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Content warning: This piece mentions misccariage and pregnancy loss. A year ago, my world stopped. At my 12-week scan, I was told there was no heartbeat. What should’ve been the first time seeing my baby move was instead the day I learned I’d lost them weeks earlier. I remember the quiet in the ultrasound room, the cold gel on my stomach, the way the sonographer’s expression shifted before the words came. Even now, I can still feel the shock in my chest — that hollow, slow-motion moment when time folds in on itself. What followed was a blur : the A&E visit that lasted through the night, the physical pain, the emotional pain... There’s a before and after version of me — and a year later, I’m still learning how to live in the “after.” Source: Authors own image The compassion that followed What surprised me most wasn’t the grief itself, but how deeply it was shared. I’d already told my family and my in-laws that I was pregnant, so when we lost the baby, I didn’t have to face it in silence. They shared their own stories of loss, ones that had stayed tucked away until then. We cried together, talked about the babies we’d never get to meet, and held space for each other’s pain. It wasn’t the kind of comfort that tried to make things better — it was the kind that simply said, I see you, I know this pain too. That connection made the grief feel less lonely. It reminded me that love doesn’t disappear with loss; it just changes form. Later, when I began sharing parts of my story online, that same compassion rippled outward. Messages came from friends, acquaintances, and strangers — each one another thread in a quiet network of women who understood. It was both heartbreaking and deeply human to realise how many of us are walking around carrying this kind of invisible love. Grief doesn’t follow a timeline At first, my grief consumed everything. I couldn’t go into a baby aisle, open pregnancy apps, or hear the word “due date” without crying. I avoided social media entirely because every pregnancy announcement felt like a personal attack. But with time, those sharp edges dulled. The grief still lives with me, but now it sits quietly beside the rest of my life instead of swallowing it whole. The hardest days are the ones that sneak up unexpectedly — a random Tuesday when I see a baby who looks the age mine might’ve been. Anniversaries, scan dates, and imagined milestones all hit differently. But I’ve learned that sadness doesn’t mean I’ve gone backwards; it’s just part of carrying love for someone I never got to meet. Source: Authors own image The mental toll of miscarriage For a long time, I didn’t fully grasp how deeply miscarriage affects mental health. I’d experienced anxiety before, but this was different — a mix of trauma and loss that I couldn’t logic my way out of. Research supports what so many of us feel: miscarriage can trigger anxiety, depression, and post-traumatic stress symptoms. According to a recent study, nearly one in three women met the criteria for PTSD one month after early pregnancy loss . And yet, psychological care after miscarriage is rarely offered automatically. Most of us are sent home with a leaflet and told to “take care.” What helped me most wasn’t a single fix, but a mix of small things that built up over time: acupuncture, walking outside every morning, reconnecting with my body through slow movement rather than punishing workouts. I had to rebuild trust with myself, physically and emotionally. I started eating warm, nourishing meals, drinking warm drinks, and keeping a journal (even when I didn’t know what to write). Healing became less about trying to “get over it” and more about learning to feel safe again. Trying again Trying to conceive again after loss brings its own storm of emotions. Hope and fear live side by side — sometimes in the same breath. Each cycle can feel like a test of endurance. I track my hormones, watch for ovulation, and ride the wave of cautious optimism followed by the gut-punch of a negative test. It’s exhausting, both mentally and physically. And yet, I keep going. Not because I’ve “moved on,” but because I’ve made peace with uncertainty. I’ve learned that grief and hope can coexist, that wanting another baby doesn’t replace the one I lost. Some months, I cope by treating trying to conceive like a personal project: tracking my sleep, nutrition, and supplements with almost clinical precision. Other months, I give myself permission to do nothing but rest. I’ve learned to listen to what my body and mind need, rather than forcing myself into a fixed plan. Source: Authors own image What’s changed in a year A year on, I feel stronger: not in the motivational quote way, but in the quiet resilience that comes from surviving something that could have destroyed me. I can look back at that version of me in the hospital and know that she didn’t break — she adapted. There’s still sadness, but it no longer defines me. I’ve found joy in small things again: in the warmth of my cat sleeping beside me while I work, in walks with my husband, in cooking dinner together without talking about ovulation or test strips. Something else changed, too. Last week, I looked at my pregnancy scan, at the baby I’d lost. I’d never looked before — it was too much. It’s taken time, but now, I can look at that snapshot of what might have been, hold space in my heart for them, and feel a rush of hope for the future. How I’m coping now Coping a year later looks different than it did at the start. It’s not about “staying positive”, it’s about balance. Here’s what that looks like for me: Routine: Structure keeps me grounded. I wake up at the same time every day, take my supplements, walk outside, and eat balanced meals. It gives my brain the consistency it craves. Connection: I’ve built gentle boundaries around who I talk to about fertility, but I’ve also found deep comfort in online communities where people truly get it. Self-compassion: I remind myself that healing isn’t a race. Some days I feel okay; others, I cry for no reason. Both are part of the process. Hope: I still believe my story isn’t over, even though I don’t have a baby in my arms yet. Whether that means a natural pregnancy, IVF, or adoption, I trust that good things are still coming. Celebrating: I’m learning to celebrate the small things and live in the moment. Friends’ baby milestones can still be hard, so I give myself time out when needed — then come back to celebrate with them, authentically. Source: Authors own image - Tassia and her husband exploring Dartmoor What I wish others knew If you’re supporting someone after miscarriage, know that you don’t need to fix it. Just showing up — sending a message, dropping off food, saying, “I don’t know what to say, but I’m here” — can mean everything. And if you’ve been through a miscarriage yourself: you’re not broken, and you’re not alone. You don’t have to rush to be okay. The sadness might never disappear completely, but it can transform into something softer: love, empathy, strength. One year later, I’m living again. Not like before, because loss changes you. But in a way that feels deeper — more aware of how precious life really is. I used to think healing meant forgetting. Now I know it means remembering with peace. This article has been sponsored by the Psychiatry Research Trust,  who are dedicated to supporting young scientists in their groundbreaking research efforts within the field of mental health. If you wish to support their work, please consider donating.

Image Source: cottonbro studio on Pexels I’ve never found Mondays particularly stressful. Over time, I’ve learned to manage my energy more intentionally, and as a freelance journalist, I’ve picked up strategies that work for me. For instance, if I work over the weekend, I try to keep my Mondays lighter, a way to ease back into the week and protect my mental balance. But if I worked in a company or had an office role with fixed hours, that kind of adjustment would be much harder to put into practice. My interest in how work affects mental health started during the pandemic, when conversations around wellbeing became more urgent and visible. Companies began offering psychological support to employees, and mental health, long treated as a private issue, finally entered the workplace agenda. Remote work, for instance, made it easier to see just how closely mental health is tied to the way we structure our time. The pandemic didn’t just change where we work, it accelerated a cultural shift. We started talking much more openly about stress, realising just how many people are affected by it, and how often work is a major cause. For many, a sense of discomfort even begins on Sunday, just thinking about the return to work on Monday, a day often loaded with meetings, deadlines, and expectations of high productivity. Maybe the stress we associate with Mondays isn’t just about facing a new workweek. Maybe it’s something we’ve internalised over years of repetition, a pattern that’s harder to break than we think. But how deep does this pattern go? One study tried to find out, and the results were surprising: even after retirement, Monday remains the most stressful day of the week. A study of over 3,500 adults aged 50+ found that those who felt more anxious on Mondays had 23% higher cortisol (a stress hormone) levels than those who didn’t report a difference in stress among weekdays.   “Feeling anxious on Mondays is correlated with long-term biological stress responses,” says Tarani Chandola from the University of Hong Kong, who led the study. He answered my questions over email, keen to explain the broader implications of the findings.  “The fact that this persisted suggests that the biological consequences of feelings of anxiety on Monday over the life-course do not go away when people retire,” he says.   His team analyzed data from the English Longitudinal Study of Ageing, a long-running national study that, since 2002, has tracked the health, social, and economic wellbeing of adults aged 50 and over in England. Participants were interviewed and completed questionnaires with questions like, “Overall, how anxious did you feel yesterday?” and answers were rated on a sliding scale from “not anxious at all” to “very anxious”. By examining hair samples, the researchers also measured fluctuations in the participants' levels of cortisol, a hormone released throughout the body in response to stress. Since cortisol accumulates in hair over time, it provides a cumulative record of stress exposure lasting weeks or even months, making it a reliable indicator of long-term or chronic stress. The team then compared these cortisol levels with reported feelings of anxiety on different days of the week. Image Source: Pedro Figueras on Pexels Chandola has been studying cortisol responses to work-related stressors for a long time, and it’s well established that our cortisol levels follow a diurnal rhythm. Cortisol levels peak about 30–45 minutes after waking up in what’s called the cortisol awakening response, helping the body prepare for the day’s demands. After this peak, cortisol gradually declines throughout the day, reaching its lowest levels around midnight and during early sleep. While cortisol levels fluctuate significantly throughout each day, hair samples measure cortisol that has accumulated over several weeks or months. Chandola wanted to investigate whether a similar pattern exists in response to weekday compared to weekend stressors – and the results surprised him.   Participants who reported feeling anxious on Mondays had hair samples with cortisol levels 23% higher than those who didn’t report a difference in stress among weekdays. “It is important to remember that stress is not just a feeling or emotion, but has biological and physiological consequences,” says Chandola.   Interestingly, this effect persists beyond work. Even some retirees reported feeling anxious on Mondays and had higher average cortisol levels compared to retirees who felt anxious on other days or not at all. Chandola thought that retired people would no longer show this pattern of higher cortisol levels and feelings of anxiety on Mondays. “The fact that it persists suggests that the biological consequences of Monday anxiety, built up over the course of a lifetime, don’t simply disappear after retirement,” he says. Image Source: Tim Gouw on Pexels This challenges the common belief that "Monday stress" stems solely from workplace pressures, suggesting instead that the stress associated with Mondays is internalised and persistent. In other words, the stress is not just a reaction to immediate job demands but becomes embedded within a person's psychological or emotional state. This means individuals may carry feelings of anxiety or tension related to Mondays even outside of work or after retirement, reflecting deeper patterns of how they process and hold onto stress over time.   In order to understand the study better, I reached out to Christopher Engeland from Pennsylvania State University. He is an expert on how stress, age, gender, and hormones affect immunity, inflammation, and health. He was not involved in the study but still confirms these findings. "If Monday is indeed the most stressful day of the week and if stress on this day is particularly linked to problems in the body’s stress response system, then these findings have important implications for both stress and health research and for the timing of potential interventions,” he says. The findings are intriguing, Engeland points out, particularly given that the same effects were observed regardless of employment status. Most stress researchers treat Monday like any other weekday, says Engeland, and findings like these could help better tailor our understanding of high-stress moments throughout the week instead. "Interventions aimed at reducing stress, like mindfulness, meditation, yoga, exercise, expressive writing might work better if they are scheduled for Mondays," says Engeland, or if extra care is taken to not skip or miss these stress-reducing practices on Mondays.   Realising that Monday stress might come from patterns we’ve absorbed over time makes me more mindful about protecting how I start my week. Noticing how I feel, and taking it seriously instead of brushing it off, feels like a small but meaningful way to take care of my well-being. If stress can shape our biology so deeply that it lingers into retirement, then learning to break these cycles becomes more than just a matter of comfort, it's an investment in long-term health. Finding ways to recover from years of long-standing stress might be the first real step toward change. Perhaps reimagining how we begin our weeks could be one of the simplest, yet most powerful, ways to ease the hold that stress has on us.

