<![CDATA[Your Journey - All Forums]]>

<![CDATA[Your Journey - All Forums]]> https://depressionforums.co.uk/chat2026/ Sat, 19 Sep 2026 19:35:40 +0000 MyBB <![CDATA[Personality disorders]]> https://depressionforums.co.uk/chat2026/showthread.php?tid=28 Sat, 19 Sep 2026 14:56:42 +0000 Pip]]> https://depressionforums.co.uk/chat2026/showthread.php?tid=28 https://www.nhs.uk/mental-health/conditi...-disorder/

Personality disorders

A person with a personality disorder thinks, feels, behaves or relates to others very differently from the average person.

There are several different types of personality disorder.

This page gives some information about personality disorders in general, linking to other sources for more detail.

Symptoms of a personality disorder

Symptoms vary depending on the type of personality disorder.

For example, a person with borderline personality disorder (one of the most common types) tends to have disturbed ways of thinking, impulsive behaviour and problems controlling their emotions.

They may have intense but unstable relationships and worry about people abandoning them.

A person with antisocial personality traits will typically get easily frustrated and have difficulty controlling their anger.

They may blame other people for problems in their life, and be aggressive and violent, upsetting others with their behaviour.

Someone with a personality disorder may also have other mental health problems, such as depression and drug addiction.

Other types of personality disorder will have different symptoms.

Find out more about diagnosing personality disorder on the Mind website

Mild, moderate and severe personality disorders

The way personality disorders are diagnosed is changing. Instead of being diagnosed with a type of personality disorder (such as borderline personality disorder), you may be diagnosed with mild, moderate or severe personality disorder, with particular personality traits. A mental health professional can talk to you about what your diagnosis means.

Treatment for a personality disorder

Treatment for a personality disorder usually involves a talking therapy and can also include other types of therapy and medicine.

Talking therapies

This is where the person talks to a therapist to get a better understanding of their own thoughts, feelings and behaviours.

Treatment can last several months or years, depending on the severity of the condition and other problems the person may have.

As well as listening and discussing important issues with the person, the therapist may identify strategies to resolve problems and, if necessary, help them change their attitudes and behaviour.

Therapeutic communities

Treatment at a therapeutic community may be offered to some people with personality disorders. Therapeutic communities (TCs) are places where someone visits or stays for an intensive form of group therapy. The experience of having a personality disorder is explored in depth.

The person usually attends for a number of weeks or months.

Medicine

Medicine may be prescribed to treat problems associated with a personality disorder, such as depression, anxiety or psychotic symptoms.

For example, moderate to severe symptoms of depression might be treated with a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI).

Read more about the treatment for borderline personality disorder.

Find out more about treatments for personality disorders:

Recovery

Many people with a personality disorder recover over time. Psychological or medical treatment is often helpful, but support is sometimes all that's needed.

There's no single approach that suits everyone treatment should be tailored to the individual.

Causes

It's not clear exactly what causes personality disorders, but they're thought to result from a combination of the genes a person inherits and early environmental influences for example, a distressing childhood experience (such as abuse or neglect).

Pregnancy, becoming a parent and personality disorders

If you have a personality disorder, you may need extra support during your pregnancy and after your child is born.

You can speak to a GP, midwife or health visitor if you would like support.

Find out more about mental health in pregnancy.

Support for people living with a personality disorder

Having a personality disorder can have a big effect on the person's life, as well as their family and friends, but support is available.

If you'd like support for yourself or someone you know, you may find the following links useful:

Ask a GP about support groups for personality disorders near you. Or find out how you can access NHS mental health services.

Page last reviewed: 4 January 2024
Next review due: 4 January 2027]]> https://www.nhs.uk/mental-health/conditi...-disorder/

Personality disorders

A person with a personality disorder thinks, feels, behaves or relates to others very differently from the average person.

There are several different types of personality disorder.

This page gives some information about personality disorders in general, linking to other sources for more detail.

Symptoms of a personality disorder

Symptoms vary depending on the type of personality disorder.

For example, a person with borderline personality disorder (one of the most common types) tends to have disturbed ways of thinking, impulsive behaviour and problems controlling their emotions.

They may have intense but unstable relationships and worry about people abandoning them.

A person with antisocial personality traits will typically get easily frustrated and have difficulty controlling their anger.

They may blame other people for problems in their life, and be aggressive and violent, upsetting others with their behaviour.

Someone with a personality disorder may also have other mental health problems, such as depression and drug addiction.

Other types of personality disorder will have different symptoms.

Find out more about diagnosing personality disorder on the Mind website

Mild, moderate and severe personality disorders

The way personality disorders are diagnosed is changing. Instead of being diagnosed with a type of personality disorder (such as borderline personality disorder), you may be diagnosed with mild, moderate or severe personality disorder, with particular personality traits. A mental health professional can talk to you about what your diagnosis means.

Treatment for a personality disorder

Treatment for a personality disorder usually involves a talking therapy and can also include other types of therapy and medicine.

Talking therapies

This is where the person talks to a therapist to get a better understanding of their own thoughts, feelings and behaviours.

Treatment can last several months or years, depending on the severity of the condition and other problems the person may have.

As well as listening and discussing important issues with the person, the therapist may identify strategies to resolve problems and, if necessary, help them change their attitudes and behaviour.

Therapeutic communities

Treatment at a therapeutic community may be offered to some people with personality disorders. Therapeutic communities (TCs) are places where someone visits or stays for an intensive form of group therapy. The experience of having a personality disorder is explored in depth.

The person usually attends for a number of weeks or months.

Medicine

Medicine may be prescribed to treat problems associated with a personality disorder, such as depression, anxiety or psychotic symptoms.

For example, moderate to severe symptoms of depression might be treated with a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI).

Read more about the treatment for borderline personality disorder.

Find out more about treatments for personality disorders:

Ask a GP about support groups for personality disorders near you. Or find out how you can access NHS mental health services.

Page last reviewed: 4 January 2024
Next review due: 4 January 2027]]> <![CDATA[Happy birthday!]]> https://depressionforums.co.uk/chat2026/showthread.php?tid=27 Sat, 19 Sep 2026 06:53:55 +0000 Amanda]]> https://depressionforums.co.uk/chat2026/showthread.php?tid=27
If you want your birthday announced, it's easy enough to do and within your profile here on the forum, you just have to put your date of birth into your profile and "make it public" or "add to calendar" or something like that lol Doing it yourself means that our admins have one less thing to do too.

Happy birthday to everyone on their special day!]]>
If you want your birthday announced, it's easy enough to do and within your profile here on the forum, you just have to put your date of birth into your profile and "make it public" or "add to calendar" or something like that lol Doing it yourself means that our admins have one less thing to do too.

Happy birthday to everyone on their special day!]]> <![CDATA[Avatars]]> https://depressionforums.co.uk/chat2026/showthread.php?tid=26 Fri, 18 Sep 2026 19:09:42 +0000 Pip]]> https://depressionforums.co.uk/chat2026/showthread.php?tid=26
Scroll down to Your Profile, again on the left side of the page where you will see Change Avatar on the list.

Click on that and in the middle of the page is Upload Avatar with Browse to the right and click on that.

From there click on the image you want then click on Change Avatar.]]>
Scroll down to Your Profile, again on the left side of the page where you will see Change Avatar on the list.

Click on that and in the middle of the page is Upload Avatar with Browse to the right and click on that.

From there click on the image you want then click on Change Avatar.]]> <![CDATA[SARAH VINE: Harry and Meghan's new life is already starting to unravel. What a ....]]> https://depressionforums.co.uk/chat2026/showthread.php?tid=25 Wed, 16 Sep 2026 10:16:20 +0000 The Rani]]> https://depressionforums.co.uk/chat2026/showthread.php?tid=25 https://www.dailymail.com/news/royals/ar...viour.html

SARAH VINE: Harry and Meghan's new life is already starting to unravel. What a pair of quitters and these are the real poor victims of their behaviour

By SARAH VINE, COLUMNIST
Published: 01:01, 16 September 2026 | Updated: 10:51, 16 September 2026

Was there ever such a pair of quitters as the Duke and Duchess of Sussex?

First, they leave Britain after just 18 months of royal life; then they abandon practically every project they embark on Stateside; now they’re back here again for unknown reasons and already, just a few weeks into their new life, things are starting to unravel.  Do they never look before they leap?

Do they always act on impulse, like headstrong teenagers?

Do they never plan a few moves ahead, or try to solve their problems instead of flouncing from one place to the next?

Every decision they make seems to be taken on a whim, with little or no thought for the long-term consequences for them or those around them.  But this time they have surpassed even themselves. They’ve pulled the children, Archie and Lilibet, out of their new prep school after just two days. Two days! Barely time for the poor mites to work out which peg is theirs and find their way to the loo and already they’re being whisked away.  Security concerns around the school run, apparently. Ha. More like bad planning, as usual, coupled with Harry and Meghan’s characteristic impulsiveness. And, as some have pointed out, this time it might well work in their favour.  After all, isn’t Ravec (the body that oversees VIP and royal security) currently ‘re-evaluating’ the Sussexes’ security status?

The safety of the children would no doubt be an important consideration.  Either way, it’s done. The kids are moving schools and all the time, expense and effort that presumably went into preparing parents, children and staff at the first place for their arrival has now been wasted. The whole process will now have to be repeated elsewhere.  As for Archie, seven, and Lilibet, five, their poor little heads must be spinning.  Not only have they just been pulled out of the only life they’ve ever known in sunny California and dumped in the middle of the Cotswolds just in time for the English winter, they’ve now also had to endure all the stresses of starting a new school in a new country, only to have the rug pulled out from beneath them.  It’s one thing for Harry and Meghan to blindside their staff and other members of the Royal Family, as they have time and time again.  Only this summer, they suddenly announced their return, shocking everyone from the King down he reportedly found out about their move the Sunday before they announced it.  But it’s quite another to do that to their own children. How anxiety-inducing must it be for poor Archie and Lilibet?

Their parents’ behaviour has already excluded them from getting to know their cousins or having a meaningful relationship with their British relatives, and now this. What a mess.  Children look to their parents for stability and wisdom. Harry and Meghan are supposed to be the grown-ups and yet they are behaving like children themselves, chopping and changing at the first sign of the slightest obstacle. Besides, kids understand so much more than we give them credit for. They will likely be feeling very scared and confused by this sudden decision, especially if they’ve picked up that it’s a security issue.  Talking of which, if the duke and duchess were really so worried about their own safety and that of the children, why would they post pictures of family life in their new countryside idyll?

Isn’t that kind of thing completely counterproductive and a gift to anyone with bad intentions towards them?

There is no need for it, and it serves no purpose other than to expose them to unnecessary scrutiny and potentially attract unwanted attention.  No one in the Press has identified either the Sussexes’ new home or the children’s school, out of respect for their right to privacy and safety and yet they themselves have strongly hinted at their location to anyone with even basic local knowledge.  That is no one’s fault but their own. And no doubt if, God forbid, something were ever to happen, the couple would blame everyone except themselves. It’s such classic Sussex denial.  One can only conclude that they are either very stupid or they like causing a melodrama.  Let’s not forget that time in New York in 2023 when they issued a dramatic statement claiming to have been involved in a ‘near-catastrophic car chase’ (a highly loaded term given Harry’s family history) which, on closer inspection, turned out to be them getting stuck in a traffic jam. Granted, they were snapped by a few paparazzi but never in a manner that put anyone in any danger.  As for their school-run complaint, I won’t reveal the name of the establishment, but I have several friends whose children have attended that school over the years, and I would say two things. Firstly, it is a brilliant, very well-established institution, and more than capable of dealing with the security concerns of high-profile parents. Second, even the most cursory enquiries would have revealed its one and only disadvantage: The local traffic, which is famously murderous.  It’s so bad I have one friend who used to leave the house at 6.30am just to get her kids there on time. Houses within walking distance are fought over by millionaires and exchange hands for eye-watering prices.  Parents endure it because the school is so good. But it is notoriously a nightmare traffic-wise.  So why, if they were going to uproot the entire family and send their children there, didn’t the Sussexes check the practicalities of their decision with some of the few remaining friends and supporters they have in Britain?

