How swimming in cold water helped a woman with depression give up her pills

And other lifestyle changes can have equally dramatic effects on common illnesses, as a unique BBC experiment showed

AT uNIverSITy, the first lecture I had on medicines opened with a simple statement: ‘drugs don’t work.’ As an opening gambit, this felt like heresy to a group of enthusiastic 18-year-olds embarking on their medical careers. In fact, it was deliberately provocative, to get us to pay attention.

But in the 20 years since that talk, I’ve come to realise it was profoundly true.

There are, of course, a few miracle drugs that extend and improve life: certain cancer therapies, for instance, as well as insulin, drugs for epilepsy, infections, faulty heart rhythms, and even the contraceptive pill. These have all helped millions of people.

But most drugs don’t work well most of the time, for most people.

I’m talking about the drugs we take because the world we live in makes us unfit, unhappy and overweight: antidepressants, painkillers and drugs such as statins.

These are among the biggest selling drugs. Prescriptions for antidepressants and statins have increased by a staggering 300 per cent in the past decade — but compared with non-drug alternatives, such as exercise, their effects are feeble.

Not only that, but like all drugs, they can be harmful.

There’s the harm of specific side-effects, such as gastric bleeding, and there’s the more subtle harm of medicalising healthy people — turning them into ‘patients’ when, with support, they could be living pill-free.

However, because writing out a prescription is so easy, it distracts both doctors and patients from alternative treatments that actually fix the cause of our most common health problems.

And by alternative treatments, I don’t mean crystals or cupping, but interventions that have solid evidence to support them. Primarily, exercise and diet.

But can patients and doctors be weaned off our growing dependence on these pills? This was the aim of a BBC documentary I’ve just spent six months making.

I wanted to treat patients without using any drugs — and, of course, without killing them.

An NHS GP surgery, Churchill Practice in Chingford, London, nervously agreed to allow me to run a (closely supervised) drugfree clinic.

I turned up on my first day quietly confident. I’d explain to patients that the drugs didn’t work well — but that the alternatives did — and pretty soon the practice would be giving drugs only where there was no alternative.

My druG-free clinic would be packed with patients desperate to throw away their pills, shake off their side-effects and get on with life. Not only would patients become healthier, the practice drugs bill would shrink.

I don’t think I’ve ever under-estimated any challenge so severely.

yes, in the end, some of the results we achieved were astonishing — but it all started very badly.

It quickly became clear that it was impossible not to prescribe. On that first day, I saw 40 patients and gave out 39 prescriptions. By the end of the day, I’d have pretty much prescribed anything that anyone wanted, just to try to get every patient seen.

The number one problem is time. Just as I’d started to explain the risks and benefits of a drug, that tiny sliver of time that GPs have per patient (eight to 12 minutes) was up, and I hadn’t even started on what they might do instead.

As my appointments ran later and later each day, conversations with increasingly angry patients about complex issues became impossible. And even when someone did seem keen to try to stop a long-term medicine, there was no immediate alternative.

Physio appointments could take weeks; counselling even longer. I found myself shouting: ‘Lose weight and do exercise,’ lamely as the patients stormed out the door, prescription in hand.

‘It takes 30 seconds to prescribe and 30 minutes not to prescribe,’ one of the GPs said to console me in a 30-second coffee break.

Patients want the quick fix of a drug, and doctors need it. The process is lubricated by the drug companies. Overuse of medication is a problem with many complex causes but one of them is corporate greed.

drug companies have behaved very badly over the past few decades and have paid billions in fines for, among other things, overselling data showing that their drugs work.

They pay drug reps to talk to your doctors about what drugs to prescribe. They also pay pharmacists to go into GP surgeries to ‘optimise prescriptions’.

They’re now banned from supplying GPs with the branded mugs, pads and pens that still litter many practices, but they’re allowed to buy your GP lunch, and there’s good evidence that this kind of thing influences prescribing. Of course it does, or they wouldn’t do it.

They’ve created a culture where the most common treatment for any medical condition is a drug. And trying to run a drug-free clinic in this kind of culture was doomed to fail.

