'I was so scared of being alone
with my thoughts. At night everything seemed so bleak. I couldn't
concentrate on anything; I couldn't read or watch TV. I couldn't relax
or unwind. Sleep seemed impossible - so many thoughts were racing
through my mind. I could spend hours fantasizing about ways of killing
myself.'
'Everything to do with everyday
life seemed like such hard work. I simply didn't have the energy to go
to work, to see friends, to shop, cook or clean. It all seemed
pointless! What was the point in eating when I didn't even want to be
alive?'
Depression can affect different
people in different ways and there are 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 which 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 which covers 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 it 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. The mind of someone who
is anxious is often 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.
Anxiety is more fully explained in Mind's booklet Understanding
Anxiety.
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. For further information see Mind's booklet Understanding
Seasonal Affective Disorder.
Postnatal
depression
This is the depression which
some mothers experience after their babies are born.
It
is thought to be brought on by the large changes in hormone levels in
the mother's
body after birth. For further information see Mind's booklet Understanding
Postnatal Depression.
Manic
depression
This
is a condition which causes people to have episodes of depression
and mania.
Mania is a state of highly excited and uncontrolled behaviour.
Manic depression is explained more fully in Mind's booklet Understanding
manic depression.
What
are the symptoms of depression?
Depression
affects different people in different ways. Depression can produce a
broad range of symptoms which can be emotional or physical. These are
some of the things you may experience if you are depressed:
·
you may experience a pervasive low mood
·
you may have poor self-esteem and self-confidence
·
you may be preoccupied with negative thoughts
·
you may feel numb, empty and despondent
·
you may blame yourself and feel unnecessarily guilty about things
·
you may find it difficult to concentrate or make decisions
·
you may be unusually irritable or impatient
·
you may wake early, or have problems getting to sleep
·
you may eat more and put on weight, or not eat properly and lose weight
·
you may not enjoy normally pleasurable activities
·
you may experience a loss of libido
·
you may use more tobacco, alcohol or other drugs than usual
·
you
may consider, or commit, acts
of self-harm or suicide
·
you may have reduced energy and reduced activity
·
you may cut yourself off from others rather than asking for help or
support
·
you may have bleak, pessimistic views of the future.
What
causes depression?
There
is no one cause for 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 is not just the negative
experience which 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.
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?
A
wide range of treatments for depression are available. However, the
availability of some of these treatments can be restricted depending on
where you live. For example, talking treatments are more readily
available in London and the southeast than they are in rural areas of
Northern England.
It
is 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.
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 practices are offered
antidepressants as the first treatment option. 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 so
that you can 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 which 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 your GP 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 organizations. Further information on counselling
is available in Mind's Counselling factsheet and Mind's
booklet Getting the best from your counsellor or psychotherapist.
Psychotherapy
Psychotherapy
is a talking treatment which 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. Further information on psychotherapy
is available in Mind's Psychotherapy factsheet and Mind's
booklet Getting the best from your counsellor or psychotherapist
Cognitive
behaviour therapy
Cognitive
behaviour therapy, or CBT, is a talking treatment which helps you to
recognize 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 useful to go on to explore what lies at the root of
your feelings and behaviour.
Cognitive
Behaviour Therapy is usually practiced by psychologists, therefore a
referral from your GP is normally necessary. Further information on CBT
is available in Mind's Cognitive Behaviour Therapy factsheet.
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.
Drugs
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. For further
information on antidepressants see Mind's booklet Making
Sense of Treatments and Drugs: Antidepressants.
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 into routines which 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 health authorities
and social services departments assess your needs and provide the right
services for you. A key worker 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. For further information on
Community care and the services which may be available to you see Mind's
booklet A-Z of your rights under the NHS
and Community Care legislation.
Electro-convulsive
therapy (ECT)
This
treatment is usually only given to people who are severely depressed and
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 is a controversial
treatment which can have severe side-effects such as memory loss. There
is more information on ECT in Mind's booklet Making
Sense of Treatments and Drugs: ECT
Alternative
complementary therapies
A
wide range of alternative I 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. Other
treatments such as acupuncture and homoeopathy 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. For further information on
the full range of alternative and complementary therapies available see
Mind's booklet A-Z of Complementary and
Alternative Therapies.
What
can I do to help myself?
Depression
has a major characteristic which 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 which 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
is important to try and break the hold which the depression has on you.
You need to try and break the cycle of negative thoughts. Try and
recognize when you are doing it, and replace it with a more constructive
activity.
Try
and find things to do which 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 about yourself.
You
need to do things which will make you feel better 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 treat
yourself. For further information see Mind's booklet How
To Look After Yourself
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 which 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
together. 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 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 is possible to do things to improve their
situation, but it needs to be done in a caring and sympathetic way to
work.
It
is 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 which you can join. There is more information for carers in
Mind's booklet Understanding Caring.
Useful
Organizations
You
should be able to get information about local mental health services
from your GP, social services department, local Mind association, and
community health council. Other useful organizations include:
Depression Alliance
35 Westminster Bridge Road,
London SEl 7JB, tel. 0171 633 9929
A self-help organization run by
people who have been, or are depressed. They can offer information or
advice to people experiencing depression. They can also offer support to
friends and relatives.
The Association For Postnatal
Illness
25 Jerdan Place, London 5W6 1
BE, tel. 0171 3860868
Offers information and advice
on overcoming postnatal depression. They can put you in touch with
volunteers who have experienced this distress themselves. Also offers
support to husbands and partners of depressed mothers.
SAD Association
P0 Box 989, Steyning, West
Sussex BN44 3HG, tel. 01903 814942
Offers information and advice
about Seasonal Affective Disorder. They can put you in touch with other
sufferers.
Campaign Against Men Living
Miserably (CALM)
0800
585858
A telephone helpline for young
men aged 15-24 years with depression. The helpline is staffed by trained
counsellors so that men who are feeling low or suicidal can talk about
their problems.
The Institute For Complementary
Medicine
P0 Box 194, London 5E16 1QZ,
tel. 0171 237 5165
The Institute gives information
on natural treatments, sponsors research, can offer education and
training.
The British Association for
Counselling (BAC)
1 Regent Place, Rugby,
Warwickshire CV21 2PJ, tel. 01788 578328
BAC can give information on
counselling and psychotherapy. Send an SAE for a list of practitioners
in your area.
United Kingdom Council for
Psychotherapy (UKCP)
167-169 Great Portland Street,
London W1N 5FB, tel. 0171 4363002
The UKCP can give information
on psychotherapy. Send an SAE for a list of practitioners in your area.
