Ms Brid O’Meara,Director of Services, Aware, provides an overview of a recent conference on the future of depression and biopolar disorder
On Saturday, 12 October 2019, Aware held its inaugural conference in O’Reilly Hall, University College Dublin, catering for over 700 people.
Titled ‘The future of depression and bipolar disorder’, the conference was aimed at both clinicians and the public, with a range of excellent speakers providing up-to-date information on developments in treatment and approaches to depression and bipolar disorder.
Prof Chris Williams, Director of Five Areas, opened the conference, explaining how access to cognitive behavioural therapy (CBT) services, considering the increase in demand, can be improved by offering CBT in different ways. He outlined that in Living Life to the Full programmes, based on the principles of CBT, two main questions are addressed — why does one feel as they do, and what changes can be made to feel better?
Dr Derek Richards, Chief Science Officer with Silvercloud and Director of the E-mental Health Group in the School of Psychology in Trinity College Dublin, spoke about the future of mental health and advances in technology. Dr Richards shared how web-based interactive programmes are a very suitable way of disseminating CBT, explaining the documented research indicating that iCBT has been effective, acceptable and practical in the treatment of depression since 2010. A study published in 2019 highlighted the statistically significant improvement post web-based programmes. This programme has been delivered by Aware, free of charge, since 2013.
Dr Cian Denihan, Consultant Psychiatrist in Saint John of God Hospital, explained that we can look to the past to determine the future of mental health services, giving an outline of the history of mental health treatments. He described the advances that have been made in treatment in recent years, a move to community-based mental health, advocacy, respect for the rights of people with mental health concerns, informed consent, ease of access to treatment and an evidenced-based approach to treatment. Dr Denihan explained that treatments for mental health are currently based on symptom clusters and that in the future, they will need to have a more biological basis in order to be more individualised.
Microbiota-gut-brain axis and psychobiotics
Dr Olivia O’Leary is Senior Lecturer in the Department of Anatomy and Neuroscience and Health Research Board (HRB) Principal Investigator, APC Microbiome Ireland, University College Cork. Her talk was about the emerging roles of the microbiota-gut-brain axis and psychobiotics in depression. She described the bidirectional relationship between the gut and the brain, referencing our common language regarding the gut, having a ‘gut feeling’, being ‘gutted’, etc. She explained this by describing the importance of the vagus nerve, the “gut-brain highway” and the hypothalamic-pituitary-adrenal (HPA) axis as our neuroendocrine stress response system. While much research is required in humans to determine the effect of psychobiotic interventions on people experiencing depression, studies already carried out on mice are showing significant results.
Dr Declan Lyons, Consultant Psychiatrist at St Patrick’s Mental Health Services and Senior Lecturer in Psychiatry at Trinity College Dublin, discussed why it can be difficult for clinicians to diagnose depression in later life. It is under-reported, under-diagnosed and under-treated. While 10 per cent of over-65s have clinically significant depression, only one-in-four are getting the clinical intervention they need. He believes risk factors need to be recognised to help identify depression. These factors include a lack of independence; bereavement; isolation; alcohol intake; having a disability; and poor social support. Dr Lyons explained that depression should not just be accepted as a part of growing old; it needs to be diagnosed and treated.
Dr Keith Gaynor, Senior Clinical Psychologist and Assistant Professor in Clinical Psychology, focused on human connection as a way through depression. He explained loneliness can cause physical pain and increase stress. Dr Gaynor described how connection releases oxytocin, which improves attention and decision-making, gives warmth and comfort. Dr Gaynor highlighted that we have the tools that we need to treat loneliness — the key is to communicate with those around us, shifting our orientation so we are able to talk to another person.
Dr Patrick McKeon, Consultant Psychiatrist and founder of Aware, delivered a talk titled ‘Living well with depression and bipolar disorder’. He spoke about what causes these mood disorders, namely genes and environment, resulting in a mix of genetics along with stress, loss, medications, lack of exercise, immune activations, pain, etc. He explained how we can get well by acknowledging the illness bit-by-bit, allowing our family be part of our support network, be open and avail of counselling. Dr McKeon said to remain well, we need to keep up whatever is working, monitor our mood daily, be able to spot a relapse, have a routine, and focus on achieving small things each day and week.
