Huge Study Of Anti-Depressants Published In ‘The Lancet’

Much has been made of a recent trial of anti-depressants published in ‘The Lancet’ last week (Feb.22nd 2018). The Royal College of Psychiatrists said the study “finally puts to bed the controversy on anti-depressants”. The authors suggest that many more people could benefit from the drugs and a list of the most and the least effective drugs has been published looking like this:

The most effective:
 agomelatine
 amitriptyline
 escitalopram
 mirtazapine
 paroxetine
The least effective:
 fluoxetine
 fluvoxamine
 reboxetine
 trazodone

Doctors are being told to hand out more and more of these drugs and the whole thing is being heralded as good news for sufferers of depression.

I say: be careful.

Whilst this may be the largest study of its type it still has its limitations. Dr. James Davies from the Council For Evidence-Based Psychiatry appeared on BBC Newsnight to say that the study was being spun to wrongly lead people into thinking that the drugs are more safe and effective than they actually are. On The CEP website (cepuk.org) the following post gives an alternative reaction to the study:

‘’Do antidepressants work? The new research proves nothing new’
By admin on 22/02/2018 in News, Psychiatric drugs
The Council for Evidence-based Psychiatry
22 February 2018
For immediate release:
Cipriani’s et al’s new research on whether antidepressants work has generated much excitement in the news media as well as the psychiatric community. The study has been represented by the Royal College of Psychiatrists as “finally putting to bed the controversy on anti-depressants“.
This statement is irresponsible and unsubstantiated, as the study actually supports what has been known for a long time, that various drugs can, unsurprisingly, have an impact on our mood, thoughts and motivation, but also differences between placebo and antidepressants are so minor that they are clinically insignificant, hardly registering at all in a person’s actual experience.
But even these differences can be accounted for. Most people on antidepressants experience some noticeable physical or mental alterations, and as a consequence realise they are on the active drug. This boosts the placebo effect of the antidepressant, helping explain these tiny differences away.
Furthermore, the trials only covered short-term antidepressant usage (8 weeks) in people with severe or moderate depression. Around 50% of patients have been taking antidepressants for more than two years, and the study tells us nothing about their effects over the long term. In fact, there is no evidence that long-term use has any benefits, and in real-world trials (STAR-D study) outcomes are very poor.
Lastly, and perhaps most importantly, the study does not bury the controversy around the damage caused by unnecessary long-term prescribing, the costs lost to the NHS, and the associated harms and disabling withdrawal effects these drugs cause in many patients, which often last for many years.
Overall, the study’s findings are highly limited, and do not support increasing antidepressant usage. Antidepressants are already being prescribed to around 10% of the UK population, and current guidelines do not even support their use by at least one-third of these patients.
This study, and the media coverage that has accompanied it, will unfortunately do nothing to help reduce this level of unnecessary prescribing and the consequent harms.’

anti-depressants

From my own experience (having had all of the drugs that on the ‘most effective’ list) I can say that being off anti-depressants has been better for me than taking them. Often I had intolerable side-effects, some of which were unpleasant physically, and some of which were disturbances in my mood leading me to be harsh and cruel and unfeeling, possibly even being the catalyst to some of the most damaging and dramatically bad life choices that I have made. I found that the best drugs only succeeded in flat-lining my mood and preventing me from plunging into overwhelming crisis. However, this flat mood was nothing more than basic survival and experiencing such a constant low mood could barely be called living.

Since coming off these drugs and switching to anti-psychotics I have experienced happiness again, something which was impossible under anti-depressants. Yes, I suffer from crippling anxiety and overwhelming emotions, but at least amongst these emotions there is happiness.

I have found that most doctors have very little knowledge of anti-depressants and very little idea of which to prescribe. It has been almost pot-luck in my experience. In fact, doctors seem to be poorly trained when it comes to depressive illness, which is strange considering the number of patients that turn up in surgeries needing treatment for depression.

We need much more funding for mental health treatment to provide talking therapy and an increase in the availability of adequately trained Psychiatrists and Psychologists.

