Sadness

Sadness is a common reaction to life. Becoming sad when someone close to us dies or when we are faced with difficulties such as divorce or financial problems, is part of what makes us human. Depression is also common, affecting about 1 in 10 people. However, it is considered to be an abnormal emotional state. In most cases, the depression is mild and does not cause much inconvenience. However, if it is more severe it can pervade your whole life and affect the way you think, feel and behave. Depression can persist, worsen and prevent you from achieving your full potential in life.

What self-help options are available for mild depression?

Depression often gets better without treatment but it can take 6-8 months. During this time your symptoms may become intrusive and affect the way you live your life. There is much you can do yourself, once you have been pointed in the right direction. This is sometimes referred to as guided self-help. There's a lot of advice out there - on the internet, in a guide such as this, in magazines and books and from professionals such as GPs, practice nurses and counsellors.

Don't bottle it up

Don't try to 'soldier on' with your depression. You may try to hide your feelings in the hope that your depression will go away. You may fear that revealing that you have depression is a sign of weakness. This may be aggravated by unkind remarks from acquaintances that you should 'pull your socks up'. Trying to suppress your depression is never a good idea and will only make you worse. This guide shows you how to understand your symptoms, that depression is an illness and that it is very common. Being open and honest with your family and friends will help them understand and they can be a good source of support for you.

Keep yourself occupied

If you are depressed, your natural reaction may be to withdraw from the world. This is the worst thing you could do. You need to increase your activity, not reduce it. Getting out from under that duvet and engaging with life may be very hard to start with, but it is the first step on your road to recovery. Make a list of activities you enjoy:

• Engage with people.
• Participate in activities.
• Do some exercise.

Making a list

You will need to get motivated, otherwise you may spend the entire day staring out of the window. Make a daily plan of the things you need to do. Add in a few 'treat' activities that you normally enjoy (and maybe don't usually have enough time for). Keep it simple and choose activities that don't need a lot of organising, such as a walk in the park or listening to music. Activities which bring you into contact with friends, family or pets are useful, and exercise has been found to be particularly beneficial. Studies have shown that regular exercise can be as good as medication in the treatment of depression.

Keeping a diary

Tick off each activity once it is done. At the end of the day, look back and see what you have achieved and what you have enjoyed. Don't be surprised if you don't enjoy some of the activities you list to start with. Give it time - the enjoyment will come back. Just think of it as therapy in the first instance. Rate your enjoyment from 1 to 10. You can see which activities you most enjoy and how you are progressing over time.

Avoiding what is unhelpful

You may list activities which you think are going to make you feel better but actually make you feel worse. Drinking alcohol, watching TV all day or staying in bed are typical examples. By keeping a daily diary you should be able to identify these unhelpful activities. Reduce the amount of time you spend on them and increase those that have brought you pleasure or a sense of achievement, to compensate.

Solving problems

Problems that you used to solve in your stride may seem insurmountable when you are depressed. Fear not - help is at hand !

Write the problem down, including as much detail as possible:

Write down possible solutions using the following approach:

• Did you solve a similar problem in the past and if so how did you tackle it?
• What would a friend do?
• What are the possible solutions? (Be creative, write the silliest or most impractical solutions first.) Break your solution down into steps and tick them off as you achieve each step.

The vicious cycle

Depression can make you lack motivation and feel physically unwell. It may be easier to avoid activities than to tackle them. You may then feel guilty and start to get angry with yourself. This in turn can cause lack of self-esteem and make you feel even more depressed. Understanding how depression affects your thinking can help you break this vicious cycle.

Make a list of any thoughts that have fallen into any of the categories below in the last couple of weeks:

Gloomy thoughts

When you are depressed, your image of yourself may suffer. You may feel you are worthless, lazy or unattractive. You may feel more sensitive about what other people think of you and imagine that you have become less popular among your friends.

Catastrophising

This means jumping to the worst conclusion. If a family member is late, you immediately picture them being rushed to hospital in an ambulance. Or if you haven't heard from a friend or a few days, you assume you've said something to upset them.

Over-generalising

This means drawing wide conclusions from one small detail. If someone spoke sharply to you at work, you may think: 'All my colleagues hate me.' Or if you run out of milk, you may think: 'I'm a total disaster and useless at organising my life.'

Focusing on the negatives

This means over-exaggerating setbacks whilst ignoring all the good things in your life. For example, you may focus on a negative comment someone has made at work, whilst taking no notice of the praise other colleagues have given you. Or you may criticise yourself for not achieving everything on your list of tasks but ignore all the things you did manage to do.

Taking the blame unnecessarily

This means blaming yourself for no good reason. For example, if a co-worker is off-hand with you, you immediately wonder what you have done wrong. It may be that the other person has just had a bad day or is preoccupied.

Guessing another's thoughts or predicting the future

A neighbor who normally stops in the street for a chat passes by with just a wave. You immediately think: 'I must have upset her last time we spoke.' In reality, she may just be late or an appointment. You may be convinced that things are not going to go well at an interview and think: 'I know they won't offer me the job, so I won't bother going.'

Breaking the cycle

Don't beat yourself up if any of the thinking patterns above look familiar to you. Celebrate the fact that you are beginning to recognise them in yourself. You will now be in a position to stop them from affecting your mood. Whatever it is that has upset you, sort it out into three parts:

• What happened?
• What did I think?
• What did I feel?

For example:

Your best friend ignored you all evening and chatted to someone else. You thought: 'She finds the other person better company than me.' You felt unwanted and inferior. Various techniques can be used to break the cycle.

