NHS takes to happiness psychology

Positive psychology is a form of CBT developed by professor Martin Seligman. I personally think it might be a bit Californian, the point isnt to be happy or sad, its to be content and aware, to know theres bad stuff in the world but be prepared to accept those bad things one cant change.

Anyway, heres an article about a British doctor getting into it:

Smiles better

Marc Leverton reports on the doctor who wants fellow medics to embrace happiness and the techniques by which it can be harnessed

Tuesday May 22, 2007
SocietyGuardian.co.uk

Dr Chris Johnstone is introducing some new ideas into the health service. "I train GPs and medical students in ways of helping patients make difficult changes, like giving up smoking or losing weight. I also teach medical students in the holistic approach, which Bristol University has the leading course in the country on. I teach that illness can't be treated with pills alone."

Dr Johnstone trained and worked as a GP before moving to Bristol's Robert Smith unit, an NHS referral unit for severe alcoholics. He has worked there for the last fifteen years and his recently published self-help book, Find Your Power, draws on his experiences of applying positive psychology to the treatment of addictions.

Developed by the American psychologist Martin Seligman, positive psychology - sometimes referred to as the new science of happiness - aims to deepen understanding of what helps promote positive mood states and desirable human qualities.

For most of us the pursuit of happiness is elusive and appears to be outside of our control, but Dr Johnstone says it doesn't have to be so. "There are many ways we can foster positive moods. A simple technique is to identify something that has happened in the last 24 hours that you feel pleased about. When you focus attention on what you feel good about, your mood improves."

Dr Johnstone believes the key is to recognise that the mind can be trained in strategies that bring long-term improvement in mood. "We can learn ways to become happier," he says, "and that is what I teach my clients."

One of positive psychology's most consistent findings in happiness research is that people tend to be at their most content when deeply involved in activities that require their full attention. Referred to as "flow experiences", these are the moments when we're so engrossed that time seems to disappear. In contrast to the passive experiences often associated with leisure, like watching television, flow experiences may stretch us at the time, but leave a warm glow of satisfaction afterwards.

One of the leading theories of depression is the model of "learned helplessness". Dr Johnstone says: "Helplessness leads to hopelessness. If people believe they can't do anything about a situation, they tend to give up trying. But pessimism can become a self-fulfilling prophecy, creating the sort of downward spiral I often see in my clients.

"My work is to help them find their power to face challenges. When you make an effort, you become more engaged. The more engaged you become, the more you get into flow, and as a result, life satisfaction increases."

Johnstone's interest in the subject began after he experienced depression himself, which was linked to work pressures.

Starting his medical career in 1986 Dr Johnstone trained as a junior doctor and was instrumental in tackling the long hours culture expected of young doctors. "In my first job I was on a 'one in three shift' which meant that, in addition to a standard 40-hour week, I would also work round the clock every third night and weekend. Some weeks I'd work well over a hundred hours," he recalls.

As part of his campaign he wrote to his local MP, Margaret Thatcher. She reminded him that junior doctors' hours had in fact decreased in the last seven years, from an average of 90 to 87.5. He continued his struggle until eventually he issued a writ against his employer, the Bloomsbury Health Authority.

"I issued the writ on a bank holiday and the story went all over the world and hit the front pages," he says. "It was a huge story, but the legal case was slow and the health authority tried to block it at ten court hearings over six years.

"Eventually it went to the Court of Appeal and they made a ruling where, if your employer works you so many hours that it damages your health, then that is unlawful. If your health suffers from overwork you could have a damages claim."

Dr Johnstone temporarily left medicine after his excessive hours led him to fall asleep at the wheel of his car and crash into a rock face. "I felt that was my wake-up call. If I went back to work I was just going to make myself ill. It was a life or death decision."

Dr Johnstone hopes his new work on happiness can continue to benefit the medical profession. "Doctors are more likely on average to commit suicide than their patients and they are also more likely to develop cirrhosis of the liver," he says.

"There are so many gains to be had from our happiness: people can think and solve problems more effectively, and there are improved health outcomes such as the functioning of the immune system. The medical profession really needs to embrace happiness."

Read more!

Tube rage in Argentina

I'm quite interested in the link between social anxiety and general urban stress - the stress that comes from living in very close proximity to millions of other people, and how this stress can spill over when things don't work.

One example of that is incidents of road rage or tube rage.