My advice is, although I hate to have to say it, that medication can actually be worse for you than taking nothing at all. It’s far more important to try a range of talking therapies and alternative treatments. What’s even more difficult to have to say is that with therapies ‘you get what you pay for’. That is, if you have the money to go private and find a Psychiatrist or Psychologist you will find that the quality of your therapy is much better and more useful than you might find on the NHS (where you may have to wait for up to two years to be seen). Save up as much as you can and go private, even for a couple of months.

My conclusion is that this study is not what it is cracked up to be and has been spun to be some sort of big breakthrough – good news on depression’ – when actually the truth is much more complicated and less positive. The attitude of NHS doctors on anti-depressants is not necessarily correct; do your research, get clued up, and be ready to challenge your GPs. Don’t give up on living without anti-depressants because they are not always the answer. This study most definitely does not put the controversy around anti-depressants to bed.

 

Book Review: ‘Pulling The Trigger’

This is a book for sufferers of OCD, anxiety, panic attacks and related depression, currently sitting on top of Amazon’s search lists for books on those topics. Adam Shaw, a successful businessman and founder of a mental health charity, reveals his problems with OCD and how Lauren Callaghan’s approach to treating him worked. The book was published by Trigger Press in 2016, which is a publishing company created by Shaw (Managing Director) and Callaghan (Director).

As a sufferer from obsessive thoughts, anxiety and depression, and diagnosed with BPD I bought the book hoping for at least something helpful.

Reading through the book I remember being very frustrated as page after page (85 of them including the introduction to be precise) just detailed Adam Shaw’s problems and kept saying how wonderful the new approach to treatment was without going on to spell it out. It actually made me quite angry.

In the second part of book the back-slapping continued. I finished the book wishing that they had just written: ‘Adam had OCD and Lauren told him to accept it’. It would have saved me a lot of time, effort and cash. The conclusion is all that you really need to read.

Accepting that you have OCD and panic attacks is very difficult. Embracing it feels wrong. It is not for the faint-hearted and I can envisage many feeling that this approach is not for them. I’m not criticising the technique because it obviously works for some people. I just think this could have been an article on a website and not a book because it keeps repeating itself all the way through.

I would advise people to google treatment for OCD and read about it online instead.

Five Years Of Hell

I wrote about my childhood and my time at university. Now I turn to the next five years or so. I hope that you find it in some way helpful – perhaps you can identify with my experiences or perhaps you are just interested in other people’s lives. Perhaps you want to share your story here. Let me know!
Whatever your reason for reading I’m glad that I can share a little more about myself with you.
I do hope that your journey hasn’t been anything like mine.

University spat me out into a great chasm. Where does a student of poetry look for a job? I imagined turning up at interviews and being asked if I had been trained to use the latest software. I imagined myself replying “No, but I know what iambic pentameter is”.

I trawled through pages and pages of jobs seeing nothing that I believed I had a chance of getting. I was at a loss and very depressed about it all. Then, motivated by that moment when I would have to ask for my future wife’s hand in marriage, and out of utter desperation, I decided that the only option open to me was teaching. What do you do with poetry? The only useful thing is to teach it to someone else. At least there was a guaranteed job at the end of it with a reasonable salary.

The problem was: I knew that I was completely unsuited for the job. It was never going to work.

I was accepted by Homerton College, Cambridge University, and enrolled on a teacher training course. The subject was ‘English with Drama’ (and believe me there was plenty of drama) and the qualification was to teach in secondary schools. What a mistake.
The course was a total nightmare and I’m not sure to this day how I stuck it out until the end. I’ll give myself credit where it’s due: I’m a determined and tough so and so when I have to be. I don’t think, given what I was going through with depression and anxiety, that most other people could have done the same.

Some of the training was done on the job, (I think I taught at three schools as part of the course) and I was used as maternity cover for one particular teacher. It turned out that she was a friend of J.K. Rowling (I had never heard of her) and she mentioned that Rowling was coming to the school and would be in the library during the lunch-break. I was not in a good place at the time and was feeling less than enthusiastic about anything to do with children, schools, teachers, books, authors and anything that I didn’t really need to be involved with. I feigned interest and didn’t bother turning up.

