Depression
COURSE
Understand and Prevent Depression
(51) Depression
OCD - Obsessive Compulsive Disorder (Video)
What is Obsessive-Compulsive Disorder (OCD)?
Obsessional compulsive state
The word ‘obsessional’ is overused. In psychiatry it can be applied in three clear settings:
• An obsessional compulsive neurosis. This is an illness in its own right;
• An obsessional symptom. This can occur in many mental illnesses, e.g. anxiety states and eating disorders. People with anorexia nervosa may feel the need to know the exact calorific content of each food they are eating or cut up their food in a particular way.
• An obsessional personality type This is a way of describing people of particular personality who may then go on to develop an obsessional compulsive neurosis. To have some features of obessionalism in your character can be very useful. Obsessional people tend to be careful, do not take undue risks, check what they are doing and set themselves high standards. The negative side of this personality profile is that it means you may be less flexible, and deal less well with change – there is a need to feel in control.
Obsessions are recurring and persistent ideas, images or impulses that the person experiencing them knows are irrational and sometimes absurd. They are fully aware that the thoughts come from their own mind. They attempt to resist the thoughts and it causes suffering. The thoughts can recur hundreds of times a day.
Compulsions are the actions that a person with obsessive compulsive disorder (OCD) feel that they must, reluctantly, perform, for example washing hands for fifteen minutes after using the lavatory. There is a compulsion plus a desire to resist it (which causes mounting agitation and unpleasant tension). There is a big overlap between OCD, depression and anxiety. Very often elements of all three illnesses are seen in OCD.
I have been told that I have OCD. What causes it?
We believe that OCD is caused by abnormalities in the dopamine system of the brain. This chemical abnormality can be seen using special PET (positron emission tomography) scans.
Can it be treated?
OCD is successfully treated with behaviour and drug therapies. As you improve, not only do you function much better but, if a PET scan is repeated, it reverses. This is an exciting finding and one of the very few illnesses in psychiatry where we can ‘track’ the chemical imbalance. In the future, we may well be able to do the same with other psychiatric illnesses.
Behaviour therapy is very helpful. Several approaches are taken:
• Response prevention is a behaviour therapy technique in which you are gently prevented from performing rituals.
The therapist might also help ‘model’ new responses – perhaps dirtying hands and waiting a long time before washing them again. The sufferer is encouraged to do likewise.
• Recurring thoughts can be more difficult to treat than the actions. Thought stopping, however, can be very helpful. You need a loose-fitting elastic band on your wrist. When the unwanted thought occurs, you say ‘Stop’ and ‘ping’ the band. This stings your skin a little, and stops your thoughts. You then try breathing more smoothly and deeply; meanwhile you can either ‘ground’ yourself in the here and now, and look, listen and become very aware of your surroundings – the colours in the room, the feel of the chair you are sitting on, and so on. This technique pulls you back from going over and over your thought and you replace it with an awareness of your surroundings. The thought will recur – you then need to repeat the process. If you prefer, instead of really being in the present, you can imagine (in detail) the scene on your favourite beach. You can become very skilled at this with practice. A yoga teacher can help teach this method.
• Cognitive behaviour therapy is much less effective in OCD than behaviour therapy.
What drugs will I be given?
Clomipramine is a long-established tricyclic antidepressant that is useful in OCD. The dose can be slowly and steadily increased as necessary. It has calming, anti-obsessional effects. The newer SSRIs like fluoxetine (Prozac), citalopram (Cipramil) and paroxetine (Seroxat) all have anti-obsessional effects. None of the group has been found to be more effective than another, but you may find that you can tolerate one particular drug better. The dose of drug used to treat OCD tends to be higher than the dose used in depression. The antiobsessional effect may not clear for up to 7 or 8 weeks. It is worth trying to be patient. Before the anti-obsessional effect is seen, some of the unpleasant tension, anxiety and low mood, which so often accompany OCD, may well show a good improvement.
Drug treatment and behaviour therapy are equally effective. There is, as yet, no research evidence to say that combining drug therapy with behaviour therapy is better still, but clinical experience suggests that it may be.
