Mental Health Awareness Week
Khurram Akhter 

In light of mental health awareness week, we spoke with Lead Physician, Khurram Akhter. Khurram has an outstanding history in the medical field, being a doctor for 24 years and a GP for 8 years. His qualifications are as follows: MBBS BSc, nMRCGP, FRACGP. Khurram’s passions lie within the realms of health optimisation and health prevention.  

When people experience anxiety or depression, there is a misconception that the solution is medication. However, mental health is complex, and if we are to start someone on medication, we are assuming that the cause of anxiety or depression is a chemical imbalance in the brain, but is it as simple as this? I would say no. 

In my experience as a health professional advising people daily and as someone interested in health optimisation, I often ask my patients to consider the following first.  

There are four foundations of mental wellness. We need to ensure that strong foundations remain in place to keep your mental health stable. The foundations are exercise, mindfulness, talking therapies, and medication.  

Foundation 1- Exercise  

We all know the physical benefits of exercise: reducing cholesterol, maintaining body weight or controlling blood pressure. What may not be so well recognised are the mental health benefits of exercise. Current guidance states that we should be doing 30 minutes of anything that gets your heart rate up and makes you sweaty five times a week. This can be running, cycling, or even ballroom dancing. But why does exercise help your mental health? 

I shall give myself as an example. If I've had a stressful day and have a lot of clutter in my mind making me anxious or sad, I’ll go for a 30-minute run around the park. The benefits are as follows: 

• Improved muscle stamina and strength from the physical strain of the run. 

• Reduced mental clutter. 

• Improved self-esteem and mood through the release of chemicals called endorphins. 

• Mental resilience through conditioning the brain to overcome challenges by setting exercise targets to achieve.  

Low motivation and energy levels are well recognised symptoms associated with mental health. My piece of advice is that you need to look at exercise as being your “pill” that will get you better. It may take some persuasion to get up and go for a walk or a short jog, and I am sure some patients may dislike me suggesting it when they are on their first few exercise sessions, but by the time you hit your 4th or 5th exercise session, you may start to enjoy it and feel the benefits of exercise. 

I have been through the full cycle of care with many patients with depression and anxiety. Many are prescribed medication, with timescales varying from patient to patient, and are then weaned off their medication once we see that the appropriate adaptations have occurred. A few patients have come to see me a year or so later after ceasing medication, and the conversation generally goes as follows: 

“Doc, my mood has crashed but I do not know why?!”.  

I ask them about work, their family, and finances where they would generally report that they were all good, with no current dramas going on. 

Then I ask them about exercise.  

“Er, I haven’t done any for 6 weeks doc”.  

So, when did your mood crash?  

“About 6 weeks ago…..”. Then the penny drops. This is not a coincidence. If you remove one of the foundations of your mental health such as exercise, your mood will likely change. We must be consistent in the exercise that we do in order to reap the long-term health benefits.  

Foundation 2- Mindfulness 

The second foundation is mindfulness meditation. Mindfulness is defined “as a mental state achieved by focusing one’s awareness on the present”. It helps you to reconnect with your mind and body.  

If your mind lives in the past, you can become depressed. These are the people who reminisce or make comparisons between different stages of their lives and may think things like ‘I preferred my life 10 years ago to what it is now’.  

If your mind lives in the future, you can become anxious. These are the people who think “what if”.  What if I don't meet this deadline? What if I don't send this email? What if I say this or don't say that?  

So, mindfulness teaches you to live in the present. Now, we will not be going into mindfulness techniques within this article, but it is essentially a form of meditation (further information on practising mindfulness techniques in the workplace can be found at Encouraging mindfulness in the workplace | Bupa UK). However, when I suggest such techniques, the typical response I get from patients is ‘’but I don’t have time to do it’’. I disagree. Let me explain.  

In our “busy” lives, if we think long and hard, we have blocks of time in the day where we are doing absolutely nothing (It may not feel like it, but it’s true!). If you can identify these periods of time, you can use this time to invest in your health. Think about it. 

What do you do when you brush your teeth? Staring at yourself in the mirror for 2 mins? Guess what I do whilst brushing my teeth? Bodyweight squats! My wife thinks I am a lunatic, and my kids find it funny and have started doing it themselves!  

Another example is, I commute on the train to work. What did I used to do whilst on my commute? Flick through nonsense on social media.  What do I do now? I play mindfulness music on Spotify (Tibetan bowels if you want to know!) and do a 40-minute mindfulness session.  

