Tag Archives: treating

Why treating your depression is like learning your times tables | Rhiannon Lucy Cosslett

In my first year of university, just after I had been prescribed fluoxetine for depression, I had an argument about it with a close friend. He told me that taking antidepressants would make my feelings false, my emotions manufactured. I wouldn’t be able to tell if what I was feeling was real – and that was wrong. At the time I did not know how to articulate that all of our feelings are linked to chemicals: that even eating a chocolate bar can give me a blood-sugar spike and alter my behaviour, that feeling the sunshine on my skin can give me hope and energy. Furthermore, that the contraceptive pills his girlfriend took were liable to make them angry, not to mention less horny. I did not know how to say that the antidepressant I took in order to cope with my life was not that different to the ketamine and cocaine he used to cope with his. In any case, it was a pretentious argument of the kind one has at university, and both of us lacked the scientific knowledge to really underpin our views. It was all posturing.


Once I accepted that I needed help and began treatment, I felt calmer within a week

I think of it now because antidepressants are in the news again: whether they work or don’t work, whether other treatments – therapy, mindfulness, exercise, volunteering, being a 96-year-old Italian with a diet of fish and olive oil – are more effective than that “magic” pill. The chemical imbalance theory is posited, then debunked, in a never-ending cycle, as we, the mentally ill and medicated, watch on with hope but also exasperation. Because for all the scientific advances, therapeutic studies and happiness indexes, the only thing an individual can say with any certainty is whether or not antidepressants worked for them.

One day a week, I help to edit the Guardian letters and leaders pages. Recently, readers have been writing in to tell us the methods that helped them learn their times tables. It struck me, reading these letters, how different our brains are from one another. One person would write in with a “fail-safe” method for learning, say, the nine times table. Others would reply saying it was no use, and suggest another method they thought would work for everyone.

The diversity of human thought processes is a reason why I tend not to invest too much in any one person’s answer to mental health problems. Maybe yoga, or some kind of therapy, worked for you. What has worked for me, three times now, is antidepressants. First fluoxetine, then, five years later, escitalopram. Then, another five years later, following another, milder trauma which prodded the previous one awake and caused severe agoraphobia, citalopram. (I am trying not to think that A Bad Thing will occur every five years for the rest of my life, because that is the kind of pessimism that my CBT therapist has taught me to avoid).

Yes, I’ve had therapy too, and it’s been incredibly helpful. I’m lucky that I had access to free trauma-focused CBT without too much of a wait. What an unbelievable privilege that is. But what really helped when my brain was misfiring to the point where terror existed in every aspect of my life – where I would stand in my back garden (the only place that I could go, most days) and worry that the planes overhead might fall from the sky – was antidepressants. I say this because I would not want anyone, going through anything similar, to resist for as long as I did, out of some intangible belief that drugs were bad and I could cope with constant fear on my own. Once I accepted that I needed help and began treatment, I felt calmer within a week.

Perhaps they’ll work for you, and your nine times table will click into place. Perhaps not. All I know is that I’m glad I didn’t listen to my friend – who I think has now changed his tune, anyway – about “manufactured emotions”. It is true that antidepressants can have a deadening affect (they are terrible for writing fiction, but great for editing, I have found). Coming off them now, I’ve been hit anew with feelings of grief about things that have happened in my past. I feel anger, too, towards certain people, and fear that bad things will happen – but in a way that is now manageable as opposed to paralysing. These are all things I have not allowed myself to feel for a long time. They are part of living. But for stretches of time, I’ve had to control them in order to live. And now I’m alive.

So yes, they work for me. Maybe they will for you; maybe they won’t. But amid the noise, it’s easy to forget that it’s your decision to try or not. No one else’s.

Rhiannon Lucy Cosslett is a novelist and Guardian columnist

In the UK, Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Other international suicide helplines can be found at www.befrienders.org

This may be a turning point in treating neurodegenerative diseases

They are diseases that threaten more than physical health: memories, personality, and the ability to move and speak are incrementally stolen. And until this year neurodegenerative diseases, from Alzheimer’s to ALS, had been entirely unstoppable.