After all, Princess Beatrice and her husband, Edoardo Mapelli Mozzi, own a six-bedroom converted farmhouse in the Cotswolds complete with ‘party barn’, tennis court and swimming pool, which they purchased in 2021 for around £3.5million.  Edo (as he’s known) attended schools in the area. By all accounts the Sussexes remain on very good terms with the Mapelli Mozzis. They would have been more than able to tell them the lie of the land and flag up any potential pitfalls concerning school runs.  Perhaps they didn’t bother to ask. Or perhaps the fact the decision to return to Britain was taken so on the hoof just meant there was no time.  It seems they did the dry run in August, when everyone is on holiday and the roads are relatively clear which makes you wonder about the quality of some of the security advisers they’re using.  Or perhaps Prince Harry is just so used to the VIP treatment he simply forgot that as mere mortals there are no motorcycle outriders to clear the way through civilian traffic. Well, all I can say is welcome to the real world, Sir. Not always as fun or as easy as it looks, is it?]]> https://www.dailymail.com/news/royals/ar...viour.html

SARAH VINE: Harry and Meghan's new life is already starting to unravel. What a pair of quitters and these are the real poor victims of their behaviour

By SARAH VINE, COLUMNIST
Published: 01:01, 16 September 2026 | Updated: 10:51, 16 September 2026

Was there ever such a pair of quitters as the Duke and Duchess of Sussex?

First, they leave Britain after just 18 months of royal life; then they abandon practically every project they embark on Stateside; now they’re back here again for unknown reasons and already, just a few weeks into their new life, things are starting to unravel.  Do they never look before they leap?

Do they always act on impulse, like headstrong teenagers?

Do they never plan a few moves ahead, or try to solve their problems instead of flouncing from one place to the next?

Every decision they make seems to be taken on a whim, with little or no thought for the long-term consequences for them or those around them.  But this time they have surpassed even themselves. They’ve pulled the children, Archie and Lilibet, out of their new prep school after just two days. Two days! Barely time for the poor mites to work out which peg is theirs and find their way to the loo and already they’re being whisked away.  Security concerns around the school run, apparently. Ha. More like bad planning, as usual, coupled with Harry and Meghan’s characteristic impulsiveness. And, as some have pointed out, this time it might well work in their favour.  After all, isn’t Ravec (the body that oversees VIP and royal security) currently ‘re-evaluating’ the Sussexes’ security status?

The safety of the children would no doubt be an important consideration.  Either way, it’s done. The kids are moving schools and all the time, expense and effort that presumably went into preparing parents, children and staff at the first place for their arrival has now been wasted. The whole process will now have to be repeated elsewhere.  As for Archie, seven, and Lilibet, five, their poor little heads must be spinning.  Not only have they just been pulled out of the only life they’ve ever known in sunny California and dumped in the middle of the Cotswolds just in time for the English winter, they’ve now also had to endure all the stresses of starting a new school in a new country, only to have the rug pulled out from beneath them.  It’s one thing for Harry and Meghan to blindside their staff and other members of the Royal Family, as they have time and time again.  Only this summer, they suddenly announced their return, shocking everyone from the King down he reportedly found out about their move the Sunday before they announced it.  But it’s quite another to do that to their own children. How anxiety-inducing must it be for poor Archie and Lilibet?

Their parents’ behaviour has already excluded them from getting to know their cousins or having a meaningful relationship with their British relatives, and now this. What a mess.  Children look to their parents for stability and wisdom. Harry and Meghan are supposed to be the grown-ups and yet they are behaving like children themselves, chopping and changing at the first sign of the slightest obstacle. Besides, kids understand so much more than we give them credit for. They will likely be feeling very scared and confused by this sudden decision, especially if they’ve picked up that it’s a security issue.  Talking of which, if the duke and duchess were really so worried about their own safety and that of the children, why would they post pictures of family life in their new countryside idyll?

Isn’t that kind of thing completely counterproductive and a gift to anyone with bad intentions towards them?

There is no need for it, and it serves no purpose other than to expose them to unnecessary scrutiny and potentially attract unwanted attention.  No one in the Press has identified either the Sussexes’ new home or the children’s school, out of respect for their right to privacy and safety and yet they themselves have strongly hinted at their location to anyone with even basic local knowledge.  That is no one’s fault but their own. And no doubt if, God forbid, something were ever to happen, the couple would blame everyone except themselves. It’s such classic Sussex denial.  One can only conclude that they are either very stupid or they like causing a melodrama.  Let’s not forget that time in New York in 2023 when they issued a dramatic statement claiming to have been involved in a ‘near-catastrophic car chase’ (a highly loaded term given Harry’s family history) which, on closer inspection, turned out to be them getting stuck in a traffic jam. Granted, they were snapped by a few paparazzi but never in a manner that put anyone in any danger.  As for their school-run complaint, I won’t reveal the name of the establishment, but I have several friends whose children have attended that school over the years, and I would say two things. Firstly, it is a brilliant, very well-established institution, and more than capable of dealing with the security concerns of high-profile parents. Second, even the most cursory enquiries would have revealed its one and only disadvantage: The local traffic, which is famously murderous.  It’s so bad I have one friend who used to leave the house at 6.30am just to get her kids there on time. Houses within walking distance are fought over by millionaires and exchange hands for eye-watering prices.  Parents endure it because the school is so good. But it is notoriously a nightmare traffic-wise.  So why, if they were going to uproot the entire family and send their children there, didn’t the Sussexes check the practicalities of their decision with some of the few remaining friends and supporters they have in Britain?

After all, Princess Beatrice and her husband, Edoardo Mapelli Mozzi, own a six-bedroom converted farmhouse in the Cotswolds complete with ‘party barn’, tennis court and swimming pool, which they purchased in 2021 for around £3.5million.  Edo (as he’s known) attended schools in the area. By all accounts the Sussexes remain on very good terms with the Mapelli Mozzis. They would have been more than able to tell them the lie of the land and flag up any potential pitfalls concerning school runs.  Perhaps they didn’t bother to ask. Or perhaps the fact the decision to return to Britain was taken so on the hoof just meant there was no time.  It seems they did the dry run in August, when everyone is on holiday and the roads are relatively clear which makes you wonder about the quality of some of the security advisers they’re using.  Or perhaps Prince Harry is just so used to the VIP treatment he simply forgot that as mere mortals there are no motorcycle outriders to clear the way through civilian traffic. Well, all I can say is welcome to the real world, Sir. Not always as fun or as easy as it looks, is it?]]> <![CDATA[Bullied teenager]]> https://depressionforums.co.uk/chat2026/showthread.php?tid=24 Sat, 12 Sep 2026 10:56:29 +0000 The Rani]]> https://depressionforums.co.uk/chat2026/showthread.php?tid=24
Unfortunately I started getting bullied by older girls and never found out why so I started dreading going to school. It was okay during lessons, it was lunchtime, morning and afternoon breaks that were difficult. My friends always had my back but it was the times when they weren't with me.

I was incredibly shy and was scared to tell my parents and teachers as I thought it would make it worse.  My parents knew something was wrong ad tried to get me to talk. I was also afraid they would think I was being silly or was trying to get out of going. It only started to ease a bit as a couple of girls were laughing about what they were doing - she and I went to different schools as she was in the last year of the 11+ where we lived. My sister overheard the conversation, I don't know where they were other than they were out, and she had words with them. Whatever was said worked but by this time my mental health was already suffering.]]>
Unfortunately I started getting bullied by older girls and never found out why so I started dreading going to school. It was okay during lessons, it was lunchtime, morning and afternoon breaks that were difficult. My friends always had my back but it was the times when they weren't with me.

I was incredibly shy and was scared to tell my parents and teachers as I thought it would make it worse.  My parents knew something was wrong ad tried to get me to talk. I was also afraid they would think I was being silly or was trying to get out of going. It only started to ease a bit as a couple of girls were laughing about what they were doing - she and I went to different schools as she was in the last year of the 11+ where we lived. My sister overheard the conversation, I don't know where they were other than they were out, and she had words with them. Whatever was said worked but by this time my mental health was already suffering.]]> <![CDATA[Hi]]> https://depressionforums.co.uk/chat2026/showthread.php?tid=23 Wed, 09 Sep 2026 16:25:54 +0000 The Rani]]> https://depressionforums.co.uk/chat2026/showthread.php?tid=23 <![CDATA[Decoding the King's striking declaration on Harry and Meghan and why royal ....]]> https://depressionforums.co.uk/chat2026/showthread.php?tid=22 Tue, 08 Sep 2026 16:23:58 +0000 Pip]]> https://depressionforums.co.uk/chat2026/showthread.php?tid=22 https://www.dailymail.com/news/royals/ar...D-KAY.html

Decoding the King's striking declaration on Harry and Meghan and why royal insiders tell me they are already 'exasperated' by couple's behaviour since returning to Britain: RICHARD KAY

By RICHARD KAY, SENIOR EDITOR-AT-LARGE
Published: 01:00, 8 September 2026 | Updated: 16:55, 8 September 2026

Some will see it as an act of kingly statecraft, a timely shot across their quasi-royal bows. To others it is a vital sign that Prince Harry’s and Meghan’s presence in Britain will not be allowed to destabilise the monarchy.  What is unquestionably clear, however, is that less than two weeks after their return to British shores, one thing remains unchanged: Megxit still means Megxit.  The decisive move by the King strongly supported, I am told, by Prince William means that just because the couple are home there will be no softening of attitudes nor any dilution of the uncompromising view of the late Queen Elizabeth that they could never be ‘half-in, half-out’ royals.  That the unprecedented announcement should come on the eve of the fourth anniversary of the Queen’s death will be lost on no one, including her grandson, Harry.  This official affirmation of his and Meghan’s continued status as non-working royals is the first since their bitter departure more than six years ago.  It is also timely, with a flurry of key royal events imminent, including Prince George’s first day at Eton College.  The letter, issued in the name of the Lord Chamberlain, Lord Benyon, the King’s most senior aide, is a rigid reminder that the Duke and Duchess of Sussex are to be treated as ‘private citizens’ while in Britain, and do not represent the Royal Family.  Nor can they use their HRH titles which, Lord Benyon emphasises, ‘remain in abeyance’.

Should there be any lingering doubts among Sussex supporters or indeed the couple themselves that returning to the UK might lead to a more flexible approach, with the couple wanting to ramp up their charity work, such hopes look wildly misplaced.  The Lord Chamberlain may have drafted the official communique, which has been sent to members of the Government, the military and Lord Lieutenants, but the content is very much in line with Charles’s sentiments.  In practical terms, it was designed to make clear to those who are involved with royal visits that any engagements carried out by the Sussexes will be in a private capacity.  And it shows that the outcome of the so-called Sandringham Summit in 2020, which led to their departure, still stands.  The language and the icily formal tone of the draft are striking. Stressing that the purpose of the letter was to ‘avoid doubt or confusion’, it says the couple do not represent the sovereign.  While any charity work they do ‘is a personal matter for them both and undertaken in their private capacity’.

One passage gives the most distinct view of how this once-golden couple are viewed. ‘In short,’ the letter says, ‘their position is akin to private citizens with commercial and charitable interests.’

Reading between the lines, the only way to divine the directive on how they are to be treated is as a command.  Royal aides may insist that there is nothing controversial, nor new, about the letter’s contents adding that it merely sets out the position for all parties.  But the fact that Buckingham Palace needed to send the letter in the first place illustrates the degree of confusion and uncertainty Harry and Meghan’s sudden return to the UK has caused.  As one long-term friend of the King told me: ‘They didn’t need to issue guidance about Andrew Mountbatten-Windsor when he ceased his royal life and gave up public duties, which suggests they have been spooked by the Sussexes.’

One factor that has raised concern at the highest levels, has been the way friends of Harry and Meghan have been spoon-feeding friendly publications with details about their plans. ‘They’ve only been back a matter of days and can have barely unpacked but we keep hearing how they want to step up their charity work which would inevitably raise their public profile,’ says one figure. ‘It’s exasperating.’

