A Guide to Depression rebrand - Inspire · everyday word. People might say “I’m ... if they lose weight. The following is a list of common symptoms of depression. It is unusual

A Guide toDepression

Depression is common. Symptomscan affect day to-day life and canbecome very distressing. Treatmentsinclude talking treatments andantidepressant medicines.Treatment takes time to work but hasa good chance of success.Some people have recurringepisodes of depression and requirelong-term treatment to keepsymptoms away.©EMIS 2010, as distributed on http://www.patient.co.uk/health/Depression.htmUsed with permission.

What is depression?The word depressed is a commoneveryday word. People might say “I’mdepressed” when in fact they mean “I’mfed up because I’ve had a row, or failedan exam, or lost my job” etc. These upsand downs of life are common andnormal.

Most people recover quite quickly.With true depression, you have a lowmood and other symptoms each day forat least two weeks. Symptoms can alsobecome severe enough to interfere withday-to-day activities.

Who gets depression?About 2 in 3 adults have depression atsome time in their life. Sometimes it ismild or lasts just a few weeks.

However, an episode of depressionserious enough to require treatmentoccurs in about 1 in 4 women and 1 in 10men at some point in their lives. Somepeople have two or more episodes ofdepression at various timesin their life.

What are the symptoms ofdepression?Many people know when they aredepressed. However, some people do notrealize when they are depressed. Theymay know that they are not right and arenot functioning well, but don’t know why.

Some people think that they have aphysical illness, for example, if they loseweight.

The following is a list of commonsymptoms of depression. It is unusual tohave them all, but several usually developif you have depression.

• Low mood for most of the day, nearlyevery day. Things always seem ‘black’.

• Loss of enjoyment and interest in life,even for activities that you normally enjoy.

• Abnormal sadness, often withweepiness.

• Feelings of guilt, worthlessness, orUselessness.

• Poor motivation. Even simple tasksseem difficult.

• Poor concentration. It may be difficult toread, work, etc.

A Guide to Depression

• Sleeping problems:- sometimes difficulty in getting offto sleep.

- sometimes waking early and unableto get back to sleep.

- sleeping too much sometimes occurs.

• Lacking in energy, always tired.

• Difficulty with affection, including goingoff sex.

• Poor appetite and weight loss.Sometimes the reverse happens withcomfort eating and weight gain.

• Irritability, agitation, or restlessness.

• Symptoms often seem worse first thingeach day.

• Physical symptoms such as headaches,palpitations, chest pains, and generalAches.

• Recurrent thoughts of death. Thisis not usually a fear of death, morea preoccupation with death and dying.Some people get suicidal ideas suchas...”life’s not worth living”.

The severity of the symptoms can varyfrom mild to severe. As a rule, the moresymptoms from the list above that youhave, the more severe the depressionis likely to be.

What causes depression?The exact cause is not known. Anyonecan become depressed. Some peopleare more prone to it, and it can developfor no apparent reason. You may haveno particular problem or worry, butsymptoms can develop quite suddenly.

An episode of depressionmay also be triggered by a life eventsuch as relationship problem,bereavement, redundancy, illness, etc. Inmany people it is a mixture of the two.

For example, the combination of a mildlow mood with some life problem, suchas work stress, may lead to a spiral downinto depression.

Women tend to develop depression moreoften than men. Particularly commontimes for women to become depressedare after childbirth (postnatal depression)and the menopause.

A chemical imbalance in the brain mightbe a factor. This is not fully understood.However, an alteration in somechemicals in the brain is thought to bethe reason why antidepressants work intreating depression.


Some myths and otherpoints about depressionDepression is common, but many peopledon’t admit to it. Some people feel thereis a stigma attached, or that peoplewill think they are weak.

Great leaders such as Winston Churchillhave suffered depression. Depression isone of the most common illnesses thatGPs deal with.