I am a current PhD student at UCL and Research Fellow with the UK Trauma Council. I was previously a Research Assistant working on the Adolescence Mental Health and the Developing Mind (AMHDM) ReThink Programme. My work explores how experiences of early adversity (especially care experience) shape mental health, and how research can meaningfully involve those it aims to serve. I wrote this blog to reflect on the "Adolescence, mental health and the developing mind" (AMHD) “Speaking Across Lines” symposia and to share why involving young people as partners in mental health research is so vital.  Historically, young people’s voices have often been left out of research concerning their own mental health. Today, researchers and funders increasingly recognise the importance of involving them as partners throughout the research process — from planning and design through implementation and evaluation. This collaborative approach is known as co-production and is grounded in the principle that those most affected by research should play a critical role in shaping it.     The Speaking Across Lines  symposia, part of the AMHDM initiative , brought early career researchers and young people together as co-creators to discuss meaningful approaches to mental health research. In this blog, four of the AMHDM young advisors — Kieran, Mya, Sophie, and Tyler — shared their experiences of planning and delivering the   symposia. They reflected on what researchers can do to ensure youth involvement in mental health research is ethical, impactful, and beneficial. Our young advisors gave their consent for their names to be shared in this blog.        How did the young advisors contribute to the planning and delivery of the symposia?   Sophie and Mya focused on “making events engaging and accessible for young people”,  by suggesting icebreakers that would “build connections”, “promote inclusivity” and  “make all participants feel comfortable ”. Kieran helped shape the symposia content: “I suggested exploring how social media could be used differently [...] and being mindful of tone and communication style when professionals post.”     Why young advisors’ involvement matters    Young people are experts in their own lives and can therefore offer perspectives and insights that adults overlook, such as trends in social media use. Mya commented that “Including these perspectives helps ensure that the research truly resonates with the intended audience and addresses gaps that researchers without similar experiences might overlook”.   Tyler highlighted how young advisors’ different perspectives can shape better research design: “It is important for researchers to consider socio-economic factors that might limit someone’s participation in research, such as lower educational attainment due to needing to support family or as a result of class”. Tyler explained , “Young people may also face pressure relating to age, for example, identity issues or work pressures which affect their willingness to participate”. They added , “Researchers should consider how they are reaching young people, for example through social media, so this fits into young people’s time constraints.”     Young advisors can also ensure research is designed, implemented, and shared in ways that are accessible to the people it is meant to serve. As Mya put it: “Working collaboratively allows knowledge from both lived experience and academic research to be combined, helping to communicate more effectively with young people about mental health”. Sophie highlighted how the language we use can make a big difference: “Excessive psychological jargon can be a factor in separating young people from these conversations, and limiting that is a helpful tool ”. This emphasis on language reflects wider evidence: a recent systematic review found that accessible language is crucial for meaningful youth engagement in mental health research. Our young advisors also reminded us of the importance of including young participants with diverse lived experiences. As Tyler explained: “Researchers should also think about extra pressures facing minority groups, for example ensuring online questionnaires are presented in an accessible format for people with disabilities.”   How to make involvement meaningful and ethical    For involvement to be meaningful, young advisors should be engaged as equal partners in shaping knowledge, with their expertise valued alongside academic expertise. For Kieran and Sophie, this equal partnership was the most rewarding part of contributing to the symposia. Kieran said “What I enjoyed the most about contributing to the event was being able to be listened to as an equal, and that no idea that I or anyone in the team had was disregarded or abandoned. All ideas were taken seriously and onboarded”. Sophie echoed this: “What I enjoyed most was feeling like my voice was valued in shaping an academic space”.     To ensure this is done ethically, Kieran thinks researchers must approach working with young advisors with "respect, sensitivity, and a strong ethical framework”.  In his words this meant creating safe and inclusive spaces, being mindful of power dynamics, building trust over time, prioritizing safeguarding, and being responsive to the emotional impact of research on participants . Kieran's reflections echo wider research, which stresses that while youth involvement in mental health research is increasingly valued, it should be done in an ethical manner with appropriate safeguards in place.  Benefits for young advisors   Young advisors’ involvement is not only about what they can contribute to research, but also what they can gain in return, e.g., offering opportunities to develop knowledge and skills, build confidence, or meet new people. Research suggests that the highest levels of youth involvement are achieved when partnerships are mutually beneficial .    Involving youth in research can be an opportunity for them to learn more about research. As Sophie said: "Participating in this event significantly shifted my perspective on what research can look like. I previously viewed research as being conducted by experts in academic and lab settings but being involved in this symposium illustrated that research can be collaborative, inclusive, and creative.” Mya also noted this, saying that participating as a young advisor had “helped build my understanding, curiosity, and enthusiasm for science”.     These opportunities can also help young people explore new ideas and consider future paths and opportunities. For Tyler:  “This event has made me consider working within research [...]. I found this event useful in considering aspects of mental health that I hadn’t considered before, e.g., the impact of theatre in research participation of neurodiverse individuals, which got me wondering how my arts interests could be combined with my academic interests.” Similarly,   Kieran reflected: “It reinforced my ambition to become a researcher who centers co-produced, media-led narratives in academic work [...]. I gained a deeper appreciation for diverse research methods that prioritize accessibility, creativity, and emotional safety.” In line with this, Sophie said that “this experience has deepened my interest in mental health, psychology research and policy making [...]. Every single moment was a new experience for me, and experiences that I’ve been able to try and incorporate into my work.” Finally, Mya noted that “Participating in this event has encouraged me to continue contributing to research and to explore topics beyond my main area of interest [...]. This experience also deepened my understanding of mental health and broadened my interest in other areas of research, allowing me to learn and engage with current and relevant topics in an alternative way”.   Speaking Across Lines illustrated what is possible when young people are actively and appropriately involved in research. As Kieran reflected: “It showed me how research can be a shared process, where lived experience and academic insight work together to meaningfully shape outcomes.”