However, a breakthrough in Huntington’s disease this week suggests this bleak picture could be about to change. The landmark trial was the first to show that the genetic defect that causes Huntington’s could be corrected, raising hopes that the drug will become the first to slow the progress of the disease – or even stop it.

The Huntington’s results alone would have been remarkable enough, but they come just a month after the same experimental class of drugs were revealed to help patients with a different degenerative disease, called Spinal Muscular Atrophy (SMA). Babies with the most severe form of SMA normally never develop the strength to sit up or roll over, but after four years on the drug, some of these children are starting to stand and take their first steps with a walker.

Q&A

What is Huntington’s disease?

Huntington’s disease is a congenital degenerative condition caused by a single defective gene. Most patients are diagnosed in middle age, with symptoms including mood swings, irritability and depression. As the disease progresses, more serious symptoms can include involuntary jerky movements, cognitive difficulties and issues with speech and swallowing.

Currently there is no cure for Huntington’s, although drugs exist which help manage some of the symptoms. It is thought that about 12 people in 100,000 are affected by Huntington’s, and if a parent carries the faulty gene there is a 50% chance they will pass it on to their offspring. 

The two trials have triggered a wave of optimism that drugs built on similar principles could be used to target a wide range of deadly brain disorders, possibly even Alzheimer’s and Parkinson’s. “I don’t want to overstate this too much, but this could be a turning point,” said Prof John Hardy, a neuroscientist at University College London who was awarded the Breakthrough prize for his work on Alzheimer’s.

Hardy describes the results as potentially the biggest advance for neurodegenerative disease in 50 years. “If it’s worked for one, why can’t it work for a lot of them? I am very, very excited,” he added.

The power of this new class of drugs – called antisense oligonucleotides – comes from their unique ability to home in on genetic flaws and shut down their destructive effects at source. They work by intercepting messenger molecules known as RNA, which are responsible for translating instructions in the genetic code into proteins.

The synthetic DNA used in the treatments can be built in the lab, like Lego, meaning that scientists can now use nature’s own machinery to intervene and switch the production of proteins on and off.

In Huntington’s, the drug called Ionis-HTTRx works by killing off the messenger molecule that is responsible for producing a toxic protein called huntingtin. A larger trial is expected to show whether this also slows or reverses the progression of the disease.

The SMA drug, Nusinersen, has already crossed this milestone. When babies were injected with the medicine in a phase 3 trial, they not only stabilised but began to gain strength. In fact, the success was so striking that the trial was stopped early so the babies who had been placed on a placebo treatment could be immediately switched to the drug.

“It’s a sentinel moment,” said Richard Finkel, the paediatric neurologist at the Nemours Children’s Hospital in Orlando, Florida, who led the trial. “Having spent 30 years telling parents that we had nothing to offer their baby except for comfort care, basically sending them home with a death sentence, having something that can be offered to them is remarkable. It’s not a cure, but it’s a great first step.”

The SMA drug works in the reverse direction – instead of blocking the production of a bad protein, it manages to restore the body’s ability to make a protein that is essential for the survival of neurons in the base of the brain and spinal cord.

Huntington’s graphic

Preliminary results from a new trial suggests that when the drug is given before symptoms appear (typically about three months old) its effects can be even more profound. Babies in the latest trial, who were given the drug from shortly after birth, are, incredibly, showing no physical signs of their illness.

They have learned to sit and roll over, and two of the three babies Finkel is treating were walking at their first birthday. “The [third one] is a little hesitant, but she’s healthy as can be,” he said. “These babies are doing remarkably well.”

Finkel said there is now a strong case for adding SMA to the panel of diseases such as cystic fibrosis that are routinely screened for at birth because, for the first time, there is a treatment.

Since bad proteins, or missing proteins, lie at the heart of all neurodegenerative diseases, a race is now underway to find new targets that synthetic DNA drugs could be applied to.

A protein called synuclein is implicated in Parkinson’s and the production of amyloid and tau are known to run out of control in Alzheimer’s and some other dementias. However, it is not yet clear whether blocking these substances in the brain will help – and the many previous drugs aimed at doing so have failed in clinical trials.

Prof Sarah Tabrizi, director of University College London’s Huntington’s Disease Centre who led the trial.


