Rethink/Recharge - Part 1
Here is the “rethinking mental health” section of a collaborative mental health venture - a talk titled “Rethink/Recharge” - which was given for the 2018 Australasian Turf Grass Growers Association Conference in Wellington. I presented this with my friend and Ancestral Health Colleague Jamie Scott whose “recharge” portion of our talk is linked at the end of this article. We had around 500 men (and a few women) in attendance and were both quite surprised and very humbled by the audience response - so many questions and open discussion about the struggles that are faced within this industry.
RETHINK
Do Half of us Really Have a Chemical Imbalance?
“Mental health crisis”. This phrase is frequently referenced in popular media both in Australia, New Zealand (NZ), and around the world. Suicide is the famously known and feared extreme end of this “crisis” continuum, however, often, declining mental health begins with mild but insidiously increasing effects. Common experiences include a “loss of zest” and changes to stress and anxiety levels, motivation, sleep, energy, appetite, irritability or agitation, libido, weight, mental functioning, connection and relationships, sense of wellbeing, and contentment with life. A variety of short-term coping behaviours may result, ranging from seeking out alcohol or other substances, ‘behavioural addictions” (e.g., shopping, gaming, porn, junk “food”), self-harm, isolation and using “harden up” mentality, and suicidal thinking or action. These may all worsen mental health functioning over time. And sadly, in New Zealand last year (2017), approximately 550 people died by suicide, with our men doing this at a rate three times more than our women (equalling approximately one man per day).
The World Health Organisation (WHO) has identified depression as the current official leading cause of disability in humans worldwide. Australia and NZ have increasingly high rates of depression and anxiety. Latest statistics report that almost 1-in-2 people are now affected with these particular concerns at some stage over their lifetime. In Australia, 1-in-3 men were found to meet criteria for a depressive, anxiety, or substance use disorder. This increase has been met with a rise in depression medication prescribing, with approximately 1-in-9 individuals being prescribed these heavy duty pills in NZ (and 1-in-6 females), which represents a 65% increase over the past decade, and a 98% increase in our children and teenagers. Australia is reported to be the second leading country in depression medication prescribing according to the OESD ‘Health at a Glance’ 2015 report. This is in spite of long-term efficacy data finding that people prescribed these medications may do worse in the long run than those who are not, and concluding that these medications are actually harmful for children and can cause suicidal thinking when used for teenagers . It has also recently been revealed that as much as 40% of the data on depression medication has been withheld from the prescribers by pharmaceutical companies and the regulatory bodies, because the findings did not shed a positive light on the medications performance.
Mental health funding in NZ is also on the rise – this increased from 1.1 billion in 2008/2009 to almost 4 billion in 2015/2016. Additionally, rates of new NZ Psychiatrists and Psychologists almost doubled between 2005 and 2015. In spite of this injection of funding and trained clinicians to the mental health treatment arena, District Health Board (DHB) reported rates of crisis intervention is ever increasing, and we have greater numbers of people on welfare and disability than ever before. There has been an ongoing community and media outcry that mental health services are letting people down. So, if funding, psychiatric assessment, and medication is meant to fix depression and anxiety then why do we have more and not less of these concerns? Do almost half the NZ and Australian population really have a “brain chemical imbalance”? Or is it time to rethink what erodes or enhances good mental health and look for solutions outside of this medical disease and medication model?
The Current Paradigm and Treatments
What has been the current model of psychiatric concerns and therefore the prescribed treatments? Most modern depression medications are called selective serotonin reuptake inhibitors (SSRIs). Prozac, the first ever SSRI, hit the shelves in 1987, and with it came a discourse of depression as a brain chemical imbalance involving low levels of the neurotransmitter serotonin (Whitaker, 2011). Despite an absence of research that finds low levels of serotonin to be the case in all cases of depression (and in fact some studies find the opposite), this became the favoured narrative for depression and supported the widespread marketing and acceptance of SSRI medication as a mainstream treatment (Whitaker, 2011). Similarly, this has occurred with medication for psychosis which acts on an “excess” of the neurotransmitter dopamine, and medication for anxiety which “enhances” the neurotransmitter GABA (Whitaker, 2011). Collectively, these were seductively termed the “anti” drugs, anti-depressant, anti-psychotic, and anti-anxiety (anxiolytic) medication. And a “magic pill” narrative was promoted by direct-to-consumer advertising and even hailed by popular press like Time Magazine (Whitaker, 2011).
