Tuesday 11 December 2012
Sunday 9 December 2012
Some dos and don'ts about depression
Don't bottle things up and 'go it alone'. Try to tell people who are close to you how you feel. It is not weak to cry or admit that you are struggling.
Don't despair - most people with depression recover. It is important to remember this.
Do try to distract yourself by doing other things. Try doing things that do not need much concentration but can be distracting, such as watching TV. Radio or TV is useful late at night if sleeping is a problem.
Do eat regularly, even if you do not feel like eating. Try to eat a healthy diet.
Don't drink too much alcohol. Drinking alcohol is tempting to some people with depression as the immediate effect may seem to relieve the symptoms. However, drinking heavily is likely to make your situation worse in the long run. Also, it is very difficult either to assess or to treat depression if you are drinking a lot of alcohol.
Don't make any major decisions whilst you are depressed. It may be tempting to give up a job, or move away, to solve the problem. If at all possible you should delay any major decisions about relationships, jobs, or money until you are well again.
Do tell your doctor if you feel that you are getting worse, particularly if suicidal thoughts are troubling you.
Sometimes a spell off work is needed. However, too long off work might not be so good, as dwelling on problems and brooding at home may make things worse. Getting back into the hurly-burly of normal life may help the healing process when things are improving. Each person is different, and the ability to work will vary.
Sometimes a specific psychological problem can cause depression, but some people are reluctant to mention it. One example is sexual abuse as a child leading to depression or psychological difficulties as an adult. Tell your doctor if you feel something like this is the root cause of your depression. Counselling may be available for such problems.
Treatment options for mild depression
The following are the commonly used treatment options for people with mild depression. Also, for people with subthreshold depression that has lasted a long time and not shown signs of improving. Some people prefer one type of treatment to another. So, personal preference for the type of treatment used should be taken into account when discussing the best treatment for yourself with your doctor.
A guided self-help programme
There are various pamphlets, books, and audio tapes which can help you to understand and combat depression. The best are based on the principles of CBT, as described earlier. Ideally, a guided self-help programme is best. That is, a programme where the materials are provided by a trained practitioner such as a doctor, and where a practitioner monitors your progress. A self-help programme takes some motivation and effort to work through - a bit like doing homework. A typical guided self-help programme consists of 6-8 sessions (face-to-face and via telephone) over 9-12 weeks.
Computer-based cognitive behavioural therapy
Computer- and internet-based self-help CBT programmes are recent innovations. They are supported by a trained practitioner who monitors progress. A programme typically takes place over 9-12 weeks, and you are given tasks to try out between sessions.
Group-based cognitive behavioural therapy
This is CBT but in a group setting of 8-10 participants. Typically, it consists of 10-12 weekly meetings.
Group-based peer support
This is an option for people with depression who also have an ongoing (chronic) physical problem. This allows sharing of experiences and feelings with a group of people who understand the difficulties and issues facing group members. Typically, it consists of one session per week over 8-12 weeks. Ideally, it should be supported by a facilitator who has knowledge of the physical health problem, and who reviews progress with people taking part in the group.
Antidepressant medicines
Antidepressant medication is not usually recommended for the initial treatment of mild depression. However, an antidepressant may be advised for mild depression in certain circumstances. For example, in people:
With mild depression that persists after other treatments have not helped.
Whose depression is associated with a physical illness.
Who have had an episode of moderate or severe depression in the past.
Treatment options for moderate or severe depression
Antidepressant medicines
Antidepressant medicines are commonly used to treat moderate or severe depression. A medicine cannot alter your circumstances. However, symptoms such as low mood, poor sleep, poor concentration, etc, are often eased with an antidepressant. This may then allow you to function more normally, and increase your ability to deal with any problems or difficult circumstances.
An antidepressant does not usually work straight away. It can take 2-4 weeks before the effect builds up fully. A common problem is that some people stop the medicine after a week or so as they feel it is not helping. You need to give it time. Also, if it is helping, follow the course that a doctor recommends. A normal course of an antidepressant lasts for at least six months after symptoms have eased. Some people stop their medication too early and the depression may then quickly return.
There are several types of antidepressants, each with various pros and cons. For example, they differ in their possible side-effects. (The leaflet that comes in the medicine packet provides a full list of possible side-effects.) If the first one that you try does not suit, then another may be found that will suit. So, tell your doctor if you have any problems with an antidepressant. Antidepressants are not tranquillisers and are not thought to be addictive.
People with moderate or severe depression have a good chance of improving within a few weeks of starting an antidepressant. But, they do not work in everybody. However, some antidepressants work better in some people than in others. Therefore, tell your doctor if symptoms do not start to improve after about 3-4 weeks of taking an antidepressant. In this situation it is common to advise either an increase in dose (if the maximum dose is not yet reached) or a switch to another type of antidepressant.
At the end of a course of treatment it is usual to reduce the dose gradually over about four weeks before finally stopping. This is because some people develop withdrawal symptoms if an antidepressant is stopped abruptly.
Psychological (talking) treatments
Various psychological treatments have been shown in research trials to be good treatments for depression. These are briefly listed below. In general, a combination of an antidepressant plus a psychological treatment is better than either treatment alone. Therefore, if available, you should consider having both treatments. However, there may be a shortage in some areas of trained therapists who can perform psychological treatments. Typically, most psychological treatments for depression last in the range of 12-20 weekly sessions of 1-2 hours per session.