(52) Depression
The Truth about Depression BBC Full Documentary 2013
AWARE – Helping to defeat depression
Association for Postnatal Illness (APNI)
Ketamine: The Future of Depression Treatment?
The future
Neuroscience research is one of medicine’s new frontiers. Today’s latest scanners and neurochemistry labs tell us a wealth of information about how the brain actually works. Antidepressants work for most people but, like all drugs, they do have some sideeffects.
We can expect future generations of antidepressants to become increasingly sophisticated, more effective with fewer side-effects.
We will have more choice of medication, and a better understanding of matching the patient’s needs to the drug’s profile. The human genome project is helping us understand much more about the effect that genetics – your family history – has on the individual.
Research into talking treatments, counselling and psychotherapy is more difficult in practical terms than testing out a new drug.
We do have clear evidence that cognitive behaviour therapy and behaviour therapy are effective treatments and they are much easier to evaluate. You can’t do cognitive behaviour therapy or counselling in a test tube.
The Health Service, however, recognises the importance of providing care that is both good value and effective for people, and evidence is constantly gathered and sifted to tell us which therapy is the most effective. So stronger evidence for – and against – today’s treatments is always emerging.
The importance of research evidence also applies to alternative therapies. They too must be scrutinised for safety and costeffectiveness, just as rigorously as any other medication. St John’s wort is a good example of a herbal remedy that is a potent antidepressant – and which can interact harmfully when misused.
It may well become prescribable before long. Apart from newer drugs and the right sort of counselling, are there any different, more radical approaches to treatment?
Vagal nerve stimulation (VNS) and transcranial magnetic stimulation (TMS) are two recently invented rather remarkable methods of affecting brain function that have shown some promise in early trials for the treatment of resistant depression.
VNS involves the implantation of a pacemaker-like device in the chest wall, which is then connected to the vagal nerve in the neck. A tiny pulse of electricity is passed up this nerve into the limbic regions of the brain every 5 minutes for 30 seconds. VNS is becoming an established treatment for intractable epilepsy and is very safe. Some preliminary research has indicated that it may be an effective treatment for severe and resistant depression as well.
However a great deal more research is needed. TMS involves the application in pulses of a very strong, but much focused, magnetic field to parts of the brain. In depressive illness, the frontal regions of the brain are targeted. The TMS causes local inhibition of function (so, for example, if this is applied over the area of brain causing movement, a brief localised paralysis results). There is some published research indicating its effectiveness in depression, but more work is needed before it can be regarded as a reliable treatment. It does not seem, however, to hold out the hope of helping people with psychotic depression.
Should I take part in research programmes? My doctor has suggested that I might like to help with a trial of some new medication.
All prescribed medication has to be exhaustively tested, first in laboratories then on human volunteers. Without the people who have helped test medication, there would be no therapeutic drugs at all. So I’m in favour of all of us helping with scientific research, for the sake of each other. You will be thoroughly informed about exactly what you are taking, what possible side-effects there may be, and what benefits to expect. Your fully informed consent is necessary before you can be included in any clinical trials, and no one will expect you to take part in anything that you are not happy about.
What constitutes good scientific evidence for a treatment’s benefits?
The gold standard is a double-blind, cross-over trial, comparing an active ingredient to a placebo (an inert substance) on twogroups of carefully matched volunteer patients. ‘Double-blind’ means that neither the volunteer patient nor the doctor involved knows which people receive the active drug. ‘Cross-over’ means that the two groups of people swap treatments halfway through the trial, so that both groups have had the same intervention.
This can be quite difficult to do for some psychiatric treatments; how do you compare counselling with an inert substance, for example? How do you evaluate the effect of personal contact?
So there are many other sorts of trial, and of course talking to our patients can teach us more than anything else.
How ‘powerful’ a trial is (that is, how much importance you can attach to its findings) will depend on how many people are involved in it. If the research is looking for a fairly rare occurrence, large numbers of people may be needed in the trial and ‘control’ groups to be sure that the difference in these groups has not merely arisen by chance.