People struggling with their mental health functioning naturally want solutions. It can be frightening, overwhelming, and life-impacting to have panic attacks, persistent anxiety, or to struggle with low mood. Thoughts that “the world would be better off without me in it” can scare the individual and those around them. Health providers also want to find solutions for their patients and generally are well intentioned – I am yet to meet a health professional who does not genuinely care about people or want to make a difference (although perhaps some exist). However, for many of them, medication solutions are the most known, convenient, affordable, or quick acting. The desire for quick solutions, coupled with the ready acceptance of a pill that “rebalances an imbalanced brain chemistry,” appears to have overridden the facts that these are serious medications to be experimenting with and that humans are the guinea pigs. The well-established adverse effects of SSRIs on emotional, physical, and sexual functioning are often overlooked or downplayed. Yet research finds that they can have serious adverse effects for many people, including sexual difficulties, emotional numbing, caring less about others, suicidality, and withdrawal effects (Gibson, Cartwright, & Read, 2014; Cartwright, & Gibson, 2014). These effects can impact on their partner, family, friends, and community. Additionally, SSRIs do not address the underlying causes for depression, which involves multiple interacting factors including personal circumstances, psychological factors, and bodily imbalance from diet and lifestyle.
Recent meta-analyses that consider all available research indicate that SSRI’s may be not much more effective than that of placebo or sugar pill, especially for mild or moderate depression, and that lifelong outcomes may be worse for those medicated than those not (Kirsch, 2014) This means that much of the effect of an SSRI may be because of hope and expectation from taking a pill that will “fix” depression. Tolerance can also occur from long-term use, meaning that these medications can stop having any desirable effects and leave people with ongoing depression symptoms and needing to try out multiple different medications and higher doses. Higher doses have no empirical support and are found to be equivalent to lower doses (except higher doses come with greater adverse effects; Kirsch, 2014). Discontinuation can be disruptive at best and almost impossible at worst due to sometimes debilitating withdrawal effects (Gibson et al, 2014; Whitaker, 2011). And in some cases, SSRI use is anecdotally considered to be lifesaving, life-enhancing, or has supported someone through a difficult patch short-term.
The “New Science” of Mental Health
The problem with the serotonin and SSRI narrative is that it’s too simplistic, it lacks robust support according to science, and it has not solved the mental health problems of our 21st Century – and arguably it may have worsened things. A newer understanding of immunity and the body’s stress response supports an integrated inflammatory model of depression (Dean & Keshavan, 2017). In this view, many cases of depression are the end-point of a stress response being constantly switched on without enough time with this switched off to recharge.
Types of stress can include circumstantial stressors, stress on your body and physiology, and psychological factors to do with your past experiences and personality. These lists are non-exhaustive but capture some commonly reported experiences:
Circumstantial stress
Parenting children
Financial pressure
Relationship difficulties or separation
Work expectations
Family health issues
Isolation or lack of connection
Bodily stress
Inadequate sleep or time out
Too much processed food
Insufficient quality animal products and seasonal produce
Alcohol and excess caffeine
Sedentary lifestyle – (e.g., office work)
Lack of movement and time in nature
Device effects – social media
Toxin exposure – pesticides
Psychological stress
Trauma and loss/grief
Difficult relationship patterns
Deficits in emotional coping skills
Unhelpful beliefs about self, the world, and others
Perfectionism and unrelenting standards
Worry about your reputation
Reluctance to seek help
Chronic multitasking
Not being in the present moment (i.e., past or future focus)
Lacking a sense of meaning or purpose
Living life or work misaligned to your values
Feeling trapped or unable to change your circumstances
