“a mental state achieved by focusing one’s awareness on the present moment, while calmly acknowledging and accepting one’s feelings, thoughts, and bodily sensations, used as a therapeutic technique.”

I’m interested in this.  As a principle, a technique, it’s very attractive. A non drug based treatment for anxiety / stress management and an uncomplicated process to follow, with the ultimate result of improving well being, Supporting calmness.

I have used these techniques before. During a period of acute anxiety back in 2014, when I could barely function, I found the concentration on immediate physical symptoms; the feel of the sheets on my skin, the hardness of the chair  on the back of my legs, the feel of wind in my hair or the smell of coffee for example, both soothing and grounding. But back then I used the techniques purely to lessen my anxiety rather than to promote well-being.

I attended an awayday about 18 months ago, in which there was a short seminar about mindfulness in the consultation, and how it might be useful for some of our patients. In a group setting, an experienced, serene woman guided us though some simple techniques. I was as impressed by her stillness, self possession and gentle unhurried demeanour as by what she imparted. Perhaps, I remember thinking, if I were more mindful, I too would be less harassed, calmer,  more poised and tranquil.

The key message from the seminar was this: Whenever you bring awareness to what you’re directly experiencing via your senses, or to your state of mind via your thoughts and emotions, you’re being mindful.

Professor Mark Williams, former director of the Oxford Mindfulness Centre, says that mindfulness means knowing directly what is going on inside and outside ourselves, moment by moment. “It’s easy to stop noticing the world around us. It’s also easy to lose touch with the way our bodies are feeling and to end up living ‘in our heads’ – caught up in our thoughts without stopping to notice how those thoughts are driving our emotions and behaviour,” he says.

“An important part of mindfulness is reconnecting with our bodies and the sensations they experience. This means waking up to the sights, sounds, smells and tastes of the present moment. That might be something as simple as the feel of a banister as we walk upstairs.

“Another important part of mindfulness is an awareness of our thoughts and feelings as they happen moment to moment.

“It’s about allowing ourselves to see the present moment clearly. When we do that, it can positively change the way we see ourselves and our lives.”

So how do we practice mindfulness?

  1. Set aside some time. You can practice anywhere, at anytime.  You don’t need a meditation cushion or bench, or any sort of special equipment to access  mindfulness skills—but you do need to set aside some time and space, ideally without obvious distractions like the TV / radio / computer
  2. Observe the present moment as it is. The aim of mindfulness is not quieting the mind, or attempting to achieve a state of eternal calm (at least that’s what they say, I think this IS in fact the longer term, overall desired effect…) In the moment however, the goal is simple: you are aiming to pay attention to the present moment, without judgement. Its sounds easy, but actually I find this hard.
  3. Let your thoughts  roll by. When we notice thoughts arise during our practice, we can make a mental note of them, and let them pass.
  4. Be kind to your wandering mind. Don’t judge or critisise yourself for whatever thoughts crop up, just practice recognising when your mind has wandered off, and gently bring it back.
  5. Feel your breath. Bring your attention to the physical sensation of breathing: the air moving through your nose or mouth, the rising and falling of your belly, or your chest.
  6. Return to observing the present moment as it is. Our minds often get carried away in thought. That’s why mindfulness is the practice of returning, again and again, to the present moment.

That’s the practice. It’s often been said that it’s very simple, but it’s not necessarily easy. The work is to just keep doing it. Results should (!)accrue.

A growing body of evidence has found that when people intentionally practice being mindful they feel less stressed, anxious and depressed, with the UK Government’s National Institute for Health and Clinical Excellence (NICE) recommending mindfulness based therapies for the treatment of recurrent depression. Research also shows positive effects on several aspects of whole-person health, including the mind, the brain, the body, and behaviour, as well as a person’s relationships with others.

So, I’ve been toying with the idea of adding ‘Do 5 minutes mindfulness a day’ to my New Year resolutions list. I can’t see any reason NOT to do it, It can’t hurt me, and it might help.

