Flagging the Therapy: Pathways Out of Depression and Anxiety

284 Pages·2013·1.4 MB·English

by  Barry

Praise for Flagging the Therapy
‘Dr Barry’s first book was truly unique. In Flagging the Therapy, he develops his highly accessible
approach to mental health with a particular emphasis on how different treatments for depression, anxiety
and other psychological problems work. Another superb contribution from one of Ireland’s most insightful
doctors.’
Dr Muiris Houston, medical correspondent, the Irish Times
‘Writing in his inimitable style, Dr Barry describes the various pathways in the brain that underpin the
myriad symptoms of depression, anxiety, post-traumatic stress disorder and so on. By reading the book,
which is liberally studded with case descriptions, patients will be able to identify closely with many of these
reports. Therapists too will find this book very useful as it not only describes pharmacological interventions
but also details the various talking interventions and alternative therapies. Once again, Dr Barry has
achieved his goal of removing the barriers that deter people from seeking professional help due to
embarrassment or lack of knowledge. He is to be lauded for this.’
Prof. Patricia Casey. Department of Psychiatry. University College Dublin
‘This is a truly ground-breaking, innovative and profoundly enlightening work. Dr Harry Barry leads the
reader on a holistic journey through the mind and its. emotional responses in a way that is both explorative
and explanatory. Brilliantly written, it is essential reading for anyone who wants to develop a
comprehensive knowledge of effective approaches to positive mental health in our society.’
Maria Carmody, President. National Counselling Institute of Ireland (NCII)
‘In this intelligent and enlightening study, Dr Barry has managed to combine everyday stories with an easily
understood discussion on the neurobiological basis of mental ill-health. His non-judgemental attitude to the
various ther apies which are at our disposal for recovery and his holistic approach to mental and spiritual
well-being are revolutionary. Flagging the Therapy is not just a book for sufferers of mental illness; it is
mandatory reading for all those who have the slightest interest in good health and human happiness.’
Carol Hunt, Sunday Independent
‘Dr Barry has done medicine and mental health a great service by writing an authoritative yet accessible
exposition on cutting-edge thinking relating to recovery from states of anxiety and depression. This is a
remarkable achievement but, more importantly, the book is a reliable field guide for patients and
practitioners alike. The Salmon of Knowledge has revisited the Boyne! I strongly recommend that you read
this book.’
Dr Justin Brophy, President, The College of Psychiatry of Ireland
‘Flagging the Therapy offers a great understanding to all on how to better one’s life. It will help thousands
with anxiety and depression to understand that they are not alone, and how and why they feel the way they
do; most of all, it offers them hope. I could not put this book down.’
Lisa Fitzpatrick, media/stylist consultant
‘In Flagging the Therapy: Pathways Out of Depression and Anxiety, Dr Harry Barry has once more gifted
us with his encyclopaedic knowledge of depression and anxiety as it presents to the general practitioner.
Extending his unique model of analysing human distress, which he provided in his previous book, Flagging
The Problem: A New Approach to Mental Health, Dr Barry now presents a bio-psychosocial approach that
covers everything from medication to meditation, herbal therapies to homeopathy, and the range of drug-
therapy pathways, alternative-therapy pathways and talking-therapy pathways, to mention but a few. Most
importantly, Dr Barry demonstrates his care, compassion, creativity and commitment, and the importance of
the work of general practitioners, who are at the forefront of promoting health and dealing with ill-health
and societal problems.’
Marie Murray, health columnist with the Irish Times, Director of Student Counselling Services in
University College Dublin, and Director of Psychology at St Vincent’s Hospital Fairview
‘This book provides a highly readable account of the biology of stress, with appropriate advice for those
seeking to rid themselves of the symptoms of anxiety and depression. For those troubled by mood disorder,
the book is an invaluable source of information.’
Prof. Ted Dinan, Department of Psychiatry, University College Cork
‘Flagging the Therapy is a wonderfully insightful book that helps people understand themselves, their
anxiety and depression, and gives them the chance to embrace life again.’
