Anxiety, Depression and Suicide

RE: Anxiety, Depression and Suicide

Robin Grimmer — Tue, 12 Mar 2019 18:09:55 GMT

Thought I'd check in as been keeping half an eye on this thread. the job is the cause of the depression. I've been there too - my main symptom was insomnia particularly early morning waking.

I can honestly say that retiring from veterinary practice is the best thing I've done. I thought I might miss it but so far I don't miss it at all. I'm sleeping better than ever and with all this time keeping in good physical shape too which is so important for mental health. Anti depressants don't deal with the cause, they just numb you. You need to deal with the underlying cause.

RE: Anxiety, Depression and Suicide

Evelyn Barbour-Hill — Tue, 12 Mar 2019 18:05:28 GMT

[quote user="Julie Innes"]don't know whether they want to be male or female.[/quote]

Oh, that one.... at the risk of SSSS, I'd say that's just responding to what they get told from all directions.... and instead of being told to cut the crap, as it were, until they are old enough to know what they are talking about, they are pandered to.

RE: Anxiety, Depression and Suicide

Robert FalconerTaylor — Tue, 12 Mar 2019 17:56:38 GMT

[quote user="Jill Butterworth"]

The serotonin explanation of depression is also being called into question

[/quote]

It died a decades ago - for a brief review see

http://www.emotions-r-us.com/behaviour/pets-fear-and-fireworks-the-fallout-and-terrible-consequences-of-fear-and-anxiety-for-our-pets-part-4-using-alternative-non-prescription-therapies/

trouble is, media-easy concepts persist because they sell phantom solutions for pets and for humans and this is where the 'alternative' tx brigade make their £££££££££££!!

RE: Anxiety, Depression and Suicide

Clive Ansell — Tue, 12 Mar 2019 17:24:25 GMT

[quote user="Julie Innes"]Half the 12 and 13 year olds in my children's school are either depressed, anxious or self harming (thankfully not mine!). They tell me about friends who run out of lessons because it's all too much for them, or who cut themselves, or don't know whether they want to be male or female.[/quote]

That's genuinely worrying.

I wonder though; what percentage actually have a mental illness, or are attention seeking? don't know. And how much of it is part of the pushy parent syndrome?, where little Johnny has to be perfect in every way and be able to split the atom and be fluent in Mongolian before his fifth birthday.

I don't have children, but many relatives and friends do. I notice that often kids don't seem to have time just to be kids anymore, and there seems little time for quality family together down time. They all seem too busy and always in too much of a hurry.

I was observing a young family in a coffee bar recently; kids were playing up because they were getting no attention and being ignored by their parents who were just twating around on mobile phones.

RE: Anxiety, Depression and Suicide

Julie Innes — Tue, 12 Mar 2019 16:59:41 GMT

I really think it must be something to do with modern lifestyles, although I'm not sure what! Computer screens, inactivity, consumerism, everything being so "safe" (health and safety abounding!)?? Half the 12 and 13 year olds in my children's school are either depressed, anxious or self harming (thankfully not mine!). They tell me about friends who run out of lessons because it's all too much for them, or who cut themselves, or don't know whether they want to be male or female.

I dn't know what the answer is, but I don't see things getting any better for the next generation, sadly

RE: Anxiety, Depression and Suicide

Arlo Guthrie — Tue, 12 Mar 2019 16:10:24 GMT

[quote user="Jill Butterworth"]The serotonin explanation of depression is also being called into question[/quote]

Laughed out loud ... I think everything I write today is going to be outmoded, called into question, or just plain wrong!

Really, I just meant 'serotonin' as a catch-all for 'happy brain chemicals'. I don't doubt it is much more complex than just serotonin.

I'm just trying to understand whether current thinking/research suggests that an underlying inability for some people to create enough happy brain chemicals is a bigger or smaller factor than external factors which cause the brain to stop making happy chemicals (or cause the brain to make 'sad chemicals' if such things exist).

I'm not explaining myself well here, I know!

RE: Anxiety, Depression and Suicide

Clive Ansell — Tue, 12 Mar 2019 15:56:28 GMT

[quote user="An On MRCVS"]still feel I want to remain anonymous so there is certainly stigma attached to this problem)[/quote]

I think you're right, there does seem to still be a stigma attached to it, and in some cases it is almost taboo.

