Stick it to Depression: Another Tool in Your Doctor's Bag

Praise for Stick it to Depression

Dr Alexander Joannou has written an excellent book, not only for medical practitioners, but also for policy makers in Public Health and members of the public looking to understand different modalities of treatment for depression. As a general practitioner practising in medical acupuncture for over 30 years, Alex’s book provides a detailed account of the useful way acupuncture can be used to treat mental illness. Based on Alex’s personal experience and extensive research, the book offers practical advice and insights in an easy to understand and relatable way. I highly recommend it for medical practitioners interested in providing acupuncture treatment to their patients as part of a holistic treatment plan.

Mark Teng, General Practitioner, Ashfield and Pymble

President, Australian Medical Acupuncture College, New South Wales Branch

Federal Vice President, Australian Medical Acupuncture College

A truly beautiful book about the art of healing! Dr Alexander Joannou suffered a chronic life threatening disease that opened his world to different healing methods to consider and address deeper causes for his illness. This personal journey made him a better, more compassionate doctor to help serve his patients. He now so generously shares his skills and knowledge with case studies of his own patients. I was particularly inspired by his wisdom of the various healing disciplines available whether they are acupuncture, nutritional medicine or mind-body medicine to help heal the patient as a whole: ... the various traditions and techniques allow us to see human beings from a different perspective. Each discipline has its own language to describe what is going on within us. Each discipline has its own strengths and its own weaknesses. None of these disciplines, including conventional Western medicine, can describe the totality of what is going on within each one of us.

Associate Professor Vicki Kotsirilos AM,

MBBS, Awarded Honorary Fellow of the RACGP, FACNEM, FASLM

Holistic GP, Academic, Media commentator, Researcher, Writer

Dr. Alexander Joannou is courageously paving the way for the future of medicine and the treatment of depression. In fact, I’d dare say, the future is now. Acupuncture is both natural and effective for helping people to activate their body’s natural ability to heal. I highly recommend Stick it to Depression, because I know it works.

Dr. Darren Weissman,

Best selling author of Awakening to the Secret Code of Your Mind and Developer of The LifeLine Technique®

Stick it Depression is a generous sharing of knowledge, experience and reflexion generated over three decades of work in a regional general practice. Dr Alexander Joannou has been contributing to health and well-being of his patients striving to provide the best care to every patient through his clinical practice, education and research. His own experience with Crohn’s disease fostered development of more integrative lens uniquely suited to identify and treat the root causes of the complex process behind the illness. This experience naturally led to further exploration of broader values and belief about his own sense of wellbeing. Dr Joannou’s book also explores our multilayered engagement with the world, beyond expression in words, symptoms and known concepts. However, his fundamental insight and curiosity never lives behind scientific underpinning or practicality of daily practice. I enjoyed a reflective stand and synthesis of different approaches and knowledge. It is also noteworthy to notice Dr Joannou’s compassion in sharing his knowledge and experience, which continues to reflect in his day to day work in teaching new generations of general practitioners.

Dr Dubravka Jankovic,

MBBS FRANZCP Consultant Psychiatrist,

Clinical Director of Bindarray Clinic

Good introduction for GPs on the limitations of modern medicine in the diagnosis and treatment of mental illness. Alternative options are explored including acupuncture. Great book for GPs looking to expand their repertoire of treatment options for what is a debilitating and devastating illness we see every day.

Dr Adrian Gilliland,

GP, Coffs Harbour

I need to thank Dr Alex for showing me what my medical education has been missing. I wish that all of my colleagues could read this book and have the same positive outlook on the future of mental health as I do now.

Arree Fielding,

Medical student

First published 2019 by Indie Experts

PO Box 1638, Carindale

Queensland 4152 Australia

indieexperts.com.au

Copyright © Alexander Joannou 2019 – All rights reserved.

Apart from any fair dealing for the purposes of study, research or review, as permitted under the copyright act, no part of this book may be reproduced by any process without written permission of the author.

Every effort has been made to trace and acknowledge copyright material; should any infringement have occurred accidentally, the author tends his apologies. Product and other names used herein may be trademarks of their respective owners. The author disclaims any and all rights in those marks.

Cover design by Maria Biaggini @ Indie Experts

Edited by Samantha Sainsbury

Internal design by Indie Experts

Typeset in 11.5/15 pt Adobe Garamond Pro by Post Pre-press Group, Brisbane

ISBN 978-0-6487018-1-1 (epub)

ISBN 978-0-6487018-2-8 (kindle)

Disclaimer:

The content of this book is for informational purposes only and is not intended to diagnose, treat, cure, or prevent any condition or disease. You understand that this book is not intended as a substitute for consultation with a licensed practitioner. Please consult with your own physician or healthcare specialist regarding the suggestions and recommendations made in this book. The use of this book implies your acceptance of this disclaimer.