When I finished my time there the teacher gave me a present: a first edition signed Harry Potter book. My disillusionment was so great that I decided to see if I could sell it. I had no idea if it was worth anything but presumed that there was always someone who wanted a first edition signed copy of something. It sold for a small amount. It would be worth a fortune now.

A career in teaching beckoned. Unfortunately the jobs on offer were not in my area and I had to become a supply teacher. With my boyish face and chronic lack of confidence becoming a stand-in for absent teachers (mostly covering subjects I knew nothing about) was a recipe for disaster.

The kids hated me (they hated all teachers and were particularly cruel to stand-ins) and I wasn’t thick-skinned enough to take it. I once had a laser sight from a gun aimed at me as I was sitting in a staff-room: one of the kids was actually pointing a gun at me. The red spot sat on my tie for a while as I tried to figure out what it was.

They demolished me by totally under-mining my authority. They threw things at me and each other, and if I playfully threw something back they threatened to sue me; they stood on the tables rioting; they threatened to throw each other out of the windows; they made comments about me that nearly reduced me to tears and they gave me a good send-off when at last I could bare it no longer: walking across the car-park to leave for the last time their cries of derision rung in my ears.

However, quitting my career and wasting my training wasn’t good for my mental health either. My wife and her family (we lived on her father’s farm) were sympathetic but I was deeply ashamed. I have tried to lose that sense of shame but shame and guilt are difficult opponents and they refuse to go away. Sometimes they disappear only to return twice as large.

Now depression really sensed its opportunity. I felt I had let everyone down and that I had no future. I felt a failure and an embarrassment. I also started to get the idea that I was cursed somehow and that the world was deliberately designed in order to exclude me and to prevent me from earning a living wage.

I was able to work some hours and earn a small amount of money on the farm (an occupation for which I was equally as unsuited) but I still felt only shame, guilt, fear, depression, isolation, hopelessness and just about every other negative emotion I can think of. There I was, a highly qualified student of poetry, shovelling shit in someone’s stable. There I was, the least practical person imaginable, with no common sense whatsoever, fiddling about with things technical and mechanical, understanding not the faintest thing about whatever job it was that I was being asked to do or trying to help with. That in itself was depressing and humiliating.

I can look back rather sentimentally now and picture myself driving tractors in the warm summer sun, watching an owl quartering the field in front of me on a late summer evening as I was turning the hay; driving the old grey Fergie’ (Massey Ferguson) from the fifties that I liked to chuff along on; lying on top of a trailer full of hay as we set off down the road, watching the white clouds in the blue skies above me with my hands underneath my head; drinking wine on summer evenings under the apple tree we had strung white lights in; walking in the fields with my dogs and looking after my goats and sheep.

However, the fact is that I was seriously ill and wanting to die.

I was seriously depressed and suffering with crippling social anxiety. When I walked through the sheds I saw thick ropes, meant for tying hay and straw securely onto trailers, and I couldn’t help but think of hanging. When we went up to see the majestic cathedral that dominated our landscape I only thought of jumping from it.

Just imagine wanting to harm yourself to that extent. We are hard-wired to survive and yet there I was contemplating ending it all by throwing myself off a tall building. That is how severe mental illness can be. My daily struggle was so awful that I was prepared to smash myself to bits or choke myself to death. I used to wake up in the morning (if I had actually managed to sleep that is) and my first thought would be to despair that another day was upon me. There was virtually no respite and nothing that anybody could do for me.

I didn’t help myself by denying that I had a problem and pretending to be a ‘normal’ person wherever I went. I expected a lot of myself and that only increased my burden. At that time I was learning about myself and my illness. I was learning what my capabilities were, what I could and could not cope with and how to look after myself. I got it very wrong for a long time by expecting too much and not being kind to myself. Knowing what I know now would have made my life much easier.

It was a secret illness. Nobody could see inside my brain. I often wished I had cancer or some other physical ailment that was visible to everybody else. Many other sufferers out there must know the feeling. We all end up being our own doctors, recognising symptoms, monitoring ourselves and trying to get the right treatment.

I began to spend as much time as possible on my own and I only left the house when I absolutely had no other choice. This only made my social anxiety worse. I found some solace in song-writing and losing myself in music but it was a seriously bleak period.