So I decided to target particular groups of patients with conditions traditionally heavily medicated but for which there are decent alternatives. My bargain would be that they’d get no drugs — but they’d have more time with me.

The GPs helped identify a group of people at risk of strokes and heart attacks and who wanted to come off their pills. The patients all had type 2 diabetes, high blood pressure and high cholesterol, and were on statins.

One of them, Mike, told me his pills were like ‘a prison’.

It wasn’t that he was having side-effects, he just hated the idea of being on medication.

drugs make people feel that they’re ill, which, in turn, means they’re less likely to make the lifestyle changes needed for a long and healthy life.

And there’s good evidence that these changes — which are not always easy to make, I know — can be extremely effective.

A large study in 2002 compared the most popular drug for type 2 diabetes, metformin, with diet and exercise and found the drug was about half as effective.

Not only does metformin have nasty side-effects, it won’t reverse type 2 diabetes. But diet and exercise can. My prescription was a miracle cure: it would

improve mood, pain, blood pressure, bone density, anxiety and cholesterol all at once, with no side-effects. And all it involved were five, brisk, 30minute walks a week, as a group, for two months.

The idea of a group was so they could keep each other motivated when I wasn’t there. Participants also stopped their statins.

In many respects this plan, like my drug-free clinic, was also a disaster. Of the original dozen patients, fewer than half kept walking regularly.

But for those who stayed the course, it was far better than I could have imagined. Blood sugar levels improved more than you might expect from a new drug. They also experienced better sleep, reduced aches and reported massively improved moods. All the walkers have decided to keep walking and remain off their statins. (Off the statins, their cholesterol remained high, but eight weeks was too short to change it.)

The GP surgery is now supporting the walking group and report that numbers are growing.

The key thing here is the word ‘support’. We treated the walkers in the same way as if they were on a drug, with regular follow-ups and check-ups.

Doctors normally only have time for a ‘do some exercise and we’ll see you in three months’ — but we gave our patients a clear exercise prescription and ensured they were able to do it.

We also had success with weaning patients off antidepressants. Even the most favourable studies show that for many people, antidepressants are not much better than sugar pills. Side-effects, such as sexual dysfunction, are incredibly common. Some may even increase the risk of suicide in young people.

ThErE is no quick answer for depression. For Sarah, whose story is told in detail below, we decided to offer an activity that would combine lots of the things that we know can help depression: exercise, mindfulness, socialising — and swimming, in cold water, in a lake. It sounds Victorian but there’s science behind this. We took Sarah to see Professor Mike Tipton — a world expert on what happens when the body is put to extremes — and his team at the University of Portsmouth, as well as Dr Mark harper, an anaesthetist with an interest in the effects of cold water on depression.

The theory is that repeated exposure to cold water improves your response to the stress that often accompanies depression.

After a day of acclimatising to the water, Sarah — and I — got totally addicted. Sarah is off her pills, and my wife and I have now joined the ranks of people who will bore you at any opportunity about the power of cold-water swimming. (Try it, but do it safely: see outdoor swimming society.com)

My final group of patients had been on painkillers for many years — even though painkillers don’t work well. Like antidepressants, any effect they have is quite small and the sideeffects are among the most severe.

Some, such as ibuprofen, can cause gastric ulcers and bleeding, while codeine makes you constipated, drowsy and depressed.

Crystal, 36, was on huge doses of Tramadol and codeine (opiates related to morphine) — hardcore painkillers that left her feeling foggy — as well as anti-inflammatories.

She was also on medications to combat the painkillers’ side-effects.

Crystal hated the pills, and if they were working at all, then they weren’t helping her do what she most wanted — to leave the house and find a job.

But when introduced to White Crane Kung Fu, that all changed. This martial art combines strength, balance and mindfulness, and while Crystal is not cured, she’s now off drugs completely and feeling infinitely better.

I don’t think we should ban drugs, but patients should be told the truth about them. Then, if they decide they don’t want them, there should be other options that doctors will support them through.

The changes we saw at Chingford GP surgery weren’t easy, but they all had joyful life-prolonging benefits of the kind you cannot put in a pill.

THE Doctor Who Gave Up Drugs is on BBC1 at 9pm on Thursday.