The team investigate the best way to beat stress, how sleep affects mental health and why laughing can be as good as exercise for improving mood.
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When it comes to our health, it seems everyone has an opinion.
But what's the health advice you can really trust?
We're here to weigh up the evidence,
and use our expertise to guide you
through the contradictions and the confusions.
We do research no-one else has done,
and put your health at the heart of what we do.
We listen to the questions you want answered,
and ensure you get the information you need.
We're here when you want to know the latest findings
and not the latest fads.
I'm Michael Moseley,
and in this series, I'm joined by a team of doctors.
Together, we'll cut through the hype, the headlines,
and the health cleanse.
This is Trust Me, I'm A Doctor.
Hello and welcome to a special edition of Trust Me, I'm A Doctor,
all about mental health.
When you're in good shape mentally, feeling positive,
then you can cope with pretty much anything that life throws at you.
But as well as ups, most of us will at some point experience significant
downs. In fact, at any given time, one in six of us is affected by
something like depression or anxiety.
So, in this programme, we want to give you the best ways to look after
and protect your mental health.
We've conducted a survey of over 2,000 people, and asked,
"What mental health issues are you really concerned about?"
You gave us a wide range of interesting questions to explore
and that in turn led us to unearth some surprising answers.
So we'll be finding out, can you eat yourself happy?
I was feeling down before,
but now all I can feel is the pain in my mouth.
Can taking antidepressants pills be dangerous?
We'll reveal an extraordinary new treatment for some serious mental
-Almost everybody has a dramatic, if not total recovery.
And, if mental health problems run in your family,
how worried should you be?
..when we asked you what issues you wanted us to explore,
the main question that people wanted answers to, 42% in our survey,
was, "How can I best cope with stress?"
It's well-known that stress is bad for our mental wellbeing,
and heightens our risk of things like depression.
So what can you do to remove some of that harmful stress from your life?
Doing the old stiff upper lip, trying to ignore it,
or saying, "Pull yourself together", really doesn't work.
So what does?
We've recruited 68 volunteers and split them into groups.
Over the next eight weeks, they'll be testing three stress-busting techniques.
Our first group will meet every week
for gardening and conservation activities.
There is growing evidence that both social interaction and contact with
nature can have a positive effect on our mental health.
Does everyone know what a thistle looks like now?
Our second group will be trying yoga.
Studies suggest it can reduce stress and lower our heart rate and blood
-See if you can begin the twist by looking forward.
Our third group will be using a phone app to do a daily session of
mindfulness - a form of meditation that focuses the mind
on the present moment.
There are claims that doing this helps you avoid being caught in a
cycle of negative thought.
-Welcome back to day 28.
And we'll be comparing all three against a control group
who'll just go about their daily life as usual.
Throughout the eight weeks, we'll be monitoring our volunteers'
stress levels. At the beginning and end of the experiment,
they'll give us saliva samples so we can measure levels of a hormone
called cortisol -
a key part of our bodies' stress response.
They'll also fill in psychological questionnaires so we can assess how
stressed they're feeling.
Helping us run the experiment are Professor Angela Clow and
Dr Nina Smyth from the University of Westminster.
They're going to show me the daily cortisol pattern you'd expect in
someone who's healthy and not particularly stressed.
OK, so we've got a graph here made out of stress balls.
So, Angela, can you talk me through this graph?
Yes, absolutely. As we know, cortisol is a hormone associated
with stress, but it's a lot more than that, actually.
Cortisol is the energising hormone,
so it activates your brain, it gets you prepared for the day ahead.
And what we see here is how when we wake up,
it initiates a huge surge in cortisol, and that,
illustrated here by the blue dots,
is called the CAR, or the Cortisol Awakening Response.
OK, I'm surprised, it must be...
I assumed that high levels of cortisol are a bad thing.
And what you're saying is actually you do need this big peak in the
-morning to get you going.
-Cortisol, at the right time of day,
is what you need, because it's an energiser.
That cortisol awakening response primes you to do what you have to do
in the day.
So a cortisol curve in a healthy person looks like this.
Big surge in the morning that gets
you ready for the day ahead
and then a drop-off.
But, if someone's suffering from chronic stress,
you'll likely see a smaller peak in the morning,
a sluggish start that leaves you feeling less able to cope,
and then, sometimes, higher levels throughout the day.
So, Nina, has a study like this one been done before?
No, so this is really exciting, cos this is the first time where we're
actually measuring the cortisol awakening response
and the decline over the day,
to see if an eight-week activity does have an impact on their
cortisol, and particularly their cortisol in the morning.
We'll be back after eight weeks to see which of our groups is
Stress is common,
so it can be hard to tell when feeling worried and anxious is
developing into a more serious problem.
In our mental health survey,
a question frequently asked was, "What is a mental health issue?"
So we've got in our very own expert to answer that question.
Over to a new member of the Trust Me team,
consultant psychiatrist Dr Alain Gregoire.
One of the biggest challenges I face as a psychiatrist
is that many people are not sure at what point simply feeling a bit
off-kilter becomes a mental health issue for which
they should seek treatment.
It can be very difficult to recognise when something is wrong,
and even if we do, most people try to hide it.
So what exactly is a mental health problem?
Don't know what a kind of mental health is. What is it?
I'm asking you!
-A lot of people hide it.