Those five years were really tough. They were hell.

 

Ten Ways To Help Your Child Or Relative With Their Mental Health Issues At University

Please note that I am not and never have been a mental health professional. I have been through university with a mental illness and have done a little research. I have children but they have not been through university.

1. Understand the challenges faced by students

Saddled with debt; likely to suffer from stress; under pressure to complete their course and get the qualification they need; living unsustainable and damaging lifestyles that may lead to alcoholism or drug addiction; struggling with abusive or failed relationships; trying to understand their mental health difficulties; coping with the realisation that they are not the top of the class anymore, not such a star on the sports field, not as perfect as they thought; vulnerable to anxiety or eating disorders; dealing with being independent, and experiencing some intense life lessons for the first time: student life is fraught with potential difficulties.

2. Choose the right university

Although this may be dependent upon how many offers your child has to choose from, (and on how much influence you have), choosing the right university has to be done wisely.

You might want to consider things like choosing a university that is close enough to home for you to go and visit them regularly: this could be more important than you might imagine.

Consider being influenced by where his/her’s friends are going.

3. Be influenced by the adequacy of the university’s’ mental health services

Check out the website and read up on the university’s mental health support services. Compare it the other university’s that you are choosing from. Give them a ring and talk about it. Understand how many staff the university employs in the area as this may determine the length of the waiting lists for counselling services. Consider choosing a university that has a specialist mental health advisor.

4. Inform the university about pre-existing mental health issues before arriving

This way a plan of help can be made quickly.

There is more help than you might imagine for people who arrive with existing mental health conditions. They can have a mentor or extended deadline dates, for example.

Being open about these things is much better than suffering in silence and these days it shouldn’t affect your application.

5. Spot the signs of depression

Go and visit your family member at university don’t remain stuck on the end of the phone. On the telephone you can’t read facial expressions and you can’t get a feeling for their circumstances, where they live, where they go. Look at their body language: do they look at you in the eyes or do they look away from you? How much do they smile? Is there something different or unusual about them? Do they sound overly pessimistic and negative about everything? How do they dress – have they lost interest in how they look? Have they lost interest in things they used to enjoy? Have they lost or gained weight suddenly?

If your child or relative is withdrawing from you in any way it may be because they are becoming depressed.

Of course, some people are too hard to read, too good at acting. They are the centre of the action, the life and soul of the party, permanently smiling, doing well in their studies and having a great social life. Sometimes making your friends roar with laughter can be a depressing experience: I know because I’ve done it. In that moment you are the only person not laughing and time seems to stand still. Your night out can’t get any better than being the centre of attention and being Mr. popular. So the only way is down.

6. Educate yourself about mental health

Make sure that you understand that depression does not improve simply by ‘jogging around the block’ or ‘going out for a laugh’. The fewer old fashioned clichés that you use the better. Being knowledgeable and understanding will help you give your child the right advice should they choose to ask you for it and will help you yourself cope with his/her’s challenges.

7. Communicate

Foster the best relationship that you can with them so that you can get them to open up about their problems. Keeping it to themselves is not going to help them at all. These days there is less stigma around mental health but it does not mean that admitting you have a problem is easy. As a parent, you will likely be one of the first people that they can trust with their problems. Being able to talk to you is vital.

8. Encourage them to give counselling a go

Talking therapies work. Talking can be the most effective way of treating some mental illnesses and often it starts with traditional counselling that may be available on campus. Other therapies can follow through referral from a GP or privately.

9. Take the pressure off them

You can take the pressure off them by telling them that it is ok to feel the way that they do. You can tell them that it is better to quit and come home than to suffer with suicidal thoughts. Once home they can work on getting well enough to move on with the next stage of their lives. Getting a degree isn’t the only stepping stone to a successful career.

10. Be a good listener

A good listener does not have to give advice but must listen sympathetically and intently. Don’t zone out. Try and summarise what you think they are saying occasionally to show them that you are listening and don’t be afraid to ask them questions. Whatever you do, don’t start talking about yourself. It’s not about you! Avoid lecturing them or making them conform to your view of the world and how you think they should live. It’s great that they are confiding in you!

Still Alive: University

University can be really tough.

