Post-traumatic stress disorder (PTSD)

What is PTSD?

Post-traumatic stress disorder (PTSD) is a type of anxiety disorder which you may develop after being involved in, or witnessing, traumatic events. The condition was first recognised in war veterans and has been known by a variety of names, such as ‘shell shock’. But it’s not only diagnosed in soldiers – a wide range of traumatic experiences can cause PTSD.

“When something traumatic happens in your life it rocks you to the core. The world is no longer a safe place. It becomes somewhere that bad things can and do happen.”

What is it like to have PTSD

When is it diagnosed?

When you go through something you find traumatic it’s understandable to experience some symptoms associated with PTSD afterwards, such as feeling numb or having trouble sleeping. This is sometimes described as an ‘acute stress reaction’.

Many people find that these symptoms disappear within a few weeks, but if your symptoms last for longer than a month, you might be given a diagnosis of PTSD. Your GP might refer you to a specialist before this if your symptoms are particularly severe.

“I started experiencing symptoms of PTSD after my boyfriend died. I suffered extremely vivid flashbacks that could happen at any time, anywhere, and were deeply distressing… I threw myself into another relationship very quickly to try and avoid how I was feeling, but then also would not express much affection to my new partner.”

Are there different types of PTSD?

If you are given a diagnosis of PTSD, you might be told that you have mild, moderate or severe PTSD. This explains what sort of impact your symptoms are having on you currently – it’s not a description of how frightening or upsetting your experiences might have been.

PTSD may be described differently in some situations:

  • Delayed-onset PTSD – if your symptoms emerge more than six months after experiencing trauma, this might be described as ‘delayed PTSD’ or ‘delayed-onset PTSD’.
  • Complex PTSD – if you experienced trauma at an early age or it lasted for a long time, you might be given a diagnosis of ‘complex PTSD’. (See our page on complex PTSD for more information.)
  • Birth trauma – PTSD that develops after a traumatic experience of childbirth is also known as ‘birth trauma’. (See our page on PTSD and birth trauma for more information.)

If you experience some PTSD symptoms while supporting someone close to you who’s experienced trauma, this is sometimes known as ‘secondary trauma’.

“I couldn’t understand why I felt like my brain wasn’t functioning – I couldn’t remember things, I couldn’t process things. It was like my brain had just slowed down and ground to a halt.”

Experiences of facing stigma

There are lots of misconceptions about PTSD. For example, people may wrongly assume it means you are ‘dwelling’ on past events. They might even suggest that you should ‘get over it’ or ‘move on’. But having PTSD isn’t a choice or a sign of weakness, and it’s important to remember that you are not alone.

Young Carers for people with Disabilities

What are young carers?

The BBC estimates that there are about 700,000 young carers in the UK. Being a young carer often means looking after a family member who is ill or helping them by looking after the other members of the family while they can’t.

Young carers often do more chores than other children would. On top of providing emotional support to the person they are caring for they may also have to learn how to nurse them or look after their personal needs like bathing and dressing.

It can be hard work being a young carer. Sometimes other children don’t understand your responsibilities and you have less free time than others.

Many young cope well with caring, especially if you have support from other family members and it’s important to look after yourself. You have the right to be looked after too and there are lots of places and people you can go to to get help.

Getting help

Sometimes, being a young carer can get too much to deal with on your own. If you’re having any of these feelings, talk to your teacher, school nurse, college counsellor or GP who can help you.

  • Stressed by too much responsibility
  • Physically tired
  • Worried about your relative’s health
  • Coping with other people’s mood
  • No time for yourself or your homework
  • Missing school
  • Feeling embarrassed about your situation
  • Being bullied
  • Low self-esteem, anxiety, anger or guilt

You’re not alone if any of these happen to you. Young carers miss an average of 48 days of school because of their role and 68% have been bullied at some point directly because of having to care for someone. Organisations set up to help young carers recognise all of these problems and have people and strategies to support you.

Even if you don’t feel like you need help for a problem, it is always good to have the support of others who understand your situation. Young carers groups run all around the UK to help with advice as well as giving you somewhere to let off steam and enjoy yourself.

Autism

What is autism?

Autism is a lifelong developmental disability that affects how people perceive the world and interact with others.

Autistic people see, hear and feel the world differently to other people. If you are autistic, you are autistic for life; autism is not an illness or disease and cannot be ‘cured‘. Often people feel being autistic is a fundamental aspect of their identity.