-Why do you think it's hidden?
-It's a taboo subject.
In psychiatry there are three key factors we consider when we are
looking at someone's mental health -
and their mood.
If all three of these are troubled,
it suggests their mental health isn't good.
But it can be really difficult to work out when things are getting so
bad that we need professional help.
I'd like to see everybody getting help.
At whatever stage it is,
it shouldn't have to get to really bad to have help.
Everybody should get help.
Do you think people might be frightened in any way of going to get help?
Frightened of going to get the truth, yeah, I think they will.
Yeah, because they're scared of what the consequences are going to be.
When it comes to our physical health,
most of us have a pretty clear idea of when we should go to the doctor,
and our mental health should be no different.
If you get a bit of wheezing after taking some exercise,
you probably wouldn't go and see a doctor about it.
But if you've got a more persistent, severe wheeze,
and it stops you getting on with your usual activities,
you'd know that you probably need some sort of treatment.
It's the same with mental health.
If you've got low mood for two or three days and then it gets better,
that's probably nothing to worry about.
But if your mood is very low over a longer period of time and you're getting gloomy and anxious thoughts,
and it's stopping you getting on with your life,
then you may well be developing a mental health problem, and it would
be sensible to go and get professional advice,
and sooner rather than later.
Because no matter what the problem is, or how severe,
the vast majority of mental health conditions are treatable.
There are lots of different approaches,
from self-help techniques and talking therapies to medication,
and often a combination of these is what works best.
Just as with any health problem,
the earlier you catch it, the more effective the treatment.
So, if you think you might be developing a problem with your
mental health, go and see your GP for advice.
In our survey, lots of you asked what you can do to improve your own
mental health. In a moment,
we're going to be looking at which foods might help
and the impact of sleep. But first,
GP Dr Zoe Williams has been investigating exercise.
If exercise could be bottled and sold,
it would probably be the most effective medicine ever invented,
reducing our risk of many serious diseases.
Some doctors will prescribe it to help prevent and treat mental health
But how effective is it, and why?
The benefits of exercise on mental health
are thought to be in part thanks to the release of hormones called
endorphins, which can make us experience positive feelings.
Some studies suggest that it can reduce the symptoms of depression
and boost self-esteem.
But there's one brand-new piece of research from Germany that indicates
the key thing is perhaps not only how much exercise you do,
but also what type.
This is bouldering, which is climbing without any equipment,
and it's been suggested that this is even better than general exercise
when it comes to treating depression.
Professor Gillian Mead from Edinburgh University
has studied the evidence.
-Oh! Hi, Gillian!
So I really want to know, why is it that bouldering is specifically such
a good exercise for depression?
Well, other forms of exercise are good for depression,
but people can still mull over their problems
when they're exercising.
That's called rumination.
But when you're bouldering, you have to have complete focus...
-So it breaks that cycle of rumination.
You have to be concentrating on what your hands are doing and what your
feet are doing. You have to focus on your balance.
You have to problem-solve, and when you're bouldering,
you must be in the present moment.
It's widely thought that focusing the mind on present sensations helps
us avoid being caught up by negative thoughts.
If bouldering isn't something you might try,
there's growing evidence that other forms of exercise that need mental
concentration, such as dancing, might have similar benefits.
But if exercise is a real struggle for you, then there is another
rather surprising way that you might
be able to get at least some of its benefits.
SCREAMS AND LAUGHTER
So this is absolutely bonkers, but so much fun,
and I'm actually... I want to take my jacket off, I'm quite sweaty
and quite out of breath.
This is Laughter Club.
There are over 10,000 of them worldwide.
Jo Bluett runs one in Edinburgh
that attracts a wide range of people.
THEY CHANT IN UNISON
Behind the fun here, there's a serious scientific purpose.
Jo has been running a study to assess the impact of laughter on the
health of a group of carers.
I was the first Laughter Club in the UK to receive NHS funding,
so we've actually been evaluating the impact of attending a regular
Laughter Club on carers.
The results over the last three years show that there's been an
average increase of 60% in carers' health and wellbeing
-by attending Laughter Club.
It's really, really powerful.
But what's fascinating is why laughter works.
It's not just about lightening your mood,
-it's actually giving your body a work-out.
When we laugh in everyday life,
we generally laugh from up in the chest and it's often fleeting.
In Laughter Club,
we encourage people to laugh from the belly for a sustained period of
time. We're increasing our heart rates, improving our lung capacity,
we're starting to sweat.
It's really a powerful work-out that we're getting.
The endorphins that we release through laughter
are our natural antidepressants, so we lift our mood.
So laughter can give your body and mind some of the benefits
you get from exercise.
Well, before I was diagnosed with Parkinson's,
I suffered from depression,
but when I was going through the finding out what was wrong,
I got really down.
-Hand on heart, I honestly don't know what I would have done emotionally...
-..and mentally if I hadn't had this before I was diagnosed.
If people wanted to give this a go at home,
what would you say is the recommended dose of laughter?
Ten minutes, nonstop continual laughter.
Which is hard to do on your own with no triggers,
this is why you need to come to a Laughter Club to practise it and
train your body, your muscles, and more importantly, your mind.
-THEY BLOW RASPBERRIES ALL:
I've always believed exercise can help improve mental health,
but looking into the latest research
has really shown me how and why it works.
