Tag Archives: talk

Why we need to talk about prostate cancer | Letters

Both George Monbiot (I have been diagnosed with prostate cancer, but I am happy, 14 March) and Bill Turnbull (Former BBC breakfast host Bill Turnbull has prostate cancer, 6 March) have performed a service to men by sharing their shock at discovering they have prostate cancer. Bill wishes he had had PSA testing more often than every five years; George says that this standard assessment is of limited use. I agree with Bill and take issue with George. My prostate cancer was discovered by two private PSA tests taken 11 months apart. My Gleason score was nine out of 10. I was finally clear of cancer last year after 14 years of treatment. I suggest things could have been a lot worse if I had not had these two tests within a year.

George should have mentioned the Prostate cancer risk management programme whose aim is: “… to ensure that men receive information about prostate cancer and the associated risks, and clear and balanced information about the advantages and disadvantages of the prostate specific antigen (PSA) test. This will help men to decide whether they want to have the test.”

It would appear that in both George’s and Bill’s cases, they did not receive clear and balanced information about the test. The implication is that surgeries need to have a notice on the wall that draws men’s attention to their rights under the risk management programme. And, if their GP does not inform them, they should make the first move.
Robert Redpath
Jordans, Buckinghamshire

It is commendable that George Monbiot shares with us his experience of prostate cancer diagnosis. Also his happiness in where it puts him in his life. It is so important to inform and educate men about this disease, to broadcast the news far and wide. Anecdotally, following 15 years of PSA monitoring due to family history, then two biopsies that make your eyes water a bit, I too was diagnosed with this disease. Like George, I am overwhelmed by the love and support from friends, family and the teams of NHS radiologists who irradiate me daily with their linear accelerators. There is almost a social group in the waiting room, where we prepare for our treatment. A dry camaradie exists and humour too, as we fill our bladders to bursting point with water and insert our microenemas, so the radiologists can see what they’re aiming at. (Big shout out for the radiotherapy teams at the Churchill hospital, Oxford.)

Cancer is the great leveller. But there is room for happiness when you do realise, by comparison, how lucky you are. Good luck with your treatment, George.
Gordon Cooper
Flackwell Heath, Buckinghamshire

I was diagnosed with prostate cancer, with a Gleason score slightly higher than George’s. I opted for radiotherapy rather than surgery, and the seven weeks I spent travelling five days a week to the Churchill hospital in Oxford were an eye-opener for me, since I have never had any contact with the NHS beyond my (very good) general practice and the odd minor operation. At every stage I was dealt with courteously, informatively and sympathetically, often by staff who were not English. There were six radiotherapy machines, each costing about £2m, to which I had free access, along with the ancillary hormone treatment. The true cost of my treatment came home to me when I read in the Guardian last week of the man who has lived in the UK for over 40 years who was asked to pay £54,000 for a course of radiotherapy for his prostate cancer.

Unless there is a change of government soon, this unique healthcare organisation will be irreparably damaged by politicians who despise anyone who is not rich, who use private medicine, and who advocate the discredited use of PFI companies that make profits from selling inferior and overpriced services to the NHS.
Karl Sabbagh
Bloxham, Oxfordshire

George Monbiot’s response to his diagnosis and forthcoming radical surgery for prostate cancer is impressive and inspiring for others in similar position. But there is a third choice of treatment other than the rather dismal choice between surgery or radiation – namely high-frequency ultrasound, which has fewer side effects and – as with a friend of mine – can be very effective. For some reason it has a lower profile, but is available – and would appear a far less daunting prospect.
Andrew Broadbent
London

Thank you, George, for that courageous and necessary writing. We admire your brave and clear-sighted approach to your private crisis. Thank you for sharing your thoughts, so that we can emulate your attitude. And we all wish you well in your surgery and aftercare. May the force be with you.
Frances Middleton
Norwich

George is fit and healthy and his prostatectomy should be very successful. I had the same operation nine years ago and I have no doubt that my life was saved by my excellent GP who insisted that I had regular annual PSA tests. Although my Gleason Score was only 4.5, my doctor was concerned by the sudden increase since my previous test and “for peace of mind” (his and mine), he suggested a biopsy. Like George, my cancer was aggressive and the operation was carried out in under a month. Fortunately, the lymph glands were unaffected and apart from the expected debilitation following major surgery, I was soon fitter than before the operation. Erectile dysfunction is an expected side-effect, but don’t worry, George, medication will help that.