Autism is a spectrum condition. All autistic people share certain difficulties, but being autistic will affect them in different ways. Some autistic people also have learning disabilitiesmental health issues or other conditions, meaning people need different levels of support. All people on the autism spectrum learn and develop. With the right sort of support, all can be helped to live a more fulfilling life of their own choosing.

How common is autism?

Autism is much more common than most people think. There are around 700,000 autistic people in the UK – that’s more than 1 in 100. People from all nationalities and cultural, religious and social backgrounds can be autistic, although it appears to affect more men than women.

How do autistic people see the world?

Some autistic people say the world feels overwhelming and this can cause them considerable anxiety.

In particular, understanding and relating to other people, and taking part in everyday family, school, work and social life, can be harder. Other people appear to know, intuitively, how to communicate and interact with each other, yet can also struggle to build rapport with autistic people. Autistic people may wonder why they are ‘different’ and feel their social differences mean people don’t understand them.

Autistic people often do not ‘look’ disabled. Some parents of autistic children say that other people simply think their child is naughty, while adults find that they are misunderstood. We are educating the public about autism through our Too Much Information campaign.

Diagnosis

diagnosis is the formal identification of autism, usually by a multi-disciplinary diagnostic team, often including a speech and language therapist, paediatrician, psychiatrist and/or psychologist.

The benefits of a diagnosis

Getting a timely and thorough assessment and diagnosis may be helpful because:

  • it helps autistic people (and their families, partners, employers, colleagues, teachers and friends) to understand why they may experience certain difficulties and what they can do about them
  • it allows people to access services and support.

How autism is diagnosed

The characteristics of autism vary from one person to another, but in order for a diagnosis to be made, a person will usually be assessed as having had persistent difficulties with social communication and social interaction and restricted and repetitive patterns of behaviours, activities or interests since early childhood, to the extent that these “limit and impair everyday functioning“.

Read more about diagnostic criteria and the triad of impairments theory.

Persistent difficulties with social communication and social interaction

SOCIAL COMMUNICATION

Autistic people have difficulties with interpreting both verbal and non-verbal language like gestures or tone of voice. Many have a very literal understanding of language, and think people always mean exactly what they say. They may find it difficult to use or understand:

  • facial expressions
  • tone of voice
  • jokes and sarcasm.

Some may not speak, or have fairly limited speech. They will often understand more of what other people say to them than they are able to express, yet may struggle with vagueness or abstract concepts. Some autistic people benefit from using, or prefer to use, alternative means of communication, such as sign language or visual symbols. Some are able to communicate very effectively without speech.

Others have good language skills, but they may still find it hard to understand the expectations of others within conversations, perhaps repeating what the other person has just said (this is called echolalia) or talking at length about their own interests.

It often helps to speak in a clear, consistent way and to give autistic people time to process what has been said to them.

Social interaction

Autistic people often have difficulty ‘reading’ other people – recognising or understanding others’ feelings and intentions – and expressing their own emotions. This can make it very hard for them to navigate the social world. They may:

  • appear to be insensitive
  • seek out time alone when overloaded by other people
  • not seek comfort from other people
  • appear to behave ‘strangely’ or in a way thought to be socially inappropriate.

Autistic people may find it hard to form friendships. Some may want to interact with other people and make friends, but may be unsure how to go about it.

Read more about communication and social interactionsocial isolation and social skills.

Restricted and repetitive patterns of behaviours, activities or interests

REPETITIVE BEHAVIOUR AND ROUTINES

The world can seem a very unpredictable and confusing place to autistic people, who often prefer to have a daily routine so that they know what is going to happen every day. They may want to always travel the same way to and from school or work, or eat exactly the same food for breakfast.

The use of rules can also be important. It may be difficult for an autistic person to take a different approach to something once they have been taught the ‘right’ way to do it. People on the autism spectrum may not be comfortable with the idea of change, but may be able to cope better if they can prepare for changes in advance.

HIGHLY-FOCUSED INTERESTS

Many autistic people have intense and highly-focused interests, often from a fairly young age. These can change over time or be lifelong, and can be anything from art or music, to trains or computers. An interest may sometimes be unusual. One autistic person loved collecting rubbish, for example. With encouragement, the person developed an interest in recycling and the environment.

Many channel their interest into studying, paid work, volunteering, or other meaningful occupation. Autistic people often report that the pursuit of such interests is fundamental to their wellbeing and happiness.

SENSORY SENSITIVITY

Autistic people may also experience over- or under-sensitivity to sounds, touch, tastes, smells, light, colours, temperatures or pain. For example, they may find certain background sounds, which other people ignore or block out, unbearably loud or distracting. This can cause anxiety or even physical pain. Or they may be fascinated by lights or spinning objects.