I arrived in Cambridge to begin my course (English Literature and Language) falling to pieces. It frightened me that I was alone in a place I didn’t know, I had no idea of how to look after myself, feed myself, or live within a budget. I was frightened because I didn’t understand why I felt the way I did or what to do about it and I was frightened about a new ‘school’, new fellow students, and a new course with new ‘teachers’.

My father’s church friends got me a place to lodge down the road from them. This came to be very fateful. I was extremely nervous about living in a stranger’s house. I had a small room downstairs and the family consisted of a husband and wife and their young son. They were nice to me to begin with but our relationship grew to be very strained and broke down badly towards the end. I’m sure that some of it must have been my fault but I still can’t work out what.

As time went on I spent less and less time in their house, preferring to be down the road with my father’s friends. I was fed many times there. The example that they set (and the suffering that I was going through) led me to being baptised as a Christadelphian. That was the most momentous thing that happened to me during my time at university: apart from meeting my future wife.

My anxiety wound me up tight and didn’t let up for a moment. I found everybody at university seemed to be on a different planet to me. I was probably the only one that arrived to what I thought was my first day, waited in a queue for an hour and then was told that I needed to come back another day. I was so anxious that I could barely function and read important information like that. Everyone else seemed to turn up late or not at all. They were all paired off and enjoying their new found freedom. They seemed comfortable and like an adult whilst I felt like a child. My insides were exploding every time I went near the place.

Classes and lectures were torturous. There I was on my own and barely able to look at anybody. The chatting and laughter around me made me feel different somehow. I began staring at the floor and couldn’t look up. Trying to find different classes and lecture places reminded me very much of how it felt when I went to secondary school for the first time. I fretted and found it difficult to find things. Sometimes I just scraped in and sometimes I was about 30 minutes early. I didn’t have a friend to help me.

I had no social life during my first year at university. My social anxiety prevented me from hanging around in the pubs and clubs. I wasn’t yet interested in church social life. I found myself alone in my tiny room reading and listening to music. I actually saved quite a lot of my student grant money because I never went anywhere to spend it and I never overspent at the supermarket. This hermit-like lifestyle was a tactic to counter social anxiety but it actually made my social anxiety worse because I might spend two days alone in my room and then have to go to university when all of a sudden the world would be around me again and it was all the more frightening and anxiety-provoking for it.

Seminars were torturous. Often, we would go around the room, saying who we were and introducing ourselves and by the time it got to me I could barely speak, my face was bright red and my bowels wanted to explode. We would each be asked to contribute something in this way quite often and it made seminars terrifying. Any time that I had to speak caused me the utmost discomfort. It wasn’t that I couldn’t keep up with the work itself – it was difficult but I could do it – it was more that I felt the odd one out, I felt everybody’s eyes on me, ridiculing me. I felt that they could see me shaking; they could see that I was some kind of weird misfit, some child that was to be laughed at.

I grew to love Cambridge, but not in those first few years. I wasn’t used to city life. All around me were shocking battles that I witnessed wide-eyed. There were car-accidents, beggars, street preachers, fights, and all sorts of people from all over the world – some real characters too. Cambridge was full of intellectual students and seemed in a political sense, to be a liberal city. I didn’t fit in with the angry drug-taking underbelly, or with the bicycle pedalling intellectuals, and sometimes I felt more like one of the numerous Japanese tourists than a legitimate student.

I remember being almost run over by Professor Stephen hawking. There were quite a few academic heavyweights around the place. So there was a city with the have-nots causing problems and the ordinary people getting on with life, and there was a city with the intellectual liberal elite. As a student with what was the old polytechnic but now a proper university I felt decidedly second-class. The Cambridge University students took all the privileges and we picked up the pieces. There was no niche that I could fit in to.

The anxiety and depression was relentless and the pressure of university never let up, including the intensity of entering whatever world the next author created. The books were mind-expanding and one book or play, or poem, followed another in quick succession. The reading lists were extensive. I bought them all second hand and they piled up into small towers on my floor. I began to get used to being the only one to read the books and be prepared for the seminars. It was my anxiety and fear of getting into trouble and having a confrontation with the lecturers that made me read everything and hand my essays in long before anyone else. It had been the same at school and that was why I achieved what I did: sheer anxiety. There was no pleasure in it.

