Nowadays there is more said and written about depression and mental health issues than ever before. So many organisations working hard supporting and more and more wonderful individuals sharing their stories and setting up support groups and social media pages to connect to others and offer help and resources. We have moved forward in ways that I don’t think people many years ago would have thought possible. ‘Crazy' people are no longer sent away to live in shame, strapped to gurneys, experimented on or observed as oddities.

Things have changed hugely, but I am still loathe to accept that depression is being treated like a ‘real’ illness. Even today I still hear comments such as ‘but what does she have to be depressed about’ referring to a seemingly privileged teenager who was displaying signs of depression. ‘But the problem with depression is that it makes the sufferer SO selfish, doesn’t it?’ in response to a family member who had been signed off from work for several months suffering with severe depression and anxiety. Or ’Suicide is such an angry act, isn’t it’.

Herein lies the problem. Society generally views physical illness as out of the sufferer’s hands and mental illness as a choice. Almost as if the depression-sufferer could simply ‘get over it’ if he or she just bucked their ideas up a bit and were a bit more grateful for their lot. I honestly believe that until this view of mental health changes, then we aren’t going to move forward in our understanding.

Maybe we have been categorising depression all wrong? Because when we attribute suffering to our moods, then it automatically seems like it is something transient and fleeting. How can you compare depression to something as awful as cancer when cancer is permanent, out of our control and potentially deadly, when, with depression you could wake up tomorrow and feel fine?

What people who have never suffered with depression can’t or don’t understand is that depression is physical. It seeps into every part of your being. Yes, it may be a mental illness that distorts your feelings, the way that you see and view every part of the world and your place in it, but it is so much more. It suffocates you, it changes the way you identify with your body. It changes your reactions and your movements, it confuses messages from brain to body and it makes you feel like you are swimming through treacle when you are simply trying to put one foot in front of the other. It’s a dark, heavy presence that permeates your brain with harmful thoughts that takes every ounce of positivity and vitality away from you. It sucks the life out of you and makes everything feel impossible. The quicksand of depression can strike at any time. You can be going through the happiest time of your life. Content, fulfilled, happy and then all of a sudden it hits. It comes from nowhere, but you feel it. You feel the shift, the kaleidoscope stops turning into focus and often there is nothing you can do. Depressives will describe this experience using different words and likening it to different experiences, but one thing that I would wager they all have in common is that it feels physical. Your whole being is affected and you need to retreat, hide, sleep, and repair until it passes. Often there is no sign, it simply strikes and knocks the wind from out of your sails. The only positive (if you can call it that) is that the chronic sufferer generally knows that it will pass. It has to. It always has before. Because if it doesn’t, then what is the alternative? What would you do if you knew it never would? What would you do if this was it? If you were permanently walking around with the chains of depression weighing you down.

There are therapies available to depression sufferers, these range from medication and talking and lifestyle therapies. They all have the potential for work depending on who you are, on what your depression feels like and looks like. How it manifests, how it affects you. But there is never a fast solution. It isn’t easy. And very often you can never be ‘cured’ because whichever therapy you choose (if indeed you choose any at all) it is always lurking, around the corner, after the next happy day out or good night’s sleep. Even when it isn’t there. It is.

A big misconception is that depressives are always sad or unhappy people. I don’t think this is true. You can, of course, have feelings of sadness and unhappiness, so can anyone. But to label it as feeling sad or low is simply an injustice. This is where I think the confusion lies and the reason that so many people cannot understand it. When non-depressives try to imagine what depression feels like, they remember a time when they felt sad. When they suffered a loss - death, accident, a break-up. I am not saying that depression can’t be triggered by one of these episodes, but that isn’t the whole story. If you suffer a trauma then a natural reaction is to be low, sad even depressed. But being depressed in reaction to a traumatic event is not always the same as having depression. I am in no way minimising the depression and anxiety that can be brought on by suffering a trauma, but often that is clearer to understand. For the sufferer and those around him or her. It makes sense. They get dispensation if you like. What is far harder for people to understand is that people suffering from depression don’t seem to have gone through a trauma in order to slide into a depressive episode. Absolutely there may be grief and trauma from the past that plays a part in the current downturn. But not always. It isn’t that simple. 