Read more about repetitive behaviour and routines and sensory processing.

Different names for autism

Over the years, different diagnostic labels have been used, such as autism, autism spectrum disorder (ASD), autism spectrum condition (ASC), classic autism, Kanner autism, pervasive developmental disorder (PDD), high-functioning autism (HFA), Asperger syndrome and Pathological Demand Avoidance (PDA). This reflects the different diagnostic manuals and tools used, and the different autism profiles presented by individuals. Because of recent and upcoming changes to the main diagnostic manuals, ‘autism spectrum disorder’ (ASD) is now likely to become the most commonly given diagnostic term.

Read more about different diagnostic profiles, terms and criteria.

Causes and cures

What causes autism?

The exact cause of autism is still being investigated. Research into causes suggests that a combination of factors – genetic and environmental – may account for differences in development. Autism is not caused by a person’s upbringing, their social circumstances and is not the fault of the individual with the condition.

Disability discrimination

What is a disability?

You have to show that your mental health problem is a disability to get the protection of the Equality Act.

‘Disability’ has a special legal meaning under the Equality Act, which is broader than the usual way you might understand the word. Even if you don’t think you have a disability, the Equality Act may protect you from discrimination if your mental health problem fits its definition of disability.

The Equality Act says you have a disability if you have a physical or mental impairment that has a substantial, adverse, and long-term effect on your ability to carry out normal day-to-day activities.

The focus is on the effect of your mental health problem, rather than the diagnosis. So you need to show that your mental health problem:

  • has more than a small effect on your everyday life
  • makes things more difficult for you, and
  • has lasted at least 12 months, is likely to last 12 months, or (if your mental health problem has improved) that it is likely to recur.

Examples of ‘substantial adverse effect’

Simon has obsessive-compulsive disorder (OCD). He has to check and recheck whether lights are switched off and doors are locked. This can make him late for work or other appointments. His obsessive thoughts often distract him from activities that he is doing and disrupt his daily routines. His mental health problem therefore has a substantial adverse effect on the way he does things.

Examples of ‘long term’

  • Jenny has had depression for 10 months and the doctor says it will be likely to last at least another 4 to 5 months.
  • Selina has bipolar affective disorder. She had her first and second episode in January 2013, then a third episode in January 2014. Even though there was a gap between her second and third episode, her mental health problem is considered to have continued over the whole period (in this case, a period of 13 months).

What if I’m getting medication or treatment for my mental health problem?

If you are getting some treatment or taking medication for your condition, you ignore the effect of your treatment when deciding whether your condition is having a substantial, adverse effect on your daily activities. This means the law is looking at how your condition affects you without your treatment or medication.

Example

Mohammed has long-term anxiety and is being treated by counselling. Anxiety would normally make him find simple tasks difficult. Because he has counselling, he is able to get up and go to work.

The Equality Act says you have to ignore his treatment in deciding whether his mental health problem has a substantial adverse effect on his day-to-day activities and so he has a disability.

What if I had a disability in the past?

You are still protected from discrimination if you had a disability in the past. That means that if your past mental health problem had a substantial, long-term and adverse effect, you will get the protection of the Equality Act.

Examples

Four years ago, Mary had depression that lasted 2 years and had a substantial effect on her ability to carry out normal day-to-day activities. She has not experienced depression since then.

If Mary is treated worse by her employer because of her past mental health problem, she will be protected by the Equality Act.

Checklist: Is my mental health problem a disability?

You can ask yourself these questions:

  1. Do I have a mental or physical health impairment?
  2. Is it long-term (meaning lasting more than 12 months or likely to do so)?
  3. Does it have a more than minor adverse effect on my day-to-day living, if I discount my treatment or medication?

If you answered “yes” to all three questions, then your mental health problem could get the protection of the Equality Act.

If you want to get the protection of the Equality Act, you may find it helpful to get some evidence from your GP, or another medical professional. You can ask them to write a letter saying whether they think you have a disability under the Equality Act. It would be particularly useful if they can give their opinion on the answer to each of these three questions.

Example

Esra doesn’t consider herself disabled because she doesn’t receive disability benefits and she is physically healthy.

Esra has been living with an anxiety disorder for the past 3 years. Because of this, it takes her a longer time to do things like get up in the morning, dress herself for the day and do the shopping. She takes medication to control the symptoms.

