Tipsheet Managing depression

This article offers general information on depression and some of the ways you might choose to access support and manage your condition. However, it’s vital to speak with your GP in the first instance to ensure that you receive the type of support best suited to your particular concerns.

What is depression?

In its mildest form, depression can mean being in low spirits. It doesn’t stop you from leading your normal day-to-day life, but it can make everything harder to do and seem less worthwhile. At its most severe, major depression (clinical depression) can be life-threatening and may require more intensive support such as hospitalisation during periods of illness.

Types of depression

There are various forms of depression including, but not limited to:

Reactive depression

It can be difficult to adjust to major life events such as a bereavement, relationship breakdown or ongoing financial problems, and reactive depression is not an uncommon experience for people faced with these types of issues. We may feel low, lacking in confidence or unfocused for weeks or even months, but the more quickly we can address the root of the problem, the more likely it will be that we recover quickly and return to our daily lives. Short-term counselling through retailTRUST, your GP, or a mental health charity can be helpful for some people, as can stress management techniques, eating well, getting enough sleep and being mindful of your alcohol intake. This form of depression is not chronic but temporary, and though it’s distressing to live with, getting back to your usual self is possible with the right support.

Chronic depression

Unlike short-term depression, chronic depression can come and go over the course of a lifetime but it’s important to understand that people can and do recover. There are many theories as to why some people are more susceptible to chronic depression than others, but we know that in some cases (although not all), genes can be play a role. This doesn’t mean however that there is no hope – far from it! People recover with professional support, and go on to lead very happy and productive lives. Depending on the severity and duration of the depression, treatments may include medication (often short-term), talking therapies and support from family and friends. A GP will usually refer someone struggling with this form of depression to a mental health specialist who will diagnose them and offer tailored support and ongoing treatment.

Seasonal affective disorder (SAD)

If you find that you tend to become depressed during the autumn and winter, it could be down to a lack of daylight. You may benefit from spending time sitting in front of a special light box which you can purchase from any high street chemist, or your GP can advise you on how to obtain one. This form of depression is seasonal and improves both with treatment and a change in seasons. Symptoms of SAD can include a low mood for most of the day, a loss of interest in your usual activities, low energy, sleeping more or less than usual, or a loss of libido. It’s important not to dismiss SAD as it’s a distressing condition and can be treated very effectively.

Postnatal depression (PND)

Many new mothers experience a period of ‘the baby blues’ after the birth of their baby. Feeling low, confused and exhausted usually passes after a few days or weeks. Postnatal depression is a more serious problem and can appear at any time between two weeks and two years after a birth; it affects between eight and ten percent of all new mums. Although every woman is different, some of the symptoms can include tearfulness, a consistently low mood for a period of weeks, irritability, a lack of interest in your new baby or yourself, feelings of guilt and the belief that you can’t cope with motherhood, feeling worthless, and physical symptoms such as tension headaches, aches and pains, and stomach upsets.

It’s extremely important that any mother who is affected speaks with their health visitor, their GP or their midwife if they experience any of the symptoms of PND. Treatments are available and may include medication, counselling, and/or attending support groups.

Mixed depression and anxiety

People who are depressed are often very anxious. It’s not clear whether the anxiety leads to depression or whether depression causes anxiety. A person who feels anxious much of the time may have a mind full of busy, repetitive thoughts which can make it hard for them to concentrate, relax, or sleep. They may also have physical symptoms such as headaches, aching muscles, sweating and dizziness. Anxiety can cause physical exhaustion and general ill health. This form of depression can be very well treated with the right kind of support from the GP or other healthcare specialist, and sufferers may be offered antidepressants, anti-anxiety medication, counselling and other forms of support.

It is important to note that there are many forms of depression and self-diagnosis is never a good idea. If you suspect that you’re suffering from depression speak to your doctor.

What are some of the signs and symptoms of depression?

Depression shows itself in many different ways. People don’t always realise what’s happening to them because their problems seem to be physical in nature – not emotional. They might tell themselves they’re simply under the weather or feeling tired. But if five or more of the following symptoms are present and impacting on daily life, it’s advisable to see a GP to get help The list below is not intended as a diagnostic tool – everyone is different and it’s wise to consult your doctor.