If you know someone who suffers from depression (and we all know someone, even if we don’t know we know) then they generally don’t sit around being sad with a big sign above their heads flashing ‘depression’ they can be some of the happiest, most attractive, engaging people you know. They can be loud and gregarious, they can also be quiet and reserved. They can be tall or short, fat or thin, rich or poor. In truth they can be anyone. And just as it is pretty much impossible to pick out ‘baddies’ and goodies’ in real life. It can be the same with depressives. Having depression is just one part of them. I have often found depression sufferers to be some of the most energetic, happy and life-loving people I know. My theory for this is that they know how shit things can get. So while they aren’t in the midst of a depressive period, trying desperately to keep afloat, they relish the respite. The light happy feeling that comes with being in remission for as long as possible. The calm before the anxiety and churning feeling of fear seeps in. The feeling that signals another downturn could be on the way. 

Think about the recent well known people who have committed suicide. You read the same comments over and over. Alluding to their fame, success, attractiveness, talent, sparkle and that…..something. Their deaths are referred to as tragic, a waste. We didn’t see it coming, why couldn’t they be saved? How could they want to die when they had so much to live for? The truth is that they probably didn’t want to die. They just couldn’t find a way to live that wasn’t agony. They may have physically brought about their own deaths, but I would imagine that they had no more choice in the matter than someone who had been knocked over by a speeding car. Suicide is not the considered act of someone who has choice. It is the desperate action of someone who has run out of options. An inner turmoil that, thankfully, many of us will never be able to contemplate.

You see, that’s the problem with calling something a ‘mental' illness. It suggests thought and choice. It gives the impression that the sufferer can simply snap out of it. Whereas a physical illness is something that is forced upon the sufferer through little fault of their own. Simply an unfortunate genetic flaw or life circumstance. If mental and physical illnesses are forever seen as different then a mental illness will forever be the misunderstood poor relation. Our language needs to change, our understanding needs to be better. We need to see something as an illness, rather than dividing it into different compartments. Sufferers require empathy but they also require understanding. Someone who has never suffered with cancer or a mental health illness will, I truly believe, be much more able to put themselves in the shoes of the cancer patient than the depression sufferer. Why? Because we seem to be able to visualise ourselves when our bodies are breaking rather than our minds. Cancer is one of the cruellest, most insidious, complex diseases I have witnessed. It seems different for each and every sufferer and I find it so hard to comprehend how someone with it must be feeling. And yet, everyone seems to understand. Especially when someone is going through the treatment phase. Losing weight, losing hair, in pain, suffering. But generally what we see is the effect of the treatment and not the cancer itself. The cancer can sometimes be as invisible to the onlooker as the dark shadow of depression is. But still, it somehow remains unreal, a state of mind that can be shaken off rather than a disease that terrifies and kills.

But they both kill. They both destroy. They wipe out people, decimate families, bring grief and pain.  

The reason that we need to understand depression better is because it’s everywhere. We no longer lock it away and refuse to speak its name. It walks next to us all. it can strike at any time and it destroys.

Let’s put this into perspective. In the UK the leading direct cause of death among new mums within the first year after their child is born is suicide, the leading cause of death in men aged between 20 - 49 in the UK is suicide. Why wait until someone has died to then understand the pain and despair that they were suffering? We need to know the signs, learn the language, keep people close. Listen. Even if they don’t have the words, we need to help them to find them. To let them know that what they are suffering with won't simply be dismissed as low mood or feeling a bit down.

Would you be too busy to listen to someone who had heart disease, or had been given 12 months to live? 
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Let's stop separating mental and physical illnesses and pitting them against each other, or believing that one is more serious than the other. Illness is illness and those suffering should be listened to, understood and helped.