Esra would be protected by the Equality Act because she has:

  • a mental impairment – an anxiety disorder
  • it is long term – she has had it for the past 3 years
  • it has a substantial effect on her daily life – her mental health has a major effect on her daily life when you ignore the effect of her medication  
  • it has an adverse effect – her mental health problem makes things more difficult for her.

What are the different types of discrimination?

The Equality Act only protects people who have a disability against these types of discrimination:

It is possible that you have experienced discrimination in more than one way.

Direct discrimination

Direct discrimination is when you are treated worse than someone else because you have a disability. You have to show that there is a link between your disability and the way you have been treated, which can be difficult. However, you don’t always have to provide an example of a particular non-disabled person who was treated better than you if it is clear from all the circumstances that your disability was the reason why you were treated as you were.

Discrimination by association: you may be treated worse because of your connection or association with another person with a disability, even if you don’t have a disability yourself.

Discrimination by perception: you can also be treated worse because a person or organisation believes you do have a disability when you don’t.

Examples of direct discrimination

  • Jon is not offered a promotion because he has depression. But his colleague Harry, who does not have depression, is offered a promotion – even though he has less experience and fewer qualifications.
  • Carrie is interviewed for a job. She has better qualifications and more experience than all the other candidates, and performs the best at the interview. One of the interviewers knows of Carrie’s diagnosis of bipolar disorder. Carrie is not offered the job, but neither are any of the other candidates. Carrie hasn’t clearly been treated worse than any of the other candidates, but she has been treated worse than a non-disabled person would have been treated in the same situation.
  • Jenny is not offered an apprenticeship after she tells the training provider that she has caring responsibilities for her partner, who has a mental health problem. This is an example of discrimination by association.
  • A bank incorrectly assumed that David had a long-term mental health problem. They refused him a loan for this reason, even though he has no mental health problem. This is an example of discrimination by perception.

Discrimination arising from disability

This is where you are treated badly not because of your disability but because of something that happens because of your disability.

Unlike direct discrimination, there is no need for you to compare yourself with anyone else. You just have to show that you were treated badly, and this treatment was linked to your disability.

You don’t need to show that the person who treated you badly was aware that the behaviour was due to your disability, but they do need to be aware that you have a disability.

Examples of discrimination arising from disability

  • Peter experiences psychosis and hears voices, which he manages by talking to them. Staff in a shop ask Peter to leave when he is talking to his voices. Peter has been treated unfavourably because of behaviour related to his disability.
  • Jan is given a disciplinary warning from her employer for taking sickness-related absences because of her bipolar disorder. Her employer’s decision to treat this as a disciplinary matter may be discrimination arising from Jan’s disability.

Situations when unfavourable treatment might not be discrimination

There are some situations in which it might be lawful for a person or organisation to treat you unfavourably. These are if they can show that:

there were valid intentions behind their action (such as ensuring the health and safety of others, or keeping up staff attendance so that their business can run properly), and that it was an appropriate action to take in the circumstance (legally this is called a ‘justification‘), or
they did not know you had a disability (and could not reasonably have known).

For example, in Jan’s situation above, her employer might argue that the reason why they disciplined her was because they need to keep up staff attendance – therefore their action was justified. Jan might accept that her employer’s intentions were valid, but argue that the action they took was much too harsh and not appropriate in the circumstance – therefore their action was not justified.

Whoever is deciding whether or not unfavourable treatment is justified needs to balance the needs of both sides carefully, which can be very complicated.

Indirect discrimination

Indirect discrimination is where:

  • a person or organisation has practices or arrangements that seem to treat everyone in an equal, non-discriminatory way, but
  • these practices or arrangements put you and others with your disability at a disadvantage compared with those who do not have your disability.

Examples of indirect discrimination

  • An advice centre will only provide advice to people who visit their centre and will not offer advice by phone or email. This practice puts people with mental health problems like agoraphobia at a disadvantage because they can’t leave their homes to travel to the centre.
  • An employer only offers promotions to people who have a driving licence and are able to drive even though this is not a key requirement of the job. This will discriminate against people with mental health problems that prevent them from holding a driving licence.

For indirect discrimination, it doesn’t matter whether the person or organisation knew about your disability. This means they have to plan in advance and think about how their policies and practices may affect people with mental health problems.

But it is not indirect discrimination if the person or organisation can show these practices and arrangements were justified.

Harassment

Harassment is behaviour from others that you don’t want, that:

  • violates your dignity or creates an environment that is intimidating, degrading, offensive or humiliating, and
  • relates to a disability. It does not have to relate to a disability that you have.