Those most commonly used for moderate or severe depression are:
Cognitive behavioural therapy (CBT). Briefly, cognitive therapy is based on the idea that certain ways of thinking can trigger, or fuel, certain mental health problems such as depression. The therapist helps you to understand your thought patterns. In particular, to identify any harmful or unhelpful ideas or thoughts which you have that can make you depressed. The aim is then to change your ways of thinking to avoid these ideas. Also, to help your thought patterns to be more realistic and helpful. Behavioural therapy aims to change any behaviours which are harmful or not helpful. CBT is a combination of cognitive therapy and behavioural therapy. In short, CBT helps people to achieve changes in the way that they think, feel and behave. (See separate leaflet called 'Cognitive Behavioural Therapy (CBT)' for more details.)
Interpersonal therapy (IPT). This is sometimes offered instead of CBT. IPT is based on the idea that your personal relationships may play a large role in affecting your mood and mental state. The therapist helps you to change your thinking and behaviour and improve your interaction with others. For example, IPT may focus on issues such as bereavement or disputes with others that may be contributing to the depression.
Other types of therapy sometimes used, depending on circumstances, include:
Behavioural activation. The basis of this therapy is that behaviours such as inactivity and ruminating on certain thoughts can be key factors in maintaining depression. The therapist aims to help you to combat these unhelpful behaviours.
Couple therapy. This may be an option for people who have a regular partner and where the relationship contributes to the depression. Or, where involving the partner is considered to be of potential useful benefit.
Other treatments
Electroconvulsive therapy (ECT) may be advised as a last resort if you have severe depression which has not improved with other treatments.
What about exercise?
It is difficult to give firm advice about exercise as a treatment. Some people claim that regular exercise helps to lift their mood and help to combat depression. But, there is conflicting evidence about this from research trials. The national guideline published in 2009 by NICE advises regular exercise as a possible treatment. A large review published in 2012 supports this advice concluding that exercise, on average, seems to improve depressive symptoms. In contrast, a large research trial published in 2012 found that the addition of an exercise programme to the usual care for depression did not improve the outcome of depression or reduce the use of antidepressants compared with usual care alone.
But also bear in mind that regular exercise is generally a good thing to do anyway.
What causes depression?
The exact cause is not known. Anyone can develop depression.
Some people are more prone to it, and it can develop for no apparent reason.
You may have no particular problem or worry, but symptoms can develop quite suddenly.
So, there may be some genetic factor involved that makes some people more prone to depression than others.
An episode of depression may also be triggered by a life event such as a relationship problem, bereavement, redundancy, illness, etc.
In many people it is a mixture of the two. For example, the combination of a mild low mood with some life problem, such as work stress, may lead to a spiral down into depression.
Women tend to develop depression more often than men.
Particularly common times for women to become depressed are after childbirth (postnatal depression)
and the menopause.
Severity of depression
The severity of depression can vary from person to person. Severity is generally divided as follows:
Severe depression - you would normally have most or all of the nine symptoms listed above.
Also, symptoms markedly interfere with your normal functioning.
Moderate depression - you would normally have more than the five symptoms that are needed to make the diagnosis of depression.
Also, symptoms will usually include both core symptoms.
Also, the severity of symptoms or impairment of your functioning is between mild and severe.
Mild depression - you would normally have five of the symptoms listed above that are required to make the diagnosis of depression.
However, you are not likely to have more than five or six of the symptoms.
Also, your normal functioning is only mildly impaired.
Subthreshold depression - this is where you have less than the five symptoms needed to make a diagnosis of depression.
So, it is not classed as depression.
But, the symptoms you do have are troublesome and cause distress.
Symptoms of depression.
Core (key) symptoms:
- Persistent sadness or low mood. This may be with or without weepiness.
- Marked loss of interest or pleasure in activities, even for activities that you normally enjoy.
Other common symptoms:
- Disturbed sleep compared with your usual pattern. This may be difficulty in getting off to sleep, or waking early and being unable to get back to sleep. Sometimes it is sleeping too much.
- Change in appetite. This is often a poor appetite and weight loss. Sometimes the reverse happens with comfort eating and weight gain.
- Fatigue (tiredness) or loss of energy.
- Agitation or slowing of movements.
- Poor concentration or indecisiveness. For example, you may find it difficult to read, work, etc. Even simple tasks can seem difficult.
- Feelings of worthlessness, or excessive or inappropriate guilt.
- Recurrent thoughts of death. This is not usually a fear of death, more a preoccupation with death and dying. For some people despairing thoughts such as "life's not worth living" or "I don't care if I don't wake up" are common.
- Sometimes these thoughts progress into thoughts and even plans for suicide.
Effects of depression.
Depression drains your energy, hope, and drive, making it difficult to do what you need to feel better.
But while overcoming depression isn’t quick or easy, it’s far from impossible.
You can’t beat it through sheer willpower,
but you do have some control—even if your depression is severe and stubbornly persistent.
The key is to start small and build from there. Feeling better takes time,
but you can get there if you make positive choices for yourself each day.
What is depression?
The word depressed is a common everyday word.
People might say "I'm depressed" when in fact they mean "I'm fed up because I've had a row, or failed an exam, or lost my job", etc.
These ups and downs of life are common and normal. Most people recover quite quickly.
With true depression, you have a low mood and other symptoms each day for at least two weeks.
Symptoms can also become severe enough to interfere with normal day-to-day activities.
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