Talk, too, of the couple establishing some kind of rival court has also irritated figures close to the King.  The Lord Chamberlain’s letter, which he says was a response to ‘a number of requests for guidance’, should indeed be viewed therefore as a shot across the Sussex bows or at least across the bows of those pushing their agenda.  The problem, however, is that it is all very well telling organisations that any visits Harry and Meghan undertake should not be treated as royal engagements, but in the years since they left Britain that is precisely the way their appearances have been treated. Even their visits overseas have been crafted to resemble the kind of duties they carried out before they abandoned their royal life, often with the same protocols, such as paying respects in war cemeteries.  As Harry himself has often chosen to remind people not least in his battle to obtain taxpayer-funded security he has always been a royal.  Yesterday’s intervention will be seen as an essential move by the King to preserve the cohesion of an institution which was undermined in the first place by the Sussexes flouncing off to California.  And while it may not prevent the couple seeking out public-facing opportunities, it may change the way people react to them.  Of course, the letter leaves many questions unanswered. It does not address the issue of family events and when and where Harry, Meghan and their children might join private House of Windsor gatherings.  Nor does it offer any insight into the police protection Harry so passionately wants, with his children about to start at school and the potential risks of shuttling them to and from the same place each day. Aware that such concerns may be raised, the Lord Chamberlain dodges it, writing: ‘Any operational security issues should continue to be directed to the relevant police authorities.’

However, he does acknowledge that accommodating the couple may be contentious and suggests that any questions ‘where recourse to public funds may be required, should be directed to Buckingham Palace’.

A sign, perhaps, that the King will intervene if he does feel Harry and Meghan’s conduct may not be in the monarchy’s best interests.  Many critics believe that although the letter was designed to draw a line under speculation about the couple’s future, there was a missed opportunity. Removing them from the royal website [where they still feature but without their HRH titles] would have been the most significant gesture to separate them as non-working royals from the rest of the family,’ a former aide to the King said.

After their tours of Africa, Central America and Australia, where they were treated as huge royal stars, it might have been useful if the Lord Chamberlain had also sent a copy of his letter to world leaders too.]]> https://www.dailymail.com/news/royals/ar...D-KAY.html

Decoding the King's striking declaration on Harry and Meghan and why royal insiders tell me they are already 'exasperated' by couple's behaviour since returning to Britain: RICHARD KAY

By RICHARD KAY, SENIOR EDITOR-AT-LARGE
Published: 01:00, 8 September 2026 | Updated: 16:55, 8 September 2026

Some will see it as an act of kingly statecraft, a timely shot across their quasi-royal bows. To others it is a vital sign that Prince Harry’s and Meghan’s presence in Britain will not be allowed to destabilise the monarchy.  What is unquestionably clear, however, is that less than two weeks after their return to British shores, one thing remains unchanged: Megxit still means Megxit.  The decisive move by the King strongly supported, I am told, by Prince William means that just because the couple are home there will be no softening of attitudes nor any dilution of the uncompromising view of the late Queen Elizabeth that they could never be ‘half-in, half-out’ royals.  That the unprecedented announcement should come on the eve of the fourth anniversary of the Queen’s death will be lost on no one, including her grandson, Harry.  This official affirmation of his and Meghan’s continued status as non-working royals is the first since their bitter departure more than six years ago.  It is also timely, with a flurry of key royal events imminent, including Prince George’s first day at Eton College.  The letter, issued in the name of the Lord Chamberlain, Lord Benyon, the King’s most senior aide, is a rigid reminder that the Duke and Duchess of Sussex are to be treated as ‘private citizens’ while in Britain, and do not represent the Royal Family.  Nor can they use their HRH titles which, Lord Benyon emphasises, ‘remain in abeyance’.

Should there be any lingering doubts among Sussex supporters or indeed the couple themselves that returning to the UK might lead to a more flexible approach, with the couple wanting to ramp up their charity work, such hopes look wildly misplaced.  The Lord Chamberlain may have drafted the official communique, which has been sent to members of the Government, the military and Lord Lieutenants, but the content is very much in line with Charles’s sentiments.  In practical terms, it was designed to make clear to those who are involved with royal visits that any engagements carried out by the Sussexes will be in a private capacity.  And it shows that the outcome of the so-called Sandringham Summit in 2020, which led to their departure, still stands.  The language and the icily formal tone of the draft are striking. Stressing that the purpose of the letter was to ‘avoid doubt or confusion’, it says the couple do not represent the sovereign.  While any charity work they do ‘is a personal matter for them both and undertaken in their private capacity’.

One passage gives the most distinct view of how this once-golden couple are viewed. ‘In short,’ the letter says, ‘their position is akin to private citizens with commercial and charitable interests.’

Reading between the lines, the only way to divine the directive on how they are to be treated is as a command.  Royal aides may insist that there is nothing controversial, nor new, about the letter’s contents adding that it merely sets out the position for all parties.  But the fact that Buckingham Palace needed to send the letter in the first place illustrates the degree of confusion and uncertainty Harry and Meghan’s sudden return to the UK has caused.  As one long-term friend of the King told me: ‘They didn’t need to issue guidance about Andrew Mountbatten-Windsor when he ceased his royal life and gave up public duties, which suggests they have been spooked by the Sussexes.’

One factor that has raised concern at the highest levels, has been the way friends of Harry and Meghan have been spoon-feeding friendly publications with details about their plans. ‘They’ve only been back a matter of days and can have barely unpacked but we keep hearing how they want to step up their charity work which would inevitably raise their public profile,’ says one figure. ‘It’s exasperating.’

Talk, too, of the couple establishing some kind of rival court has also irritated figures close to the King.  The Lord Chamberlain’s letter, which he says was a response to ‘a number of requests for guidance’, should indeed be viewed therefore as a shot across the Sussex bows or at least across the bows of those pushing their agenda.  The problem, however, is that it is all very well telling organisations that any visits Harry and Meghan undertake should not be treated as royal engagements, but in the years since they left Britain that is precisely the way their appearances have been treated. Even their visits overseas have been crafted to resemble the kind of duties they carried out before they abandoned their royal life, often with the same protocols, such as paying respects in war cemeteries.  As Harry himself has often chosen to remind people not least in his battle to obtain taxpayer-funded security he has always been a royal.  Yesterday’s intervention will be seen as an essential move by the King to preserve the cohesion of an institution which was undermined in the first place by the Sussexes flouncing off to California.  And while it may not prevent the couple seeking out public-facing opportunities, it may change the way people react to them.  Of course, the letter leaves many questions unanswered. It does not address the issue of family events and when and where Harry, Meghan and their children might join private House of Windsor gatherings.  Nor does it offer any insight into the police protection Harry so passionately wants, with his children about to start at school and the potential risks of shuttling them to and from the same place each day. Aware that such concerns may be raised, the Lord Chamberlain dodges it, writing: ‘Any operational security issues should continue to be directed to the relevant police authorities.’

However, he does acknowledge that accommodating the couple may be contentious and suggests that any questions ‘where recourse to public funds may be required, should be directed to Buckingham Palace’.

A sign, perhaps, that the King will intervene if he does feel Harry and Meghan’s conduct may not be in the monarchy’s best interests.  Many critics believe that although the letter was designed to draw a line under speculation about the couple’s future, there was a missed opportunity. Removing them from the royal website [where they still feature but without their HRH titles] would have been the most significant gesture to separate them as non-working royals from the rest of the family,’ a former aide to the King said.

After their tours of Africa, Central America and Australia, where they were treated as huge royal stars, it might have been useful if the Lord Chamberlain had also sent a copy of his letter to world leaders too.]]> <![CDATA[Bipolar disorder]]> https://depressionforums.co.uk/chat2026/showthread.php?tid=21 Sat, 05 Sep 2026 15:15:15 +0000 Pip]]> https://depressionforums.co.uk/chat2026/showthread.php?tid=21 https://www.nhs.uk/mental-health/conditi...-disorder/

Bipolar disorder

Bipolar disorder is a mental health condition where you have extreme mood changes. Medicines and talking therapy can help manage it.

Symptoms of bipolar disorder

The main symptom of bipolar disorder is extreme changes to your mood.

You sometimes have either:

high moods (mania or hypomania) – for example, feeling very happy, excited or energetic
low moods (depression) – for example, feeling sad, tired or hopeless

These moods usually last a few days or weeks at a time.

If you have bipolar disorder, you will usually have times where your mood is stable and you do not have any symptoms. This can last for weeks, months or years.

See a GP if:

you have extreme changes in your moods that last a long time or impact your everyday life
you've been diagnosed with bipolar disorder and treatments are not helping (or speak to your mental health specialist if you have one)

If you're worried about someone else, encourage them to speak to their GP.

How bipolar disorder is diagnosed

If a GP thinks you may have bipolar disorder or another mental health condition, they will refer you to a mental health specialist (psychiatrist).

The mental health specialist will ask you about things like your moods, behaviour, health and family history.

Bipolar disorder can take time to diagnose because it affects everyone differently and the symptoms are similar to other mental health conditions.

Treatment for bipolar disorder

Bipolar disorder cannot be cured, but there are treatments that can help manage it.

A mental health specialist will work with you to create a treatment plan.

Treatments you may have include:

medicines to help stabilise your moods
talking therapy such as cognitive behavioural therapy (CBT)

Some medicines you need to take all the time, others you only take when your symptoms get worse.

The medicines can cause side effects. These will vary depending on which medicine you take and how your body responds to it.

You'll usually have appointments at a GP surgery, clinic or hospital.

If doctors are worried you're at risk of self-harm, suicide or harming someone else, you may need to stay in hospital or have support from a crisis team at home.

Important

Do not stop taking your bipolar disorder medicine unless you are told to by a doctor, even if you feel better.

Some medicines for bipolar disorder are not safe to take if you are pregnant. Talk to your doctor if you are pregnant or planning a pregnancy.

Things you can do to help with bipolar disorder

If you have bipolar disorder, it's important to know what can trigger your high and low moods. This can include things like feeling stressed, not getting enough sleep or being too busy.

There are some things you can do that can help to keep your moods stable.

Do

try to have a regular routine
get plenty of sleep
eat a healthy diet
exercise regularly
try to avoid and manage stress

Don’t

do not take recreational drugs
do not smoke
do not drink too much alcohol
do not do shift work or work very long hours if you can avoid it
do not fly at night or across time zones if you can avoid it
do not drink lots of caffeinated drinks such as coffee, tea or cola

Help and support for bipolar disorder

If you have bipolar disorder, you will be supported by a mental health specialist or GP.

There are also national and local charities such as Bipolar UK, Mind and Rethink Mental Illness that offer information and support for anyone affected by bipolar disorder.

Support groups and forums

It can be helpful to speak to other people who have bipolar disorder.

There are many people offering support and sharing their stories in support groups, forums and on social media.

Comments in forums and on social media are often based on personal experience and should not be taken as medical advice.

Support for family, friends and carers

If you care for someone who has bipolar disorder, you can get advice and support from charities.

More information and advice

There are charities that offer advice and information for anyone affected by bipolar disorder.

Causes of bipolar disorder

It's not known exactly what causes bipolar disorder.

You're more likely to have it if you have a parent, brother or sister who has bipolar disorder.

There are some things that can increase your chances of having it, including:

childhood trauma or abuse
a stressful event such as relationship problems, abuse, the death of someone close to you or money problems
recreational drugs such as cannabis or cocaine
a parasite called toxoplasma gondii (which causes toxoplasmosis)

]]> https://www.nhs.uk/mental-health/conditi...-disorder/

Bipolar disorder

Bipolar disorder is a mental health condition where you have extreme mood changes. Medicines and talking therapy can help manage it.

Symptoms of bipolar disorder

The main symptom of bipolar disorder is extreme changes to your mood.

You sometimes have either:

high moods (mania or hypomania) – for example, feeling very happy, excited or energetic
low moods (depression) – for example, feeling sad, tired or hopeless

you have extreme changes in your moods that last a long time or impact your everyday life
you've been diagnosed with bipolar disorder and treatments are not helping (or speak to your mental health specialist if you have one)

medicines to help stabilise your moods
talking therapy such as cognitive behavioural therapy (CBT)

try to have a regular routine
get plenty of sleep
eat a healthy diet
exercise regularly
try to avoid and manage stress

Don’t

do not take recreational drugs
do not smoke
do not drink too much alcohol
do not do shift work or work very long hours if you can avoid it
do not fly at night or across time zones if you can avoid it
do not drink lots of caffeinated drinks such as coffee, tea or cola

More information and advice

There are charities that offer advice and information for anyone affected by bipolar disorder.

childhood trauma or abuse
a stressful event such as relationship problems, abuse, the death of someone close to you or money problems
recreational drugs such as cannabis or cocaine
a parasite called toxoplasma gondii (which causes toxoplasmosis)

]]> <![CDATA[How to Approach Conversations With Adult Patients Who Might Have ADHD: New Tools....]]> https://depressionforums.co.uk/chat2026/showthread.php?tid=20 Thu, 03 Sep 2026 14:02:33 +0000 Pip]]> https://depressionforums.co.uk/chat2026/showthread.php?tid=20 https://www.psychiatrictimes.com/view/ho..._source=hs

How to Approach Conversations With Adult Patients Who Might Have ADHD: New Tools and Insights
Author(s)Leah Kuntz, Nona Kocher, MD, MPH

Key Takeaways

Quintessence Psychiatry uses Mentavi's Diagnostic Evaluation to enhance ADHD assessments, offering a structured, objective alternative to traditional testing.
Dr. Nona Kocher highlights the importance of open, exploratory conversations with patients, focusing on understanding rather than criticism.