Examples of harassment

  • Mary has an eating disorder. Mary’s manager knows she has an eating disorder and she makes offensive remarks in the open plan office about people with anorexia.
  • Steve has schizoaffective disorder. He is on a day out from inpatient treatment in a psychiatric hospital and is eating with fellow patients at a local café. A member of staff who knows he is a psychiatric patient uses silent gestures and mime to make fun of him. Steve is very upset.

Victimisation

Victimisation is when an employer or organisation puts you at a disadvantage just because:

  • you have made allegation about discrimination, or
  • you have supported someone who has made an allegation of discrimination

Examples of victimisation

  • Jibin’s colleague has bipolar disorder. Jibin supports her colleague to complain to their employer about disability discrimination. After this, Jibin’s manager refuses her promotion on the basis that her loyalty to the company is in question.
  • Deb has an anxiety disorder. She complains to her local supermarket that she genuinely believes that she has been discriminated against by an assistant who made remarks about her condition in front of customers. After this, the manager says she should shop elsewhere.

Making reasonable adjustments

The Equality Act says that employers and service providers should think about making reasonable adjustments (in other words, changes), if you are at a substantial disadvantage compared to other people who do not have a mental health problem.

Reasonable adjustments include:

  • making changes to the way things are organised or done
  • making changes to the built environment, or physical features around you (for example physical features of a building that put a disabled person at substantial disadvantage)
  • providing aids and services for you to overcome the substantial disadvantage.

You cannot be asked to pay for the cost of reasonable adjustments. If a person or organisation does not make reasonable adjustments when it would have been reasonable to do, this will be unlawful discrimination.

To find out more, see our pages on asking for reasonable adjustments from:

Examples of reasonable adjustments

  • Sylvie is working in an office and has depression. She is taking part in a supported employment scheme from the workplace mental health support scheme. Her employer lets her make private phone calls to her support worker in the working day as a reasonable adjustment.
  • Tomasz has a range of problems with anxiety, and he gets particularly anxious travelling on crowded public transport. He speaks to his manager about his mental health problem and explains that he is finding it hard to get to work in the morning travelling during the rush hour. Tomasz’s manager agrees to adjust his working hours so that he comes into work before the morning rush hour and leaves before the evening rush hour. His employer would not have to make adjustments if they did not know about Tomasz’s condition, or how it was affecting his working life.

Epilepsy – Carbamazepine/Tegratol

What is carbamazepine?

Carbamazepine is an anticonvulsant. It works by decreasing nerve impulses that cause seizures and nerve pain, such as trigeminal neuralgia and diabetic neuropathy.

Carbamazepine is also used to treat bipolar disorder.

Carbamazepine may also be used for purposes not listed in this medication guide.

Important Information

You should not take carbamazepine if you have a history of bone marrow suppression, if you are allergic to it, or take an antidepressant such as amitriptyline, desipramine, doxepin, imipramine, or nortriptyline.

TELL YOUR DOCTOR ABOUT ALL OTHER MEDICINES YOU USE. Some drugs can raise or lower your blood levels of carbamazepine, which may cause side effects or make this medicine less effective. Carbamazepine can also affect blood levels of certain other drugs, making them less effective or increasing side effects.

Carbamazepine may cause serious blood problems or a life-threatening skin rash or allergic reaction. Call your doctor if you have a fever, unusual weakness, bleeding, bruising, or a skin rash that causes blistering and peeling.

Some people have thoughts about suicide while taking seizure medicine. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor.

Do not stop taking this medicine without asking your doctor first, even if you feel fine.

If you are pregnant, do not start or stop taking carbamazepine without your doctor’s advice.

Before taking this medicine

You should not take carbamazepine if you have a history of bone marrow suppression, or if you are allergic to carbamazepine or to an antidepressant such as amitriptylinedesipraminedoxepinimipramine, or nortriptyline.

Do not use carbamazepine if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include furazolidoneisocarboxazidlinezolidphenelzinerasagilineselegiline, and tranylcypromine.

Carbamazepine may cause severe or life-threatening skin rash, and especially in people of Asian ancestry. Your doctor may recommend a blood test before you start the medication to determine your risk.

Tell your doctor if you have ever had:

You may have thoughts about suicide while taking carbamazepine. Your doctor should check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.

Do not start or stop taking seizure medication during pregnancy without your doctor’s advice. Carbamazepine may harm an unborn baby, but having a seizure during pregnancy could harm both mother and baby. The benefit of preventing seizures may outweigh any risks to the baby.

Tell your doctor right away if you become pregnant.

If you are pregnant, your name may be listed on a pregnancy registry to track the effects of this medicine on the baby.

