“If it matters, it produces controversy”
Treatments for depression are not one size fits all and as humans, we are multi-faceted with our health reflecting this, so each doctor and patient work together to find the pathway that is right on an individual level. Taking a holistic approach often starts with a baseline diagnosis(es) as evidence based-treatments historically are related to standard diagnostic practices. From here, treatment plans are adapted specifically depending on symptoms or if secondary disorders present.
So, what happens when there are beneficial treatments out there which aren’t as commonly known or used? We dive into this with Dr Janet Meehan to understand the realities of treatment plans, innovation in clinics, and the difficult but optimistic road ahead for the future of depression treatment.
Dr Janet Meehan has been a consultant psychiatrist for over 25 years with extensive experience in the assessment and management of all forms of depression. Based in the UK, Dr Meehan set up her practice after many years working with different hospitals and the NHS treating patients on a broad spectrum of illnesses and severity.
Passionate to cater to a wide range of patients with a diverse range of treatments, Dr Meehan’s practice employs Jungian principles to empower patients in their recovery.
Can you tell us a little bit about your process for treating patients in your practice?
For me, a patient’s recovery is a long-term journey that we embark on together, starting with treating the mental health illness and then taking a step to look at the whole system around that patient. The symptoms they experience are just one part of the puzzle and once that is addressed we can look at how things might have gotten to this point. There is no formula that fits everyone and so I take a holistic approach and use all the tools available in the toolbox.
I decided to take the step to see patients privately because in my experience there is a large proportion of people suffering from depression to varying degrees who find it difficult to access treatment. Current health care systems are overpopulated and have limited resources, so naturally, they focus on the most severely ill and once they become less ill they are discharged from care. However, some people are struggling daily who are seen as sub-threshold, not ill enough or risky enough but their illness, nonetheless, is very debilitating. In my experience, a lot of people could be helped by quite simple measures, for example, a change in their dosage of medication over the different cycles of their life, however, they don’t have the support on their whole journey; only when their symptoms are acute.
Before I started my own practice, I was seeing referred patients and treating them the normal way, giving recommendations about medication and therapy, but I was always looking for new ways of helping people. This was because many patients are treatment-resistant or prefer not to have medication and need alternatives to help their recovery journey.
Why have alternative treatment options like brain stimulation interested you?
Simply, to be able to reach a wider range of people and what works for them. After working with many patients you find that it is quite common that they don’t necessarily want to go down a solely medication or therapy route. They might have had bad side effects or don’t believe in taking medication and in terms of therapy it can be harmful if it is not done at the right stage. So what are we to do then? It doesn’t mean that a person’s treatment should just stop, there needs to be support for finding other options for an active recovery process that can fit across someone’s life cycle. This might mean at the beginning a person goes on medication to reduce their symptoms, then would like to try an option such as brain stimulation, to support a long term and viable recovery.
I’m a great proponent of treatments such as ECT, even though many psychiatrists don’t like it or don’t admit to it even if they do. ECT in the UK, and across the world, is seen as a very controversial treatment – even though I don’t think it should be. I have found in my clinical practice it has been a very effective treatment for those who have experienced severe depression. Especially patients with psychotic symptoms, at high risk of suicide or at dangerous levels of depression who are unable to drink or eat. The positives of ECT, which aren’t often discussed, is that the results are rapid and patients can improve after 1 to 2 sessions – being able to sit up and interact, eat, drink – which isn’t something any drug can achieve so quickly.
Having worked in Mersey Care, an NHS foundation trust and a centre of excellence for ECT, I’ve seen it as a life-saving treatment for many patients. The trust is headed up by Dr Barnes, a very experienced consultant and also an advocate for ECT who treats elderly patients that may no longer tolerate medication, might get agitated or be malnourished and has found stimulation to have positive results in this group.
Standard treatment practices are selected due to familiarity and reliability. However, when treating patients holistically we need to push for more innovative options that could become the first line of care for patients in the future – to offer better support across their life and for their personal choices.
Can you explain a bit more about why you seek for innovation in your practice and products like Flow for your patients?
I believe there are positives in treatments that can help a broad range of patients and which are easily accessible. As discussed, ECT is a treatment where we see great improvements quickly, but it isn’t so easily accessed and it does have side effects. The brain stimulation you offer, tDCS, is one that is delivered when the patient is fully awake and is very gentle compared to ECT. It is also specific and targets the frontal lobe which is important in depression whilst ECT involves the whole brain hence there is more of a propensity for other effects to arise. Having an option that can be used flexibly at home, is low on side effects and works with their lifestyle is something that appeals to me as a treatment line for those who need something either combined with their medication or because they have decided not to take medication at all.
There are many patients who would benefit from brain stimulation, both in severe cases and mild as medication either won’t work by itself or in terms of mild depression, it isn’t indicated as a line of treatment. However, as with anything new, it is difficult to bring it into a standard treatment line, whilst it is innovative and can help practices reach more patients, the success rate is something that has to be taken into consideration.
Is there anything else you’d like to add?
Psychiatry is still a relatively new speciality and our knowledge of mental diseases and their causation is in its infancy. People and populations have diverse views about the origin of mental illness and its treatment. Therefore, it is necessary to offer a broad range of treatment options to suit different individuals. We need to treat mental illness outside of healthcare settings, as well as within them. To give an example only a quarter of suicides in the UK have been seen by mental health services within a year of death. Therefore, the vast majority of depressed people who commit suicide haven’t seen their GP or a health professional before death. We need to find ways of reaching these people. Offering self-diagnosis and home treatment options is one way forward.
We want to thank Dr Janet Meehan for sharing her expert insights and experiences as a psychiatrist – highlighting the importance of a unique care plan which has a range of options available to any patient. If you want to hear more from Dr Meehan, follow her on LinkedIn.
Stay tuned for our next Expert Spotlight!
“Time and Tide Wait for No Man”
Barbados – I went on holiday there about 2 years ago, but I had to continue to run my business whilst I was there. I got up early on the first day, and went down to the beach and took my laptop with me. I saw a double rainbow which is a rare sight and a symbol of transformation, which made sense to me at that point in my life.
A Christmas Carol (1984). A heart-warming story of human transformation