All men should have regular PSA tests from age 50 and, if there is a family history of prostate cancer, tests should begin earlier. Delay does kill. I am looking forward to reading George’s next article following his discharge from hospital.
Joe Haynes
Reading, Berkshire

Thank you, George. I have just been diagnosed too and, at 77, I like the idea of being part of this season’s smart young men. And I like the reasons you give for being happy. They make a lot of sense. My hormone treatment started yesterday and every member of staff was wonderful, kind, thoughtful, skilful and reassuring. Like you, I am happy, but I am also very angry. The idea that the government is determined to sell this national service off to US private business is unbearable.
John Airs
Liverpool

George Monbiot has covered everything accurately. His urinary tract infection bad luck turned out to be life-saving good luck. For me a hip replacement pre-op test discovered a heart condition, treatment for which led to the diagnosis of prostate cancer, early developing, responding well to the simplest treatment. Definitely good luck. “All the smart young men have it this season” – no, but all the smart men of any age should be aware of it, speak of it and check for symptoms. I’m old enough to remember when tuberculosis was unmentionable. Let’s not fear to speak of prostate cancer. All the best with the surgery, George.
Denis Ahern
Stanford-le-Hope, Essex

Join the debate – email guardian.letters@theguardian.com

Read more Guardian letters – click here to visit gu.com/letters

Antidepressants do work – but children need someone to talk to

Nearly a decade ago I found myself perched on the edge of a hard chair in a dark doctor’s office. I was 13 and struggling a lot with self harm, body image, and the simple task of keeping myself alive. Shuffling my feet and wondering how I ended up here, I remember not fully understanding what was happening when I was handed a little green prescription for Fluoxetine – an antidepressant drug often better known as Prozac.

Back then, my frame of reference for mental illness was pretty minimal. All I knew was that I felt numb and I wanted everyone to leave me alone. The thought of something being able to help felt so far away it was almost laughable. Antidepressants had never crossed my mind. Everything I knew about them was framed around the words of American emo bands or soap operas. As the doctor handed me the prescription, I remember it was talked about as the most natural thing in the world. “We’ll give you a course of pills and go from there.” What? Go where? Am I really hopeless enough that only drugs can fix this?

In 2008, I was just one of 40 million people worldwide taking a green-and-yellow pill each day. I was sceptical. How could anything make me feel better? But, 10 years down the line, I still pick up my prescription every month and cannot imagine my life without Prozac.

Last month, I read about how a major study had confirmed that antidepressants do work. The headlines – “The drugs do work” and so on – suggested that we were right all along to medicate depression as soon as it presents itself.

This message should be welcomed and will hopefully battle the stigma surrounding antidepressants. But, for children in particular, there is more to it. In June last year, it was reported that almost 65,000 young people in England, including children as young as six, were taking antidepressants . Guidelines from the National Institute for Health and Care Excellence (NICE) state that they should only be given to teenagers and children with moderate or severe depression, when psychotherapy has failed. It also states that medication should always be taken in concert with other support, such as talking therapies.

Here is where my concern lies. When I was handed my first prescription, I was told that was the starting point, and that I could not possibly start any therapy without the medication. Before then, I had not seen a fully trained psychotherapist – nor did I even have a full diagnosis from the specialist team sitting in front of me. While I cannot predict how things would be if they had been handled differently – by offering children medication, before giving them the chance to talk to someone, we are telling them we would rather write them a prescription than listen to what they have to say. In moments of intense pain and suffering, children are often left not understanding what is happening to them and, instead of offering them a caring hand to hold, we are giving them a medicinal cold shoulder.

Yes, the pills do work. I’m not afraid to say that they have changed my life, and I honestly believe that without them, things would be very different for me now. But there are a whole host of other things being used to tackle depression that cannot be ignored. The entirety of my teenage years were defined by talking therapies, medication, hospital appointments and care plans. It was never the case that I was going to take the magic pills and things would get better for me, and to suggest that the drugs were responsible for saving my life would be to dismiss a lot of hard work by a lot of wonderful people. Countless therapy sessions and a close, trusting relationship with a dedicated nurse helped me get to the bottom of my illnesses and understand how to manage them. My family rallied around and learnt everything they could to be supportive and understanding. This came along with hospital care and, above all, my own hard work to get through it. Medication is an excellent tool for treating depression – but it is just that – a tool in part of a much more complex selection of resources.

I have sympathy with a system which is struggling among government cuts and lack of strategy, and can understand that sometimes offering medication is the first thing we can do in a child and adolescent mental health service with a wait of up to 18 months for initial support. As a society, we need to work harder to support – not just a quick-fix pill.

I am grateful for the support and love I received to get me to where I am today, and medication has been a valuable part of that. But I wonder, if people had not been so quick to prescribe the pills, perhaps I would be able to imagine my life without them today.

Antidepressants do work – but children need someone to talk to

Nearly a decade ago I found myself perched on the edge of a hard chair in a dark doctor’s office. I was 13 and struggling a lot with self harm, body image, and the simple task of keeping myself alive. Shuffling my feet and wondering how I ended up here, I remember not fully understanding what was happening when I was handed a little green prescription for Fluoxetine – an antidepressant drug often better known as Prozac.

