Category: Depression

CBD as an alternative to pharmaceutical drugs

Cannabidiol (CBD) is a chemical compound that is extracted from the cannabis sativa plant, a compound that has been gathering considerable interest in the potential treatment of a spectrum of neuropsychiatric disorders. Depression, anxiety and insomnia are commonly treated with pharmaceutical drugs, like benzodiazepines, serotonin reuptake inhibitors, (SSRI’s), tricyclics and monoamine oxidise inhibitors (MAOI’s). However, these medicines widely used in psychiatry, can have limited responsiveness, carry residual side effects and can be dependency forming, as in the long term use of benzodiazepines. Preclinical evidence gathered from neuroimaging and human psychological studies support the considerable potential that CBD has as a healthy alternative to pharma drugs in the acute treatment of anxiety and in preventing long term adverse effects of stress with minimal sedative effects. It also has analgesic, anticonvulsant, anti-arthritic, anti-flammatory, antioxidant, antipsychotic and antiemetic properties and it can slow the growth of cancer.

The medicinal properties of cannabis plant have been understood and used by many cultures for several millennia and its use as popular medicine had been referenced by the Chinese in 2900 BC. Medicinal cannabis use can be can be traced back to the Egyptians, Scythians, ancient Chinese and by the Indus Valley civilisation in Ayurvedic medicine. It was also used by the ancient Greeks, across the Arabic world during Roman times and also by the Romans to modern times.

CBD is legal in the UK, however the law around its purchase and use is unclear, as is its role in current medical treatment. Most CBD in the UK is imported and British farmers are compromised on selling by restrictions imposed on harvesting methods. There are an array of costly CBD products stacked up on chemist’s shelves but there are labelling inaccuracies (*Journal of the American Medical Association, 2017;318(17):1708-1709). Many products do not supply what they promise on the label and are sold at very low concentrations. Furthermore, CBD is not yet fully evaluated in the UK and undeniably further clinical studies are required to measure its longer term effects as a treatment in both adult and child populations.

In 2018, following controlled clinical trials, a prescriptive oral CBD product (Epidiolex) was given approval in the USA for the treatment of two rare and severe forms of epilepsy in children aged two years and under. In the UK, evidence of its therapeutic value remains anecdotal and parents would be advised to learn as much as possible about the effects of CBD before giving it to their children. There is a wide variation in the quality and dosage of CBD products, with a possibility of contaminants in the products and an overall lack of knowledge about how CBD may interact with other medicines a child may be taking. The World Health Organisation (Cannabidiol (CBD) Critical Review Report, 2018) recognises the evidence that CBD is generally well tolerated with a good safety profile and it ‘may be a useful treatment for other medical conditions’ besides epilepsy. Considerable evidence supports the potential of CBD in treating anxiety, however clinical evidence is required to evaluate its use among children for treatment for Attention deficit and hyperactivity disorder (ADHD), Autistic spectrum disorder (ASD) or Asperger’s disorder.

Regulation of CBD in the UK market combined with an emergence of a new medical model would help to dispel spurious moral assumptions about a drug that has provided medicinal value to cultures for six thousand years or more. Medicinal cannabis use in the UK has not rolled forward as it has in Canada and the USA, where cannabis is still illegal under federal law but is sold by licensed producers. Britain is poorly prepared for amendments to cannabis law reform that are already flourishing in other areas of the globe. This is a missed opportunity, not only to cultivate a new growth industry on which to raise tax revenue and boost economy but especially in conducting research on a treatment that would undeniably benefit the health and emotional well-being of millions of people.

Are there alternatives to drugs for maintaining our children’s mental and emotional wellbeing?

If you missed this BBC documentary, here is the link to catch up with Dr Chris van Tulleken as he investigates whether there are alternative treatments to drugs (in particular Calpol) to treat our children. He focuses on a small group of children who are medicated for Attention Deficit and Hyperactivity Disorder, otherwise known as ADHD.  https://www.bbc.co.uk/iplayer/episode/b0b4jjq3/the-doctor-who-gave-up-drugs-series-2-episode-1

Mental health lead in schools and colleges

 

Schools and colleges are to be given the incentive to appoint a designated “senior lead” for developing a ‘whole school approach to mental health. Their role will be co-ordinate support services, provide pastoral care, support school policy and facilitate access to specialist therapies and NHS services for children. According to a green paper which is to be published on Monday, proposals will enable children in England to access mental health in schools and colleges with £300 million in additional funding over the next three years.

Included in the proposal, new mental health support teams are to improve pathways between schools and the NHS to offer specialist support and treatment. Reduction in waiting times for NHS services, mental health awareness training in schools are also planned.

If planned and delivered effectively, the proposal is a step forward. Hopefully sufficient funding will be allocated to provide consistent, on-going high quality specialist mental health support by a skilled designated senior lead. It would be essential to develop clear care pathways enabling children rapid access to specialist mental health services.