Here's an example from the day's papers of a big incident of tube rage in Buenos Aires:

BUENOS AIRES, Argentina - Argentina's president on Wednesday threatened to crack down on private rail operators for failing to make upgrades after frustration over poor service boiled over into a riot at a major commuter station.
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Commuters enraged by constant delays in train service to Buenos Aires' poor suburbs set fire Tuesday evening to parts of the capital's Constitucion station, looted nearby shops and clashed with riot police, who responded with rubber bullets and tear gas.

Passengers' aggravation came to a head at the evening rush hour when a train broke down on a track just outside the station, blocking other trains from leaving the station that serves some 300,000 commuters daily.

Buenos Aires area commuter rail lines were privatized in the 1990s, and passengers for years have complained about the failure of new operators to provide timely service on oft-crowded routes.

In response to the riots, President Nestor Kirchner on Wednesday criticized commuter rail operators for neglecting needed overhauls.

"The state is going to give a swift kick where it counts," Kirchner said during a Government House meeting. He said privatized railroad operators who have yet to upgrade trains where "shameless."

Sergio Taselli, the head of the Metropolitano concession that runs trains out of the Constitucion station, rejected the criticism.

"There was a breakdown on just one train," he said on Radio 10, adding it regrettably forced delays on other lines at rush hour.

He said the number of passengers on Metropolitano routes had doubled in three years and "improvements to service can't be made" at the same pace.

Workers cleaned up broken glass and sought to rebuild a shattered ticket office at the Constitucion station as trains ran again normally Wednesday morning. There were no reports of delays and calm returned with the morning rush hour.

Twelve police officers were slightly injured in Tuesday's rioting and nine people were also treated for smoke inhalation, said Alberto Crescenti, a spokesman for emergency medical workers.

Police Commissioner Ricardo Falana reported 16 arrests. He said about 100 police were needed to quell the rioters, who he said threw a "hail of rocks" at officers.

Read more!

CBT and Stoicism

Here is a blog that I wrote on the New Statesman's website this week, http://www.newstatesman.com, which talks about how I overcame social anxiety with the help of Stoicism and CBT.

Not many people know about the link between CBT and Stoicism, but the one actually evolved from the other, as the founders of CBT - particularly Albert Ellis - happily admit.

How Stoicism Helped Me Get My Groove Back

I first read Stoicism when I was seventeen or so, and it immediately struck a chord with me. But it wasn’t until I was around 22, seven years ago, that I really started to apply it.

By that time my life had gone rather awry. I’d had a very easy first 18 years of my life, with success and good fortune coming easily to me. I’d then experimented somewhat recklessly with drugs, had some traumatic experiences on them, and been unable to accept those experiences.

This led to me developing an anxiety disorder, where I was plagued with panic attacks, constant feelings of stress and unease, and bouts of moodiness and depression.

At the root of it, perhaps, was an inability to accept what had happened to me, or that I had lost the happiness and good fortune of my youth. I was miserable over having lost friends and squandered my talents, and terrified of being a failure, or worse, being perceived by others to be a failure.

The psychiatrist, whom I visited when I was 22 or so, told me I had post-traumatic stress disorder and social anxiety. He said he could make me better simply by waving his finger in front of my face – a hip new technique called Eye Movement Desensitization and Reprocessing, or EMDR. It sounded too good to be true, and was.

Around that time, I bought a book called The Discourses, by the Stoic philosopher Epictetus. It was he who first declared that it was not external things, but our opinions about them, which caused us suffering. It was our own thoughts and opinions that imprisoned us and made us miserable.

But, uniquely among animals, we had the power of ‘meta-thinking’. This means we could become aware of our own thinking patterns, analyze them, and if necessary change them. Our mind could imprison us, but it could also set us free.

Epictetus declared that passions were the result of misconceptions about the world. Something happens to us (A), then we make an assessment of that event (B), then we attach powerful emotions to that event (C).

For example – you lose your job (A), you make an assessment of that event such as ‘this is an awful and intolerable event that proves I’m a good-for-nothing loser’ (B), then the powerful emotion of depression comes in and locks that assessment in place (C).

But a Stoic would look at (B), at your original assessment of the event. Is it really so god-awful to be fired? Does the fact that you have lost one job mean you are a complete good-for-nothing? Perhaps the circumstances leading to you losing your job were out of your control. In any case, you did your best, what’s the point beating yourself up about it?