Prof Sarah Tabrizi, director of University College London’s Huntington’s Disease Centre who led the trial. Photograph: David Bishop, UCL Health Creatives

Tim Miller, David Clayson professor of neurology at Washington University in St Louis, led the preclinical testing of a drug aimed at lowering tau in the brain. In mice, it reversed the animals’ brain damage, halted memory loss and extended their lives.

The biotech company Ionis, which was behind the Huntington’s success, is now carrying out a clinical trial of the treatment in early Alzheimer’s patients that is expected to end in 2020.

Miller describes the recent results in SMA and Huntington’s as a “massive deal”, that have added to his confidence in trying the approach for other degenerative diseases. He is also involved in a trial for a genetic form of ALS. “We don’t know whether there will be success yet,” he said. “I want to be a little bit careful, because we just don’t know yet.”

If the drugs were ultimately shown to help treat the kinds of dementias that affect millions of people, it would pose a new problem of economics rather than science.

DNA strands cannot be conveniently packaged into a pill form, and the drugs have to be spinally injected in order to have an impact in the brain. In a recent talk, Hardy estimated the current cost of treating a single patient with this kind of drug at $ 750,000 per year. Of course, the figure would come down if more patients were treated, he said, but from a high starting point. There would also be the question, ethical and economic, of whether treatments that just slowed the progress of dementia, potentially prolonging the period of decline, could be justified.

“These are very complicated questions,” said Hardy. “It’s going to be a challenge for neurologists and the health service in general.”

Treating a dying child made me reflect on my role as a paramedic

We arrived at the scene in an ambulance to see the usual collection of bystanders clustered around a body. It was a child. She was still alive. A pale grey face, mumbling and moaning, eyes half shut and flickering. There was blood pooling from a wound to the back of her head and one of her legs was facing the wrong way.

The five-year-old girl had been struck by a car. The driver hadn’t been speeding or driving recklessly. The road was quiet. She had been out on her scooter. Suddenly, with a child’s spontaneity, she rode her scooter off the pavement and onto the road. The driver didn’t have time to brake.

We started high-flow oxygen and inserted a plastic airway into her mouth to stop her tongue blocking her airway, taking extreme care not to move her head in case she had a spinal injury. A dressing was placed under her head and her leg was realigned to a neutral position to prevent further tissue damage. Although she was breathing and her lungs sounded normal, we placed a bag valve mask over her mouth.

I shone a light into the child’s eyes. The right pupil was fixed and dilated. I advised the rest of the team of my finding and a colleague started to cry as she knew it meant bad news.

When the helicopter arrived, the doctor administered anaesthetic drugs and passed a tube down the child’s throat to manually control her breathing.

At some point the parents arrived. I can’t remember when, but it was before the helicopter had landed. I remember the mother running up to our huddle of green paramedic shirts and seeing her daughter lying there, her hands clamping over her mouth in horror. I cannot begin to imagine what she was going through. Seeing your small child, grey, moaning, bleeding and unable to respond to you is something no parent should experience. We encouraged her to kneel next to her daughter’s head, hold her hand and keep talking to her. Even now, years later, I’m crying while typing this.

As the crescendo of the ascending helicopter became a distant clatter I reflected on the picturesque setting. This was a tranquil village – in complete contrast to the trauma that had unfolded at its centre.

In the post adrenaline-fuelled, great-team-work atmosphere we bantered with each other. There was dark, dark humour as we checked over our shoulders to make sure the bystanders were out of range. Lots of swearing and jokes that only paramedics remain hardened to. Each of us adding another layer of veneer to shield our bravado.

After a quick debrief back at base we were back on the road, dealing with all the usual mundane shit.

I thought I would be ok.

When I got home my seven-year-old wanted to dance with me in the kitchen while my wife was preparing dinner. I remembered how three short years ago he had been riding his green scooter around our neighbourhood, carefree and happy, jumping off curbs crying: “Watch me do this, watch me do this.”

During dinner I held his hands and remembered how I had held smaller hands a few hours earlier, my blue examination gloves sticky with blood.

I remember an anecdote about a city where the ambulance service went on strike. The police were called upon to fill the gap in emergency medical response. When someone dialled the emergency number they would turn up, throw the patient in the back of a police car, no matter how serious the condition, and rush them to hospital. It was reported that patient survival rates significantly increased during this period, which caused the public to question the utility of the ambulance service.