People with depression may be told byothers to ‘pull their socks up’ or ‘snap outof it’. The truth is, they cannot, and suchcomments by others are very unhelpful.

Understanding that your symptoms aredue to depression, and that it is acommon illness, may help you to acceptthat you are ill and need help. This maybe particularly true if you have physicalsymptoms such as headache or weightloss.

Some people ask “am I going mad?” Itmay be a relief to know that you are notgoing mad, and the symptoms that youhave are common and have been sharedby many other people.

You may ‘bottle up’ your symptoms fromfriends and relatives. However, if youare open about your feelings with closefamily and friends, it may help them tounderstand and help.

What are the treatment options fordepression?In general, treatments are divided intothose used for mild depression and thoseused for moderate and severedepression.

What if I don’t have any treatment?Most people with depression would getbetter without treatment. However, thismay take several months or even longer.Meanwhile, living with depression canbe difficult and distressing (and also foryour family and friends).

Relationships, employment, etc, may beseriously affected. There is also a dangerthat some people turn to alcohol or illegaldrugs. Some people think of suicide.Therefore, many people with depressionopt to try some form of treatment.

Treatment options for mild depressionIn general, mild depression means thatyou have some of the symptoms listedabove, but are still able to copereasonably well with normal activities. Forexample, you may still be able to do yournormal job, and get by with householdchores, but perhaps with difficulty. Yourdoctor may suggest oneor more of the following.


Talking treatments(psychological treatments)Talking through feelings may be all thatyou need for mild depression. Sometimestalking with an understanding friend orrelative is helpful. Your doctor may also‘talk things through’ with you or refer youto a counsellor. A brief course of cognitivebehavioural therapy may help (see belowfor further details of this.)

Specific counsellingIn some cases there is a particularproblem that triggered the depression, oris making it worse. For example, maritalproblems, sexual problems, bereavement,previous childhood abuse, etc.

Counselling directed at a specific areamay then be helpful. Sometimes this maybe done by a local agency or self-helpgroup which deals with specific problems.

For example,

RELATE for marital or sexual problems,or a bereavement counsellor following abereavement, etc.


An exercise programmeResearch has shown that regularexercise can help to ease symptoms ofdepression in some cases.

A typical exercise programme to helpease depression would be three ‘formal’sessions per week of moderate duration(45-60 minutes) for 10- 12 weeks.

Aerobic exercises are probablybest such as jogging, brisk walking,swimming, playing a vigorous team sportsuch as football or netball, etc. However,ideally you should try to get into the habitof doing some sort of exercise on mostdays in between any ‘formal’ exercise.

For example, try to go out for a walk eachday.

A self-help programmeThere are various pamphlets, books,and audio tapes which can help you tounderstand and combat depression. Thebest are based on the principles ofcognitive behavioural therapy.

There is some evidence to say that a‘guided self help programme’ can helpsome people with mild depression torecover. That is, a programme where thematerials are provided by a doctor ornurse, and where a doctor or nursemonitors your progress. Theseprogrammes take some motivationand effort to work through - a bitlike doing homework.

Computer and internet based self-helpcognitive behavioural therapyprogrammes are recent innovations andmay become more popular.

Antidepressant medicinesAntidepressant medication (discussed indetail below) is not usually recommendedfor the initial treatment of milddepression.

However, an antidepressant may beadvised for mild depression in certaincircumstances. For example, in people:

• with mild depression that persists afterother treatments have not helped.

• whose depression is associated with aphysical illness.

• who have had an episode of moderateor severe depression in the past.

Treatment options for moderate orsevere depressionIn general, moderate depression meansthat you have several of the symptomslisted above, and you find great difficultyin coping with normal activities.

Severe depression is even worse. Inthese situations, a doctor may suggestone or more of the following.