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The pre-Christmas party season is well underway and you may find that your diary is starting to fill up with long, boozy lunches, year-end catch ups over a glass of wine (or 3) and lots of parties. This is before we even hit the days surrounding and including Christmas and New Year.


Before we think about the New Year and all that brings, let’s instead focus on getting through the next few fun-filled weeks feeling as refreshed as possible and (ideally) hangover-free.

• Keep hydrated

As soon as we get an alcoholic drink in our hands we can totally forget that we should also be consuming water throughout the evening (as well as during the day). Don’t arrive at a party already thirsty, and if you do, ensure that you have several glasses of water before you hit the hard stuff. A good way to avoid getting very drunk (and therefore avoiding the hangover from hell) is to drink one glass of water for every alcoholic drink you have. Opt for not drinking in every round and alternate with water instead. Remember to drink a glass of water before bed and leave a glass at your bedside so that you can drink it as soon as you wake

• NEVER drink on an empty stomach

We ALL know that this is something to avoid, but we often forget or run out of time - DON’T! If you drink without eating then you increase the rate of alcohol absorption. Even if you are planning to eat during a party, ensure that you eat something before you start drinking, as you may feel less hungry and avoid food after a drink or two. Opt for foods that will take longer for you to digest and will therefore help to slow down the alcohol absorption. Ideally a mix of slow-release carbohydrates, fats and protein, so some wholemeal brown brown with butter or olive oil, or some olives and nuts, or if you are grabbing something before you leave home or the office and you don’t have time for a meal then 3-4 oatcakes with a tablespoon of hummus is a good option. Ideally, in the day leading up to a celebration, keep your food intake balanced and regular so that your appetite is stable before you start

• Choose your drinks wisely

As a general rule, the darker the drink, the more congeners it contains which basically means the worse your handover will be. Opt for clearer drinks (vodka, gin, white wine) over darker choices and opt for fruit mixers instead of carbonated drinks as this will help to slow down the alcohol absorption. Cheap booze will often contain more toxins and can result in feeling much worse the next day, so pick quality over quantity!

• Eat breakfast the next day

So, you have prepared for the party, kept your food intake stable and balanced, ensured that you are hydrated throughout and not hit the bar too hard. However you could still be feeling a little delicate the next day as alcohol is pretty hard for our bodies to process and will often disrupt our sleep.. So how do we ensure that we start the day after a heavy night on the right track? No matter how much you don’t feel like food, it is a really wise idea to eat breakfast. It doesn’t need to be a huge amount of food, something simple like scrambled eggs on a slice of wholemeal toast will often do the trick. A perfect mix of slow release carbohydrate and essential fatty acids. Eggs also contain cysteine which helps to break down the toxins that cause hangovers. If you really feel that you cannot face cooked food, then opt for some dry toast or oat cakes and the all important water. Sachets of rehydration salts such as Dioralyte can stop feelings of nausea.

• Pace Yourself!

Try to avoid several weeks of continued drinking. Your liver won’t thank you, you are likely to opt for calorific food and will hit 2016 feeling exhausted. We all know that January is the time for detox, but don’t start on the back foot. You won’t thank yourself if you start the New Year overweight and sluggish. Avoid drinking daily and ensure that your diet doesn’t slip. Keep meals nutritionally balanced and full of seasonal fruit and vegetables. There is so much wonderful, healthy food available at this time of year, it is not all about Twiglets & Quality Street!

Whenever we discuss weight loss or improving our health the first items we tend to discuss are diet and exercise. We don’t often see the 2 things mentioned independently of each other. And, like love and marriage they go together like a horse a carriage – don’t they? As a doctor, personal trainer, nutritional therapist or any other health professional you would never tackle one without mentioning the other. After all what is the point of exercising regularly if you aren’t eating a healthy and balanced diet, and equally what is the point of eating properly if you aren’t exercising?

I personally see them both as of equal importance. But I also see other life choices that are as important. Getting the right amount of sleep and rest, managing stress effectively and ultimately living a healthy and balanced life – mentally as well as physically. To me, it isn’t so much a case of diet and exercise as two sides of the same coin; it is more of a puzzle with lots of different lifestyle factors to consider.