Exercise that needs concentration seems to be particularly effective,
as it focuses the mind away from stressors and negative thoughts.
And even something as simple as laughter
can give you great benefits.
In our survey, more than one in four of you asked us,
"What impact does diet have on mental health?"
Well, Dr Giles Yeo, who studies the impact of food on the brain
has been investigating.
We all know that when it comes to our physical health, what we eat
plays an enormous role. But is the same true for our mental health?
Well, when it comes to what's bad for us, yes.
One well-known effect of eating junk food is that it gives us extreme
highs and lows of blood sugar,
and some research suggests that, in the long term,
this pattern can interfere with particular brain chemicals that
affect mood. But can eating healthy food make a difference?
There is a growing industry in blogs, vlogs,
and diet plans that claim you can eat yourself happy.
But can certain foods really improve your mental state?
One of the first scientific experiments to test the idea was
performed in a prison.
Half the inmates in the study took supplements of multivitamins
and fish oil. In a matter of weeks,
the behaviour of these prisoners improved dramatically.
They committed 26% fewer misdemeanours than a control group
taking placebo pills.
No-one knows exactly what was in the supplement that changed the
behaviour of the prisoners so drastically,
but it points to some trace nutrients that our brain requires in
minute amounts, yet has a profound influence on our mental state.
One of the supplements in the prison experiment contained B vitamins -
iron, calcium, magnesium, chromium,
zinc and selenium.
Some studies suggest that, by improving brain function,
these can also benefit your mental health.
Many of these are found in green vegetables.
When you're buying your vegetables, though,
bear in mind that British veg is are often poor in selenium.
Brazil nuts are very high in it,
so factor a handful into your diet each week.
Now, the other key supplement the prisoners took was fish oil.
It's known to contain high levels of omega-3 fatty acids,
which some studies have linked to brain health.
A study in Norway showed that people who consume fish oil regularly were
about 30% less likely to have depression.
Now, if fish is not to your taste,
then you could have walnuts or flaxseeds.
Your diet also needs to provide your brain with ingredients for making
serotonin and dopamine -
two chemicals linked to emotional health.
The ingredients for making serotonin and dopamine are present in most
proteins, so if you swap out your higher fat and higher sugar foods
with leaner sources of protein such as fish, chicken or turkey,
that should give your brain all that it needs.
Vegetarian options include beans, lentils and quinoa.
Meanwhile, there are lots of claims out there for individual ingredients
that supposedly boost your mood,
though the evidence for these is scant, and eating more of one thing
is often not very practical.
Chillies are meant to improve your mood.
I can see why. I was feeling down before,
but now all I can feel is the pain in my mouth.
The spicy heat of the chilli prompts the brain to release endorphins,
which are known to make you feel good,
at least in the short term.
And there you have it, the diet to keep you in top mental health.
Now, what to wash all this down with?
I think I deserve a glass of wine.
But take it easy on the alcohol, because it is a known depressant.
We've already seen how exercise and diet can help,
but what else can we do to look after our mental health?
Alain's been looking at the impact of sleep.
A bad night's sleep leaves most of us irritable and grumpy.
ALARM CLOCK RINGS
But is that as far as it goes,
or could it affect us more deeply than we think?
As a psychiatrist, I'm interested in anything that can have a negative
impact on our state of mind. So what I want to know is
exactly what effect can lack of sleep have
on our mood and our thinking?
And can it affect our mental health in the longer term?
To find out, we've teamed up with sleep scientists at the University
of Oxford to run our own experiment.
We've recruited four volunteers with healthy sleep patterns,
and over six nights, we're going to test whether reducing their sleep
has an impact on their mental health.
We're fitting them all with devices to monitor their sleep.
For the first three nights of our study,
they get a full undisturbed eight hours.
Then, for the next three nights,
we're restricting their sleep to just four hours.
It's still a few hours before I have my first four-hour sleep,
and I'm pretty tired, to be honest.
I'm really hating it.
During the day, our volunteers have to follow their normal routine.
The day seemed to take twice as long as it normally does.
I've just noticed that...
I started getting quite a lot of tension and anxiety in my chest.
Each day, they fill in a psychological questionnaire designed
to reveal any changes in their mood and thinking.
And they're also keeping video diaries.
You can feel your body's natural rhythm trying to send you to sleep,
and you're trying to fight it.
So, that's a bit of a struggle.
After their three nights deprived of sleep, our volunteers are back.
And doctoral student Sarah Reeve is going through all their data.
I've just got in their sleep recording devices,
and also getting their questionnaires,
which they've been filling in online...
So these are kind of standard scientific questionnaires that we know work?
Exactly, they've been used on big samples of people before,
so we know that they're really good for measuring the things we're
interested in, which are things like depression and low mood, anxiety.
We're also measuring things like feelings of mistrust of other people,
and also any unusual experiences that people have been having,
because we know all those things are really important for mental health.
So those are things we're looking for changes.
Oh, here come our sleepwalkers. Hi, guys, come and sit down.
It's time to reveal the results.
First, the average scores for the whole group.
What we can say is that, looking at your scores before and after the
sleep restriction, it's actually pretty impressive.
There have been increases in
anxiety, depression, and stress.
