Depression, diabetes and medication: Is there a better way?

The Health and Social Care Information Centre has just published data showing that in England 1.08 billion prescription items were dispensed in 2015 at a cost of £9.27 billion. For the eighth year in succession, the prize for the highest cost goes to drugs used in the treatment of diabetes whilst the prize for the greatest increase in prescribed drugs goes to our old friend the ‘anti-depressant’.

Despite its title, the focus of this article isn’t so much about depression, diabetes or prescription drugs, as it is about our attitude to our own physical health and mental well-being.

The rationale for choosing to highlight depression and (type 2) diabetes centres a) on their prevalence and b) on the fact that they both respond exceptionally well to lifestyle changes. As such, they are not only curable but also preventable.

The link between lifestyle and non-communicable diseases such as diabetes, depression, obesity, heart disease, cancer and stroke is now well-established, yet the evidence suggests we are failing to take a proactive role in our own health. Why are so many of us foregoing self-care and turning instead to prescription drugs and the ‘men in white coats’ in order to manage our physical and mental well-being?

Well the answer is not likely to be a simple one. But what if part of the problem lay in the existence of our glorious NHS? I’m not advocating getting rid of it – far from it – but I wonder how much more we might care for our own health if there were no NHS to pick up the pieces of our self-neglect? No freely-available medication; no ability to patch us up after we have had more ‘contact’ than ‘sport’ in our favourite contact sport; to set broken limbs; pump our stomachs when we’ve drunk or drugged ourselves into oblivion; deal with the consequences of our over-eating, over-smoking or under-exercising?

Chronic back pain is known to be associated with inactivity as both a cause and effect. Musculoskeletal problems are the most common reason for repeat consultations with GPs, accounting for up to 30% of primary care consultation. But given the compelling evidence of a link between chronic pain and negative lifestyle behaviours, why don’t we move, stretch and bend more?

I met someone recently from Siberia who said that the attitude ‘back home’ was much more focused on keeping oneself healthy as their whole livelihood depended on being well enough to work and earn money. What if that were our reality? What if we couldn’t be ‘signed off’ from work with a bad back? I know our welfare state comes in for some criticism, but what if we had no welfare state? No safety net?

We spend more time taking care of our employer’s business than we do taking care of ourselves. We stay in work environments that are toxic rather than seek healthier pastures. We hold onto relationships that are toxic rather than let them go. We rely on the Government to introduce a sugar tax rather than simply choose to fill our shopping basket with healthier food options. We complain of tiredness but refuse to follow the basic rules of winding down, having ‘quiet time’ and switching off our electronic screens. We complain of stiffness and aches and pains but refuse to move and stretch. We obsess about our looks, how many Facebook ‘likes’ we’ve got or what car we drive as if these are the making of who we are. We worry about things of no consequence or that we have no control over.

We compartmentalise our health and hand it over to someone else to fix. Yet there is compelling evidence that individuals who understand and are involved in managing their health have better outcomes. We cannot feign ignorance of our health issues; the web educates us about the risk factors of being overweight. It tells us what a balanced diet is and is not. It tells us that taking anti-depressants will be all for nought if we fail to address the underlying causes of our depression as well. It tells us how to exercise, how many units to drink, what sun exposure does to our skin. Ignorance is no excuse.  

If you’re depressed, learn about depression. Did you know that people with depression dream up to three times more than people without it? Do you know why? Learn about your condition. Did you know that sleep deprivation causes an imbalance in two hormones that play a critical role in weight regulation? Are you sleeping badly and finding your weight increasing? Learn about it. Get engaged.

Some people who seek to lose weight no longer recognise the natural signals for ‘hunger’. They’ve stopped listening to their body. Depression is a signal from your body that all is not well in your world – it’s your body crying out for something to change. Pain is a signal not that a pain killer is needed, but that something else needs sorting. 

And the wonderful thing is that we all have, within us, the ability to make better choices for ourselves. To think in more helpful ways, to eat more healthily, manage stress more effectively, exercise more regularly, drink less. We can choose to replace bad habits with better ones. You don’t have to keep pressing the self-destruct button if you’re fed up with the consequences. But you do have to decide to put yourself in the driving seat.

So coming back to the question: Depression, diabetes and prescription drugs: is there a better way? Yes, there is, but it all hinges on this: “Are you ready to play an active role in your own health and well-being?