A Stoic would actually look at the situation as a great opportunity to assert their inner freedom over external events. Epictetus would say that adversity is the cosmos sending us a sparring partner, something we can take on and try to conquer, in order to strengthen our inner detachment and mastery over our passions and conventional opinions.

Sure, sometimes we may lose and fall into a depression, but then we get back up, dust ourselves off, and get back in the ring. Each time we beat our conventional opinions, they get less and less power over us, and we become more and more masters of ourselves.

Above all, we can learn to accept what happens to us. Stoics accept external events because they believe they are part of the Logos, the divine law that guides all events. They believe the universe is rationally ordered, so we should accept whatever it dishes out to us.

Even if you don’t believe in the Logos, you can still use Stoicism to overcome negative emotions. Cognitive behavioural therapy (CBT) is a modern therapy that updates Stoicism and applies it to modern emotional disorders like social anxiety or post-traumatic stress disorder.

The founder of CBT, a New Yorker called Albert Ellis, was inspired by reading Epictetus when he was a young man. Ellis also asserts that it’s our opinions about things that cause us suffering, rather than the things themselves.

Ellis suggests that we wall ourselves in with ‘must statements’, such as ‘I must be successful’ or ‘I must be popular’, and when the opposite occurs, we beat ourselves up and consider ourselves complete failures.

CBT tries to make patients aware of how their own thoughts, their own ‘must statements’, are at the root of their depression or anxiety, so that they can challenge their own habitual thoughts and replace them with more rational or flexible statements such as ‘it would be nice if I was successful, but it’s not the end of the world if I’m not’.

So CBT uses the psychological insights of Stoicism, but without the cosmic faith in a divinely-ordered plan. For Ellis, bad things happen, and that’s just life. Shit happens, as he puts it. You can either accept it, or be miserable the rest of your life. It’s your choice.

CBT has been proven to be the most successful form of treatment for most emotional disorders. It’s now widely accepted by western medicine, and by a number of national governments such as the British government, which is putting millions of pounds into providing CBT for the mentally ill.

Speaking from my own experience, I can say that it proved very successful, and has helped me re-gain both my self-control, and my pleasure in life.

So CBT is a fairly unique case where western medicine has embraced the insights of a 2000-year-old philosophy.

Read more!

Can social anxiety make people murder?

That seems to be the implication of this rather startling story from Canada's Globe and Mail newspaper:

Suspect called himself a 'fringe individual'

NEWMARKET -- Alicia Ross hit a raw nerve when she called her neighbour Daniel Sylvester a "loser," a murder-trial jury heard yesterday.

In one of several audiotape confessions he made when he turned himself in to police one month after Ms. Ross disappeared from her Markham home in the early hours of Aug. 17, 2005, Mr. Sylvester said the insult "really got me going" and led to his fatal attack on Ms. Ross.

When York Regional Police Detective Rick McViety quizzed him further, Mr. Sylvester said he had been dubbed a loser "many times throughout high school" and even in grade school.

"I just had problems socially, trying to adapt. I never assimilated ... with the high-school crowd ... I did have some friends in high school, but they were never mainstream friends," Mr. Sylvester told Det. McViety.

Mr. Sylvester went on to portray himself as a reclusive and nervous social misfit. He said he had attention deficit disorder and was prone to depression, anxiety and thoughts of suicide.

"I would describe myself ... [as a] fringe individual. ... I feel very ill at ease and I feel very nervous and apprehensive around people."

While straining to recall therapy sessions with up to 15 psychiatrists and psychologists from the early 1990s on, Mr. Sylvester said he prefers not to go any longer because "it just doesn't seem to work out."

Mr. Sylvester, 33, has pleaded not guilty to second-degree murder, but guilty to manslaughter in Ms. Ross's beating death. Crown attorney Kelly Wright has rejected the plea.

When asked what day of the week it was when he killed Ms. Ross, Mr. Sylvester, who rarely worked, and watched television at home most days, said "one day blends with the next."

The eight-woman, four-man jury has heard Mr. Sylvester tell police that as he and Ms. Ross struggled, Ms. Ross kicked at his ribs.

Mr. Sylvester said that after he forced Ms. Ross to the ground and she began to claw at his head, he tried to get her to stop, kneeing her in the chest and then slamming her head into the ground two or three times.

