(https://theface.com/society/antidepressants-mental-health-crisis-pandemic-2021)

Maybe, fortuitously, it has bought to a head, the limited conventional treatment options, which even to date, are inadequate, if not potentially dangerous, particularly when looking at the pharmaceutical drug approach, given the well documented potentially dangerous side effects.¹ The ‘chemical imbalance’ theory as a cause for depression, has been all but debunked, thus leaving the prescription of medications such as SSRI antidepressants seriously open to question regarding any usefulness. Therefore, this current, now possibly controversial methods of treatment, (due to potentially dangerous side effects for often little benefit) will be discussed, together with new advances, some of which are alternative in their nature, but showing great promise, following ongoing research.

To assess how far we have come, what has changed and evolved, a glance back at history helps to put the treatment of mental health issues into context.

The Middle Ages

In 1247 the Priory of St Mary of Bethlehem was founded, devoted to healing sick paupers. By the early 15th century, it had become Britain’s first hospital for treating the mentally ill. The small establishment became known as Bethlehem Hospital, Londoners later abbreviating this to 'Bethlem' which often was pronounced as 'Bedlam' a term we now all identify with chaos, confusion and uproar, and which clearly has its origins here.

At this time those with psychiatric issues were often seen as social outcasts, possessed by demons, labelled witches, and subjected to cruel treatments. The hospital regime combined religious devotion disguised as inhumane punishments involving chains, manacles, locks and stocks, at best.

The 16th Century onwards

Asylums became even more prevalent in the sixteenth century, continuing until at the least the mid 1960’s. Ironically, the etymology defies the reality: Asylum: ‘early 15c, place of refuge, sanctuary, from Latin asylum sanctuary, from Greek asylon refuge, fenced territory, noun use of neuter of asylos, inviolable, safe from violence, especially of persons seeking protection.’

I have great respect for a journalist called Nellie Bly, who went undercover at the Blackwell Island Insane Asylum in New York in 1887. She was committed of her own volition, after feigning insanity, in order to bring to light the atrocities. She witnessed inhumane brutalities. One patient described her experience to Bly: “For crying, the nurses beat me with a broom-handle and jumped on me. Then they tied my hands and feet, and throwing a sheet over my head, twisted it tightly around my throat, so I could not scream, and thus put me in a bathtub filled with cold water. They held me under until I gave up every hope and became senseless.” Deaths were common from ill treatment. Freezing water treatments, as described above, allegedly reduced agitation, particularly for those experiencing manic episodes. People were either submerged in a bath for hours at a time, mummified in a wrapped ‘pack,’ or sprayed mercilessly with freezing cold water in showers. Restraints as previously described including straitjackets, which continued to be used well into the 20th Century, and modified versions still employed, in extreme cases. As time went on, asylums became laboratories for even more brutal treatments.

20th Century

Several ‘heroic’ therapies appeared in the 1920s and 1930s based on the belief that mental illness had ‘a physical basis in the nervous system or the brain’. The term ‘heroic’ was used for a ‘treatment which possesses a high risk of causing further damage to a patient's health, but is undertaken as a last resort with the understanding that any lesser treatment will without doubt, result in failure. These included:

• Insulin coma therapy

• Chemical shock therapy

• Psychosurgery

• Electroconvulsive shock therapy

Patients were often powerless and too weak to refuse these experimental therapies, which were sometimes well-meaning in their application to solve cases, yet more often than not, debilitating and brutal. Details on all of these therapies can be found in an interesting article ‘Heroic therapies in Psychiatry,’² however, two that were consistently used were Psychosurgery and Electroconvulsive Shock treatment, both of which will be briefly discussed.

Psychosurgery (Lobotomy)

The most invasive of the physical therapies was psychosurgery, also called leucotomy or prefrontal lobotomy. As the name suggests, this was a surgical procedure in which the neural connections to and from the prefrontal cortex of the frontal lobes of the brain were severed. The procedure was controversial from the outset, and offered low expectations of improvement, let alone a cure. Following the operation, responsiveness, self-awareness and self-control were reduced. Other side effects included disorientation in time and space, incontinence, and childish emotions. One is invariably reminded of Jack Nicholson, in ‘One Flew Over a Cuckoo’s Nest.’ Many psychiatrists and patients’ families believed that despite potentially catastrophic consequences, the results of lobotomy would make the patient more manageable and easier to care for, or, at the very least the outcome would be better than the alternative of long-term institutionalisation. Long-term studies of post-operative patients finally confirmed that the treatment was worse than the disease and lobotomies were discontinued in most countries by the 1960s.