Back then, my frame of reference for mental illness was pretty minimal. All I knew was that I felt numb and I wanted everyone to leave me alone. The thought of something being able to help felt so far away it was almost laughable. Antidepressants had never crossed my mind. Everything I knew about them was framed around the words of American emo bands or soap operas. As the doctor handed me the prescription, I remember it was talked about as the most natural thing in the world. “We’ll give you a course of pills and go from there.” What? Go where? Am I really hopeless enough that only drugs can fix this?

In 2008, I was just one of 40 million people worldwide taking a green-and-yellow pill each day. I was sceptical. How could anything make me feel better? But, 10 years down the line, I still pick up my prescription every month and cannot imagine my life without Prozac.

Last month, I read about how a major study had confirmed that antidepressants do work. The headlines – “The drugs do work” and so on – suggested that we were right all along to medicate depression as soon as it presents itself.

This message should be welcomed and will hopefully battle the stigma surrounding antidepressants. But, for children in particular, there is more to it. In June last year, it was reported that almost 65,000 young people in England, including children as young as six, were taking antidepressants . Guidelines from the National Institute for Health and Care Excellence (NICE) state that they should only be given to teenagers and children with moderate or severe depression, when psychotherapy has failed. It also states that medication should always be taken in concert with other support, such as talking therapies.

Here is where my concern lies. When I was handed my first prescription, I was told that was the starting point, and that I could not possibly start any therapy without the medication. Before then, I had not seen a fully trained psychotherapist – nor did I even have a full diagnosis from the specialist team sitting in front of me. While I cannot predict how things would be if they had been handled differently – by offering children medication, before giving them the chance to talk to someone, we are telling them we would rather write them a prescription than listen to what they have to say. In moments of intense pain and suffering, children are often left not understanding what is happening to them and, instead of offering them a caring hand to hold, we are giving them a medicinal cold shoulder.

Yes, the pills do work. I’m not afraid to say that they have changed my life, and I honestly believe that without them, things would be very different for me now. But there are a whole host of other things being used to tackle depression that cannot be ignored. The entirety of my teenage years were defined by talking therapies, medication, hospital appointments and care plans. It was never the case that I was going to take the magic pills and things would get better for me, and to suggest that the drugs were responsible for saving my life would be to dismiss a lot of hard work by a lot of wonderful people. Countless therapy sessions and a close, trusting relationship with a dedicated nurse helped me get to the bottom of my illnesses and understand how to manage them. My family rallied around and learnt everything they could to be supportive and understanding. This came along with hospital care and, above all, my own hard work to get through it. Medication is an excellent tool for treating depression – but it is just that – a tool in part of a much more complex selection of resources.

I have sympathy with a system which is struggling among government cuts and lack of strategy, and can understand that sometimes offering medication is the first thing we can do in a child and adolescent mental health service with a wait of up to 18 months for initial support. As a society, we need to work harder to support – not just a quick-fix pill.

I am grateful for the support and love I received to get me to where I am today, and medication has been a valuable part of that. But I wonder, if people had not been so quick to prescribe the pills, perhaps I would be able to imagine my life without them today.

Antidepressants do work – but children need someone to talk to

Nearly a decade ago I found myself perched on the edge of a hard chair in a dark doctor’s office. I was 13 and struggling a lot with self harm, body image, and the simple task of keeping myself alive. Shuffling my feet and wondering how I ended up here, I remember not fully understanding what was happening when I was handed a little green prescription for Fluoxetine – an antidepressant drug often better known as Prozac.

Back then, my frame of reference for mental illness was pretty minimal. All I knew was that I felt numb and I wanted everyone to leave me alone. The thought of something being able to help felt so far away it was almost laughable. Antidepressants had never crossed my mind. Everything I knew about them was framed around the words of American emo bands or soap operas. As the doctor handed me the prescription, I remember it was talked about as the most natural thing in the world. “We’ll give you a course of pills and go from there.” What? Go where? Am I really hopeless enough that only drugs can fix this?

In 2008, I was just one of 40 million people worldwide taking a green-and-yellow pill each day. I was sceptical. How could anything make me feel better? But, 10 years down the line, I still pick up my prescription every month and cannot imagine my life without Prozac.

Last month, I read about how a major study had confirmed that antidepressants do work. The headlines – “The drugs do work” and so on – suggested that we were right all along to medicate depression as soon as it presents itself.

This message should be welcomed and will hopefully battle the stigma surrounding antidepressants. But, for children in particular, there is more to it. In June last year, it was reported that almost 65,000 young people in England, including children as young as six, were taking antidepressants . Guidelines from the National Institute for Health and Care Excellence (NICE) state that they should only be given to teenagers and children with moderate or severe depression, when psychotherapy has failed. It also states that medication should always be taken in concert with other support, such as talking therapies.

Here is where my concern lies. When I was handed my first prescription, I was told that was the starting point, and that I could not possibly start any therapy without the medication. Before then, I had not seen a fully trained psychotherapist – nor did I even have a full diagnosis from the specialist team sitting in front of me. While I cannot predict how things would be if they had been handled differently – by offering children medication, before giving them the chance to talk to someone, we are telling them we would rather write them a prescription than listen to what they have to say. In moments of intense pain and suffering, children are often left not understanding what is happening to them and, instead of offering them a caring hand to hold, we are giving them a medicinal cold shoulder.