Discover how best to approach ADHD assessments and utilize tools such as the Mentavi Diagnostic Evaluation, which can help improve patient care and reduce stigma.

CLINICAL CONVERSATIONS
Over 15.5 million US adults had an attention-deficit/hyperactivity disorder (ADHD) diagnosis.1 Telepsychiatry practice Quintessence Psychiatry recently adopted a clinically validated diagnostic tool to change the patient care workflow: Mentavi Health’s clinically validated asynchronous Diagnostic Evaluation for adult ADHD assessments, an alternative to a structured clinical interview.2 Psychiatric Times sat down with Nona Kocher, MD, MPH, a psychiatrist at Quintessence Psychiatry, to learn more about ADHD assessment and how best to implement new tools in patient conversations.

Psychiatric Times: How do you typically approach conversations with patients who might have ADHD? What advice can you offer your peers?
Nona Kocher, MD: I try to approach these conversations with an open mind rather than assumption. Many adults who suspect they have ADHD have spent years feeling misunderstood or self-critical about their struggles with attention, organization, or follow-through. My goal is to explore these experiences, validate what they have been feeling, and frame the evaluation as a process of understanding—not criticism. I usually ask detailed questions about their history, as there are many experiences common among individuals who have grown up with ADHD symptoms.

For peers, I would emphasize listening and taking a thorough history before labeling. Explore how the person’s symptoms affect their executive functioning and self-confidence. That context helps guide a meaningful discussion about diagnosis and treatment rather than a checklist-style assessment. A detailed clinical history provides a deeper understanding of the symptoms’ origins and helps determine whether they stem from ADHD or from another condition, such as anxiety.

PT: The Mentavi Diagnostic Evaluation is clinically validated for the diagnosis of ADHD in adults. How has this tool changed the way you approach treatment conversations? Can you give an example?
Kocher: The Mentavi Diagnostic Evaluation adds structure and objectivity to what can otherwise be a very subjective process. It provides clear, data-driven insights that support clinical impressions and help patients see their symptoms reflected in measurable ways. It also asks many more questions about a patient’s experiences with attention and focus than can typically be covered in a standard psychiatric appointment. Combined with an in-depth interview, it can make a clinician far more confident in their diagnostic conclusions.

For example, many patients present with overlapping symptoms that could stem from depression, anxiety, posttraumatic stress disorder, or ADHD. The Mentavi Evaluation, with its detailed psychological measures, helps clarify which symptoms are present and makes it easier to determine whether difficulties with focus arise from ADHD, mood symptoms, anxiety, or trauma.

PT: What challenges does it address? Is there a reduction in stigma around ADHD diagnosis?
Kocher: It addresses 4 major challenges: diagnostic uncertainty, patient skepticism, clinician skepticism, and lack of clinician time. ADHD symptoms often overlap with anxiety, depression, and trauma, and traditional evaluations can feel subjective—leaving both physician and patient unsure whether the assessment was comprehensive. Having a standardized, validated tool builds confidence for both parties that the diagnosis is accurate and evidence-based.

As for stigma, I see a gradual reduction. When patients can review their own data and see ADHD framed as a neurobiological condition rather than a personal flaw—and understand which elements of their mental functioning are more affected—it shifts the narrative from “What’s wrong with me?” to “How does my brain work, and how can I support it?”

PT: How does this assessment help patients understand the findings? Do you think it makes them more informed participants in their care?
Kocher: Absolutely. The feedback reports are clear, visual, and accessible. Patients can see how their responses compare with normative data, which helps them understand why certain patterns emerge in daily life and which areas of mental processing they need the most support with. That shared understanding makes them more engaged in treatment—they are not just following recommendations, they are collaborating based on insight into how their mind works. I find this one of the most useful aspects of the Mentavi Evaluation. Informed patients tend to have better adherence, greater self-compassion, and improved long-term outcomes.

PT: In your opinion, does the Mentavi Diagnostic Evaluation reduce trial and error in treatment selection? Why should clinicians be excited about this tool?
Kocher: Yes—it provides additional data that helps reduce the inherent subjectivity in diagnosing any mental health condition. By clarifying symptom profiles, comorbidities, and severity in greater detail than can be covered in a standard appointment, clinicians can make more informed diagnostic and treatment decisions. It does not replace clinical judgment, but it adds a reliable layer of evidence to what can otherwise be a nuanced and complex process.

Clinicians should be excited because this tool saves time, strengthens diagnostic confidence, and builds patient trust. It integrates smoothly into telehealth workflows and supports more precise, individualized care—something every busy provider can appreciate.

PT: Anything else you would like clinicians to know?
Kocher: ADHD is often a hidden disorder that can profoundly affect quality of life. Tools like the Mentavi Diagnostic Evaluation don’t just streamline the diagnostic process—they elevate the standard of care. Using validated assessments shows patients that we take their concerns seriously and that we are committed to data-driven, compassionate treatment.

PT: Thank you!

Dr Kocher is a board-certified psychiatrist at Quintessence Psychiatry who is licensed in both Florida and New York.

References
1. Staley BS, Robinson LR, Claussen AH, et al. Attention-deficit/hyperactivity disorder diagnosis, treatment, and telehealth use in adults — National Center for Health Statistics Rapid Surveys System, United States, October–November 2023. MMWR Morb Mortal Wkly Rep. 2024;73(40):890-895.
2. Quintessence Psychiatry adopts Mentavi's Mental Health Diagnostic Evaluation to offer more rigorous, timely ADHD assessments in private practice. News release. October 1, 2025. Accessed October 8, 2025. https://www.newswire.com/news/quintessen...c-22649518]]> https://www.psychiatrictimes.com/view/ho..._source=hs

How to Approach Conversations With Adult Patients Who Might Have ADHD: New Tools and Insights
Author(s)Leah Kuntz, Nona Kocher, MD, MPH

Key Takeaways

Quintessence Psychiatry uses Mentavi's Diagnostic Evaluation to enhance ADHD assessments, offering a structured, objective alternative to traditional testing.
Dr. Nona Kocher highlights the importance of open, exploratory conversations with patients, focusing on understanding rather than criticism.

Discover how best to approach ADHD assessments and utilize tools such as the Mentavi Diagnostic Evaluation, which can help improve patient care and reduce stigma.

CLINICAL CONVERSATIONS
Over 15.5 million US adults had an attention-deficit/hyperactivity disorder (ADHD) diagnosis.1 Telepsychiatry practice Quintessence Psychiatry recently adopted a clinically validated diagnostic tool to change the patient care workflow: Mentavi Health’s clinically validated asynchronous Diagnostic Evaluation for adult ADHD assessments, an alternative to a structured clinical interview.2 Psychiatric Times sat down with Nona Kocher, MD, MPH, a psychiatrist at Quintessence Psychiatry, to learn more about ADHD assessment and how best to implement new tools in patient conversations.

Psychiatric Times: How do you typically approach conversations with patients who might have ADHD? What advice can you offer your peers?
Nona Kocher, MD: I try to approach these conversations with an open mind rather than assumption. Many adults who suspect they have ADHD have spent years feeling misunderstood or self-critical about their struggles with attention, organization, or follow-through. My goal is to explore these experiences, validate what they have been feeling, and frame the evaluation as a process of understanding—not criticism. I usually ask detailed questions about their history, as there are many experiences common among individuals who have grown up with ADHD symptoms.

For peers, I would emphasize listening and taking a thorough history before labeling. Explore how the person’s symptoms affect their executive functioning and self-confidence. That context helps guide a meaningful discussion about diagnosis and treatment rather than a checklist-style assessment. A detailed clinical history provides a deeper understanding of the symptoms’ origins and helps determine whether they stem from ADHD or from another condition, such as anxiety.

PT: The Mentavi Diagnostic Evaluation is clinically validated for the diagnosis of ADHD in adults. How has this tool changed the way you approach treatment conversations? Can you give an example?
Kocher: The Mentavi Diagnostic Evaluation adds structure and objectivity to what can otherwise be a very subjective process. It provides clear, data-driven insights that support clinical impressions and help patients see their symptoms reflected in measurable ways. It also asks many more questions about a patient’s experiences with attention and focus than can typically be covered in a standard psychiatric appointment. Combined with an in-depth interview, it can make a clinician far more confident in their diagnostic conclusions.

For example, many patients present with overlapping symptoms that could stem from depression, anxiety, posttraumatic stress disorder, or ADHD. The Mentavi Evaluation, with its detailed psychological measures, helps clarify which symptoms are present and makes it easier to determine whether difficulties with focus arise from ADHD, mood symptoms, anxiety, or trauma.

PT: What challenges does it address? Is there a reduction in stigma around ADHD diagnosis?
Kocher: It addresses 4 major challenges: diagnostic uncertainty, patient skepticism, clinician skepticism, and lack of clinician time. ADHD symptoms often overlap with anxiety, depression, and trauma, and traditional evaluations can feel subjective—leaving both physician and patient unsure whether the assessment was comprehensive. Having a standardized, validated tool builds confidence for both parties that the diagnosis is accurate and evidence-based.

As for stigma, I see a gradual reduction. When patients can review their own data and see ADHD framed as a neurobiological condition rather than a personal flaw—and understand which elements of their mental functioning are more affected—it shifts the narrative from “What’s wrong with me?” to “How does my brain work, and how can I support it?”

PT: How does this assessment help patients understand the findings? Do you think it makes them more informed participants in their care?
Kocher: Absolutely. The feedback reports are clear, visual, and accessible. Patients can see how their responses compare with normative data, which helps them understand why certain patterns emerge in daily life and which areas of mental processing they need the most support with. That shared understanding makes them more engaged in treatment—they are not just following recommendations, they are collaborating based on insight into how their mind works. I find this one of the most useful aspects of the Mentavi Evaluation. Informed patients tend to have better adherence, greater self-compassion, and improved long-term outcomes.

PT: In your opinion, does the Mentavi Diagnostic Evaluation reduce trial and error in treatment selection? Why should clinicians be excited about this tool?
Kocher: Yes—it provides additional data that helps reduce the inherent subjectivity in diagnosing any mental health condition. By clarifying symptom profiles, comorbidities, and severity in greater detail than can be covered in a standard appointment, clinicians can make more informed diagnostic and treatment decisions. It does not replace clinical judgment, but it adds a reliable layer of evidence to what can otherwise be a nuanced and complex process.

Clinicians should be excited because this tool saves time, strengthens diagnostic confidence, and builds patient trust. It integrates smoothly into telehealth workflows and supports more precise, individualized care—something every busy provider can appreciate.

PT: Anything else you would like clinicians to know?
Kocher: ADHD is often a hidden disorder that can profoundly affect quality of life. Tools like the Mentavi Diagnostic Evaluation don’t just streamline the diagnostic process—they elevate the standard of care. Using validated assessments shows patients that we take their concerns seriously and that we are committed to data-driven, compassionate treatment.

PT: Thank you!

Dr Kocher is a board-certified psychiatrist at Quintessence Psychiatry who is licensed in both Florida and New York.

References
1. Staley BS, Robinson LR, Claussen AH, et al. Attention-deficit/hyperactivity disorder diagnosis, treatment, and telehealth use in adults — National Center for Health Statistics Rapid Surveys System, United States, October–November 2023. MMWR Morb Mortal Wkly Rep. 2024;73(40):890-895.
2. Quintessence Psychiatry adopts Mentavi's Mental Health Diagnostic Evaluation to offer more rigorous, timely ADHD assessments in private practice. News release. October 1, 2025. Accessed October 8, 2025. https://www.newswire.com/news/quintessen...c-22649518]]> <![CDATA[Alcohol-use disorder]]> https://depressionforums.co.uk/chat2026/showthread.php?tid=19 Thu, 03 Sep 2026 13:49:05 +0000 Pip]]> https://depressionforums.co.uk/chat2026/showthread.php?tid=19 https://www.nhs.uk/conditions/alcohol-use-disorder/

Alcohol-use disorder

Alcohol-use disorder is drinking alcohol in a way that's harmful. People sometimes call this alcoholism. Treatment and support is available to help you cut down or stop.