Electroconvulsive shock therapy (ECT)

https://www.sciencemuseum.org.uk/objects-and-stories/medicine/heroic-therapies-psychiatry

In 1938, two Italian scientists, Ugo Cerletti and Lucio Bini, developed an apparatus to induce convulsions electrically. It was initially tested on a patient with chronic schizophrenia, giving him several shocks of increasing voltage and duration. He received the treatment several times, apparently becoming more lucid, he was thus thought to be cured, but sadly readmitted two years to the Milan asylum with schizophrenia, once again. The treatment is still used in certain cases today, but has evolved into a less barbaric and often ‘chosen’ therapy. A single electrode is attached to one side of the head and the patient is given anaesthesia and muscle relaxants during the ultra-brief pulses of electricity; convulsions and other brutal side effects such as thrashing around, are generally a thing of the past.

Psychiatric Medications Today

In the 21st century and especially in the last few years, mental health treatment has come to the forefront of medical care and in the media, with many famous and widely respected public figures speaking honestly about the struggles they’ve faced, and the stigma around mental health. Talking therapies such as Psychotherapy and Cognitive Behaviour Therapy are used frequently, depending on the condition. A wide range of medications are readily available, but these continue to bring with them, some serious concerns.

Drugs had been used in treating the mentally ill as far back as the mid-1800s. Opium and morphine, were used to sedate patients both of which carried side effects and the risk of addiction. Toxic mercury was used to control mania. Barbiturates put patients into a deep sleep thought to improve their madness. Chloral hydrate came of use in the 1950s, but like the drugs before it, it had side effects, including psychotic episodes.

And then came Thorazine, the medical breakthrough psychiatrists had seemingly been searching for all these years. While it wasn’t perfect, it proved much safer and effective at treating severe mental illness. Its use, along with other drugs that quickly followed, such as Risperdal, Zyprexa, Abilify, and Seroquel, marked the beginning of a sea change for mental health patients.

To put things into perspective, in 1955, the year the first effective antipsychotic drug was introduced, there were more than 500,000 patients in asylums. By 1994, that number decreased to just over 70,000. Treatments inside mental asylums became more humane and sophisticated. Challenges still exist though and it is imperative that new solutions are found. What is clear to me is there is a lot we still don’t understand and although there is clearly improvement in the treatment of most mental health conditions, we have a long way to go in terms of effective, side effect free treatment.

The chemical imbalance theory giving rise to SSRIs

Selective serotonin reuptake inhibitors were introduced to the market in 1987, with the introduction of Fluoxetine. The SSRIs were almost instantly popular because they were deemed to be safer than those that preceded them. These drugs increase the amount of serotonin available in the brain. However, in June 2022, after decades of deliberation, and unsubstantiated theories regarding the ‘chemical imbalance theory’ the following was discussed and conclusions made:

In July 20th 2022 the conclusion was emphatic in denying any consistent data supporting the idea that low serotonin causes depression:

‘A recent review (above) of evidence, published in July in Molecular Psychiatry, finds no consistent data supporting the idea that low serotonin causes depression. Some headlines declared that the study was a grand takedown of the serotonin hypothesis. To depression researchers, the findings weren’t a surprise. Many had already realized this simple description wasn’t helpful.

The researchers go on to say:

It appears it is time to put the chemical imbalance theory to bed. Given this, it is essential that we continue to understand the nature of depression whilst urgently extending the research into new treatment options.