We've also had increases in paranoia
and feelings of mistrust about other
people. Given that you've only done
three nights, four hours a night sleep,
to have these sorts of changes happening so quickly,
I hope, you know, it's quite interesting for you to hear about.
Sarah has also been looking at the effects on each of our volunteers
-So for each of you, we have a graph.
-Chris, this is yours.
-After Chris was deprived of sleep,
positive emotions - feeling happy and relaxed - reduced,
while negative emotions - including stress, anxiety, anger,
and mistrust of others - all increased.
Yeah, I definitely felt it. So, yeah,
I wouldn't have been able to cope with it for much longer than I did.
The same was true of Lily and Alex.
But our fourth volunteer, Josh,
seemed to feel much better than the others.
This week really hasn't taken as much of a toll as I thought it would
on me. I feel perfectly fine, I'm not happy, sad, angry,
-stressed or anything.
-But his graph reveals a different story.
His positive emotions fell sharply
after two disturbed nights,
while some negative emotions were
beginning to rise.
So even though he felt OK,
there are signs that his mental
wellbeing was beginning to suffer.
I guess it's just...a false cover on my mind,
thinking, "Everything's OK",
and it was actually getting progressively worse.
The outcomes of our small test reflect the results of a wider study
carried out by the Oxford team.
Leading that research is Daniel Freeman,
Professor of Clinical Psychology.
So what do the results of our small demonstration and your larger study
-I think they're a beautiful illustration of how even a short
period of reduced sleep has such a psychological cost.
So imagine having that sort of reduction of sleep for a longer
period on a severer level.
So both our mood and our thoughts are affected by loss of
-Yeah, it skews our thoughts to the more downbeat and fearful,
and it skews our brain processing into these sort of loops of
repetitive negative thinking.
We have more negative thoughts when we are sleep-deprived,
-and we get stuck in them.
Does that make it inevitable if you're not sleeping well
that your mind isn't going to be working that well?
No, it's certainly not inevitable.
I mean, in any one night, one in three people having difficulty
sleeping - perhaps 5-10% of the general population
has insomnia - and many people get on with their lives
and they cope with it, but it does raise the risk of a whole range of
mental health difficulties.
Well, that was a bit of an eye-opener.
Even as a psychiatrist,
I'm surprised at how quickly lack of sleep can affect our mood
and our thinking. It emphasises how important sleep is to us.
But that knowledge is also an opportunity for us to look after our
mental health by taking care of our sleep.
If you're not sleeping well, take exercise during the day,
have a wind-down routine,
and avoid looking at screens
in the hour before bed.
Have a regular bedtime and waking up time,
and don't spend too long in bed not sleeping.
If this doesn't help, there are a range of treatments available,
so do go and see your GP.
If you do suffer from mental health problems, and millions of us do,
then getting the right help is crucial.
In a moment, I'm going to be looking at the pros and cons of taking
antidepressants, but first, surgeon Gabriel Weston has been
looking at something which could prove to be a significant
breakthrough in the treatment of mental illness.
Every now and again in the history of medicine, there's been a
breakthrough that shifted our understanding of mental illness.
The Victorians routinely sent syphilis patients to the asylum,
until it was discovered that the real cause of their
mental disturbance was an infectious disease.
But these sorts of diagnostic misunderstandings aren't just a
thing of the past. In fact,
recent discoveries reveal that some cases of mental illness might
not be quite what they seem.
Nafisa is 17 and has just started at university -
something that little more than a year ago
seemed impossible when she developed disturbing symptoms.
Tell me about how things started.
So it started with me being socially withdrawn, highly emotional.
I knew something was wrong, but I didn't know what it was.
And that, for me, was hard,
because I did go to my doctor about it and he just put it down to
depression. He thought that because I'm a teenage girl doing A Levels,
but I knew it wasn't that.
And when things got worse, what sorts of experiences were you having?
I felt paranoid.
I felt everything, everyone was watching me.
Like I could see things that weren't there.
I just saw all my family members... I saw my late grandad. I physically
thought they were there, and I was calling out to them.
Nafisa's hallucinations and paranoia were classic symptoms of psychosis.
But then something unexpected happened -
she had a violent seizure.
Consultant neurologist Professor Sarosh Iran,
began to suspect Nafisa's symptoms might have a very different cause.
The clues in the rapid onset of Nafisa's psychosis, associated with
this, with her thrashing movements of her arms and legs,
the pouting movements of her face, and the fact that she then had a
seizure and a heart rate which fluctuated.
Professor Irani thought Nafisa's symptoms could be due
to a rare form of encephalitis, where antibodies produced by her
immune system were actually attacking her own brain.
The antibodies go and target the body's own proteins, and in
this case, the protein is called the NMDA receptor,
and because the NMDA receptor is involved in features of psychosis
and learning and memory,
it's those sorts of problems which the patients experience.
Such as seeing things that aren't there, hearing things that aren't there.
The diagnosis meant that Nafisa urgently needed treatment,
not for a mental illness, but for an autoimmune disease.
Professor Irani began a course of immunotherapy, removing from
Nafisa's blood the rogue antibodies that were attacking her brain.
Almost immediately, she began to make a rapid recovery.
For her to recognise us, acknowledge us, and give us a hug and smile,
I think that was the, you know, the point where we thought,
-"Yeah, we've got our daughter back."
