by S Black, R Donald, M Henderson, NHS Borders Acknowledgement to Newcastle, North Tyneside and Northumberland Mental Health NHS Trust Developed with assistance from: The National Programme for Improving Mental Health and Well Being www.wellontheweb.net
"I feel so alone, I never see my friends now, I guess they have dropped me. They probably don't like me - who would? There is no point in making any effort it doesn't pay off ... I just hate myself". "I feel like crying all the time, I am so tired and can't get interested in anything. In fact I just don't even get started with the jobs I should be doing,I can't even do basic things that seem so easy to other people..."
At this point you may feel that nothing can be done to help. But there are things that you can do yourself which can make a difference and there are also other places where you can get help if the depression does not seem to be getting any better. This page aims to tell you more about depression, how to overcome it and what help may be available.
What is depression?
Depression is a very common problem. 1 in 5 adults will at some time experience symptoms of depression. This is often because of life stresses such as bereavement, money or housing problems or difficulties in relationships, but for some people the problem becomes much worse and normal life itself becomes difficult. It is the most common reason for attending a GP. In its mildest forms depression does not stop you from leading a normal life, but the most severe forms of depression can be life threatening, with thoughts of death and suicide.
|These are some of the signs or symptoms that you may experience if you are depressed.|
|Emotions or feelings||- Feeling sad, guilty, upset, numb or despairing - Losing interest and enjoyment in things - Crying a lot or feeling unable to cry - Feeling alone even if you are in company|
|Physical or bodily signs||- Tiredness - Restlessness - Sleep problems, especially waking early or interrupted sleep - Feeling worse at a particular time of the day (usually morning) - Changes in appetite, eating and weight|
|Thoughts||- Losing confidence in yourself - Expecting the worst and having negative or gloomy thoughts - Thinking that everything seems hopeless - Thoughts of suicide - Thinking you hate yourself - Poor memory or concentration|
|How these feelings, physical signs and thoughts may affect your life||- You may find it difficult to do even simple things - You stop doing your normal activities - You cut yourself off from other people - You may become inactive, just doing nothing for long periods of time - You may feel that you have to double check everything|
Not everyone who is depressed has all of these symptoms. And even if you are not seriously depressed, it is usual to feel some of these things from time to time. This is particularly true if you have recently suffered a loss and especially if someone close has died. When these symptoms are part of a normal reaction to loss or distressing events they should resolve with time. Most people find it helpful to talk over these feelings with somebody who cares. If these feelings are very strong, however, or continue for some time, then depression may have developed. When this happens you need to take steps to help yourself and/or seek help from others.
What causes depression?
No single cause for depression has been found. Usually there is more than one reason and this differs from person to person, but sometimes depression can happen without any obvious reason. As we have already mentioned, distressing events can make someone start to feel depressed and at times this may turn into a more serious depression from which it is difficult to emerge. Circumstances can play a part. So, being alone, having no money, physical illness and unemployment can all contribute. Sometimes several different factors cause depression. At times, even events that you might think of as good and positive, such as getting married or starting a new job, can be stressful enough to cause depression. Just because there is a clear reason for feeling depressed, this does not mean that the depression is not a problem and does not need to be helped. Having a baby leads to a post-natal depression for one in ten women. Different people will react to depression in different ways and although some may be sad and withdrawn, some show their distress in other ways, such as heavy drinking or irritability. One in ten people who have a severe depression also have periods where they are excited, with uncontrolled behavior. This is known as manic depression and it affects equal numbers of men and women. Some people seem to be more vulnerable than others to becoming depressed. This may be because of body make up (including body chemistry) or because of early life experiences and family influences. Some people may be more inclined to "look on the gloomy side" of life in general, and this may make them more likely to develop a depression.
How can I help myself to feel better?
