anti-depressants

Day 565

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What people do may be a better marker of depression than how people say they are feeling. Behavior can be objectively measured using mobile phones. It is an active sensing and prediction platform to identify behavior changes when individuals suffer from common colds, influenza, fever, stress and depression.

Studies have found a strong relationship between location (using GPS) and clinical PHQ-9 scores. The daily pattern, variability and extent of communications can also be analysed to give valuable clues to changing trends in activity. It is possible to monitor depression passively using phone sensor data. This has significant public health implications. Most people are unwilling to answer questions repeatedly over long periods of time, while passive monitoring could improve the management of depression in populations, allowing at risk patients to be treated more quickly as symptoms emerge or monitoring patients’ responses during treatment.

The efficacy of smartphone sensors and self reporting for mental health care has not been proven yet and remains a very important research question in the pervasive health community.

2 billion people already carry their smartphone with them most of the time. Even the cheaper models have sensors that can track movement and activity, generating data to provide insights into our wellbeing.

StayClose is a free family care app, powered by Touchkin’s predictive care platform. The app helps families care for loved ones while being afar by enabling them to know how they are, without having to ask. They can also share a touch or video moment, or do something to help, like send a ride to take them to the doctor.

For example, when a person is depressed, their phone is likely to show more time spent at home, unusually low activity, changes in communication or sleep patterns. It is possible for a machine learning engine to learn anyone’s phone’s normal sensor patterns and generate alerts if unusual activity indicates any health issues.

I look forward to collaborating with Touchkin for a few pilot studies in London.

 

 

 

 

Day 532

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Cardiac arrest, stroke, seizures, a blood clot in the lungs, pneumonia – these are examples of modes of death. The root cause of all these symptoms could be cancer. But when we speak of these deaths, we acknowledge that these patients died of cancer, whatever the modality.

The root cause of at least 70% of suicides is depression. Yet, we say they died of ‘suicide’ as though they had a choice in the matter. In fact, they did not choose to have depression just like patients who die of cancer do not choose to have cancer.  Suicide is only a symptom of the underlying illness, which Is often a deep depression. So, in effect they died of depression.

Depression is a much misunderstood condition as it is far more complex than general sadness. It is a devastating illness that robs people of their focus, restorative sleep, memory, sex drive, ability to work, play and love. So much so that it can cause them to loose their will to live. It is scientifically proven that depression activates the pain circuits in the nervous system causing immense torment and agony.

It is a global epidemic and the incidence is increasing with every generation.

The use of antidepressants has gone up by 300% in the USA over the last 20 years. These drugs may contrarily worsen suicidal ideation in the young. Psychiatric pharmacology is still a very poorly understood blunt instrument. Yet, it is easier for doctors to prescribe pills rather than invest time and effort in people to make them feel better. As a result more and more misunderstood drugs are being dished out for a misunderstood condition and people are dying as a result.

Robin Williams died of depression.
Saagar died of depression.

Day 522

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Andrew Kirkman was the same age as Saagar. He was a second year physics and philosophy student at Oxford. He ended his life in December 2013. Earlier that week he had seen the college doctor who had prescribed antidepressants for him. His parents had no knowledge of his illness.

Andrew’s mother, Wendy Kirkman has been actively campaigning for a directive that makes it possible for university doctors to inform parents of their children’s mental illness if they are at all concerned. She hopes this would save the lives of other students. “People seem to be frozen into inaction by the fear of disclosing information to the parents of students who are over 18, when they have always had the legal right and perhaps obligation to do so anyway.”

Dr Geoff Payne has issued new guidelines advising university doctors to contact parents if concerned for a students’ mental health.

The argument against this guideline is that merely telling the parents doesn’t fix the problem. That is true. However parents can provide additional support. Close monitoring of such cases and intensive talking therapies also have a very important role. Non-disclosure by itself is not a problem but it does translate to further lack of support in a system that has long waiting lists and inadequate capacity to provide optimal care for patients in need.

The other argument against it is student’s right to privacy.
Can the right to privacy be more important than the right to life?

Day 506

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Last week I attended an appointment at the new GP surgery with our (new) GP for my annual review of Rheumatoid Arthritis. It was more like the doctor had a consultation with the computer. He looked at the blood results, the prescriptions and notes. He measured my weight and blood pressure but he didn’t ask me anything about the condition I was there for. How are the joints doing? How long have I been in remission? He probably knows as do I that we might never see each other again. He is not ‘my’ GP. He works at the GP surgery where I am registered. I suppose he did what he could in the 10 minutes he was given. The achievement of the day was that I got the prescription of medications.

Last week I met a young man who has recently lost a parent to suicide. He went to his GP asking for help and was instantly offered antidepressant medication. He was dismayed as he knew that is not what he needed. He needed someone to talk to. “People in the UK are consuming more than four times as many antidepressants as they did two decades ago. Despite this, we still do not fully understand the effects of these drugs” says an expert from UCL.

The UK has the seventh highest prescribing rate for antidepressants in the Western world, with about four million Britons taking them each year — twice as many as a decade ago.

According to the analysis conducted by Nordic Cochrane Centre in Copenhagen, the clinical study reports on which decisions about market authorization of these medicines are based often underestimate the extent of drug related harms.”

Four deaths were misreported by one unnamed pharmaceutical company which claimed they had occurred after the trials had stopped. One patient strangled himself after taking venlafaxine but because he survived for five days, he was excluded from the results because it was claimed he was no longer on the trial while he was dying in hospital.

More than half of the suicide attempts and suicidal thoughts had been misrecorded as emotional instability or worsening of depression. In summary trial reports from the drugs giant Eli Lilly, suicidal attempts were missing in 90 per cent of cases. It appears that big pharmaceutical companies reap profits while carelessly tossing aside all human costs and ominously covering them up.

 

 

 

 

Day 427

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It’s done.
The facts have been established.
Not all, but a few important ones.
It would have taken a few weeks of deliberation to get all of them out in the open.
I was not looking forward to it and wanted to jump to the other side of it asap.

The inquest was once again conducted in an open and investigative manner. Everyone was given time to say what they wanted to.
The verdict was:

“Took his own life while of unstable mind.”

Contributory factors identified were:

  • Poor communication with the family about Saagar’s illness, the seriousness of it and the side effects of the medications he was on.
  • Poor discharge summary and handover from psychiatrists to the GP – diagnosis and warning signs for a referral back to the psychiatrists not clearly mentioned.
  • Poor judgement on the part of the GP to have not sought specialist help for him on seeing his highest possible PHQ-9 score, possibly causing him to prescribe inappropriate medication which might have added to Saagar’s suicidal ideation.

All the things I have been going on about! 

The one person that struck me most was the witness from SLaM (South London and Maudsley) Trust who was in-charge of patient pathways and improvement in services. He had been a nurse but now is a ‘manager’ of sorts. He uttered nothing but jargon, office-speak, absolute rubbish, completely devoid of any heart or clinical sense. He claimed to disseminate the lessons learnt through ‘business meetings’. I don’t understand how the two things are connected. That is the true face of modern NHS.

While the verdict was what I had hoped for, I don’t have much hope for change as the people responsible for improvement are nothing but pimps.

I feel completely scooped out, as if my insides have been hollowed out with a blunt knife. It’s time for some rest.

Good night.