BIOS5140 - anxiety, depression and sleep disorders

Mental Health in the UK

• Public Perception

  • 81% of British consumers believe mental and physical health problems are equally serious

  • 77% of mental health patients report receiving medication tailored to their needs

• Employment Statistics

  • 12,745 psychiatrists employed in the UK as of 2020, up from 8,193 in 2000

  • UK workers increasingly reporting job-related mental health issues, with work-related stress, anxiety, and depression prevalent.

• NHS Mental Health Support

  • Despite rising NHS expenditure on mental health services, the economic costs continue to increase.

  • The UK has one of the highest rates of mental illness in Europe, with varied prevalence among countries (e.g., UK vs. Spain, France)

• Recent Trends

  • Significant increase in detentions under the Mental Health Act since 2007.

  • Reports from patients regarding NHS mental health services reflect declining perceptions of care adequacy (2014 vs 2021).

  • 70% of patients rated their experience of NHS services as better than average in 2021.

• Expenditure and Backlogs

  • NHS annual spending on mental health services has been rising since 2016, yet services face substantial backlogs.

  • 1.1 million people referred to community-based services awaited further contact as of Q3 2021-22.

  • Economic costs of mental ill health estimated at £70 billion annually through lost productivity and healthcare costs.

Common Mental Health Disorders

• Affective Disorders

  • Depression characterized as the most common affective disorder, either unipolar or bipolar in nature.

  • Major symptoms can include low mood, lack of motivation, and sleep or appetite changes.

• Causes and Treatment Challenges

  • Complicated neurochemical pathways hinder targeted treatments; empirical findings guide therapeutic approaches.

  • Rapid increases in clinical care demands highlight the need for effective management strategies.

Pharmacological Treatment of Depression

• Monoamine Theory of Depression

  • Proposes functional deficits in neurotransmitters (noradrenaline and serotonin) contribute to depression, while mania results from an excess.

  • Treatment primarily involves medications targeting these neurotransmitters; however, outcomes vary between patients.

• Treatment Mechanisms

  • Antidepressants increase monoamine concentration in synaptic clefts.

  • Treatments include reuptake inhibitors to enhance monoamine availability at post-synaptic receptors.

• Types of Antidepressants

  • Tricyclic Antidepressants (TCAs): Block monoamine reuptake but can cause significant side effects, including cardiotoxicity.

  • SSRIs (Selective Serotonin Reuptake Inhibitors): More commonly prescribed and well-tolerated, focusing on serotonin reuptake mechanisms.

  • MAO Inhibitors: Older class of antidepressants affecting monoamine degradation but with higher risk for side effects.

NICE Guidelines for Depression Treatment

• First-Line Treatments for Less Severe Depression

  • Recommended options include guided self-help, interpersonal therapy, and certain medications based on patient preference and condition severity.

• First-Line Treatments for More Severe Depression

  • Suggests personalized treatment options considering patient preferences; options include psychotherapy and antidepressants based on clinical needs.

• Specific Guidance for Unique Populations

  • NICE outlines special considerations for patients with learning disabilities, autism, dementia, pregnancy complications, and other health issues.