Common conditions

Depression
Dealing with depression

It’s normal to feel sad, unhappy or a bit low from time to time. But depression is something different and can last for weeks or months at a time. Depression is an illness that can affect your work, your sleep, your relationships and your appetite. And it can make you feel like you can't cope with everyday life.

The good news is that there is a range of treatments and medications that can help you recover.


What causes my depression?

Sometimes your brain starts working in a different way and this can lead to depression. The brain sends signals from nerve to nerve using chemicals called neurotransmitters. And if you have depression, it’s often because two of these neurotransmitters, called noradrenaline and serotonin, are out of balance and not working properly.

But life events are important too and depression can often be triggered by stressful events like the break-up of a relationship or financial problems, or if you’re feeling isolated from friends and family. If you’ve had a difficult childhood you can be vulnerable to bouts of depression. And it may be linked to your genes too as family history can play a part in depression. You’re also more likely to get depressed if you have a physical illness such as a stroke or heart attack.


What are the symptoms of depression?

The key symptoms of depression are feeling sad most of the time, losing interest in the things you used to enjoy, and feeling very tired. If you’re depressed, you’ll have some of these symptoms most of the time.

You may also find you have some of these symptoms too:

• Problems sleeping, or sleeping too much
• Finding it hard to concentrate or make decisions
• Having little confidence in yourself
• Having little appetite, or more appetite than usual
• Feeling guilty for no reason
• Feeling either agitated or sluggish
• Thinking about suicide


What treatment can I expect?

It’s important to check that your symptoms aren't caused by any medication you’re taking or any other medical condition. So you may need some blood or urine tests to rule these things out.

Your depression can then be treated by taking antidepressants or by talking treatments (psychotherapy) or a combination of the two. Antidepressants may take a while to start working and you will need to keep taking them even when you start feeling better to stop a recurrence of the depression. Antidepressants are not addictive.


Talking treatments

If you have mild or moderate depression, talking treatments may be helpful and may even work better than taking antidepressants. The aim is to help you get rid of negative thoughts and beliefs, and to help you think more positively. You would normally have up to 20 sessions with a trained therapist, over a three or four months period. About half the people who have talking therapies recover during treatment.


Prescribed medication

If you have more severe depression you could be prescribed a course of antidepressants. About 50–75% of the people described antidepressants feel better after taking them although there are side effects to think about such as dry mouth, constipation, dizziness, stomach upsets, anxiety, headaches and problems sleeping.

You'll probably need to take antidepressants for at least six weeks before they start to affect your mood. So it's important not to stop taking them early. It’s also recommended you take antidepressants for six months after you start feeling better. People who keep taking antidepressants for at least six months are much less likely to get another bout of depression.


The next steps

If you think you’re depressed, you should visit your GP in the first instance who can then refer you to me for diagnosis and treatment.

In the meantime you might want to visit Depression Alliance or Rethink for further advice and support.

Bipolar disorder
What is bipolar disorder?

When it comes to moods swings we all have our ups and downs. But if you have bipolar disorder your mood swings can be extreme and have a detrimental effect on your everyday life. Sometimes you feel high with lots of energy. Other times you feel low. This is known as bipolar depression. This can make it hard to hold down a job or to attend college regularly. And it can put a big strain on your relationships with family and friends.

But with the right support and long-term treatment it’s possible to control your extreme high and low moods and lead a normal life.


What causes bipolar disorder?

The exact cause of bipolar isn’t known. It may be something to do with chemicals in your brain, which carry messages between different parts of your brain.

There maybe a genetic link too, although not everyone who has relatives with bipolar disorder gets it themselves. Certain experiences can bring on the first symptoms of bipolar disorder or can trigger a relapse if you already have bipolar, such as giving birth or using drugs recreationally.


What are the symptoms?

The main symptoms of bipolar disorder are periods or episodes of mania and depression. A manic episode can feel quite positive and you might feel energetic and creative. During this time you might not feel like eating or sleeping and you may talk rapidly. You may also behave irrationally and spend money on things you don’t need or want.

But this may be followed by a depressive phase where you may have overwhelming feelings of worthlessness as well as suicidal thoughts.

There are many types of bipolar disorder. The two most common are:

• Bipolar type 1 disorder with bouts of mania and bouts of depression.
• Bipolar type 2 disorder also means you get bouts of mania and bouts of depression. But the mania is milder. It’s sometimes called hypomania and is slightly more common than type 1.

