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Understanding
depression

understanding

depression

Understanding depression
If you are depressed, you may feel that nothing
can help
...
Most people recover
from bouts of depression, and some even look
back on it as a useful experience, which forced
them to take stock of their lives and make changes
in their lifestyle
...
It
suggests ways that you can help yourself, and what
family and friends can do
...
Usually, these feelings pass in due course
...

In its mildest form, depression can mean just being in low spirits
...
At its most severe, major depression
(clinical depression) can be life-threatening, because it can make you feel
suicidal or simply give up the will to live
...
It usually comes on in the autumn and winter,
when days are short and the sun is low in the sky, and gets better as
the days get longer and brighter
...
)
P
•  ostnatal depression – many mothers have ‘the baby blues’ soon
after the birth of their baby, but it usually passes after a day or two
...
(See
Understanding postnatal depression
...

When manic, they are in a state of high excitement, and may plan
and may try to carry out over-ambitious schemes and ideas
...
(See Understanding
bipolar disorder
...

My feelings
 am low-spirited for much
I
of the time, every day
I feel restless and agitated
I get tearful easily
 feel numb, empty and full
I
of despair
 feel isolated and unable to
I
relate to other people
 am unusually irritable or
I
impatient
 find no pleasure in life or
I
things I usually enjoy
I feel helpless
I have lost interest in sex
 am experiencing a sense
I
of unreality
My behaviour
 not doing activities I
I’m
usually enjoy
 am avoiding social events
I
I usually enjoy
 have cut myself off from others
I
and can’t ask for help
I am self-harming
I find it difficult to speak

My thoughts
 am having difficulty
I
remembering things
 find it hard to concentrate or
I
make decisions
 blame myself a lot and feel
I
guilty about things
 have no self-confidence or
I
self-esteem
 am having a lot of negative
I
thoughts

The future seems bleak
What’s the point?
 have been thinking about suicide
I
My physical symptoms
I have difficulty sleeping
 am sleeping much more
I
than usual
I feel tired and have no energy
 have lost my appetite, and am
I
losing weight
 am eating a lot more than usual
I
and putting on weight
 have physical aches and pains
I
with no obvious physical cause
I am moving very slowly
 am using more tobacco, alcohol
I
or other drugs than usual

5

Understanding depression

As the table on p
...
You may not realise what's going on, because sometimes your
problems seem to be physical, rather than mental or emotional
...


Anxiety
People who are depressed often have anxiety as well – the two problems
often occur together, and each can make the other worse
...
You may have physical
symptoms, such as headaches, aching muscles, sweating and dizziness
...
)

It was like I'd fallen into a deep abyss… Even when I tried
scrambling up the sides, it was no good, as exhaustion and an
overwhelming feeling of nothingness pulled me back down again
...

Psychotic experiences
If you are severely depressed you may start to have experiences or
thoughts that others around you do not share
...
You may believe that you are a bad
person and you deserve to feel as you do
...


Suicidal thoughts
You may feel that life is not worth living and start thinking about ways
of killing yourself
...
If you feel that you may harm yourself you can call
Samaritans on 08457 90 90 90 to talk to someone immediately
...
)

6

What causes depression?

Depression is like Hell on Earth, it's dark, lonely and very
selfish
...


What causes depression?
Depression varies very much from person to person and can happen for
one or more reasons
...


Life events
In many cases, the first time someone becomes depressed, it has been
triggered by an unwelcome or traumatic event, such as being sacked,
divorced, or physically or sexually assaulted
...
It could be following the actual death of someone
close, a major life change (such as moving house or changing jobs),
or simply moving from one phase of life into another, e
...
as you reach
retirement, children leave home, or you come to realise that you may
never have a family of your own
...
If the feelings provoked are not expressed or explored at
the time, they fester and contribute towards depression
...
You may have
experienced something which left you feeling angry and helpless, and if
you were unable to express your feelings at the time – perhaps because
you were a child, or your feelings were unacceptable to others – the anger
becomes internalised and is expressed as depression
...


Physical conditions
The following conditions may cause depression, but are sometimes
overlooked because of the focus on their physical symptoms:
• conditions affecting the brain and nervous system
•  ormonal problems, especially thyroid and parathyroid problems;
h
symptoms relating to the menstrual cycle or the menopause
• low blood sugar
• sleep problems
...
Some of these problems can be diagnosed by
simple blood tests, and your doctor may suggest that these are done to
help make the right diagnosis, or you can ask for blood tests if you think
they might be relevant for you
...