-My mum told me I faced death twice,
but obviously I don't remember, but now I'm grateful that I have this
life back, so I'm just going to live it to the full.
Remarkable cases like Nafisa's are leading to a seismic shift
in our understanding of mental illness,
showing that, at least in some cases,
what might appear to be a psychiatric illness,
is actually caused by an immune malfunction
requiring a completely different kind of treatment.
And this new discovery has opened up
an exciting new field of medical investigation.
At the forefront of the research
is consultant psychiatrist Professor Belinda Lennox
from the University of Oxford.
She wondered if some patients with a diagnosis of schizophrenia,
which has similar symptoms to Nafisa's,
might instead have an autoimmune
condition that had gone unrecognised.
To find out, she carried out blood
tests on a group of patients to see
if they had the same rogue antibodies.
We took some blood from nearly 50 patients
and we sent it off to the lab.
And we got three positives.
It was really fascinating and quite dramatic, actually.
So you found that there was something going on in their blood
that suggested they didn't quite fit into the usual psychiatric picture.
Absolutely. They had diagnoses of schizophrenia,
they had all not responded well to the standard treatments,
and they had these antibodies.
So we decided to look more broadly.
We tested nearly 240 patients,
and we found antibodies in those
patients in about 1 in 11 patients.
Belinda then tried the same
immunotherapy as had been given to Nafisa on nine
of these patients with schizophrenia.
The results were astonishing.
In our experience, in patients that
we've identified the antibody and we have treated,
almost everybody has a dramatic if not total recovery.
Belinda has now begun the world's
first clinical trial using immunotherapy
to treat schizophrenia.
This really does look like it could
have a revolutionary feel for psychiatry.
I've been a psychiatrist for 20 years now, and this is what
I've been waiting for, to actually
find a proportion of patients that we
can offer a radical, new, effective treatment for.
Professor Lennox's trial holds the promise that in future,
patients who appear to have symptoms of a severe mental illness could be
tested for an autoimmune condition.
And, in some cases, treated with immunotherapy.
It's such an exciting prospect that research has already begun at other
universities to see if immunotherapy might also be used in common
conditions like depression.
When I was at medical school,
we were taught about psychiatric
disease as being completely distinct from medical disease.
So the idea that there might be a
biological explanation for a psychiatric
condition is really interesting.
Now, obviously, this research is in its infancy,
but it is ground-breaking,
because for the first time
it suggests the possibility of treating, even curing,
a group of patients who might otherwise be condemned to a lifetime
of mental ill health.
Depression and anxiety are incredibly common,
and if you go and see a doctor,
it is increasingly likely you will be prescribed something like this.
Last year alone in the UK,
there were more than 70 million prescriptions written.
The thing is that a lot of people are suspicious about antidepressants.
So are they right?
Should we worry about taking antidepressants?
In our nationwide survey,
almost a quarter of you wanted to know the answer.
In a moment, I'll be asking two renowned experts who have completely
opposing views. But first,
I want to explore why so many of us are wary of these drugs.
He taught me no-one was going to give me anything.
That no-one was going to help.
This is Vicki Bran.
..I had to adapt like a rat.
She suffers from anxiety and depression on a regular basis.
She's also a performance artist.
I thought that I would be a happy rat.
I am a happy rat.
Vicki's chosen not to take medication,
and I want to know why.
So you go and see your GP, and what did he or she prescribe or suggest?
They suggested that I might take antidepressants
and that I would take
beta blockers as well.
And you chose not to?
-I did, yeah.
I function on a kind of spectrum of quite intense highs and lows,
and I was concerned that if I take antidepressants,
that I might sit somewhere in the middle of that wave and I'd miss out
on the very top of that kind of wave which, for me,
is periods of intense creativity, like I can get a lot done.
And what happens when you hit low?
I'm in bed, really, unable to get up.
Thoughts are incredibly scattered.
Thinking about brushing my teeth,
but also thinking about killing myself.
We're sitting here, we're chatting, you're looking sort of cheerful,
very good body language,
open and friendly, and you're talking about killing yourself.
-And that's quite an odd experience.
Yeah, yeah, definitely.
I've had three bouts of ill health in my life,
and I've always got through them
with talking therapies and support.
And I made performance work.
In the time where I was most struggling,
and where I was most at risk,
I wasn't being supported.
And that, I think, is the time
where I would consider taking antidepressants in the future.
But so far, I haven't.
Now, I thought Vicki was very moving and eloquent about her condition,
and she's obviously determined to
try and sort this out without resorting to drugs.
But is she right to be worried about them?
I'm going to speak to two notable
psychiatrists with very different views.
Dr Joanna Moncrieff is a practising psychiatrist who also lectures at
University College London.
She's well known for her critical views about treating mental health
problems with drugs,
and has published several books
including The Myth Of The Chemical Cure.
So prescription rates of antidepressant are soaring.
Do you see this as a good thing or bad thing?
I see it as very worrying for a number of reasons.
First, I don't think these drugs do much good for people, so it means
that a lot of people are taking medication that they don't need.
Secondly, they do cause serious adverse effects.
There's some evidence that they
increase suicidal thoughts among young people particularly.
Little bit of evidence that they might increase aggressive behaviour.
We know that they cause sexual
dysfunction in a large number of people.
What most people would probably say
is that the benefits that antidepressants
have outweigh those adverse effects.