Signs of alcohol-use disorder

Signs of alcohol-use disorder include:

regularly drinking more alcohol than you mean to
difficulty stopping or reducing the amount you drink, even if you want to
feeling guilty or remorseful after drinking
people you know being concerned about your drinking
continuing to drink even when it's causing problems for your health, work or relationships
craving alcohol, for example, needing a drink when you wake up in the morning
needing increasing amounts of alcohol to get the same effect
getting withdrawal symptoms when you stop or reduce drinking

Alcohol withdrawal symptoms

If you stop drinking or cut down, you may get withdrawal symptoms. This is a sign your body is dependent on alcohol. Symptoms include:

anxiety
difficulty sleeping
feeling and being sick (nausea and vomiting)
a racing heartbeat, sweating and shaking (tremor)
seeing, hearing or feeling things that are not there (hallucinations)
confusion
seizures

Withdrawal symptoms begin within 6 to 12 hours of your last drink, and usually last from 3 to 7 days. But some symptoms may last for a few months, especially if you drink heavily.

Important

It can be very dangerous to stop drinking suddenly if you're dependent on alcohol. If you get withdrawal symptoms, get medical help before you try to stop drinking.

See a GP or an alcohol addiction support service if:

you're worried about your drinking
you want help to stop drinking
you get symptoms like anxiety, difficulty sleeping, sweating or feeling and being sick when you try to stop drinking
you're worried about someone else's drinking

Find alcohol addiction support services

Check your drinking

If you're worried about your drinking but you’re not sure how serious it is, you can check your drinking on the Alcohol Change UK website.
Call 999 or go to A&E if:

You or someone else has severe withdrawal symptoms after stopping drinking alcohol, such as:

shaking visibly
being unusually restless, irritable or upset
confusion (for example, not knowing what day it is)
seeing, hearing, or feeling things that are not there
having a seizure

Find your nearest A&E

Do not drive to A&E. Ask someone to drive you or call 999 and ask for an ambulance.

Bring any medicines you take with you.

How alcohol-use disorder is diagnosed

If you see a GP or alcohol support service about your alcohol use, they will ask about your drinking and how it's affecting your life. You may be asked to fill in a questionnaire about your symptoms.

You may also be offered blood tests to check if your drinking is affecting your health.

Treatment for alcohol-use disorder

You can get treatment for alcohol-use disorder from your GP or a specialist alcohol addiction service.

The aim of treatment is usually to help you stop drinking completely, especially if you're dependent on alcohol. But if you're not ready to stop yet, or just want to cut down, you'll be supported to reduce your drinking to a safer level.

Treatment for alcohol-use disorder can include:

talking therapies such as cognitive behavioural therapy (CBT)
medical help for withdrawal symptoms when you stop drinking alcohol, either at home or in hospital
help to prevent relapses (where you start drinking again), such as medicines to reduce alcohol cravings
support to make positive changes in other areas of your life, such as your relationships
help accessing other forms of support, for example with employment or housing

Medicines for alcohol-use disorder

Medicines for alcohol-use disorder can help you to avoid drinking. They're usually offered once you've stopped drinking and need help to stay sober.

These medicines can include:

acamprosate or naltrexone, which help reduce alcohol cravings
disulfiram, which causes unpleasant effects (such as a headache, feeling sick, high body temperature and heart palpitations) when combined with alcohol

Risks of alcohol-use disorder

Drinking too much alcohol is very bad for your health. Stopping drinking is the best way to reduce your risk of serious health problems.

Short term risks of drinking too much include:

serious accidents or injuries while drunk
alcohol poisoning

Longer term risks include:

liver damage such as alcohol-related liver disease
increased risk of many different types of cancer
high blood pressure and stroke
heart problems including cardiomyopathy and heart failure
acute pancreatitis and chronic pancreatitis
mental health conditions such as anxiety and depression
alcohol related brain damage

Risks of drinking alcohol when pregnant

If you're pregnant or planning to get pregnant, it's recommended that you don't drink any alcohol.

Drinking alcohol during pregnancy increases the risk of miscarriage, stillbirth and premature birth. It also puts your baby at risk of long-term problems such as fetal alcohol spectrum disorder.

If you're finding it hard to stop drinking while you're pregnant or planning to get pregnant, get help from your GP or an alcohol support service.
Find out more

Things you can do to stop or cut down drinking

There are things you can do to help stop or reduce your drinking.

Get medical help before you stop or reduce drinking if you get withdrawal symptoms.
Do

keep a daily diary of how much you're drinking, or try a drink tracking app
to cut down, try alternating alcoholic drinks with soft drinks, or choose lower strength (ABV in %) drinks
tell people you're stopping drinking so they can help keep you on track
avoid situations where you know you're likely to drink
find different activities to do when you'd usually drink, such as trying a new hobby
try joining a support group

NHS drink tracking app

Support for alcohol-use disorder

Stopping drinking can be difficult. You can get support from your GP or alcohol addiction support services.

There are also charities and peer support groups where you can get support from other people going through the same thing.

Support groups

Organisations offering support for people trying to stop drinking, including helplines and support groups, include:

Support for friends, family and carers

Organisations offering support for friends, family and carers, including helplines and support groups, include:

More information about supporting someone else:

]]> https://www.nhs.uk/conditions/alcohol-use-disorder/

Alcohol-use disorder

Alcohol-use disorder is drinking alcohol in a way that's harmful. People sometimes call this alcoholism. Treatment and support is available to help you cut down or stop.

Signs of alcohol-use disorder

Signs of alcohol-use disorder include:

regularly drinking more alcohol than you mean to
difficulty stopping or reducing the amount you drink, even if you want to
feeling guilty or remorseful after drinking
people you know being concerned about your drinking
continuing to drink even when it's causing problems for your health, work or relationships
craving alcohol, for example, needing a drink when you wake up in the morning
needing increasing amounts of alcohol to get the same effect
getting withdrawal symptoms when you stop or reduce drinking

Alcohol withdrawal symptoms

If you stop drinking or cut down, you may get withdrawal symptoms. This is a sign your body is dependent on alcohol. Symptoms include:

anxiety
difficulty sleeping
feeling and being sick (nausea and vomiting)
a racing heartbeat, sweating and shaking (tremor)
seeing, hearing or feeling things that are not there (hallucinations)
confusion
seizures

you're worried about your drinking
you want help to stop drinking
you get symptoms like anxiety, difficulty sleeping, sweating or feeling and being sick when you try to stop drinking
you're worried about someone else's drinking

shaking visibly
being unusually restless, irritable or upset
confusion (for example, not knowing what day it is)
seeing, hearing, or feeling things that are not there
having a seizure

talking therapies such as cognitive behavioural therapy (CBT)
medical help for withdrawal symptoms when you stop drinking alcohol, either at home or in hospital
help to prevent relapses (where you start drinking again), such as medicines to reduce alcohol cravings
support to make positive changes in other areas of your life, such as your relationships
help accessing other forms of support, for example with employment or housing

acamprosate or naltrexone, which help reduce alcohol cravings
disulfiram, which causes unpleasant effects (such as a headache, feeling sick, high body temperature and heart palpitations) when combined with alcohol

serious accidents or injuries while drunk
alcohol poisoning

Longer term risks include:

liver damage such as alcohol-related liver disease
increased risk of many different types of cancer
high blood pressure and stroke
heart problems including cardiomyopathy and heart failure
acute pancreatitis and chronic pancreatitis
mental health conditions such as anxiety and depression
alcohol related brain damage

keep a daily diary of how much you're drinking, or try a drink tracking app
to cut down, try alternating alcoholic drinks with soft drinks, or choose lower strength (ABV in %) drinks
tell people you're stopping drinking so they can help keep you on track
avoid situations where you know you're likely to drink
find different activities to do when you'd usually drink, such as trying a new hobby
try joining a support group

NHS drink tracking app

Support for friends, family and carers

Organisations offering support for friends, family and carers, including helplines and support groups, include:

More information about supporting someone else:

]]> <![CDATA[Eating disorders]]> https://depressionforums.co.uk/chat2026/showthread.php?tid=18 Thu, 03 Sep 2026 13:39:36 +0000 Pip]]> https://depressionforums.co.uk/chat2026/showthread.php?tid=18 https://www.nhs.uk/mental-health/feeling.../overview/

Overview – Eating disorders

An eating disorder is a mental health condition where you use the control of food to cope with feelings and other situations.

Unhealthy eating behaviours may include eating too much or too little or worrying about your weight or body shape.

Anyone can get an eating disorder, but teenagers and young adults are mostly affected.

With treatment, most people can recover from an eating disorder.

Types of eating disorders

The most common eating disorders are:

anorexia nervosa (often called anorexia) – trying to control your weight by not eating enough food, exercising too much, or doing both
bulimia – losing control over how much you eat and then taking drastic action to not put on weight
binge eating disorder (BED) – eating large portions of food until you feel uncomfortably full

Other specified feeding or eating disorder (OSFED)

A person may have an OSFED if their symptoms do not exactly fit the expected symptoms for any specific eating disorders.

OSFED is the most common eating disorder.

Find out more about OSFED on the Beat website

Avoidant/restrictive food intake disorder (ARFID)

ARFID is when someone avoids certain foods, limits how much they eat or does both.

Beliefs about weight or body shape are not reasons why people develop ARFID.

Possible reasons for ARFID include:

negative feelings over the smell, taste or texture of certain foods
a response to a past experience with food that was upsetting, for example, choking or being sick after eating something
not feeling hungry or just a lack of interest in eating

Find out more about ARFID on the Beat website

Check if you have an eating disorder

If you or people around you are worried that you have an unhealthy relationship with food, you could have an eating disorder.

Symptoms of eating disorders include:

spending a lot of time worrying about your weight and body shape
avoiding socialising when you think food will be involved
eating very little food
making yourself sick or taking laxatives after you eat
exercising too much
having very strict habits or routines around food
changes in your mood, such as being withdrawn, anxious or depressed

You may also notice physical signs, including:

feeling cold, tired or dizzy
pains, tingling or numbness in your arms and legs (poor circulation)
feeling your heart racing, fainting or feeling faint
problems with your digestion, such as bloating, constipation or diarrhoea
your weight being very high or very low for someone of your age and height
not getting your period or other delayed signs of puberty

You can read more about:

Warning signs of an eating disorder in someone else

It can be very difficult to identify that a loved one or friend has an eating disorder.

Warning signs to look out for include:

dramatic weight loss
lying about how much they've eaten, when they've eaten, or their weight
eating a lot of food very fast
going to the bathroom a lot after eating
exercising a lot
avoiding eating with others
cutting food into small pieces or eating very slowly
wearing loose or baggy clothes to hide their weight loss

Getting help for an eating disorder

If you think you may have an eating disorder, see a GP as soon as you can.

A GP will ask about your eating habits and how you're feeling, plus check your overall health and weight.

They may refer you to an eating disorder specialist or team of specialists.

It can be very hard to admit you have a problem and ask for help. It may make things easier if you bring a friend or loved one with you to your appointment.

You can also talk in confidence to an adviser from eating disorders charity Beat by calling the Beat helpline on 0808 801 0677.

Further information:

Beat: get information and support

Getting help for someone else

It can be difficult to know what to do if you're worried that someone has an eating disorder.

They may not realise they have an eating disorder. They may also deny it, or be secretive and defensive about their eating or weight.

Let them know you're worried about them and encourage them to see a GP. You could offer to go along with them.

Read more about talking to your child about eating disorders and supporting someone with an eating disorder.

The eating disorder charity Beat also has information and advice:

Treatment for eating disorders

You can recover from an eating disorder, but it may take time and recovery will be different for everyone.

If you're referred to an eating disorder specialist or team of specialists, they'll be responsible for your care.

They should talk to you about the support you might need, such as for other conditions you have, and include this in your treatment plan.

