rTMS for Anorexia Nervosa: The Results Are In

So here we are, a year on from my initial inquiries into the trial and it’s time to tell you the results. It’s been a long time coming.

If you’ve read the previous blogs you’ll know I’ve been very apprehensive about the results and this reveal. In the last blog I stated I thought and hoped I had been in the placebo group because (so far at least) I hadn’t seen or felt any noticeable improvement. I said I felt bruised from all the treatment doors and didn’t want to feel another thud against my face.

I’ve waited awhile to tell you all because I’ve needed time to process it myself. Regardless of result an answer meant finally getting some closure on the previous months but also held sway over what happened next. If it was placebo then I would now be allowed to go through the procedure again, this time for real which would mean making arrangements to fit another month of travel into my life. If it was real then I would have to decide if I wanted to look for treatment elsewhere, whether that meant grudgingly going back to my previous NHS Community Eating Disorder Team,  looking into third sector support or even going to my parents for help with a paid, private therapist.

Drum Roll Please….

So enough already, the results.

I opened the envelope, unfolded the paper and the results were there:

“Real Treatment”

So there we go, it was not, as I’d hoped, the placebo. I had received 17 sessions of actual Repetitive Trans-Cranial Magnetic Stimulation Therapy.

How Do I Feel Now I Know?

I’m feeling Okay about things now to be honest. Initially, yes, I was disappointed. I hadn’t been looking forward to going through the whole thing again but I didn’t and still don’t feel any different.

I’ve been told that you can still sometimes see signs of improvement in the six months after the treatment has ended so I guess there is a chance that something might shift. So far results seem to show that in people that do notice improvement it isn’t a massive thing, you never (and I never expected to) wake up “cured” or a thousand times better. But for some people it seems it does help to slightly shift, adjust, “rewire” almost, parts of the brain and can help pave a clearer path to recovery.

I’ll never know for sure why this seemingly hasn’t worked for me. It could be that I didn’t have enough sessions or a high enough dose, perhaps it only works for specific people, a sub-cohort of people with Anorexia we haven’t identified.

It might well be that my head, my life and my illness are too complex right now. Finding out a family member has Cancer is enough to throw anyone completely and I know my head has been in a very bad place for a very long time now.

Maybe it never stood a chance against my environment.

On taking part in a clinical trial

I will never regret my decision to take part in the trial. That it hasn’t worked is a shame for me personally but when you are part of a trial you are just one piece of a much bigger puzzle. The TIARA study I have been participating in sets out to be the biggest ever RCT of rTMS for Anorexia Nervosa and it feels good to have been part of something so big and groundbreaking.

My data and the data from other participants will be gathered and painstakingly picked over by some of the brightest minds in the country. The results will then be scrutinized by their peers across the world and released to the scientific community and wider world for further examination, discussion and replication.

Given that my condition, Anorexia, has the highest mortality rate of ANY mental illness I am grateful that I have had the opportunity to be part of the race to find better treatment and save lives. We know that 20% of people with Anorexia die prematurely. And even if it doesn’t kill us less than half of us will make a “full recovery”. The odds for Anorexia are worse than some forms of Cancer.

Despite this mental health still receives very little funding in terms of research which is vital if we want to develop new treatments and save lives. To not do so is (to put it bluntly) a seriously false economy when you take into account lost lives, earnings etc. In fact the whole of mental health research spend in the UK per year is just £115 million an average, 22x less than Cancer.

Part of my hope with this series of blogs has been to shine some light on mental health research and show you what it looks like to be a participant in a clinical trial and I hope it has at least been mildly interesting.

From here I’m not sure what I will do.

I am looking into a local charity which provides an Eating Disorder Support Group and I have been re-referred back to the NHS Community Eating Disorder Service (grudgingly but that is a story for another day).

Until then I battle on.

Thank you for reading my story.

Mental Health Research: More Information

If you’re interested in finding out more about mental health research or get involved check out organisations like MQ: Transforming Mental Health, The McPin Foundation and the brilliant blog Mental Elf.