Yes, the pills do work. I’m not afraid to say that they have changed my life, and I honestly believe that without them, things would be very different for me now. But there are a whole host of other things being used to tackle depression that cannot be ignored. The entirety of my teenage years were defined by talking therapies, medication, hospital appointments and care plans. It was never the case that I was going to take the magic pills and things would get better for me, and to suggest that the drugs were responsible for saving my life would be to dismiss a lot of hard work by a lot of wonderful people. Countless therapy sessions and a close, trusting relationship with a dedicated nurse helped me get to the bottom of my illnesses and understand how to manage them. My family rallied around and learnt everything they could to be supportive and understanding. This came along with hospital care and, above all, my own hard work to get through it. Medication is an excellent tool for treating depression – but it is just that – a tool in part of a much more complex selection of resources.

I have sympathy with a system which is struggling among government cuts and lack of strategy, and can understand that sometimes offering medication is the first thing we can do in a child and adolescent mental health service with a wait of up to 18 months for initial support. As a society, we need to work harder to support – not just a quick-fix pill.

I am grateful for the support and love I received to get me to where I am today, and medication has been a valuable part of that. But I wonder, if people had not been so quick to prescribe the pills, perhaps I would be able to imagine my life without them today.

Antidepressants do work – but children need someone to talk to

Nearly a decade ago I found myself perched on the edge of a hard chair in a dark doctor’s office. I was 13 and struggling a lot with self harm, body image, and the simple task of keeping myself alive. Shuffling my feet and wondering how I ended up here, I remember not fully understanding what was happening when I was handed a little green prescription for Fluoxetine – an antidepressant drug often better known as Prozac.

Back then, my frame of reference for mental illness was pretty minimal. All I knew was that I felt numb and I wanted everyone to leave me alone. The thought of something being able to help felt so far away it was almost laughable. Antidepressants had never crossed my mind. Everything I knew about them was framed around the words of American emo bands or soap operas. As the doctor handed me the prescription, I remember it was talked about as the most natural thing in the world. “We’ll give you a course of pills and go from there.” What? Go where? Am I really hopeless enough that only drugs can fix this?

In 2008, I was just one of 40 million people worldwide taking a green-and-yellow pill each day. I was sceptical. How could anything make me feel better? But, 10 years down the line, I still pick up my prescription every month and cannot imagine my life without Prozac.

Last month, I read about how a major study had confirmed that antidepressants do work. The headlines – “The drugs do work” and so on – suggested that we were right all along to medicate depression as soon as it presents itself.

This message should be welcomed and will hopefully battle the stigma surrounding antidepressants. But, for children in particular, there is more to it. In June last year, it was reported that almost 65,000 young people in England, including children as young as six, were taking antidepressants . Guidelines from the National Institute for Health and Care Excellence (NICE) state that they should only be given to teenagers and children with moderate or severe depression, when psychotherapy has failed. It also states that medication should always be taken in concert with other support, such as talking therapies.

Here is where my concern lies. When I was handed my first prescription, I was told that was the starting point, and that I could not possibly start any therapy without the medication. Before then, I had not seen a fully trained psychotherapist – nor did I even have a full diagnosis from the specialist team sitting in front of me. While I cannot predict how things would be if they had been handled differently – by offering children medication, before giving them the chance to talk to someone, we are telling them we would rather write them a prescription than listen to what they have to say. In moments of intense pain and suffering, children are often left not understanding what is happening to them and, instead of offering them a caring hand to hold, we are giving them a medicinal cold shoulder.

Yes, the pills do work. I’m not afraid to say that they have changed my life, and I honestly believe that without them, things would be very different for me now. But there are a whole host of other things being used to tackle depression that cannot be ignored. The entirety of my teenage years were defined by talking therapies, medication, hospital appointments and care plans. It was never the case that I was going to take the magic pills and things would get better for me, and to suggest that the drugs were responsible for saving my life would be to dismiss a lot of hard work by a lot of wonderful people. Countless therapy sessions and a close, trusting relationship with a dedicated nurse helped me get to the bottom of my illnesses and understand how to manage them. My family rallied around and learnt everything they could to be supportive and understanding. This came along with hospital care and, above all, my own hard work to get through it. Medication is an excellent tool for treating depression – but it is just that – a tool in part of a much more complex selection of resources.

I have sympathy with a system which is struggling among government cuts and lack of strategy, and can understand that sometimes offering medication is the first thing we can do in a child and adolescent mental health service with a wait of up to 18 months for initial support. As a society, we need to work harder to support – not just a quick-fix pill.

I am grateful for the support and love I received to get me to where I am today, and medication has been a valuable part of that. But I wonder, if people had not been so quick to prescribe the pills, perhaps I would be able to imagine my life without them today.