Your treatment will depend on the type of eating disorder you have, but usually includes a talking therapy.

You may also need regular health checks if your eating disorder is having an impact on your physical health.

Your treatment may also involve working through a guided self-help programme if you have bulimia or binge eating disorder.

Most people will be offered individual therapy, but those with binge eating disorder may be offered group therapy.

Read more about the different treatments for:

Treatment for other specified feeding or eating disorder (OSFED) will depend on the type of eating disorder your symptoms are most like.

For example, if your symptoms are most like anorexia, your treatment will be similar to the treatment for anorexia.

What causes eating disorders?

The exact cause of eating disorders is unknown.

You may be more likely to get an eating disorder if:

you or a member of your family has a history of eating disorders, depression, or alcohol or drug misuse
you've been criticised for your eating habits, body shape or weight
you're really worried about being slim, particularly if you also feel pressure from society or your job, for example, ballet dancers, models or athletes
you have anxiety, low self-esteem, an obsessive personality or are a perfectionist
you've been sexually abused

Further information

]]> https://www.nhs.uk/mental-health/feeling.../overview/

Overview – Eating disorders

An eating disorder is a mental health condition where you use the control of food to cope with feelings and other situations.

Unhealthy eating behaviours may include eating too much or too little or worrying about your weight or body shape.

Anyone can get an eating disorder, but teenagers and young adults are mostly affected.

With treatment, most people can recover from an eating disorder.

Types of eating disorders

The most common eating disorders are:

anorexia nervosa (often called anorexia) – trying to control your weight by not eating enough food, exercising too much, or doing both
bulimia – losing control over how much you eat and then taking drastic action to not put on weight
binge eating disorder (BED) – eating large portions of food until you feel uncomfortably full

negative feelings over the smell, taste or texture of certain foods
a response to a past experience with food that was upsetting, for example, choking or being sick after eating something
not feeling hungry or just a lack of interest in eating

spending a lot of time worrying about your weight and body shape
avoiding socialising when you think food will be involved
eating very little food
making yourself sick or taking laxatives after you eat
exercising too much
having very strict habits or routines around food
changes in your mood, such as being withdrawn, anxious or depressed

You may also notice physical signs, including:

feeling cold, tired or dizzy
pains, tingling or numbness in your arms and legs (poor circulation)
feeling your heart racing, fainting or feeling faint
problems with your digestion, such as bloating, constipation or diarrhoea
your weight being very high or very low for someone of your age and height
not getting your period or other delayed signs of puberty

You can read more about:

Warning signs of an eating disorder in someone else

It can be very difficult to identify that a loved one or friend has an eating disorder.

Warning signs to look out for include:

dramatic weight loss
lying about how much they've eaten, when they've eaten, or their weight
eating a lot of food very fast
going to the bathroom a lot after eating
exercising a lot
avoiding eating with others
cutting food into small pieces or eating very slowly
wearing loose or baggy clothes to hide their weight loss

Beat: get information and support

you or a member of your family has a history of eating disorders, depression, or alcohol or drug misuse
you've been criticised for your eating habits, body shape or weight
you're really worried about being slim, particularly if you also feel pressure from society or your job, for example, ballet dancers, models or athletes
you have anxiety, low self-esteem, an obsessive personality or are a perfectionist
you've been sexually abused

Further information

]]> <![CDATA[When Treatment-Resistant Depression Means Mismatched]]> https://depressionforums.co.uk/chat2026/showthread.php?tid=17 Tue, 01 Sep 2026 19:06:45 +0000 Pip]]> https://depressionforums.co.uk/chat2026/showthread.php?tid=17 https://www.psychiatrictimes.com/view/wh...e=hs_email

When Treatment-Resistant Depression Means Mismatched: Rethinking Difficult-to-Treat Depression
Author(s)Walter Paganin, MD, PhD

Much of what we call "treatment-resistant" depression may be mismatched, not resistant. A psychiatrist makes the case for trading the failed-drug tally for a difficult-to-treat framework clinicians can act on Monday morning.

Case Study
“Cheryl,” a woman in her early 60s, is referred to you with “treatment-resistant depression.” Her chart lists 4 antidepressants across 2 classes over 18 months, 2 of them stopped early for adverse effects, one abandoned without explanation. What dominates the picture is not sadness but a flat, effortful anhedonia: she moves slowly, tires within an hour of waking, complains that her memory “isn’t there anymore.”Buried in her intake, easy to skim past, is a history of early-life trauma, a childhood of chronic adversity and fear, that no prior note has connected to the adult in front of you. Her inflammatory status has never been checked, because why would it be? She is, after all, simply treatment resistant. But before you reach for a fifth agent, it is worth asking a different question: is this resistance, or is it a mismatch?
That question sits at the heart of a shift now underway in the depression literature, one that has not yet reached most of us at the bedside. It is the move away from “treatment-resistant depression” (TRD) toward the broader, more clinically honest construct of difficult-to-treat depression (DTD) and, within it, toward stratifying patients by the biology and the circumstances that are actually driving their illness.

The Trouble With “Resistant”
A systematic review identified 155 distinct definitions of treatment-resistant depression (TRD) currently in use.1 This is not merely a pedantic concern. It means that the same patient may qualify as “treatment-resistant” in one clinic but not in another, depending on how many failed treatment trials are required, how long those trials must last, and whether psychotherapy or neuromodulation are considered at all. The label influences decisions regarding access to advanced treatments and reimbursement, yet it rests on no universally accepted definition.
Worse still, much of what we call resistance may not be resistance at all. A substantial proportion of apparent nonresponders, estimated at between 30% and 60% in some studies, reflects pseudoresistance: inadequate dosing, insufficient treatment duration, poor adherence, unrecognized comorbidities, or pharmacokinetic variability that renders standard doses subtherapeutic in a meaningful minority of patients.1 When treatment adequacy is not rigorously assessed and documented, the prevalence of “resistance” is artificially inflated, leading to potentially inappropriate clinical decisions.
The clinical consequences of this label are far from neutral. Fava and Rafanelli have described a process of “cascade iatrogenesis,” whereby clinicians reflexively move from one pharmacological strategy to another, switching, escalating, and augmenting treatment, before adequately addressing adherence, psychosocial determinants, or considering whether psychotherapy and neuromodulation should already be part of the treatment plan.2 A construct originally intended to identify patients in need of alternative approaches too often results in more of the same.

From Counting Failures to Understanding Difficulty
DTD reframes the problem (Figure). Rather than tallying pharmacological failures, it asks what is actually sustaining the burden.1 The international consensus defines DTD as depression that continues to cause significant burden despite usual treatment efforts, and it shifts the therapeutic target from symptom reduction alone to functioning and quality of life.3 That burden is never the patient’s alone: it is carried by families, who absorb the caregiving, the lost income, and the vigilance about relapse, and by clinicians and services, who accumulate repeated visits, escalating polypharmacy, and their own demoralization when nothing works.3,4 Rush et al make the same move explicit: when remission proves elusive, the goal becomes optimal symptom control and a disease-management approach rather than an endless pursuit of the next agent.5
This is more than semantics. DTD integrates the things the TRD frame tends to push aside: treatment adequacy, functional impairment, psychiatric and medical comorbidity, trauma history, symptom profile, patient goals, and even organizational barriers such as access and continuity of care.4 It abandons the binary responder/nonresponder logic for a spectrum, and it treats chronic depression the way we treat other chronic illnesses, as something to be managed across domains rather than cured in one. For the clinician, the practical consequence is a change in the first question you ask. Not “which drug next?” but “what is making this depression difficult, and have I addressed it?”

Inflammation: A Worked Example of Why Stratification Matters
Among the determinants the DTD frame brings into view, the inflamed subgroup is the clearest illustration of what stratification buys us. Roughly a quarter of patients with major depressive disorder show low-grade systemic inflammation (high-sensitivity C-reactive protein, hs-CRP, ≥3 mg/L).6 These patients respond more poorly to standard monoaminergic antidepressants independent of how severe their depression.7 The phenotype is recognizable: marked anhedonia, psychomotor slowing, fatigue, cognitive complaints—like Cheryl, the woman in the vignette.
The reframing is the important part. Their poor response is not stubbornness of the illness; it is a mechanistic mismatch between the driver (neuroinflammation acting on reward circuitry) and the mechanism of the drug (monoaminergic modulation).8 Calling such a patient “resistant” misnames the problem. They are mismatched, and mismatch is potentially actionable. The logic is simple enough to use: screen with hs-CRP, a test you already order, interpreted during clinical stability and against BMI, smoking, and intercurrent infection; where it is elevated, phenotype further with a parsimonious cytokine panel (IL-6, TNF-α, IL-1β); then align the intervention to the biology rather than escalating blindly.
Here honesty is essential. At present, inflammatory stratification is a tool for phenotyping, prognosis, and enriching clinical trials, not a validated trigger for routine anti-inflammatory prescribing. The evidence for immunomodulatory agents is genuinely mixed: a large trial of infliximab in TRD found no overall benefit, yet in an exploratory analysis a subgroup with elevated baseline hs-CRP (>5 mg/L) improved, which is precisely the argument for enrichment rather than unselected treatment.9 So the near-term value of measuring inflammation is not that it tells you to prescribe a biologic. It is that it tells you why a patient may not be responding, flags those for whom lifestyle, behavioral, and psychosocial interventions are biologically rational early choices, and keeps you from a sixth monoaminergic switch that mechanism predicts will fail.

What to Do on Monday Morning
None of this requires specialized infrastructure. It requires a change in sequence, summarized in the Table. Before you accept “resistant,” verify adequacy of the dose, start a trial of at least 6 to 8 weeks, ensure adherence, and complete therapeutic drug monitoring where pharmacokinetics are in doubt.1 Reconsider the diagnosis, screen for comorbidity, and take a brief trauma history. In the patient who is stalling rather than responding, measure hs-CRP. Assess function and cognition explicitly, not by impression. The Sheehan Disability Scale takes a minute, and a brief cognitive screen, such as the THINC-it battery, captures the deficits patients rate as most disabling.10 Bring psychotherapy and psychosocial intervention forward rather than reserving them for after the pharmacological options are exhausted.3 In everyday clinical practice this is concrete rather than aspirational: a brief trauma history,even a handful of adverse-childhood-experience questions, fits inside a standard visit, can be documented in the shared record and flagged to the collaborating primary care clinician, and turns an apparent “resistance” into a life-course vulnerability that makes trauma-focused psychotherapy a rational early move rather than a last resort. It is also essential to work collaboratively with primary care, social supports, family, and conduct periodic reassessments of the diagnosis itself.

Back to the Patient
Let’s return to Cheryl. Read through the DTD lens, she stops being a dead end and becomes a short list of concrete moves.
First, confirm adequacy: were those 4 trials actually delivered at therapeutic dose for 6 to 8 weeks, with adherence verified? Given the 2 early discontinuations for adverse effects, is tolerability the real story rather than resistance?
Second, rediagnose: her early-life trauma history, the early discontinuations, the prominent anhedonia and psychomotor slowing all warrant a fresh look at comorbidity, including posttraumatic presentations, bipolarity, and medical contributors before another switch.
Third, read the phenotype rather than the failure count: the anergic, anhedonic, cognitively blunted presentation is exactly the profile in which an hs-CRP, a test already on the order set, earns its place, not as a verdict but as one more piece of information.
Fourth, measure what matters: an SDS and a brief cognitive screen turn "she isn't better" into a functional baseline you can track.
Fifth, widen the plan now, not after the next failure: bring psychotherapy, structured psychosocial support, and family involvement forward alongside whatever pharmacological adjustment follows.
The point is not that an inflammatory marker would have "explained" her, or that an anti-inflammatory would have fixed her. It is that "treatment-resistant" closed her case, while "difficult-to-treat" reopens it with a sequence of actions any clinician can run on Monday. The label described our frustration; the framework gives us something to do with it. That is the whole of the shift and it is available now, in the clinic you already work in, with the tests you already order and the colleagues you already have.

Dr Paganin is a psychiatrist and psychotherapist in the public mental health service and holds a PhD in neuroscience at the University of Rome Tor Vergata, Rome, Italy; he also collaborates with Studio Psicologia Signorini, Guidonia, Italy. His research focuses on difficult-to-treat depression and the neurobiology of psychiatric disorders, with particular attention to the role of childhood trauma, and he works with multifamily and interfamilial therapy approaches.