I took this On line stress test on a mindfulness website. Rather alarmingly I scored 30/34. A (validated) burnout test for doctors put me at ‘high risk’ of burn out, and that was when I was on holiday. Much of the stress in my life I’m not able to alter, so perhaps I need to alter my response to it.

I’ll let you know how I get on….






Today I had a consultation with someone I have previously mentioned in my blog, here

The person concerned is very ill physically. Huge swollen belly, jaundiced, stick thin apart from swollen abdomen.This is end stage alcoholic liver disease

The child protection proceedings continue.

They are slow, but inexorable. The parent has been unable to stop drinking, they have not engaged with the local alcohol support services. They remain in denial, telling everyone that they are ‘sober’ or drinking only a glass of wine a day. This persists, even when it is clear to professionals that the individual is intoxicated in meetings.

They refuse to see that there is an adverse effect on their child from being forced to live with an active alcoholic.

The family home is now for sale. If the home is not sold in a ‘reasonable time frame’ the social services will go to Court and seek an order that prevents this person from living in their home. They may remove the child since the other parent is also in denial and colluding.

The consultation was very blunt. They do not see that ALL of their misfortune; arrest, inpatient stay in a psychiatric ward, children’s social service involvement, being forced to sell the family home, being in intensive care, not allowed to spend anytime with your own child unsupervised etc etc – ALL due to alcohol. Still they will do nothing to alter the situation. …

I explained, bluntly, that it may seem as if SS have ‘backed off’ but its temporary. And they will not go away. They will ensure that the child does not continue to live with an actively alcoholic parent. Nothing will change.

Denial is a desperately powerful thing.

It’s amazing how we forget. And not in a good way. Here is an extract form a journal entry I wrote back in April 2013 after I got drunk at a family lunch that ExP  and I hosted. I don’t remember much of the later afternoon, as I was drinking from mid-day and cooking…I went to bed at about 7 – before my children – drunk – and woke at about 2 am sweating, sick and head-achy. This is what I wrote

“Sweating, Anxious, barely slept. Strong suicidal thoughts, imagining hanging myself, intrusive, persistent thoughts. desperately ashamed, amnesia, what did I do, say ? alone, isolated, twisting like a fish on a hook. fear fear fear. and stuck.”

I stopped drinking for 3 days after that. THREE days. I honestly wanted to kill myself because I was so ashamed, but THREE days later I was drinking again .

Denial is a desperately powerful thing

I don’t judge my patient above. That could have been me. I remember how difficult it was to think of a life without drinking, and I and so thankful that I had the strength and conviction to just do it anyway, and trust that it would be ok… I’m lucky; my patent is still mired in the gutter due to alcoholism .. what a bloody waste

Denial …

Breathe in ; breathe out

This piece is written by Danielle LaPorte, and was kindly posted on my site. I am reproducing it with appropriate credit to the original author.

When I first read it, I was too distressed to properly take it in. I read it again today, calmer, and it resonated strongly with me. I coloured it green, because it seems life affirming to me.

Are you hanging by a thread?
It’s hard. It’s wrenching. It’s incredibly painful and it’s difficult to feel lightness.

Or to see clearly.

Hanging by a thread can be really disorienting. What you’re going through undeniably sucks.

Listen to me: It’s going to be okay. You’re going to get through this. You can do it. Baby, you ARE doing it.

You’re getting through this. Right now your cells are plumping up and your heart is beating and you have your breath. *In breath. Out breath.* It’s really okay if you have to get that basic about getting through it.

In breath, out breath. Sun’s gonna rise. It’s going to be okay.

Take encouragement from strangers. Like me. Go ahead. Take it. It’s free and I don’t feel karmically entangled. So listen to me: It’s going to be okay.

This will not kill you.

Do you believe in angels? If you don’t, just believe in them for the next twenty fours. There are a hundred thousand angels by your side.