My reason for feeling that they don't
is that the benefits that have been shown in proper randomised control
trials are very, very small.
And yet, there must be people out there that take the antidepressant
and, weeks later, they feel an awful lot better.
Yes, of course, but we know that many people will feel better because
they're taking a pill and that gives them hope,
and they feel supported as well.
-So we don't know...
-Isn't hope good, though?
-Shouldn't we be offering hope?
-Hope is good,
as long as it's based in reality.
I think offering false hope is problematic.
Do you think there are problems with people being on antidepressants
-I think people worry that they can't cope without
antidepressants and become psychologically dependent on them.
And that, I think, is a worry because it means that people aren't
developing other ways of managing
their difficulties and it might erode
people's confidence that they can do that.
So somebody comes to see you and they have severe depression.
Would you not put them on antidepressants?
I think that seeing depression as a disease, as a biochemical imbalance,
is a wrong way of seeing it.
In almost all cases in my experience,
depression has been caused by
something going wrong in someone's life.
And then the logical way to help people is to try and identify those
difficulties and help people to address them.
But most psychiatrists take a different view of antidepressants.
Sir Simon Wessely is a professor of psychological
medicine at the Institute of Psychiatry,
King's College London,
and former president of the Royal College of Psychiatrists.
Simon, last year there were roughly 70 million prescriptions
And this is something like double the number ten years ago,
so are we just prescribing too many?
The number of diabetes drugs have doubled or the number of
anti-hypertensive drugs have doubled,
we immediately say, "That's a scandal. That's too many."
It's the wrong question.
The question you should be asking
is of the people who have depression
who might need antidepressants, are sufficient numbers taking them?
OK, so are the right people getting
them and are they getting them in the right amount?
No, they're not, actually.
We know from the big studies that
it's still the case that perhaps only about half
of people who have depression are getting treatments.
Now if that was the case in cancer,
we would be absolutely appalled.
The problem now is that people still feel stigmatized, ashamed,
reluctant to come and seek help.
People like Dr Joanna Moncrieff
would argue that we don't know how some of these antidepressants work
and we also don't really know that they do work.
Frankly, Jo's right.
We're not sure. But then there's lots of areas of medicine where we
know something works, but we don't know how.
We knew antibiotics saved lives generations before
we worked out how they do it.
And ditto with antidepressants.
The one thing that is irrefutable is the evidence that they are effective
treatments is absolutely enormous.
What about side effects?
All drugs have side effects.
The side effects for antidepressants are well-known.
They're relatively mild in most people.
Some of them can be serious,
but you will spot them and will either change the drug or stop it.
But what do you think about the
argument that all you are doing is masking symptoms?
First of all, there's nothing wrong with masking symptoms.
If the symptoms are what's making you feel like taking your own life,
let's mask them. That's great.
But if we're thinking also about
should you be looking for other causes as well,
should we be looking for issues such as child abuse,
should we be looking for issues in relationships?
Of course, you should.
And, indeed, that is what psychiatry does.
It works not just on the biological,
but we also look at the social and
we look at the psychological, and anyone who only
does one of those isn't a psychiatrist.
So there you have it, two
psychiatrists with very different points of view
about the potential benefits or otherwise of taking antidepressants.
Where they would both agree
is on the incredible importance of involving your family, your friends,
and ideally health professionals
if you do suffer from depression.
Now, if I was depressed, then I must admit,
I would start on a trial of antidepressants.
But I'd also keep a fairly close eye on potential side effects.
I'd also monitor how long I was taking them for.
They often don't need to be long-term,
and they can be a means to help you become more receptive to other forms
of therapy and support that will help you recover.
So far, we've looked at different
ways you can improve your mental health
and what can help you recover if you do have problems.
In a moment, we'll be tackling another of your big questions.
If mental illness runs in your family,
how likely are you to get it?
And we'll bring you the results of
our big experiment to find the best way to beat stress.
over the last few years, the use of
social media has absolutely exploded.
So, not surprisingly,
many of you want to know what
effect this was having on our mental health.
Zoe has been investigating.
Whether it's Facebook or Twitter, Snapchat or Instagram,
like the vast majority of us,
I use social media to keep up with friends or share my news.
Recently, social media has been getting a reputation that
it's been bad for your mental health, but is it true?
Spending time on social media has been blamed for heightening anxiety,
causing insecurities, and loneliness.
And there is some scientific evidence to back this up.
Recent studies have found that
passively following other people's news
prompts a range of negative emotions, including envy.
And have identified a specific
feeling called FOMO - fear of missing out.
-Do you want to jump in?
So what's the truth?
Is using social media mainly good for our mood or bad?
To find out, we've set up an experiment.
We've asked ten avid social media users to come and take part.
They'll place yellow balls into one of three tubes as they read or reply
to 100 posts.
A ball in the smiley face tube means positive.
Things that made them laugh or feel happy or inspired.
Negative, things that made them feel jealous, angry,
or that they were missing out.
stuff that was neither positive nor negative.
Meanwhile, I will be doing my own
test to rate my own level of FOMO - fear of missing out.
Totting up all the scores is Professor Andrew Przybylski
from the University of Oxford.
So the results are in.
What do the numbers show?
Well, of just under a quarter of the posts that we looked at,
about 20% actually evoked negative feelings.