The depression phase of bipolar is often diagnosed first as clinical depression. Later, following a manic episode you may be diagnosed with bipolar disorder instead. But in between the mania and the depression, you may have times when you're in a normal, stable mood which can last for weeks, months or even years.


What treatment can I expect for my bipolar disorder?

If you’re diagnosed with bipolar disorder you’ll probably need to take medication in the long-term to keep your mood stable.

The type of medication and the dose you take will depend on how well you are and what your symptoms are.

If you stop taking your medication because you’re feeling better or you don’t like the side effects you could find that your symptoms come back. This is known as a relapse. So it’s essential you talk to your GP or me first if you’re unhappy with your medication.

Relapses can also be triggered by events in your life too such as:

• Stressful situations like exams, problems in relationships, or difficulties at work
• Sleeping too little or too much
• Taking illegal drugs or drinking too much alcohol

Talking therapies may help you handle the stresses of life better and help you avoid a relapse in the future.


The next steps

If you’re experiencing difficulties, the first step is to visit your GP who can refer you to me for treatment.

In the meantime visit the Bipolar UK website which is a UK charity that provides advice and support to people with bipolar disorder, as well as their friends and family. The organisation also runs a network of self-help groups.

Alcohol dependence
What is alcohol dependency?

Alcohol dependency is a substance related disorder where you become addicted to alcohol either physically or mentally and develop a pattern of drinking excessive amounts of alcohol over a period of time. Alcohol dependency can have a detrimental effect on all areas of your daily life including work, relationships with family and friends and your financial situation. And it can cause numerous long-term physical and psychological problems too.

In the UK around 9% of men and 4% of women show signs of alcohol dependency. But the right treatment and rehabilitation can help reduce the impact of alcohol related problems.


What causes alcohol dependency?

The process of becoming dependent on alcohol can develop over a period of time and genetic, psychological, social and environmental factors all have an impact on how alcohol affects your body and your behaviour.

If you grew up in a home of heavy drinkers you are more likely to have issues with alcohol. Likewise you have an increased risk of alcohol dependency if you have:

• Depression, bipolar or anxiety disorders
• Easy access to alcohol
• Low self-esteem
• Problems with relationships
• A stressful lifestyle

Or if you come from a culture or social background where alcohol use is widespread and accepted.

Over time, drinking too much may also change the normal balance of chemicals in your brain that are associated with the experience of pleasure, judgment and the ability to exercise control over your behaviour. And this may lead to you craving more alcohol to restore good feelings or remove any negative ones you have.


What are the symptoms of alcohol dependency?

Alcohol dependency affects different people in different ways but the signs that alcohol is having a detrimental effect on your life may include behavioural problems such as:

• Not being able to socialise without a drink
• Struggling at work or college because of hangovers
• Having to take days off to recover
• Having poor concentration
• Feeling irritable without a drink
• Becoming defensive or angry when drinking habits are discussed or challenged
• Feeling you need to hide your drinking from others
• Drinking to get going in the morning
• Waking up with unexplained injuries or bruises
• Drink driving
• Not having days without alcohol
• Getting into situations where your safety might be at risk
• Having sex you later regret
• Not being able to remember what happened when you were drinking

There are physical symptoms too including:

• Gaining weight
• Struggling to get pregnant
• Having irregular periods
• Having problems getting or maintaining an erection
• Anxiety
• Depression
• Feelings of suicide


What treatment can I expect for my alcohol dependency

Your treatment will very much depend on the level of your alcohol dependency, your current medical situation and your personal circumstances.

You may also benefit from an addiction treatment programme such as that run The Priory Hospital, Roehampton where a team of therapists will oversee your detoxification programme for on average a 28 day admission followed by 12 months of free aftercare and family support.


The next steps to take

If you think you have a problem with alcohol or someone close to you does, the first step is to visit your GP who can make a referral for you to see me.

In the meantime, please visit Drink Smarter for details of services, supports and other useful websites and resources.

Anxiety and panic attacks
Dealing with anxiety

Everyone gets anxious from time to time. We all worry about work, relationships and money. But when your worry is out of proportion it can make you feel ill and exhausted and stop you enjoying your everyday life.


What causes anxiety?