- Even if you have a doctor or mental health worker involved in your treatment there are things you can do to help yourself in overcoming depression:
- Do something active Physical activity is particularly helpful: walk, run, cycle, skip; anything that begins to increase your activity can help to improve how you feel. Plan 15 or 20 minutes of activity every day, or every other day to begin with. This kind of physical activity can actually begin to make you feel less tired. Find something that interests you and spend some time on it. Plan to focus on things you usually enjoy and build some time into each day for these activities. You might find it helpful to take up a new interest. Some people find that creative activities such as painting, writing poetry or playing music that helps them to express their feelings, can help them to feel better. Make a small start on tasks that you may have been avoiding, break big tasks down into smaller stages and tackle these one by one. For example, there might be jobs in the house or the garden that really need to be done, but you have been putting off doing them. If that is the case begin on day one by tackling just one small area. This way, by not taking on too much you are more likely to achieve your goal and that will make you feel good. What do you enjoy? What could you do today, even for 10 minutes? Sometimes it is better to do in spite of how you feel. After the activity, ask yourself – How do I feel? Better? Worse? The same? If worse, try something else.
- Talk to others Try and tell those close to you how you are feeling. They may be able to listen and help you to think things through. Having a cry can help to relieve tension and let things move on. You may be surprised to find those you talk to have felt depressed themselves at some time and can understand how you feel. It may help to let them read this booklet.
- Look after yourself Be kind to yourself. You are depressed – not your usual self. If you had flu or a bad cold you would try and do something nice to make yourself feel a little better. Try and 'treat' yourself by doing something you enjoy each day. Resist the temptation to cope with your depression by drinking alcohol, misusing medication or turning to illegal drugs. These may give some immediate relief but quite soon create further health and psychological problems for you to cope with. Eat well; a good diet can help to keep you in good health so recovery is easier.
- Challenging negative thinking
When someone is experiencing depression they often tend to think and expect the worst of themselves, their life and the future. Don't just accept these thoughts, try to:
- identify when your mood is very low
- jot down the unpleasant thoughts you are having during that time
- try and counter these thoughts by writing down arguments against them. Imagine what you would say to a friend if they had such negative thoughts about themselves
- try and keep a diary of things you have enjoyed or achieved during the week. This can help you to concentrate on the good things rather than the bad things in your life.
What treatment is available for depression?
Most people are treated for depression by their family doctor. The doctor may suggest a talking treatment or antidepressant tablets or both. The doctor may refer you to a mental health worker. This could be a psychiatrist (a medically qualified doctor who specializes in mental health), or it may be to a counselor, community psychiatric nurse, psychologist or other mental health worker.
The talking treatments are usually counseling or therapy. These will help you understand your own difficulties and begin to work out ways of overcoming depression. 'Cognitive therapy' is one kind of therapy that is often used. It can help people to challenge their negative thinking and get on with their lives. Whatever type of therapy is used, it will usually take a little time before you begin to feel the benefits, but treatment of this kind has helped many people and can be very effective.
Antidepressants are sometimes prescribed by your family doctor or psychiatrist. They have been shown to be helpful for many people suffering from depression. Antidepressants influence the chemicals in the brain to make you feel less depressed. They are not addictive and once you begin to feel better, usually after quite a few months, you can plan, with your doctor, to stop taking them. This should not cause you any difficulty and your doctor will gradually adjust and reduce the dose. When you begin a course of antidepressants it is important to remember that they do not work immediately. It will take 2-4 weeks before they take effect and you need to keep taking them regularly to feel the benefit. They can have some side effects at first but these are usually quite mild and will generally wear off as treatment continues. Your doctor or pharmacist will advise you about this. Although people often start to feel better within 2-4 weeks of taking antidepressants it is important to keep taking them for as long as your doctor advises. This helps stop the depression coming back. If you are taking antidepressants it is important to consult your doctor before taking any other tablets, drugs or alcohol.
There is strong research evidence that regular exercise can help with mild to moderate depression. Speak to your GP about being referred to the GP exercise program or look for ways to try things like walking, cycling or swimming.
~ Mark Twain
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