Depression

Depression is a common condition, 15% of the population will suffer from clinical depression at some point in their lives.

Everybody has periods where they feel low, or down. These are normal emotions and appropriate after bad news, bereavement, separation, job loss, financial worries and so forth. However, depression – the illness, is persistent, and help is required to recover. The difference with depression is when the unhappiness is without cause, or lasts much longer and is out of proportion to circumstances, or seems beyond the sufferers personal control to manage.

Depression affects people differently. Some are mildly affected – often known as dysthymia, and manage to function despite their condition. Others may be severely depressed and find it very difficult to carry out even the most basic tasks, such as washing and dressing.

There are also different types of depression, such as the episodes of depression, followed by elation in manic depression (bipolar affective disorder, SAD (seasonal affective disorder) and PND (post natal depression).

Winston Churchill, Agatha Christie, Buzz Aldrin & Charles Darwin are just four famous people suffering with depression. Depression is not selective of class, status or upbringing.

SYMPTOMS

Symptoms are many, varied and not all sufferers will exhibit the same problems. They may include:

• Continual low mood
• Feeling of inadequacy
• Feeling “tearful” and “emotional”
• Irritability
• Anger / aggression
• Anxiety
• Lack of motivation
• Lack of social interest
• Poor personal care
• Irrational / guilty thoughts
• Feeling of hopelessness
• Suicidal thoughts
• Tired all the time
• Loss of appetite / weight
• Comfort eating
• Inability to sleep
• Disturbed sleep
• Loss of concentration
• Sleeping too much / not waking refreshed
• Loss of libido
• Avoiding people / social situations
• Lack of energy
• Feeling physically ill
• Extreme lethargy
• Bleak and pessimistic view of the future

N.B. Anxiety and depression are closely linked. Anxiety can cause depression, and depression can cause anxiety.

SO WHY DO I FEEL LIKE THIS?

Depression is a complex illness, and can occur for several reasons.

In a person suffering from depression, levels of neuro-transmitters are lowered. One of these is serotonin (5-hydroxytryptamine or 5HT).

It can be triggered as a result of a number of causes:

Social Circumstances

Unemployment, divorce or break down of relationship, bereavement, redundancy, sudden/dramatic change to personal circumstances

Physical Conditions

Glandular fever, influenza, anaemia, diseases such as multiple sclerosis, severe arthritis, and treatments such as chemotherapy and radiotherapy

Hormonal Changes

Pregnancy, resulting in PND (Post Natal Depression) – about 10% of all women experience significant PND. Depression presents more commonly in women (this may also be because men are more reluctant to visit their doctor)

Psychological Conditions

Sufferers of anxiety may also find they develop depression. Unresolved psychological issues also contribute. About 60% of people suffering chronically with anxiety and panic will also develop associated depression.

Drug and Alcohol Abuse

Self-explanatory.

WHAT TREATMENTS ARE AVAILABLE?

Each sufferer is an individual, and treatments vary. Many people combine treatments for optimum effect, i.e. medication and counselling. The preferred choice at present is SSRI’s along with CBT. The medication is to lift the mood enough to be able to take on board and learn skills needed to overcome the condition long term.

The first step is to visit your GP. They can confirm your diagnosis and ensure your depression does not have a physical cause. You must be prepared to be honest with yourself and your GP. If you have some unresolved issues, medication alone will not provide a cure, and your GP can recommend you for some form of therapy.

Therapy

This may include Cognitive Behavioural Therapy or counselling. All health authorities have a Community Mental Health Team, who will be able to select and provide appropriate treatment upon your referral by your GP. If you really feel you need it, do not be afraid to request a referral.

Medication

There are several different types of anti-depressants. You are likely to be offered one of the following types:

• SSRI – (selective serotonin re-uptake inhibitors), the most known household brand name being Prozac (fluoxetine) but now include a whole stable of closely related medicines
• Tricyclic antidepressants
• MAOI (monoamine oxidase inhibitors)
• Moclobemide

Different people respond better to different drugs, and different categories of depression respond better to different drugs to, so there may be a degree of trial and error before you find the right one for you. There is no universal wonder drug, and what worked for your friend may not be beneficial to you.

Before you go to your GP, you may like to make a list of lifestyle considerations to discuss the most suitable medication. For example, if you lead a busy life, or drive for a living, a drug which makes you drowsy may not suit, where if you have problems sleeping at night it may be beneficial.