I have had 3 non-NHS medical examinations by my GP in the last 2 years, and each time the 1998 (mis)diagnosis of depression has been mentioned. God knows why when it was 20 years ago, not relevant, and was subsequently discounted by a consultant psychiatrist.

RE: Anxiety, Depression and Suicide

Julie Innes — Tue, 12 Mar 2019 15:51:45 GMT

I was never actually diagnosed with depression as such. I went to the doctor because I just simply didn't want to be here. I love my family far too much to do anything to myself, but I used to fantasise about getting seriously ill, or being involved in a car crash that wasn't my fault. There were no real horrific life events that triggered it, although 1 case at work possibly compounded it. I eventually spoke to my family and, at their insistence, went to my doctor.

My doctor was really good. I don't know whether just seeking help and having someone understand was also hugely useful. She offered me anti-depressants as a stop-gap, and I agreed to try them, although I was a little sceptical. It was only a couple of weeks later when I found myself singing in the shower that I realised I must be feeling better! I never really looked back, although nothing else really changed in my life, so I can only conclude that the drugs did work. Stayed on them a few months, been fine ever since.

RE: Anxiety, Depression and Suicide

Jill Butterworth — Tue, 12 Mar 2019 15:47:32 GMT

That the explanation of depression: endogenous/exogenous is outmoded as an over simplification.

[quote user="Arlo Guthrie"]depression = a lack of serotonin.[/quote]

The serotonin explanation of depression is also being called into question (you'd have to read the whole book!) by some mental health experts because:

a. SSRI's don't work reliably

b.Patients' depression often doesn't resolve and ever increasing doses are required

c. The placebo effect works

d. Pharmaceutical companies have a vested interest in perpetuating this model and financing research which perpetuates drug use, rather than, for example, social prescribing, which is just as efficacious.

I'm not qualified to explain it further, but it seems plausible.

RE: Anxiety, Depression and Suicide

Arlo Guthrie — Tue, 12 Mar 2019 15:06:00 GMT

[quote user="Jill Butterworth"]From my reading of the book I mentioned, 'Lost Connections', the model of exogenous depression (caused by circumstances) and endogenous depression (arising from within spontaneously) is an outmoded view. [/quote]

Jill, I'm not sure I quite understand what is outmoded. The idea that depression is caused by one or the other, rather than both?

Actually, I'd presume it would be both, but varying in proportion from one person to the next.

My understanding, in simple terms (the only ones that work for me!), is that depression = a lack of serotonin.

a) Some people have a lack of seratonin because their body simply does not create enough of the stuff.

b) Some people have a lack of seratonin because they are having such a shitty time that their brain is not triggered to make the stuff.

Logically, those in group a) need to take an SSRI to deal with the physiological problem whilst those in group b) would benefit from getting their problems sorted (or perhaps taking an SSRI until they are).

In most cases, it is presumably a mixture of the two, and what would be interesting to know is whether there is any research showing whether either is a dominant cause. If that could be ascertained (and perhaps it is different in different groups of people), then it might indicate whether medical treatment or problem solving is likely to be more effective.

(That said, I've always thought that anything which helps improve the working environment is worth doing, regardless of whether it is likely to reduce the incidence of depression or not. I mean who doesn't want to enjoy their working day?)

RE: Anxiety, Depression and Suicide

Clare Tapsfield-Wright — Tue, 12 Mar 2019 12:04:26 GMT

[quote user="Arlo Guthrie"]

[quote user="Arlo Guthrie"]It would be really interesting to hear from those who have suffered from depression whether they can remember it being brought on by external factors or not.[/quote]

Anyone?!

[/quote] I was diagnosed with depression, my GP referred to it as reactive depression after both of my sons were diagnosed with autism and severe learning difficulties. I did find Prozac helped , counselling not so much, as nothing was going to change the facts and the lack of support and understanding from some family members. I became able over several years to cope without medication though I probably didn’t get better until I made some life changes , dedicated time for me, and took up riding. I manage myself better and I feel well now. The odd bad day and some anxiety but I think that’s life. I never had a breakdown , I think I came close and had lots of running away fantasies but was needed too much to feel I could leave my sons in the lurch. Some people are more resilient than others, I had a tough childhood with a schizophrenic mother and was quite a free range child. Maybe that prepared me and made me stubborn and self sufficient but I think my best asset is my sense of humour. Life can be tough but I can always find something to make me smile.