The jury heard Mr. Sylvester tell police that after he realized Ms. Ross was dead, he dragged her body into his garage and then 45 minutes later drove north in his truck and dumped her body near the town of Manilla.

When asked by Detective McViety if he wanted to say something to Ms. Ross's family, Mr. Sylvester, in a rare moment of emotion, said he didn't now if he could face them.

"There are no words that are sufficient to apologize for something like that. I would say I had no right to take your daughter's life ... and I wish I had never done that."

Read more!

Social anxiety in India

Looks like anxiety disorders are increasingly becoming a problem in India, particularly among the new urban middle class. They don't seem that clear about the cures yet though, beyond 'healthy eating'.

Here's an article on it from an Indian website called Merinews:

ANXIETY HAS COME to rule our lives in the contemporary world. The metamorphosis of our life is centered at the core of a highly stressful environment that has given way to various psychological problems.

Neeti Mehta, 32, is a businesswoman in Delhi. She is crammed between her workplace and two kids, shuffling between daily chores, meetings and client visits. Off late she started to worry about small things. On being asked what was going on, she was clueless. She’d complain of heart palpitation, was always scared, developed a sense of insecurity and was never at peace with herself.

“I kept worrying endlessly about nothing. I started to feel as if something real bad was about to happen. Yet, I could not figure it out. I started to have bouts of anxiety accompanied by extensive crying. I could no longer focus on my work or give proper attention to my children. That was when my sister asked me to consult a psychologist.”

Neeti was suffering from an anxiety disorder. The stressful lifestyle she was leading paved the way for the disorder to sink in. Today, millions of people are prone to anxiety related disorders due to various reasons.

According to Dr. Vikas Mohan Sharma, consultant Psychiatrist, VIMHANS Hospital, “Anxiety is a by product of stress. Those people are highly prone to it that have fewer resources available and too much work.”

“Anxiety is often misunderstood as worry. Worry has a reason whereas anxiety does not have one. Anxiety is a normal reaction to stress but when it begins to affect our social, personal and professional lives adversely, it becomes a disorder,” opines Dr Sharma.

He further says that there are different types of anxieties ranging from acute to mild.

Panic Disorder:
The person gets repeated attacks or episodes of flooding anxiety characterized by intense fear leading to the patient becoming traumatized. It overwhelms the patient who tends to become scared. In severe cases the patient might even become homebound out of fear.

During a panic attack the patient feels increased heart palpitation, sweaty, nauseatic, faint or dizzy. At times it can also be accompanied by chest pain.

Generalised Anxiety Disorder:
This form of anxiety disorder is more generalised, as it is a continuous form of anxiety. It is likely to affect the performance criteria of the person on the social, political and professional level in a generalised way.

Social Phobia:
If a person is an introvert by birth and is characteristically shy then it is not a social phobia. A social phobia can be identified if the person was normal but has suddenly developed a phobia of mingling with people. This could be an outcome of various circumstances.

Kavita Elias, 34, is a teacher in Lucknow. She recently underwent a divorce. She stopped socializing with people out of fear about what they might think of her unsuccessful relationship.

“She was under constant pressure and we failed to see that she was developing traits of a psychological disorder. It was not until she collapsed in school one day and was rushed to the hospital that the problem was identified,” says her mother Kusum.

Kavita says, “I was petrified to go out of the house or even meet parents at school. I felt everybody was giving disdainful looks wherever I went. I was desperate to escape the stares and glances. Even if I’d go to the market and see two people talking, I’d felt they were speaking about me. This made me anxious.”

She added, “I knew this could not be for real but it was out of my control. I’d often feel my pulse racing, get sweaty and worry about absolutely nothing. I eventually broke down.

Obsessive Compulsive disorder (OCD):
Obsession is an anxiety disorder that needs to be taken seriously. All thoughts and images start becoming intrusive, repetitive and they do not go way from the patient’s mind. The disorder is characterized by repetitive behaviours such as washing hands, cleaning, counting, checking etc. Performing these rituals relieves the person temporarily but they get the urge to repeat the act sooner or later.

Soft Anxiety:
This is completely related to stress. When people come under a lot of pressure they are likely to suffer from this disorder.

Most people have their own way of coping with stress but when they are unable to handle it, the problem takes a form of a psychological disorder.

