Newsletter Feb 2002 |
Dr White's sabbatical
Nicky White has returned safely from her sabbatical leave in the autumn, having successfully walked 100kms along The Great Wall of China looking after 86 other participants as their doctor for the trip. In total they raised a staggering £230,000 for autism.
Following this she was the "Mickey Mouse" doctor for Dreamflight taking 192 disabled and ill children to the theme parks of Florida. The American helpers were especially delighted to welcome Dreamflight this year following the tragic events of 11 September.
PRHO – Dr Matt Symons
You may remember that we explained about Pre-Registration House Officers (PRHOs) in the July newsletter, and introduced Dr Lindsay Khan in the August letter. Lindsay has now completed her stint with us, and has been replaced by…
Dr Matt Symons - who has a romantic attachment to Southampton and describes himself as having a "burning interest in nothing in particular". He likes to read and play tennis, but hasn't really got round to doing either yet!
Meningitis-C Vaccine
When it was launched in 1999, this jab ("MenC") was made available to all under 18 year olds. It only stops one version of meningitis, but since its introduction, the vaccine has decimated rates of Group C disease - the sort of success story which gets neglected in favour of all the funnies over MMR (see www.chawtonpark.org.uk). What has become clear is that the risk of meningococcal infection is twice as high in the 20-24 year olds as in the rest of the over 20s, and the government is allowing jabs for this lot too. It's being done "opportunistically" - ie only if you come and ask. Unlike the Prime Minister, we are entirely happy to say we have our children vaccinated with MMR - and would thoroughly recommend MenC too. Ask at the desk.
New Surgery
Our surgery project at the site next to the Community Hospital continues to inch forward. All sorts of bits are in place, like a pharmacy, and even a Detailed Planning Application. The only thing being unacceptably slow is decision-making on a land deal (demolition of the old boilerhouse etc) by the NHS Estates Agency. We keep trying to urge this forward, but would welcome patients’ urgings too, so please feel free to write to Mr M Hackwell - Capitec, Highcroft Lodge, Romsey Road, Winchester SO22 5RR to say how keen you are to see it move forward!
For more words and pictures about the new surgery, see the website
news section.
A doctor writes… about DEPRESSION
Acknowledged, our pet hates suck. Unacknowledged and over-stressed, our systems blow. Everyone thinks they’ve got the lowdown on depression, probably because we all need to think we’ve got a handle on something which we think could never happen to us. Depression, they’ll say, is just being down in the dumps: pull yourself together, look on the bright side, buck up.
But when docs talk about depression, they’re not meaning just the feeling of depression as it’s known in common parlance, but a brain disease, an imbalance of brain chemicals, which affects anything up to half of the population in their life. And, like the difference between flu and a cold, once had, never forgotten. That chemical imbalance produces a very characteristic set of symptoms - principally a pervasive low mood, often worst in the mornings and a little list of losses:
For many doctors, it’s that particular sleep disturbance which sets the alarm bells ringing. It’s called EMW – early morning wakening – and is very different from all those worried folk who can’t get off to sleep. Here you can often – exhaustedly – get to sleep OK, but then come awake again in the wee small hours, often with your mind racing, turning over and over – very chemical.
And that’s often how the docs will tend to tackle it. Now that we can put you through a positron scanner and see you being depressed in chemical terms, we’re much more likely to shoot first and ask questions later: give you pills first and then talk. Notwithstanding, depression will get better on its own. All the evidence is that it’ll take 18 months to 2 years with all its misery and a significant suicide risk. As ever in medicine, all we do is speed up the healing.
Antidepressants are shrouded in misunderstanding: many folk will know of someone who was on them forever and, yes, that still does happen when someone’s got a nasty recurrent depression tendency. But they’re not addictive, and the majority of folk with a single episode of depression will be on them for a specific stretch of 4-6 months. Why that time? Well, they take 3-4 weeks to get going, and after counselling a patient about them and all the wind-up that entails, there’s often this unnerving period when folk don’t feel any different, and feel like they’re taking Smarties. They wonder what all the fuss was about. You can get earlier, blessed, effects on sleep with the older, zonkier, antidepressants like amitriptyline, but you often have to start at a low dose and work up – and so these take longer to chip into mood itself.
By contrast, the more modern Prozac family only got its reputation because it doesn’t have those sleeping tablet effects, and for the first time we had a damn good antidepressant which was much more side-effect-free. Prozac doesn’t deserve either its cult following (you know - four out of every three people in California are on it, or some such). Nor does it deserve the condemnation it’s attracted: anyone who says it changed their personality didn’t really know themselves that well in the first place. On this side of the pond it’s just a darn good antidepressant.
And they work. The combined Royal College of Psychiatrists and Royal College of GPs “Defeat Depression” campaign re-emphasised that if we find someone meriting antidepressants then they should have them for that full 6 months or so. The remaining months are strongly protective against slip-back – recurrence. In the bad old days we might have let people go with their shyness about the disease, with the stigma, with misconceptions about the tablets. They would have stopped them, feeling much better, at the one month mark, but then have reappeared a few months later with more of the same. So there are a lot of folk walking up and down Anstey Road taking their antidepressants although entirely “well”, but they do seem to emerge treated at the end of the course, and less likely to relapse. A bit like leaving the plaster on the broken leg until the bone’s fully mended.
And what about preventing relapse? Well, that begs the question of how you got depressed in the first place. A significant number of folk with depression may have a family history of it, but like being obese, that’s probably only a partial excuse! My best and broadest analogy for people getting depression is with those old psychology experiments where caged animals were given electric shocks they couldn’t control – they got depressed. And the electric shock analogy works for me across a broad spectrum of patients – being prodded by emotions they can’t ‘control’ (or rather haven’t acknowledged) or by images of themselves (for instance as perfect mother/worker/provider/friend) which are unsustainable in the long term. To change these takes more than pills; once you’re well enough to see the wood for the trees then it’s time to ask yourself some hard questions, possibly with the help of your favourite doctor. Together, you may consider referral to a counsellor or therapist, and these can be very useful in adapting the way you’ve traditionally operated or thought – patterns which predisposed to depression in the first place.
Dr Matt de Quincey
(Other articles are available in the website section "A Doctor Writes")