The Homeopathic Approach and Treatments on the Horizon

What strikes me is clearly the homeopathic approach has unquestionably helped many people, there is much empirical and clinical evidence to support this, some cases are documented in this issue of Simile, but they represent a drop in the ocean given the sheer amount of people that have been helped. Due to the nature of the homeopathic consultation, lifestyle habits and physical illnesses are taken into account, as they could easily be affecting the mental state; only in addressing the totality is healing possible and by removing ‘maintaining causes’ which will prevent healing, no matter what form of medicine/treatment is given. In addition, the homeopathic consultation would obviously take into account the entire set of presenting symptoms given by the patient to the homeopath; by doing this the correct constitutional remedy is prescribed and in conjunction with the above approach, could be greatly beneficial to the overall health of a person suffering from depression. Homeopathy is a treatment that comes without the dangerous side effects of chemical medications, so should be further researched and recommended. In addition, lifestyle changes are essential as we try to reduce pollution and aspire to living a healthier ‘greener’ life, also, we cannot ignore the elephant in the room; psychiatric medications following consumption, are not only potentially dangerous to the patient, they are literally destroying the aquatic life and supressing their mating habits; they are poisoning our ecosystem and the broader environmental ripple effects are just beginning.

Similarly, there is evidence unremittingly coming to light, that toxicity through GMOs, herbicides, pesticides and food additives are strongly linked to mental illness. By adapting a holistic approach, through modifying the diet to food that has not been adulterated with chemicals, and keeping it as simple and pure as possible, avoiding allergens detected through testing, taking natural supplements as required, adequate sleep and exercise and minimising exposure to toxins of every variety, we could go a long way to improving mental health.

As an adjunct, it may be significant to mention that an article in The Guardian (June 4th, 2015) discusses that in 2007, Prince Charles advocated the use of homeopathy for several conditions, depression being one of them (also eczema and irritable bowel syndrome.) He wrote to the then Health Secretary, Alan Johnson. The then Prince Charles wrote: ‘The only reason I persist in my efforts over integrated healthcare – despite waves of invective over the years from parts of the medical and scientific establishments – is because I cannot bear people suffering unnecessarily when a complimentary approach could make a real difference. ‘He went on to suggest illness should be treated with a ‘whole person approach” rather than a “reductionist focus on the particular ailment. This approach to see the individual as a whole and unique being, taking into account the totality of symptoms is beautifully outlined in §18

§ 18 Sixth Edition

From this indubitable truth, that besides the totality of the symptoms with consideration of the accompanying modalities (§ 5) nothing can by any means be discovered in disease wherewith they could express their need of aid, it follows undeniably that the sum of all the symptoms and conditions in each individual case of disease must be the sole indication, the sole guide to direct us in the choice of a remedy.

New Treatments

There are many new treatments in the pipeline, for example the use of psychedelics, especially psilocybin and MDMA, both are undergoing a renaissance, ketamine therapy is also currently being explored. Many more in the same vein are being researched. Some interesting developments include Optogenetics and stem cells.

‘Optogenics is a way to use light and genetic tools to control the activity of certain neurons. These techniques have been used to map connections in the brain, but there is hope that someday this technique with be able to positively impact specific cellular pathways in depression.’⁵

Stem Cells: ‘A theory is currently being studied that stem cells may decrease depression by helping create more neurons that can form more connections in the brain.’ Current research includes investigating if there are new molecules that can activate stem cells to act in this antidepressant way.⁶

New approaches to the management of mental illnesses will be welcomed and indeed there appears to be some exciting developments. Going back to the question in the title: how far have we really come? Clearly, huge shifts have happened since the days of the harsh treatments in mental asylums, torture and barbaric conditions. We are not however, there yet. Research should be ongoing and education around lifestyle and nutrition made public. Without doubt, one should be encouraged to reconnect to nature, whilst encouraging fun and creativity, beautifully highlighted by David Owens’ article, on creativity as a healer. In the same vein, reconnecting with nature; outdoor activities such as walking, cycling, swimming should be encouraged, similarly recognising that food can also be medicine, which often requires a complete re-education of the patient. Encouraging community, friendship where possible and help and guidance from people in our circles. These are all common-sense steps to be advised initially.

I strongly feel it is time to move away from the dependence on chemical drugs (anti-depressants) which could undermine people's sense of self-efficacy, potentially setting them up for a lifetime of chronicity and dependence. Each case therefore should be treated as unique, which is certainly indicative of the homeopathic approach; depression is a signal that change is needed in some aspect of life and the experience is, by its very nature deeply personal. In the end, the situation that provoked the negative emotion and subsequent depression, needs to be addressed, which brings us back to the homeopathic approach; addressing the aetiology.

References