References
1. Paganin W. Treatment-resistant depression: time to rethink current definitions and clinical practice. Front Psychiatry. 2026;16:1733678.
2. Fava GA, Rafanelli C. Iatrogenic factors in psychopathology. Psychother Psychosom. 2019;88(3):129-140.
3. McAllister-Williams RH, Arango C, Blier P, et al. The identification, assessment and management of difficult-to-treat depression: an international consensus statement. J Affect Disord. 2020;267:264-282.
4. Rush AJ, Sackeim HA, Conway CR, et al. Clinical research challenges posed by difficult-to-treat depression. Psychol Med. 2022;52(3):419-432.
5. Rush AJ, Aaronson ST, Demyttenaere K. Difficult-to-treat depression: a clinical and research roadmap for when remission is elusive. Aust N Z J Psychiatry. 2019;53(2):109-118.
6. Osimo EF, Baxter LJ, Lewis G, et al. Prevalence of low-grade inflammation in depression: a systematic review and meta-analysis of CRP levels. Psychol Med. 2019;49(12):1958-1970.
7. McIntyre RS, Alsuwaidan M, Baune BT, et al. Treatment-resistant depression: definition, prevalence, detection, management, and investigational interventions. World Psychiatry. 2023;22(3):394-412.
8. Paganin W. Stratifying the inflamed endotype in difficult-to-treat depression: a roadmap from biomarkers to precision immunopsychiatry. Clin Neuropsychiatry. 2025;22(6):529-539.
9. Raison CL, Rutherford RE, Woolwine BJ, et al. A randomized controlled trial of the tumor necrosis factor antagonist infliximab for treatment-resistant depression: the role of baseline inflammatory biomarkers. JAMA Psychiatry. 2013;70(1):31-41.
10. McIntyre RS, Best MW, Bowie CR, et al. The THINC-Integrated Tool (THINC-it) screening assessment for cognitive dysfunction: validation in patients with major depressive disorder. J Clin Psychiatry. 2017;78(7):873-881.]]> https://www.psychiatrictimes.com/view/wh...e=hs_email

When Treatment-Resistant Depression Means Mismatched: Rethinking Difficult-to-Treat Depression
Author(s)Walter Paganin, MD, PhD

Much of what we call "treatment-resistant" depression may be mismatched, not resistant. A psychiatrist makes the case for trading the failed-drug tally for a difficult-to-treat framework clinicians can act on Monday morning.

Case Study
“Cheryl,” a woman in her early 60s, is referred to you with “treatment-resistant depression.” Her chart lists 4 antidepressants across 2 classes over 18 months, 2 of them stopped early for adverse effects, one abandoned without explanation. What dominates the picture is not sadness but a flat, effortful anhedonia: she moves slowly, tires within an hour of waking, complains that her memory “isn’t there anymore.”Buried in her intake, easy to skim past, is a history of early-life trauma, a childhood of chronic adversity and fear, that no prior note has connected to the adult in front of you. Her inflammatory status has never been checked, because why would it be? She is, after all, simply treatment resistant. But before you reach for a fifth agent, it is worth asking a different question: is this resistance, or is it a mismatch?
That question sits at the heart of a shift now underway in the depression literature, one that has not yet reached most of us at the bedside. It is the move away from “treatment-resistant depression” (TRD) toward the broader, more clinically honest construct of difficult-to-treat depression (DTD) and, within it, toward stratifying patients by the biology and the circumstances that are actually driving their illness.

The Trouble With “Resistant”
A systematic review identified 155 distinct definitions of treatment-resistant depression (TRD) currently in use.1 This is not merely a pedantic concern. It means that the same patient may qualify as “treatment-resistant” in one clinic but not in another, depending on how many failed treatment trials are required, how long those trials must last, and whether psychotherapy or neuromodulation are considered at all. The label influences decisions regarding access to advanced treatments and reimbursement, yet it rests on no universally accepted definition.
Worse still, much of what we call resistance may not be resistance at all. A substantial proportion of apparent nonresponders, estimated at between 30% and 60% in some studies, reflects pseudoresistance: inadequate dosing, insufficient treatment duration, poor adherence, unrecognized comorbidities, or pharmacokinetic variability that renders standard doses subtherapeutic in a meaningful minority of patients.1 When treatment adequacy is not rigorously assessed and documented, the prevalence of “resistance” is artificially inflated, leading to potentially inappropriate clinical decisions.
The clinical consequences of this label are far from neutral. Fava and Rafanelli have described a process of “cascade iatrogenesis,” whereby clinicians reflexively move from one pharmacological strategy to another, switching, escalating, and augmenting treatment, before adequately addressing adherence, psychosocial determinants, or considering whether psychotherapy and neuromodulation should already be part of the treatment plan.2 A construct originally intended to identify patients in need of alternative approaches too often results in more of the same.

From Counting Failures to Understanding Difficulty
DTD reframes the problem (Figure). Rather than tallying pharmacological failures, it asks what is actually sustaining the burden.1 The international consensus defines DTD as depression that continues to cause significant burden despite usual treatment efforts, and it shifts the therapeutic target from symptom reduction alone to functioning and quality of life.3 That burden is never the patient’s alone: it is carried by families, who absorb the caregiving, the lost income, and the vigilance about relapse, and by clinicians and services, who accumulate repeated visits, escalating polypharmacy, and their own demoralization when nothing works.3,4 Rush et al make the same move explicit: when remission proves elusive, the goal becomes optimal symptom control and a disease-management approach rather than an endless pursuit of the next agent.5
This is more than semantics. DTD integrates the things the TRD frame tends to push aside: treatment adequacy, functional impairment, psychiatric and medical comorbidity, trauma history, symptom profile, patient goals, and even organizational barriers such as access and continuity of care.4 It abandons the binary responder/nonresponder logic for a spectrum, and it treats chronic depression the way we treat other chronic illnesses, as something to be managed across domains rather than cured in one. For the clinician, the practical consequence is a change in the first question you ask. Not “which drug next?” but “what is making this depression difficult, and have I addressed it?”

Inflammation: A Worked Example of Why Stratification Matters
Among the determinants the DTD frame brings into view, the inflamed subgroup is the clearest illustration of what stratification buys us. Roughly a quarter of patients with major depressive disorder show low-grade systemic inflammation (high-sensitivity C-reactive protein, hs-CRP, ≥3 mg/L).6 These patients respond more poorly to standard monoaminergic antidepressants independent of how severe their depression.7 The phenotype is recognizable: marked anhedonia, psychomotor slowing, fatigue, cognitive complaints—like Cheryl, the woman in the vignette.
The reframing is the important part. Their poor response is not stubbornness of the illness; it is a mechanistic mismatch between the driver (neuroinflammation acting on reward circuitry) and the mechanism of the drug (monoaminergic modulation).8 Calling such a patient “resistant” misnames the problem. They are mismatched, and mismatch is potentially actionable. The logic is simple enough to use: screen with hs-CRP, a test you already order, interpreted during clinical stability and against BMI, smoking, and intercurrent infection; where it is elevated, phenotype further with a parsimonious cytokine panel (IL-6, TNF-α, IL-1β); then align the intervention to the biology rather than escalating blindly.
Here honesty is essential. At present, inflammatory stratification is a tool for phenotyping, prognosis, and enriching clinical trials, not a validated trigger for routine anti-inflammatory prescribing. The evidence for immunomodulatory agents is genuinely mixed: a large trial of infliximab in TRD found no overall benefit, yet in an exploratory analysis a subgroup with elevated baseline hs-CRP (>5 mg/L) improved, which is precisely the argument for enrichment rather than unselected treatment.9 So the near-term value of measuring inflammation is not that it tells you to prescribe a biologic. It is that it tells you why a patient may not be responding, flags those for whom lifestyle, behavioral, and psychosocial interventions are biologically rational early choices, and keeps you from a sixth monoaminergic switch that mechanism predicts will fail.

What to Do on Monday Morning
None of this requires specialized infrastructure. It requires a change in sequence, summarized in the Table. Before you accept “resistant,” verify adequacy of the dose, start a trial of at least 6 to 8 weeks, ensure adherence, and complete therapeutic drug monitoring where pharmacokinetics are in doubt.1 Reconsider the diagnosis, screen for comorbidity, and take a brief trauma history. In the patient who is stalling rather than responding, measure hs-CRP. Assess function and cognition explicitly, not by impression. The Sheehan Disability Scale takes a minute, and a brief cognitive screen, such as the THINC-it battery, captures the deficits patients rate as most disabling.10 Bring psychotherapy and psychosocial intervention forward rather than reserving them for after the pharmacological options are exhausted.3 In everyday clinical practice this is concrete rather than aspirational: a brief trauma history,even a handful of adverse-childhood-experience questions, fits inside a standard visit, can be documented in the shared record and flagged to the collaborating primary care clinician, and turns an apparent “resistance” into a life-course vulnerability that makes trauma-focused psychotherapy a rational early move rather than a last resort. It is also essential to work collaboratively with primary care, social supports, family, and conduct periodic reassessments of the diagnosis itself.

Back to the Patient
Let’s return to Cheryl. Read through the DTD lens, she stops being a dead end and becomes a short list of concrete moves.
First, confirm adequacy: were those 4 trials actually delivered at therapeutic dose for 6 to 8 weeks, with adherence verified? Given the 2 early discontinuations for adverse effects, is tolerability the real story rather than resistance?
Second, rediagnose: her early-life trauma history, the early discontinuations, the prominent anhedonia and psychomotor slowing all warrant a fresh look at comorbidity, including posttraumatic presentations, bipolarity, and medical contributors before another switch.
Third, read the phenotype rather than the failure count: the anergic, anhedonic, cognitively blunted presentation is exactly the profile in which an hs-CRP, a test already on the order set, earns its place, not as a verdict but as one more piece of information.
Fourth, measure what matters: an SDS and a brief cognitive screen turn "she isn't better" into a functional baseline you can track.
Fifth, widen the plan now, not after the next failure: bring psychotherapy, structured psychosocial support, and family involvement forward alongside whatever pharmacological adjustment follows.
The point is not that an inflammatory marker would have "explained" her, or that an anti-inflammatory would have fixed her. It is that "treatment-resistant" closed her case, while "difficult-to-treat" reopens it with a sequence of actions any clinician can run on Monday. The label described our frustration; the framework gives us something to do with it. That is the whole of the shift and it is available now, in the clinic you already work in, with the tests you already order and the colleagues you already have.

Dr Paganin is a psychiatrist and psychotherapist in the public mental health service and holds a PhD in neuroscience at the University of Rome Tor Vergata, Rome, Italy; he also collaborates with Studio Psicologia Signorini, Guidonia, Italy. His research focuses on difficult-to-treat depression and the neurobiology of psychiatric disorders, with particular attention to the role of childhood trauma, and he works with multifamily and interfamilial therapy approaches.

References
1. Paganin W. Treatment-resistant depression: time to rethink current definitions and clinical practice. Front Psychiatry. 2026;16:1733678.
2. Fava GA, Rafanelli C. Iatrogenic factors in psychopathology. Psychother Psychosom. 2019;88(3):129-140.
3. McAllister-Williams RH, Arango C, Blier P, et al. The identification, assessment and management of difficult-to-treat depression: an international consensus statement. J Affect Disord. 2020;267:264-282.
4. Rush AJ, Sackeim HA, Conway CR, et al. Clinical research challenges posed by difficult-to-treat depression. Psychol Med. 2022;52(3):419-432.
5. Rush AJ, Aaronson ST, Demyttenaere K. Difficult-to-treat depression: a clinical and research roadmap for when remission is elusive. Aust N Z J Psychiatry. 2019;53(2):109-118.
6. Osimo EF, Baxter LJ, Lewis G, et al. Prevalence of low-grade inflammation in depression: a systematic review and meta-analysis of CRP levels. Psychol Med. 2019;49(12):1958-1970.
7. McIntyre RS, Alsuwaidan M, Baune BT, et al. Treatment-resistant depression: definition, prevalence, detection, management, and investigational interventions. World Psychiatry. 2023;22(3):394-412.
8. Paganin W. Stratifying the inflamed endotype in difficult-to-treat depression: a roadmap from biomarkers to precision immunopsychiatry. Clin Neuropsychiatry. 2025;22(6):529-539.
9. Raison CL, Rutherford RE, Woolwine BJ, et al. A randomized controlled trial of the tumor necrosis factor antagonist infliximab for treatment-resistant depression: the role of baseline inflammatory biomarkers. JAMA Psychiatry. 2013;70(1):31-41.
10. McIntyre RS, Best MW, Bowie CR, et al. The THINC-Integrated Tool (THINC-it) screening assessment for cognitive dysfunction: validation in patients with major depressive disorder. J Clin Psychiatry. 2017;78(7):873-881.]]> <![CDATA[Comfort eating]]> https://depressionforums.co.uk/chat2026/showthread.php?tid=16 Tue, 01 Sep 2026 09:56:31 +0000 Amanda]]> https://depressionforums.co.uk/chat2026/showthread.php?tid=16
My compulsions are checking that the front door is locked 3 times whenever I leave the house and checking everything is locked and secure 5 times every night which didn't prevent me from losing 3 close relatives in 2 years which was the main reason for me doing it, as well as counting the stairs every time I went up and down the stairs (there have always been 13).