Balancing

This means cancelling out the negative thought with a positive thought. Using the above example:

"She finds the other person better company than me.' This could be balanced with: 'She bought me a great present for my birthday.' It may be worth keeping a diary of events, with columns for feelings, negative thoughts and balancing thoughts. It's known that people who are depressed are not very good at recording details so keeping a diary will help. Diaries are useful not only to help with the balancing technique but also to record positive experiences such as praise from a colleague or a compliment from a partner.

Challenge long-held views

You may be your own worst critic and you may have developed long-held negative opinions about yourself. For example, you may think you are lazy, not well liked or not particularly bright. These criticisms are often imagined and have no basis in reality. Imagine that you were trying to cheer up a friend who had these thoughts. Look for evidence that supports the opposite view. Writing things down may help.

Mindful awareness

This is a technique which has become increasingly popular as a way of getting 'in tune' with our thoughts and bodily feelings. It can be used to help manage anxiety. Entire books have been written about it and it's not easy to summarise the whole subject in a few lines.

However, in a nutshell it involves focusing on what is happening in the present and not being distracted by the past or the future. One exercise involves concentrating on your breathing whilst observing in an objective way whatever else is happening to your mind and body. If thoughts come into your mind, acknowledge them but bring your attention back to your breathing. You may notice physical feelings, emotions and sounds: notice them but let them drift away, and come back to your breathing. If you do become distracted, recognise that this has happened but just bring your focus back on to your breathing. The more you practise this technique, the easier it will be to deal with the negative thoughts that come into your mind during a bout of depression. What other treatment options are available for mild depression?

1. See your GP.
2. If self-help techniques don't do the trick, your doctor can help to rule out physical causes. These may include:

• An underactive thyroid gland (hypothyroidism).
• An underactive pituitary gland (hypopituitarism).
• Head injury.
• Polymyalgia rheumatica - an inflammatory condition causing severe pain and stiffness.
• Early dementia.
• Some medicines and some illicit drugs.
• Having ruled out treatable causes of depression, your doctor might suggest other treatments.
• What are the treatment options for mild depression?

Talking therapies

This involves sessions with a psychologist. The most common technique is cognitive behavioural therapy (CBT). The aim is to change the way you think and behave, using techniques similar to those described at the beginning of this guide. For mild depression, CBT is often offered in a group or via a computer. However, if the depression persists, one-to-one CBT may be advisable. Group-based peer support is a technique in which you share
experiences and feelings with other people who are in a similar situation. This is often helpful for people whose depression is associated with a long-term physical illness.

Antidepressant medicines

These are not usually necessary for mild depression. However, they may be considered if our depression has persisted despite self-help techniques, if you have had moderate or severe depression in the past, or if your depression is associated with a physical illness. What are the treatment options for moderate to severe depression?

As with mild depression, physical causes must be ruled out. Your doctor may then recommend talking therapy, antidepressant medication or a combination of both. Studies suggest that a combination of psychological treatment and a course of antidepressants produces a better outcome than either treatment alone.

Cognitive behavioural therapy

CBT is offered in a more intensive way than for mild depression and usually needs one-to-one sessions.

Interpersonal therapy

This uses similar techniques to CBT but focuses particularly on your relationships with others and the way these affect your mental state and mood. This may be particularly helpful if your depression was a reaction to a bereavement or a dispute within the family.
Behaviour activation

This involves focusing on increasing the amount of activity you do. It is based on the fact that certain behaviours in depression, such as avoidance of activity and dwelling on negative thoughts, perpetuate the vicious cycle of depression.

Couple therapy

This is sometimes considered when your depression is thought to stem from your relationship with your partner, or where it would be thought particularly helpful for your partner to be involved.

Antidepressant medicines

These are particularly helpful in moderate to severe depression. They are good at controlling the symptoms of depression such as sleep disturbance and low mood. They take 2-4 weeks to work and need to be taken for at least six months. There are various groups of medicines, each with its own pros and cons. Your doctor can help you decide which is the best one for you.

Electroconvulsive therapy

This used to be used widely in severe depression but is now reserved as a last resort in cases which do not respond to other treatments.

Am I depressed?

If you are depressed, you may notice the following:

Emotions

Sadness, guilt, feeling upset, despairing, or feeling as if your mind is numb. Not enjoying the things, you normally do or losing interest in them. Feeling lonely even when you are with people. Being on a 'short fuse'.

Bodily signs

Feeling tired. Lacking energy. Not being able to relax. Having sleeping problems and waking up early in the morning. Feeling worse at a particular time of day, particularly in the morning.
Weight changes, poor appetite, going off your food.

Thoughts

Loss of confidence. Being pessimistic. Thinking everything is hopeless. Thinking you hate yourself. Difficulties with memory or concentration. Suicidal thoughts (if you are severely depressed).

Your behaviour

Being unable to make up your mind. Putting off daily tasks. Not doing hobbies or things you enjoy. Steering clear of other people. If most of these features apply to you, you may be depressed. Most people will experience some of these symptoms from time to time but with depression they persist for more than a few weeks.

What are the causes of depression?

Usually, there is no one single cause of depression. Common life events associated with depression include the loss of a loved one, loneliness, money worries and unemployment. Some people seem to cope better with these difficulties than others. People who are vulnerable to depression tend to have other members of the family who have depression, who have had a difficult childhood, something in their personality or a chemical imbalance. Sometimes, depression occurs for no rhyme or reason.

Stay healthy, stay loving, live well and prosper.

K.C.