You’re probably feeling devastatingly alone, like an iceberg drifting. No one can hear you cracking. It’s cold. But, just like an iceberg, you have so much beneath the surface. Years of layers and lifetimes of experience and strengths to call on — skills of expanding consciousness that you didn’t even know you had. You will not sink.

People have been through what you’re going through right now. Thousands of them.

Really and truly. Your picture of heartbreak, your strain of pain is part of the human fabric, and that tapestry is holding you like an Eskimo blanket. Other people have survived this and when they got out of the hole, they left a morphogenic popcorn trail out of the pain. You can trace their steps.

It may be hard to believe right now, but not only will it be okay, not only will you get through and over this, you will thrive again. You will be clear and vibrant and INCREDIBLE.

You will not only have more character to pull out at parties and wisdom to offer the world, but you will feel more joy than you think is possible right now.

You will.

You may walk with a limp. You may wince when you look back (understandable) you may cry unexpectedly in the book store, but you’ll be more alive, and more You. You will be strong. And you will feel a curious sensation of being more useful. And it will feel really, really fantastic.

What you’re going through right now is so difficult.

And it’s going to be okay.

More than okay.


What does a woman who loves herself do?

  • The last few days have been emotionally very tough. In truth  they have been the culmination of months of increasing anxiety, stress, and frustration. As I realised at the weekend, I was being made thoroughly miserable by the behavior of two people; and I had no control whatsoever over it. As I know very well you cannot MAKE people change, or do any thing except change ones own reaction to it.

    It made me start thinking about behaviors I have observed in emotionally string people; people I admire. Behaviors an attitudes I would like to try to adopt. Strong, mature , sorted women, who look great , well dressed to suit their figure, women who look well groomed and have a well organised productive fulfilling life….

    In some literatures I’ve seen this described as  “a woman who loves herself” and that’s the  image I’m trying to think of …

    Strong women move on. They don’t waste time feeling sorry for themselves, holding grudges, dissecting imainary slights. they look at whats happened, learn from it and MOVE ON. They accept responsibility for their errors.

    I think Im quite good at accepting responsibility for my behaviour. Probably less good at moving on

    • They embrace change. They welcome challenges, they adapt and change. They have a ‘can do’ attitude rather than moaning ab0ut what they have lost.

    I do find change challenging and some times cling on to the familiar

    • They stay positive . They don’t complain about problem. They don’t waste energy on things they can’t control. They focus on the bits that CAN be controlled and work with that.

    im getting much better at this. I don’t waste energy ftretting about the weather for example; I make contingency plans if required

    Strong women who love themselves are kind, fair, and unafraid to give their opinion. They don’t worry about pleasing other people. They stick up for they bullied, and they stand up to be counted. They dont seek conflict but don’t avoid it either.

    I admire this quality greatly and I am working towards it. personally I HATE conflict . I hate challenging people even what I know they have not behaved well.Not drinking has helped me here as I am able to tate my position less emotionally, more calmly and factually.

    • They are willing to take calculated risks. They weigh the risks and benefits before taking action.

    I can do this. Actually I do it every single day at work and part of my role is supporting and mentoring those who can’t.

    • They accept full responsibility for their past behaviour. They don’t make the same mistake over and over.

    hmmm – took me a long time, but I don’t drink any more

    Im sure there are more. But it help me to look,at where I need to work on my attitudes and behaviours,

    tomorrow we go on holiday . All looks like it’s going ahead.i am looking forward to it very much. I am anxious for my sobriety, but I have my sober toolbox , and 152 sober days behind Me…


In April 2014 I had a breakdown. Not a fully fledged, admitted to hospital, breakdown, but an acute episode of anxiety and depression that rendered me unable to cope with day to day life.

I snapped one morning in clinic. I had seen two well known patients and dealt with their concerns. The next was someone I didn’t know. I suddenly felt completely unable to think or make decisions. I felt that my brain was breaking apart. I developed a full blown panic attack, and despite knowing that it WAS a panic attack I was terrified and completely unable to get control of myself.