Carbamazepine can make birth control pills or implants less effective. Use a barrier form of birth control (such as a condom or diaphragm with spermicideto prevent pregnancy.

You should not breastfeed while you are using carbamazepine.

How should I take carbamazepine?

Take carbamazepine exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.

Take with food.

Swallow the extended-release tablet or capsule whole and do not crush, chew, or break it. Tell your doctor if you cannot swallow a pill whole.

The chewable tablet must be chewed before you swallow it.

Shake the oral suspension (liquid) before you measure a dose. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).

It may take up to 4 weeks before your symptoms improve. Keep using the medication as directed and call your doctor promptly if this medicine seems to stop working as well in preventing your seizures.

You will need frequent medical tests.

Store at room temperature away from moisture, heat, and light.

Do not stop using carbamazepine suddenly, even if you feel fine. Stopping suddenly may cause increased seizures. Follow your doctor’s instructions about tapering your dose.

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include severe drowsiness, weak or shallow breathing, and loss of consciousness.

What to avoid

Drinking alcohol with this medicine can cause side effects, and can also increase your risk of seizures.

Grapefruit may interact with carbamazepine and lead to unwanted side effects. Avoid the use of grapefruit products.

Avoid driving or hazardous activity until you know how this medicine will affect you. Your reactions could be impaired.

Carbamazepine could make you sunburn more easily. Avoid sunlight or tanning beds. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.

Carbamazepine side effects

Get emergency medical help if you have signs of an allergic reaction to carbamazepine (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (feversore throat, burning in your eyes, skin pain, red or purple skin rash that spreads and causes blistering and peeling).

Seek medical treatment if you have a serious drug reaction that can affect many parts of your body. Symptoms may include: skin rash, fever, swollen glands, muscle aches, severe weakness, unusual bruising, or yellowing of your skin or eyes.

Report any new or worsening symptoms to your doctor, such as: sudden mood or behavior changes, depression, anxietyinsomnia, or if you feel agitated, hostile, restless, irritable, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

  • a skin rash, no matter how mild;
  • loss of appetite, right-sided upper stomach pain, dark urine;
  • slow, fast, or pounding heartbeats;
  • anemia or other blood problems – fever, chills, sore throat, mouth sores, bleeding gums, nosebleeds, pale skin, easy bruising, unusual tiredness, feeling light-headed or short of breath; or
  • low levels of sodium in the body – headache, confusion, severe weakness, feeling unsteady, increased seizures.

Common carbamazepine side effects may include:

  • dizziness, loss of coordination, problems with walking;
  • nausea, vomiting; or
  • drowsiness.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.Carbamazepine side effects (more detail)

What other drugs will affect carbamazepine?

Sometimes it is not safe to use certain medications at the same time. Some drugs can affect your blood levels of other drugs you take, which may increase side effects or make the medications less effective.

Using carbamazepine with other drugs that make you drowsy can worsen this effect. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety, depression, or seizures.

Many drugs can interact with carbamazepine, and some drugs should not be used together. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide. Tell your doctor about all your current medicines and any medicine you start or stop using.

Book Review: The Anxious Perfectionist — Mental Health @ Home

The Anxious Perfectionist by Clarissa W. Ong and Michael P. Twohig uses an acceptance and commitment therapy (ACT) approach to help readers who struggle with perfectionism. I’m a big fan of ACT, and I think it makes a great approach for perfectionism. The book begins by exploring what perfectionism is, including the differences between adaptive […]

Book Review: The Anxious Perfectionist — Mental Health @ Home

Melancholic Depression

Melancholic depression is a form of major depressive disorder (MDD) which presents with melancholic features. Although melancholic depression used to be seen as a distinct disorder, the American Psychiatric Association (APA) no longer recognizes it as a separate mental illness. Instead, melancholia is now seen as a specifier for MDD — that is, a subtype of major depressive disorder.

MDD is a significant mental health condition characterized by persistent and intense feelings of sadness and hopelessness. The disorder can affect many areas of life, including work, school, and relationships. It may also impact mood and behavior as well as various physical functions, such as appetite and sleep. People with MDD often lose interest in activities they once enjoyed and have trouble getting through the day. Occasionally, they may also feel as if life isn’t worth living.

The severity and type of MDD symptoms vary greatly from person to person. Some people experience traditional symptoms of MDD, while others develop additional syndromes, such as melancholia and catatonia. Most symptoms can be managed with treatment, which may consist of medication and talk therapy.