I often tell clients that I find many of the health, diet and exercise messages that are communicated in society and the media incredibly confusing to the layman. We are inundated with how much exercise we should be doing, what we should be eating, how obesity is affecting society etc. but it seems to me that the more information we have at our fingertips the harder it is to find the right path for us. Looking at it positively we have never had the ability to exercise and look after ourselves as easily as we can now. Which seems ironic, as we have never lived more busy and stressful lives with less balance as we currently do. We seem unable to marry the theory with the practice as life keeps getting in the way. Sadly, no matter what we say and think, it appears that our health has never been less of a priority and the really worrying thing is that we aren’t even aware.  Many of us are walking around thinking that we are being as healthy as we possibly can be but are making mistakes left, right and centre.

Anyway, to get back on track let me go back to where I started – diet and exercise.  As I have already said I see them both as of equal importance, but I understand them both and I enjoy them both. But, unlike many people, I don’t see either of them as short-term projects. They are both an integral part of my life. I exercise daily and have done for many years and I follow a healthy and balanced diet that works for me. But I didn’t get to this point overnight and I don’t do either to be a certain weight or look a certain way, I simply do it to feel good and for my body to stay as healthy as it can. I personally wouldn’t go on a calorie-restricted diet to squeeze into an outfit. I am a great believer in if you adopt a healthy and balanced lifestyle then you will look and feel good as a consequence. I still think too many people look at diet and exercise on a short-term basis. The January detox, the month avoiding alcohol, starving yourself for a holiday/wedding/party. Even people training for exercise events such as marathons and triathlons. Of course you have many people who take part in sporting events regularly, but often I meet people who will devote x amount of weeks and months training and dieting for a one-off event and, as soon as they have crossed it off their to-do list they slip back into their unhealthy habits and never really progress. I am not saying that everyone needs to go out and embark on a schedule to make them an ultra athlete, I am simply saying that it makes much more sense to moderate your diet and exercise, approach it in a balanced fashion and make it part of your long-term life.

The problems we are facing with obesity could, in part, be due to the fact that we are still not looking at health from a long-term perspective. I actually think more people would succeed in managing their health and weight over a longer period if we stopped tackling diet and exercise at the same time. Changing your exercise regime (or simply starting to exercise when it isn’t something you commonly do) at the same time as completely overhauling your diet doesn’t always make sense. If we look at lifestyle as a whole – work, family, hobbies, exercise, diet, rest – then trying to tackle two pretty major things at the same time seems optimistic at best and foolhardy at worst. How we behave and what we spend our time doing is in part down to habits we have formed. Habits are not broken and formed overnight. They take time to cultivate and enjoy and should be tackled slowly and over a long period. If you change everything at once you are unlikely to stick to it as you will simply feel that you are depriving yourself of too much, have too much pressure to ensure that you don’t fall off the wagon, feel miserable and give up.

Maybe by looking at one at a time we may start to see a greater level of success and compliance. I maintain that the two are inextricably linked and both need to be adhered to help guarantee long-term health, but that doesn’t mean that applying them at the same time in the same way is going to work for everyone. The facts speak for themselves, we need to eat a balanced diet and we need to exercise, but maybe we need to change the way in which we approach them.

In the job that I do I am obviously very interested in research and articles relating to health and wellbeing. Many of these focus on weight and I will often tweet what I read to my Twitter followers. I don’t always 100% agree with what I am reading (I know that most research will often have a compelling counter argument, and many of the headlines in the media can be open to bias) I do think it is good to read what is being talked about and to understand what the issues of the day are relating to health. It is good to take a balanced and reasoned approach to everything one reads and not believe everything on face value though.

