Understanding Depression

This booklet describes the symptoms of depression and the different kinds of treatment available. It suggests ways that people can help themselves, and what family and friends can do. It also tells you where to find further advice and information. Depression can affect different people in different ways and can produce a wide variety of symptoms, both psychological and physical. If you are depressed, you may feel that nothing can help. But there are things you can do that can make a difference. Deciding to do something is the most important step you can take. Most people recover from bouts of depression, and some even look back on it as a useful experience, which forced them to take stock of their lives and make changes in their lifestyle.

What is depression?

Depression is a medical term that covers quite a broad range of psychological distress. In its mildest form, depression can cause lowered mood, which does not stop you leading your normal life, but makes everything harder to do and seem less worthwhile. At its most severe, depression can be life threatening. You may feel like killing yourself, or simply give up the will to live.

Anxiety

People who are depressed often experience anxiety, too. You become anxious when you feel threatened, whether the threat is real or imagined. Anxiety can be expressed through physical symptoms, such as headaches, aching muscles, sweating and dizziness. Someone who is anxious may have a mind full of busy, repetitive thoughts. These can make it hard to concentrate, relax, or sleep. In the long term, anxiety can cause physical exhaustion and general ill health.

Seasonal affective disorder (SAD)

This type of depression is thought to be due to the lack of daylight

during the winter months, which makes some people more prone

to depression.

Postnatal depression

Some mothers experience depression after their babies are born. It’s thought to be brought on by the huge changes in hormone levels.

Manic depression

This causes people to have episodes of depression and mania. Mania is a state of highly excited and uncontrolled behaviour. ?

What are the symptoms of depression?

Depression affects different people in different ways. It can produce a broad range of symptoms, which can be emotional or physical.

People suffering from depression may:

• feel low-spirited a lot of the time
• have low self-esteem and may lack self-confidence
• be preoccupied with negative thoughts
• feel numb, empty and despairing
• blame themselves and feel unnecessarily guilty about things
• find it difficult to concentrate or make decisions
• be unusually irritable or impatient
• wake early, or have problems getting to sleep
• eat more and put on weight, or not eat properly and lose weight
• not enjoy normally pleasurable activities
• experience a loss of sexual drive
• use more tobacco, alcohol or other drugs than usual
• consider, or commit, acts of self-harm or suicide
• have reduced energy and reduced activity
• cut themselves off from others, rather than asking for help or support
• have a bleak, pessimistic view of the future.

What causes depression?

There is no one cause of depression; it varies very much from person to person. In many cases, depression is triggered by life-events, especially in a first episode of depression. What happened to you as a child can have a profound effect on how you feel about yourself in the here and now.

Traumatic experiences, such as a physical attack or rape, can trigger depression, as can bereavement. It’s not just the negative experience that causes depression, but how you deal with it. Negative experiences are more likely to contribute towards depression if your feelings about the experience are not expressed or explored.

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Depression can also be linked to physical causes. Poor diet, lack of physical fitness and illnesses, such as influenza, can all leave you feeling depressed. Frequent use of some recreational drugs can also lead to depression.

What treatments are available?

It’s ironic that when seeking help for depression, it can seem like an added burden to choose between a range of treatment options at a time when you may well find making decisions difficult. A wide range of treatments for depression are available. However, the availability of some of these treatments can be limited, depending on where you live. For example, talking treatments, such as counselling, are more readily available in London and the South-East than they are in rural areas of northern England.

People experiencing depression should be able to choose freely between the range of treatment options, or combinations of treatments. In practice, the majority of people attending GP surgeries are offered antidepressants as the first treatment choice. For many people, a combination of talking treatments and antidepressants is the most effective way of coping with depression.

Counselling

Counselling involves talking with someone who is trained in the art of listening. This allows you to express how you feel in order to begin to find your own solutions to your problems. Talking and being listened to, by someone who shows empathy and acceptance, can help you to explore issues that are troubling you. The counsellor may be able to help you to develop a greater understanding of your feelings, thoughts and behaviours. ?

Your GP practice may have a counselling service attached to it, or may be able to refer you to another counselling service within the NHS. Counselling can also be obtained from a variety of voluntary and private organisations

Psychotherapy

Psychotherapy is a talking treatment that helps you to find ways of coping with problems you may be experiencing. It aims to provide you with an opportunity to work towards living in a more satisfying and resourceful way. The psychotherapeutic process goes deeper than counselling: you may be encouraged to look closely at your past, particularly your childhood, and your relationships with significant people in your life. Some short-term psychotherapy is available on the NHS, but most psychotherapists work in private practices.

Cognitive behaviour therapy

Cognitive behaviour therapy, or CBT, is a talking treatment that helps you to recognise problems and overcome emotional difficulties. The therapist enables you to identify connections between your thoughts, how your thoughts affect you and how you behave. CBT helps you to develop practical skills, enabling you to explore what lies at the root of your feelings and behaviour. Cognitive behaviour therapy is usually practised by psychologists, therefore a referral from your GP is normally necessary.

Self-help groups

Self-help groups work on the principle that it can be useful to meet with other people who are experiencing depression. It can break down feelings of isolation and, at the same time, show you how other people have coped. Finding that you can support others can help you too. These groups are often led by people who have overcome depression themselves.

Medication

Antidepressant drugs are the most common medical treatment for depression. They work on chemicals in the brain to lift your mood. They do not cure depression, but they do alleviate the symptoms so that you may feel able to take action to deal with the depression yourself. Antidepressants do not work for everyone and frequently cause unpleasant side effects. It often takes between two to four weeks before the drugs take effect. Some antidepressants can be dangerous when used with other drugs, and you may experience withdrawal symptoms when you stop taking them.