The others seemed to know that they could get away with not reading the books or turning up to the lectures. By the time my last year came around I wasn’t attending lectures either because I had realised that they were either irrelevant and of no use whatsoever. I feel let down my university. The books that were suggested as helpful for our assignments were not available in the library because usually they had one copy for hundreds of students. I remember doing assignments from the top of my head when I couldn’t access a single book to refer to.

The most important single piece of work was the dissertation so I decided to give a rough draft to a lecturer to get his unofficial opinion on the direction I was taking. Unfortunately, he then proceeded to mark it as if it was finished. I told him this was unfair but the mark was not changed. I narrowly missed out on a first and it galls me to this day.

My mental health was deteriorating sharply. It was about this time that I first began considering suicide. I felt so bad that I went to the university counsellor for help. She told me that I was suffering from Clinical Depression. It felt strange hearing a professional confirm what I already feared. On the one hand it was good because I could now go to my doctor and be more likely to have a fair hearing, but on the other hand I felt like a condemned man and I now had an adversary with a name. I was fighting this external aggressor like the flu virus I had struggled so badly with in first year. It put all sorts of things in my head as I found out a bit more about it. I even read Freud, I was pretty intense in those days and academia was all I knew.

My doctor put me on a medication called Dothiepin. Looking back, all it ever did for me was take away my appetite, give me nausea and dehydration and make me cold and unfeeling. My mood was still rock bottom but any glimpses of joy were squashed. This was to become a familiar problem. Being on medication worried me. These drugs were altering things in my brain but what exactly were they doing to me? How could the doctor know exactly how they were functioning in my brain and what long term effects they could have? My heart seemed to be racing and they put me on more medication to deal with that. That really scared me because I didn’t want to think about anything messing with my heart.

I don’t remember telling anyone about all this. There was more of a stigma in those days and I stigmatised myself. It was a case of living with an invisible plague in contrast to having a physical disability. Down the years I wished that people could see my illness and understand why I acted the way I did.

My connection with the Christadelphians might have saved my life. I found a safe haven down the road, at the church, and with families who took students under their wing and fed them on Sundays. I was helped by one particular family regularly and was taught how to drive tractors and work on their farm. They relied on students for help and I was glad of the diversion, I became very much a regular and got involved in activities that were run just for young people, gaining some friends on the way. Little was I to know that the daughter of my hosts that was away at university was to become my future wife…I like to think that the angels were at work!

By the end of my time at university my wife’s family took me in as a lodger. Every day away from their house, away from my wife to be, was such a contrast. I felt nauseous and full of panic, frightened and depressed, and very lonely. Insomnia plagued me and intensified my problems because I got no respite from the panic. At this time I was very quiet and withdrawn, I appeared aloof and intense, as if I was somehow angry and disapproving of everybody. I was just an impenetrable wall of ice and only my wife could see through it.

I hope this insight into what life can be like at university proves in some way to be useful to you.

Still Alive: The First Eighteen Years

All schools ever said about me came in the form of whatever was written in my yearly report. I did well. My reports were good. Teachers liked me because I was bright and polite. They called me ‘quiet’ and ‘conscientious’.

However, my ‘brightness’ and ‘conscientiousness’ didn’t endear me to the rest of the children and being the teacher’s ‘pet’ singled me out as a target. I was different to most of the other kids I neither condoned nor condemned their behaviour in their hearing but by not joining in I earned their wrath. I was scared every day of my school life, at primary school and secondary school, in term time or out: scared of abuse, either physical or verbal, and scared of being mocked and humiliated. I was ostracized at times and tormented at others. This was always going to impact on me both then and in the future.

I was rarely involved in fights because I could run fast and I could make myself scarce at the right moments. I slipped in and out of school through a hedge and managed to avoid being kicked and punched on most days. There were exceptions but nothing was ever done about them. In a way it was for the best because those kids would have hated and persecuted me even more if they had been punished for attacking me. My trials slipped under the radar.

And so, I was just ‘quiet’.