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I’m trying to come to terms with Chronic Illness

We are lucky to live in a world where most conditions are treatable, and as many slogans go “beatable”. For many of us our experiences of illnesses have been followed by effective treatment leading to remission. If I have a cold or flu I know there are tablets I can take that will make it go away. If I break a bone I know a cast will help knit the bones back together and leave me, hopefully, with full function in that limb again. This is a model that certainly in the UK the NHS and ministers understand.

What then if your condition has a murkier prognosis? What if there is no cure or a high chance of repeated relapse? It’s not only then a struggle often for the treatment and management needed but also a huge philosophical concept to bend one’s head around. It’s also, I’ve found, a difficult one for friends and family because they can’t “fix” it and that hurts.

Many of you will be aware of the “spoonie movement” which was originally created for those with chronic physical health conditions, hence when I was always restrained in my use of the word and felt uncomfortable labelling myself as part of that community.

However my mind is changing on that front.

I have been ill for 20 of my 26 years on this planet, I have approximately 7 conditions and have had more treatment than most and yet here I am, still chronically ill.

My issues are around my mental health, although some conditions are now in remission I still struggle with Major Depressive Disorder, Anorexia Nervosa, Generalised Anxiety Disorder and Obsessive Compulsive Disorder.

Right now it’s Anorexia and Anxiety that are majorly kicking my ass (to use non medical parlance), I am currently in my third full round of treatment and admittedly it is much more intensive than I have experienced elsewhere (thanks postcode lottery) but so far it’s barely scratching the surface. I have been ill so long I don’t have a “before” to remember and strive for. In fact research suggests that if an Eating Disorder is present for seven years your prognosis is not good – so with 13 years under my belt I’m not feeling hopeful.

I spoke to an Eating Disorder consultant recently who reintroduced me to the term “SEED” or Severe and Enduring Eating Disorder. One of her patients was offended by this – “I don’t want to be a seed, I want to be a flower”. I think this is very powerful and says a lot about our chronic patients – we often feel like a burden and hopeless – something I myself experienced when my CAMHS team aged 17 told me they had “run out of options”. As chronic patients we are fully aware we are difficult and complex but please don’t throw up your hands and give up on us. And please, we’ve been living these conditions for a very long time so take us seriously.

This is also why I’m seeing a strong backlash in the mental health community against the “recovery” movement and also the government’s seeming need to define “recovery” as “in work”. Recovery is fabulous and we should strive for the best for our patients but let’s not give false hope. Some of us, may never recover. We may take medication for the rest of our lives. We may have to surf the waves of our illnesses ad nauseum for decades.

12 sessions won’t fix us.

Living with a chronic illness is bloody difficult to say the least, I would offer a day in my shoes but you would know you could take those shoes off at the end of the day. I can’t. There is no real comparison.

There are points we cope well, we say “f*** you” to our bodies and fight for what WE want, even though this often ends up in a body backlash (case in point I slept 19 hours after a 2 day trip to Manchester recently”). There are points when either through medication or the boom/bust cycle many of us experience we can function like “normal” human beings. And we rarely “look sick”. When you see us and tell us how “well” we look it’s probably the first time in awhile we’ve been able to leave the house. For more on this check out the brilliant But You Don’t Look Sick.

However there are points, and I’m sorry to say I’m here now, when we get desperate, when something snaps.

I feel lost and hopeless right now. I have had 10 years on and off of almost every therapy NICE approves, I’m 31 weeks into an experimental non NICE approved group therapy, I stopped counting when I tried the 20th medication, I’ve tried everything over the counter and even tried Acupuncture. I’ve tried to sign up to experimental treatment studies including TMS, I’ve taken meds that I shouldn’t due to contraindications or legal issues because anything is better than how this feels. Which of course leads to risky behaviours.