Antidepressants do work – but children need someone to talk to

Nearly a decade ago I found myself perched on the edge of a hard chair in a dark doctor’s office. I was 13 and struggling a lot with self harm, body image, and the simple task of keeping myself alive. Shuffling my feet and wondering how I ended up here, I remember not fully understanding what was happening when I was handed a little green prescription for Fluoxetine – an antidepressant drug often better known as Prozac.

Back then, my frame of reference for mental illness was pretty minimal. All I knew was that I felt numb and I wanted everyone to leave me alone. The thought of something being able to help felt so far away it was almost laughable. Antidepressants had never crossed my mind. Everything I knew about them was framed around the words of American emo bands or soap operas. As the doctor handed me the prescription, I remember it was talked about as the most natural thing in the world. “We’ll give you a course of pills and go from there.” What? Go where? Am I really hopeless enough that only drugs can fix this?

In 2008, I was just one of 40 million people worldwide taking a green-and-yellow pill each day. I was sceptical. How could anything make me feel better? But, 10 years down the line, I still pick up my prescription every month and cannot imagine my life without Prozac.

Last month, I read about how a major study had confirmed that antidepressants do work. The headlines – “The drugs do work” and so on – suggested that we were right all along to medicate depression as soon as it presents itself.

This message should be welcomed and will hopefully battle the stigma surrounding antidepressants. But, for children in particular, there is more to it. In June last year, it was reported that almost 65,000 young people in England, including children as young as six, were taking antidepressants . Guidelines from the National Institute for Health and Care Excellence (NICE) state that they should only be given to teenagers and children with moderate or severe depression, when psychotherapy has failed. It also states that medication should always be taken in concert with other support, such as talking therapies.

Here is where my concern lies. When I was handed my first prescription, I was told that was the starting point, and that I could not possibly start any therapy without the medication. Before then, I had not seen a fully trained psychotherapist – nor did I even have a full diagnosis from the specialist team sitting in front of me. While I cannot predict how things would be if they had been handled differently – by offering children medication, before giving them the chance to talk to someone, we are telling them we would rather write them a prescription than listen to what they have to say. In moments of intense pain and suffering, children are often left not understanding what is happening to them and, instead of offering them a caring hand to hold, we are giving them a medicinal cold shoulder.

Yes, the pills do work. I’m not afraid to say that they have changed my life, and I honestly believe that without them, things would be very different for me now. But there are a whole host of other things being used to tackle depression that cannot be ignored. The entirety of my teenage years were defined by talking therapies, medication, hospital appointments and care plans. It was never the case that I was going to take the magic pills and things would get better for me, and to suggest that the drugs were responsible for saving my life would be to dismiss a lot of hard work by a lot of wonderful people. Countless therapy sessions and a close, trusting relationship with a dedicated nurse helped me get to the bottom of my illnesses and understand how to manage them. My family rallied around and learnt everything they could to be supportive and understanding. This came along with hospital care and, above all, my own hard work to get through it. Medication is an excellent tool for treating depression – but it is just that – a tool in part of a much more complex selection of resources.

I have sympathy with a system which is struggling among government cuts and lack of strategy, and can understand that sometimes offering medication is the first thing we can do in a child and adolescent mental health service with a wait of up to 18 months for initial support. As a society, we need to work harder to support – not just a quick-fix pill.

I am grateful for the support and love I received to get me to where I am today, and medication has been a valuable part of that. But I wonder, if people had not been so quick to prescribe the pills, perhaps I would be able to imagine my life without them today.

Antidepressants do work – but children need someone to talk to

Nearly a decade ago I found myself perched on the edge of a hard chair in a dark doctor’s office. I was 13 and struggling a lot with self harm, body image, and the simple task of keeping myself alive. Shuffling my feet and wondering how I ended up here, I remember not fully understanding what was happening when I was handed a little green prescription for Fluoxetine – an antidepressant drug often better known as Prozac.

Back then, my frame of reference for mental illness was pretty minimal. All I knew was that I felt numb and I wanted everyone to leave me alone. The thought of something being able to help felt so far away it was almost laughable. Antidepressants had never crossed my mind. Everything I knew about them was framed around the words of American emo bands or soap operas. As the doctor handed me the prescription, I remember it was talked about as the most natural thing in the world. “We’ll give you a course of pills and go from there.” What? Go where? Am I really hopeless enough that only drugs can fix this?

In 2008, I was just one of 40 million people worldwide taking a green-and-yellow pill each day. I was sceptical. How could anything make me feel better? But, 10 years down the line, I still pick up my prescription every month and cannot imagine my life without Prozac.

Last month, I read about how a major study had confirmed that antidepressants do work. The headlines – “The drugs do work” and so on – suggested that we were right all along to medicate depression as soon as it presents itself.