Anxiety disorders are generally caused by biological or environmental factors and can develop over months, even years. Biological factors include changes in brain chemistry and genetics; for instance, you’re more likely to experience anxiety disorders or panic attacks if a close relative does too.

And your environment also plays an important role: stress, trauma, your upbringing, life changes and abuse or neglect can all increase the risk of you experiencing anxiety at some point in your life.


What are the symptoms?

When your anxiety has become an illness you may find you experience some of the following behavioural symptoms:

• Worrying about things for no apparent reason
• Not being able to concentrate
• Becoming easily tired
• Sleeping badly
• Feeling restless and unable to relax
• Feeling irritable

You may also experience physical symptoms including:

• Feeling cold
• Clammy hands
• Feeling sick
• Dry mouth
• Diarrhoea
• Palpitations
• Headaches and shortness of breath
• Tense muscles


What treatment can I expect for my anxiety?

Anxiety and panic attacks can be treated with talking therapies or medication or very often a combination of the two.

Talking therapies

Cognitive behaviour therapy and applied relaxation are some of the therapies that work well for anxiety. These talking treatments will help you to relax and feel calmer although they won’t work instantly and you’ll need to keep practising your mindfulness and applied relaxation skills at home. Your sessions will normally last an hour and you’ll have treatment over a number of weeks either individually or in a group.

Medication

Some medication works fast in the short-term whilst others are used to treat anxiety in the long-term. We will talk about what is the best option for you. Antidepressants will help you feel more comfortable around people and reduce your anxiety but they will take a few weeks to start working and you’ll need to keep taking them for at least six months.


The next steps

If you’re feeling anxious all the time and it’s having a detrimental effect on your life, please speak to your GP in the first instance who can then make a referral for you to see me.

In the meantime, also visit Anxiety UK, which is a UK based charity helping people of all ages and backgrounds with anxiety disorders.

Psychosis
Understanding psychosis

About 20 per cent of the general population experience psychotic-like symptoms at some point in their lives. But for some people these symptoms are persistent and distressing, making it difficult to function.

Psychosis is a condition of the mind that affects your thoughts, feelings and behaviours. You may experience delusions and hallucinations and will find it difficult to tell the difference between reality and imagination. People experiencing psychosis or having what’s known as a psychotic episode are often described as ‘having a loss of contact with realty’ and this experience can vary greatly from person to person.

However, the likelihood of a complete recovery is much better with proper early treatment.


What causes psychosis?

Psychosis is caused by chemical imbalances in the brain triggered by a combination of both genetic and environmental factors or vulnerabilities.

The environmental factors that can slightly increase our chances of experiencing psychosis include being born in the winter months, being brought up in a big city, immigration, childhood head injury, stressful or traumatic life events and the use of recreational drugs. Each of these alone will not cause psychosis, but a combination of a few of them, along with a genetic vulnerability may do so.

Genetic vulnerability is caused by variations in our genes so they work in different ways in different people. Recent research has identified variants in several genes, which scientists think might contribute to psychosis and explain why psychosis often runs in families.


What are the symptoms of a psychotic episode?

There are three phases to a psychotic episode: the early or prodromal phase; the acute phase; and the recovery phase.

Common symptoms in the early stages of a psychotic episode include:

• Reduced concentration and attention
• Reduced drive and motivation and lack of energy
• Depressed mood
• Sleep disturbance
• Anxiety
• Social withdrawal
• Suspiciousness
• Deterioration in role functioning such as no longer attending school or going to work
• Irritability

During the acute phase you may experience:

• Delusions, such as feeling that you’re being controlled or there are plots against you
• Hallucinations which involve seeing, hearing, feeling, smelling, or tasting something that is not actually there
• Disorganised speech or behaviour such as difficulty speaking or performing everyday tasks
• Lowered levels of motivation or drive
• And other issues such as depression, anxiety, suicidal thoughts or behaviours, substance abuse and sleep disturbance

When you’re in the acute phase of a psychotic episode this is when you’ll feel most unwell and will need help.


The recovery phase

The length of your recovery phase will depend on how quickly you respond to treatment and how much functional improvement there is. Some people recover very quickly and return to their lives and responsibilities soon afterwards. However, others may need a little more time to get better and may need to return to their ‘old life’ more gradually.


What treatment can I expect for my psychosis?