RE: Anxiety, Depression and Suicide

Jill Butterworth — Tue, 12 Mar 2019 11:59:43 GMT

[quote user="Arlo Guthrie"]

[quote user="Arlo Guthrie"]It would be really interesting to hear from those who have suffered from depression whether they can remember it being brought on by external factors or not.[/quote]

Anyone?!

[/quote]

From my reading of the book I mentioned, 'Lost Connections', the model of exogenous depression (caused by circumstances) and endogenous depression (arising from within spontaneously) is an outmoded view. Some individuals are genetically predisposed, and so if rubbish life circumstances coincide, one's chances of being affected are hugely increased. The signs are similar/the same as profound grief, which could affect any of us to some extent, and most people report some kind of trigger, I think?

My personal view is that for many people, veterinary work itself induces a state of anxiety, and that unexpected death(s) causes(s) a form of PTSD. This might leave us in a more vulnerable state for depression?

RE: Anxiety, Depression and Suicide

An On MRCVS — Tue, 12 Mar 2019 11:27:21 GMT

I was depressed at university... couldn't stop crying all the time, didn't want to eat anything, darkest possible thoughts of how to stop everything, couldn't sleep etc etc.

But I knew it was circumstances not illness. Relationship break down complicated by best friendship breakdown and social awkwardness because of the circumstances with a group of people I had to live and work with all the time. Combined with breakup of parents marriage and final exams... and the "lecture free final year" which meant we were supposed to be in rotations and lectures at the same time!

I knew that I needed to escape and took my final exams knowing that if I failed I would never go back... so my only chance to qualify. Luckily I passed... but I have never been back to that Uni for CPD or any other meetings. Felt better within a year of normal life. Never suffered again with depression... so possibly not true depression (never saw a GP or any form of help... still feel I want to remain anonymous so there is certainly stigma attached to this problem)

RE: Anxiety, Depression and Suicide

Clive Ansell — Tue, 12 Mar 2019 09:43:10 GMT

I was diagnosed with depression by my GP and given anti-depressants, at about 2 years qualified, which did not help.

After a private referral for full psychiatric evaluation, the consultant told me I was not clinically depressed at all, and that I was just exhausted and run down. I had suffered multiple traumas that year; relationship break up, work was tough, father was diagnosed with terminal illness and my brother was very ill. I was taken off all medication and told to take some rest and some quality down time, which I did and have been fine ever since.

The consultant also commented that these episodes, and those of clinical depression, are usually multi factorial and something usually just tips the balance as it were. In addition he commented there could be a genetic disposition too, but that it wasn't entirely known.

Take home message for me was to be wary of a diagnosis of depression, and being given anti-depressants, based on a sub 10 minute GP appointment. My evaluation involved 3 days in a clinic.

RE: Anxiety, Depression and Suicide

Arlo Guthrie — Tue, 12 Mar 2019 09:17:20 GMT

[quote user="Arlo Guthrie"]It would be really interesting to hear from those who have suffered from depression whether they can remember it being brought on by external factors or not.[/quote]

Anyone?!

RE: Anxiety, Depression and Suicide

Jill Butterworth — Mon, 11 Mar 2019 16:57:36 GMT

This has been going on forever, it's just that the internet makes it so easy to create a story. I've been around the profession since the 1980's and have seen a marked change in the aggressiveness of both clients and 'veterinary management' around debt. In the days when almost all practices were independently own, it was highly likely that the vet would know the family and their circumstances (you know, a real social interaction, with a flexible human element to fit the circumstances) and could adjust the bill or allow a payment plan. One practice I worked at had a little fund for these occasions too and we pulled together and helped out.

Fees have escalated wildly to pay the management layers which didn't used to be there and something important has been lost. These cases provide the perfect opportunity for a young vet to practice a new technique without stress (ie a much reduced fee, on the understanding that the animal can't be referred and would be otherwise euthanased), but modern management seems too short sighted to understand the huge benefit to allowing vets to gain experience under these circumstances (ratty clients are usually transformed into pussycats once they know you are doing your best and not charging much). I once thought about starting a 'Lucky Legs' scheme to get enthusiastic young vets some kit, to prevent needless amputations and euthanasias after a particularly demoralising weekend...

RE: Anxiety, Depression and Suicide

Julie Innes — Mon, 11 Mar 2019 12:35:09 GMT

I also thought that was a good article, Arlo. I wish the media would be more on our side.

RE: Anxiety, Depression and Suicide

Arlo Guthrie — Mon, 11 Mar 2019 11:04:28 GMT

I wonder ... there's this distinction between 'depressed' and 'clinical depression'. Does anyone know of any research showing a link between the two.