The most powerful evidence comes from ‘meta-analyses’ where the results of a number of trials (which must have identical rules) can be added together.
Aren’t there too many new drugs around for you to know the evidence about all of them?
A national body called ‘NICE’ (the National Institute for Clinical Excellence) has recently been formed to consider the evidence and form guidelines about new treatments, especially where a treatment is expensive or controversial. They publish guidelineson what is good practice.
The NHS has to be concerned not only with finding out what treatment works the best, but also with obtaining best value for money – the most cost-effective – so that our resources are not wasted on less effective treatments and so enabling more people to be treated. Most of NICE’s work so far has been on expensive new treatments where there is some controversy, such as Aricept, the new treatment for Alzheimer’s.
Bandolier is a fascinating medical journal published on the Internet, which is building up an ever increasing evidence base of good clinical trials. Currently there are more than 300 online journals participating. The Cochrane Collaboration is a group of enthusiasts who promote evidence-based medicine, and collect good quality clinical trial information.
(53) Depression
What is depression? - Helen M. Farrell (Video)
USA NATIONAL INSTITUTE OF MENTAL HEALTH - DEPRESSION
What are emotions, and why do we have them?
No absolutely agreed on definition for emotions exists. Many dictionaries refer to “feelings” or “moods” when defining the word; this further begs the question of what they are. Scientists who attempt to study emotional phenomena characterize them in terms of their particular interest, and thus, definitions change depending on whether the scientist is studying the biological, psychological, or social basis of emotions. This, of course, further complicates the understanding of emotions.
Historically, the mind was thought to be separate from the body and part of the soul. In fact, psyche is the Greek root for “soul.” With the advent of a more scientific understanding of the brain and mind, some scientists attempt to liken the mind to software and the brain to hardware. In actuality, however, it is not quite so simple. A simultaneous change in brain activity accompanies every change in thought, feeling, perception, or action. Today, scientists increasingly appreciate the fact that no sharp demarcation exists between the brain and the mind.
Despite the fact that mind and brain are essentially unified, drawing a boundary between the two allows for practical differences between them to be conceptualized in everyday lives. For example, such a boundary permits distinction between acts and motives. Distinguishing acts from motives helps with negotiation through everyday social interactions. For example, consider the feelings generated when standing in line and having your toes stepped on.With the immediate sensation of pain comes the feelings of shock, surprise, and probably anger. The feelings experienced are immediately followed by an assessment of the person’s motives or state of mind. Action on that assessment is guided by feelings. Emotions therefore serve to engage the body to act in some manner. The manner on which an action is taken usually carries some survival value to a given individual. Thus, lack of emotions could be likened to the lack of physical pain sensation. There would be numbness to the environment and thus problems in interacting with it appropriately. Without the ability to feel anger, joy, sorrow, fear, or love, humans would be incapable of generating priorities to action. Emotions help to prioritize-to decide when to act and when not to act. Without such abilities, choosing between arrays of decisions that are confronted on a daily basis would be unfeasible.
Words to Know
Addiction - A dependency on something that gives comfort. Usually refers to substances (legal or illegal), e.g. nicotine, alcohol, benzodiazepines, heroin, although the term is also used more loosely in connection with certain activities, e.g. gambling, overeating, workaholism, risk-taking, sexual behaviour - and even shopping. Addiction may be physical (involving your body) or psychological (involving the mind).
Affective disorder - A disturbance of emotion or mood. High, excited moods are found in manic states, and low moods are found in depressive illness. See also bipolar disorder, depression, hypomania, mania, manic depression.
Alzheimer’s disease - A progressive brain disorder, causing Dementia. This is commoner in old age and also in Down’s syndrome. It causes shrinkage and degeneration of brain tissue. The effects are increasing loss of memory and reasoning ability. Whilst there is no known cure, recently introduced drugs such as Aricept may slow the deterioration. analyst A therapist (customarily, but not always, a psychiatrist) who practises classical (psycho)analysis, as developed by Freud and his followers. Whilst this fascinating intellectual discipline was hugely influential in the birth of psychiatry and all the ‘talking treatments’, psychoanalysis plays little part nowadays in mainstream adult psychiatric treatment, not least because a course of analysis may take several years.