I was left with similar questions. Two ambulances and a helicopter didn’t make any real difference to the outcome for this little girl. We made a difference to the parents and the bystanders. For as long as we were still treating their child, they held on to the fragile hope that everything would be ok in the end.

I guess sometimes that’s the only difference you can make.

Some details have been changed.

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Labour accuses Tories of treating GP services with astonishing neglect

Labour has accused the government of treating GP services with astonishing neglect, as the party released an analysis that showed millions of patients have worse access to their family doctor than five years ago.

The shadow health secretary, Jonathan Ashworth, said a study of the GP patient surveys showed access to surgeries had got worse every year since 2012, when measuring how people feel about their local practices.

He said the analysis demonstrated the effects of sustained underfunding of primary care services under the Conservatives, despite the government’s claims to be moving toward better round-the-clock access to GPs.

“This research exemplifies just how hard it is becoming to see a GP in Tory Britain, with patients’ overall experience of their GP services getting drastically worse,” Ashworth said.

“Overworked and underfunded GPs are struggling to cope with rising needs from patients. Across the country GPs and practice staff are working to keep the service running in the face of astonishing neglect from Theresa May and her ministers.”

The survey for this year showed only 68% of people found it easy to get through to their surgery by phone compared with 79% in 2012. It also showed a rise in the number of people who were unable to get appointments at all, up from 8.9% to 11.3% of those surveyed.

Other findings included a 7% increase in patients waiting a week or more until they saw their GP or nurse and a fall of 10% in patients regularly able to see or speak to their preferred doctor. There were also small rises in people finding their experiences of making an appointment fairly poor or very poor, and patients saying they have to wait far too long for an appointment.

“The British public deserves better. Labour would give GPs the resources and support they need to provide better and more accessible services for patients,” Ashworth said.

A Department of Health spokeswoman highlighted an “extra £2.4bn of funding for general practice and 5,000 more GPs by 2020”.

She said: “Patients deserve to be able to get the right care at the right time for them and 17 million people are already able to make a routine appointment with a GP at evenings and weekends.”

Labour accuses Tories of treating GP services with astonishing neglect

Labour has accused the government of treating GP services with astonishing neglect, as the party released an analysis that showed millions of patients have worse access to their family doctor than five years ago.

The shadow health secretary, Jonathan Ashworth, said a study of the GP patient surveys showed access to surgeries had got worse every year since 2012, when measuring how people feel about their local practices.

He said the analysis demonstrated the effects of sustained underfunding of primary care services under the Conservatives, despite the government’s claims to be moving toward better round-the-clock access to GPs.

“This research exemplifies just how hard it is becoming to see a GP in Tory Britain, with patients’ overall experience of their GP services getting drastically worse,” Ashworth said.

“Overworked and underfunded GPs are struggling to cope with rising needs from patients. Across the country GPs and practice staff are working to keep the service running in the face of astonishing neglect from Theresa May and her ministers.”

The survey for this year showed only 68% of people found it easy to get through to their surgery by phone compared with 79% in 2012. It also showed a rise in the number of people who were unable to get appointments at all, up from 8.9% to 11.3% of those surveyed.

Other findings included a 7% increase in patients waiting a week or more until they saw their GP or nurse and a fall of 10% in patients regularly able to see or speak to their preferred doctor. There were also small rises in people finding their experiences of making an appointment fairly poor or very poor, and patients saying they have to wait far too long for an appointment.

“The British public deserves better. Labour would give GPs the resources and support they need to provide better and more accessible services for patients,” Ashworth said.

A Department of Health spokeswoman highlighted an “extra £2.4bn of funding for general practice and 5,000 more GPs by 2020”.

She said: “Patients deserve to be able to get the right care at the right time for them and 17 million people are already able to make a routine appointment with a GP at evenings and weekends.”

Labour accuses Tories of treating GP services with astonishing neglect

Labour has accused the government of treating GP services with astonishing neglect, as the party released an analysis that showed millions of patients have worse access to their family doctor than five years ago.

The shadow health secretary, Jonathan Ashworth, said a study of the GP patient surveys showed access to surgeries had got worse every year since 2012, when measuring how people feel about their local practices.