If you are feeling depressed after starting any kind of medication, it’s
worth looking at the patient information leaflet that came with the drug
to see if depression is listed among the side effects
...


8

What causes depression?

Diet
Poor diet and general lack of fitness can both contribute to depression
...
Such a reaction is very
individual, and people are often not aware of the particular food substance
or drink that is causing the problem
...
If this is the cause, your mood should lift very
quickly, so long as you don’t consume any more of the particular item
...
)

Street drugs and alcohol
Although you may be very tempted to have a drink to cheer you up,
alcohol is a depressant, and will tend to make you feel worse overall
...
(For more information, see Understanding the mental health
effects of street drugs
...
This could also be because we learn behaviour
and ways of responding from our relatives, as well as inheriting our genes
from them
...
Some doctors may tell
you that you have a ‘chemical imbalance’ and need medication to correct
it
...
Although there are
physical tests which are occasionally used in research on depression, they
are not very accurate or consistent, and there are none that are done
routinely to help make a diagnosis
...
Solving problems involves time, energy and work
...
But if you are able to take an active part in your
treatment, it should help your situation
...
Being in a state of depression can then become a bigger
problem than the actual difficulties that caused it in the first place
...
Deciding to do something to help yourself is the most
important step you can take
...
Look for things to do that
occupy your mind
...
13-14
...
Physical
activity stimulates chemicals in the brain called endorphins, which can
help you to feel better
...
It does not have
to be very strenuous or sporty to be effective
...
Walking in
a green environment, such as the park or the countryside, is especially
helpful (see Ecominds, under ‘Useful contacts’)
...
Some local Minds
have projects like this (see ‘Mind in your area’ on the Mind website or
phone the Mind Infoline for details)
...
(See Mind tips for better mental health:
physical activity
...
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
...

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
...

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
...
Self-help groups
can show you how other people have coped and provide mutual support,
as well as breaking down feelings of isolation
...
For help in finding
local self-help groups, talk to your local Mind (see ‘Mind in your area’ on
the Mind website), call the Mind Infoline, or ask your GP
...

•  llow yourself positive experiences and treats that reinforce the
A
idea that you deserve good things
...
g
...

• Pay attention to your personal appearance
...

•  f you find it hard to remember things, you may want to write
I
them down on sticky notes, in a diary or set reminders on your
mobile phone
...
Oily fish,
L
in particular, may help reduce depression
...


Would I change what happened to me? Definitely not
...
I could look to the future and want to
live it… Believe me, it can get better
...

The National Institute for Health and Clinical Excellence (NICE) guidelines
on the treatment of depression recommend:
•  ctive monitoring – this is for mild depression and means keeping an
a
eye on you while waiting to see if your depression goes away without
treatment, which mild depression often does
•  ognitive behaviour therapy (CBT), including self-help books,
c
computerised CBT for mild depression; a series of sessions with a
therapist for more severe depression
• mindfulness-based cognitive therapy
• behavioural activation
•  ther forms of talking treatment, such as counselling or interpersonal
o
psychotherapy
...
This should
be combined with CBT or psychotherapy
• exercise
...
A talking treatment should be available to you via
your GP
...
(Also see
Mind's booklet Making sense of talking treatments
...
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
...
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 (is) a neat little trick that really helps and I wish
I'd been taught it years ago
...
Activity helps you to
feel better, and once you have conquered some everyday tasks, you
may feel ready to tackle some bigger ones
...
The bigger the pile, the less you feel like doing it
...
As you do it, the dishes get clean, your kitchen gets
tidier, and you feel a bit better about everything
...

• Guided self-help delivers a 6-8 week therapy programme through selfhelp books, under the guidance of a healthcare professional
...
Therapy can
continue for 6 to 12 months
...
This involves talking
with someone who is trained to listen with empathy and acceptance
...


14

What treatments are available?

•  sychodynamic counselling and psychotherapy focus on how past
P
experiences may be contributing to experiences and feelings in the
present
...
It may be more
frequent and intensive than counselling, and may go deeply into
childhood experience and significant relationships
...

G
•  roup therapy allows a group of people to work together on their
problems, with a therapist
...


Whatever progress I have made in my battle with depression,
is due entirely to group psychotherapy
...

You can also seek therapy or counselling privately, if you are able to pay
...
Some
offer a reduced fee for people on a limited income
...


Medication
Antidepressants
Antidepressant drugs work on brain chemicals (such as serotonin and
noradrenaline) to lift your mood
...
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
...

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
...

Antidepressants can cause unpleasant side effects, some of which are
worse to begin with
...
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
...