Some doctors are sympathetic (thankfully my current one is) and if you find a good GP cling on for dear life. A conversation with a previous GP went like this:

Me: Well if you won’t prescribe me benzos, I’ve tried every other med under the sun that I can, what am I meant to do to deal with my crippling anxiety while also working full time, commuting and trying desperately to keep a roof over my head?

GP: Just cope.

Chronic illnesses are sneaky too. I thought I had come to terms with what I had done to myself some time ago – more around my scars. Now though, age 26 I am beginning to experience more of the physical side effects and it’s currently having a very detrimental effect on my work and relationships with friends and family because I am not strong or well enough to do basic tasks that were once a piece of cake.

Currently I am struggling massively with fatigue, constant aches and pains and raging anxiety which means headaches, uncontrollable shaking, brain fog and many more very physical symptoms – bolstering my argument that this mental/physical health divide is bogus.

Having a chronic condition means redefining your “normal” and managing your expectations. Maybe once upon a time running 10k was an option, maybe today you should applaud yourself for just getting out of bed. It’s tough. I know, I have tried but when you have low self esteem it can be hard to see boiling a kettle as an achievement.

I don’t know much admittedly but I would recommend above all:

  1. Find a sympathetic GP and work with them to build an understanding health team around you
  2. Talk to your friends, don’t withdraw or cover up what’s happening – from my experience you will be surprised how many understand and will support you. Some won’t, some may withdraw, that will hurt but ultimately show you who your true friends are.
  3. Find your “tribe”. I’ve been running support communities, mostly around mental health for the last 13 years and they have not only changed but saved my life. Find people who understand and won’t judge and lean on them when you need them.

My treatment isn’t NICE (approved)

My treatment isn’t approved by NICE, The National Institute For Clinical Excellence (and that’s OK with me).

Over the last few years there has been a revolution in the way we view, commission and use mental health services in the UK. One of the biggest changes is a push towards providing purely evidence based treatment. These days if you have a product or treatment for mental health and you are trying to break into the NHS market I can guarantee that one of the very first questions you will be asked is “where is your evidence base”.
Is this enough evidence for you?

Is this enough evidence for you?

Despite the title of this blog I do mostly agree with this approach. For most of it’s history our mental health services, in terms of size, access and treatment offered, have been haphazard at best, often based on gut instinct and previous experience rather than data and scientific evidence, mostly because we don’t have enough of either. This has resulted in a landscape that is incredibly difficult to navigate, not just for service users like myself but also for families, friends, other sectors and even the clinicians and commissioners. Worst of all it has resulted in a postcode lottery of services, which if youre lucky you win but all too often means that people do not receive the best care possible..or in some cases any care at all.

As you know I have used NHS mental health services on and off for twelve years now and have experienced four distinctly different services in three geographical locations. It was only after my most recent referral to mental health services since moving back to my home town last year that I realised not only the real extent of the postcode lottery but also truly felt the personal knock on effects.

Sorry you haven't won, better luck next time.

Sorry you haven’t won, better luck next time.

To paint a picture..

When referred to my new trust I received a phone call within a week from a lovely man who immediately apologised that i would have to wait 6 weeks for an assessment. I tried to choke back laughter as he was so apologetic about a time that for me, with my previous experiences, seemed almost miraculous. After having the assessment I was immediately given a care co-ordinator (the same woman that assessed me). She once again apologised and said that it would be 3 months until I could start treatment. In the meantime I was contacted by another branch of the service who offered me 29 sessions of group therapy for 2.5 hours each week to “tide me over” until the 40 sessions of individual treatment started – probably the most treatment I’ve ever been offered by a service.

Flash back a few years and one county over I had a very different experience. I was referred to the same type of mental health team, I then spent 13 months (yes, over a year) waiting for an assessment while both my physical and mental health deteriorated. When I was finally seen i was told that they could only provide minimal support and that (direct quote) what I needed (i.e. more than 12 sessions) was “not available on the NHS at the moment”. We considered putting me on the waiting list (at least another year long) for treatment but decided against it because, due to a reorganisation in the trust they weren’t sure if the service I was waiting for would even exist by the time I got there. It felt a bit like stepping onto an escalator that you know may have nothing at the top.