Handy tips for helping you sleep

Insomnia means a lack of sleep, but it also refers to non-restful sleep, early morning waking, waking in the night, or difficulty falling asleep. Sleep forms an integral part of our daily routine and a lack of it can cause irritability, reduce our ability to concentrate and focus and even impair our motor function. Sleep loss can also raise blood pressure, increase the risk of heart disease and diabetes and even weaken the immune system. Sleeplessness can also be a sign of anxiety and depression and it can exacerbate them both. People vary on the amount of sleep they need but on average, a person needs approximately 7-8 hours daily.

Here are some handy tips for helping you sleep.

Do:

  1. Only use your bed for sleep (incl. sex).
  2. Establish a regular bed time / getting up time and keep to a regular bed time routine.
  3. Try having a warm bath or shower before going to bed.
  4. Exercise 5-6 days per week for 30 minutes in the mornings or afternoons.
  5. Make sure you get daily exposure to natural light.
  6. Try using mindful breathing or relaxation techniques before going to bed.
  7. Ensure your pillows and bed are comfortable.
  8. Make sure your sleep environment is relaxing and pleasant and the room temperature is comfortable.
  9. Reduce your alcohol (and drug) intake as these can disrupt your sleep.
  10. Try downloading screen dimming software if required. (E.g. Dimmer, Flux are both good programmes).
  11. Move your clock so that it cannot be seen if you wake up in bed.
  12. Turn off phone email and text alerts
  13. Keep a journal by your bed so that you can jot down things that come to mind when waking.

 

What not to do: 

  1. Avoid taking naps during the day.
  2. Avoid drinking coffee, tea, or energy drinks and lots of liquids during the afternoon.
  3. Avoid taking stimulants (chocolate, nicotine, medication) near bed time.
  4. Don’t eat heavy meals late.
  5. Don’t watch TV or mobile devices in bed or engage in activities that stimulate the brain.

 

Finally, if you are not asleep after 20 minutes of going to bed, get up and do something relaxing such as reading, try a hot milky drink, then return to bed later.

Natural and herbal remedies may assist you to sleep, however these suggestions are recommended without the use of prescribed hypnotics and medication.

If, after a period of time of trying these tips you are still suffering from insomnia, a course of CBT may help you to find ways to sleep.

Mindfulness reading for all

Mindfulness has definitely been the trend for a while and has become mainstream over the course of the past decade. This new age concept has transformed into a multi-million pound business and the number of books on mindfulness has mushroomed, bringing a range of meditation methods that are now easily accessible to all and practiced by many. Millennials aspire to Scandinavian notions of ‘Hygge’ and ‘lykke’, words of Danish origin that have been adopted into the English language expressing notions of comfort, happiness and well-being. As high tech, high speed, frenetic lifestyles and increasing reliance upon social media and technology can prevent people from being deeply aware of themselves, let alone of each another. Humans are in danger of becoming deprived of giving face to face contact, of a sense of deeper awareness and sense of being human, of feeling healthy in mind and body. Stress, anxiety, depression, pain, illness and addiction pursue, especially amongst young people where the anxieties and stresses can easily commence early in life. Mindfulness can deal with many issues including teenage depression, addiction, pain and anxieties.

The roots of mindfulness originally lie in the heart of Buddhist meditation in which awareness is cultivated and the mind is calibrated and stabilised. The idea is to help one find a state of being in which the person may reclaim the present moment, anchoring oneself in the here and now, free from distortion and interpretation so they may reframe their narrative. It can be practiced by anyone, virtually anywhere and I use it in my practice.

Jon Kabat-Zinn, Professor of Medicine Emeritus, developed the Mindfulness-Based Stress Reduction program (MBSR) at Massachusetts Medical Centre Stress Reduction Clinic and his methods have been adopted by a host of notable cognitive psychologists and developed into the practice of Mindfulness Based Cognitive Therapy (MBCT). These include Dr Zindel Segal at University of Toronto, Oxford based John Teasdale and, Prof. Mark Williams, founding Director at the Oxford Mindfulness Centre. Dr Patrizia Collard at University of East London has written ‘The little book of mindfulness’ and Christina Feldman at The Insight Meditation Society offers meditation retreats.

Let the teachers get on with teaching

Children's mental health at risk
Children’s mental health at risk

teenager-422197_1280So, teachers in secondary schools are to receive mental health training! £200,000 has been pledged by a Government funded scheme known as Mental Health First Aid and the scheme will also be rolled out into primary schools by 2022.  It is fair to say that teachers are on the front line,  not just for safeguarding, but additionally for helping to build resilience in children and young people.

Evidence given in a recent report on Social media and children’s mental health by the Education Policy Institute, demonstrates that 37.3% of UK 15 year olds are classed as extreme internet users (6+ hours daily). Evidence of the correlation between extreme internet use and the harmful effects on young people’s well-being makes teachers uniquely well placed to educate about the strong links between periods spent on social media and mental health and well-being problems. Especially to raise their concerns about vulnerable pupils or pupils who are exposed to problems relating to their mental and emotional well-being.