With the right treatment, it’s very likely you’ll recover well from your initial episode of psychosis. It can be treated in a number of ways and it’s likely that a combination of treatments will help speed up the recovery process.

Medication, including close monitoring of side effects

Medication will relieve symptoms of your psychosis and is critical in preventing a relapse. It’s usually recommended you should take your medication for at least a year after your recovery to protect against future relapse. During this time you’ll be monitored closely for side effects, which may include tiredness, dry mouth, blurred vision and weight gain, although not everyone will experience these.

Psychological therapy

There are a number of psychological therapies for individuals and families that can help in the recovery process. Having someone to talk to who understands your experience is an important part of your treatment.

Your therapy sessions may be aimed at understanding how your psychosis came about, how to cope with the symptoms, how they affect you and the people around you, as well as how to reduce distress.

Specific types of therapy such as cognitive behavioural therapy (CBT) can be particularly useful.


The next steps

If you are concerned about your mental health please visit your GP in the first instance who can then refer you to me for diagnosis and treatment.

Joining a support group can also be very beneficial as support groups provide a safe environment for you to meet other people who have had similar experiences. Groups are also a great way to learn about psychosis through discussions and other people's perspective.

Please visit UK charity Rethink for more information on psychosis.

Obsessive compulsive disorder (OCD)
Managing obsessive compulsive disorder (OCD)

OCD is an anxiety disorder that’s associated with obsessions and compulsions.

You may experience thoughts, images, or impulses that repeatedly enter your mind and feel out of your control. These impact negatively on your daily life and you may even recognise that some of these ideas and impulses don’t actually make sense.


What causes OCD?

OCD is caused by a combination of biological and psychological factors as well as life experiences and personality traits.

Research suggests that genes can play a role in the development of the disorder and there is evidence that OCD runs in families. If your parent has OCD, the risk of you developing OCD increases, albeit slightly. But this may only be true for some forms of OCD.

Research has also shown that several general personality traits may be linked to some forms of OCD. One of these is anxiety, where you have the predisposition to become anxious more easily or more frequently, or by a greater number of experiences, than other people. Another is anxiety sensitivity, or the tendency to feel uncomfortable with your anxiety and have catastrophic thoughts about it. Another trait sometimes associated with OCD is perfectionism, particularly when it entails setting excessively high or rigid standards for yourself that you rarely ever reach.

Life stresses can also make symptoms worse if you have OCD. During stressful periods such as a new baby, new job, relationship problems or exams at school you may experience obsessions and greater difficulty resisting compulsions. Other emotional problems, such as depression, may also interact with OCD vulnerability and worsen the symptoms.


What are the symptoms of OCD?

OCD obsessions are accompanied by troubling feelings that can take many forms, such as fear or apprehension, anxiety, disgust, tension, or a sensation that things are ‘not right’.

Recent research shows that the symptoms of OCD follow a few broad themes and within these themes, obsessions can take a countless number of forms. Common examples include:

• Contamination e.g. fears of germs, dirtiness, chemicals, AIDS, cancer
• Symmetry or exactness e.g. of belongings, spoken or written words, or the way you move or completes actions
• Doubting e.g. whether appliances are turned off, doors are locked, written work is accurate
• Aggressive impulses e.g. thoughts of stabbing one’s children, pushing loved ones into traffic
• Accidental harm to others e.g. fears of contaminating or poisoning a loved one, or of being responsible for a break in or a fire
• Religion e.g. sexual thoughts about a holy person, satanic thoughts, distressing thoughts regarding morality
• Sexual e.g. thoughts about personally upsetting sexual acts
• Other miscellaneous obsessions having to do with themes such as lucky or unlucky colours or numbers, or with the need to know ‘trivial’ details e.g. house numbers, licence plates

OCD compulsions are the distressing feelings that result from obsessions and may motivate you to behave in a particular way of perform some kind of ritual that offers a relief from the distress. Even though compulsions are usually recognised as excessive, embarrassing, or problematic, you may feel powerless to resist them.