I was rescued by my dear friend and senior practice nurse, who calmly phoned my partner, cancelled the rest of my clinic, and got me an appointment to see an experienced GP.

The next few weeks passed in something of a blur. I was extremely anxious – at times it was hard to go out at all; I couldn’t THINK – and for someone who has always been decisive and relied on a sharp intellect and quick grasp of complex problems, this was truly terrifying. I was suicidal, in that I could see no way out of my problems other than jumping off a high building. I went only as far as planning which high building, and the rational part of my brain knew that suicide would be devastating for my family – but I still could see no other way out. I achieved very little in those first weeks. Lola, my dog, was a 3 month old puppy and I managed a short walk with her most days. That was about all.

I was well cared for, by an excellent GP who provided just the right mix of sympathy, support and direction; and by a fantastic service for physicians that was set up a few years ago in London. I was medicated and allowed to recover.

So far, so pretty normal to be honest. It didn’t feel like it, when it was me, but I had a fairly standard period of mental ill health and made a pretty good recovery. I was off work for 8 weeks.

The thing that struck me yesterday was that I was sober when this happened. The first time I stopped drinking was October 28th 2013 – so by April I had been largely sober for 5 months. (two evenings slip in that period) I had always thought that I broke down despite the fact that I was sober.

Now I wonder if it was because I was sober.

And that scares me. Because I feel truly awful right now. Anxious, irritable, flat, despairing, trapped and a bit desperate. My concentration is shot to pieces. I lack motivation to do anything at all.  I’m exhausted but struggling to sleep. And I am 5 months sober next Friday. What has alcohol been medicating all this time ? Currently I take an SSRI, which i was not doing last time… but …

I don’t know what to do


I am absolutely terrified of “loss”.

Most things in life I can accept with a degree of equanimity. At least I can face the prospect of them with a fatalistic composure. Loss / Ending, especially of relationships, fills me with fear. Actually its not the loss, its the intense grieving reaction that I have afterwards.

I think this dates back to when I was 18, and my first serious boyfriend dumped me. I grieved for several years, for the loss of a 6 month relationship. I was literally broken hearted. I told NO-ONE how desperately unhappy I was, because I was ashamed that I loved someone who didn’t love me, and I don’t think it occurred to me that this lengthy, intense grieving was abnormal. I was literally consumed with the loss. I couldn’t enjoy anything, I thought about HIM every single minute of every single day. My first thought on waking and my last before sleeping. Of course my thoughts and yearning were for what I thought I had lost – my image of a stability, a happy relationship, rather than the reality – I made lists of things about him that had annoyed and upset me  (and there were quite a few !! )- but this made absolutely no difference whatsoever to the depth of my suffering. I could not rationalise or think myself out of the enormous well of pain.  My yearning continued through my initial university years, probably until I was 22 and fell in love again. I can still remember vividly the aching void and the pain of the loss.

This happened again when I separated form a more serious boyfriend in my early 30’s. Although we were clearly unsuited for each other, I was not at all happy with him, and I ended the relationship, once it was over I entered another protracted period of intense grief. Same thing. Intellectually I knew it was best that the relationship was over, that I could move on, that it was going nowhere and giving me nothing …  by the end I didn’t even LIKE him much. But I was stuck grieving, keening, yearning for something that I felt I had lost. Bonkers. This time I DID recognise that the depth of my despair was a) ridiculous and b) not ‘normal’ ; but , possibly because I still couldn’t bring myself to speak of it to anyone, I never worked out why I reacted like this, or how I could respond more healthily in the future.

This intense aversion to loss, or fear of going through THAT disconsolate mourning process again, keeps me in situations I would be better off leaving. Or would I  ?  How much effort do others put into maintain relationships that are not making them happy ? With adult children? partners ? friends? How long do you go on trying to fix things ? when do you know that things just will not work out in a way that you can find acceptable, when and how do you walk away ? Or does everyone hate loss this much?  does everyone else compromise and bury what they need in order to ” keep the peace”.