Dr Andrea Higgins, Clinical Psychologist and Clinical Director at Aware, spoke about caring for yourself while you are caring for another. She clarified anyone who is supporting someone is a ‘carer’. Sometimes the caring role is a privilege, but it can sometimes be unanticipated, or we feel obliged. She said the key message is to look after ourselves. Thinking of your own needs is not a selfish act. Dr Higgins highlighted that what works for someone, won’t work for someone else. She said carers need to think about how they are coping and what helps. Things that help us should continue to work and Dr Higgins advised that people should talk about how they are feeling with someone they trust. If they are under pressure, they should seek support.
Living with vitality
Dr Mark Rowe, medical doctor, author, speaker and educator shared his recipe for living with vitality. He argued “the key in life is to know yourself” and that self-care is not ‘selfish’ care. By writing things down, you get an objective perspective. He shared that two years ago he started to prescribe ‘green exercise’ to his patients. Irish people often spend up to 90 per cent of time indoors; he referred to this as “nature deficit disorder”. Dr Rowe explained that spending more time in nature helps to de-stress and recharge and feel so much better. He also spoke of the power of gratitude; want what you have, not simply have what you want. Each night we should focus on “www” — what went well today?
Dr Claire Hayes, Clinical Psychologist, spoke about choosing to live well. We can sometimes be afraid of making the wrong choice, she said, and there is a subtle but powerful value in language. There is no shame in what we have, but there is a responsibility in choice. Dr Hayes said she recognises that sometimes choosing well can feel uncomfortable, but she argued if we deliberately choose well, we will then choose eating well and exercising well, etc.
Ms Deirdre McSwiney, Sleep Technologist, talked about sleep. She said tiredness and fatigue are simply your body telling you it needs a break; sleepiness should be a signal that you should listen to. She talked of how when sleep goes wrong, people get distressed, irritated, frustrated, annoyed. Worry kicks-in, which causes anxiety. However, sleep loss is not as catastrophic as we might think, and she explained we can cope with a lot of sleep loss.
The power of food
Ms Sarah Keogh, Consultant Dietician, spoke about the power of food when looking after our mental health. She said “everything in your body is made out of what you eat”. The biggest factor that affects our mood is iron levels. Low iron makes doing things a struggle. Kale and spinach are good for iron and experts in cancer would say 500g of red meat per week is fine and we need to consume iron-rich food two-to-three times per week. She explained digestion can also impact our mood, carbohydrates are good for fibre and 80 per cent of us do not eat enough fibre; we need 25g a day. The skin on a potato, along with beans and lentils, are great for fibre, she said, and seeds are also a source of iron and fibre. Look at your plate and do something now that your future self will thank you for, she added.
The final session of the day was the ‘resilience session’ where we heard from Mr Pat Caslin, Ms Sinead Hingston and Mr Jack Kavanagh, who each shared their own relationship with resilience.
Pat was diagnosed with multiple sclerosis 12 years ago and now uses a wheelchair, as his disease has become progressive and he views life with positivity, optimism and gratitude. He shared how hope and fear are both projections into a future that may or may not happen; instead, he tries to focus on positivity. He believes to be resilient, you have to have purpose. He is confident everybody can become resilient, everybody has the capability, but it is a process, and there is “no tablet for it”.
Sinead was just 30 years old when her husband passed away suddenly. She was pregnant with her first baby and had been married for just seven months. She described how “we were pregnant” when it happened and she could not turn to alcohol or medicate to take her mind off it. She discovered walking helped her, as well as talking to people. As Sinead came to terms with it in the following years, she realised she had given all her focus to her daughter and forgot herself. From there, she was able to turn her life around. Sinead believes it is not enough to exist; we all deserve to enjoy life, but it is down to each of us to make that choice.
Jack sustained a spinal cord injury in 2012 only weeks before entering his second year of university. As a result, he is paralysed from the armpits down, with 15 per cent muscle function remaining. He found the physical part of his accident hard, but his tougher battle was the mental challenge. He was constantly being told all the things he couldn’t do, so he created a bigger vision for his life. He realised if he didn’t have a sense of meaning and purpose, he would gradually dwindle and expire. So he made some little choices each day: To say ‘yes’ more often than ‘no’, to say ‘I can’ more than ‘I can’t’, and to choose more often to fight than to give up.
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