Dr Sharma also says that the physical symptoms of anxiety disorder can be easily identified as follows:
Palpitations
Shortness of Breath
Urge to pass urine
Tremors

Mental:
Sense of impending doom
Fearfulness
Restlessness
Negative thoughts

Dr. Sharma suggested various preventive methods. He says that we need to identify the stress level in order to cope with it. A healthy lifestyle needs to be maintained. One mustn’t ignore the benefits of healthy eating habits and regular exercise.

Regular exercise helps do away with stress by providing a means for the body to release pent up tension. Yoga and Ti Chi are also excellent means by which one can remain healthy.

“Early diagnosis helps one to identify the problem and it can be cured with counseling but at a later stage one requires medication along with therapy,” suggests Dr Sharma.

He furthers adds that almost all anxiety disorders are curable. It is not a disease. One must be very particular while identifying ‘Obsessive Compulsive Disorders’ as they have the capacity of becoming chronic.

Anxiety can afflict any strata of society. It is most likely to affect adolescents and people in their twenties.

We need to watch out for stress in a big way and keep it at bay. The moment it invites anxiety to enter your life, it can create havoc. People are constantly under stress nowadays. They need to drift towards a healthier and happier lifestyle in order to enjoy life to its fullest.

Read more!

The Empress of Japan's battle with social anxiety

Here's a rather sad, and remarkable, story about the Empress of Japan's apparent battle with social anxiety. It seems she developed it after being demeaned and humiliated by the courtiers in Japan, and made to feel like a commoner. She was even unable to speak for seven months, so small did she feel. She says she dreamt of having a 'cloak of invisibility' so she could escape their disapproving eyes.

Reminds one what a problem social anxiety -or TKS as it is known there - is in Japan:

Sad, tormented life of the Empress who dreams of an invisibility cloak

Empress Michiko of Japan has spoken of the “sorrow and anxiety” she experienced as the first commoner to marry into Japanese royalty, and of her fantasy of donning a magic coat of invisibility to escape the constraints of life within the Imperial Family.

Her remarks give a remarkable insight into a woman who has suffered repeated nervous breakdowns as a result of bullying criticism first from her mother-in-law, the late Empress, and later from rightwing traditionalists dismayed at the “modernising” of the world’s oldest hereditary monarchy.

Seated alongside Emperor Akihito, at a press conference before a visit to Britain later this month, the Empress spoke of the sense of inadequacy and self-doubt that has haunted her and the prayers she whispers in times of pain and stress.

“After I married I experienced difficulties in my new life every day amid many demands and expectations,” she said in a prepared answer to a question submitted by foreign journalists. “I never expressed it in terms of the word ‘pressure’. I just felt sad and sorry for not living up to people’s expectations and demands.

“I feel the same way even now. Much of the time I find it difficult to be confident in my decisions. It has been a great challenge to get through each and every day with my sorrow and anxiety.

“When I am sad and concerned about things, I don’t know how to cope. So sometimes I pray or whisper a childish magical charm. I also feel an affinity with the many other people who live wordlessly under sadness and anxiety. Perhaps this is an illusion, but I regard it as a boon, and take solace and encouragement.”

The Empress was born Michiko Shoda in 1934, the daughter of a wealthy industrialist who met the then Crown Prince Akihito over a game of tennis in a fashionable summer mountain resort. When they married in 1959, in a Shinto ceremony followed by a horse-drawn procession based upon those of the British royal family, it was a source of excited delight to many Japanese. But it dismayed rightwing traditionalists and members of the old – and now disempowered – Japanese aristocracy.

Akihito’s policy of presenting the image of an ordinary couple who danced together, played with their children and dressed fashionably, enraged those who believed in a dignified and unapproachably remote Emperor, the direct descendant of the Sun Goddess, Amaterasu Omikami. Former aristocrats, who were deprived of their lands and titles after the war, regarded her as having robbed their daughters of a place in the imperial family.

It has been reported that Michiko got on particularly badly with her mother-in-law, the Empress Nagako, a formidable figure of the old aristocracy who looked down upon the commoner princess. Powerful Shinto priests also focused their resentment of Michiko on her family’s Catholicism and on her own education at Sacred Heart Catholic school.

Akihito was tutored and mentored by a number of Christians, leading to speculation that the imperial couple may harbour crypto-Christian sympathies. Courtiers dismiss this, insisting that Michiko was never baptised and is not a believer. In her remarks this week, she did not specify what kind of prayers she utters in times of stress.