I find one of the biggest (pardon the pun) issues I read about is obesity. Not only why are we getting bigger but what getting bigger is doing to our health and the impact on society as a whole. We know – or have the ability to know – more than we have ever known before. We are inundated with stats on an almost daily basis about how dangerously unhealthy we are all becoming –

'Nearly 2/3 of middle aged people in Wales are overweight or obese' (University of London – Nov 2013),

 ‘Overweight seen as the norm, says chief medical officer’ – March 2014,

‘At least 900 Welsh children attend slimming classes’ (Public Health Wales – August 2013),

‘WHO: Daily sugar intake ‘should be halved’ – March 2014

The above links give you an idea of what we regularly see in the press health pages and although there are often two sides to every story, it is becoming harder to ignore that our lifestyle choices have an important impact on our long-term health. I believe one of the more frightening aspects to the weight debate is that obesity seems to be affecting more and more children than ever before. Poor eating habits seem to be starting younger with many children overweight and obese before they start secondary school. Many of our habits are formed in childhood and those of us who become overweight and unhealthy, as children will find it easier to continue in this vein for the rest of our lives. Over the past 10 years there have been many studies that have been published that have frighteningly claimed that children born now may die at younger ages than their parents. As I have previously said you will often find counter arguments and varying factors that have gone into making a point with regards to health, but this cannot be ignored as simply scare mongering.

I am unfortunately programmed now to look at people in a certain way. I can usually tell just by looking at someone whether or not their diet is healthy (skin, breath, energy levels, physical presentation) and what exercise they should be doing. I would never advise anything by simply looking at someone, but how we look and where we are carrying fat and how vital we appear is usually a pretty good starting point and can help when taking a detailed case history. I am often shocked when I see the size of some young children. I have been on the train or the bus on many occasions when I will see young children gorging themselves on fast food and junk food. I see children eating crisps, fizzy drinks and chocolate on the way into school (around 7:30 – 8am) in the morning and outside McDonalds, Dominos and other fast food establishments at lunchtime eating vast amounts of fatty, processed foods. Eating badly has never been easier, I get that, but why (if we know all we know) is this allowed to happen?  Do people still not understand that eating food like this, regularly over a period of time is going to kill us? Do we not understand that fat doesn’t just sit there looking a bit ugly; it actually prematurely ages us, and may kill us (probably many years before it should and after causing years of ill health and misery?) Do people really think that their lifestyle choices really only affect them? What about your friends and family? What about your work colleagues? Not to mention the huge societal impact – the NHS simply cannot cope with a nation of obese people, can it? And why should it?

So, what can we do to prevent obesity and ideally keep ourselves disease-free for as long as possible? The answer seems to lie with tackling it from many different angles. The government needs to seriously look into the stranglehold the food industry has on all aspects of society and effectively manage more campaigns, such as those designed to cut down on smoking. If taxes are to be levied on sugar then there needs to be consistent messaging and rules applied. All foods need to be considered when applying taxes and looked into properly. And, if we are going to be penalized for eating less healthy foods, will we be incentivized for eating healthy foods? It is not just about making unhealthy food less appealing we need to make healthy food more appealing. We need to redress the balance. Schools and parents need to work together to educate children on why and how they can make sensible food choices and take time and energy to teach children how to cook healthy, low-cost meals and to understand that that eating badly will affect them health-wise. We need to stop being afraid of talking about people being fat and create a dialogue and a way of tackling this that is sympathetic and effective. Young people cannot be blamed for this. They are getting the junk food and the money to buy the junk food from somewhere. This needs to be seriously looked at. The NHS has a very important job to do. With everything we know it is still very difficult in 2014 to be able to buy any healthy food in a hospital. I have been in hospitals in the UK that have fast food and junk food franchises in the same building as the hospital. How can this be allowed to happen?

In order to tackle the issue seriously and effectively everyone needs to be on the same page and a consistent action is needed. It won’t be easy but it needs to happen, as unfortunately the endless articles, research and knowledge are not making enough of a difference. We have the information and the control to prevent obesity, which will in turn help to prevent to prevent long-term serious illnesses, which will in turn help to prevent a strain on society and untimely deaths. This is everyone’s problem, and we need to make this a priority.