Anorexia nervosa - An eating disorder. Occurring mainly in adolescent girls (and less often in males), this consists of a distortion of body image so that the sufferer fears that she (or he) is unpleasantly fat. Despite all efforts at reassurance, the person will diet severely, losing over 15% of body weight and, in the case of females, periods will cease. Bulimia nervosa is a variation of anorexia. Both are serious and always warrant expert assessment.
Antidepressant - A class of drugs used to treat depression. Some types of antidepressants include tricyclics (TCAs), tetracyclics, monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), noradrenaline uptake reinhibitors (NARIs).
Anxiety - The natural response to any danger, threat or stress. Helps alert us to respond actively when under pressure; but, when it occurs out of context or in an exaggerated or disordered way, it can interfere with our daily lives. Anxiety frequently coexists with depression. See also generalised anxiety disorder, obsessive compulsive disorder, panic disorder, post-traumatic stress disorder.
Approved Social Worker (ASW) - A social worker with training in dealing with mental illness. Will play a key part in text procedures, as the person’s representative.
Art therapist - Art therapy may be used in hospital or be provided as part of a Community Mental Health Team’s resources. Drawing, painting, or other creative activities can be enjoyed at whatever level of ability. Sometimes it is easier to put emotion into paint or clay than into words, and quite a simple painting can be a real achievement. The work produced can be a powerful expression of feeling. Art therapists use art as a medium for therapy. atypical antipsychotic drugs A group of drugs recently evolved to treat psychotic illnesses. Though more costly than older drugs, they may have fewer side-effects. Amisulpiride, clozapine, olanzepine, quetiapine, risperidone and zotepine are in this group.
Benzodiazepine - A family of minor tranquillisers. Includes Valium (diazepam), Librium (chlordiazepoxide), temazepam and nitrazepam. Effective for short-term reduction of anxiety, and as sleeping tablets. Because of their addictive potential, they are recommended only for short-term relief (2-4 weeks only) of severe, disabling or distressing anxiety or insomnia. Tolerance can even develop quicker than this, within 3-14 days of use. Withdrawal from long-term use has to be in gradual steps of perhaps one-eighth of the daily dose per fortnight. This may take from 4 weeks to 1 year.
Bipolar affective disorder - Also called manic depressive illness, bipolar disorder is a mood disorder in which spells of high excited mood (hypomania or mania) occur, as well as spells of depression. Mood-stabilising medication, including lithium and carbamazepine, helps prevent these episodes. Brain scan CT (computerised tomography) and MRI (magnetic resonance imaging) brain scans can be helpful in studying the structure of the brain and spinal cord, where injury or other disease may be present.
Bulimia nervosa - An eating disorder, involving food bingeing, then vomiting and purging, in which there are periods of feeling out of control with eating. Binges of large volumes of food occur, with attendant guilt and misery. These may be followed by vomiting and use of laxatives to try and limit the weight gained.
Chronic fatigue syndrome - A condition of ‘severe, disabling fatigue, lasting at least 6 months, that affects both physical and mental functioning, and is present most of the time’. It may be triggered in a vulnerable person by a viral infection plus life stress, and it can lead to prolonged disability. Symptoms may include poor concentration, memory loss, sore lymph glands, muscle and joint pains, poor sleep, and exhaustion after exertion. Depression is often present. Evidence shows that prolonged rest is harmful. Graded exercise programmes and cognitive behavioural therapy have the highest success rates for treatment.
Cognitive behaviour therapy - A form of psychotherapy that concentrates on a person’s current thoughts and feelings, and how we can alter the direct effects of them by practising more positive attitudes. Has been shown to be effective in various conditions
including depression.
Community Psychiatric Nurse - A psychiatric nurse who works outside hospital. May be attached to a General Practice (GP) surgery or to a Community Mental Health Team. He or she may keep in touch with a caseload of people with ongoing psychiatric problems, and some will also take on individual counselling.
