contact Life Surfing to register an interest:
www.life-surfing.com Freephone 0300 321 4514 Or 07922 537 646
info@life-surfing.com
Mental Health First Aid Fails to Deliver impact. We should focus on a smaller number of ‘high impact level’ health improvement areas”. Mixed objectives While the rationale behind Mental Health First Aid is good, political involvement meant the initiative had to meet too many agendas. For example, because the “Bridgend Suicides” were in the news at the time the programme was being designed, the training includes far too much (often out of date) information about suicide rates in Wales. There is also far too much information on Government policy, even though this has no impact on anyone’s understanding of mental distress or how to respond.
The Mental Health First Aid (Wales) initiative has failed to demonstrate sufficient benefits according to an influential committee of public health experts. The final report of the National Health Improvement Review Transforming health improvement in Wales - published in September 2013, examined 25 Welsh Government funded public health schemes, but was only able to recommend that three should be maintained and built upon.
Nor was it fully clear whether the aim was to create a network of first aiders or to provide information aimed at combating stigma and discrimination. It was simply assumed that these were the same thing.
Although the review decided that Mental Health First Aid needed “further consideration”, a health economics “Programme Budgeting and Marginal Analysis” group recommended that Mental Health First Aid should be de-invested:
The result of mixed political objectives is that Mental Health First Aid training takes 12 hours to deliver. This makes it unattractive to many private businesses that are reluctant to lose that amount of staff time. In practice, Mental Health First Aid has tended to preach to the converted - mostly delivering to charities and public sector departments that are already aware of mental distress and how to respond to those who need help.
“This was on the basis of a lack of evidence of effectiveness, costeffectiveness or support from local public health teams, or any evidence of impact on inequality”. With Welsh health budgets coming under increasing strain, the need to invest only in those schemes that provide effective results has never been greater: “Spreading funding too thinly across a range of areas is unlikely to be efficient or produce the desired
All too often, the Welsh Government wags a finger at the private businesses where most of us work. Had it instead consulted them about how best to deliver Mental Health First Aid, there would have been greater engagement, and the programme might not now be at risk.
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Food for Mood
Zinc and Depression As with all essential vitamins and minerals, it is much better and much safer to make improvements to your diet than to use often expensive and potentially dangerous artificial supplements.
A new meta-analysis has found a strong correlation between depression and zinc deficiency. The analysis of 17 studies which measured blood–zinc concentrations in 1643 depressed patients and 804 control participants found that blood–zinc concentrations were lower in depressed individuals compared with control participants. Severe depression was associated with greater differences in zinc levels between depressed and control participants.
Foods Containing Zinc Seafood - 100g of cooked oysters contain 524 percent of the recommended daily intake of zinc. Lobster, crab and other shellfish also have high amounts of zinc.
This type of study cannot demonstrate a causal link between zinc deficiency and depression (it might be that physiological changes or changes in the diet of depressed people result in zinc deficiency). However, Canadian researcher Walter Swardfager points to: “A growing body of evidence demonstrates that experimental zinc deficiency can induce depressive-like behavior in animals, which can be effectively reversed by zinc supplementation”, as persuasive evidence for a causal link.
100g Toasted Wheatgerm contains 110 percent of the recommended daily intake of zinc. Red Meats lamb and (particularly) beef are high in zinc. Pumpkin and Squash seeds are also high in zinc. However, while other seeds contain zinc, concentrations are much lower. 100g Cashew nuts contain 37 percent of the recommended intake of zinc. Most other nuts contain zinc in lower quantities.
Preliminary stage clinical trials into the benefits of adding zinc supplements to treatment with antidepressants have also produced favourable results.
And for those of us who want an excuse, 100g dark baking chocolate contains 80 percent of the recommended daily intake of zinc.
More work would need to be done to have zinc supplements approved as a formal treatment. Nor is it advisable to take large doses of zinc supplements or to take them for prolonged periods.
Although there are no guarantees, adding zinc-rich foods to your diet may help you to improve your mood and increase your energy levels.
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Food for Mood Recipe
Warming Beef & Vegetable Stew When we think about “comfort food” we most often think of chocolate, cakes and crisps foods that give us momentary comfort, but if eaten to excess pile on the pounds and ultimately damage our health. Stews offer comfort of a different kind. On a cold Winter evening, there is something very comforting about curling up with a bowl of hot stew and a fresh bread roll in front of a warm fire.