Other medication
If you are having psychotic symptoms (see p
...
(See Making sense of antipsychotics for more information)
...
10-11), 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
...


16

What treatments are available?

You may be offered the help of a peer support worker
...

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
...
A
neighbour might love cooking, but be unable to manage their garden
...

TimeBank organises scheme like this in some places (see ‘Useful contacts’
on p
...


Arts therapies
Art and music therapies may help you to express how you are feeling,
especially if you are having difficulty talking
...
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
...
(Contact Mind
Infoline for local information and see Mind’s online booklet Making sense
of arts therapies
...
They spend more time with you than a GP can
...

St John’s wort is one of the herbal remedies that many people find helpful,
and may help to lift your mood
...
If you are taking

17

Understanding depression

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
...


Social care and support
If you are very depressed, you may need support to live independently in
the community
...

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
...

For more information about what help may be available to you in your
area, talk to your local Mind (see ‘Mind in your area’ on Mind’s website), or
call Mind Infoline (0300 123 3393)
...
This gives a psychiatrist the opportunity to monitor the effects

18

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

of different treatments, and also means that you will get regular meals
...
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
...
(See Mind rights guide: civil admission to hospital
...
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
...
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
...
For more information, see Mind’s online booklet, Making
sense of neurosurgery for mental disorder
...

Feelings of hopelessness, helplessness and worthlessness are a major part
of depression
...
However, this is a time when they
need your help and support most
...
You can reassure
them that it is possible to do something to improve their situation, but
you need to do so in a caring and sympathetic way
...

•  ou can show that you care by listening, sympathetically, by being
Y
affectionate, by appreciating them, or simply by spending time with them
...


He used to have recurrent episodes and would shut himself
away and not answer the door or the telephone, but if I wrote him
a note, and managed to push it under the door, he would tell me
later how much it meant to him
...

•  ry not to blame the person for being depressed, or tell them to ‘pull
T
themselves together’
...


20

What can friends or family do to help?

•  omeone with depression may get irritable, and be more liable to
S
misunderstand others, or feel misunderstood, than usual; they may need
reassurance in some situations, and you may need to be patient with them
...


I find what helps is letting people who are understanding about
your illness know when you're having a bad day
...

•  emember that, even after someone has started treatment for
R
depression, it still may be some time before they really start to
feel better
...
If, for
example, they are not looking after their physical needs, should you take
over and do the shopping, cooking and cleaning for them, if you are able
to? Or should you try and encourage them to do it? There are no easy
answers to this situation
...


Look after yourself
Supporting a friend or relative who is depressed can be an opportunity
to build a closer and more satisfying relationship
...
Unless you pay attention to your own
needs, it can make you feel depressed, too
...
You could also talk to your GP or another
healthcare professional about getting help for yourself and your family
...
)

21

Understanding depression

Useful contacts
Mind
Mind Infoline: 0300 123 3393
(Monday to Friday, 9am to 6pm)
email: info@mind
...
uk
web: mind
...
uk
Details of local Minds, other
services, and Mind’s Legal Advice
Line
...

British Association for Behavioural
and Cognitive Psychotherapies
(BABCP)
web: babcp
...
01455 88 33 00 (general
enquiries)
web: itsgoodtotalk
...
uk
To find a therapist
...
org
Information and advice on all
aspects of caring
...
org
Information, support and self-help
groups
...
org
A self-help organisation made up of
individuals and local groups
...
org
...

The Institute for Complementary
and Natural Medicine (ICM)
tel
...
org
...

National Institute for Health and
Clinical Excellence (NICE)
web: nice
...
uk
Guidelines on treatments for
depression
...
org
web: samaritans
...
020 7014 9955
web: psychotherapy
...
uk
Has a voluntary register of qualified
psychotherapists
...
org
...


Further information
To read or print Mind's information booklets for free, visit mind
...
uk
or contact Mind infoline on 0300 123 3393 or at info@mind
...
uk
To buy copies of Mind's information booklets, visit mind
...
uk
phone 0844 448 4448 or email publications@mind
...
uk
This booklet was written by Katherine Darton
First published by Mind 1989
This edition published 2012 © Mind 2012
To be reviewed 2014
ISBN 978-1-906759-48-3
No reproduction without permission
Mind is a registered charity No
...
020 8519 2122
fax: 020 8522 1725
web: mind
...
uk

23

Mind
W
 e're Mind, the mental health charity for
England and Wales
...

We're here for you
...
Now
...

Whether you're stressed, depressed or in crisis
...
And we'll push for a better deal
and respect for everyone experiencing a mental
health problem
...
org
...
org

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