Hospital admission

If you are severely depressed, you may need the shelter and protection offered by the psychiatric ward of a hospital. It can also give your psychiatrist the opportunity to monitor the effects of different treatments. Hospital can provide a safe and supportive environment if you are in a state of distress, and it may be comforting to have other people around you and to know that you are being cared for. However, it can be distressing to be on a ward where you have little privacy, where you have to fit in to routines that may not suit you, and where you may be upset by the behaviour of other patients. Generally, doctors want to keep patients out of hospital, but some patients are compulsorily detained if it is thought to be necessary for their own health or safety, or the protection of others.

Community care

If you have long-term, severe depression and require support to live independently in the community, a number of services may be available to you. The Care Programme Approach aims to ensure that you are assessed and the right services provided for you by social services and the health authorities. A care co-ordinator may be allocated who will try to co-ordinate the services provided to support you. Community mental health teams (CMHTs) and community psychiatric nurses (CPNs) can provide support for people living in their own homes.

Electro-convulsive therapy (ECT)

This treatment is usually only given to people who are severely

depressed, who have not responded to drug treatment. You are

given a general anaesthetic and then an electric current is passed

through your brain, causing a convulsion like an epileptic fit. It’s a

controversial treatment that can have severe side effects, such as

memory loss.

What can I do to help myself?

Depression has one major characteristic that you need to be aware of when thinking about what you can do to defeat it – depression can feed on itself. In other words, you get depressed and then you get more depressed about being depressed. Negative thoughts become automatic and are difficult for you to challenge. Being in a state of depression can then itself become a bigger problem than the difficulties that caused it in the first place. An important thing to remember is that there are no instant solutions to problems in life. Solving problems involves time, energy and work. When you are feeling depressed, you may well not be feeling energetic or motivated to work. But if you are able to take an active part in your treatment, for example by participating in talking treatments, it should help your situation.

It’s necessary to try and break the hold that the depression has on you. You need to break the cycle of negative thoughts. Try and recognise when you are doing it, and replace it with a more constructive activity. Look for things to do that occupy your mind. Although you may not feel like it, encouraging yourself to take part in physical activities is very therapeutic. Playing sports, running, dancing, cycling, even brisk walking can stimulate chemicals in the brain called endorphins, which can help you to feel better. ?

You need to do things that will improve the way you feel about yourself.

Try and treat yourself kindly. You need to look after yourself physically

– eat well, exercise and don’t abuse your body with tobacco, alcohol

or other drugs. Pay attention to your personal appearance and give yourself treats.

Alternative and complementary therapies

A wide range of alternative and complementary treatments are available, which may be of some benefit in treating depression. Herbal antidepressants, such as Hypericum (St John’s Wort), can help lift your mood and have become very popular. However, it is important to note that, if you are taking medicines, it may not be safe to take St John’s Wort. Call NHS Direct for more information. Other treatments such as acupuncture and homeopathy are also used for treating people with depression. Many complementary therapies do not see the mind and body as separate. They see you as a whole person and are not concerned with merely treating symptoms.

What can friends or relatives do to help?

People who are depressed often withdraw from the friends and relatives around them, rather than asking for help or support. However, this is a time when they need your help and support most. Perhaps the most important thing that family and friends can do is to encourage the depressed person to seek appropriate treatment. The very nature of depression, the feelings of helplessness, hopelessness and worthlessness, can keep the depressed person from seeking help.

Supporting a friend or relative who is depressed can be an opportunity to build a closer and more satisfying relationship. However, it can also be hard work. It can feel frustrating at times, and unless you look after yourself, it can make you feel depressed yourself. What people who are depressed need most is someone who cares for them. You can show that you care by listening sympathetically, by being affectionate, by appreciating the person, or simply by spending time with them. You can help by encouraging them to talk about how they are feeling and help them to work out what they can do, or what they need to change, in order to deal with their depression.

If the person you are supporting is severely depressed, you may be faced with some hard decisions about how much to do on their behalf. If, for example, they are not looking after their physical needs, should you take over and do the shopping, cooking and cleaning for them, if you are able to? Or should you try and encourage them to do it? There are no easy answers to this situation. It will help if you can find someone with whom you can discuss these, and other issues.

When supporting a friend or relative, you must try not to blame them for being depressed, or tell them to ‘pull themselves together’. They are probably already blaming themselves, and criticism is likely to make them feel even more depressed. Praise is much more effective than criticism. You can remind them that it’s possible to do things to improve their situation, but it needs to be done in a caring and sympathetic way to work.

It’s important that you pay attention to your own needs. If you can, try and share the responsibility of supporting your friend or relative with as many people as possible. Try and find people to whom you can express your frustrations. There may be a local support group for people in your situation.

Crisis telephone counselling service for children, young people and adults on any issue, including depression. Face-to-face counselling for adults. Referrals to other agencies and support groups throughout the country

For details of your nearest Mind association and of local services contact Mind’s helpline, MindinfoLine: 0845 7660 163 Monday to Friday 9.15am–5.15pm. For interpretation, MindinfoLine has access to 100 languages via Language Line. Typetalk is available for people with hearing or speech problems who have access to a minicom. To make a call via Typetalk dial 0800 959598, fax: 0151 709 8119.

Scottish Association for Mental Health tel. 0141 568 7000.

Northern Ireland Association for Mental Health tel. 02890 328474

Mind works for a better life for everyone with experience of mental distress