What I mean is ...

We all get 'depressed', in the loosest sense of the word, from time to time: business not going well, problems with relationships with other people, can't pay the bills, bereavement, feeling of being on a treadmill with no real purpose, that sort of thing.

My question is whether anyone, exposed to enough of these sorts of things, for long enough, will likely suffer from clinical depression.

Or is clinical depression completely separate to any external trigger. In other words, sufferers will suffer depression regardless of external triggers around them.

It would be really interesting to hear from those who have suffered from depression whether they can remember it being brought on by external factors or not.

If external factors are causative, then addressing things like this https://medium.com/@drsarahboston/medias-emotional-blackmail-is-killing-veterinarians-51bcb3823164 could be expected to help.

(I thought that was a very well written article BTW, worth a discussion in its own right).

RE: Anxiety, Depression and Suicide

Jill Butterworth — Sat, 09 Mar 2019 14:18:37 GMT

[quote user="Anthony Todd"]That is assuming that it is the job that is unsatisfactory whereas it may be the employee and not the job.[/quote]

Horses for courses. It's got to fit, or both parties will be unhappy.

RE: Anxiety, Depression and Suicide

Anthony Todd — Sat, 09 Mar 2019 08:57:06 GMT

[quote user="bevs2251"]The most important thing to do, I believe, is to leave an unsatisfactory job,[/quote]

That is assuming that it is the job that is unsatisfactory whereas it may be the employee and not the job.

RE: Anxiety, Depression and Suicide

bevs2251 — Fri, 08 Mar 2019 22:45:33 GMT

The most important thing to do, I believe, is to leave an unsatisfactory job, even if it means tightening the belt for a while. I have stayed way too long at some jobs. It is a nightmare for one's mental health, if you keep pushing yourself. That's when you stop circling the drain and end up going down it. A 6 month sabbatical might be a good idea (contemplating one myself at the moment).

There seems to be plenty of jobs in the UK so the anons should be able to take their pick, or do locum work for a while (at good practices).

RE: Anxiety, Depression and Suicide

Evelyn Barbour-Hill — Fri, 08 Mar 2019 18:46:26 GMT

[quote user="Alistair Graham-Evans"] I say sympathy as a psychologist told me that if someone is drowning , throwing a lifebuoy for them is sympathy but jumping in to help is empathy![/quote]

Rather a weird analogy and not at all accurate. But going with it for now: if I saw someone drowning in deep water, throwing them a lifebuoy is exactly what I would do. Practical help is what's needed, not heroics that might just end up with me drowning as well. So, translate that back into what to do for someone with mental health problems.

RE: Anxiety, Depression and Suicide

Bob Russell — Fri, 08 Mar 2019 11:23:27 GMT

How many people are actually in the wrong career and how many just have the wrong job (with the wrong management)?

We are still advertising the right job with wonderful management and have had some interesting candidates.

A practice can be genuinely family friendly as I hope ours is!

We still start Saturday clinics at 9.30 because I had to take my boys to football!

The jobs are out there and it does not have to be a battle with employers. Here it is us united against the world (our clients are OK)!!

RE: Anxiety, Depression and Suicide

Jill Butterworth — Fri, 08 Mar 2019 10:01:54 GMT

Contemplating the wrong job vs wrong career can be really difficult when you are in a bad place, literally and metaphorically and very difficult to put right when you are drowning in the mire. Little things become triggers and can cause you to over react and become difficult to work with.

Going part time transformed my life (i.e. a 25-30 hr week mostly), and I've noticed that many of the vets I know avoided burnout by doing this in some way, and were able enjoy the profession and set their lives/practices up to do this.

Taking a break, it might even be a year (remind yourself that lots of parents return to practice successfully after a gap), take lots of relaxation to empty the stress bucket, do some free CPD to stay sharp, and then locumming on your own terms, by deciding what you can offer, can be a way out of this.

RE: Anxiety, Depression and Suicide

Bob Russell — Fri, 08 Mar 2019 09:49:22 GMT

One peice of advice I have for those having problems associated with relationships is to consider RELATE.

My experience with them was a long time ago but I was in a mess and meetings with the councillor proved to be unbelievably constructive.

To this day I wish she could be installed in a little shed at the bottom of the garden!

I accept there are good and less good councillors but in my case it was great and kept my head straightish when my world was spinning!