I've also been comfort eating recently and that's all I thought it was until I read Pip's post about OCD which kinda got the cogs whirring that maybe it's not comfort eating, maybe it's a part of my OCD?

I've already snacked on a sharing packet of crisps, a full sleeve of biscuits and a multi-pack of 8 chocolate biscuit bars this morning and it's not even 11am yet! Could it be my OCD after all or is it really comfort eating like I first thought please?

]]>
My compulsions are checking that the front door is locked 3 times whenever I leave the house and checking everything is locked and secure 5 times every night which didn't prevent me from losing 3 close relatives in 2 years which was the main reason for me doing it, as well as counting the stairs every time I went up and down the stairs (there have always been 13).

I've also been comfort eating recently and that's all I thought it was until I read Pip's post about OCD which kinda got the cogs whirring that maybe it's not comfort eating, maybe it's a part of my OCD?

I've already snacked on a sharing packet of crisps, a full sleeve of biscuits and a multi-pack of 8 chocolate biscuit bars this morning and it's not even 11am yet! Could it be my OCD after all or is it really comfort eating like I first thought please?

]]> <![CDATA[Overview - Obsessive compulsive disorder (OCD)]]> https://depressionforums.co.uk/chat2026/showthread.php?tid=15 Mon, 31 Aug 2026 14:02:38 +0000 Pip]]> https://depressionforums.co.uk/chat2026/showthread.php?tid=15 https://www.nhs.uk/mental-health/conditi.../overview/

Overview - Obsessive compulsive disorder (OCD)

Obsessive compulsive disorder (OCD) is a mental health condition where a person has obsessive thoughts and compulsive behaviours.

OCD can affect men, women and children. People can start having symptoms from as early as 6 years old, but it often begins around puberty and early adulthood.

OCD can be distressing and significantly interfere with your life, but treatment can help you keep it under control.

Symptoms of obsessive compulsive disorder (OCD)

If you have OCD, you'll usually experience frequent obsessive thoughts and compulsive behaviours.

An obsession is an unwanted and unpleasant thought, image or urge that repeatedly enters your mind, causing feelings of anxiety, disgust or unease.
A compulsion is a repetitive behaviour or mental act that you feel you need to do to temporarily relieve the unpleasant feelings brought on by the obsessive thought.

For example, someone with an obsessive fear of being burgled may feel they need to check all the windows and doors are locked several times before they can leave their house.

Women can sometimes have OCD during pregnancy or after their baby is born. Obsessions may include worrying about harming the baby or not sterilising feeding bottles properly. Compulsions could be things such as repeatedly checking the baby is breathing, and intrusive, unwanted and unpleasant thoughts, images or urges. These can cause anxiety and lead to repetitive behaviours.

If you keep getting these thoughts and they have an effect on your daily life, speak to your GP or health visitor. They can support you or refer you to a specialist mental health team if you need it.

Getting help for obsessive compulsive disorder (OCD)

People with OCD are sometimes reluctant to seek help because they feel ashamed or embarrassed.

OCD is a health condition like any other, so there's nothing to feel ashamed or embarrassed about. Having OCD does not mean you're "mad" and it's not your fault you have it.

There are 2 main ways to get help:

refer yourself directly to an NHS talking therapies service – find an NHS talking therapies service in your area
see a GP – they'll ask about your symptoms and can refer you to a local talking therapies service if necessary

If you think a friend or family member may have OCD, try talking to them about your concerns and suggest they get help.

If you’re under 18, or want to get help for someone under 18, find out how to get mental health support for children and young people.

It's unlikely OCD will get better without proper treatment and support.

Treatments for obsessive compulsive disorder (OCD)

There are some effective treatments for OCD that can help reduce the impact it has on your life.

The main treatments are:

talking therapy – usually cognitive behavioural therapy (CBT), which helps you face your fears and obsessive thoughts without "putting them right" through compulsions
medicine – usually a type of antidepressant medicine called selective serotonin reuptake inhibitors (SSRIs), which can help by altering the balance of chemicals in your brain

CBT will usually have an effect quite quickly. It can take up to 12 weeks before you notice the effects of treatment with SSRIs, but most people will eventually benefit.

If these treatments do not help, you may be offered:

an alternative SSRI
a combination of an SSRI and CBT
an antidepressant called clomipramine

Some people may be referred to a specialist mental health service for further treatment.

Causes of obsessive compulsive disorder (OCD)

It's not clear what causes OCD. A number of different factors may play a part, including:

family history – you're more likely to develop OCD if a family member has it. It may be learned behaviour, or possibly because of your genes
differences in the brain – some people with OCD have areas of unusually high activity in their brain or low levels of a chemical called serotonin
life events – OCD may be more common in people who have been bullied, abused or neglected, and it sometimes starts after an important life event, such as childbirth or a bereavement
personality – neat, meticulous, methodical people with high personal standards may be more likely to develop OCD, also people who are generally quite anxious or have a very strong sense of responsibility for themselves and others

Support groups

Living with OCD can be difficult. In addition to getting medical help, you might find it helps to contact a support group or other people with OCD for information and advice.

The following websites may be useful sources of support:

OCD Action, OCD-UK and TOP UK can also let you know about any local support groups in your area.

Social care and support guide

The social care and support guide has advice about where you can get support if you:

need help with day-to-day living because of illness or disability
care for someone regularly because they're ill, elderly or disabled, including family members

More in Obsessive compulsive disorder (OCD)

Overview - Obsessive compulsive disorder (OCD)
Symptoms - Obsessive compulsive disorder (OCD)
Treatment - Obsessive compulsive disorder (OCD)

]]> https://www.nhs.uk/mental-health/conditi.../overview/

Overview - Obsessive compulsive disorder (OCD)

Obsessive compulsive disorder (OCD) is a mental health condition where a person has obsessive thoughts and compulsive behaviours.

OCD can affect men, women and children. People can start having symptoms from as early as 6 years old, but it often begins around puberty and early adulthood.

OCD can be distressing and significantly interfere with your life, but treatment can help you keep it under control.

Symptoms of obsessive compulsive disorder (OCD)

If you have OCD, you'll usually experience frequent obsessive thoughts and compulsive behaviours.

An obsession is an unwanted and unpleasant thought, image or urge that repeatedly enters your mind, causing feelings of anxiety, disgust or unease.
A compulsion is a repetitive behaviour or mental act that you feel you need to do to temporarily relieve the unpleasant feelings brought on by the obsessive thought.

refer yourself directly to an NHS talking therapies service – find an NHS talking therapies service in your area
see a GP – they'll ask about your symptoms and can refer you to a local talking therapies service if necessary

talking therapy – usually cognitive behavioural therapy (CBT), which helps you face your fears and obsessive thoughts without "putting them right" through compulsions
medicine – usually a type of antidepressant medicine called selective serotonin reuptake inhibitors (SSRIs), which can help by altering the balance of chemicals in your brain

an alternative SSRI
a combination of an SSRI and CBT
an antidepressant called clomipramine

family history – you're more likely to develop OCD if a family member has it. It may be learned behaviour, or possibly because of your genes
differences in the brain – some people with OCD have areas of unusually high activity in their brain or low levels of a chemical called serotonin
life events – OCD may be more common in people who have been bullied, abused or neglected, and it sometimes starts after an important life event, such as childbirth or a bereavement
personality – neat, meticulous, methodical people with high personal standards may be more likely to develop OCD, also people who are generally quite anxious or have a very strong sense of responsibility for themselves and others

need help with day-to-day living because of illness or disability
care for someone regularly because they're ill, elderly or disabled, including family members

More in Obsessive compulsive disorder (OCD)

Overview - Obsessive compulsive disorder (OCD)
Symptoms - Obsessive compulsive disorder (OCD)
Treatment - Obsessive compulsive disorder (OCD)

]]> <![CDATA[Grief and depression]]> https://depressionforums.co.uk/chat2026/showthread.php?tid=14 Sun, 30 Aug 2026 18:00:10 +0000 Pip]]> https://depressionforums.co.uk/chat2026/showthread.php?tid=14 https://www.cruse.org.uk/understanding-g...epression/

Grief and depression

Feelings of sadness and hopelessness are really common after someone dies. It's important to recognise when you might need some extra support.

Feelings of sadness and hopelessness are really common after someone dies. These feelings are often referred to in every-day life as ‘depression’.

Sometimes people who are grieving might wonder if their feelings have changed from what they think of as ‘normal’ grief, and become a sign that they might be depressed.

What’s the difference between grief and depression?

It’s important to remember these terms are just labels. There is no easy way of fitting complicated human feelings into neat categories. Grief can be an overwhelming experience and it affects every part of our lives, including our mental and physical health.

Clinical depression is the name for when deep sadness persists over weeks or months. These feelings are also after someone dies, and of course it is possible to be depressed while you are grieving, and vice versa.

What is complicated grief?

Another term you might sometimes hear is complicated grief. It generally refers to situations is struggling to cope with the emotional impact of grief and deal with everyday life many months after a bereavement. It is often associated with situations where the death was very tragic, traumatic or unexpected. Read more about complicated grief.

When is it time to ask for help?

We experience a wide range of feelings and physical experiences after someone dies. Usually these feelings do change over time and slowly become more manageable. If our feelings don’t change and we start to feel stuck it can be useful to get support. If you notice that it’s affecting large parts of your life – for example you can’t get to work or can’t get out of bed – it might be time to reach out for help.

Asking for help

Finding the words to explain how you are feeling can be difficult. It can help to find a bit of time to think about what you want to say beforehand.

If you don’t have anyone you feel able to speak to, or you need help from someone not part of the situation, you can talk to to us. You can also speak to your GP if you are concerned about depression or other ongoing mental health issues. Find out how to get grief support.]]> https://www.cruse.org.uk/understanding-g...epression/

Grief and depression

Feelings of sadness and hopelessness are really common after someone dies. It's important to recognise when you might need some extra support.

Feelings of sadness and hopelessness are really common after someone dies. These feelings are often referred to in every-day life as ‘depression’.

Sometimes people who are grieving might wonder if their feelings have changed from what they think of as ‘normal’ grief, and become a sign that they might be depressed.

What’s the difference between grief and depression?

It’s important to remember these terms are just labels. There is no easy way of fitting complicated human feelings into neat categories. Grief can be an overwhelming experience and it affects every part of our lives, including our mental and physical health.

Clinical depression is the name for when deep sadness persists over weeks or months. These feelings are also after someone dies, and of course it is possible to be depressed while you are grieving, and vice versa.

What is complicated grief?

Another term you might sometimes hear is complicated grief. It generally refers to situations is struggling to cope with the emotional impact of grief and deal with everyday life many months after a bereavement. It is often associated with situations where the death was very tragic, traumatic or unexpected. Read more about complicated grief.

When is it time to ask for help?

We experience a wide range of feelings and physical experiences after someone dies. Usually these feelings do change over time and slowly become more manageable. If our feelings don’t change and we start to feel stuck it can be useful to get support. If you notice that it’s affecting large parts of your life – for example you can’t get to work or can’t get out of bed – it might be time to reach out for help.

Asking for help

Finding the words to explain how you are feeling can be difficult. It can help to find a bit of time to think about what you want to say beforehand.

If you don’t have anyone you feel able to speak to, or you need help from someone not part of the situation, you can talk to to us. You can also speak to your GP if you are concerned about depression or other ongoing mental health issues. Find out how to get grief support.]]>