But back to my initial statement, what is this non-NICE approved treatment and why don’t I care that it comes without this gold stamp of approval? Especially given my dedication to improving mental health care in this country.

Well the group therapy I recently started is called RODBT..I must admit its actually so new that even I hadn’t heard of it, and with my background that’s surprising. It stands for Radically Open Dialectical Behavioural Therapy (quite the mouthful) and is a form of What is DBT which has been developed to help people like me with chronic Depression and Anorexia. It is being used in some other countries and all early stage research is very positive however it is not far enough down the evaluation line to have the coveted NICE approval.

I’d never had group therapy before now so I really wasn’t sure what to expect and it turns out neither did the clinicians as this is the first time they have ever delivered these new sessions.
Welcome to the guinea pig club.

They stated in the first session to us all that we would have to sign a consent form to say we understood that this was NOT NICE APPROVED TREATMENT. Given what I said in the first paragraph you might have expected me to run a mile after hearing this and not sign the form, after all were told time and time again how important it is for treatment to be evidence based. In fact I was quite relived.

You see a NICE guideline may be the gold standard but because of that NICE also have to do a lot of research and be very thorough. It actually takes on average two years to rewrite a NICE guideline, let alone write one from scratch, and like randomised control trials (RCT) it may be the gold standard but it’s (by its very nature) quite removed from the realities of creating and trialling any new treatment or product. Certainly it’s a barrier we come across frequently in the digital mental health world.

Now for me as a patient, obviously I want good care, I want to have faith and confidence in the treatment I am receiving but I don’t particularly want to wait two or more years. Maybe some will see that as selfish or impatient but I’ve been ill with this particular condition for 13 years now, exactly half of my life and quite frankly I can do without another two years of the pain and suffering this disease causes. Not just to me in terms of my mental and physical health but also for the sake of my partner, my family, friends, employer and colleagues who have to deal with the fallout and pick up the pieces in the meantime.

I also don’t mind being a guinea pig, if it works then I will be ecstatic and maybe I can have a bit of my life back from the monster in my head. And if it doesn’t turn out so well then at least we tried, got some evidence and it can either be shelved or better, tweaked, so that the next group have an even more helpful experience.

So in conclusion, generally speaking evidenced based treatment is a very good thing. We need more of it. However getting more evidence bases involves conducting a lot of ongoing, extensive and time consuming research and so care cannot be put on hold during this time. We need to make sure that “evidence base” isn’t used as a barrier to buying new products or services and that people can still receive good quality care even if it doesn’t have a golden seal of approval just right yet.

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If you’d like to learn more about the move towards evidenced based treatment I’d recommend checking out the work of the Evidence Based Practice Unit (EBPU) which is run by University College London and the Anna Freud Centre.  

Remember, it’s almost Eating Disorders Awareness Week!

beat eating disorders

Tomorrow is the start of the annual Eating Disorders Awareness Week. I have been looking forward to it because i know what an amazing job people like the Beat Ambassadors  taking the stage they have been given to tell us their stories, to show their campaigns, raise awareness and fight some of the terrible misconceptions about these dangerous disorders.

This year the leading UK Eating Disorder charity Beat are asking us to “Sock it to Eating Disorders!” and i know i will be!

To find out how you can get involved check out Beats helpful page here where you can find out more on how to celebrate and raise money for a great cause. You can also talk to other sufferers and carers on their great message boards and even attend events which you can find here.

You can also Follow Beat on Twitter  

As well as these people on Twitter:

Me: I will be tweeting a lot during EDAW13 mostly with my service user hat on here

The big London mental health project i am currently working on which will be tweeting about London Eating Disorder Services, resources and more here :

The absolutely wonderful VIK Project:

And of course  YoungMindsUK