Depression :4.

What can I do to help myself?

An important thing to accept is that there are usually no instant solutions to problems in life. Solving problems involves time, energy and work. When you are feeling depressed, you may not be feeling energetic or motivated to work. But if you are able to take an active part in your treatment, it should help your situation.

Break the cycle of negativity

If you are starting to feel depressed it can be very easy to get into a cycle of automatic negative thoughts that then become difficult for you to challenge: you get depressed and then you get more depressed about being depressed. Being in a state of depression can then become a bigger problem than the actual difficulties that caused it in the first place.

You need to make a conscious effort to break the hold that the depression has on you. Deciding to do something to help yourself is the most important step you can take.
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. 

Keep active

Research and individual personal experience show that regular exercise can be very effective in lifting your mood and increasing your energy levels, and it is also likely to improve your appetite and sleep. Physical activity stimulates chemicals in the brain called endorphins, which can help you to feel better.
Although you may not feel like it to start with, it’s very therapeutic to take part in physical activities, for 20 minutes a day. It does not have to be very strenuous or sporty to be effective. Walking at a reasonable speed and taking notice of what is around you is a good start. Walking in a green environment, such as the park or the countryside, is especially helpful 
If you like gardening but haven’t got a garden, you might find there is a community garden near you which you could help with. Some local Minds have projects like this. .
You may also enjoy swimming, running, or joining in competitive or team sports, which can also give you the opportunity for social contact with people who share your interests.

It's so important to keep as busy as your depression allows you to. It's easy to dismiss engaging in hobbies and activities, saying that they wont help and giving up… even people who don't have depression become low if they are bored or under-stimulated for long periods. Learning to become active again played an essential part in my recovery and helps me to stay well.

Connect with other people

Although you many not feel like it, keeping in touch with people can help you feel a bit more grounded and sometimes get things more in perspective. Try a short phone call to a close friend or relative, or if you can’t manage it, just an email or text message.

When you feel ready, you may find it helpful to do something to help other people, as this may help overcome any feelings of isolation you have, take your mind off your own problems and make you feel better about yourself.
It can also be a great relief to meet and share experiences with other people who are going through the same thing you are.

Self-help groups can show you how other people have coped and provide mutual support, as well as breaking down feelings of isolation. They are often led by people who have overcome depression themselves. For help in finding local self-help groups, talk to your local Mind 

Care for yourself

You need to do things that will improve the way you feel about yourself.

• Allow yourself positive experiences and treats that reinforce the idea that you deserve good things. eg a long bath, a day out with a friend.
• Pay attention to your personal appearance.
• Set yourself goals that you can achieve and that will give you a sense of satisfaction.
• If you find it hard to remember things, you may want to write them down on sticky notes, in a diary or set reminders on your mobile phone.
• Look after yourself by eating healthily, as much as possible. Oily fish, in particular, may help reduce depression.
• Be cautious with tobacco, alcohol or other drugs, which make depression worse, and a lot of caffeine which may make you a bit jittery.

Would I change what happened to me? Definitely not. It made me who I am, its part of me and it’s made me a better person…
I started enjoying life again. I could look to the future and want to live it… Believe me, it can get better.

What treatments are available?

At a time when you may find making decisions difficult, it can also seem like an added burden to try and choose between a range of treatment options.

The National Institute for Health and Care Excellence (NICE) guidelines on the treatment of depression recommend:

• active monitoring – this is for mild depression and means keeping an eye on you while waiting to see if your depression goes away without treatment, which mild depression often does
• cognitive behaviour therapy (CBT), including self-help books, computerised CBT for mild depression; a series of sessions with a therapist for more severe depression
• mindfulness-based cognitive therapy
• behavioural activation
• other forms of talking treatment, such as counselling or interpersonal psychotherapy.
• medication for severe depression, but not for mild to moderate depression unless other treatments have not helped. This should be combined with CBT or psychotherapy
• exercise.

