By Dr Raj Chandok & Dr Serena Foo
Modern life is such that we all go through periods of anxiety, feeling low and sadness; the uncertainties imposed by the COVID-19 pandemic are emotionally challenging for many of us.
Indeed, even as we progress through this pandemic, some of these mental health issues will remain with us individually, and this will have an impact on us as a society beyond the end of the pandemic.
Within our profession, these vulnerabilities are also very clear; a recent British Medical Association COVID-19 survey found that 41 percent of Doctors were suffering with depression, anxiety, stress, burnout, emotional distress or another mental health condition relating to or made worse by their work, with 29 percent saying this had got worse during the pandemic.
“For my part I know nothing with any certainty, but the sight of the stars makes me dream.” Vincent van Gogh
It is normal to feel sad, and low, especially when life is not going so well. But when does this sadness become an illness?
Depression is a medical condition, and is more than just being sad. It is a condition that affects an individual’s life and ability to manage day to day. There are two core symptoms of depression: feeling down, depressed or hopeless, and loss of interest in most things. These have to be present for most days, most of the time, for at least two weeks. There may be associated symptoms of disturbed sleep, increase or loss of appetite, loss of energy, slowness of movement or agitation, poor concentration, feelings of worthlessness and guilt, suicidal thoughts or acts.
The condition can range from being mild to severe, and may be associated with other mental health conditions such as anxiety or even psychosis.
It is important to note that depression is a medical condition and is not necessarily precipitated by a stressful life event, although in many cases these are contributing factors.
There are no laboratory tests for depression, but it is sometimes worth testing for physical health conditions which may cause some of the symptoms, such as iron deficiency or thyroid disorders.
The management and treatment of Depression depends on the severity and whether there are other mental health issues. Firstly, talking to someone and seeking help is important. In my experience, people are often reluctant to tell close friends and family, for fear of causing distress. However, friends and family, when they find out, often feel rejected, or guilty that they were not able to do something earlier. Seeing a GP enables a diagnosis to be made, including an assessment of severity, and then a jointly agreed treatment plan can be developed.
Talking Therapies are usually an important part of treatment. There are many different types. The “Improving Access to Psychological Therapies” (IAPT) Programme was launched in 2008 in order to increase access to talking therapies such as counselling or Cognitive Behavioural Therapy. There are other types of counselling which may be provided by charities such as MIND, or more complex psychotherapies provided by mental health teams.
Exercising regularly is effective in helping people with mild to moderate depression; physical activity helps to improve mood and reduce anxiety.
When symptoms are more severe, medication such as antidepressants may be needed. There are many different types available, with different modes of action. In recent years, the most commonly used have belonged to the group known as ‘selective serotonin reuptake inhibitors’ or SSRIs; Fluoxetine [Prozac], Citalopram [Cipramil] and Paroxetine [Seroxat] are commonly used SSRIs. Antidepressants work by increasing levels of chemicals in the brain called neurotransmitters; some neurotransmitters such as serotonin and noradrenaline are linked to mood and emotion.
Each individual responds differently to different medication, and in fact medication may not be appropriate for everyone. Depression can, and does get better; obtaining the right support and treatment is essential.
‘To be human is to be anxious’ is a concept developed by the Danish philosopher Kierkegaard. Anxiety is a normal emotion experienced by all on occasions, and is an adaptive part of human emotion and behaviour. Some people develop anxiety disorders characterised by intense, excessive and persistent worry, out of keeping with that demanded by the situation. Symptoms include feeling nervous and tense, having a sense of impending doom, shortness of breath, sweating, trembling, difficulty concentrating, poor sleep.
Anxiety disorders include generalised anxiety disorder (free floating anxiety), agoraphobia, panic disorder, social anxiety disorder, phobias, etc. Treatment options include psychological treatments such as cognitive behaviour therapy, social measures such as exercise and support from friends and family, as well as medication such as SSRIs. It is important to try to obtain treatment for anxiety and avoid temptation to ‘self medicate’ using alcohol, as this will result in the development of a more serious problem.
Anxiety symptoms/disorders can be part of depressive illnesses and the prognosis is usually very good, with effective treatments available.
If you, or anyone close to you, may have symptoms of depression and/or anxiety, please seek advice from your GP.
If you are feeling distressed, there is support available 24 hours a day:
Nationally : Samaritans 116 123
Locally : West London NHS Trust helpline 0300 1234 244 & CNWL 0800 0234 650
Dr Raj Chandok
FRCGP FRSA MSc MBBS DC DRCOG DFFP D Med Ed
Principal, Dr G Singh & Partners
Dr Serena Foo
FRACGP MRCGP MSc MBBS. Principal, Westseven GP,
Mental Health Lead NHS Ealing CCG,
Clinical Director North West London Mental Health Transformation Board