Image source: Daniel Sherman on Unsplash Content warning: The following short story contains references to drug misuse. Work karaoke was his idea of hell, to be honest, though Matt strung along for the free bar. He sipped his pint too swiftly as he propped up against a faux marble pillar, watching his colleagues mingle while an analytics guy in Digital massacred I’d Do Anything for Love by Meatloaf. Third beer, already. Gonna be p****d at this rate. Nice view, though. The company had gone large for the anniversary and hired out a Kensington hotel, rooftop venue, windows framing Harrods in the sunset.   Given they were a trendy media conglomerate, there was the odd B-list celeb on the payroll, swanning around the room. Matt’s job was nothing as exciting. He compiled quizzes on the likes of Fleetwood Mac for the radio station website, and often, when he was coming up with multiple choice answers on the origin of Rhiannon ,   he questioned why his role existed and why anybody paid him to do this task. On the sunnier side, he’d learnt an awful lot about the 1976 recording of Rumours  and would probably be shit-hot in the music round of a pub quiz, should anybody invite him.   “Hiya, Matt.”   Lizzie had ambushed him, appearing around the side of the pillar before he could sidle away. She was in a light pink dress. He almost didn’t recognise her without the glasses, and was struck by the revealed angularity of her features. Her eyelids gleamed with an ultramarine eyeshadow.   “Hi Lizzie!” He had to shout over the operatic rock. His breaths became shallow, and he downed the remainder of his pint. “Do you want a drink?”    “Are you offering?”   “No, it’s a free bar.”   “I know, Matt, it was a joke.”   “Oh!”   He bared his teeth in a silent impression of laughter. Sometimes he left social events massaging an ache in his facial muscles. They moved to the waistcoated bartender, where Matt ordered a white wine and, for himself, a fourth pint.   He had developed a desperate strategy for The Panic. Questions were his number one weapon. Matt flung an interrogation at Lizzie, barely able to register a word as she explained the intricacies of rewriting HR policies, and he nodded as if she’d just stumbled down the mountain with a prophecy fresh from the burning bush.   “Anyway,” she said. “I’m boring you with all my EDI stuff–”   “Oh god, not boring at all.”   “How are things with you?”   He grasped the new pint and took a big swig. People were just too polite. Matt heard himself begin to splutter, “– ah, well, you know, Soul’s hit 200k followers – yeah, yeah, real, uh – achievement, the team’s – um – pumped”, and then he was Lizzie watching him. Matt Hawthorne, corpse, live at the Apollo. Each excruciating pause and wild-eyed search for those greasy words, and f*****g  hell, it was hard to keep a conversation going when your brain had morphed you into both participants.   Strangely, his monologue didn’t seem to have put her off. Lizzie, face flushed red in the mood lighting, pointed her wine glass at the stage.   ‘Fancy a duet?’   Matt stroked the baggie in his pocket.   ‘Nah, I’m gonna do some coke.’   ‘You’re going to get a coke?’   ‘No, I’m going to do cocaine.’   Her face became very serious. She touched his hand lightly, and his body stiffened.   ‘Matt, I’m not being funny, but you’ve got to be careful. A person I knew at uni died from a heroin overdose.’   He nodded, oddly moved by her concern.   ‘Don’t worry, I’ve done it a load of times.’   ‘Do you think you’re addicted?’   ‘No. It’s just, you know, fun. Like your wine.’   She looked baffled, then shook her head.   ‘I think I need another wine.’   He smiled at her, as happy-go-lucky as he could muster, then fled to the bathroom.   After, Matt headed back to the bar. He bantered easy football chit-chat with a lad in Commercial as he ordered a Peroni and suavely closed the conversation down before becoming trapped. This, my son, was how you lived.   He clocked Cecilia, Head of Soul, at a cabaret table and thought now was a good time to have that shadowing chat. Right then, he could envisage his stellar career: learn the production ropes on Soul, jump ship to Radio 1, then make the leap to TV. Earn the big bucks, become a man who mattered. Cecilia offered him a glass of Prosecco – ‘nah, I mix the beer and the fizz, Ceel, and I’ll be up there doing Gangnam Style ’ – and she actually laughed at his joke. Matt was king of the world.   “Oh dear,” Cecilia murmured “she’s worse for the wear.’   Lizzie was stumbling up the stage steps. The Mancunian compere, vaguely familiar from some comedy quiz show, took her hand.   “Had a couple of VKs, darling?”   “Chardonnay.” “How many bottles?”   A laugh swept over the crowd. Lizzie slapped him on his breast pocket.   “Don’t be rude.”   Several people took out their phones to record. The compere played for the gallery as he handed Lizzie a microphone.   “What’s your song then?”   “Can I say something first?”   The compere winked at the crowd, “The floor’s yours, babe.”   Lizzie squinted into the stage lights, “I want to say to Matt Hawthorne –”   A nausea cut through the coke high. Cecilia looked at him, amused. Matt kept his eyes rigidly fixed on the stage.   “ Don’t let it consume you.”   The compere giggled.   “Okay…! What’s your song, darling?”   “It’s The Drugs Don’t Work by The Verve.”   The melancholy strings filled the bar over a sudden gossipy chatter. Matt’s vision shimmered. Everybody in the room was staring at him. Cameras were recording his reaction. Cecilia’s eyes glowed liquid and amber in the half-light. Matt smiled strangely, gabbled an excuse and escaped into the cold Kensington night.   He got the tube to King’s Cross and boarded the N30 bus, taking a seat on the upper deck. Not for the first time, he wondered who would truly miss him if he just exited stage left . He’d always imagined these feelings came with some dramatic breakdown, a spectacle of despair like the Titanic sinking live at the IMAX-3D, he’d never expected that the loss of will would be quite so mundane.   His attention was dragged back to a crew of East London hipsters, standing in the bus aisle. A middle-aged man in a fedora announced they were – oh, for f**k’s sake, as if things couldn’t get any worse – a poetry collective . A youngish and catwalk-tall girl stepped to the front of the deck: full sphere of tightly coiled afro hair, imperious cheekbones, mischievous smile. The bus lights glimmered on her hoop earrings.   ‘Hey N30, I’m Charlie Sunday,’ she said.   Matt suspected Charlie Sunday wasn’t the name written on her passport. He searched his pockets fruitlessly for headphones.   ‘I’m gonna perform for you,’ she continued. ‘Can I get a click?’   Life was taking the actual p**s. Charlie Sunday’s posse gave an energetic holler, whooped screeches, and drum rolled their feet. Matt glanced around at the upper deck; apart from those lucky few lost in music, most warily listened. Charlie clicked her fingers slowly, tapping her boot as she found the beat. A group of drunk clubbers clicked with her. Satisfied, she began a strut down the aisle.               London’s unforgiving             London’s merciless to its thieves             And I’m a thief of London             I’m a thief of London’s dreams   She swayed between the seats as she spoke. A hooded teenager pushed past her to the stairs. “You going now?” she called, “It’s just getting good!”               Because London dreams in diamond             Of another city shining             Sapphire eye sparkling             On rippled river’s darkness   Slowly, Matt clicked his fingers to the beat. Charlie winked at him as she passed his seat. Matt craned round to watch her.                         Who am I, said I?             I’m the Prince of Thieves             London, you should have locked up your dreams!             I’m a monster, London             I dance the devil’s dance   An energy swept down the bus as she returned down the aisle. Matt began to click louder, feeling the words and beat gain pace. Back at the front window, against a glow of Dalston kebab shops, Charlie lowered her ochre nails.               Because there are jewels in Tower Bridge             Wrapped up like fish and chips             And any thief wants jewels   The bus rippled with applause. Matt joined in merrily. For a few minutes, the anonymous city had shifted, and the space between him and these strangers had narrowed. Charlie yelled out the name of a spoken word night and threw a cascade of paper flyers down the deck before stampeding with her gang to the lower deck. Matt leaned over the seat and picked up a flyer from the aisle floor.   A week later, he lay on his bed and watched the wind rustle the treetops. Liam lived on the opposite side of the city now. Long gone were the glory days of the mouse-ridden student house share, but there were still trains and buses and, allegedly, free will. Fifteen years of friendship had to mean more than just liking each other’s photos on Facebook. Matt rewrote the text several times before finally sending:             Fancy a pint this weekend?     His phone buzzed immediately, and it was a pure shiver of joy.                         Can’t this weekend mate, pre-natal classes. But can you come to Ed’s stag in Riga? Gonna be crazy lol   Liam added him to the WhatsApp stag group. Matt wrote ‘ Hey lads, massively up for this! ’ and an emoji of clinking beer pints. An hour later, nobody had replied. Matt scanned through the names who’d seen the message. Probably screen-shotted, texting each other, laughing. What a w****r. He tried to argue rationally with himself – they all had busy lives, kids, and work – but eventually he had to turn the phone off.   Then he was alone in his box room – supposed to be a temporary fix post-Clare, but it’d morphed into a stupor. Could play Xbox. Finish that series on Netflix. Sometimes he Googled them to find out about their lives.   He picked up his keys to head down to the office and noticed the crumpled flyer. ‘ Do you write?’  the top line demanded in bold.   No, no. Not me. Wrong man.   Except whatever he’d done till then hadn’t exactly gone right.   Once he had a beer in his hand, he thought: sure, why not, he’d give it a go.   Come Wednesday night, he would have missed the narrow doorway if not for the student-ish queue outside. Matt joined at the end, munching a packet of crisps for dinner, not making eye contact. The pint beforehand had done nothing to settle his nerves. ‘Man up, son , ’ he could hear his Dad say, ‘ Grow a pair. ’ At the front of the queue, a fedora-wearing man he recognised from the bus signed Matt up for the first round.   His adrenaline pumped as he descended the rickety staircase. The narrow basement room was painted black and felt madly crowded. There were giant pink p*****s drawn on the toilet doors. At the far end of the room, a lone microphone stood in the stage light. His shoulders tensed off the scale, then he saw her.   Charlie was standing by the bar, holding court with a drink in her hand. She was wearing a sleeveless green dress with a pleated skirt. Same hoop earrings. He couldn’t just stare like a creep. Go on, son – speak !   “Excuse me.”   Charlie stopped mid-sentence. Her friends regarded his interruption coolly. The Panic abruptly began its surge.   “I - uh…” She waited for him to finish. The seconds stretched out. “I came.”             “You sure did,” she said guardedly. “I’m sorry, you are?”   He stuttered his name and reminded her of the bus.   “Cool, man, are you reading?” Matt could barely hear a word she said. The background chatter had intensified to a deafening pitch. His ears pounded with rushing blood. “Uh, yeah,” he said. “I’ve never –”   A piece of crisp had lodged in his throat. He choked ‘excuse me’  and broke into a hacking cough. Charlie touched him on the upper arm.             “Do you want a glass of water?” He nodded. Charlie poured a plastic cup of water from the jug at the bar and handed it to him. He gulped, gratefully.             “I’ve never done this before.”   She broke into a smile.   “It’s your first time! Man, that’s great. We’ll cheer you on, won’t we?”   He searched for a reply as the man in the fedora announced Round One. A hush fell over the club, and Charlie turned to watch. Matt slunk to the far end of the bar and quietly ordered a Red Stripe. Cough-free. Perfect hearing.   Charlie took the mic, followed by three other speakers. His mind was clamouring to flee, but he forced himself to remain. Gotta have some kind of pride, at least. This isn’t stupid. You’re not stupid. You’re not going to be laughed at. He felt a trickle of sweat inch down his back. His left leg began to tremble.   The host was saying, ‘ The last reader in Round 1…’  Matt was about to die of mortification –  ‘First time here tonight…’  People would think he was such a p***k –  ‘Please give it up for…’  He wanted to curl up on the ground.   "Matt Hawthorne!"   The crowd shrieked. He pushed through the audience benches, hopping over young people on the floor, and took his place at the mic. Looking out, he could only see the white spotlight. The room fell to a tomblike silence.   “Before I begin,” he said, his paper shaking in his hand. The Panic increased as he heard his own dull tone from the speakers. “I just want to say–”   Matt angled himself towards Charlie’s silhouette.   “Thanks– I mean, um– for inspiring me–”   Her head gave a minute nod. Matt’s sweaty fingertips dropped the paper. He scrambled for it on the floor.   “I– I’m sorry,” he tried again. “I get a bit– nervous–”   A girl with pink hair began clicking her fingers. Get on with it . Of course, he was wasting their time. He glimpsed the scrawled page and felt the room’s contempt. He saw the poem’s emptiness, the cringeworthy stabs at emotion, the mockery the words deserved. The Panic tightened around his neck like a noose.   “I’m sorry. I can’t.”   He pushed his way into the merciful darkness. A purple spot of light was seared onto his retina as he escaped up the rickety stairs. Immediately, Matt entered the Turkish grocery next door and bought six cans of Polish beer for a fiver. Nothing mattered. It didn’t matter. He’d just go home and get drunk and forget.   Charlie was outside the shop. “Are you okay?”   “I’m fine.”, he stated as certainly as he could.   “I really think you should come back down,” she tried to encourage.   “Um, not tonight, thanks.” He nodded goodbye, gave her a false smile, and began a fast pace towards Church Street. Annoyingly, thrillingly, she fell in with his step.   ‘You got a spare one of those?”   He handed her a can. “You can have one, if you want.”   “You gonna tell me your poem?”   “No way.”   “Tell me why you came then.”   “You wanna know why I came?”   He poured the tale out. Charlie adored every moment of the karaoke. Matt found himself made into a storyteller. He might have even exaggerated a few parts for laughs. He found out she was not a full-time poet – ‘as if anybody gets paid for poetry!’ – but was doing a postgraduate degree at UCL, dissecting mosquitos to try and prevent the spread of malaria. Matt nodded, welcoming his feeling of admiration. Be gone, resentment!  He told Charlie straight that he wrote quizzes about Fleetwood Mac.   “ Rhiannon is a tune, man.”   “Do you think?”   “I know.”   She began humming the chorus as they entered Hackney Downs. A group of kids wheelied bikes in the dusk, evening dog walkers and fluorescent runners zig-zagged through the paths. She knew a pretty great climbing frame, she said, and he agreed, mid-way through his second can, to verify its greatness. At the red pyramid climbing frame in its middle, Matt grabbed the nearest rope.   “I did Media Arts,” he offered.   “You enjoy it?”   “Yeah, yeah – could have studied more. Thought I was gonna be a hotshot exec.”   “It’s all a trap. Get a degree, get into debt, become a manager.”   At the pinnacle, perched on the shorter ropes, they opened the last of the beer cans. Through the London smog above, a few faint stars twinkled blue.   “So,” she said. “Is it time?”   “For what?”   “I wanna hear your poem.”   He gazed out at the park. Spires of the downtown City glowed on the horizon: Walkie-Talkie, Cheesegrater, Scalpel. Jagged point of The Shard. All of us, he supposed, dance in the shadow of the Shard.   “Okay, the poem,” he said.   “Yes!”   His scribbled words were just visible. Matt heard his voice falter in the wind. His breathing was shallow when he’d finished. He drew in a breath, and it felt like the first time he’d filled his lungs. He couldn’t look at Charlie, so he examined the lights on the buildings instead. He blinked a tear into the April breeze.   “I think I needed that,” he said.    Charlie sipped the dregs from her can and crumpled the aluminium against the frame. She pushed his shoulder.   “Tag”   “What?”   She jumped from the climbing frame. He followed her uncertainly, self-conscious about being seen. Charlie was halfway down the path. He began to run after her, and as he was running he started laughing. It was a well of pleasure that he’d forgotten. He was playing, he was laughing, and, for a time, he was free.

Why is the use of antidepressants so controversial, and how could we prescribe them more effectively? This question is a priority in my research at King’s College London, where I work as professor of statistical genetics. My academic background is in statistics, and I am passionate about using genetics to improve the diagnosis and treatment of mental health conditions.  Together with people with lived experience of depression, my research team integrates clinical and biological data to study these important questions.  Antidepressants are some of the most prescribed drugs in the UK. The number of NHS antidepressant prescriptions increased from 36 million in 2008 to 88 million in 2023 , at a cost of £230 million.  Antidepressants are widely and successfully used to treat depression and other conditions, but their use is controversial. Many people suffer from side effects and need to stop taking them. Others get no benefit from their first prescribed antidepressant, and it can take several rounds of trial-and-error prescribing to find an effective drug.  Image by Kaboompics.com on Pexels Antidepressant studies In clinical trials, participants are randomised (allocated by chance) to receive either an antidepressant or a placebo (a dummy pill).   Response rates are higher for people on the drug arm  of the trial than the placebo arm, but the differences between groups are low.  Placebo rates are high , and there are many reasons for this. Some people’s episodes of depression will naturally reduce over time.  And - curious but true - placebos are powerful medicine : being cared for, with the hope of recovery, can have a positive effect on people’s health itself. Across trials, the consistent if modest effect of antidepressants - with more people responding to the antidepressant than to placebo - is reassuring that antidepressants can be helpful. Similar evidence is seen in other studies - when UK Biobank participants  were asked whether specific antidepressants had helped them, at least 7 out of 10 people  said that the drug had helped.   Clinical trials  are stringently designed to ensure that no biases creep in, so that we can have confidence in the results of the trial. To measure how well antidepressants work, patients and clinicians complete questionnaires of symptoms of depression, and a score, summing across the number of symptoms present, is used to assess the severity of depression before and after taking the antidepressant (or the dummy pill).  A widely used trial outcome is “remission”, where a participant is no longer depressed by the end of the trial, so their depression symptoms are very low or absent. In clinical trials, usually only about one-third of people reach remission, which is much lower than the 70% of UK Biobank participants who say that antidepressant drugs helped them.  Why are those figures so different?   Remission is a stringent outcome, requiring that someone reaches a depressive symptom score threshold at a specific week of treatment.  In contrast, asking people retrospectively about their treatment is a more general question about whether they felt their depression improved while they were taking the drug.  Feeling better does not mean you are completely well and free from symptoms of depression.    How can we use antidepressants better? So, on average, antidepressants work and, on average, people find them helpful.  But most patients are not ‘average’.  We believe there is scope for improving prescribing of antidepressants so that people are prescribed a drug they find tolerable and which reduces their depression symptoms.  Antidepressant prescribing in the UK is currently a one-size-fits-all all procedure: NICE guidelines  indicate an SSRI (selective serotonin reuptake inhibitor; the drug believed to work by increasing serotonin) as the first-choice drug for moderate to severe depression, moving to a second SSRI if there is little response after a few weeks, and then exploring further options as necessary.   But responding to a drug is not a yes/no event.  Some people respond very well with a steady reduction in symptoms over the weeks and months they take the antidepressant. Others have no response, or only a modest reduction in their depressive symptoms. Can we tell who is who?  Sadly, not yet: there is little information to inform personalised prescribing for antidepressants, where a drug is chosen because it is the best fit for that specific patient, likely to give a response with minimal adverse events.   The real question for antidepressants is not whether they work, but for whom they work. There is much scope for improving the matching between patient and antidepressant, providing patients with a drug where the risk of severe side-effects is low, and the chance of improving their depression is high.  But while we think such discriminating factors do exist, further research studies are needed to identify them. Given the heavy burden that depression places on people across the world, shouldn’t this be an important research priority?  Genetics and antidepressants We know that genetics - our DNA that is present in every cell in our body  - plays a role in response to antidepressants. Several key genes, including CYP2D6  and CYP2C19 , metabolise antidepressants, controlling how fast the drug is processed and how long it remains in your body.  A drug can be a poor match for you - either because you metabolise the drug slowly (poor metaboliser), giving stronger side-effects, or because you metabolise the drug too fast (rapid metaboliser) and the drug disappears before it has had time to work.  These pharmacogenomic tests  are a good start towards better prescribing of antidepressants, but they are incomplete.  My research team aims to discover what other genes contribute to the response to antidepressants , and how these can be used to improve antidepressant prescribing.  Image by BYB on Pexels In our Wellcome-funded AMBER study, we are applying informatic, genetic, and cellular approaches to unpick why antidepressants work, and for whom they work, focusing on selective serotonin reuptake inhibitors.  In informatics, we apply artificial intelligence to patient electronic health records, giving the rich data and large groups of people needed to study antidepressant prescribing.  In genetic studies, we look at how biology affects how we respond to antidepressants, measuring the genes that we inherit or changeable biological substances in our blood, such as methylation, proteomics and metabolomics.  Finally, laboratory experiments allow us to test the effect of antidepressants in human cells. Together, we hope this research will enable us to better understand antidepressants and enable us to use them more effectively to help treat depression.    Conflict of Interest: Cathryn Lewis sits on the Scientific Advisory Board for Myriad Neuroscience, which develops the GeneSight test.