Cathy Kelly, author and UNICEF ambassador
‘Dr Barry is a general practitioner with an extensive range of experience working in communities where
mental-health difficulties abound. Drawing on a wealth of first-hand clinical experience, this very readable
book captures how physical and psychological therapies complement one another in helping people to
overcome anxiety and depression. He charts a truly holistic path to mental health, where both the head and
the heart are viewed as indispensable to achieving healing.’
Tony Bates, founding director of Headstrong: The National Centre for Youth Mental Health
‘Dr Barry has written a fascinating and information-packed tour of mental-health therapies. He takes us
through the science of emotional problems and describes this complex topic using easy-to-understand
concepts and language. The tone brims over with his enthusiasm, wisdom, and everyday experiences as a
treating clinician. Throughout, the emphasis is on the holistic approach, and he couples the research
evidence with his personal views when assessing the effectiveness of the bewildering range of medication
and talking-therapy choices facing anybody with anxiety or depression today. Flagging the Therapy will
help making the right treatment choices easier.’
Prof. Patrick McKeon, Aware

The author would like to acknowledge the particular
assistance provided by leading CBT psychotherapist and
ICGP CBT project director Enda Murphy in writing this
book. His advice, support and technical expertise were
invaluable.
Contents
Title Page
Dedication
Acknowledgements
Connections
A Note to Readers
1 Our Journey Begins
2 The Brain Pathways
3 The Therapy Pathways
4 The Anxiety Pathway
5 The Depression Pathway
6 Our Journey Ends
Technical Section
Drugs and Therapies Commonly Used for Depression and Anxiety
Help Groups and Contact Details
Bibliography
Copyright
Acknowledgements
There are so many people that have played a part in making this book possible. I
would like to start by thanking my editor, Seán O’Keeffe (and his background
staff) of Liberties Press, for seeing its potential and agreeing once again to create
order out of my ramblings. I also thank Peter O’Connell of Liberties for his wise
advice at crucial stages of writing the text and his help with media and
marketing.
I have already mentioned my friend and colleague Enda Murphy and his
invaluable assistance. I have to thank his lovely wife Mei for putting up with the
pair of us through nights of soul searching and hard work.
My thanks go to Cathy Kelly, author and UNICEF ambassador, for her
continuing support and for taking the time from a hectic schedule to review the
book. I also welcome the support and interest of fellow Raggy Doll Club
‘honorary member’ and media organiser Lisa Fitzpatrick, and of well-known
Sunday Independent journalist Carol Hunt, whose articles are so filled with
humour and humanity. These women represent the best of modern Ireland and it
is a privilege to be associated with them.
I also would like to thank Dr Muiris Houston for taking the time to review the
text, and for his friendship and support. His reports in the excellent Irish Times
Health Plus supplement under editor Barry O’Keeffe are widely respected by us
all.
I would like once again to thank Prof. Ted Dinan, UCC, for his support and
useful articles; also Prof. Patricia Casey, whose opinion I greatly value. I would
like to thank reviewer Dr Justin Brophy, President, Irish College of Psychiatry –
a fellow ‘neuroplastic’ advocate; and Prof. Pat McKeon of St Pat’s and founder
member of Aware, for sharing his extensive knowledge of bipolar disorder.
I am indebted to Prof. Paul Salkovskis of King’s College London, an
internationally renowned expert in the psychology of anxiety, for taking the time
to review my humble text. As always, to my dear friend Dr Tony Bates for his
support; and for taking time over dinner and a glass of red wine to share his
wisdom in the area of mindfulness. His work with young people with the
organisation Headstrong deserves our full support; it is a blueprint for what
youth mental-health services should be all about. As always, I am indebted to
psychologist Marie Murray for her constant support and encouragement. UCD
are indeed fortunate to have such a warm, caring person looking after the well-
being of their students.
I must also mention Caroline McGuigan of the No Panic organisation (which
helps so many with anxiety disorders), for her support. My thanks go to Maria
Carmody, of the National Counselling Institute of Ireland (NCII) for reviewing
the book. Having spent some time sharing my knowledge with her students, I
can vouch for the calibre of counsellors being produced.
To all at Aware, particularly CEO Geraldine Clare, Sandra and all the
executive and regional staff, David, our most able chairman, the hard-working
members of the board, and many members around the country – this book is for
you all.
