Barnet, Enfield and Haringey Mental Health NHS Trust Understanding Depression An information and guidance booklet Page
What is Depression? Mild depression is a very common experience. Everyone feels fed up, miserable or sad sometimes. However for some of us mild depression can become more severe and stop us from leading a normal life. Things that trigger more intense depression might be life events such as divorce, bereavement or redundancy. This is much more intense than mild depression and can go on for months or years rather than days or weeks. The person experiencing depression will often feel like they cannot cope or that life is not worth living. People around them may think the person suffering from depression has 'given in', but severe depression is an illness and needs treatment. It is not a sign of weakness. Who suffers from depression? Depression is very common and at least one in six people will experience it at some point in their life. It occurs at any age, even in children and young people. What are the symptoms of depression? There are three ways depression can affect you. It affects: How your body behaves: Difficulty getting to sleep or waking up Lack of Energy Losing appetite and weight Over eating and weight gain Becoming unable to enjoy anything/going off sex Finding it hard to make even simple decisions Feeling irritable or tired all the time How you feel: Feelings of unhappiness that don't go away Losing interest in life/self/appearance Feeling restless, agitated, upset or numb Feeling alone even if you are in company Crying a lot or feeling unable to cry Page 2
How you behave and think: Avoiding other people Not wanting to get up in the morning Losing self-confidence/feeling hopeless Poor memory or concentration Thinking of suicide Negative thoughts Not everyone who is depressed has all of these symptoms. You might find the symptoms you do have make 'day to day' activities very hard. There will usually be a noticeable change in your mood, a feeling of hopelessness about the future and gloomy thoughts of death and disaster. What causes depression? The causes of depression can vary from person to person. Usually there is more than one cause, but sometimes depression can happen without any obvious reason. Circumstances becoming unemployed, divorced or socially isolated, can be important factors, particularly in later life. Stress, loneliness, worries or being physically run down, may contribute to becoming more seriously depressed where in happier times you might be able to cope. Quality of health can be important at the start of depression. Lifethreatening illnesses such as cancer and heart disease, illnesses that last a long time, are uncomfortable or painful, can all contribute to depression. Personality, although anyone can become depressed, under certain circumstances some people seem to be more vulnerable. This may be because of the particular make-up of their body, experiences early in their life, or both. Page 3
What is Clinical Depression? The term Clinical Depression' generally refers to any depression that requires some form of treatment. What are the different types of depression? Post-natal Women commonly become weepy for a few days after giving birth ( baby blues'). Postnatal depression can begin anytime up to six months after the birth and develops slowly. Seasonal Affective Disorder (SAD) This is linked to the changing seasons, some people become depressed in the autumn and winter when there is less natural light and recover in the spring when daylight time increases. Psychotic depression People with psychotic depression can be out of touch with reality. They may be unable to distinguish between what is real, and what they believe is happening in their imagination. Bipolar disorder This is characterised by severe mood swings, either to mania (a state of extreme excitement and over-activity) or to severe depression, or to both. Page 4
What can I do to help myself? Even when a doctor is involved in the treatment of depression, there are things you can do to help yourself: Don't bottle things up: if you've recently had some bad news, or a major upset in your life, try to talk to someone close to you about it and how it feels. Do something: get out of doors for some exercise, even if only for a long walk. This will help you to keep physically fit, and might help you sleep better. Eat a good, balanced diet, even though you may not feel like eating. Resist the temptation to drown your sorrows. Alcohol actually makes depression worse. Try not to worry about finding it difficult to sleep. Even if you're not actually asleep, it can still be helpful to listen to the radio or watch TV while you're resting your body. Remind yourself that you are suffering from depression, something many other people have gone through. You will eventually come out of it, as they did, even though it does not feel like it at the time. Alternative Therapies may help you to relax, Yoga, reflexology, aroma therapy etc. What professional help is available? Your GP or local hospital will be able to provide you with information and help available in your area. For further information see the Useful Organisations section at the end of this leaflet. What treatments are available? For mild depression some form of psychological therapy may be the most effective form of treatment. Talking therapies can help you understand your own difficulties and begin to work out ways of overcoming depression. Cognitive Behavioural Therapy (CBT) is one kind of therapy that can help you learn to identify and challenge faulty, negative patterns of thinking. Page 5
Health professionals, such as your GP, can help by giving a clear explanation of your symptoms and information and advice. There are also many voluntary organisations offering counselling and depression self help groups. For moderate to severe depression, the doctor is likely to prescribe an antidepressant to lift your mood and help you feel well enough to get back to normal life. Selective Serotonin Re-uptake Inhibitors (SSRIs) are drugs developed to be as effective as older antidepressant (Tricyclics) but with fewer sideeffects. The best-known SSRI is fluoxetine (Prozac). Prozac works in the body for a long time (2-3 weeks). If side effects do occur, they may last for longer than with other SSRI's. Monoamine Oxidase Inhibitors (MAOIs), which are very widely used in the treatment of moderate and severe depression, often in addition to counselling and social treatments. Moclobemide (Manerix) is a drug used exclusively in the treatment of severe depression. MAOIs can cause dangerously high blood pressure if certain foods are eaten. If you are prescribed MAOI's you will be given a list of foods to avoid by your doctor. Electro-convulsive therapy (ECT) This involves passing an electric current through the brain while the patient is under a general anaesthetic to induce a seizure (a fit'). ECT has side effects such as short and long term memory loss. National guidelines issued by NICE (National Institute for Clinical Excellence) recommend that ECT be used only to achieve rapid and short term treatment of severe symptoms' after other treatment has not worked, for individuals with severe depressive illness, catatonia [or] a prolonged severe maniac episode'. The guidelines say the patient's consent should be obtained without pressure or coercion'; that carers should be consulted; and that the individual should be reminded of their right to withdraw consent at any point. This Trust follows the guideline very closely and has a special information leaflet on ECT. Page 6