Writer’s note: This article has been co-written by Courtney Worrell and Tony Woods It has long been said that art is good for our health, but we didn’t know much about how or why. So, this summer, we set up shop in front of the likes of Van Gogh and Manet at the Courtauld Gallery in London to look at the science behind this relationship and explore how the body really responds to viewing art. Spoiler alert – what we found was very, very interesting.   Vincent Van Gogh’s Self-Portrait with Bandaged Ear (1889), courtesy of the Courtauld Gallery Anecdotal accounts saying that art is good for boosting wellbeing and reducing stress, for a long time, have remained just that - anecdotal. However, in the last few years, scientists have begun to explore this to finally answer the question of what impact art can really have. For instance, previous studies have shown that regularly visiting galleries and museums can enhance wellbeing and mental health . A more recent but unpublished study has also shown that viewing original artworks led to stronger emotional responses in the brain , compared with viewing reprints. Our Study As Programme Managers in the Stress, Psychiatry, and Immunology (SPI) Lab at King's College London, we have recently built on this to run a new study exploring art and health. In our study, we were particularly interested in exploring whether viewing a genuine masterpiece in a gallery setting had different effects from viewing a reproduction in a laboratory setting, focusing on the different ways the body might respond. Due to our study design (comparing original vs reproductions), we had to be pretty selective in the art we chose. For obvious security reasons, it wasn’t possible to hoist world-renowned artworks off the gallery wall, and so we curated a selection of artworks the Courtauld Gallery were able to kindly lend us high-quality reproductions of. The reproductions were so accurate that we occasionally received some quizzical looks from passers-by as we carried them out of the building. The artworks and their corresponding reproductions were: Henri Toulouse-Lautrec’s Jane Avril in the Entrance to the Moulin Rouge (c1892) Édouard Manet’s A Bar at the Folies-Bergère (1882) Édouard Manet’s Banks of the Seine at Argenteuil (1874) Vincent Van Gogh’s Self-Portrait with Bandaged Ear (1889) Paul Gaugin’s Te Rerioa (The Dream) (1897) We recruited 50 participants who were aged 18-40 years old and hadn’t visited a gallery in the last 30 days. Participants were then divided into two groups: 25 viewed the masterpieces in the Courtauld Gallery (during opening hours), and 25 viewed the reproductions in a laboratory setting. When it came to data collection, we first asked all participants to complete a short emotional intelligence questionnaire and provide samples of their saliva. We then asked them to wear a watch while viewing each of the 5 artworks, in order, for 3 minutes each. These watches weren’t the usual run-of-the-mill smart watches. In fact, they didn’t even tell the time. What they were doing, however, was collecting thousands of pieces of data on heart rate variability and skin temperature. Finally, after viewing the pieces, we repeated the saliva samples. From this, we were able to collect large amounts of physiological data from the participants, despite their sessions only being around 20 minutes long. Here is what we found. Édouard Manet’s Banks of the Seine at Argenteuil (1874), courtesy of the Courtauld Gallery Heart Rate Variability and Skin Temperature Heart rate variability (HRV), the tiny changes in the time between heartbeats, can tell us interesting things about our autonomic nervous system (a system which controls our involuntary actions, such as breathing and heart rate). In this system, we have a balance between a sympathetic nervous system (otherwise known as ‘fight or flight’), preparing us to deal with a stressor, and the parasympathetic nervous system (‘rest and digest’), which is more about slowing down and aiding recovery. A higher HRV usually means your body is momentarily flexible and adaptable, better prepared to handle stress. On the other hand, a lower HRV can indicate that the body is under stress or less resilient. When we looked at the data from our participants, we found that those who viewed the original artworks had greater variation in HRV than those who viewed the reproductions. This suggests that their autonomic nervous systems were more engaged, and interestingly, their heart rates were, on average, a little faster than the reprint group’s. Similarly to HRV, for skin temperature, we were also looking at differences when viewing the different types of artworks. Again, the participants viewing the original artworks had bigger dips in their skin temperature, which is thought to indicate bursts of emotional arousal. It is worth noting, however, that the overall trends were more similar between the groups here. Cortisol and Cytokines The saliva samples we collected were used to explore two things: cortisol and cytokines. Cortisol is a stress hormone produced in response to a stressor, helping our bodies prepare to handle it. Our analyses showed that participants viewing the original artworks in the gallery had a reduction of cortisol after looking at the art, suggesting that it had a stress-reducing or restorative effect. We weren’t able to find the same result in the participants who viewed the reproductions. In saliva, we are also able to measure what we call 'cytokines' – proteins produced by immune cells. We found that IL-6 and TNF-α, which are two pro-inflammatory cytokines which drive inflammation (essentially activation of the immune system), were significantly reduced in the participants in the gallery after viewing original artworks, compared to the participants who viewed reproductions. On the other hand, other cytokines that we measured (IL-1β and IL-8) didn’t change significantly for either group of participants. This is particularly interesting as it hints that there may be an activation of specific pathways of inflammation which are sensitive to stress. Édouard Manet’s A Bar at the Folies-Bergère (1882), courtesy of the Courtauld Gallery Emotional Intelligence And let’s not forget that emotional intelligence questionnaire. We asked participants to complete this so that we could find out if there were any patterns between the responses to the art and certain personality traits. We couldn’t find anything significant here, and this is actually quite a positive finding. It suggests that the physiological effects we observed from viewing art aren’t limited to a specific group, but could potentially be experienced by everyone. Final Thoughts So, altogether, we found that viewing the original artworks in a gallery had a stronger effect on the body than looking at reproductions. More specifically, those viewing the original works showed a significant reduction in stress hormone levels, more variation in their heartbeat patterns, and brief drops in skin temperature. We think that this combination points to both emotional arousal and deep relaxation when it comes to viewing original artwork in a gallery. We have written this research up in a paper, which is currently available as a preprint and will soon be submitted for publication in a peer-reviewed scientific journal. With exciting news coverage received from our results today from the likes of the BBC, Sky News, The Guardian , The Times and more, it is fair to say that we are both pretty chuffed with the outcome, and we can’t wait to put together another study to combine the worlds of science and art yet again. This research was done with the support and hospitality of the Psychiatry Research Trust, ArtFund, and the Courtauld Gallery. And of course, a special thanks to our wonderful participants and research team.

My name is Pierrette, and I am a Master's student studying Neuroscience at King's College London. A few months ago, I was introduced to the concept of the brain's "dark energy" during a lecture on neuroimaging. Deeply interested in this topic, I began to wonder about the origin and nature of consciousness and questioned whether the awareness of oneself resides in the body, or if our mind and body are two separate entities that converge to make us human. Photo by Shawn Day on Unsplash What is the Brain's Dark Energy? It might be interesting to find out that our minds never really rest; instead, they are constantly busy even when we are not actively using them. The first to come to this deduction was Hans Berger in 1929. After noticing ceaseless recordings of electrical oscillations through the encephalogram (EEG), a device of his invention, he was able to record brain activity. He deduced that our central nervous system is always in an active state . The energy needed to keep our brain alive even when inactive has been defined as the ‘brain’s dark energy’. The term ‘dark energy’ was borrowed from cosmology, where it is defined as a hypothetical energy that fills all of space .  It is believed to be responsible for the accelerating expansion of the universe. However, the term is used metaphorically in neuroscience to describe the seemingly spontaneous, random fluctuations in brain activity that are not directly related to any specific task or stimuli. The brain’s dark energy seems to account for most of the brain’s energy use, around 60-80%,  with only 5% being directed to goal-related neuronal responses. This form of intrinsic activity, and thus the energy used for it, is thought to be related to the brain’s default mode network (DMN).   The Default Mode Network as the Possible Core of Consciousness The DMN can be defined as a group of interconnected brain regions that are active when an individual's brain is at rest or not focused on their environment or external stimuli . Examples of behaviours activating the DMN include daydreaming, self-referential thinking, and mind-wandering . Photo by Helena Lopes on Unsplash Self-referential thoughts are the basis of consciousness, as these involve the processing of how information relates to one’s own identity, experiences, and goals. In synthesis, we could say that such thoughts are what allow us to differentiate ourselves from others so that we are aware of who we are. There is a growing body of research that defines the DMN as the core of consciousness  and aims to use it as a target to restore consciousness in the context of various pathologies.   Since the recording of DMN activity through neuroimaging devices, we can hypothetically observe a reflection or proof of the existence of our consciousness. The DMN has been defined as 'the unifying thread that binds together humans’ perceptions and gives it continuity between present moments, past experiences, and future goals.' The Mind-Body Problem Throughout history, humans have always tried to understand the relationship between our psyches and our bodies, with speculations regarding the mind-body connection being made as early as the BC period. One of Aristole's most famous treatises, De Anima , otherwise known as On the Soul , described the mind and body as a 'synolon,' intended as two inseparable components of one being that complete each other as matter and form. However, the mind-body problem was officially outlined by Descartes in the 17th century, as he rejected Aristotle’s theory in favour of viewing the mind and body as two separate entities , giving rise to a theory known as dualism .   Since then, humans have proposed different theories to resolve the mind-body problem, with the most dominant being the theory of physicalism. This theory sees the mind and body as one, basing its conclusion on the belief that the mind is, in fact, physical, and that every mental state can be explained by physical brain processes. What Does This Mean for Science and Philosophy? Viewing the DMN as the basis of consciousness would imply that the psyche and body are in fact, one and inseparable, a synolon. Despite this, the DMN   could also be seen as the reflection of our consciousness and not the consciousness itself. This interpretation would link the DMN to the emergent theory that sees psyche processes as related but not solely limited to the mind.  This assumption would thus disprove both the physicalism and dualism. Photo by Vitaly Gariev Viewing the psyche and body as one, fits the possibility of the DMN being the core of consciousness, as, according to this, the emergence of sentience is the result of the interaction of various brain regions.   This encapsulates what the DMN is, a network born from the interactions of regions such as the posterior cingulate cortex, medial prefrontal cortex, and the bilateral inferior parietal lobule , along with other associated regions. The amalgamation of these neurointeractions can generate those self-referential thoughts that are seen as the basis of consciousness, binding together one’s perception of themselves through time. Nevertheless, it would be too simplistic to resolve the mind-body problem with the DMN. If we even decided to accredit the emergent theory, we would be faced with the limit of never being able to solve such a problem and only accept that consciousness is an emergent property of the brain, which cannot be explained or understood. Although we cannot be overly reductionist when explaining the origin of consciousness, the DMN posits a great basis for speculation regarding the nature of consciousness and its association with the body.