Counsellor - Someone who provides counselling. May be based in a GP surgery, practise as an independent (private) practitioner, or be attached to a charitable organisation. The most experienced ones will have a qualification issued by the British Association of Counsellors and Psychotherapists (BACP).
Craving - An overwhelming desire; associated with addictions.
Delusion - A fixed, irrational belief. May be a part of a psychosis. Examples are feelings that one is being controlled by others or is being persecuted, that one has some dreadful illness, or is a famous person.
Dementia - A deteriorating illness causing loss of all mental functioning (memory, personality and thinking ability) caused by degeneration of the brain. Alzheimer’s disease is one principal cause; repeated small strokes (multi-infarct dementia syndrome, MIDS) are another.
Depot injection - Some neuroleptic medication can be given in a slow release form, perhaps every 2-4 weeks, by deep intramuscular injection. This can be much more convenient than taking tablets daily. So far the newer, atypical drugs - with fewer side-effects - are not available in depot form.
Discontinuation syndrome - Some of the SSRI antidepressant drugs are associated with a group of symptoms that can occur when tablets are stopped or decreased suddenly. The symptoms can mimic anxiety. This does not mean that the illness is recurring but that the medication should be tailed off gradually, perhaps over 3-4 weeks.
Dopamine - A neurotransmitter that has an adrenaline-like action in the central nervous system.
Drama therapy - A form of psychotherapy that enables people to act out unspoken tensions and feelings, by playing through incidents or acting in roles, and having the content reflected back to them.
DSM4 - The American Psychiatric Association has produced this national manual of definitions of psychiatric illness.
ECT (electroconvulsive therapy)- A treatment for certain types of severe depression. It involves inducing a carefully controlled seizure while the patient is deeply asleep under a brief general anaesthetic. It is highly effective and has saved many lives.
EEG (electroencephalogram) - A recording made from electrodes applied to the scalp. It shows the levels of electrical activity in the brain and is helpful in diagnosing epilepsy, as well as other organic illness.
Group therapy - A powerful type of ‘talking treatment’. In contrast to one-to-one therapy or counselling, groupwork involves a number of people meeting regularly and working together on a common problem. Strict rules about confidentiality are usually agreed upon
(‘What you hear here, stays here’). and a facilitator may be present to see fair play. Members of groups help support each other and find solutions from their own experiences to others’ problems. Alcoholics Anonymous and Narcotics Anonymous, among others, use this format with good results.
Hallucination - A disturbance of one of the senses. A perception without a stimulus. May take the form of sights (e.g. visions), sounds (e.g. voices), touch, smells or tastes. Associated with psychotic illness, and can occur with both schizophrenic and bipolar disorders, as well as drug and alcohol misuse and withdrawal.
ICD10 - The International Classification of Disease is a classification of psychiatric illnesses. Produced by the World Health Organisation, it is designed to apply to every country in every major language. Like the DSM4, it can be used to help make a clear diagnosis from a group of symptoms, and also has information on some causes of illness.
Lithium - Lithium salts are used as mood stabilisers for bipolar – and sometimes unipolar – illness. It is also used in resistant depression. It is one of the few drugs that help prevent depressive illness. Blood tests are needed regularly.
Mania - A state of high excitement, with sleeplessness, flight of ideas, overactivity, and much mental energy and drive. Delusions and hallucinations can occur. Associated with bipolar disorder. The term hypomania is used for less severe forms of mania.
MAOI (monoamine oxidase inhibitor) - A class of antidepressant. Early MAOIs had serious potential dietary interactions, and people taking these had to avoid certain foods, but the most recent version (moclobemide) is more user-friendly.
USA Mental Health Act 1983 - This Act makes provision for the care of the psychiatrically ill. It defines when and how someone may be admitted to hospital under a compulsory order (known as a ‘Section’ procedure).
MIDS (multi-infarct dementia syndrome) - A cause of dementia, following a series of small strokes. See also Alzheimer’s disease.
NARI (noradrenaline re-uptake inhibitor) - A class of antidepressants that acts by reducing the rate at which noradrenaline is removed from the synapse.