Symptoms of Melancholic Depression

People with melancholic depression may experience symptoms of MDD, such as:

  • persistent feelings of extreme sadness for a long period of time
  • loss of interest in activities that were once enjoyable
  • having a lack of energy or feeling fatigued
  • feeling anxious or irritable
  • eating too much or too little
  • sleeping too much or too little
  • experiencing changes in body movement (for example, jiggling your leg when you didn’t before)
  • difficulty concentrating, making decisions, and remembering things
  • thinking or talking about death or suicide
  • suicide attempt

They may also experience melancholic features of MDD, which include:

  • loss of pleasure in all or most daily activities
  • lack of reactivity to positive news and events
  • deep feelings of despair and worthlessness
  • sleep disruptions
  • significant weight loss
  • persistent feeling of excessive or inappropriate guilt
  • symptoms of MDD that are worse in the morning

Melancholic features are more likely to occur in people who frequently experience severe symptoms of MDD. They are also seen more often in those who have MDD with psychotic features.

Diagnosing Melancholic Depression

The APA no longer recognizes melancholic depression as a distinct form of depression, and it is listed as a type of MDD. When someone shows signs of depression and melancholia, the diagnosis is “major depressive disorder with melancholic features.” To make this diagnosis, a doctor will usually ask some of the following questions:

  • Do you have difficulty getting out of bed and getting started in the morning?
  • Are your symptoms generally worse in the morning or in the evening?
  • How do you sleep?
  • Has there been a change in your sleep patterns?
  • What does a typical day look like for you?
  • Has your daily routine changed recently?
  • Do you enjoy the same things you once did?
  • What, if anything, improves your mood?
  • Do you have more trouble concentrating than usual?

Treatments for Melancholic Depression

MDD is often treated with newer antidepressants, such as selective serotonin reuptake inhibitors (SSRIs). These include well-known medications, such as fluoxetine (Prozac), citalopram (Celexa), or paroxetine (Paxil). However, many people who have MDD with melancholic features may respond better to older antidepressants such as the tricyclic antidepressants or monoamine oxidase inhibitors (MAOIs), as well as serotonin-norepinephrine reuptake inhibitors, such as venlafaxine (Effexor). These medications help inhibit the breakdown of serotonin and norepinephrine in the brain, resulting in higher amounts of these “feel good” chemicals. Sometimes, certain atypical antipsychotics such as Abilify (aripiprazole) may be used to augment the effects of antidepressants.

In addition to medication, talk therapy is commonly used to treat people who have MDD with melancholic features. A combination of these two treatment methods is usually more effective than either approach on its own. Talk therapy involves meeting with a therapist on a regular basis to discuss symptoms and related issues. It can show people how to:

  • adjust to a crisis or other stressful event
  • replace negative beliefs and behaviors with positive, healthy ones
  • improve communication skills
  • cope with challenges and solve problems
  • increase self-esteem
  • regain a sense of satisfaction and control in life

Group therapy can help in a similar way and give you the ability to share your feelings with people who can relate.

In severe cases, electroconvulsive therapy (ECT) may be performed to help relieve symptoms of MDD with melancholic features. This treatment involves attaching electrodes to the head that send electrical impulses to the brain, triggering a mild seizure. ECT is now considered a safe and effective treatment for mood disorders and mental illnesses, but there’s still a stigma surrounding it. As a result, it may not be used as the primary treatment for symptoms of melancholia. However, a combination of medication, talk therapy, and ECT may be the best treatment for MDD with melancholic features.

Suicide prevention

If you think someone is at immediate risk of self-harm or hurting another person:

  • Call 999 or your local emergency number.
  • Stay with the person until help arrives.
  • Remove any guns, knives, medications, or other things that may cause harm.
  • Listen, but don’t judge, argue, threaten, or yell.

Depression, Anxiety & Me

Around the year 2000 I started suffering Depression, Anxiety and what I remember most about it was I had no get up and go about me. (I just couldn’t be bothered). As far as the anxiety was concerned I would get up tight about things to a point where I realised I was holding my breath. ( Not a clever idea is it?)

There are two things that stick in my mind even all these years later about my depression and anxiety,

Around this time our daughter was 8/9yrs old and we decided to hire a static caravan in Northumberland here in the UK along with my parents. As my wife wasn’t sure of the way there my father said he knew how to get where we were going.

It was on the road home an anxiety issue arose because despite being told to follow my father, my wife overtook my father and I and up ahead their was a fork in the road. She should have taken the fork to the right when she took the fork to left. This meant my father and I waiting at that junction anxiously till they reappeared.

