Depression

Low mood or depression

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What type of help is available to me?

If you have any doubts or questions about seeking help for depression, it is better to be on the safe side and go ahead and speak with a professional. Left untreated, depression can continue for weeks, months or years. Over time it can become worse and may be more difficult to treat successfully. Untreated depression can also increase a person's risk of suicide. Up to 15% of those who are clinically depressed die by suicide.

Self-help

How can I help myself?

In mild and moderate cases of depression you are more likely to have the energy and motivation to consider ways of helping yourself. Depressive disorders can make you feel exhausted, worthless, helpless and hopeless. Such negative thoughts and feelings make some people feel like giving up altogether. It is important to realise that these negative views are part of the depression and typically do not accurately reflect the situation. Negative thinking fades as treatment begins to take effect.

Some of the following may be helpful to you:

• Set realistic goals and assume a reasonable amount of responsibility
• Break large tasks into small ones, set some priorities and do what you can as you can
• Try to be with other people and to confide in someone; it is usually better than being alone and secretive
• Participate in activities that may make you feel better
• Mild exercise, going to the cinema, a football game or participating in religious, social or other activities may help
• Expect your mood to improve gradually, not immediately. Feeling better takes time
• It is advisable to postpone important decisions until the depression has lifted. Before deciding to make a significant transition – change jobs, get married or divorced – discuss it with others who know you well and have a more objective view of your situation
• People rarely "snap out" of a depression. But they can feel a little better day by day
• Remember, positive thinking will replace the negative thinking that is part of the depression and will disappear as your depression responds to treatment
• Let your family and friends help you.

The following individuals or organisations can often provide help or treatment for you and/or make a referral for help or treatment to another service on your behalf:

• Your GP
• Your Community Mental Health Team (CMHT) which includes psychiatrists, psychologists, social workers, counsellors, community mental health nurses
• Hospital psychiatric units and outpatient clinics
• Accident and emergency departments in times of crisis
• Social service agencies
• Private hospitals and clinics
• School, college and university counselling services
• Occupational health services.

The Yellow Pages or local directory can provide phone numbers and addresses.

Traditional Therapies

Psychotherapies

'Counselling and Psychotherapy are ways of responding to a wide range of human needs and provide opportunities for those seeking help to work towards living in more satisfying and resourceful ways'

COSCA: Counselling and Psychotherapy in Scotland www.cosca.org.uk

In making the decision to undertake counselling you are entering into a relationship which will afford you a period of non-judgmental listening when you will be heard by the counsellor who will journey with you as you attempt to unpack whatever issue or problem you feel you have to discuss. You should be able to talk freely and comfortably about problems without feeling judged.

What you will receive in counselling are qualities which are often described as the 'Core Conditions' namely Acceptance, Genuineness and Empathy. These qualities are necessary to create a safe environment for you to talk about any problems you are finding hard to resolve.

• The counsellor, in providing acceptance or unconditional positive regard, provides an environment where your feelings, experiences and values are respected. You will not be judged or criticised because of your own attitudes or beliefs
• In being afforded genuineness the counsellor is demonstrating that they will be honest and open with you and will not present an outward appearance of one attitude while actually holding another
• Empathy is the ability to let the person know that you have truly heard what they are saying. It is not the same as sympathy as that is about feeling sorry for a person. You will experience the counsellor as having really understood what you are putting across.

At the first meeting the counsellor will hear what you want from counselling and talk about regularity of appointments and what he or she will expect of you. You also, at this first meeting, can discuss with the counsellor what you expect from counselling. Normally you will be given one appointment per week and each session will last for one hour.

It is important for you to know that your counsellor will be bound by a Code of Practice and Ethics, normally by COSCA or The British Association of Counselling and Psychotherapy (BACP). The counsellor will also be supervised by an approved/accredited Supervisor.

For more details on Counselling and Psychotherapy contact:

COSCA: Counselling and Psychotherapy in Scotland www.cosca.org.uk

British Association of Counselling and Psychotherapy (BACP) www.bacp.co.uk

Cognitive Behavioural Therapy (CBT)

CBT is a form of counselling which involves learning to overcome distorted negative thinking patterns that can lead to depression.

Therapists may use techniques which enable the depressed person to do more things that give them pleasure; helping them to solve problems in their life; and learning better social skills.

How does it work?

• People who are depressed have distorted thinking patterns. They see themselves and their situations more negatively than others. These thinking patterns make their depressed mood worse
• In CBT, distorted thinking is challenged by the therapist who teaches the person to overcome their negative thinking patterns in everyday life.

Is CBT effective?

• There are studies showing that people with mild or moderate depression recover more quickly if they are treated with CBT
• CBT is as effective as antidepressant drugs
• Unlike antidepressant drugs, CBT works as well for adolescents as adults
• An advantage of CBT is that it helps people learn skills that may prevent them from becoming depressed in the future
• CBT is not suitable for severely depressed pepole as they are too depressed to learn new thinking skills
• However, once they have begun to recover with medical treatment CBT may be helpful.

The way we think can effect how we feel!

'It is not things in themselves which trouble us, but opinions we have about these things'

Epictetus

• Life's experience can develop our thinking habits and belief systems
• The meaning we place on our experiences can influence how we feel and behave
• Unrealistic thinking can cause and/or maintain distressing feelings.

Ten common types of thinking distortions that make coping more difficult:

1. Black and white thinking – all or nothing
2. Setting unrealistic expectations – living by fixed rules
3. Selective thinking – looking on the dark side
4. Converting positive into negatives – being a cynic
5. Overgeneralising – here we go again
6. Magnifying unpleasantness – making mountains out of molehills
7. Catastrophising – whatever can go wrong will go wrong
8. Personalising – it is all my fault
9. Mistaking feelings for facts – I feel therefore I am
10. Jumping to negative conclusions.