Neuroleptics - Drugs used to treat psychotic illnesses. Also helpful with extreme anxiety states, and especially useful because they are not habit forming.
Neurology - The study of diseases of the nervous system.
Neuropharmacology - The study of drugs that affect the brain and nervous system.
Neurophysiology - The study of nervous system functioning. This includes the study of EEGs, nerve conduction and muscle studies.
Neuropsychiatry - The branch of medicine that spans psychiatry and neurology.
Neurosis - A group of mental illnesses, where contact is kept with reality. Examples are neurotic depression, anxiety, phobias and obsessional states. Sufferers experience normal emotions but in an exaggerated, inappropriate, even disabling, way, causing disruption and reduced levels of functioning. Unfortunately the term ‘neurotic’ has been devalued and has become insulting in general parlance.
Neurotransmitter - Chemicals that act between the ends of the nerve cells of the brain and spinal column to send messages – either to stimulate or to reduce activity – to different organs: nerves, muscles or glandular structures. Acetylcholine, dopamine, serotonin, adrenaline, GABA and noradrenaline are some of the main types. Antidepressants act by altering their levels, i.e. by inhibiting their reuptake (as do the SSRIs) or by reducing their breakdown rates (as do the MAOIs).
Noradrenaline - One of the key neurotransmitters.
Organic illness - A mental disturbance caused by a recognizable disease process. Conditions such as uncontrolled diabetes, severe urinary or chest infections, liver failure, head injury, epilepsy and drug withdrawal can all cause mental disturbances.
Panic disorder - A form of anxiety, where the sufferer suddenly experiences overwhelming anxiety and may feel that they are dying. These panic attacks can occur on a background of continuing anxiety. Palpitations (fast heartbeat), sweating and overbreathing can occur. Relaxation training, CBT, and antidepressant treatment are all effective.
Paranoia - A form of delusion, involving feelings of persecution or jealousy. May be part of a psychosis. The term ‘paranoid personality’ is used to describe a sensitive, suspicious personality type.
Parkinson’s disease - Caused by damage to dopamine-producing cells in a specific area of the brain, Parkinson’s disease causes a progressively stiff, slow, shuffling gait, with a ‘pill-rolling’ tremor of the hands, tiny handwriting, and a featureless, unsmiling face. Treatment is by increasing dopamine levels with drugs such as levodopa. It is associated with mood disorders, and can sometimes be associated with dementia.
Phobia - An excessive, irrational fear of some specific object or situation.
Psychiatrist - A medically trained doctor who has a special interest and further training in psychiatric illnesses and in dealing with emotional and behavioural disorders.
Psychoanalyst - A therapist who practises classical analysis. Based on Freud’s theory, this can consist of regular sessions over several years. Although the traditional image of the psychiatrist includes the patient lying on Freud’s couch, analysis is no longer part of mainstream psychiatric treatment.
Psychologist - A university graduate with a degree in the study of behaviour and its mental processes. Clinical psychologists are often part of hospital or community mental health teams. They may evaluate memory, intelligence, personality and emotions. Other branches of psychology include educational and industrial psychology.
Psychosis - A mental illness in which there is a loss of contact with reality, delusions, and an inability to see this as illness. There may also be hallucinations. Psychosis may be produced by many different causes: very severe depression, part of some physical illness, bipolar disorder, schizophrenia, schizoaffective disorder, and drug or alcohol abuse.
Psychotherapist - Someone who carries out talking therapy; or any of the many types of psychotherapy. These include cognitive behavioural therapy and interpersonal therapy.
PTSD (post-traumatic stress disorder) - Exposure to a severe trauma outside normal experience, which would cause suffering in almost everybody. It causes intense fear and helplessness, with nightmares and flashbacks, sometimes triggered later by less serious upsets. It leads to overarousal and sleep disturbance, with avoidance of situations that recall the trauma. Sufferers may overuse alcohol, making symptoms worse.