This message should be welcomed and will hopefully battle the stigma surrounding antidepressants. But, for children in particular, there is more to it. In June last year, it was reported that almost 65,000 young people in England, including children as young as six, were taking antidepressants . Guidelines from the National Institute for Health and Care Excellence (NICE) state that they should only be given to teenagers and children with moderate or severe depression, when psychotherapy has failed. It also states that medication should always be taken in concert with other support, such as talking therapies.

Here is where my concern lies. When I was handed my first prescription, I was told that was the starting point, and that I could not possibly start any therapy without the medication. Before then, I had not seen a fully trained psychotherapist – nor did I even have a full diagnosis from the specialist team sitting in front of me. While I cannot predict how things would be if they had been handled differently – by offering children medication, before giving them the chance to talk to someone, we are telling them we would rather write them a prescription than listen to what they have to say. In moments of intense pain and suffering, children are often left not understanding what is happening to them and, instead of offering them a caring hand to hold, we are giving them a medicinal cold shoulder.

Yes, the pills do work. I’m not afraid to say that they have changed my life, and I honestly believe that without them, things would be very different for me now. But there are a whole host of other things being used to tackle depression that cannot be ignored. The entirety of my teenage years were defined by talking therapies, medication, hospital appointments and care plans. It was never the case that I was going to take the magic pills and things would get better for me, and to suggest that the drugs were responsible for saving my life would be to dismiss a lot of hard work by a lot of wonderful people. Countless therapy sessions and a close, trusting relationship with a dedicated nurse helped me get to the bottom of my illnesses and understand how to manage them. My family rallied around and learnt everything they could to be supportive and understanding. This came along with hospital care and, above all, my own hard work to get through it. Medication is an excellent tool for treating depression – but it is just that – a tool in part of a much more complex selection of resources.

I have sympathy with a system which is struggling among government cuts and lack of strategy, and can understand that sometimes offering medication is the first thing we can do in a child and adolescent mental health service with a wait of up to 18 months for initial support. As a society, we need to work harder to support – not just a quick-fix pill.

I am grateful for the support and love I received to get me to where I am today, and medication has been a valuable part of that. But I wonder, if people had not been so quick to prescribe the pills, perhaps I would be able to imagine my life without them today.

Antidepressants do work – but children need someone to talk to

Nearly a decade ago I found myself perched on the edge of a hard chair in a dark doctor’s office. I was 13 and struggling a lot with self harm, body image, and the simple task of keeping myself alive. Shuffling my feet and wondering how I ended up here, I remember not fully understanding what was happening when I was handed a little green prescription for Fluoxetine – an antidepressant drug often better known as Prozac.

Back then, my frame of reference for mental illness was pretty minimal. All I knew was that I felt numb and I wanted everyone to leave me alone. The thought of something being able to help felt so far away it was almost laughable. Antidepressants had never crossed my mind. Everything I knew about them was framed around the words of American emo bands or soap operas. As the doctor handed me the prescription, I remember it was talked about as the most natural thing in the world. “We’ll give you a course of pills and go from there.” What? Go where? Am I really hopeless enough that only drugs can fix this?

In 2008, I was just one of 40 million people worldwide taking a green-and-yellow pill each day. I was sceptical. How could anything make me feel better? But, 10 years down the line, I still pick up my prescription every month and cannot imagine my life without Prozac.

Last month, I read about how a major study had confirmed that antidepressants do work. The headlines – “The drugs do work” and so on – suggested that we were right all along to medicate depression as soon as it presents itself.

This message should be welcomed and will hopefully battle the stigma surrounding antidepressants. But, for children in particular, there is more to it. In June last year, it was reported that almost 65,000 young people in England, including children as young as six, were taking antidepressants . Guidelines from the National Institute for Health and Care Excellence (NICE) state that they should only be given to teenagers and children with moderate or severe depression, when psychotherapy has failed. It also states that medication should always be taken in concert with other support, such as talking therapies.

Here is where my concern lies. When I was handed my first prescription, I was told that was the starting point, and that I could not possibly start any therapy without the medication. Before then, I had not seen a fully trained psychotherapist – nor did I even have a full diagnosis from the specialist team sitting in front of me. While I cannot predict how things would be if they had been handled differently – by offering children medication, before giving them the chance to talk to someone, we are telling them we would rather write them a prescription than listen to what they have to say. In moments of intense pain and suffering, children are often left not understanding what is happening to them and, instead of offering them a caring hand to hold, we are giving them a medicinal cold shoulder.

Yes, the pills do work. I’m not afraid to say that they have changed my life, and I honestly believe that without them, things would be very different for me now. But there are a whole host of other things being used to tackle depression that cannot be ignored. The entirety of my teenage years were defined by talking therapies, medication, hospital appointments and care plans. It was never the case that I was going to take the magic pills and things would get better for me, and to suggest that the drugs were responsible for saving my life would be to dismiss a lot of hard work by a lot of wonderful people. Countless therapy sessions and a close, trusting relationship with a dedicated nurse helped me get to the bottom of my illnesses and understand how to manage them. My family rallied around and learnt everything they could to be supportive and understanding. This came along with hospital care and, above all, my own hard work to get through it. Medication is an excellent tool for treating depression – but it is just that – a tool in part of a much more complex selection of resources.