  • Feeling restless and agitated
  • Waking up early without meaning to, having difficulty sleeping, or sleeping more
  • Feeling tired and lacking energy; doing less and less
  • Using tobacco, alcohol or other drugs more than usual
  • Experiencing significant changes in eating patterns (disinterest in food, or eating more than usual)
  • Losing or putting on weight
  • Crying or becoming tearful unexpectedly
  • Having difficulty remembering things
  • Aches and pains without any physical cause
  • Feeling low and sad much of the time or every day
  • Feeling unusually irritable or impatient
  • Getting little pleasure out of life
  • Sexual difficulties
  • Finding it hard to concentrate or make decisions
  • Blaming yourself and feeling unnecessarily guilty about things
  • Lacking self-confidence and esteem
  • Being preoccupied with negative thoughts
  • Feeling numb, empty and despairing
  • Feeling helpless
  • Distancing yourself from others and keeping your problems to yourself
  • Taking a bleak, pessimistic view of the future
  • Experiencing a sense of unreality
  • Self-harming 
  • Often thinking about death and/or suicide.

What can people do to help themselves?

Depression has one major characteristic that you need to be aware of when thinking about what you can do to defeat it. It can feed on itself. In other words, you become depressed and then feel more depressed about being depressed. Negative thoughts become automatic and are difficult for you to challenge. Being in a state of depression can then, in itself, become a bigger problem than the difficulties that caused it in the first place. It’s important to break the hold that the depression has on you.

An important thing to remember is that there are no instant solutions to challenges 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 towards recovery. If you are able to take an active part in your treatment, it should help your situation.

People do recover from depression, and some of the following tips can help you on your journey towards becoming well again:

Fight negative thought patterns

Try to recognise the pattern of negative thinking when you are doing it, and replace it with a more constructive activity. Look for things to do that occupy your mind.

Get active – it’s good for the mind

Although you may not feel like it, it’s very therapeutic to take part in physical activities. Even 20 minutes a day of running, dancing, cycling, or gentle walking can stimulate chemicals in the brain called endorphins, which can help you to feel better.

Care for yourself

It can really help to do things that will improve the way you feel about yourself – even if doing so feels like an enormous amount of effort. Allow yourself positive experiences and treats that reinforce the idea that you deserve good things. Pay attention to your personal appearance. Set yourself goals that you can achieve and that will give you a sense of satisfaction.

Eat well

Look after yourself by eating healthily. Oily fish, in particular, may help to alleviate depression and B vitamins can also help to improve mood and outlook. Before taking any vitamins or supplements, do speak with your GP as some may not be right for you especially if you’re on regular medication for a health condition. You might also want to consider avoiding alcohol – or cutting down at least – when you’re feeling depressed. Alcohol is a mood depressant and many people find that abstaining when feeling low can really help their return to wellness.

Alternative and complementary therapies

Practitioners of complementary and alternative medicine concern themselves with the person as a whole, and don’t just treat symptoms. They can also take more time with you than a GP can which can be very reassuring. Practitioners may offer treatments such as acupuncture, massage, homeopathy and herbal medicine that many people with depression have found helpful. However, even natural remedies can have a negative impact on your wellbeing if you suffer from certain health conditions or you’re on any kind of medication. For example, St John’s Wort can make some forms of depression more difficult to manage. Before taking any kind of natural treatment, see your GP for advice.

Self-help groups

It can be a great relief to meet and share experiences with other people who are going through the same thing you are. 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. For help in locating local self-help groups, talk to your GP or telephone Mind, the National Association for Mental Health, on 0300 123 3393 or text 86463 or visit www.mind.org.uk

What treatments are available?

At a time when you may well find making decisions difficult, it can seem like an added burden to have to choose between a range of treatment options. You should be able to choose freely but in practice, most people attending GP surgeries are offered antidepressants as the first treatment choice. However, medication isn’t the answer for everyone and it’s worth looking into your options with your doctor. Don’t be afraid to ask your GP about available treatments and what the alternatives are. It’s your body, your mind and your choice.

In fact, the National Institute for Health and Care Excellence (NICE) guidelines on the treatment of depression (updated 2009) suggest that, for mild depression, antidepressants are not appropriate because the risk of side effects outweighs the benefits. Suggested treatments include:

  • Watchful waiting – a recognition of the fact that depression often resolves itself without any kind of treatment
  • Guided self-help  programmes - your GP can advise on the options
  • Short-term talking treatments such as cognitive behavioural therapy (CBT), interpersonal psychotherapy (IPT), behavioural activation, and exercise programmes
  • Making lifestyle changes such as reducing alcohol intake, talking to friends and family, getting a good night’s sleep, practicing stress management techniques and getting exercise every day.

For more severe depression, antidepressants may be appropriate, and selective serotonin reuptake inhibitors (SSRIs) are suggested because they are usually better tolerated than alternative types of antidepressants. However, combining a psychological treatment with medication is thought to be the most effective course for severe depression.