So feelings of sadness, anger, etc.
43%, a little bit less than half, were positives.
These are people feeling happy about what they saw.
And in the middle, about 37%, just
over a third, they didn't know what to make of it for good or bad.
So although some types of post,
particularly news and bad-tempered rants, unsurprisingly,
triggered negative emotions,
on balance, our group's responses were more often positive.
This is consistent with larger scale scientific studies.
There's also evidence that actively
sharing information yourself on social media,
rather than just consuming other people's,
has a positive effect on mood.
Why do you think people have this
desire to share what's going on in their lives with other people?
Human beings have psychological
needs and one of the most important ones is belonging.
So feeling like you love other people and other people love
and care about you is kind of intrinsic to us as social creatures.
And we also find that the opposite is true.
So when people feel like they're not connected,
they're more likely to gravitate
towards social media in those moments.
But what about fear of missing out?
The test I did earlier was designed to measure this response.
I've got some bad news for you.
Your levels of fear of missing out
-are higher than almost 75% of the adult British population.
I guess it doesn't surprise me, actually.
I think I'm... I'm very much aware of a FOMO feeling.
In future, I'll try to skip over
posts that trigger negative emotions like this.
Our results also suggest that as well as the type of posts we look
at, the amount of time we spend on
social media also affects our emotional response.
Across the experiment, we actually
found that people were feeling more and
more ambivalent and more and more negative over time.
So, you know, across the 20 or so
minutes that they were doing the task,
more and more of those yellow balls
were going into the cylinders with the sad face.
A lot of parents are really worried about the amount of time
that their kids are spending on social media.
Should they be worried?
Our research indicates that actually the link between screen time and
wellbeing and functioning isn't linear.
It's more that there's a slight uptick,
so a little bit is good for you until an hour or two,
maybe three hours a day, believe it or not.
And then after that, there's a decrement.
There's a slow negative slope.
Is it possible to become addicted to social media?
In everyday use, you would call a fun app addictive or a fun game
addictive, but it doesn't
necessarily mean that what's going on is something like a hard drug.
And so when we talk about real addiction, clinical addiction,
the answer is no.
So far, the evidence suggests that
at least in the short-term the effects
of moderate social media on our mood
are broadly more positive than negative.
Social media gets the blame for a lot of things,
but damaging your mental health probably shouldn't be one of them.
So if it's something that you enjoy, there's no need to stop.
Maybe just try and limit it to a maximum of two hours a day,
and have a break before bedtime.
In our survey, the second most
popular question was, "Can mental health issues run in families?"
So can they, and how important are genetics?
This, I think, is one for Giles.
When it comes to our physical health,
we know our fortunes are partly written in our genes.
The chance combination we inherit from our parents
determines our risk of certain diseases,
while our own choices about our
lifestyle can also help seal our fate.
But what about diseases of the mind?
Is our risk of developing mental illness something we can inherit?
And, if so, can we do anything about it?
It was long thought that conditions
like depression were solely caused by life experiences.
But it's actually far more complex.
Professor Cathryn Lewis leads the Statistical Genetics unit
at King's College London.
All mental health disorders have some genetic component,
and that comes as a surprise to a lot of people who tend to think
it's all about the environment, it's all about what life throws at you.
And not at all.
All of these disorders that we're talking about
have a very strong genetic underpinning.
But identifying which genes are responsible is a huge challenge.
Scientists spent a decade analysing the DNA of thousands of patients,
but without success.
The key problem was the patients were all too different.
What was needed was a group of very similar patients,
so that scientists could try to
identify a gene or genes they had in common.
Then one scientist had an idea, and he went on the hunt in China.
In China, only extreme cases of depression tend to be diagnosed,
so it was possible to recruit
patients with similar symptoms and from the same ethnic background.
Now with a more homogeneous group of patients,
the researchers found what they were looking for.
Two variations in the patient's DNA
that were shown to affect the risk of depression.
One of them was in a gene that controls mitochondria,
which is the cell's powerhouse of energy,
and so that seems reasonable that
that could play a role in depression.
But just identifying the variance is the first step in a long path of
research to figure out exactly what those variants are doing.
The team published their findings in 2015.
Since then, further studies have
pointed to more genetic variations
that may be involved in mental illness.
And surprisingly, some individual
genes seem to be linked to more than one mental health condition.
There clearly is some overlap and some variants for schizophrenia also
seem to increase risk of bipolar disorder and depression.
And so what is probably happening here
is that there is a certain set of
variants that just increase the risk of
mental health disorders across the board.
It's not specific for a single disorder.
And then there are other variants that are
specific to individual disorders.
It's hoped that decoding which genes are responsible for mental illnesses
will one day mean that they can be more easily detected and treated.
Perhaps even before the symptoms arise.
But for now, that leaves one burning question.
So if your parents or grandparents have a mental illness,
how worried should you be about getting it?
Geneticists have worked this out by looking at patterns of illness in
studies around the world
involving thousands of families.
If one of your parents had depression...
..then you are two times more likely to get depression.
For bipolar disorder...
..you are four times more likely.
And if one of your parents had schizophrenia...
..then you are eight times more likely to get schizophrenia.
But that's not as worrying as it might sound.
Because, remember, schizophrenia is a very rare disorder.