Michiko suffered a nervous breakdown after a whispering campaign in the press in 1963 and again in 1993 when she lost the power of speech for seven months. Since then she has had recurrences of shingles and two months ago suffered intestinal bleeding – all, according to courtiers, caused by stress.

Her unhappy history has been repeated, in part, by her daughter-in-law Princess Masako, who has also been treated for depression after clashing with the courtiers of the Imperial Household Agency, which regulates the lives of the Emperor’s family.

At the time of her marriage, Michiko was celebrated for her poise and beauty. Now she is a thin, strained-looking, but still elegant woman who is unable to travel freely outside the vast grounds of the Imperial Palace.

This week she recalled a Japanese folk story about a coat of invisibility. “If I wore it, the imperial police officer might say, ‘Go and enjoy yourself, but be careful’!” she said. “I would practise walking through a crowded railway station. Then I would go to Kanda-Jimbocho [an area of Tokyo famous for its bookshops], and spend much time browsing as I did in my student days.”

Read more!

Is the UK becoming a prozac nation?

The Times' front page article yesterday was on the apparent epidemic in mental illness, or at least in GPs prescribing prozac, zanax etc for depression and anxiety.

It says almost 3 million people suffer from anxiety in the UK at any one time.

Here's the piece:

Britain becomes a Prozac nation
David Rose

The number of Britons prescribed antidepressants is at a record high, despite official warnings that many patients may not need them.

More than 31 million prescriptions were written by doctors for antidepressant drugs last year, figures published today reveal, with the use of drugs such as Seroxat and Prozac increasing by 10 per cent. The findings, which show a big increase on previous years, come despite growing concerns over the country’s excessive reliance on chemical treatments and over their possible side-effects.

The exact number of people taking pills for depression is not known but is thought to be several million, with many taking the medications over long periods on repeat prescriptions.

The most common drugs, known as Selective Serotonin Reuptake Inhibitors (SSRIs) – which include Seroxat and Prozac – are the easiest treatment to prescribe and are often effective. However, guidelines from the National Institute for Health and Clinical Excellence (NICE) in 2004 recommended that they should not be used as a first-stop remedy for depression. They have also been found occasionally to trigger suicidal thoughts and self-harm in children and adults, and are not recommended for use by under18s.

Research on doctors’ habits also revealed that many felt they were prescribing the drugs too often, but did so because patients wanted medication. They said that funding was often not sufficient for alternative behavioural therapies and other counselling treatments, despite NICE guidance that they can be as effective as antidepressants for those with mild to moderate depression.

The 31 million prescriptions for all antidepressants represented a 6 per cent rise last year, while SSRI use increased from from 14.7 million in 2005 to 16.2 million in 2006. The cost to the NHS of antidepressants was £291.5 million last year, with SSRI use reaching £119.6 million.

Depression is estimated to affect as many as one in five people at some point during their lives. At any moment, 1.5 million people aged between 16 and 75 are suffering from depression, and 2.7 million from anxiety, although although most cases are untreated. Depression is responsible for 70 per cent of recorded suicides in Britain.

Campaigners also claim that taking regular exercise in a green space could alleviate the symptoms of sufferers. But a lack of funding for such treatments contributes to the increasing use of antidepressants as a “quick fix”, despite government pledges to bring an end to the “Prozac nation”.

According to Mind, the leading mental health charity, adult patients with moderate depression should instead be given counselling and cognitive behavioural therapy or encouraged to take more exercise.

An estimated 93 per cent of GPs continued to prescribe the drugs because a lack of alternatives, the charity said. The figures were released quietly last month, but are quoted in a report released today by Mind.

Paul Farmer, chief executive of Mind, said: “Doctors are guilty of a knee-jerk reaction in prescribing pills, which are commonly long-term prescriptions and have well-known issues with side-effects. The mindset of GPs will have to change so that they consider counselling and other forms of therapy as a frontline treatment.”

But William Bird, a family doctor from Reading, said that patients increasingly expected to be given medication rather than other therapies. “Antidepressants seem to have lost the stigma they once had and now most patients seem to want to take them.

“On the other hand, it can be hard to motivate patients with depression and we need to do more to raise awareness of counselling services and promote physical activity.”

David Healy, a professor of psychological medicine at Cardiff University and a leading critic of SSRIs, said that while the drugs were of benefit to patients with severe depression, the risks outweighed the benefits in those with less serious problems. Read more!