Have you got 15 minutes in the morning when you are in bed or 15 minutes in the evening before bed? Use this time and invest in your health! 

Whether or not someone is depressed or anxious, we should all have the foundations of exercise and mindfulness in place. We cannot predict the future, but a good exercise regime and regular mindfulness practices will keep us mentally resilient to deal with arising or unpredicted circumstances.  

It is still possible that these 2 foundations of exercise and mindfulness may not be enough to help you see the appropriate changes in your mood. This is when we start to think about talking therapies and medication. 

Foundation 3- Talking Therapies 

Your third foundation is talking therapies. Therapy is delivered by psychologists with expertise. As with all things relating to mental health, therapy takes time: time for the practitioner to get to know you, understand your circumstances, and then offer you a strategy moving forward. The time it takes to complete a therapy course varies from person to person, so course length is individualised. There are a variety of talking therapies available face-to-face and digitally, here are three examples and what they focus on: 

• Cognitive Behavioural Therapy (CBT): how our thoughts, feelings, and attitudes can influence our actions and emotions. 

• Psychodynamic Psychotherapy: how our unconscious brain (the part we are unaware of) and events from our past can influence our behavior.  

• Interpersonal therapy: how our current interactions and relationships with those around us can influence our emotions.  

Therapy has been proven to provide a range of different health benefits in the form of communication skills, decision-making, managing distress, and so much more. Going down the therapy route can equip you with life-long skills that are transferable to different areas of life. For example, if you are presented with a new challenge in your life, therapy aims to provide you with long-lasting tools and coping mechanisms to weather the storm and ensure that your mood stays stable. In other words, therapy is a lifelong investment in your health.  

Foundation 4- Medication 

Your fourth and final foundation is medication. There are many antidepressants out there and the guidance states that the antidepressant of choice to start with is a Selective Serotonin Reuptake Inhibitor (SSRI) for anxiety or depression. However, today we are just focusing on the principles of treatment rather than treatment choice. Ultimately medications work by manipulating levels of chemicals in the brain. As with many medications associated with mental health, it is not a happy pill. Improvements take time, usually many weeks or months. Once we see the appropriate adaptations in behaviour change, many anti-depressants must be slowly weaned off. It is not that you are addicted to the medication, it is just that your brain gets used to the chemical changes caused by the pill in a way that if you suddenly stop the medication, your brain thinks “Where has this chemical gone?!” and you start to feel symptoms of withdrawal. Thus, time is needed to allow your brain to become used to taking less of the medication over a few months. 

I often ask if my patients are ready to commit to taking the medication as they must be religious in how they take it and attend frequent GP appointments so we can monitor progress. In addition, if they are to commence medication, they need to build the foundations of exercise and mindfulness +/- talking therapy because it is likely a time will come when the medication will be ceased. When this occurs, your foundations must be in place to ensure your mental health remains stable. 

Understanding and incorporating these foundations (especially exercise and mindfulness) in everyday life will put you in a good position to have stable mental health. 

Once this is the case and mental health is stabilised, we can then start to talk about mental health optimisation - how to take your mental health to another level and achieve superhuman status. How to push boundaries beyond the norm and live your best life to the extreme. But for now, we leave you with these four foundations as food for thought.  

At Bupa, we continue to prioritise mental health all year round. Our remote GP team will be walking up Snowdon in June to raise money for charities such as Mind, so keep an eye out for any updates on this activity. This is Health. This is Bupa.  

References 

1. Chekroud, S.R., Gueorguieva, R., Zheutlin, A.B., Paulus, M., Krumholz, H.M., Krystal, J.H. and Chekroud, A.M., 2018. Association between physical exercise and mental health in 1· 2 million individuals in the USA between 2011 and 2015: a cross-sectional study. The lancet psychiatry, 5(9), pp.739-746. 

2. The Oxford Online Dictionary (2024). Mindfulness. Retrieved from https://www.oxfordlearnersdictionaries.com/definition/english/mindfulness?q=mindfulness.  

3. British Association for Counselling and Psychotherapy (2024). What is Psychodynamic Therapy. Retrieved from https://www.bacp.co.uk/about-therapy/types-of-therapy/psychodynamic-therapy/  

4. APA (2017). What is Cognitive Behavioural Therapy? Retrieved from https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral 

5. CAMH (2024). Interpersonal Psychotherapy. Retrieved from https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/interpersonal-psychotherapy#:~:text=What%20is%20Interpersonal%20Psychotherapy%20(IPT,than%20childhood%20or%20developmental%20issues.