Mentions in the Media

LATEST NEWS:

Our Appearance in the Kent Messenger

Thousands of people have been tuning in to understand more about mental health in an unlikely place - listening to two friends talk over a beer.

The Why The Long Face? podcast is hosted by Chatham’s Oliver Turnbull and his psychiatrist friend Dr Paul Keedwell.

The pair met through mutual friends while Paul was studying at the University of Leeds and Oliver was at the University of Nottingham more than 30 years ago.

Paul went on to earn his doctorate and write books on psychology, while Oliver has become a Management consultant.

They devised a plan to start their own podcast which would help people understand issues surrounding mental health.

Father-of-two Oliver, who lives in the Historic Dockyard where the podcast is also recorded, said: “If you are suffering, you don’t necessarily want to hear a very sombre, cold podcast."

“Paul comes from an educational perspective and I was quite surprised how well we are able to pull a podcast together and our rapport is so natural because we have known each other for so long.”

The show covers topics including anxiety - which Oliver has first-hand experience of - as well as depression and how things such as social media and gender can affect these.

“The first episode is called ‘Coming out’ and it is all about when you start to admit you have a problem which is the first step to recovering.”

After two seasons of the show, the duo are looking to do some live recordings in Kent after getting positive feedback from some of their 5,000 listeners.

Oliver added: “It’s very gratifying when you get emails from strangers. It’s a great way of soothing and calming people and making them realise they are not alone.

“It started off as a hobby and now we see that’s genuinely helping people.”

.

Paul’s view on Ketamine as featured in the Daily Mail

Here is Paul’s my full response to the NICE committee decision to refuse esketamine prescribing on the NHS:

A substantial number of individuals suffering from major depression fail to respond to two or more conventional antidepressants. Existing approaches to treatment resistance, including medication combinations, talking therapy, or ECT, often fail, or are unacceptable. New approaches are required to reduce the costs to society of protracted suffering, disability and chronic health care needs.

The NICE refusal to recommend intranasal esketamine for the management of treatment resistant depression (TRD) will thus disappoint many sufferers in the UK who have failed to respond to existing treatments.

The committee's objection to its use in TRD appears to be largely based on cost rather than lack of effectiveness.

Esketamine is an isomer of ketamine made by Johnson and Johnson. The drug is expensive, and it could be argued that ordinary ketamine, which has been prescribed for decades in various forms as an analgesic, is just as effective in treating depression. However, clinical trials are required to demonstrate the safety and effectiveness of any drug for a new indication, and such trials are also expensive. The costs of any new treatment tend to reduce over time.

While it is an expensive treatment, the additional costs incurred with any promising new medication must be compared to the financial burden of persisting depression. Furthermore, the costs of acute treatment with the drug are unlikely to exceed those of ECT, a commonly used treatment in this group of patients. Ketamine could replace ECT for TRD going forward.

While the committee was advised that the set up costs for ketamine clinics would be high, this is not necessarily the case. In Oxford, for example, ketamine has been prescribed for patients within existing ECT facilities, and this is likely to be the model of care, at least initially. Moreover, the intranasal preparation is easier to administer then ECT, and is relatively safe.

Meanwhile, the guidance downplays the therapeutic potential of esketamine in this difficult to treat population. Although ketamine (or its isomer) is not a panacea, for those who respond, they improve dramatically quickly (in hours, compared with weeks or months), and it seems that they are more likely to go in to complete remission. Partial responders tend to remain quite disabled.

Another consideration is the emerging evidence that ketamine rapidly quells suicidal thoughts - an effect that could not only reduce levels of self-harm but could also reduce dependence on costly emergency services and crisis admissions to hospital. Although esketamine has not been evaluated in this regard, more information is needed.

The benefits of ketamine and esketamine do not usually persist beyond days. Repeat doses are therefore required to sustain benefit. However, it seems that, provided doses are given no more than the recommended twice per week, tolerance does not develop. Research at Oxford over the past 10 years has not revealed any evidence of drug-seeking or dose escalation during long term treatment.

In someone who’s life is transformed by this drug, the big ethical question is when do you stop it, if ever? Concerns raised by the committee about the potential harms of halting its prescribing need to countered by the observation that many individuals are “dependent” on drugs to keep them well - consider bipolar patients, diabetics, asthmatics and epilepsy sufferers. There is no evidence thus far of a ketamine withdrawal syndrome, only evidence of relapse of depression.

These guidelines are preliminary. It is hoped that if and when more evidence emerges of the efficacy and cost effectiveness of esketamine the NHS might add this extra weapon to its armoury for managing TRD. For the time being it will be restricted to research centres only.

We are TV experts! Well, Paul is!

We were invited onto KMTV to talk about the podcast and were delighted to be able to comment on gambling addiction which has been in the news and is often linked to poor mental health.

Oliver got a little over excited and talked over Paul a lot, but The Doctor didn’t seem to mind too much and the chaps managed to get a good plug in about Why The Long Face!

Very happy to share the sofa (albeit briefly) with Keilan Webster.

To find out more about how to engage with us, please contact Louise at hi@whytlf.com