Antidepressant medicinesAntidepressants are usually the first linetreatment for moderate or severedepression. A medicine cannot alter yourcircumstances. However, symptomssuch as low mood, poor sleep, poorconcentration, etc, are often eased withan antidepressant. This may then allowyou to function normally, and increaseyour ability to deal with any problems ordifficult circumstances.

Antidepressants do not usually workstraight away. It takes 2-4 weeks beforetheir effect builds up fully. A commonproblem is that some people stop themedicine after a week or so as they feelthat it is doing no good. You need to giveit time.

Also, if it is helping, follow the coursethat a doctor recommends. A normalcourse of antidepressants lasts up to sixmonths or more after symptoms haveeased. Some people stop treatment tooearly and the depression quickly returns.


There are several types ofantidepressants, each with various ‘prosand cons’. For example, they differ intheir possible side-effects. (The leafletthat comes in the medicine packetprovides a full list of possible side-effects.) If the first one that you try doesnot suit, then another may be found thatwill suit. So, tell your doctor if you haveany problems with an antidepressant.

Antidepressants are not tranquillisers andare not thought to be addictive. About 5-7in 10 people with moderate or severedepression improve within a few weeksof starting treatment with a prescribedantidepressant.

However, up to 3 in 10 people improvewith dummy tablets (placebo) as somepeople would have improved in this timenaturally. So, you are roughly twice aslikely to improve with antidepressantscompared to taking no treatment. But,they do not work in everybody.

Talking (psychological) treatmentsIf available in your area, an option is tobe referred to a psychologist or otherprofessional for a more specific type oftalking treatment. Most psychologicaltreatments for depression last in therange of 16-20 sessions over 6-9 months.


For example:• Cognitive therapy. Briefly, cognitivetherapy is based on the idea that certainways of thinking can trigger, or ‘fuel’,certain mental health problems suchas depression.

The therapist helps you to understandyour thought patterns. In particular, toidentify any harmful, unhelpful, and‘false’ ideas or thoughts which you havethat can make you depressed. The aim isthen to change your ways of thinking toavoid these ideas. Also, to help yourthought patterns to be more realistic andhelpful.

Therapy is usually done in weeklysessions over several months. You arelikely to be given ‘homework’ betweensessions.

• Cognitive-behaviour therapy (CBT).This is a combination of cognitivetherapy and behaviour therapy.

Behaviour therapy aims to change anybehaviours which are harmful or nothelpful. In short, CBT helps people toachieve changes in the way that theythink, feel and behave. (See separateleaflet for more details on CBT.)

• Other types of therapy sometimes usedinclude: interpersonal therapy,problemsolving therapyand psychodynamicpsychotherapy.

For moderate depression, the number ofpeople who improve with cognitivetherapy and cognitive behaviour therapyis about the same as withantidepressants.

These treatments may not be so good forsome people with severe depression.This is because you need somemotivation to do these treatments andpeople with severe depression often findmotivation difficult.

Also, there is a shortage of trainedtherapists who can perform psychologicaltreatments. So, it might not be an optionin your area, or there may be a longwaiting list.

Some research suggests that acombination of an antidepressant plus atalking treatment such as CBT is betterthan either treatment alone.

Exercise and counsellingIn addition to the above treatments, aswith mild depression, regular exercise isthought to help to improve symptoms (ifyou are able to do some exercise).

Also, counselling for a specific problemmay help too if a particular problem istroubling you (relationship breakdown,bereavement, etc).

Other treatments

St John’s Wort (hypericum)This is a herbal antidepressant that youcan buy from pharmacies without aprescription. It recently became apopular ‘over the counter’ treatment fordepression. However, many doctors nowdo not advise that you take this because:

• It is not clear how well it works.Although some studies suggest that itmay help depression, other studies havefailed to confirm this.

• Side-effects sometimes occur. (Somepeople think that because St John’s wortis ‘natural’ then it is totally safe. This isnot true. It contains many chemicalswhich sometimes cause problems.)

• It may react with other medicines thatyou may take. Sometimes the reactionscan cause serious problems.