Having Depression and anxiety quite often meant I couldn’t go further than my front door. I am a uniformed Salvationist of the Salvation Army and I can even remember every Sunday for weeks on end putting my uniform on (except jacket) until it came time to go and I would come to put jacket on and I couldn’t. Nerves and anxiety got the better of me and I used to ask my wife to call the Church to say I wouldn’t be there.

The main factor that played a part in my recovery was every week my father came to see me and we didn’t just talk about my depression we had general conversations as well. I also used to get regular visits from my then pastor who used to suffer from Clinical Depression, again the discussion I had with him again were general.

There’s a saying on one of the UK’s tv channel’s says “It’s good to talk”.

Disability

  • What is a disability?
  • What if I’m getting medication or treatment for my mental health problem?
  • What if I had a disability in the past?
  • Checklist: Is my mental health problem a disability?

What is a disability?

You have to show that your mental health problem is a disability to get the protection of the Equality Act.

‘Disability’ has a special legal meaning under the Equality Act, which is broader than the usual way you might understand the word. Even if you don’t think you have a disability, the Equality Act may protect you from discrimination if your mental health problem fits its definition of disability.

The Equality Act says you have a disability if you have a physical or mental impairment that has a substantial, adverse, and long-term effect on your ability to carry out normal day-to-day activities.

The focus is on the effect of your mental health problem, rather than the diagnosis. So you need to show that your mental health problem:

  • has more than a small effect on your everyday life
  • makes things more difficult for you, and
  • has lasted at least 12 months, is likely to last 12 months, or (if your mental health problem has improved) that it is likely to recur.

Examples of ‘substantial adverse effect’

Simon has obsessive-compulsive disorder (OCD). He has to check and recheck whether lights are switched off and doors are locked. This can make him late for work or other appointments. His obsessive thoughts often distract him from activities that he is doing and disrupt his daily routines. His mental health problem therefore has a substantial adverse effect on the way he does things.

Examples of ‘long term’

  • Jenny has had depression for 10 months and the doctor says it will be likely to last at least another 4 to 5 months.
  • Selina has bipolar affective disorder. She had her first and second episode in January 2013, then a third episode in January 2014. Even though there was a gap between her second and third episode, her mental health problem is considered to have continued over the whole period (in this case, a period of 13 months).

What if I’m getting medication or treatment for my mental health problem?

If you are getting some treatment or taking medication for your condition, you ignore the effect of your treatment when deciding whether your condition is having a substantial, adverse effect on your daily activities. This means the law is looking at how your condition affects you without your treatment or medication.

Example

Mohammed has long-term anxiety and is being treated by counselling. Anxiety would normally make him find simple tasks difficult. Because he has counselling, he is able to get up and go to work.

The Equality Act says you have to ignore his treatment in deciding whether his mental health problem has a substantial adverse effect on his day-to-day activities and so he has a disability.

What if I had a disability in the past?

You are still protected from discrimination if you had a disability in the past. That means that if your past mental health problem had a substantial, long-term and adverse effect, you will get the protection of the Equality Act.

Examples

Four years ago, Mary had depression that lasted 2 years and had a substantial effect on her ability to carry out normal day-to-day activities. She has not experienced depression since then.

If Mary is treated worse by her employer because of her past mental health problem, she will be protected by the Equality Act.

Checklist: Is my mental health problem a disability?

You can ask yourself these questions:

  1. Do I have a mental or physical health impairment?
  2. Is it long-term (meaning lasting more than 12 months or likely to do so)?
  3. Does it have a more than minor adverse effect on my day-to-day living, if I discount my treatment or medication?

If you answered “yes” to all three questions, then your mental health problem could get the protection of the Equality Act.

If you want to get the protection of the Equality Act, you may find it helpful to get some evidence from your GP, or another medical professional. You can ask them to write a letter saying whether they think you have a disability under the Equality Act. It would be particularly useful if they can give their opinion on the answer to each of these three questions.

Example

Esra doesn’t consider herself disabled because she doesn’t receive disability benefits and she is physically healthy.

Esra has been living with an anxiety disorder for the past 3 years. Because of this, it takes her a longer time to do things like get up in the morning, dress herself for the day and do the shopping. She takes medication to control the symptoms.

Esra would be protected by the Equality Act because she has:

  • a mental impairment – an anxiety disorder
  • it is long term – she has had it for the past 3 years
  • it has a substantial effect on her daily life – her mental health has a major effect on her daily life when you ignore the effect of her medication  
  • it has an adverse effect – her mental health problem makes things more difficult for her.