PubMed - This is a World Wide Web (WWW) retrieval service developed by the US National Library of Medicine. It provides access, free of charge, to MEDLINE, a database of more than 10 million health-related scientific publications. PubMed is an easy to-use search tool for finding medical research articles that have been published in peer-reviewed journals (i.e. scrutinised by experts). Users search by entering a few key words or phrases. Search on www.ncbi.nlm.nih.gov/PubMed/
Resistant depression - Depression which fails to respond to two courses of at least 8 weeks of full doses of antidepressants taken regularly. Management may involve combinations of treatments, e.g. CBT plus medication and addressing possible triggers.
RIMA (reversible inhibition of monoamine oxidase inhibitor) - A recently developed MAOI. This antidepressant has fewer food and drug interactions than the original versions.
UKRoyal College of Psychiatrists - The academic institution that sets national standards for psychiatric training. Entrance is by examination, and members will have the letters MRCPsych after their name. This qualification enables a doctor to follow a career in psychiatry. The College publishes two journals, the Psychiatric Bulletin and the British Journal of Psychiatry. These are accessible via PubMed.
Schizoaffective disorder - This illness involves a mixture of mood disorder plus some symptoms of schizophrenia; it has a better outcome than the latter condition.
Schizophrenia - This psychotic illness affects about 1% of the population. It varies in its severity and form. It is characterised by delusions, hallucinations (most often auditory or ‘voices’) and ideas of being controlled in mind or body.
Seasonal affective disorder (SAD) - Low moods associated with low levels of sunlight, e.g. during winter months. Light therapy may be helpful.
‘Section’ procedure - A compulsory admission procedure under the Mental Health Act. Usually involves two doctors, and an Approved Social Worker (ASW). Can only be used where a patient is a risk to their own health or to that of someone else, owing to a mental illness.
Section 12 Doctor - A doctor with experience in the diagnosis and management of mental illness, who is approved to take part in compulsory admission procedures under the Mental Health Act.
Sedation - Relaxing or calming someone who is distressed or agitated, e.g. with medication.
Serotonin - One of the brain’s main neurotransmitter chemicals. Low levels of serotonin are associated with depression. SSRI drugs work as antidepressants by increasing brain levels of serotonin.
Social phobia - A form of anxiety disorder, involving extreme shyness, and intense difficulty with being among other people. This condition may be quite disabling, and can lead to heavy alcohol use. Treatment with cognitive behaviour therapy and SSRIs is effective.
SSRI (selective serotonin re-uptake inhibitor) - A newer class of antidepressants. Safe in overdose, and has fewer contraindications and side effects than older antidepressants (TCAs, MAOIs), although more expensive.
Stress - Any change (whether physical, psychological or social, welcome or unwelcome) that requires us to adapt. Responses to stress may be useful or unhelpful, even damaging. Life without some stress would be unimaginable.
Synapse - The gap at the end of a nerve cell, through which neurotransmitters travel, sending impulses to other nerves, muscle or gland tissuee.
Syndrome - A collection of symptoms, which together are characteristic of a particular illness.
TCAs (tricyclic antidepressants) - These older drugs are as effective as any newer ones, but have different interactions or contraindications. For example, they should be used with caution if a patient has heart disease or glaucoma.
Tolerance - The dose of certain drugs needs to be increased to obtain the same effect as time goes by. For example, the dose of sleeping tablets, such as the benzodiazepines, may need to be increased as their effect wears off.
Tranquilliser (major and minor) - Medication that calms or relaxes. ‘Minor’ tranquillisers may be helpful for anxiety and insomnia, and include the benzodiazepines. ‘Major’ tranquillisers (more often known as neuroleptics) are helpful in anxiety and also psychotic illness.
Withdrawal symptoms - Unpleasant feelings when you have to go without a particular substance. May be psychological (anxiety, irritability and poor sleep) or physical (restlessness, sweats, muscle cramps). Some substances, e.g. alcohol and benzodiazepines, can trigger fits if heavy users stop suddenly. Symptoms vary with the substance: Valium withdrawal, for example, may last over several weeks and symptoms include restlessness, broken sleep, anxiety, nightmares and, in severe cases, fits. Antidepressants do not cause withdrawal but some SSRIs need to be tailed off gradually to avoid a discontinuation syndrome.