Stress researcher Bruce McEwen states that “the brain perceives what is stressful” and this interaction of the individuals perception of their situation and a build-up of various stressors over time is what leads to chronic stress (McEwen & Lasley, 2002). We also know that the gut communicates to the brain and that food is information that shapes brain and body functioning, hence the reason that nutrition matters to mental health (Greenblatt & Brogan, 2016). Chronic stress can alter mental health functioning via the gut-brain-axis (the vagus nerve which signals from brain-to-gut and gut-to-brain), poor or habitual stress coping mechanisms, and inadequate diet and lifestyle (Greenblatt & Brogan, 2016). Initial signals I see in my practice are usually of feeling switched on and alert, difficulties sleeping, increased feelings of stress or anxiety, racing thoughts, cravings for food or addictions, and changes to cognitive functioning (e.g., “brain fog”, memory changes). Chronic stress implicates adrenaline and cortisol, which are designed to help with short-term survival (e.g., running from a tiger) but in chronic doses (like regularly working long sedentary hours without respite) are damaging to the brain, body, and can cause health conditions due to the involvement of the immune and hormonal systems (McEwen & Lasley, 2002). Because of the damaging effects of chronic stress, the body will eventually protect itself from further stress inducing damage via an exhaustion phase. This effectively stops the person who has not heeded earlier messages in their tracks, and enforces a period of rest and repair, which will look much like depression. At this point people often are at a loss as they expect themselves to be able to maintain the previous level of functioning however everything in their body is working differently.
The Future of Mental Health
We need to rethink how we think and talk about mental health, its causes, and therefore the solutions. The chemical imbalance myth is inaccurate and insufficient and is contributing to the expectation that mental health solutions are found within a prescription. What we are doing is not working for many people and this time may be looked back on as a dark age in the psychiatry field, similarly as we do to the use of asylum’s in the 19th and early 20th centuries. Mental health is not separate to physical health – the brain itself is a physical organ encased within the body just like your kidneys – and our new understanding of the gut-brain-immune-endocrine axis shows that many causes of depression result from bodily imbalance rather than a chemical imbalance (Dean & Keshavan, 2017; Greenblatt & Brogan, 2016). And this bodily imbalance arises in the context of 21st century living – with our stress responses being switched on without a break, with an increase in insults from our diet and lifestyle, and a breakdown of recharging and connecting with those who matter the most to us. Perhaps psychiatric medications will continue to have their place in the future of mental health, it is not my place to say if these medications should or should not be used and certainly anyone using these medications should not stop without consulting their prescriber, but they need to be considered after all other options have been explored. In my experience, other options are effective at getting to the root of the problem rather than simply masking symptoms or providing a placebo. Other options may also help our society to be more connected and may help the environment at a broader sustainability level, and the other options have less adverse effects on the 1-in-9 human guinea pigs taking part in this experiment.
So, what is this concept I’ve referred to as recharge? This refers to recharging your physical, emotional, mental, and spiritual energies in the face of modern 21st Century stress. This section is handed over to my ancestral health colleague, Jamie Scott at: Rethink/Recharge - Part 2.
Please note: this blog is here to share information on a public talk given on Mental Health. The information here is not designed to replace individual medical advice from your health professional - please do not stop or reduce medication without consulting with them first.
References
Dean, J. & Keshavan, M. (2017). The neurobiology of depression: An integrated view. Asian Journal of Psychiatry, 27, 101-111.
Greenblatt, J. M., & Brogan, K. (Eds.). (2016). Integrative Therapies for Depression: Redefining Models for Assessment, Treatment and Prevention. CRC Press, USA.
Gibson, K., Cartwright, C., & Read, J. (2014). Patient-centered perspectives on antidepressant use: A narrative review. International Journal of Mental Health, 43(1), 81-99.
Kirsch, I. (2010). The Emperor’s New Drugs: Exploding the Antidepressant Myth. Random House Group Ltd, United Kingdom.
McEwen, B. S., & Lasley, E. N. (2002). The End of Stress as we Know it. Joseph Henry Press, New York.
Read, J., Cartwright, C., & Gibson, K. (2014). Adverse emotional and interpersonal effects reported by 1829 New Zealanders while taking antidepressants. Psychiatry research, 216(1), 67-73.
Whitaker, R. (2011). Anatomy of an epidemic: Magic bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. Random House Inc, New York.