For example, you should not take StJohn’s wort if you are taking warfarin,cyclosporin, oral contraceptives,anticonvulsants, digoxin, theophylline, orcertain anti-HIV medicines. Also, youshould not take it at the same time ascertain other prescribed antidepressants.


Specialist and hospital basedtreatmentsOther treatments such as specialistmedicines or electrical treatment (ECT)may be advised if you have severedepression which has not improved withother treatments.

Some dos and don’ts aboutdepression• Don’t bottle things up and ‘go it alone’.Try and tell people who are close to youhow you feel. It is not weak to cry oradmit that you are struggling.

• Don’t despair - most people withdepression recover. It is important toremember this.

• Do try and distract yourself by doingother things. Try doing things that donot need much concentration but canbe distracting such as watching TV.Radio or TV is useful late at night ifsleeping is a problem.

• Do eat regularly, even if you do not feellike eating.

• Don’t drink too much alcohol. Drinkingalcohol is tempting to some people withdepression as the immediate effect mayseem to relieve the symptoms. However,drinking heavily is likely to make yoursituation worse in the long run.

• Don’t make any major decisions whilstyou are depressed. It may be temptingto give up a job, or move away, tosolve the problem. If at all possible youshould delay any major decisions aboutrelationships, jobs, or money until youare well again.

• Do tell your doctor if you feel that youare getting worse, particularly if suicidalthoughts are troubling you.

• Sometimes a spell off work is needed.However, too long off work might notbe so good as dwelling on problemsand brooding at home may make thingsworse.

Getting back into the hurly-burly ofnormal life may help the healing processwhen things are improving. Each personis different, and the ability to work willvary.


• Sometimes a specific psychologicalproblem can cause depression, but somepeople are reluctant to mention it.

One example is sexual abuse as a childleading to depression or psychologicaldifficulties as an adult. Tell your doctorif you feel something like this is the rootcause of your depression. Counsellingmay be available for such problems.

Will it happen again?A ‘one-off’ episode of depression at somestage in life is common. However, somepeople have two, three, or more episodesof depression. You can have treatmentfor each episode. However, if you areprone to recurring episodes ofdepression, you may be advised to takean antidepressant longterm to preventdepression from recurring.

Some related conditions PostnataldepressionSome women develop depression justafter having a baby.

Bipolar affective disorderIn some people, depression canalternate with periods of elation andover-activity (mania or hypomania). Thisis called bipolar affective disorder ormanicdepression.

Treatment tends to include moodstabiliser medicines such as lithium.

Seasonal affective disorderSome people develop recurrentdepression in the winter months only.This is called ‘Seasonal AffectiveDisorder’ or SAD. For people in the UKwith SAD, symptoms of depressionusually develop each year sometimebetween September and November, andcontinue until March or April.

You, and your doctor, may not realizethat you have SAD for several years.This is because recurring depression isquite common.

You may have been treated fordepression several times over the yearsbefore it is realized that you have theseasonal pattern of SAD. Treatment ofSAD is similar to other types ofdepression. However, ‘light therapy’ isalso effective. See separate leaflet called‘Seasonal Affective Disorder’ for details.


Other mental health problemsDepression sometimes occurs at thesame time as other mental healthproblems.

• People with anxiety, panic disorder, andpersonality disorders quite commonlyalso develop depression. As a rule,depression should be treated first,followed by treatment of the otherdisorder. In particular, anxiety will oftenimprove following treatment ofdepression.

• Eating disorders such as anorexia andbulimia may accompany depression. Inthis situation the eating disorder isusually the main target of treatment.

Further help and informationDepression Alliance212 Spitfire Studios, 63-71 Collier StreetLondon N1 9BE

Telephone 0845 123 23 20www.depressionalliance.org

Provide information, support andunderstanding to those who are affectedby depression.