He said the analysis demonstrated the effects of sustained underfunding of primary care services under the Conservatives, despite the government’s claims to be moving toward better round-the-clock access to GPs.

“This research exemplifies just how hard it is becoming to see a GP in Tory Britain, with patients’ overall experience of their GP services getting drastically worse,” Ashworth said.

“Overworked and underfunded GPs are struggling to cope with rising needs from patients. Across the country GPs and practice staff are working to keep the service running in the face of astonishing neglect from Theresa May and her ministers.”

The survey for this year showed only 68% of people found it easy to get through to their surgery by phone compared with 79% in 2012. It also showed a rise in the number of people who were unable to get appointments at all, up from 8.9% to 11.3% of those surveyed.

Other findings included a 7% increase in patients waiting a week or more until they saw their GP or nurse and a fall of 10% in patients regularly able to see or speak to their preferred doctor. There were also small rises in people finding their experiences of making an appointment fairly poor or very poor, and patients saying they have to wait far too long for an appointment.

“The British public deserves better. Labour would give GPs the resources and support they need to provide better and more accessible services for patients,” Ashworth said.

A Department of Health spokeswoman highlighted an “extra £2.4bn of funding for general practice and 5,000 more GPs by 2020”.

She said: “Patients deserve to be able to get the right care at the right time for them and 17 million people are already able to make a routine appointment with a GP at evenings and weekends.”

Labour accuses Tories of treating GP services with astonishing neglect

Labour has accused the government of treating GP services with astonishing neglect, as the party released an analysis that showed millions of patients have worse access to their family doctor than five years ago.

The shadow health secretary, Jonathan Ashworth, said a study of the GP patient surveys showed access to surgeries had got worse every year since 2012, when measuring how people feel about their local practices.

He said the analysis demonstrated the effects of sustained underfunding of primary care services under the Conservatives, despite the government’s claims to be moving toward better round-the-clock access to GPs.

“This research exemplifies just how hard it is becoming to see a GP in Tory Britain, with patients’ overall experience of their GP services getting drastically worse,” Ashworth said.

“Overworked and underfunded GPs are struggling to cope with rising needs from patients. Across the country GPs and practice staff are working to keep the service running in the face of astonishing neglect from Theresa May and her ministers.”

The survey for this year showed only 68% of people found it easy to get through to their surgery by phone compared with 79% in 2012. It also showed a rise in the number of people who were unable to get appointments at all, up from 8.9% to 11.3% of those surveyed.

Other findings included a 7% increase in patients waiting a week or more until they saw their GP or nurse and a fall of 10% in patients regularly able to see or speak to their preferred doctor. There were also small rises in people finding their experiences of making an appointment fairly poor or very poor, and patients saying they have to wait far too long for an appointment.

“The British public deserves better. Labour would give GPs the resources and support they need to provide better and more accessible services for patients,” Ashworth said.

A Department of Health spokeswoman highlighted an “extra £2.4bn of funding for general practice and 5,000 more GPs by 2020”.

She said: “Patients deserve to be able to get the right care at the right time for them and 17 million people are already able to make a routine appointment with a GP at evenings and weekends.”

Labour accuses Tories of treating GP services with astonishing neglect

Labour has accused the government of treating GP services with astonishing neglect, as the party released an analysis that showed millions of patients have worse access to their family doctor than five years ago.

The shadow health secretary, Jonathan Ashworth, said a study of the GP patient surveys showed access to surgeries had got worse every year since 2012, when measuring how people feel about their local practices.

He said the analysis demonstrated the effects of sustained underfunding of primary care services under the Conservatives, despite the government’s claims to be moving toward better round-the-clock access to GPs.

“This research exemplifies just how hard it is becoming to see a GP in Tory Britain, with patients’ overall experience of their GP services getting drastically worse,” Ashworth said.

“Overworked and underfunded GPs are struggling to cope with rising needs from patients. Across the country GPs and practice staff are working to keep the service running in the face of astonishing neglect from Theresa May and her ministers.”

The survey for this year showed only 68% of people found it easy to get through to their surgery by phone compared with 79% in 2012. It also showed a rise in the number of people who were unable to get appointments at all, up from 8.9% to 11.3% of those surveyed.