I have sympathy with a system which is struggling among government cuts and lack of strategy, and can understand that sometimes offering medication is the first thing we can do in a child and adolescent mental health service with a wait of up to 18 months for initial support. As a society, we need to work harder to support – not just a quick-fix pill.

I am grateful for the support and love I received to get me to where I am today, and medication has been a valuable part of that. But I wonder, if people had not been so quick to prescribe the pills, perhaps I would be able to imagine my life without them today.

Antidepressants do work – but children need someone to talk to

Nearly a decade ago I found myself perched on the edge of a hard chair in a dark doctor’s office. I was 13 and struggling a lot with self harm, body image, and the simple task of keeping myself alive. Shuffling my feet and wondering how I ended up here, I remember not fully understanding what was happening when I was handed a little green prescription for Fluoxetine – an antidepressant drug often better known as Prozac.

Back then, my frame of reference for mental illness was pretty minimal. All I knew was that I felt numb and I wanted everyone to leave me alone. The thought of something being able to help felt so far away it was almost laughable. Antidepressants had never crossed my mind. Everything I knew about them was framed around the words of American emo bands or soap operas. As the doctor handed me the prescription, I remember it was talked about as the most natural thing in the world. “We’ll give you a course of pills and go from there.” What? Go where? Am I really hopeless enough that only drugs can fix this?

In 2008, I was just one of 40 million people worldwide taking a green-and-yellow pill each day. I was sceptical. How could anything make me feel better? But, 10 years down the line, I still pick up my prescription every month and cannot imagine my life without Prozac.

Last month, I read about how a major study had confirmed that antidepressants do work. The headlines – “The drugs do work” and so on – suggested that we were right all along to medicate depression as soon as it presents itself.

This message should be welcomed and will hopefully battle the stigma surrounding antidepressants. But, for children in particular, there is more to it. In June last year, it was reported that almost 65,000 young people in England, including children as young as six, were taking antidepressants . Guidelines from the National Institute for Health and Care Excellence (NICE) state that they should only be given to teenagers and children with moderate or severe depression, when psychotherapy has failed. It also states that medication should always be taken in concert with other support, such as talking therapies.

Here is where my concern lies. When I was handed my first prescription, I was told that was the starting point, and that I could not possibly start any therapy without the medication. Before then, I had not seen a fully trained psychotherapist – nor did I even have a full diagnosis from the specialist team sitting in front of me. While I cannot predict how things would be if they had been handled differently – by offering children medication, before giving them the chance to talk to someone, we are telling them we would rather write them a prescription than listen to what they have to say. In moments of intense pain and suffering, children are often left not understanding what is happening to them and, instead of offering them a caring hand to hold, we are giving them a medicinal cold shoulder.

Yes, the pills do work. I’m not afraid to say that they have changed my life, and I honestly believe that without them, things would be very different for me now. But there are a whole host of other things being used to tackle depression that cannot be ignored. The entirety of my teenage years were defined by talking therapies, medication, hospital appointments and care plans. It was never the case that I was going to take the magic pills and things would get better for me, and to suggest that the drugs were responsible for saving my life would be to dismiss a lot of hard work by a lot of wonderful people. Countless therapy sessions and a close, trusting relationship with a dedicated nurse helped me get to the bottom of my illnesses and understand how to manage them. My family rallied around and learnt everything they could to be supportive and understanding. This came along with hospital care and, above all, my own hard work to get through it. Medication is an excellent tool for treating depression – but it is just that – a tool in part of a much more complex selection of resources.

I have sympathy with a system which is struggling among government cuts and lack of strategy, and can understand that sometimes offering medication is the first thing we can do in a child and adolescent mental health service with a wait of up to 18 months for initial support. As a society, we need to work harder to support – not just a quick-fix pill.

I am grateful for the support and love I received to get me to where I am today, and medication has been a valuable part of that. But I wonder, if people had not been so quick to prescribe the pills, perhaps I would be able to imagine my life without them today.

Where does cancer come from? We must talk about preventable risk | Ranjana Srivastava

Although my patient constantly and laughingly referred to himself as a “vegetable”, I never got used to it. I cringed at the expression, often wondering how he really felt beneath the smiles. Short in height and morbidly obese, he hated moving and told everyone how much he loved fat and sugar, preferably together. The first time I met him he struggled to walk the few metres to my room before crashing into a chair and clutching its sides as he regained his breath. He was only 57 years old.