Not getting better? A small number of depressed people may not improve with these treatments. These people are likely to be referred to a psychiatrist for specialised help. A psychiatrist is a medical doctor who specialises in the treatment of emotional and mental disorders. The first interview with a psychiatrist will probably last about an hour, and you may be invited to bring a relative or friend with you if you wish. There is no need to feel nervous. The psychiatrist will want to find out about your general background and about any serious illnesses or emotional problems you may have had in the past. He or she will ask about what has been happening recently, how the depression has developed and whether any treatment has already been given. It can sometimes be difficult to answer all these questions, but they will help the doctor to get to know you and decide on what would be the best treatment. If the depression is severe or needs a specialised type of treatment, it might be necessary to come into hospital. What can partners; friends and relatives do to help? Sometimes it might be hard for partners, relatives and friends to identify depression because people do not always react in ways that are usually associated with the illness. It is important to be aware that: People experiencing depression are not able to express how they are feeling and may sometimes complain about physical problems such as headaches, stomach pains, breathing difficulties, palpitations, or pins and needles in the hands and feet, as well as feeling panicky, frightened or uneasy. Family and friends often want to know what they can do to help. Being a good listener (and a patient listener if you've heard it all before) is very important. It is helpful to spend time with someone who is depressed. They don't need to be nagged, but they need to be encouraged, perhaps to talk, but also to keep going with some of the things they normally do. Someone who is depressed will find it hard to believe that they can get better. Reassurance that they will get better can be helpful, but may have to be given over and over again. On a practical level, make sure that they eat well and help them to stay away from alcohol. Page 7
People with depressive illness can make those around them, particularly their family, feel depressed too. There are several things that can be done to help: Encourage them to talk about how they feel and to have a good cry if it helps. Discuss the illness with them. Be affectionate and tolerant. Reassure the person that you care about them, and that they will get better with help over time. If the depressed person is talking of suicide, you should get help immediately. Show you understand that they are going through a very unpleasant and distressing time. Praise them whenever you can and reassure them constantly that you care. Share the responsibility of caring with others if you can. Supporting someone else through emotional problems can be very rewarding, but it can also be very frustrating. It is important to look after yourself. Finding someone you can confide in may be very useful. If you are living with the person, make sure that you have a break. If their depression is stopping them doing things it doesn't mean you should stop as well. You should not feel guilty about doing things on your own. If you enjoy your life you will find it easier to be supportive. What is the outlook? Most people do recover from depression, but without treatment, it may take many months or even years. If experiencing depression, it is important to get help as soon as possible, both for the persons and carers sake. Page 8
Useful Organisations Depression Alliance Tel: 0845 123 23 20 Email: information@depressionalliance.org Web: www.depressionalliance.org Depression Alliance is a national charity providing information and support for people with depression. MDF The Bipolar Organisation MDF The Bipolar Organisation 21 St. George's Road London SE1 6ES Tel: 020 7793 2600 Email: mdf@mdf.org.uk Web: http://www.mdf.org.uk/ MDF The Bipolar Organisation is a national user-led charity for people whose lives are affected by bipolar disorder. Association for Post Natal Illness (APNI) 145 Dawes Road London SE6 7EB Tel: 0207 386 0868 Web: www.apni.org.uk The APNI provide support to women suffering from Post Natal Depression. Samaritans PO Box 9090 Stirling FK8 2SA Tel: 08457 909090 Email: jo@samaritans.org Web: www.samaritans.org Provides 24/7 confidential support for people in crisis Page 9
Relate - North East London Tel: 01708 441722 Telephone counselling booking line: 0300 100 1234. (Open Mon - Thurs: 8am to 9pm, Friday: 8am to 5pm and Saturday: 9am to 5pm (excluding Bank Holidays). Email: enquiries@relatenelondon.org.uk Web: www.relatenelondon.org.uk Relate is a national charity providing relationship counselling. North London Cruse Tel: 01923 857612 National Helpline: 0844 477 9400 Email: helpline@cruse.org.uk Web: www.northlondoncruse.org.uk Cruse provide care and support to bereaved people and those caring for bereaved people SANE 1st Floor Cityside House 40 Adler Street London E1 1EE Tel: 020 7375 1002 Email: info@sane.org.uk Saneline: 08457 678 000 (6-11pm) Email: sanemail@sane.org.uk Web: www.sane.org.uk SANELINE is a national out-of-hours telephone helpline offering support to people coping with mental illness, their families and friends. Rethink Information and Advice Tel: 0207 840 3188 or 0845 456 0455 (National Advice Line open 10am to 2pm Mon-Fri) Email: advice@rethink.org Web: www.rethink.org Rethink is a charity working to help everybody affected by severe mental illness. Page 10
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You can ring for a translation Monday - Friday 9.00am - 5.00pm. Please give this number: 69613 and also for Audio, Large Print and Braille, call now on: 0800 952 0119 Produced By: Date of Publication: Page 12Review Date: Reference: Communications 04/07/2013 04/07/2015 lc00004493