Other findings included a 7% increase in patients waiting a week or more until they saw their GP or nurse and a fall of 10% in patients regularly able to see or speak to their preferred doctor. There were also small rises in people finding their experiences of making an appointment fairly poor or very poor, and patients saying they have to wait far too long for an appointment.

“The British public deserves better. Labour would give GPs the resources and support they need to provide better and more accessible services for patients,” Ashworth said.

A Department of Health spokeswoman highlighted an “extra £2.4bn of funding for general practice and 5,000 more GPs by 2020”.

She said: “Patients deserve to be able to get the right care at the right time for them and 17 million people are already able to make a routine appointment with a GP at evenings and weekends.”

Labour accuses Tories of treating GP services with astonishing neglect

Labour has accused the government of treating GP services with astonishing neglect, as the party released an analysis that showed millions of patients have worse access to their family doctor than five years ago.

The shadow health secretary, Jonathan Ashworth, said a study of the GP patient surveys showed access to surgeries had got worse every year since 2012, when measuring how people feel about their local practices.

He said the analysis demonstrated the effects of sustained underfunding of primary care services under the Conservatives, despite the government’s claims to be moving toward better round-the-clock access to GPs.

“This research exemplifies just how hard it is becoming to see a GP in Tory Britain, with patients’ overall experience of their GP services getting drastically worse,” Ashworth said.

“Overworked and underfunded GPs are struggling to cope with rising needs from patients. Across the country GPs and practice staff are working to keep the service running in the face of astonishing neglect from Theresa May and her ministers.”

The survey for this year showed only 68% of people found it easy to get through to their surgery by phone compared with 79% in 2012. It also showed a rise in the number of people who were unable to get appointments at all, up from 8.9% to 11.3% of those surveyed.

Other findings included a 7% increase in patients waiting a week or more until they saw their GP or nurse and a fall of 10% in patients regularly able to see or speak to their preferred doctor. There were also small rises in people finding their experiences of making an appointment fairly poor or very poor, and patients saying they have to wait far too long for an appointment.

“The British public deserves better. Labour would give GPs the resources and support they need to provide better and more accessible services for patients,” Ashworth said.

A Department of Health spokeswoman highlighted an “extra £2.4bn of funding for general practice and 5,000 more GPs by 2020”.

She said: “Patients deserve to be able to get the right care at the right time for them and 17 million people are already able to make a routine appointment with a GP at evenings and weekends.”

Labour accuses Tories of treating GP services with astonishing neglect

Labour has accused the government of treating GP services with astonishing neglect, as the party released an analysis that showed millions of patients have worse access to their family doctor than five years ago.

The shadow health secretary, Jonathan Ashworth, said a study of the GP patient surveys showed access to surgeries had got worse every year since 2012, when measuring how people feel about their local practices.

He said the analysis demonstrated the effects of sustained underfunding of primary care services under the Conservatives, despite the government’s claims to be moving toward better round-the-clock access to GPs.

“This research exemplifies just how hard it is becoming to see a GP in Tory Britain, with patients’ overall experience of their GP services getting drastically worse,” Ashworth said.

“Overworked and underfunded GPs are struggling to cope with rising needs from patients. Across the country GPs and practice staff are working to keep the service running in the face of astonishing neglect from Theresa May and her ministers.”

The survey for this year showed only 68% of people found it easy to get through to their surgery by phone compared with 79% in 2012. It also showed a rise in the number of people who were unable to get appointments at all, up from 8.9% to 11.3% of those surveyed.

Other findings included a 7% increase in patients waiting a week or more until they saw their GP or nurse and a fall of 10% in patients regularly able to see or speak to their preferred doctor. There were also small rises in people finding their experiences of making an appointment fairly poor or very poor, and patients saying they have to wait far too long for an appointment.

“The British public deserves better. Labour would give GPs the resources and support they need to provide better and more accessible services for patients,” Ashworth said.

A Department of Health spokeswoman highlighted an “extra £2.4bn of funding for general practice and 5,000 more GPs by 2020”.

She said: “Patients deserve to be able to get the right care at the right time for them and 17 million people are already able to make a routine appointment with a GP at evenings and weekends.”