Just before starting chemotherapy he developed a urine infection. His symptoms settled quickly but even I was surprised at the way he became deconditioned. Previously able to get to the bathroom, now he would collapse in bed with each attempt to get up. Then he developed a hospital-acquired pneumonia and nearly died. It was assumed that cancer caused his deterioration, but the real culprit was his dismal lack of fitness. Ultimately, I witnessed my patient’s treatment, and then his life, compromised by habits encompassed by the benign-sounding term “lifestyle factors”. Unfortunately he was neither the first nor the last patient of this kind.

Recently, Australian researchers added to a growing body of evidence that a large proportion of cancers are preventable. The researchers studied known groups of cancer risk factors including smoking, diet, weight, physical inactivity and infections such as hepatitis C and human papillomavirus and estimated that of the 44,000 cancer deaths annually in Australia, 17,000, or nearly 40%, are potentially preventable. This figure mirrors those stated by Cancer Research UK, the American Cancer Society and the World Health Organisation.

Reflecting on the “untold grief and heartache” that cancer causes, the researchers remind us that even small improvements in our lifestyle have the capacity to translate into important health gains. On current trend, one in two people will be diagnosed with cancer by age 85. To reduce this risk, they suggest we make better dietary choices, eat a little less, move a little more, don’t smoke, curb drinking, and lose some weight. They’re right, of course. The frustration lies in seeing knowledge translated into action.

Every cancer clinic is witness to the end result of a series of lifestyle choices gone wrong. The middle-aged truck driver with lung cancer who has spent 20 years on the roads, with cigarettes, soft drinks and fast food for company. The obese, sedentary office worker suddenly diagnosed with advanced bowel cancer. The scores of men and women with obesity, emphysema, diabetes, heart and kidney disease, before facing cancer as a final insult. Everyone seems surprised that these chronic health conditions can imperil just as much as cancer.

Listening to patients provides insights into how their lifestyle came to be so. Some people can’t afford the cost premium of fresh fruit and vegetables and their living or working conditions make regular exercise difficult, if not impossible. Some people smoke because that’s what their whole family does. They drink because to refrain would be considered abnormal among their friends. Everyone in their family is on the large side, so they haven’t thought of themselves as overweight.

Smoking impairs response to cancer treatment. Obesity increases recurrence risk. Lack of fitness portends hazardous complications. Poor diet hampers immunity. There is common awareness of the link between smoking and cancer but few people are aware of the other major and controllable risk factors. Mostly, they think that cancer happens due to bad luck and bad genes.

Oncologists are no strangers to the plentiful associations between lifestyle and cancer but while I have no illusions about changing human nature in the course of a few appointments, it never fails to strike me how seldom we broach lifestyle. For one, it’s easier to prescribe chemotherapy than to counsel patients about their habits. In the short time available, it is expedient to stick to the necessary conversations which tend to be about diagnosis and management. It is increasingly challenging to adopt a long-term and holistic view of the person behind the cancer but this shortcoming undoubtedly hurts patients.

Giving chemotherapy is the easy part. Linking a patient into accessible, publicly funded, sustainable harm reduction programs, whether related to diet, exercise, smoking, drugs or alcohol is surprisingly difficult. There is enormous geographic and socioeconomic variation in access to such services – the employed executive with generous leave arrangements can find several options within easy reach but things aren’t so easy for the unemployed single mother who is also the carer for her disabled son. She is much more likely to retain all the factors that led to cancer development in the first place that will now claim her life.

One might ask if we shouldn’t take personal responsibility for getting healthy but recidivism rates are high because poor health habits are addictive and people need more structured help than simply being told to quit. The result of gaps in public health policy is a failure of primary prevention that leads to expensive hospital-based care, which is ill-equipped to change long-term health indicators.

When it comes to communicating risk, cancer occupies a unique and unfortunate space. Societies are aware about the dangers of unprotected sex. Mothers know why childhood vaccination matters. Public transport carries the warning features of a stroke. But the origin of cancer remains shrouded in mystery even as researchers peel back the layers.

It’s tricky at the best of times to tell someone to lose weight or drink less but it’s even harder to tell a patient that a cancer diagnosis might have been preventable if not for a host of lifestyle decisions. By sidestepping a conversation about risk factors we miss an important opportunity for educating the patient, concerned relatives and the broader community.

The conversation about cancer has always been framed as a battle. With its powerful imagery of productive lives laid to ruin cancer evokes fear, powerlessness and devastation like none else. It is widely perceived as a mysterious, insidious, and ultimately hopeless condition. For a disease where the patient never feels in charge, what the Australian researchers provide us is hope. Hope that knowing the risk factors is a step towards modifying them. Hope that like other diseases we have demystified, there are things we can do to prevent cancer.

While some of us have heard of someone who never smoked or drank, ran marathons and still got cancer, we all know someone who was obese or smoked or drank excessively who got cancer. Everyone deserves our sympathy and understanding but it would be even better if their experiences taught us something. A striking proportion of cancers are preventable. We ought to be grateful to the Australian researchers for showing us the way.

  • Ranjana Srivastava is an oncologist and a Guardian Australia columnist