It is also fair to say that the government should ‘get real’ about the mental health problems facing children and young people. Talking therapies are in desperately short supply and underfunded, specialist services, like CAMHS, have long waiting lists. Dumping the problem onto teachers is a pitifully inadequate way to tackle serious mental health issues affecting our young and which require much more specialist input than schools-based first aid. Teachers already have overwhelming workloads and schedules and are driven to attain high targets. Target crunching is not the mind set required to understand and deal with mental health problems.  To expect teachers to be able to recognise and cope with mental health issues as well, is not only naïve but it undermines the skill and experience of a properly trained mental health professional. How would a teacher be expected to have the time or skills to successfully deal with a child or young person with a full blown psychosis or offer counselling support to a suicidal teenager?

Funding needs to be pumped into specialist mental health services for children and young people so that trained and skilled mental health professionals can meet the needs of children and young people with emotional and mental health problems. Meanwhile, let the teachers get on with what they are trained to do, and do best, which is to educate.

Government pledge for mental health

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In a climate of deepening NHS crisis, it is heartening news that the PM is talking about making an investment in mental health services and even addressing the issue of ‘parity’. Whether or not it is a question of ‘hard’ or ‘soft’ parity, one certainty is the fact that there needs to be new Treasury money for these investment plans. Professor Sir Simon Wessely, Regis Professor of Psychiatry at the Royal College Of Psychiatrists states that there is a need for more specialist mental health workers, Child and Adolescent Psychiatrists, nurses etc. “We have a long way to go before mental health services are on an equal footing with those for physical disorders.”

The reality is that almost 250,000 children and young people and children aged 18 and under receive treatment by specialist NHS support services each month and this is probably just the tip of the iceberg. Child and Adolescent Mental Health Services (CAMHS) account for just 0.7% of NHS spending and approximately 6.4% of mental health spending, therefore Clinical Commissioning Groups (CCG’s) will be using some of the 1.4 billion that has been allocated by ministers to improve mental health services for young people. Some mental health charities argue that just how much of this funding actually reaches frontline services is debatable. It is a great pledge, but the capacity for CAMHS to provide support is limited because their services are already overstretched with long waiting lists and high threshold levels for treatment which means that many children are being turned away from services.

Jeremy Hunt, Health Secretary has said that care for children and young people is a “black spot” needing urgent attention as the pressures of social media, cyber bullying and a big increase in self-harming is a “massive worry for parents”. He pledges that he will improve diagnosis and treatment of mental health conditions and put specialists in schools with a proposal that CAMHS and schools work closely together and for more schools to have a CAMHS specialist.

The Mental health charity Sane states that these plans need to “be matched by substantially increased funds to mental health trusts”. Mind said it is “important to see the prime minister talking about mental health” but the difference it made to patients’ day-to-day experiences would be proof.

Teresa May has pledged to help CAMHS by investing £250 million more and by offering mental health first aid training to teachers to recognise symptoms of distress. This puts teachers on the frontline when they already have heavy workloads and are driven by a target led culture that is judged by rigorous observations and inspections. The prospect of Ofsted monitored mental health support provided by schools adds further pressure. An outcome of outstanding, good or requiring improvement is not an appropriate approach to dealing with young people’s mental health issues. The focus needs to be entirely on recognition and sensitive understanding of the needs of the individual child and young person and how they are rapidly going to get the vital support required before self-harm occurs.

Recognition of mental health disorders can require a trained eye and skilled personnel are able to recognise and deal with mental health issues to ensure clear and rapid signposting to the relevant service.

 

Rise in anti-depressant prescribing for teenagers

 

Increased prescribing of anti-depressants for children and young people
Increased prescribing of anti-depressants for children and young people. It’s time to consider counselling alternatives.

What is disturbing is that the mental health of children appears to be so depressingly poor and prescribing of anti-depressants to children has significantly increased by GP’s. Research by Dr Ann John at Swansea University shows a 28% increase in prescribing of anti-depressants to children in Wales aged from six to 18, with girls being three times more likely to be prescribed than boys. Furthermore, some of this prescribing is being done beyond the limits of prescribing guidance and using anti-depressant medication that is not suitable for children, due to their toxic side effects. Research would no doubt reveal a similar prescribing pattern in England.

The question is however, whether this prescribing trend reflects an actual decline in children’s mental health with increased incidence of depression, or whether it is due to over-prescribing by GP’s creating medicalisation of normal teenage emotional development. Whatever the cause, training for GP’s and primary care workers is essential because future generations of children are at risk of growing up with a dependency, albeit psychological, on a host of toxic mood lifting drugs.

Counselling support for children and young people can easily prevent the use of potentially harmful drug therapies and normalise emotional turmoil, which is often a natural progression of childhood and teenage development.

Children’s counsellors who are qualified, experienced and trained specifically to counsel children and young people are able to provide specialist support for children in their emotional development. Children’s Counsellors at charities like Place2Be, deliver professional counselling in schools to children from primary age up to 18. They work closely with teachers and other professionals to provide essential support to children and young people. Any concerns about the welfare or mental health of a young person or child may be referred to a GP, who may in turn refer a child or young person to a children’s counsellor.

The use of anti-depressant therapies however, should be administered in the event of counselling therapies being ineffective, and only then with extreme caution and certainly within prescribing guidelines.

The National Institute for Health and Care Excellence (NICE) can issue guidelines about the use of anti-depressant therapies.

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