Like obsessions, compulsions take many forms, and can include:

• Washing and cleaning e.g. excessive showering, hand washing, house cleaning
• Checking e.g. locks, appliances, paperwork, driving routes
• Counting e.g. preferences for even or odd numbers, tabulating figures
• Repeating actions or thoughts e.g. turning lights on and off, getting up and down in chairs, re-reading, re-writing
• The need to ask or confess e.g. asking for reassurance
• Hoarding e.g. magazines, flyers, clothing, information
• Ordering and arranging e.g. the need for things to be straight, sequenced, or in a certain order
• Repeating words, phrases, or prayers e.g. repeating ‘safe’ words again and again


How can my OCD be treated?
OCD is often treated by medication or talking treatments or a combination of the two.

Taking medication

Drugs traditionally used to treat anxiety are not effective at reducing obsessions and compulsions but a number of medications originally developed as antidepressants have been shown to be useful for treating OCD. What medication may benefit you most will depend on your past treatment history, your medical history, the interaction with other drugs you’re taking, potential side effects, and other factors.

Psychological treatments

Talking treatments can be very effective at treating OCD especially cognitive behavioural therapy (CBT), which tackles the controlling compulsive rituals and avoidance and reducing the anxiety associated with obsessions, and their intensity and frequency.


The next steps

If you feel you have symptoms of OCD and would like to seek help please visit your GP in the first instance who can then make a referral for you to see me.

In the meantime you might want to visit OCD-UK which is the UK’s leading charity for people who have OCD.

ADHD / ADD in adults
Addressing ADHD/ADD in adults

Attention deficit hyperactivity disorder (ADHD/ADD) is a well-recognised child developmental disorder although not so readily recognised in adulthood.

You may have had a diagnosis in childhood and symptoms are persisting into adulthood, albeit in a different form. Or perhaps you were never diagnosed in childhood and are now experiencing issues in your everyday life that are ADHD related.

The good news is that whatever challenges you face, your symptoms are completely manageable with the right support and medication.




What causes ADHD?

The exact cause of ADHD isn’t known but it’s thought to be largely genetic combined with environmental issues such as exposure to cigarettes, alcohol, or other toxins while in the womb.

Unlike other psychiatric disorders, such as anxiety and depression, ADHD doesn't begin in adulthood. So symptoms must have been present since childhood for a diagnosis of adult ADHD to be made.




What are the symptoms of adult ADHD?

Common symptoms of adult ADHD are often more subtle than those symptoms associated with childhood ADHD. These may include:

• Difficulty getting organised
• Reckless driving
• Poor relationships
• Being easily distracted
• Poor listening skills
• Restlessness and difficulties relaxing
• Difficulty starting a task
• Chronic lateness
• Angry outbursts
• Difficulty prioritising issues
• Having a short attention span




What treatment can I expect for my ADHD?

Adult ADHD is best treated using a combination of talking treatments, support groups, educational assistance and medication. Following your diagnosis we can talk about what treatment is best for you as I have a network of psychological therapists and life coaches who specialise in ADHD and can combine this with medication.




Taking medication

There’s good evidence that certain types of medication (especially stimulant drugs) are very effective in the treatment of ADHD. They need closely monitoring for side effects and are tightly regulated (known as 'controlled drugs').

I’m able to prescribe ‘controlled drugs’ on a private basis and can then liaise with your GP to help negotiate the possibility of getting ongoing prescriptions via the NHS if required once your medication and dose is established and stable. This is consistent with the way the main body advising the NHS suggests is the optimal treatment approach (National Institute for Healthcare and Clinical Excellence - NICE). Some patients use this as a way to get treatment established whilst on an NHS waiting list for local ADHD assessment as in some regions delays can be lengthy.

Medication could help you:

  • Concentrate better
  • Be less impulsive
  • Feel calmer
  • Learn and practise new skills

Therapy treatments

There is a range of therapies, including CBT, that are particularly good for helping you manage your adult ADHD as well as dealing with additional problems such as anxiety disorders.

Talking therapies can offer practical advice, which can help you:

  • Get organised
  • Change your habits
  • Understand your condition
  • Challenge negative beliefs
  • Improve your social skills
  • Improve relationships with friends, family and work colleagues




The next steps

If you are experiencing difficulties which you think maybe related to adult ADHD, please visit your GP in the first instance who will then be able to refer you to me.

I also see many patients who have been referred to NHS ADHD services, or have recently arrived from overseas in order to establish the diagnosis and get treatment underway, and are waiting for an NHS appointment.

You may also want to look at the ADDISS website which is a national charity providing information support and training to both parents and professionals on ADHD.

And detailed medication info, including sheets for downloading / printing….