These feeling too I drank to avoid. These hard questions are easier avoided, ignored and not aired….buried in a fuzzy head full of  wine … But they are still there, and one day, somehow they need resolving



Again. At least I think so. Or hope so ? Because if it’s not …. .

I’d never really heard of PAWS before I became a non drinker; when after the initial difficulties and emotional roller coaster of withdrawal, I didn’t exactly enter the happy calm space I was anticipating … No, I found myself still subject to mood swings, unexpected bouts of depression, sudden onset of anxiety symptoms, insomnia, and emotional uncertainty …

Then kind members of the sober community enlightened me, and I started reading about PAWS.

After acute withdrawal, the next stage of sobriety includes symptoms known as the Post Acute Withdrawal Syndrome (PAWS). This stage has fewer physical symptoms, the manifestations are more emotional and psychological.

As I understand it,  Post-acute withdrawal occurs because your brain chemistry is gradually returning to normal. As your brain recovers from being regularly poisoned,  the levels of your brain chemicals fluctuate as they approach the new normal equilibrium, and this fluctuation causes PAWS.

Over the past decades, much has come to be known about the long-term effects of drugs of addiction, especially on the neurobiology of the brain. Most substances of addiction, like alcohol, benzodiazepines, opiates, and stimulants lead to lasting changes in the brains handling of learning, motivation, and pleasure. Primarily, these drugs hijack the brain’s “reward” circuits, a critical part of which is dopamine. In the case of alcohol (and drug) abuse and dopamine, the brain not only becomes tolerant, but it also gets used to, and “expects” an excess of dopamine, meaning the newly sober user  experiences a simultaneous lack of dopamine (which is unpleasant) AND increased brain craving for the trigger that provides dopamine. In other words, not only does an addict feel bad without the drug, his focus turns solely to it to make him feel good again. Great ! Cravings explained in one easy sentence ….

There are several other key neurotransmitters involved, as well as dopamine, including serotonin ( mentioned here https://wordpress.com/post/alcoholfree2016.com/2097 )

While different drugs of abuse seem to lead to different sub-sets of PAWS symptoms, PAWS that occur from alcohol and benzodiazepines are generally more similar because they’re pharmacologically more similar in mode of action – key things are irritability, anxiety, and sleep difficulties. I have read that how long people experience these paws symptoms is typically a reflection of how long they were using  the drugs as opposed to how much.  great . So my 30 odd years of alcohol excess is definitely going to come back and haunt me here ….

The most common post-acute withdrawal symptoms are:

Mood swings  (triple tick)
Anxiety. tick
Irritability. Tick
Tiredness. Double tick
Variable energy, double tick
Low enthusiasm. Triple tick
Variable concentration double tick
Disturbed sleep tick

Im utterly fed up right now. I’m stressed , fighting with Mr Lily over problems that are insoluble, anxious about the responsibility I’m taking on in our upcoming holiday, worried about no 1 son – and totally alone with no support in this one, I feel fat, sluggish, lazy and unmotivated. So unmotivated I even missed my favourite yoga class this evening.
This feels like a total rollercoaster of symptoms. At the beginning; the first two weeks were really tough – my symptoms would change minute to minute and hour to hour. Then I had a period of pink cloud – when I felt AWESOME …. I enjoyed that 🙂 But in the last 3 months of so, I don’t feel I’ve made any significant progress . I get these awful low moods, then they will disappear for a few days / a week , only to return again. I hoped that  the good stretches would get longer and longer, I’m not sure that’s happening and the bad periods of post-acute withdrawal are just as intense and last just as long.

Thank goodness I’m not craving alcohol right now, as I’m feeling so very vulnerable ….

What’s next ? 

Since I have been sober lots of things have got better; some were things that I had expected or hoped for, other things have been a surprise. The sobriety itself has been both easier and harder than I expected.

One thing I had really hoped for, once I stopped tipping alcohol down my neck every day, was a bit of weight loss. Just a bit, a reward for the denial, a positive, tangible, physical demonstration of the healthy choice I have made, I felt I DESERVED it. 