Only about 1% of the population have schizophrenia,
so eight times that 1%
still only gets you to an 8% risk of schizophrenia.
So even if one of your parents have schizophrenia, you're much
much more likely not to develop schizophrenia than to develop it.
Whatever your family history,
your genes are only one of many
factors that will determine your mental health.
If you have no family history of developing mental illness,
then your genetic risk will be low.
Imagine this jar represents your
chances of developing a mental illness.
If it runs in your family,
the jar will be roughly this full.
In order to develop a mental illness,
the cylinder would need to be filled up all the way to the top.
But most of the tube is still empty.
The rest of the space is what happens during your lifetime.
Your chances might be increased by stressors such as poverty,
poor health, physical or mental abuse,
or perhaps losing a loved one.
Add it to gather, this overflow of stressors that could lead you to
developing a mental disorder.
Just because a mental illness runs in your genes
doesn't mean you're definitely going to get it.
If you do get it,
that will mainly be down to other
factors in your life and dealing with
those will help you to recover as well as anyone else.
So although genes play an important role in mental illness,
they're only part of
the bigger picture.
Eight weeks ago, we kicked off our
big experiment looking for the best ways to beat stress.
We recruited 68 volunteers and we allocated them to different groups.
Each group we asked to do a different activity.
Our first group got together every Saturday to do gardening and
Complete difference to what I would be doing usually on a Saturday
morning, which probably consists of waking up from a hangover.
The second group have been doing yoga.
Then the ribs, upper chest and shoulders, and then the eyes.
Head, neck, eyes.
The third group have tried ten minutes a day of mindfulness,
a meditation technique that focuses the mind on the present moment.
Ah, that feels so good.
At the start and end of the eight weeks,
we measured levels of the hormone cortisol.
A healthy stress response is to have a big burst of cortisol in the
morning called the cortisol awakening response or CAR,
and lower levels throughout the day.
Professor Angela Clow and Dr Nina Smyth of the
University of Westminster have our results.
Hi, everyone! Hello! You've all got your stress balls?
Who is feeling better than they were eight weeks ago?
OK, that's a significant number of you.
Who is not feeling better?
OK, right. So we shall see how that correlates with the cortisol
-measurements. Over to you.
the people that engaged in the
different activities had an increase in their
cortisol awakening response.
And that was across all interventions, was it?
-Compared to the control group.
Yes, so it was overall, compared to
the control group, you had bigger CAR.
So this blue line represents everybody in all the activity groups
together, showing an increase of 14% in the cortisol awakening response.
That is actually very impressive.
Looking at each activity individually,
yoga saw a healthy reduction of
cortisol during the day and small increase
in CAR. What about our gardeners?
Overall, your CARs rose by about 20%.
-Really impressive. That's fantastic.
And then for the mindfulness, who's the mindfulness?
Yours rose by 58%.
The results for our study showed
that mindfulness had the greatest effect
on our volunteers' stress levels.
And they also showed something else that we hadn't quite expected.
OK, so that was all really good,
but there was one other thing which I found really, really interesting.
OK, put your hands up if you enjoyed the activity you took part in.
For those people that enjoyed the activities,
the rise in CAR was even bigger.
For those people, it rose from 14% increase to 42% increase.
For those who enjoyed it, their response went up like that.
For the mindfulness group, overall, their CARs rose by 52%,
but then for the people that really enjoyed the activity,
it rose to 78%.
-So it's a big change.
Really big changes. All driven or appear to be driven by whether you
enjoyed it or not.
This is a fascinating result,
showing that enjoying an activity actually makes a crucial difference
to the way our body and mind responds to it.
I've been quite isolated lately, so
the social aspect's been brilliant.
Everyone should do it, especially if you're really busy and don't find
time in your day, those are the people that need it the most.
I loved it. I loved it.
-So that was good.
Every single intervention worked, with mindfulness slightly on top.
I think the really surprising and interesting thing was how much it
mattered whether you enjoyed your intervention,
because basically if you didn't, it really didn't work.
So the moral of this particular story is do shop around.
There are things you can do to reduce stress.
But above all, look for something you're going to enjoy.
One major cause of stress in young people and their parents is exams.
The BBC has set up the Mindset,
an online tool that features 12 student coaches who've recently been
through their GCSEs or nationals.
I think it's crucial for you to get enough sleep during your exams.
It's something that's usually overlooked by a lot of students.
You can hear their hints and tips for reducing stress and find expert
advice for students and parents
by going to:
That's it from this special mental health edition of
Trust Me I'm A Doctor.
We've seen how cutting edge medicine is changing our understanding
of mental illnesses.
But most importantly,
we've learned just how much we
ourselves can do to look after our mental health
and reduce our risk of problems.
The thing that strikes me is just
how closely entwined the mind and body really are.
Which means that if you take steps to improve one,
you're likely to improve the other.
If you'd like to find out more, then do visit our website.
Trust Me, I'm a Doctor is back with a special programme on mental health.
Michael Mosley runs an experiment to find the best way to beat stress - mindfulness, yoga or gardening. Psychiatrist Dr Alain Gregoire reveals how sleep affects mental health. GP Zoe Williams discovers why laughing can be as good as exercise for improving mood. Surgeon Gabriel Weston investigates a new cure for some patients with serious mental illness. And geneticist Giles Yeo asks if you can eat your way to happiness.