To my loyal and devoted staff at 5 Leland Place – Fiona, Carmel, Susan,
Anne and my practice nurse, Brenda – for all their help and support throughout
the period of writing this book. I am indeed fortunate to have such a wonderful
team at my back. A special thank—you to Lee, and also to Darina, as always, for
her help and support.
To my mother Dilly Barry (Thurles), who has battled illness with bravery and
courage; and my brothers Gerald and Kevin and in-laws Patricia, Una and Nora
for their support and encouragement. To my mother-in-law, Ciss Lahart
(Eyrecourt), who also has shown great courage in coping with illness, for her
help and support down through the years; and to all our friends and relatives who
have backed this project.
There are a number of people who sadly will not be here to see this
published. The first is my brother David. We miss you. The second is our great
family friend, Sister Kieran Saunders, MMM, who is mentioned in the main text.
We miss you so much, Kieran, and pray that you will remain our ‘spiritual
guide’ throughout this mysterious journey through the pathways of life and
beyond. We also remember my father Harry and father-in-law Nicholas, who are
sadly not with us to share this moment.
I have to give special credit to my son Daniel, who has been my right-hand
man throughout the writing of this book. His background in psychological
research has been invaluable, and his superb diagrams adorn and enhance this
book. Without his help, it would have been almost impossible to put it all
together. I am indeed very proud of him. As I am of my son Joseph, whose
sunny disposition, observations and support have kept me going; and my
daughter Lara, who constantly fretted that her dad was overdoing it (as indeed he
was) and whose love and caring nourishes us all. A special welcome to Hans,
who has lit up her life!
I reserve my biggest thank you for my wife Brenda, whose love, friendship,
support, encouragement, and particularly patience have made this book possible.
Writing is a lonely experience not only for the author but also for loved ones
who have to endure their ‘absences’ when writing. Your love has sustained me
through it all.
This book is about connections and in particular pathways. All of us will
have key moments when our lives are transformed by particular occurrences, and
future pathways can be shaped by such. Mine was the moment when, more years
ago than I care to remember, in the Great Hall of Earlsfort Terrace (now the
National Concert Hall), I ‘lost my heart to a Galway girl’. ‘Mo ghrá, mo chroí’.
Connections
A person’s wealth lies not in their possessions, homes, cars or bank balances.
Neither does it lie in their title or position in life, whatever that may be. A
person’s wealth lies in their connections; the bonds that tie us together. All of us
are special and unique, and these connections are represented by the love
between parents and children, husbands and wives, partners, brothers and sisters,
close friends and all the other key relationships in our lives. These are similar to
the connections between neurons in our brain. Both need a positive and
nourishing environment in which to flourish, but shrivel in the presence of
emotional famine. Stress, bereavement and separation, working, commuting and
rearing our children in the cauldron of modern Ireland, and unemployment,
disappointment and illness, can all have a devastating effect on these
connections at various stages of our lives.
Those reading this book are a microcosm of Ireland of the past, present and
future. Many are fortunate in experiencing positive, nurturing relationships with
rich connections. Others, less fortunate, bear the pain and hurt of separation.
Some will have suffered the searing loss of those closest to them, and
accompanying this is the seeming loss of those vital connections. Others have
suffered the pain of illnesses like depression, finding themselves in dark, lonely
places where all connections to those they love seem absent. Some may have
been damaged by interactions with the world of addiction, particularly alcohol
abuse. Others have been damaged by the harsh brutality of life, with its
seemingly uncaring ways.
Apart from the connections with those we love and care for in this world,
there are the connections between us and those who have left to explore the next,
where we pray they are in good company and at peace. Much is hidden from us,
and all is shrouded in mystery. Sometimes those of us left behind struggle in the
tempest of life to keep alive those connections.
Just as connections between neurons in our brains need nourishment, so do
those between us and our fellow human beings. It is love that provides the
greatest nourishment for these bonds. It is my wish that despite any damage, past
or present, to these vital connections, all of us will always try to keep our hearts
open to love: firstly, by shaking off any heavy emotional baggage we may be