Talking treatments

The Improving Access to Psychological Therapies (IAPT) programme, aims to make talking (psychological) treatments that follow NICE guidance available to everyone who needs them, regardless of race, age, gender, or where they live. A talking treatment should be available to you via your GP. The choice will depend on what's available locally, your own preferences, how severe your depression is and other factors. 

• Cognitive behaviour therapy (CBT) helps to identify and change negative thoughts and feelings affecting your behaviour and, although often a short-term treatment, may last up to 12 months. For mild depression you may be offered computerised CBT, which uses a programme you can follow either by yourself or in addition to sessions with a therapist.
• Mindfulness-based cognitive therapy is an approach to wellbeing that involves accepting life, and living and paying attention to the present moment. It includes taking time to see what is happening around you in a non-judgmental way, rather than going over your problems again and again. Mindfulness-based cognitive therapy is usually done in groups.

Mindfulness (is) a neat little trick that really helps and I wish I'd been taught it years ago.

• Behavioural activation makes you look at the simple everyday tasks you may be avoiding and start doing them. Activity helps you to feel better, and once you have conquered some everyday tasks, you may feel ready to tackle some bigger ones. For example, you may have felt too depressed to do the washing up and let it pile up in the kitchen. The bigger the pile, the less you feel like doing it. Behavioural activation would encourage you to tackle it, even if you start by only doing some of it. As you do it, the dishes get clean, your kitchen gets tidier, and you feel a bit better about everything. Behavioural activation usually forms part of a CBT programme, but may be offered on its own.
• Guided self-help delivers a 6-8 week therapy programme through self help books, under the guidance of a healthcare professional.
• Interpersonal psychotherapy focuses on relationships. Therapy can continue for 6 to 12 months.
• Counselling, which can be short- or long-term. This involves talking with someone who is trained to listen with empathy and acceptance. It allows you to express your feelings and helps you to find your own solutions to your problems.
• Psychodynamic counselling and psychotherapy focus on how past experiences may be contributing to experiences and feelings in the present. Therapy can be short- or long-term. It may be more frequent and intensive than counselling, and may go deeply into childhood experience and significant relationships. It may not be available on the NHS.
• Group therapy allows a group of people to work together on their problems, with a therapist. You may find it easier to talk with others who have similar experiences, and that the insights of others help you to understand yourself better; you may also learn about relationships with others.

Whatever progress I have made in my battle with depression, is due entirely to group psychotherapy. It has transformed my little life in ways I thought impossible to begin with, and shown me that  whenever I have suddenly felt worse, there is ALWAYS an explanation from my past.

You can also seek therapy or counselling privately, if you are able to pay. For lists of qualified and regulated therapists.  Some offer a reduced fee for people on a limited income.
Combining a psychological treatment with medication may be the  most effective course for severe depression.

Medication

Antidepressants

Antidepressant drugs work on brain chemicals (such as serotonin and noradrenaline) to lift your mood. It often takes between two to six weeks before the drugs take effect. They don’t cure depression, but they can make you feel better so that you may feel able to take action to deal with the problems causing your depression.
The NICE guidelines suggest that, for mild depression, antidepressants are not appropriate because the risk of side effects  outweighs the chance of benefit, but they are recommended for severe depression, or moderate depression that has gone on for a long time.

If you do take antidepressants, the usual recommendation is that you stay on them for six months after you feel better in order to stop the depression coming back. Many people find them helpful, although they don’t work for everyone.

Antidepressants can cause unpleasant side effects, some of which are worse to begin with. Some can be dangerous when used with other drugs. Of the various types available, SSRIs (selective serotonin reuptake inhibitors, such as Cipramil or Prozac) are usually the preferred first choice because, they are usually better tolerated than some of the other antidepressants. But if these do not suit you for any reason, there are other types to try, which work in slightly different ways 

Other medication

If you are having psychotic symptoms, your GP may refer you to a psychiatrist who may prescribe an antipsychotic drug, such as quetiapine (Seroquel). 