So , I am today 144 days sober, And I am three fricking pounds HEAVIER than I was on March 11th.


I’ve got this little app on my phone , called “I’m done drinking” (I found it on the App Store) .. You enter how much of what you were drinking, and how much it cost. The app does the rest. So, I have apparently saved 157,007 kcals. Just from not drinking alcohol….

If I use the well recognised equation which tells us that 3,500 kcals = 1 lb of fat, then I have saved myself a staggering 44.9 lbs of fat. That’s just over THREE STONE’s worth of calories I have not drunk… But , am I lighter. No. I. am. NOT. which in turn means I have eaten , on average 1,163 kcals MORE (EVERY DAY) than I was eating previously, more than I needed to eat, to not only maintain my body weight, but actually increase it.

This really depresses me. But if I’m honest, I have not paid any attention whatsoever to my diet since I quit drinking. I have eaten shed loads of chocolate, cake, sweeties, ice cream, biscuits and pretty much anything sweet, fattening and unhealthy I could find.

It occurred to me today as I glowered at myself in the mirror again that my attitude to this self indulgent food fest is not a great deal different to my attitude to alcohol when I was deep in my petulant alcoholic denial.

Quite a lot of “I deserve it”; “just one won’t hurt”; “it won’t do me any harm”; a rather obstinate refusal to look at the realities, a head in the sand – self defeating “tomorrow will do” attitude.

Now maybe that shouldn’t matter, after all, I’m not vastly overweight, and surely a bit of laxity with cream buns is allowed in the initial stages of getting sober… Maybe. But what does matter to me is how lousy I feel in myself. The lack of self control and the burgeoning waist line makes me feel every day like a failure.. I want to feel in control of myself, not a slave to whims and greed…

I’m really not sure what to do. I’m not sure if this is a full scale cross addiction , whether being ‘strict’ with myself is likely to be counter productive, whether I should make a proper diet plan and follow it … I’d been sort of hoping that a natural rhythmic eating pattern would emerge once the alcoholic / sugar highs and lows had evened out – that I would want  to eat healthily and nourish myself … That hasn’t really happened yet…..

I slightly feel (and I don’t want to think this) that my addiction tendencies, are finding another outlet …and that unless I deal with whatever is underneath, I will continue to have one issue or another ….

Bugger. Not a great couple of days really


I don’t know about anyone else but I always subscribed to the view that alcohol reduced inhibitions and “allowed” me to express emotions / feelings that I otherwise kept suppressed. As I am a bit of a master at suppressing emotions and avoiding conflict, it’s perhaps not surprising that after a few drinks a torrent of rage and frustration would, at times, burst out of me.

There have been many, many such occasions over the years. Many evenings that ended in tearful recriminations, many stand up arguments, many outbursts triggered by innocuous comments that spiralled into full-blown raging conniptions. Afterwards, the next morning, I would piece together who said what, what I remembered, and cringe a bit. Underneath though, I always believed that I had some justification for screaming and yelling – letting my feelings out – MAKING someone understand how I felt. Whilst I understood and accepted that alcohol had a part to play in the genesis of these episodes, I always firmly believed that the alcohol didn’t manufacture the feelings – these were there already – alcohol just lowered my inhibitions and allowed me to say what I thought. And thats a good thing, right ?


I’m still early on in this journey, and this is part of a half formed thought process, so I’m not 100% sure about this, but despite my ongoing (though less frequent) mood swings, there seems to be less RAGE in my soul.

There are several things in my personal life that make me very unhappy. They did result in pretty regular outbursts whilst under the influence. Mr Lily has taken quite a few verbal batterings over the years. Did anything change ? No. Did I feel better having let it all out? . Not really. Did I learn ? No. The next time, or the time after that, the same argument would ensue, again with no resolution. All that has been left by that enormours emotional carnage are scars and fear and damaged trust.