Family or couples therapy

Family or couples therapy is very beneficial when depression is directly affecting the family. This type of therapy addresses the interpersonal relationships between family members. It seeks to improve communications and often examines the roles played by family members that reinforce depression in the patient. Educating the family or partner about depression in general is also an important part of this therapy.

Alternative or complementary therapies

A health treatment that is not classified as standard western medical practice is referred to as "alternative" or "complementary". Alternative therapy encompasses a variety of disciplines that include everything from diet and exercise to mental conditioning and lifestyle changes. Examples of alternative therapies include aromatherapy, guided imagery, chiropractic treatments, yoga, hypnosis, biofeedback, acupuncture, relaxation, herbal remedies, massage and many others.

There is no evidence that any alternative treatment is effective for treating moderate to severe depression. For some people, however, they may be used as an addition to other treatments – providing relaxation, relief from depressive symptoms and helping you cope with some of the causes of depression such as grief, anxiety, changing roles and even physical pain. If you have depression and are considering using an alternative form of therapy, you may wish to talk to your GP or other health professional.

Aromatherapy

Can help in mild forms of depression. It may ease mental fatigue and help with sleep. However, if you or someone you know, are severely depressed, additional support and therapy are necessary. Aromatherapy is more effective when used as a complementary therapy, assisting other therapies.

Homeopathy

Specific homeopathic remedies are available to individuals experiencing depression and may be prescribed following consultation with a reputable homeopath. Homeopathic remedies have no side effects and are perfectly safe, non-toxic and non-addictive.

Prayer and spiritual healing

Spiritual healing, religious belief or faith – is shown to have a profound effect on our health. Research has shown that spiritual healing can provide relief from the worries and difficulties that affect us. It can effect enduring physical, mental and emotional change.

Herbal medicine

Many commonly prescribed antidepressants work by keeping the neurotransmitter serotonin circulating in the brain. Herbs such as Siberian ginseng, liquorice and St. John's wort also increase the availability of serotonin in the brain.

Herbs useful for depression

Listed below are important herbs that are useful for depression either for depression itself or to minimize the depression related side effects.

• Liquorice (Glycyrrhiza glabra)
  Liquorice is a very powerful antidepressant. Its role takes a back seat due to the media attention on St. John's Wort
• St. John's wort (Hypericum perforatum)
  St. John's wort has a long history of folk use for treating anxiety and depression. Modern science has shown that generations of folk herbalists were right. The flowers of this herb make an infusion that is effective in relieving sadness and melancholy
• Siberian ginseng
  Siberian Ginseng improves the balance of important neurotransmitters in the brain. In studies using laboratory animals, Siberian ginseng has been shown to act as an MAO inhibitor. In people with depression, the herb helps improve their sense of well-being.

Light therapy

Most people with Seasonal Affective Disorder (SAD) become depressed in the autumn and winter, when days are shorter and sunlight is limited. Although researchers are still studying the exact cause of SAD, some believe the body's 24-hour biological clock (circadian rhythms), which controls sleep/wake cycles, may be affected by seasonal changes of light and darkness and that subsequent biochemical changes in the brain may cause depression. Light therapy helps to "reset" your biological clock.

Light therapy, which has few side effects, is also an alternative to taking medications to treat depression. It can also be used with medications and counselling.

Acupuncture

Acupuncture is an ancient Chinese method of healing that prevents and cures specific diseases and conditions by sticking very fine, solid needles into specific points on the body. It stimulates the body's ability to resist or overcome illnesses and conditions by correcting imbalances. Acupuncture also prompts the body to produce chemicals that decrease or eliminate painful sensations.

Social support

Those who talk to others about how they feel often get help quicker and generally fair better in terms of recovery than those who have difficulty in talking about how they feel.

If you "bottle up" your feelings this may make problems worse do not feel it is a sign of weakness to say you are depressed.

Many people who are experiencing depression seek and receive help from their own social network of family, friends and colleagues. It cannot be underestimated how beneficial it can be to share how you feel with those you trust and feel comfortable with and to get the support and understanding that you need. Whilst you may be caught up in your depression and have difficulty in seeing things clearly others close to you can look objectively at your situation and assist with decisions which may be difficult for you to make alone.

Family, friends and colleagues can help you to make any necessary adjustments in your work or personal life until you have fully recovered from your depression. It is therefore helpful for them to know how you are feeling on a day to basis as part of the recovery process often means that you will have both good and bad days.

Medical help

Medication

There are several types of antidepressant medications used to treat depressive disorders. These include:

• Selective serotonin reuptake inhibitors (SSRIs)
• Tricyclics
• Monoamine oxidase inhibitors (MAOIs).

Sometimes your doctor will try a variety of antidepressants before finding the medication or combination of medications most effective for you. Sometimes the dosage must be increased to be effective. Antidepressant medications must be taken regularly and it may take up to a few weeks before the full therapeutic effect occurs.

Patients often are tempted to stop medication too soon. They may feel better and think they no longer need the medication. Or they may think the medication isn't helping at all. It is important to keep taking medication until it has a chance to work, though side effects may appear before antidepressant activity does. Once the individual is feeling better, it is important to continue the medication for 4 to 9 months to prevent a recurrence of the depression. Some medications must be stopped gradually to give the body time to adjust. For individuals with bipolar disorder or chronic major depression, medication may have to be maintained indefinitely.

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• Depressed
  • Depressed
• Suicidal
• Stressed and anxious
• Lonely