Depression. Information for service users and carers. RDaSH. Adult Mental Health Services

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1 Depression Information for service users and carers RDaSH Adult Mental Health Services

2 Depression is a very common problem. It can affect anyone, regardless of your age, personality, culture, social or financial background. Many adults will at some time experience symptoms of mild depression because of the stress in their life. We have all said at some point that we feel down or miserable and can t be bothered. These mild symptoms of depression are unpleasant but generally do not stop you from leading a normal life. However, clinical depression can stop you from leading a normal life. Clinical depression can be diagnosed if your symptoms are more intense, continue longer than two weeks and are often accompanied with a reduced or increased appetite, disrupted sleep and poor concentration. This booklet aims to tell you more about depression, how to overcome it and what help may be available. Signs or symptoms of depression Feeling Sad Guilty Numb Hopeless Tearful Lonely even if you are in company. Physical Tiredness Restlessness Sleep problems, especially waking early or interrupted sleep Feeling worse at a particular time of the day Changes in appetite, eating or drinking Poor memory. 2 Depression

3 Thoughts No one likes me Everyone is better than me I am a failure Things will never change. Behaviour Stop doing things you used to enjoy Stay in bed longer Stay away from other people Have difficulty making decisions. Not everyone who is depressed has all of the symptoms listed. The symptoms can also be part of a normal reaction to loss or distressing events. If this is the case then they should get better with time and it may be helpful to talk to someone close about your feelings. However if these symptoms are very strong, or continue for some time, then you may be depressed and it is advisable to take steps to help yourself and/or seek help from others. It is worth remembering that different people will react to depression in different ways. Although some may be sad and withdrawn, others show their distress in other ways, such as drinking too much alcohol or being irritable. What causes depression? There is no single cause for depression. Sometimes it can happen without any obvious reason or for more than one reason, and it differs from person to person. Life events Distressing life events, such as bereavement, the breakdown of a relationship, losing your job or living with a physical illness Stress. Experiencing negative or even positive events, such as getting married, starting a new job or having a baby can be stressful enough to cause depression. 3

4 Thinking style People who tend to look on the gloomy side of life in general may be more likely to develop depression. If you are continually thinking critical thoughts about yourself and others, it is likely that you will feel depressed. These all interact and maintain symptoms of depression. Look at the cycle of depression below. Notice how the more you think negatively and the less you do, the more depressed you will feel. Look at the cycle of depression below. Life situation Loss: of job / releationship / money Behaviour Stopping doing activities or seeing people we used to enjoy can lead to and increase depressive symptoms. Generally life becomes less satisfying and less rewarding. Feelings Down Weepy Depressed negative thinking It s all my fault Things will never change Cycle of Depression Physical symptoms Tired Poor appetite Poor sleep Biology Some people seem to be more prone than others to becoming depressed. This may be because of their body chemistry and/or because of early life experiences and family influences. It is likely that for most people there is no single cause of depression but a combination of the factors listed above. Behaviour Withdraw from others Avoid doing things Drink more alcohol Can you relate to the cycle of depression? Yes No Breaking the cycle of depression There are many ways to break the cycle of depression one way is to start to alter the way we think. What keeps depression going? Depression keeps going because of how we behave, think and feel. 4 Depression

5 Challenge unhelpful thinking When someone is experiencing depression, they often tend to think very critically about themselves, others and their future. The thoughts are often automatic, out of their control and are often distressing. Write down the thoughts you have about: Yourself:... Others:... Your future:... If your thoughts are very negative it probably has affected your confidence and in your every day situations you will be more likely to have this type of thinking. To start to change these it is best to start with being more aware of situations when this happens. Think about the last time this happened. Write down the situation:... What was your first negative automatic thought:... How did you feel when you thought this?... Look at the unhelpful thinking styles below which occur more frequently when you are low and a depressed person will accept as true. Tick which one or ones fit with the way you think: Ignoring the positive: Means looking at the negative parts of the situation and forgetting the positives Jumping to conclusions: When you assume you know what people are thinking (mind reading), and when 5

6 we predict what is going to happen in the future Taking things personally: Blaming yourself for things that go wrong or could go wrong Catastrophising: Blowing things out of proportion viewing it as awful or terrible when the problem is quite small Emotional reasoning: Basing your view of situations or yourself on the way you are feeling. For example the only evidence you have is that you feel something bad will happen Black and white thinking: There is no in between, for example, a B in English is not acceptable. This makes people feel as though things are never good enough Should statements: Include thoughts like I should not have made a mistake, will lead to you feeling guilty and He should not have done that leads to you feeling angry and frustrated with others or the world in general Breaking the cycle of unhelpful thoughts It is important to remember that depression alters our thoughts. To help you feel better don t just accept these thoughts as being true. Recognise when they are happening, stop and take a minute to challenge and check them out rather than accept them. Look back at your negative automatic thought and challenge yourself by asking the following questions: What evidence do I have that my thought is true? Are there facts that I am ignoring? What other explanations could there be? Am I getting things out of proportion? Is there another way of looking at this? Am I exaggerating the good aspects of others, and putting myself down? 6 Depression