SanelineTelephone 0845 767 8000www.sane.org.uk

Saneline is a national out of hourstelephone helpline providing informationand support for anyone affected bymental health problems including familiesand carers.

The British Association of Behaviouraland Cognitive Psychotherapies (BABCP)Globe Centre, PO BOX 9Accrington BB5 2GD

Telephone 01254 875277www.babcp.com

They maintain a register of qualifiedpractitioners. They also have a series ofpamphlets (available for a small charge)which provide information aboutfrequently encountered problems suchas Anxiety, Depression, Schizophrenia,PTSD, General Health, OCD,Agoraphobia, Learning Disability,Insomnia, Chronic Fatigue Syndrome,Eating Disorders, UnderstandingCBT, Sexual Dysfunction, Chronic Pain,Conduct Disorder, Bipolar Disorder,Social Phobia, Fear of Flying and SelfHelp.


Oxford Cognitive Therapy Centre (OCTC)www.octc.co.uk

Based in the Oxford PsychologyDepartment, part of Oxfordshire MentalHealthcare NHS Trust.

Their website gives details of how toorder a number of educational andselfhelp booklets with a CBT approach forconditions such as Depression,Obsessive Compulsive Disorder, BulimiaNervosa, Anorexia Nervosa, Anxiety,Panic, Phobias.

Self-help leaflets based on a CBTapproach

For common mental health issuesincluding depression. Written bymembers of the Newcastle, NorthTyneside and Northumberland MentalHealth NHS Trust.

Available on the web at: www.nnt.nhs.uk/mh/content.asp?PageName=selfhelpUltrasis www.ultrasis.com

Produce interactive, computer basedCBT programmes for healthcareprofessionals, corporations andconsumers.


Inspire Mental Health works with and for people with mental illness to ensure theylive healthy, productive lives and are supported to achieve their full potential withinall aspects of their lives. We provide a range of supported accommodation includingfloating support that supports over 400 people per year. Day opportunities andrecovery focused services are provided to over 1000 people per year and ouradvocacy services touch the lives of thousands every year.

We also provide a range of community support services for people over 60 leavinghospital or who have become socially isolated to help them reintegrate into society.

We provide support to people with Personality Disorders, who self-harm and whoare in prison. We also provide support to young mothers struggling with parentingand their mental wellbeing.

Inspire

Central Office

Lombard House

10-20 Lombard Street

Belfast

BT1 1RD

Inspire

Dundalk Office

Clontygora Drive

Muirhevnamor

Dundalk

Co.Louth

Email

NI/UK: [email protected]

Ireland: [email protected]

Telephone

Central Office: (00 44) 28 9032 8474

Inspire, Inspire Mental Health and Inspire Community Resilience are operating names of Inspire Wellbeing a company limited by guarantee registered in Northern Ireland RegisteredOffice: Lombard House, 10 - 20 Lombard Street, Belfast, BT1 1RD Company No: NI025428 Charity No: NIC103470 Inspire Disability Services is a company limited by guaranteeregistered in Northern Ireland Registered Office: Lombard House, 10 - 20 Lombard Street, Belfast, BT1 1RD Company No: NI073751 Charity No: NIC101899 Inspire Workplaces, InspireStudents and Inspire Knowledge & Leadership are operating names of Carecall (NI) Limited a company limited by guarantee registered in Northern Ireland Registered Office: LombardHouse, 10 - 20 Lombard Street, Belfast, BT1 1RD Company No: NI038960 Vat Registration No: 179 1484 72 Addiction NI is an operating name of Northern Ireland Community AddictionService Ltd, a company limited by guarantee registered in Northern Ireland Registered Office: Lombard House, 10-20 Lombard Street, Belfast, BT1 1RD Company No: NI012654 CharityNo: NIC100628

A Guide to Depression rebrand - Inspire · everyday word. People might say “I’m ... if they lose weight. The following is a list of common symptoms of depression. It is unusual

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