depression

DEPRESSION HELP AND ADVICE
Depression is common. About 1 in 5 adults suffer significant levels of symptoms and at least 1 in 8 experience depression severe enough to require treatment. The rate of depression in women is approximately twice that in men.

Depression is different from just being fed up or miserable; it is an illness. It is common and can seriously interfere with work, interests, relationships and every area of life. The good news is that it can be helped

HOW CAN DEPRESSION MAKE YOU FEEL?

• Emotional: sadness, anxiety, guilt, irritability, loss of enjoyment
• Physical: sleep disturbance, loss of appetite (or occasionally increased appetite), tiredness, loss of sex drive, feeling worse at a particular time of day (usually mornings)
• Behavioural: loss of interest, loss of motivation, lowered activity levels avoiding other people, agitation, restlessness
• Psychological/Cognitive: poor concentration, difficulty making decisions decreased self confidence and self worth, negative thinking - thoughts of being useless, worthless and inadequate; hopelessness and suicidal thoughts
  

Sometimes depression may not show itself as feelings of sadness but may produce bodily pain, headaches, sleeplessness etc.

WHAT MIGHT THE CAUSES BE?

More often than not it is caused by a combination of many factors:

• Bodily/biological: imbalance of brain chemicals, some physical illnesses some drugs used to treat physical illnesses, other drugs and alcohol
• Historical: difficult life experiences, traumas, abuse
• Environmental: life stresses and problems e.g. with housing work finances, family
• Psychological: low self esteem, negative thinking
  

Causes can be divided up into:

• Things that make people vulnerable to depression e.g. family history of depression or alcohol or drug problems, early parental loss or neglect or long term lack of self esteem
• Things that trigger off a bout of depression e.g. recent life events - deaths, traumas, relationship breakdown, loss of job or physical illness
• Things that prolong/maintain depression e.g. critical or hostile partner, lack of a close, confiding relationship, lack of adequate social support, social isolation, difficulties in family, high degree of work stress, heavy regular use of alcohol or chronic physical illness
  

TREATMENTS
Untreated episodes of depression may resolve within 3-6 months. However, relapse is frequent and 1 in 5 people follow a longer-term course. Treatment must aim not only to speed recovery from the current episode, but also to maintain improvement and, if possible, reduce the likelihood of recurrence

ANTIDEPRESSANTS
In many cases, antidepressants are helpful and necessary, decreasing the time taken to return to a normal level of functioning and thus enabling people to start to tackle life stresses / underlying issues. Antidepressants seem to be most effective for those with strong physical symptoms such as sleep, energy and appetite disturbance. Sometimes some tablets have side effects. You may wish to discuss
this with a member of staff at your surgery

It usually takes 2-3 weeks for an antidepressant to start working. Your doctor will probably suggest that you take it for at least 6-8 weeks before you can be sure whether or not it is helping you. Although most people will respond to the first antidepressant drug, it may be necessary to try 2 or more courses of different drugs until you find one that suits you and improves your symptoms.

Length of treatment will vary depending on how long you have been depressed and how many bouts of depression you've had. It's important to seek advice from your doctor about how long to continue treatment, but this will usually be at least 6 months from the time of feeling completely better. Side effects may include nausea, dizziness and headache. These can resolve in a few days

PSYCHOLOGICAL THERAPIES (TALKING TREATMENTS)
There are many kinds of talking therapies. Three of the most common include counselling, cognitive therapy and dynamic psychotherapy. Counselling focuses on the present and may be valuable in sorting out any immediate problems that may be contributing to your depression. Cognitive therapy looks at the way you think and understand the world and attempts to change negative patterns of thinking that can contribute to depression. Dynamic psychotherapy looks at early life experiences to understand any problems that may underlie your depressive illness. Exploring and confronting the reasons behind your depression can be painful and takes energy and motivation; it may not be possible to do this whilst your depression is severe

SELF HELP
Although depression is an illness and definitely not your fault, there are many things that you can try to do to help yourself feel better. None of these things are easy - but they get easier with perseverance and practice. Trying them may make you feel more in control and ease your sense of helplessness. Strategies include:

1. Learning to break the "lethargy spiral"
Depression slows you down mentally and physically so that everything you do becomes an effort. You get tired more easily and start to do less and less You then start to blame yourself for doing less. You begin to believe that you can't do anything and that you will never get over your depression; this makes you feel more depressed and makes it even harder to do anything. It is important to break out of this vicious circle by becoming more active

Benefits of being more active

• It makes you feel better by taking your mind off painful feelings; you may even start to enjoy yourself. It gives you a sense that you are trying to get back in control of your life and are achieving something worthwhile
• It makes you feel less tired. Doing nothing for long periods of time just makes you feel apathetic and exhausted
• Doing something gives you the motivation to gradually do more and more
• It improves your ability to think

Getting going
You will need to learn to challenge the gloomy and pessimistic thoughts that get in the way. When you are depressed it's very common to think that you are doing nothing, achieving nothing, enjoying nothing. It's difficult to organise your time productively or involve yourself in things you normally enjoy. It can be helpful to plan ahead (perhaps the evening before) what to do at different times of the day. Making a written timetable of activities can help make the day seem less overwhelming since the day is broken down into manageable chunks and you no longer face having to make lots of minor decisions about what to do at any time

2. Distraction techniques
Sometimes distressing thoughts can become overwhelming and it seems impossible to push them out of your mind. Although it is important to face up to and work through painful issues in times, when depression is severe, it may be helpful to use distraction techniques:

• Try focusing on your surroundings as a whole, using all your senses. What can you see or hear around you? Inside the room? Outside the room? Inside your body? What are you touching? Can you feel the clothes on your body? Your hair? Your shoes? What can you smell? What can you taste? etc.
• Try remembering a favourite walk in detail
  

3. Learning to identify and challenge automatic negative thoughts
Cognitive theory links together events, thoughts, feelings and behaviour and demonstrates that what we think affects how we feel which in turn affects how we behave. Negative thinking is part of depression. Characteristically a person who is depressed will have distorted negative views of him / herself, of the world, of current experience and of the future. Typical thoughts of depressed people include: "I'm useless; nothing I do turns out right," "I'll never get better," "No one likes me," "I'm pathetic," "I'm weak," "My family are fed up with me," "I'm a lousy parent," "I'm no good to anyone," "I'm sure to fail so there's no point in trying" etc. Since such thoughts tend to pop into the head repeatedly and automatically they are known as "negative automatic thoughts."

As depression worsens these negative automatic thoughts become more frequent and more convincing, which in turn makes depressive symptoms worse. It is important to try to break this vicious circle by learning to catch, challenge and balance the negative automatic thoughts. The thoughts are very real and powerful and thus seem to be true; it is important to learn to challenge them and test them out, looking for evidence that they are not completely true all of the time.

• Try to notice when your mood changes (when you suddenly feel more upset, sad, angry, anxious etc.) or when you have a strong reaction to something
• Try to identify what was going through your mind at the time; this might be thoughts, visual images or memories
• Learn to recognise how negative thoughts affect your mood, try to "fight back" by catching the thoughts and try to change them into alternative, more balanced thoughts

  There are some good self-help workbooks, tapes, videos and CD-ROMs that you could use. Examples of self help literature are listed at the end of this leaflet

4. Problem solving
Depression has many causes. Environmental problems - life stresses in the here and now - are often major factors and thus trying to solve them can help to reduce the depression. Sometimes it's easy to feel overwhelmed by things - particularly when you are depressed. Solving one small problem may seem like a "drop in the ocean" but it's important to start somewhere. Making small changes can make life seem less hopeless