7 If I were not depressed would I view the situation differently? What would I say to my friend if they had a similar thought? How helpful is it for me to think this way? Write down your answers then read them through and write down a more balanced thought. For example, a person thinks that their friend must think they are a failure because they have not telephoned as they had agreed when they last spoke. A more balanced thought could be: I don t have any evidence to support my view. My friend could be ill or something unexpected could have happened. The last time we spoke they were very supportive of me. I will give them a call. Next write down your balanced thought:... Now notice how you feel when you focus more on the balanced thought. Remember this will take practice but it will help you feel more confident. You could try sharing your thoughts or diary with someone close to you. Together you may be able to challenge your unhelpful thoughts. Changing unhelpful behaviours Another way to break the cycle of depression is to change our unhelpful behaviours by increasing activity and spending time doing things. This will give you more positive and rewarding feelings. Look at the suggestions below. Increasing physical activity: Increasing your physical activity has huge benefits. It can help to improve how you feel about yourself especially as you will feel less tired, it will improve your ability to think more clearly and most importantly it will reduce the time focussing on your unhelpful thoughts. Research has also shown that it can help your body produce natural antidepressants and 7

8 improve your sleep pattern, even if it s only 15 minutes every day. You might find it helpful to take up a new relaxing interest. Creative activities such as painting, writing poetry or playing music may help you to express your feelings and feel better. Socialising more: Do activities you enjoy such as talking more to others, arranging to see friends or going to the cinema will give more enjoyment and feeling of well being. Do this even if you do not feel like it. Scheduling routine activities Try to get back to the regular routine you may have been avoiding, such as jobs in the house, paying a bill or doing the gardening. By putting things off it only makes you feel worse but to think about doing things can seem overwhelming. We suggest that you break big tasks down into smaller stages and tackle these one by one. This way, by not taking on too much, you are more likely to achieve your goals and that will make you feel good. 8 Depression List things you would like do:... Recording your activity Using a diary is an excellent way to get you started on making small changes to your routine. It will help you see and plan things as well as tackle things you may have been putting off. Keeping a diary of things you have enjoyed or achieved during the week will also help you monitor your mood more accurately and notice what has helped you feel better. Start filling in the Activity diary below but remember to put in a balance of pleasurable time for your self, time to spend with others and tasks that you have been putting off. Follow your diary and notice what happens to your mood. Don t give yourself a hard time when things don t go exactly to plan just accept this can happen.

9 Monday Tuesday Wednesday Thursday Friday Saturday Sunday Keep your diary where you will see it every day and put reminders on your mobile phone to do things you have planned. Talk about your feelings People close to you may be able to listen and help you think things through. They too may have felt depressed themselves at some time, and if so are likely to understand how you feel. Having a cry can help to relieve tension and assist you in being able to let things move on. Take care of your physical health and wellbeing It may be tempting to drink alcohol, misuse medication or turn to illegal drugs. These may give some immediate relief, but soon create further health and psychological problems. Eat well - a good diet can help to keep you in good health which makes recovery easier. Try and treat yourself to things you normally enjoy. 9

10 Treatment for depression If you think you may be depressed read this self help material and go through the exercises. Remember to practice these daily. If your depression does not lift make an appointment with your GP. They will have information about services which may be able to help such as a talking therapy or they may suggest taking antidepressant tablets, or both. Talking therapies The doctor will usually refer you to a psychological professional to help treat your depression or you may be assessed and treated by a community mental health nurse and/or psychiatrist. There are many talking therapies treatments recommended by the NHS such as Cognitive Behavioural Therapy (CBT) which is the treatment often used to help people to change unhelpful behaviours or unhelpful thinking. Other talking type treatments may also be recommended. These treatments have helped many people, but it is important to remember that the more active you are in working with your therapist the more effective your treatment will be. Antidepressants Antidepressants work on the chemicals in the brain that helps us feel better. They have been shown to be effective for many people suffering from depression. They don t work immediately; it will take two to four 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. Even when you begin to feel well it is important to keep taking the antidepressants for as long as your doctor advises. This is because it helps to stop the depression coming back. They are not addictive and once you begin to feel better, you and your doctor 10 Depression

11 can plan to reduce the dose and so that eventually you can stop taking them. If you are taking antidepressants, it is important to consult your doctor before taking any other tablets, using drugs or drinking alcohol. Further help and information Association For Post Natal Illness for women who are experiencing depression following the birth of their baby 145 Dawes Road, London SW6 7EB. Tel: CRUSE Bereavement Line help line for bereaved people and those caring for bereaved people. Tel: MIND Tel: National Debt Line - help for anyone in debt or concerned they may fall into debt. Tel: (freephone) Relate help with marital or relationship problems. Tel: (local rate) Samaritans Linkline (local rate). Confidential support for anyone in a crisis. Tel: Useful websites: information about mindfulness for wellbeing podcasts downloadable to mp3 players or burn on to CD for relaxation downloads uk/resources_info.asp?id+14 for free relaxation guide foodandmood for information about food and its impact on mood healthy minds website useful information on all aspects of mental health. 11

12 This information is correct at the time of publishing Last Reviewed: June 2012 get approved We are a smokefree organisation Design and Print Services WZT723/DP2834/8925/06.12