For Karina, who opened my eyes to seeing the body from another perspective

And for my Ruby Rose, without whom this book would not have been written

Contents

Foreword: The Changing Landscape of General Practice

1 Another Tool in My Doctor’s Bag

2 DSM Approach to Mental Illness

How is Depression Classified and Why Bother?

What is Depression?

A Simpler Classification of Depressive Disorders

The Dangers of Pigeonholing

The dangers of multiple diagnoses

3 The Solution: Pills, Pills, Pills

The Rise and Rise of SSRIS

Trust Me, I’m a Drug Rep

Post-Marketing Surveillance

A Shocking Side Effect

4 What Crohn’s Disease Taught Me About the Modern Medicine Model

5 Body Maps

Pathology: The Biomedical Model

Yin Yang and the Autonomic nervous system: The Traditional Chinese Model

Chakras and Maslow’s Hierarchy of Needs: The Indian Ayurvedic Model

6 Why Acupuncture? Why Not?

The Acupuncture Evidence Project

7 Case Studies

8 Acupuncture FAQs

Conclusion: Another Tool in Your Doctor’s Bag

About Alexander Joannou

Acknowledgements

Other books by Alexander Joannou

Foreword

THE CHANGING LANDSCAPE OF GENERAL PRACTICE

I have been a general practitioner in Coffs Harbour, New South Wales since October 1982 and am still practicing. There is nothing like time to give one a perspective of things and 37 years in the one medical practice has given me a long span of time to see many changes in medical practice.

I started off as a solo practitioner, practicing from my house. The essential equipment included my prescription pad, letterhead paper for referrals and medical certificates, and a pen, together with my torch, tongue depressors, otoscope, stethoscope and mercury sphygmomanometer. With these I could cover the vast majority of consultations.

My receptionist was equipped with my appointment book, telephone, a manual typewriter and the ‘book’. Patients knew that their consultations would be bulk-billed by ‘signing the book’. The book consisted of a batch of 50 forms assigning the patient’s rebate to the doctor. Once the book was filled, my receptionist posted it to the then HIC – the Health Insurance Commission (the forerunner of Medicare). If errors were made in the book, it would be posted back for correction, often with all 50 claims rejected. These were corrected and posted back to the HIC. It was not unusual to take two weeks or more to be paid.

Oh, did I mention the eight by four cards? These cards were eight inches by four inches in dimension (that’s around 20cm by 10cm for you young-uns). These were used to record the consultations. There was room for name, date of birth, address and phone number at the top of the front side, and my receptionist would date stamp it when the patient arrived. (Yes, with a literal date stamp). This was suitable for short presentations of an acute illness, but not much more. I found myself squeezing a list of a patient’s ongoing medical conditions into the demographic section of the card and carrying that over to the next card which was stapled to the front of the original card. I would highlight ongoing medications with a yellow highlighter to remind myself what medications and what dosages a patient was on. As for a reminder system, that was non-existent. I would rely on the patient’s memory to remember when a pap test or colonoscopy was due.

General practice was the frontline for acute illnesses in those days, especially childhood infectious diseases. It still is of course, but the sheer numbers made these acute presentations a much greater part of my working week. Measles used to do the rounds every three or four years, and in its peak years it would be not uncommon for me to see a dozen cases or more a week. Similarly, chickenpox, mumps and rubella. Together with the frequent coughs and colds of childhood and the frequent coughs and colds of the more prevalent adult cigarette smokers, I think the majority of my consultations then would have been these types of acute and short presentations. Without the huge number of older patients and the huge number of patients with chronic medical problems, it was nothing to average two hundred patients a week.

Record keeping was short and to the point. There was no such thing as computerisation, and therefore no demands from the electronic health record prompting checks for blood pressure, smoking status, allergy status, health assessments and so on. As an aside I began using an electronic health record with Medical Director for Windows version 1.0 in August 1996. I immediately noticed a lengthening of my consultations, due to the demands of the computer and all its reminders and flags. The longer consultations have continued to this day.

In those early days mental illness was not so much an issue. Sure, there were patients with depression and panic attacks as well as those with psychosis. Those with psychosis were usually handled by the local hospital’s mental-health unit staffed by the town’s one and only psychiatrist and one psychologist. The main option for the depressed was the tricyclic antidepressants. The side effects of daytime sleepiness and dry mouth limited their use to the severely depressed. I guess, I would have prescribed antidepressants around a half dozen times a week, if that. The anxious were prescribed benzodiazepines. There was a large array to choose from, but Valium was most patients’ favourite. Insomnia was a large problem, especially with the elderly, and they usually picked up a script for their moggies (Mogadon – nitrazepam) and seres (Serepax – oxazepam) while attending for other reasons. This added only about 30 to 60 seconds to a consultation. In retrospect, their insomnia was probably due to unvoiced and unresolved psychological