As I excelled in sports (I was virtually always captain of both cricket and football teams in primary and secondary school) along with the academic side of school life teachers must have thought that I was coping with school life better than anyone. Unfortunately, the more they praised me and promoted me the more I was hated, and the more I achieved the more scared I became.

I lost my grandfather (I idolised and loved him more than my own father) when I was ten: he committed suicide on Christmas day. Now I can sympathise with what he must have been going through but I’ll never be able talk to him about it, I’ll never be able to try and help. It gave me a deep wound that has hurt for over thirty years.

My problems only seemed to get worse at secondary school. It was an achingly sad time. In fact it would be fair to say that I spent most of my days in desperate anxiety, dreading every school day and getting more and more nervous from the moment the Friday home time bell went to the moment Monday morning came and my next week of distress began.

The school bus was hell. Sometimes I was persecuted; spat upon; mercilessly and ceaselessly mocked for thirty minutes twice every day. It hurt to take it without fighting back. I kept my anger inside because of cowardice and a hatred of confrontation. My main battle was to keep from blubbering every day.

My mother asked me for permission to divorce my father. When I said yes I felt terrible. I’ll never forget watching him packing up his things in the back of a van and leaving, or the time I saw him crying and said nothing. I sided with my mother but it was still heart-breaking.

I came to live with my father because one of us children had to go with him rather than leaving him totally alone. It meant that I avoided the bus as he had moved into town. Unfortunately we had never got along, I had always lived in fear of his moods and hurt by his lack of praise for me and the atmosphere in the house quickly became poisonous.

During my A-levels my doctor first used the word ‘depression’. Nothing, however, was done about this and I didn’t bother mentioning it to my parents. I was scared of it and didn’t want to be stigmatised.

I left school with good enough qualifications to go to university but also with a lifetime’s worth of issues.

Conclusions

Was it really a surprise that I began to develop stress-related problems, depression and social anxiety? It is not a cliché to look back at these formative years and see problems in later life. There is a reason for psychiatrist’s being interested in our childhoods.

Child and young adult psychology should be made more available than it is now. If it’s not, parents and teachers at last need to be talking about mental health.

I was lonely and isolated and I was being picked on. That’s not just ‘kids being kids’. Teachers should pick up on this and have a conversation.

School time is an intense social experience for children exploring relationships for the first time: relationships with each other, with their teachers, their parents and the wider world. Those children who seem to have trouble with these relationships need to be looked after and monitored.

Is there training and funding for specialist staff in the field of child mental health? Do teachers know enough about what is happening to their pupils at home? What should they know and how should they find out? Do parents know enough about what is happening to their children at school? Does the government care about any of this?

The signs that I was having difficulties were that I had few friends; I was unusually quiet and I was moody; I wanted to run away from home and I was extremely sensitive; I never felt rested after sleep and so I felt tired and weary at school; I was always sad. If they had talked to me they would have picked up on a lack of self-esteem and problems at home.

There are no ‘loners’ in the school system that should be ignored. They need to be dealt with sensitively. If I had the opportunity to talk to someone during my time at school, someone I felt that I could trust, I would have admitted that I faced serious challenges. The long and short of it is that parents and teachers need to understand how important mental health is for kids. They need to see the signs and know where to go to get help.

Every class or year group should have access to someone they can talk to. It’s so important.

I suppose, as with most things, it comes down to money. If the government is serious about targeting mental health it needs to give schools sufficient funding. If we get it right early on we may see the benefit later. The state has had to fund care for me: maybe it could have saved itself from this burden if I had help earlier on in my life.

Every school day I make sure that I talk to my son about how he felt during the day. I give him the vocabulary to be able to answer that question; when he was younger it used to be: was your day ‘good’, ‘ok’, ‘bad’ or ‘really bad’? Sometimes we would say was it a ‘normal’ day or an ‘abnormal’ one (he liked this because he was learning about similar structures in grammar)? I always ask him if he played with the other children and if there were any tears. How is he getting on with his teacher? Is there anything worrying him? Does he want to talk to me about anything?

I try to get him to open up and tell me everything. I would thoroughly recommend this approach to all parents. One thing we know for sure about mental health is that talking works.