Antidepressants

Antidepressant drugs are the most common medical treatment for depression. They work on chemical messengers in the brain to lift your mood. They can’t cure depression but they can alleviate the symptoms so that you may feel able to take action to deal with the depression yourself. It can take between two and six weeks for the drugs to take effect so you need to be patient. The usual recommendation is that you stay on them for six months to prevent a recurrence. They don’t work for everyone however, and antidepressants can also cause unpleasant side effects for some people. Some can also be dangerous when used with other drugs so it’s vital that the GP knows of any medications you might be taking in addition to the ones he or she has prescribed (and this includes over the counter medications). Of the various different types available, SSRIs are usually the preferred first choice because, although they have as many listed side effects as older drugs, they are usually better tolerated. Others include tricyclic antidepressants and monoamine oxidase inhibitors.

Whichever type of antidepressant you take, you may experience withdrawal symptoms when you stop taking them, especially if you have been taking them for some time. Because of this you should withdraw slowly, reducing the dose in stages over a period of weeks, and you should always do this with the support of your doctor.

Mindfulness

Mindfulness meditation has been shown to give people control over their own depression and anxiety levels and levels of chronic pain, according to a paper published in the journal Frontiers in Human Neuroscience. Previous studies have found that mindfulness meditation can cut the recurrence of depression by 50%, and neuroimaging scans have shown significant positive change in brain activity of long-term meditators. But while scientists knew mindfulness was having an effect, they have not known how until now. When we are depressed, our attention is consumed by negative preoccupations, thoughts and worries. Instead of disengaging and moving on, we find ourselves digging deeper into negative thought patterns and the cycle continues.

Mindfulness gives people control over this habitual chain via a body scan technique, where they systematically engage and disengage with the sensations in each part of the body. As they do so, alpha rhythms, which organise the flow of sensory information in the brain, increase and decrease. This has been described as a sensory volume tuner and it is this flexible focusing skill which can regulate attention so that it does not become biased toward negative physical sensations and thoughts. Early Buddhists advanced a similar theory 2,500 years ago in a famous practice text called ‘Mindfulness of the Body and Breath’.

As many as 30% of GPs refer patients to mindfulness training and it is worth asking your doctor for more information if this approach is of interest to you.

Psychological treatments

Your GP may offer you one of the following psychological treatments. The choice will depend on what’s available in your area, your own preferences, how severe your depression is, and other factors:

  • Short-term (five or six sessions) problem-solving therapy can help people to address their problems by breaking them down into manageable pieces and develop strategies for coping.
  • Cognitive behavioural therapy (CBT) helps to identify and change negative thoughts and feelings which may be affecting behaviour.
  • Computerised CBT (CCBT) is now available and can be used in addition to, or instead of, sessions with a therapist. It is not suitable for someone with severe symptoms though, and NICE recommends that individuals are assessed before using one of the programmes.
  • Guided self-help delivers a six to eight week therapy programme through self-help books (known as bibliotherapy) under the guidance of a trained healthcare professional.
  • Interpersonal psychotherapy (IPT) focuses on relationships, and can continue for up to 12 months.
  • Psychodynamic counselling or psychotherapy focuses on how past experiences may be contributing to behaviours and feelings in the present. This type of therapy can be short or long-term.

Counselling is available through your GP although the wait times can be long so ensure that you are clear on what you can expect in terms of referral times. This form of support can be short or long term and involves talking with someone who is trained to listen with empathy and acceptance. This allows you to express your feelings and find your own solutions to your problems. If you are unable to wait for an appointment through the NHS, you might like to consider a private counsellor (visit the British Association for Counselling and Psychotherapy (BACP) BACP for a directory of qualified counsellors in your area or contact a mental health charity for advice on finding counselling.

retailTRUST offers short-term counselling over the telephone and face-to-face. For more details, you can contact the retailTRUST helpline on 0808 801 0808 or by emailing [email protected]

Psychotherapy on the other hand is not usually available on the NHS. It is more frequent (up to a couple of times a week for some people) and more intensive than counselling, as it delves more deeply into childhood experiences and other significant experiences. Most psychotherapists work in private practice. For lists of qualified and regulated therapists, contact the British Association for Counselling and Psychotherapy. Painful experiences are hard to talk about, but professionals understand this. Be as frank as possible, so that people can offer you the best help. And don’t be afraid to ask questions about your condition.

Remember, you can always contact the retailTRUST helpline on 0808 801 0808 or by emailing [email protected] if you wanted to speak to someone in confidence.