Ingredients 500g lean diced stewing beef 2 x white onions 1 x red onion 4 x medium size carrots 1 x medium size swede 1 x parsnip 3 x leeks 1-2 tsp mixed herbs 1-2 tsp chilli flakes 1 tbsp olive oil 1.5 Ltr vegetable stock Method 1. Wash, peel and chop the onions, carrots, swede, parsnip and leeks. 2. Prepare 1.5 litre of vegetable stock (a couple of stock cubes will do)
3. Pour the olive oil into a large pan and warm on a low heat. 4. Add mixed herbs and chilli flakes to the oil 5. Add the onions and warm until they become soft. 6. Add the diced beef and stir until sealed. 7. Add the vegetable stock bring to the boil and simmer for 1½ hours or until beef is tender. 8. Add the chopped vegetables (and if necessary top up with water) and simmer for a further 30-40 minutes Serve with fresh crusty bread and butter. Serves 6-8
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5 quick ways to de-stress (without alcohol) More of us are diagnosed with stress and common mental illnesses like depression and anxiety disorders between January and March than at any other time of year. These can be exacerbated by inappropriate attempts at stress relief. Here we set out five more appropriate and quick ways that anyone can use to de-stress. 1. Stretch Muscle tension is part of your stress response as your body prepares to fight or flee. Stretching will help relieve this tension and lower your stress levels. 2. Take time for yourself Taking time away from other people can help you to unwind and gather your thoughts.
Breathing for Calm
The quickest and easiest way to overcome stress is to learn to breathe properly.
3. Eat some mango Mangoes are a source of Linalool, a chemical that helps to reduce stress levels.
4. Imagine your next holiday Visualising yourself in a calm, positive environment will help break the thoughts and emotions that accompany stress. 5. Dance Any cardiovascular exercise is good for stress. Dancing is particularly good because you must remain focused and aware of your body, and keep to a rhythm. This promotes a sense of calm.
When we get stressed we tend to take fast, shallow breaths at the top of the lungs. Taking conscious control of breathing allows us to change this, and this in turn helps neutralise stress. Students of yoga learn a variety of breathing techniques that each produce different effects on mind and body. However, for instant stress relief, you need only practice three: 1. Breathe rhythmically - any (reasonably slow) rhythm will do, and you can download free apps that give you a rhythm to follow. 2. Breathe smoothly - allow the breath to come and go in single, steady motions rather than the staccato breaths that come with stress. 3. Focus at the centre of the chest - this is not only where physical relaxation begins, it also improves our emotions.
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Life Surfing publications Life Surfing has published a growing range of wellbeing and self-help guides for anyone who is struggling with life’s ups and downs, and anyone who wants to do more to help. Our publications are available from Amazon in paperback and Kindle formats - see the the Life Surfing website for details. Beating Anxiety: A Guide to Managing and Overcoming Anxiety Disorders This Life Surfing guide explains what anxiety is, how it is treated, and - crucially - what steps you can take to help yourself recover and sustain your personal wellbeing.
Getting to sleep: A guide to overcoming stress-related sleep problems With 1 in 3 of us experiencing stress-related insomnia, this important Life Surfing guide will give you a good understanding of sleep and crucially - the steps you can take to improve the quality and duration of your sleep... night after night.
Depression: A guide to managing and overcoming depression This Life Surfing Guide to depression provides you with an introduction to what depression is, how it is treated, and - crucially - what you can do to help yourself overcome the condition and create long-term personal wellbeing.
How to Help: A guide to helping someone manage mental distress In this Life Surfing guide, we explain what mental health and mental illness are, and - crucially - the steps that you can take to help someone experiencing mental health problems or mental illness.
Depression Workbook: 70 Selfhelp techniques for recovering from depression This book provides you with 70 self-help techniques covering the seven key areas of your personal wellbeing.
Helping Hands: How to Help Someone Else Cope with Mental Health Problems Worried about the wellbeing of a relative, friend, colleague or client? Not sure what to do or worried you might say or do the wrong thing?
Distress to De-stress: Understanding and managing stress in everyday life This Life Surfing guide explains what stress is, and - crucially - what healthy steps you can take to manage stress and promote long-term personal wellbeing. The guide includes 30 stress management techniques. Food for Mood: A guide to healthy eating for mental health In this Life Surfing guide we explain how mental health problems can impact on diet and how you can improve your diet by using foods from the helpful lists of good mood foods set out in the guide. We also provide some good mood food starter recipes for anyone who is relatively new to cooking.
Helping Hands will provide you with an understanding of wellbeing, and knowledge of mental illness, and will show you how you can help and support someone who has, or is at risk of developing, a mental health problem. Helping Hands also sets out a great deal of what has been learned about self-help and self-management strategies for recovery from mental illness over the last 25 years.
www.life-surfing.com Freephone 0300 321 4514 Or 07922 537 646
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Listings Beth Whelan, Duopody Reflexology (illness, injury, stress, fatigue) in tranquil St Hilary, near Cowbridge. Tel 07504982623. Email: barefootbeth1@gmail.com YogaMobility provides specialist accessible yoga classes for disabled and less able adults. Classes are held at Sbectrwm Community Centre, Fairwater, Monday and Thursday (10.30-12.30) and Roath Church House, Wednesday (6.00-7.20pm). www.yogamobility.org
If you would like to advertise in The Wave please contact Julia or Tim at Life Surfing. Freephone 0300 321 4514 - mobile 07922 537 646 info@life-surfing.com The Wave is designed and printed by Waye Forward Ltd - www.wayeforward.com
Cover photographs: Nick Kaye
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“You can’t stop the waves… … but you can learn to surf”
The Wave is published by Life Surfing a Community Interest Company limited by guarantee (07399335) registered in England & Wales