Exercise

Although exercise is something you can do for yourself, it is also recommended as a treatment for depression in the NICE guidelines, and some GPs will give you a prescription for exercise, referring you to a programme at a local gym or health centre.

Befriending, peer support and volunteering schemes

Your GP may put you in touch with a local befriending scheme, with trained volunteers who may visit you at home, or arrange to meet you somewhere for a chat, or a walk or other social occasion that you both enjoy.
You may be offered the help of a peer support worker. They have usually had similar experiences to you, and can empathise with your situation and offer hope for recovery, as well as helping you to access other services.

You might also be put in touch with a volunteering scheme where you can exchange skills or offer help to others who have problems that you might be able to help them with. For example, you might not feel up to cooking for yourself, but might feel able to cut someone’s grass for them. A neighbour might love cooking, but be unable to manage their garden. So you could exchange lawn-mowing for a hot meal, and both of you benefit.

Arts therapies

Art and music therapies may help you to express how you are feeling, especially if you are having difficulty talking. Drama therapy may help you to come to terms with traumatic events that you may have experienced in the past and which may contribute to your depression. Writing about how you are feeling can also be very helpful, and there is no need to share this with anyone if you don’t want to. Arts therapies and writing groups may be available through a local group, such as a local Mind. 

Alternative and complementary therapies

Practitioners of complementary and alternative medicine concern themselves with the person as a whole, and don’t just treat their symptoms. They spend more time with you than a GP can. Practitioners may offer treatments such as acupuncture, massage, homeopathy and herbal medicine that many people with depression have found helpful.

St John’s wort is one of the herbal remedies that many people find helpful, and may help to lift your mood. However, you should not take St John’s wort if you are taking prescription antidepressants. If you are taking any other medication you should seek advice from a pharmacist before adding St John’s wort, because it interferes with the effects of many other medicines. 

What if my depression is worse, or won't go away?

Your GP may refer you to a specialist mental health professional, such as a psychiatrist, psychologist or mental health nurse, who can review your treatment so far. They may suggest a different medication, or a combination of drugs with other treatments.

Social care and support

If you are very depressed, you may need support to live independently in the community. Your Community Mental Health Team (CMHT) can provide support for you in your own home, and may include a psychiatrist, community psychiatric nurses (CPNs), social workers and peer support workers.

You may be allocated a named care coordinator and have a written treatment plan that specifies what your current treatment is, what should happen in an emergency or crisis, and any treatments you would prefer not to have.

Crisis resolution services

These are teams of doctors and nurses who provide intensive support, which will enable you to stay at home if you're in crisis, rather than going into hospital.

For more information about what help may be available to you in your area, talk to your local Mind (see Mind in your area), or call Mind Infoline (0300 123 3393).

Hospital admission

If you are severely depressed, you may need to be cared for in hospital as an in-patient. This gives a psychiatrist the opportunity to monitor the effects of different treatments, and also means that you will get regular meals. 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 may have little privacy, where you have to fit in to routines that may not suit you, and where you may be upset by the behaviour of other patients.

Generally, doctors prefer to keep patients out of hospital, but some patients are compulsorily detained under the Mental Health Act, if it’s thought to be necessary for their own health or safety or the protection of others.

Electroconvulsive therapy (ECT)

This is a controversial treatment, and is usually suggested only if you are severely depressed and haven’t responded to talking treatments or different types of medication. ECT involves passing an electric current through the brain, while you are under general anaesthetic, in order to induce a convulsion, or fit, which is believed to lift the depression.

Some people find it very helpful, but it can also have severe side effects, including memory loss. You cannot be given ECT without your consent unless you are assessed as being incapable of giving consent. 

Other physical treatments

For very severe depression that has not improved with any of the normal treatments, including ECT, there are other treatments including neurosurgery, and deep brain stimulation. These  treatments are used extremely rarely. 

END.