a. Make a list of your problems. Potential problem areas include relationships, daytime activities, employment, studies, child care difficulties, finances, accommodation, physical health, mental health, alcohol, drugs or bereavement
b. Decide which problem to tackle first. It is often helpful to choose the one which will make the most difference to you if solved: think "if I had a magic wand the first thing I'd change would be....." Perhaps choose the one that is most distressing. However it is also important to first choose one that is realistic and practical to change. Urgent problems must also be prioritised
c. Define the problem - be very specific, e.g. exactly which aspects of work is/are difficult
d. Think of all possible solutions - include extreme solutions. The more solutions you come up with the more likely a good one will emerge. Are there other solutions that friends / family / partner may suggest or other people such as the Citizens Advice Bureau?
e List advantages and disadvantages of each solution
f. Choose desired solution. Try to choose something helpful and achievable
g. Break solution down into small steps. Work out exactly what needs to be done to achieve each step; go through each step in your imagination to identify any possible difficulties. Make a plan of the practical steps you need to take. Rehearse in your head to pre-empt difficulties: "If that hitch happens then what will I do next?"
h. Action - Do it!
i. Review progress and reward yourself for trying. Acknowledge that you have been brave in daring to take a risk and do something. Think: "what did I learn from this?" "What might I do differently next time?"

5. Taking care of yourself
It is important to make lifestyle changes - both to try to speed your recovery and to maximise your chances of staying well. These include:

• Learning to be kind to yourself
• Eating sensibly - regular meals; healthy, balanced diet
• Take some exercise
• Cutting down on alcohol and smoking
• Avoiding street drugs (cannabis, speed, cocaine, etc.)
• Cutting down on caffeine (coffee, tea, coke, chocolate)
• Making time to engage in activities you enjoy
• Spending time with your friends/with people that care about you
• Trying to find someone to confide in
• Reducing avoidable stresses
• Remembering to attend appointments with your GP/psychiatrist/community psychiatric nurse, etc
• Remembering to take prescribed medication regularly
• Learning to be less self critical
• Learning self acceptance
  

SEEKING HELP IN CRISIS
Asking for help is not a sign of weakness; it is responsible and appropriate to seek out help when necessary. At times you may feel your distress is too intense and too painful to cope with on your own. Learning to turn to friends and family for support is important but may not always be possible. In crisis, particularly if you are feeling suicidal, you may consider contacting:
GP - You can contact your GP during surgery hours or out of hours there is always an "emergency doctor" on call and you will be given this number if you ring your usual GP practice
Community Mental Health Team - If you have an allocated worker from the Community Mental Health Team, then it is appropriate to try to contact them during weekday working hours. If they are unavailable there is always a worker "on duty" who will be happy to speak to you

HELP AND SUPPORT
You may wish to consider contacting:

• Depression Alliance, 35 Westminster Bridge Rd, London SE1 7JB, Helpline 0207 6330557 www.depressionalliance.org
• Fellowships of Depressives Anonymous, 01702 433838 www.depressionanon.co.uk

Self help books:

• Managing Anxiety & Depression, Mental health Foundation www.mentalhealth.org.uk
  
• Overcoming Depression: a five areas approach, Christopher J Williams, (Hodder Arnold H & S)
  
• Mind over Mood: Cognitive Treatment Therapy Manual for Clients, Christine Padesky & Dennis, Greenberger (Guildford Press)

There are many organisations which may be able to help you:

• Your own doctor
• Samaritans - 08457 909 090. Free phone line offering emotional & confidential support for people who are experiencing feelings of distress or despair, including those which may lead to suicide (24 hours)
• NHS Direct - 0845 46 47 (24 hours). Free information service on all aspects of health problems, NHS services and other local services www.nhsdirect.nhs.uk
• MIND Infoline - 08457 660 163. Free national information line (9.15am-5.15pm, Monday-Friday) - interpretation available for over 100 languages www.mind.org.uk
• Mental Health Foundation: www.mentalhealth.org.uk
• Rethink: www.rethink.org
• www.besttreatments.co.uk (provides clinical evidence for patients on a range of problem areas)

Source text: Leeds Mental Health Trust and Leeds Primary Care Trusts
Image source: Message Internet magazine
The original version of this leaflet was written by Ardsley Community Mental Health Team, East Ardsley Health Centre, Wakefield WF3 2DN

NHS Direct 0845 46 47 www.nhsdirect.nhs.uk