What role alcohol? Its certainly true that sobriety has not erased the problems. It hasnt changed the things I think or the position I take. It hasnt made the hurt of certain circunstances less intense, or provided me with an acceptance of things I really struggle to accept. I’ve not morphed into some complient doormat who has no problems. BUT, it seems to me now that just maybe, being sober has firmed me up a bit, in a non confrontational, calm, solid kind of way.

To explain. I spent a LONG time ANGRY about certain things, really deep down angry and hurt, but I felt unable to express those feelings when sober. So they all burst out, exploded out when I was drunk, Nothing changed. Now, sober, I dont feel any happier about those things but I am beginning to accept that I CANNOT CHANGE THEM. And in that acceptance, comes the next thought that what I CAN do is either;

  • state what I want, calmly and clearly, why I believe its right; Ask for others to change, and make a plan for what I will do if things remain the same
  • accept that life isn’t perfect and that I have no more right to what I want than anyone else.

That saying – known in AA as the serenity prayer, feels very apt.

grant me the serenity
to accept the things I cannot change;
courage to change the things I can;
and wisdom to know the difference.

It looks so simple. But it isnt.

I am less sure about how aspects of my life will pan out now, but what I do believe, is that I will be taking responsibility for my own emotional wellbeing. That I am, or will be, strong enough to do that – and that after years of being too befuddled to accept that personal responsibility, I can now see it in front of me. I’m not there yet, but I’m closer.





I’ve been really struck in the last few days at the number of blog posts I have read from people struggling with guilt and shame at having to take, or being recommended to take, antidepressants / medication for anxiety.

I work as a General/ Family practitioner and I see this so often. People struggling with crippling anxiety and debilitating anhedonia, who somehow believe this is a sign of ‘weakness’ or  a character flaw. That if they could just “pull themselves together’ it would all go away.

This is just NOT the case. Low mood / anxiety are two sides of the same coin and they are both due, in part at least, to low levels of the neurotransmitter serotonin. This is FACT. An individual can no more control their levels of serotonin than their levels of insulin. Ergo, will power alone will NOT , CANNOT manage anxiety and depression.

Anxiety / Low mood is very,very, very common. Probably about one in three people will visit their doctor at some time with this complaint. Sometimes its presented as fatigue, sometimes as somatic symptoms. But the underlying low serotonin, if treated, will improve all these symptoms

(and before any one jumps on me, not everyone with fatigue is depressed, obviously, but its very common)

This is a somewhat simplified version of the role of neurotransmitters, as my aim with this blog post is not to discuss the finer points of neurophysiology, but offer evidence that might make someone who is low, feel less stigmatised about being offerred / taking antidepressants.

NEUROTRANSMITTERS are the brain chemicals that communicate information throughout our brain and body.  They relay signals between nerve cells, called “neurons”  The brain uses neurotransmitters to tell your heart to beat, your lungs to breathe, and your stomach to digest.  Serotonin is a neurotransmitter which affects mood, sleep, concentration, weight, anxiety, appetite, memory and learning, temperature, and behaviour. Norepinephrine, dopamine, endorphines and oxytocin are also involved in various aspects of mood.

Lots of things, obviously affect mood. Social circumstances, relationships and thousands of other things. But low serotonin levels- are definitely one of the factors that affect mood and one of the factors that we can modify. The diagram below shows the overlapping relationships between some of the neuro chemicals involved


We can ‘help ourselves’ with exercise and a variety of other techniques, we can try to manage stress levels, and we can avoid substances that deplete serotonin – eg alcohol… BUT, for many people, medication is a very useful tool to improve mood and reduce anxiety. I will often explain to my patients that lifting your mood allows one to create a ‘virtuous circle’ – when you feel a but more motivated, you are likely to exercise more, get more done – this makes you feel better – and so on…

so please, if you are low, depressed, anxious, unmotivated, exhausted, struggling with mood disorder, please recognise that this is an illness; Its not under your ‘control’ and there is treatment that can help.

DOI. I take a serotonin reuptake inhibitor, and I believe it has, if not saved my life, helped me beyond measure.