Writer's note: This piece was written with the support of Maria Ferrara, MD PhD; Psychiatrist | First Episode Psychosis Program, Ferrara, Italy; Assistant Professor | University of Ferrara, Italy First Episode Psychosis (FEP) refers to the first experience of psychotic symptoms, such as hallucinations or delusions. FEP affects 2–3% of young people and marks a critical turning point in mental health care, as early identification and treatment strongly influence long-term outcomes. About 25% of patients recover fully, 50% recover but experience relapses or develop chronic conditions, and 25% do not fully recover, especially when treatment is delayed. Such delayed care can lead to persistent social, academic, and functional difficulties. Early intervention (within weeks to months), on the other hand, greatly improves chances of recovery, school or work reintegration, and reduced relapses. I am a final-year psychiatry trainee with a long-standing interest in both FEP and gender-specific medicine, now working in a specialised early intervention service in Northern Italy. What first drew me to this field was the chance to intervene early, when recovery is most possible, and to help young people make sense of their experience and regain hope for the future.  As a woman and a doctor, I’m also very interested in gender specific medicine. This blog explores the challenges faced by women experiencing FEP at different phases of their life course. Image source: Anda Lupulet on Unsplash Is psychosis different in women? Women typically develop FEP later in life than men. While men most commonly experience it between 18 and 25 years old, women and people who menstruate tend to develop it in their late twenties or early thirties, with a second peak around menopause. This temporal difference underscores the need for sex-specific approaches in early intervention that take into account the very different life phases in which women and men may experience FEP. Women experiencing FEP around menopause may be managing established careers and family responsibilities. For these women, recovery involves not only overcoming symptoms but also protecting and maintaining what they have built. The psychotic experience can be especially complex for women, as it often intersects with pregnancy, motherhood, and menopause. As healthcare providers, it is essential to be sensitive to these unique challenges and to adopt proactive, tailored strategies that support women’s recovery in the context of their lives. The Menstrual Cycle The menstrual cycle adds a further layer of complexity to the psychotic experience in women. Some of the medications that are prescribed in FEP can disrupt or even stop the menstrual cycle. This might seem like a minor issue compared to severe hallucinations or thought disorders, but it matters to women, and their reproductive health should matter to us as providers. Patients rarely bring this problem up spontaneously, perhaps out of embarrassment or because they don’t see the connection between the drug and their menstrual cycle. Given that the menstrual cycle is being increasingly recognised as a vital sign of health , it is up to providers to ask the question and to figure out different treatment options. Image source: Alice Guardado on Unsplash Pregnancy and Motherhood Few situations are as delicate as psychosis in the context of pregnancy. In rare cases women can experience their FEP immediately after birth (namely, post-partum psychosis which affects 0.1-0.2% of mothers). If left untreated, postpartum psychosis risks serious harm for both mother and baby, ranging from difficulty caring for the infant to maternal self-harm, suicide, and infanticide in the most severe cases. Other women can develop symptoms during pregnancy itself, which is equally risky and is associated with pre-term birth, stillbirth, increased rates of C-section, poor foetal development, and maternal self-harm and suicide .   Intriguingly, some women experience a psychotic denial of pregnancy, whereby they genuinely do not recognise that they are pregnant. We have seen patients in our service who have entered the service in psychosis and received ongoing clinical evaluations and anti-psychotic medication but have been unable to acknowledge that they are indeed pregnant. These patients are a reminder of how reproductive health should be routinely part of our psychiatric care, as patients with severe mental illness may miss or misinterpret signs of pregnancy. Engaging patients in conversations about reproductive healthcare is essential. Then there are women in treatment for psychosis who express the wish to become mothers. These conversations require openness and appropriate clinical preparation; we need to talk about potential health risks, responsibilities, and preventative strategies to ensure healthy pregnancies and births for both mother and baby. Menopause The second spike in presentation of FEP in women is seen at the onset of menopause. The cause of this association is not entirely clear. Some studies suggest that the hormone oestrogen, which is present in higher amounts during a woman’s reproductive years, may help to protect the brain against psychosis. During menopause, oestrogen levels drop dramatically, diminishing this potentially protective effect. This may be what causes some women to become more vulnerable to developing psychotic symptoms for the first time and helps to explain why FEP frequently occurs in middle-aged women, while men, who never have the protective level of oestrogen, are more likely to present with psychosis at a younger age. Of course, this is not the only mechanism at work, as only ~1% of women experience FEP at menopause.   At times, symptoms of FEP during menopause can be overlooked due to their subtle nature and overlap with perimenopausal symptoms such as sleep disruption, anxiety, and cognitive changes. This can lead to delays in recognising FEP and therefore treating it, and minimising the impact on the patient’s life and wellbeing. Psychosocial stressors at midlife – including work and caring responsibilities – may further increase vulnerability in perimenopausal women. Clinician awareness, careful and specialised assessment in this high-risk period is essential to distinguish menopausal symptoms from the early signs of FEP. Why sex and gender matter in psychiatry For a long time, psychiatry paid little attention to sex and gender differences. As in many other medical fields, symptoms were described, treatments tested, and protocols written as if men and women experienced illness in the same way (Samrina Sangha previously wrote about the Invisibility of Women in Healthcare for ITM). But as research has grown, it has become clearer that sex and gender shape when and how psychosis appears and the patient’s experience of the disorder. We have all heard of the infamous belief that women are natural “multi-taskers”. Because of that, they often need to juggle multiple responsibilities as professionals, partners, and caregivers. Psychosis can disrupt all of these at once, leading to widespread impacts in a woman’s life and recovery. Ignoring the clinical relevance of the complexity of the multiple roles culturally assigned to women (for more on this read the Mental Load of Motherhood on ITM by Professor Jodi Pawluski) means providing care that is technically correct but delivers incomplete results in recovery. As clinicians, our role is not only to prescribe medication or deliver therapy, but also to protect our patients’ self-identities, relationships, and futures. Supporting recovery from psychosis means much more than reducing symptoms. It is about helping women to reclaim their place in the world, in all their complexities. And perhaps that is the most poignant lesson I have learnt while working in early psychosis: that mental illness may bend a life’s path, but with timely, thoughtful care, it doesn’t have to break it.

Why are some young people still missing from mental health research and what can we do to change that? Hi, I’m Rachel Perowne, a PhD researcher and I’m passionate about making youth mental health research more inclusive. I believe that the best way to achieve this is to involve young people in a meaningful way in the research process. Together with my supervisors and colleagues, including three young co-researchers, I recently published a systematic review exploring the barriers and facilitators to involving under-represented children and young people (aged 8–25) in mental health research. This blog is my reflection on what we found, why it matters and how we can do better. Why this matters When young people are involved in mental health research, this make the research more successful, relevant and impactful. But despite growing interest in participatory approaches, certain groups, such as those from ethnic minorities, lower-income households, migrant backgrounds or with disabilities are still under-represented. This gap matters because we risk continuing to exclude certain groups and past inequalities being repeated, making research less relevant to those who have historically been left out and who are often disproportionately affected by mental health issues. What we did We conducted an extensive search of the literature (over 13,000 papers) and found 27 studies from seven countries which contained relevant information about why certain under-represented groups might be less likely to be involved in research. We applied the Behaviour Change Wheel (BCW) – a tool which helped us understand what helps or hinders involvement and identify actions to overcome the barriers. Figure by Michie and Colleagues (2014) We also worked closely with a group of young co-researchers who shaped the review from start to finish. They were involved in many stages of the systematic review process including reviewing the research question, identifying terms to include in the search, carrying out their own searches and reviews of potentially suitable papers and extracting relevant data.  Their insights were invaluable and three of them co-authored the paper. Barriers to involvement As the illustration below shows, most barriers reduced opportunity, things like: Digital exclusion : Not everyone has access to stable internet or devices. Language : Materials often weren’t accessible or available in young people’s preferred languages. Time and competing priorities : Especially for those in vulnerable or precarious situations, such as having caring responsibilities. Bureaucratic hurdles : Ethics processes which can make it harder to involve younger age groups. Mistrust of researchers : Particularly among Indigenous and racially minoritised youth who may have had negative previous experiences. Some barriers were more subtle and connected with relationships or identities. For example, unbalanced power dynamics in mixed adult–youth groups, or male identity and stigma, which made some young men feel that mental health research wasn’t for them. Facilitators to involvement The good news? Many barriers had a flip side, that we can learn from. These “facilitators” included: Flexible and creative engagement: Offering a range of methods for involvement such as WhatsApp, visual methods and co-design workshops to make contributing easier and convenient for more young people. Accessible communication: Using plain language, interpreters and culturally or age relevant materials. Relationship-building: Taking time to build trust and mutual respect with the aim of increasing young people’s confidence to contribute and feeling of safety. Supportive adults : Allies who champion young people’s voices rather than speaking for them. Shared experiences: Organising activities and groups so that young people are with others who they feel understood by and comfortable with. Building in fair rewards and incentives: that young people will value such as payment in line with national guidance . Figure by Rachel Perowne and colleagues (2025) Strategies for change We identified practical strategies that align with the BCW’s intervention functions of enablement and environmental restructuring. These include: Tailoring communication to young people’s needs – for example, videos or easy read versions of materials. Creating safe, inclusive spaces for engagement, which can be as simple as providing refreshments at meetings or more thoughtfully, offering support options and self-care tools Providing flexible involvement options, such as adapting timings of meetings to meet young people’s schedules e.g., holding meetings in the evenings or at weekends or going to meet young people where they are. Recruiting beyond traditional networks: through local community groups or places where young people not in work or school might be. Investing time to build trust and relationships – for example, by providing induction sessions and icebreakers, placing young people in position of responsibility such as co-facilitating meetings. What does all this mean? Overall while involving young people in mental health research is widely recognised as valuable, the review found that many young people still face barriers, especially those from under-represented groups.  Importantly, we found that different groups face different challenges. For example, refugee youth may need more language support, young carers may struggle with time constraints and young men may feel mental health research isn’t for them. If we don’t think carefully about these differences and address them by taking targeted approaches, research risks continuing to be shaped only by those who have previously been consistently included, making it less relevant and less effective for those who are most affected by mental health inequalities. What’s next? We still have work to do. We need more research that centres the voices of under-represented young people and make efforts to understand and include those who haven’t been involved before. The review also highlights that there is room for improvement in how researchers report the involvement of young people. When reporting is vague or inconsistent, we lose valuable opportunities to learn from each other and to build on the good work already being done to involve young people in appropriate and meaningful ways. Better reporting can help create a culture of transparency and continuous improvement in youth involvement practices. There are tools which researchers can use to do this. The GRIPP2 checklist, for example, is a simple checklist which guides researchers to think about what to report and how, with the aim of improving our knowledge base. You can find the checklist here . Final thoughts This is a call to action: inclusive involvement isn’t a matter of lip service. It requires thoughtful, flexible and supportive approaches. It also shows the value of using theory, like the Behaviour Change Wheel, to guide how we design involvement strategies. Most importantly, it reminds us that young peoples lived experience, insights and ideas are essential for shaping better mental health research. My thanks to everyone who contributed to this review – including Professor Leslie Gutman, Dr Sarah Rowe, Gabrielle Grey, Pamela Thomas, Azin Lajevardi, Ella Parry, Luke Bingham and the other young people in our Young Researchers’ Oversight Group as well as Lucy Condon (Public and Patient Involvement Facilitator).

