Sunday, 20 November 2016

Removing the Gilded [Eli] Lily’s Mask with Sticky Fingers

Last Wednesday evening I found my hands covered in that kind of sticky substance that seems to get everywhere, clinging to skin, clothes and hair. I was packing the car at the time and checking a case of Christmas present wine when I noticed my hands were sticky. One of the bottles had leaked and black sticky gunge was the consequence. Whilst I was able to wash my hands and was soon on my way, it seems what I should have been more worried about was what I couldn't see on my hands. Professor Pieter Dorrestein, from the University of California, San Diego School of Medicine, reports that there are at least 1000 different microbes living on the averages persons skin.

In a study he published last week in the Proceedings of the National Academy of Sciences, he reported that we leave trace chemicals, molecules and microbes on every object we touch, and these can reveal much about us. Even washing hands thoroughly cannot hide the presence of these molecules. By analysing the molecules left on peoples mobile phones, the researchers could tell the likely gender of the person, whether they drink coffee, wear sunscreen, prefer beer over wine, like spicy foods and whether they are taking medication for depression. 

We know that worldwide, mental health problems account for £1.6 trillion worth of economic burden. That’s more than the combined costs of dealing with cardiovascular disease, chronic respiratory disease, cancer and diabetes's. We know that 1 in 4 of us will experience a mental health problem each year. We know that 1 in every 10 people will experience this as depression. We also know that the average age of onset for depression today, is 14 years compared to 45 in the 1960s.  What we don't know is what causes this mental health problem and what the best way might be of helping people through a depressive experience.

Indeed it's difficult to find a study that provides any degree of certainty. When I was becoming a mental health nurse (something I increasingly think of as a lifetimes work) I was taught that depression was caused by low levels of the brain chemical serotonin. Much treatment has thus been focused on prescribing antidepressants that correct this imbalance. However there have been many studies that show most of these drugs don't work. The most recent, published in the Lancet earlier this year, found that of the 14 leading antidepressant medications only Fluoxetine (Prozac) helped young people with depression more effectively than placebo pills. The rest were reported to have no effect on symptoms but could give rise to serious side effects (suicidality being one of these).

There is evidence that other factors could be responsible for depression in some people. Professor Carmine Pariente, from Kings College London published a study in July this year that focused on the use of biomarkers which can measure inflammation in the body. The study showed that those people with high levels of inflammatory markers also made up the group who are most likely not to respond to antidepressants. One outcome from this result is the possible conjecture that inflammation in the body, caused by the body’s immune system reacting to an infection and or stress may be responsible for an individual's depression in much the same way that our experiences and environment might.

In children and young people this is an important consideration and adds to what we already know. In the UK, there are 850,000 children aged 5 – 16 who have mental health problems, of which 80,000 have a diagnosis of severe depression. Dr Valarie Mondelli (also from Kings College London) has published a study that found that children who experienced high levels of infection or trauma in childhood may have compromised immune systems. They were found to have higher levels of brain inflammation and were more susceptible to developing depression as an adult.  Indeed, 50% of all lifetime cases of mental ill health (including depression) begin by the age of 14. 

I have long thought that medication as a way of treating mental health problems with young people is not the most effective response. The evidence appears to support my view. For me and many others, finding ways of building emotional resilience in our children and young people is the key to making a difference. There is a nothing new to be known in how we do this. For example, play and learning, particularly with others, is important in gaining a sense of self, self-worth and self in relation to others. Likewise, diet and exercise, physical as well as mental can help ensure physical and psychological development is balanced and sustained.

This is not rocket science! In my experience of being with and around children of all shapes, sizes and ages is that most either don't mind or really dislike getting their hands dirty. But most will really enjoy taking part in activities that might result in this state of being. Its up to us to make sure this happens, and occasionally be there, ready with the wet wipes.