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Article in today's Guardian
A year ago, a 24-year-old woman with depression was given an unusual prescription by her doctor: a weekly swim in cold water.
The patient, Sarah, was filmed as part of the BBC documentary series The Doctor Who Gave Up Drugs, presented by Christoffer van Tulleken, a doctor and researcher at University College London.
“It was a series that looked at our most prescribed drugs, particularly where there are weaknesses in the evidence for their effectiveness,” said Van Tulleken. Sarah had been on treatment for major depressive disorder and anxiety since she was 17, but her symptoms were resistant to first-line treatment and the drugs made her feel as if she was in a “chemical fog”.
After she gave birth to her daughter, Sarah wanted to be medication- and symptom-free. Under Van Tulleken’s supervision, she gradually reduced her doses of medication and began a programme of weekly swimming in open water with a temperature of 15C. Within four months of this unconventional treatment, Sarah was drug-free – and her symptoms had stopped.
Depression is a leading cause of disability worldwide, and Van Tulleken says prescriptions for antidepressants are on the rise. “In the real world, antidepressants are taken for many, many years,” said Van Tulleken, adding that the “biggest analysis” of the effectiveness of these medications was a study published in The Lancetthat followed patients for only eight weeks. With this in mind, many researchers are studying alternatives to medication.
Sarah’s story formed the basis for a case report published in the British Medical Journal that Van Tulleken co-authored. In the report, Van Tulleken and his colleagues describe Sarah’s experience and highlight the need for further research to establish if and how cold water swimming might work for other patients.
The body’s initial response to immersion in cold water is an immediate cooling of the skin, which results in cold water shock. This can be extremely dangerous, especially for those with certain medical conditions, as it leads to a massive increase in breathing and heart rate.
Michael Tipton, a professor at the department of sport and exercise science at the University of Portsmouth and a co-author of the report, said: “For years we worried more about the dangerous aspects of cold water immersion rather than thinking about the beneficial side.”
Cold water swimming also activates stress responses in the body, and repeated exposure to cold water can result in a process of adaptation called habituation.
“One theory is that if you adapt to cold water, you also blunt your stress response to other daily stresses such as road rage, exams or getting fired at work,” said Van Tulleken.
According to Shirley Reynolds, a clinical psychologist and professor at the University of Reading who was not involved with the work, there is evidence that doing a meaningful activity like exercise is helpful in and of itself. Reynolds also commented that “a single case can’t tell us anything” about the effectiveness of the intervention, which “could be a natural recovery or response to placebo”.
Van Tulleken said that even if it is the cold water swimming that is responsible for the improvements that Sarah experienced, further studies would be needed to understand why.
Of Sarah herself, he said: “She’s a phenomenal person – she’s just a really unusually strong, resilient, brave person.” And although it’s not clear how the cold water treatment worked, or whether it was a placebo, it has helped at least one person. To date, Sarah remains medication-free and is still swimming.