Image by Eduardo Ramos on Unsplash Every human being begins life as a single cell.  That cell divides, multiplies, and transforms into many different types of cells — muscle, nerve, skin, blood, bone, and so on — until, somehow, a complete body emerges. But this transformation raises one of biology’s oldest and most fascinating questions: how do cells know what to become? What determines whether one group of cells forms the brain and spinal cord, while another group becomes the skin, the heart, or the liver?  My PhD research focused on this fundamental mystery — how cells gain the ability to choose their fate. This process is not only beautiful in its precision but also deeply relevant to medicine. When this decision-making system goes wrong, as it often does in diseases like cancer, cells lose their sense of identity and start to grow uncontrollably. Conversely, understanding how cells decide what they should become could allow us to guide stem cells to form new tissues, opening new possibilities in regenerative medicine and healing.  The Big Picture: The Signals That Shape an Embryo In the early embryo, a small cluster of cells acts like a conductor leading an orchestra. These cells are known as organisers — regions that send out signals to nearby cells, instructing them on how to develop. The concept of the organiser dates back to 1924, when scientists Hans Spemann and Hilde Mangold transplanted a tiny piece of tissue from one amphibian embryo into another. Astonishingly, this fragment was able to instruct surrounding cells to form a second body axis — effectively generating a second nervous system. This discovery revolutionised developmental biology , earning Spemann a Nobel Prize and establishing organisers as key “instruction hubs” of early life.  Organisers do not build tissues themselves; rather, they communicate with their neighbours. They release chemical messages that tell nearby cells, “You will become part of the nervous system,” or “You will form the skin.” But these instructions only work on cells that are ready to receive them. That readiness is what scientists call 'competence'. Competence determines whether a cell can “listen” to an organiser’s message and act upon it. It is a bit like having the right lock and key: the organiser’s signal is the key, but if the cell’s lock is jammed or mismatched, the door will not open. Without competence, even the most powerful developmental cue will be ignored. This concept — that not all cells are equally receptive — has intrigued scientists for nearly a century. Yet despite decades of study, the underlying reasons for competence remained unclear. What molecular changes make some cells capable of responding to organiser signals, while others remain deaf to them? My PhD set out to uncover the hidden mechanisms behind this ability — and to ask whether competence, once lost, could ever be restored.  Image by Getty Images on Unsplash My Approach: Watching Fate Unfold in the Chick Embryo To investigate, I turned to a model organism that has guided embryology for generations: the chick embryo. For over a hundred years, chick embryos have been a cornerstone of developmental biology. They are large enough to manipulate easily, develop outside the mother’s body, and share many features of early human development. Historically, scientists used chick embryos to map how organs form, how the heart begins to beat, and how the brain takes shape. In the modern era, they offer the perfect bridge between traditional observation and cutting-edge molecular biology.  In my work, I combined classical embryological manipulations — the kind used by Spemann and his successors — with modern molecular tools such as gene-expression analysis, single-cell profiling, and imaging. This allowed me to see, at the level of individual cells, which genes switched on or off when a cell gained or lost competence.  I compared four different groups of cells within the same embryo: one group that was competent to respond to organiser signals and form nervous tissue, and three groups that were non-competent — exposed to the same signals but unable to form the nervous system. By analysing and contrasting these groups, I sought to understand what distinguishes a cell that can “hear” the organiser’s call from one that cannot — and whether those silent cells could ever learn to listen again.  What I Found: The Rules of Cellular Competence — and How to Restore It My experiments revealed that competence depends on a combination of timing, molecular readiness, and signal interpretation — a developmental choreography that determines whether a cell can change its fate.  Non-competent cells often had their “locks” jammed by inhibitory pathways, preventing them from opening to the organiser’s instructions. Others lacked the right “keys” altogether — the specific transcription factors required to decode the signal. Some cells attempted to respond, but too late, after the critical developmental window had closed. Others never performed an initial “reset,” a step that wipes away their former identity and allows a new fate to emerge.  But my research went further. By reapplying specific combinations of organiser-like signals, I was able to reawaken competence in cells that had previously lost it. In essence, I showed that the ability to respond can be restored. Once those dormant cells received the correct molecular cues, they once again became receptive — capable of forming neural tissue and interpreting developmental instructions.  This finding overturned the long-held assumption that competence loss is irreversible. It demonstrated that cellular deafness is not permanent; with the right signals, even silent cells can learn to listen again.  Image by Galina Nelyubova on Unsplash Why It Matters Understanding why some cells can respond to developmental signals while others cannot — and how to reverse that silence — has far-reaching implications. My research provides one of the first mechanistic explanations of cellular competence and shows that it is a flexible, recoverable state rather than a fixed property.  Competence also reframes how we think about therapeutics. Today, most treatments — whether aimed at regenerating tissues or blocking tumour growth — focus on the signals we deliver to cells: growth factors, drugs, or engineered molecules designed to influence behaviour. Yet these approaches often overlook a crucial variable: whether the target cells are actually capable of responding. My work highlights that the effectiveness of these signals depends as much on the cell’s internal readiness as on the quality of the cue itself.  This insight helps explain why some cells fail to respond to tissue-repair signals in the body, or why certain cancer cells resist even the most sophisticated therapies. It suggests that future treatments might not only need to deliver the right messages but also restore the ability of cells to hear them — making competence itself a therapeutic target.  In cancer, for example, tumour cells often lose responsiveness to signals that normally keep growth in check. Restoring their competence might make them sensitive again to the body’s natural control mechanisms or to anti-cancer drugs. In regenerative medicine, ensuring that stem cells are competent before applying differentiation signals could improve the reliability and precision of tissue generation.  Beyond its medical implications, these discoveries deepen our understanding of basic biology. They reveal that development is not a one-way script but a dialogue — a conversation between signals and receivers that can be interrupted, misunderstood, or reawakened.  Conclusion: Restoring the Ability to Listen My PhD uncovered the molecular logic of competence: why some cells hear developmental instructions while others cannot — and, crucially, how that ability can be restored once lost. I demonstrated that by carefully tuning the molecular environment, it is possible to re-open the developmental window and make previously unresponsive cells receptive again.  This discovery shifts the paradigm from simply sending biological messages to ensuring they can be received. It raises new questions that now drive my work: Can competence restoration be used to improve tissue repair or reprogram diseased cells? Could it help us design therapies that reactivate communication between cells rather than just amplify signals?  In the end, studying competence reminded me of a profound truth: building a body is not merely about construction, but communication. Every cell must learn when to speak, when to remain silent, and, most importantly, when to listen. My work helps decode that language — showing that even when silence falls, life’s instructions can still be heard again.