There are several sites on the Internet which explain in detail each type of medication, and their possible side effects.

Anti-depressants are not addictive. However, you may suffer withdrawal symptoms if you stop taking them suddenly. Any withdrawal should be gradual and under medical supervision.

Alternative Medicine

St Johns Wort is a herbal remedy, which has a similar effect to SSRI’s and is commonly used in the treatment of depression. Do research this carefully before starting yourself on this. It can be very effective but can also have some severe interactions with medication you may be taking for other medical conditions so if you are on any other prescribed medication at all please do not take this without taking specialist advice.

SIDE EFFECTS AND CONTRA-INDICATIONS

ALL medicines have the potential to cause side effects, some of which may be unpleasant. Most side effects only occur during the first few weeks of starting to take the medication, and then disappear. If you are taking the medication and have panic or anxiety – it is not uncommon for this to get worse for a few weeks before the benefit is felt. It can be helpful in these circumstances to drop your dose and gradually increase it.

However, many people take these medicines without experiencing any side-effects.

You should also ensure you tell your doctor about any medicines you use regularly. Some medications can react with each other, for example, St Johns Wort can effect the efficiency of the contraceptive pill, and decongestants shouldn’t be used with MAOI and tricyclic anti-depressants. With the MAOI family, there are also some important food restrictions too. Your GP may need to review they way you self medicate certain conditions.

SELF HELP

Sufferers can also do a lot to help themselves, by taking positive action to help improve their lives.

Diet

Ensure you eat a healthy nutritionally balanced diet, including plenty of water, fresh fruit and vegetables, and whole-grains and pulses.

Exercise

Exercise as regularly as possible, be it a brisk walk to the shops or round the park, a swim or joining the gym.

Reduce / Cut Down on Stimulants

Review alcohol, caffeine, nicotine and any “recreational” drugs taken. Stop or limit your intake. Swap tea / coffee for water, green, black or herbal teas. Set yourself limits and stick to them. You may choose to allow yourself two glasses of wine at a family celebration. Stick to your limit, and consider swapping wine for wine spritzer to make your drinks last longer

Relax

Sign up for yoga, Tai-chi or pilates. Buy a relaxation CD. Go for a massage. Indulge in a bubble bath.

Change the Pace

Do you need to do everything you do in your life? Do you need to do it when you do it? If not, slow the pace of your life down a little. Consider taking a short holiday.

Remove Stressors

Whilst it is never a good idea to make major lifestyle changes whilst suffering from depression, review your life with a view to reducing stress. If you have relationship problems, discuss them with your partner, visit Relate. If you have problems at work, discuss them with human resources or your manager.

Some stressors can be minor, but putting them off can cause unnecessary aggravation. These may be little things, like a car interior that needs cleaning, or a wardrobe that needs tidying. Find the time to deal with any issues that “bug” you, however small.

Keep Your Mind Occupied

Read a book, watch a film, phone a friend. Try not to simply “sit and dwell”. Take up a new hobby. Keep busy and occupied.

Keep a Mood Diary

Note how you feel each day, what stressors are present, what activities you’ve done, what you’ve eaten and drunk. Monitor for any patterns

Don’t Bottle It Up

Don’t keep your feelings to yourself. Explain to your close family and friends what you are experiencing. If necessary, educate them about your illness and treatment. Avoid people who tell you to pull yourself together, or to just get on with it! You have an illness, and cannot help the way you feel.

Rediscovery

Write down all the things that usually give you pleasure. These can be hobbies or experiences – reading, embroidery, playing squash, ice skating, trying out new recipes. Make time to read a book, sew a sampler, book a squash court

Create a Self Help Folder

Keep any information you find useful filed together, and use it for reference. This can include articles, journals, magazine cuttings, or even quotes or pictures that make you smile.

Some sufferers find that they may experience another period of depression at some point in their lives. This is quite common, and should not cause concern. It is very likely that you will notice the signs much sooner should it occur again, and can take appropriate action.

FURTHER INFORMATION

For more detailed information about depression, it’s causes and treatment, contact:

https://guidance.nice.org.uk/CG90/NICEGuidance/pdf/English – NICE guidelines.

www.rcpsych.ac.uk – Royal College of Psychiatrists

www.medinfo.co.uk – Medinfo

www.sane.org.uk

www.depressionalliance.org

www.samaritans.org.uk

www.mind.org.uk

Please take some time to read the following article that was kindly written by a Hypnotherapist. It is called ‘When the Gloves come off’.