Disclaimer:   This blog does not promote or endorse the use of illegal substances. It is intended solely to explore the growing body of research investigating the potential role of psychedelics in innovative mental health treatments. Please be aware that the recreational use of psychedelics is illegal in many countries. These substances should only be used within the legal framework of your country and under the guidance of a qualified clinical professional.   What if healing deep emotional wounds didn’t take years of therapy but just the right experience guided by a clinical professional at the right moment?   I am an undergraduate student at the University of Chicago, majoring in Neuroscience and Economics. I was recently captivated in my psychology class (called ‘Sensation and Perception’, which I would recommend to anyone interested in understanding how the brain perceives the world around us) when my professor mentioned the effects of LSD on a patient suffering from PTSD, and how this changed their perception of trauma.  Here I want to talk about recent research  in animals by Nardou et al. (2023) suggesting that psychedelics like LSD (lysergic acid diethylamide) and psilocybin (a psychedelic found in mushrooms) may be able to reopen “critical periods,” which are windows that allow to rapidly learn language, emotions, and relationships during childhood. This may be because psychedelics specifically reshape the emotional side of your brain, which is the part of the brain specific to the sense of self, and open up and rewire new pathways that could potentially alter a post-traumatic stress disorder (PTSD) response. However, without clinical guidance, the sense of self can be disrupted, causing depression, suicidal thoughts, and severe anxiety, indicating the potentially dangerous nature of psychedelics.   This suggests that LSD, in association with therapy, as well as adequate support from a clinician, could potentially support the healing process. However, as of right now, results are solely based on animal studies, and more research is needed for humans before a connection can be made.    Psychedelic Drugs  Psychedelic drugs, more commonly called hallucinogens, alter someone’s perception, thoughts, and feelings. As inferred from the name, they also cause a person to hallucinate. Looking closely at the brain, this occurs because they affect the brain network and communication through serotonin and dopamine release.  Serotonin and dopamine are neurotransmitters, which means that they send messages and affect communication in the brain through nerve cells. Serotonin mostly helps regulate one’s mood, with low concentrations linked to depression, while dopamine is linked to a feeling of reward, motivation, and focus. Therefore, as one can imagine, the two are associated and promote well-being when functioning normally.   As mentioned above, psychedelic drugs may temporarily reopen critical windows. In neuroscience, "critical periods" are short windows in early life when the brain is particularly sensitive to certain experiences. Think of how babies effortlessly absorb language or how young animals learn to bond with caregivers. These learning abilities usually weaken as we age. By adulthood, the brain becomes more stable and, in many ways, more rigid.  However, individuals can become  tolerant to psychedelic drugs , as they may constantly seek the feeling induced by them, and making them increase their dosage. People can also become “psychologically dependent”, as they feel that these drugs are an important part of their lives.    Despite their potential being studied, psychedelic drugs can cause uncomfortable physical effects  such as nausea, vomiting, diarrhoea, headaches, abdominal pain, tremors, and rapid heartbeat. These effects can be damaging and dangerous and may require immediate medical attention. In some cases, they might even be fatal. Similarly, psychological adverse effects  can be very severe and long-lasting, like anxiety, panic and flash-backs of the hallucinatory experiences.     LSD, The Most Effective Drug for Critical Periods  A previous animal study from Nardou et al.  (2019) found that psychedelics can reopen these critical periods in mice and specifically, the one related to social reward learning. In the study, adult mice given LSD, psilocybin, a naturally occurring hallucinogen found in some mushrooms, or MDMA (also known as ecstasy, which is a stimulant) regained the ability to form strong social bonds, a trait usually limited to their juvenile stage. These effects lasted for weeks.  It was discovered that different drugs kept the learning window open for mice for different lengths of time. Ketamine lasted for about 48 hours. Psilocybin stretched for two weeks. And LSD for a full three weeks.    Psychedelics can impact the brain as such by exploiting a process known as metaplasticity , which is the brain’s natural ability to potentiate synaptic connections and thus retain new information. Psychedelics seem to enhance this process by increasing the function of serotonin in the brain.     Findings and Their Effect on Therapy  Rather than just managing symptoms, psychedelics may enable change by reopening the brain's natural learning machinery (although it has only been tested on mice as of today).   For people with depression, PTSD, or attachment difficulties, it could mean accessing the kind of emotional rewiring that seemed impossible in adulthood. This of course can only happen if supported by guidance from a therapist, which might enhance learning abilities. Thus, proper and guided use of these drugs within future approved medical treatments could potentially help create new pathways that, with the help of a licensed therapist, may act as complementary tools in the healing process from conditions such as PTSD and trauma.  In conclusion , it is important to remember that this evidence is in mice, and that translating mouse studies into human therapies takes time. Hence, no clear connection can be made yet between the human brain and psychedelics in terms of trauma healing as a mode of therapy.   Also, it is important to remember that, despite the presence of clinical trials exploring psychedelics’ effects in people, including using brain imaging, and indicating a potential therapeutic role, psychedelics are dangerous drugs. They can have a very harmful effect, and non-medical use is never advised.

The SHAPER-PND study I am Dr Rebecca Bind, a Postdoctoral Research Associate working in the Perinatal section of the Stress, Psychiatry and Immunology Lab at The Institute of Psychiatry, Psychology and Neuroscience. Most recently I managed a clinical trial for mothers with postnatal depression called SHAPER-PND, the exciting results from which have just been published and I will discuss below. Postnatal depression   Postnatal depression has become more common in recent years, thought to affect up to 1 in 4 mothers. Symptoms—which include low mood and sadness, loss of interest and motivation, tearfulness, fatigue, and feelings of guilt— can begin in pregnancy and carry on into the postpartum period or appear after the baby is born. While conventional treatments, like antidepressants and talking therapy, show to be beneficial, many mothers still face difficulties in accessing standard care.   In light of this, it has become increasingly necessary for alternative or complementary interventions to be made available, like community-based arts activities. In fact, studies show that group singing help mothers with a sense of social support, stress reduction and relaxation, and a stronger bond with their babies. Our study   To understand whether community singing sessions are an effective intervention for postnatal depression, the SHAPER research team , myself included, set up a clinical trial, led by Professor Carmine Pariante of King’s College London. Our trial had three main aims (more detail of which can be read in our protocol paper and in our recently published findings):   1)    To evaluate whether 10 weeks of singing sessions can reduce symptoms of postnatal depression 2)    To understand whether mothers who participated in the singing sessions found it to be a useful intervention 3)    To assess whether the intervention is affordable for the NHS to incorporate into standard care for postnatal depression. Study design   For the SHAPER-PND study, we recruited 199 mothers across South London who were experiencing symptoms of postnatal depression and their babies. Mothers were recruited from social media, their GP surgery, perinatal mental health services, word-of-mouth, and community centres. Our recruitment flyer for the SHAPER-PND study Eligible mothers enrolled and completed a baseline assessment for demographic information and to evaluate their mental health. Mothers were then randomly (that is, by chance) allocated to either our 10-week singing intervention (intervention group), called Breathe Melodies for Mums (described below), or to already-existing mother-baby groups at local children’s centres, like baby sensory and messy play (control group).   They filled in questionnaires at baseline, week 6 (mid-intervention), week 10 (end-of-intervention), and weeks 20 and 36 (post-intervention follow-ups) so we could track their symptoms and whether they were finding their assigned activity to be helpful for their mental health.   We also filmed mothers interacting with their babies at baseline, week 10, and week 36, to look for changes in their relationship and we collected biological samples (saliva) at baseline and week 10 to look at mothers’ and babies’ levels of stress hormones, including cortisol. Results from these two aspects of the trial are still being analysed. Saliva being taken from a baby during a Melodies for Mums session. Photo credit: Breathe Arts Health Research Breathe Melodies for Mums   Breathe Melodies for Mums (M4M) is a singing programme that was developed by Breathe Arts Health Research as a bespoke intervention for postnatal depression and piloted in a previous research study.   For M4M, mothers and their babies attended 10 weekly, in-person, hour-long singing sessions, led by a specialist Breathe-trained music lead. Mothers and babies sat in a circle on the floor and classes began with welcome songs to introduce everyone. Songs were from around the world in different languages and from different cultures, were sung in rounds with multiple parts and harmonies, and sometimes included instruments. A Melodies for Mums session. Photo credit: Breathe Arts Health Research What did we find?   We found that mothers in both groups experienced a significant decrease in their symptoms of postnatal depression by the end of the intervention (week 10). However, once the intervention period ended, mothers in the singing group maintained lower levels of depression than mothers in the control group, seen at weeks 20 and 36, that is up to six months after the end of the singing sessions. This was a very important finding as it showed us that not only is M4M effective at reducing symptoms of depression during the intervention period itself, but that its effects are long-lasting.    Secondly , we looked at participant retention, meaning whether mothers remained in the study. We found a difference between the intervention and control groups, such that mothers in the intervention group were likelier to remain in the study and attend their sessions. This suggested that the intervention group was finding their activity to be more helpful and motivating. We next found that mothers who participated in M4M found it to be a more useful and valuable intervention than the mothers who attended community mother-baby activities found their sessions to be.     Finally, M4M was found to be affordable, with the cost of a 10-week intervention falling within the range that NICE recommends the NHS pay for an intervention. This was very encouraging, given that M4M is clinically effective for postnatal depression and mothers enjoy and greatly benefit from the sessions. Why does M4M work?   The Breathe M4M singing intervention is a promising intervention for postnatal depression and we believe there are numerous reasons why it works. Firstly, it is possible that the skills mothers learn during the sessions help them care for and bond with their babies, leading to increased feelings of competency and reduced depression. Additionally, previous studies have found that singing to one’s baby decreases cortisol, a stress hormone closely tied to depression. Furthermore, the singing sessions have been specifically tailored to mothers experiencing postnatal depression, providing mothers with social support that they likely wouldn’t receive in standard mother-baby activity groups. In fact, mothers in the intervention group told us in interviews conducted that they greatly valued the opportunity to build social connections in a group setting with other mothers going through similar mental health difficulties.   A Melodies for Mums session. Photo credit: Breathe Arts Health Research Going forward   Overall, the SHAPER-PND trial provides exciting novel evidence that the Breathe M4M singing intervention is clinically effective, highly-rated by mothers, and cost-effective. Given this, in addition to the fact that mothers in the intervention group had longer-lasting relief from their depressive symptoms, and were more likely to attend their sessions, we believe there is great value in our health and social care systems investing in this intervention.