What is depression?
We all feel down from time to time. But with time we get over it. Depression is feeling sad for weeks, months or longer. It is a normal reaction to too many stressful situations at once and will affect most people at sometime in their lives (about one in ten of us in any one year).
How do you know if you're depressed?
When you’re feeling down, make an effort to think about what’s been going on in your life recently. The big things that have happened to you might make you prone to depression or anger but sometimes it’s the little things that we don’t notice, like not getting enough sleep, which trigger it off. Getting to know your own patterns can make the difference.
Look at the big three areas in our lives - work, relationships and home life. Short-term ups and downs are normal but when you start having long-term problems in one or more of these areas, the stress will mount. That’s not because you’re weak; that’s because you’re normal.
Is it about childhood or genes?
People who have had tough upbringings tend to release more cortisol hormone in stressful situations than those who haven’t. But you don’t have to have ‘had it tough’ for childhood to leave its mark. Anything painful that you haven’t talked about - or at least thought about - can come back to affect you as an adult. Could the way you feel and behave today be related to something unresolved from your past?
Genes may also play a role in how we respond, but the way our genes are expressed can be altered by our experiences, and our brains are especially malleable - or ‘plastic’ - in our early years. Even as adults we can rewire our brains to respond in more useful ways (through, for example, CBT or mindfulness).
It’s about working out your own triggers, how they affect you and how you can avoid or reduce them.
What are the warning signs?
Here are the common signs that things are beginning to get on top of you:
- Feeling really tired and lacking in energy
- Withdrawing from family and friends
- Finding it hard to concentrate and struggling at work
- Losing interest in things you usually enjoy
- Behaving out of character
- Mood swings
- Dramatic sleep or appetite changes
- Having unusual experiences, like seeing or hearing things that others don’t.
Sometimes it’s hard to notice these things. Family or friends may notice it first (so it makes sense to listen to them even if you don’t see the same thing). But knowing what to look out for means you can take action yourself.
Frequent mood swings could be a sign that you’re bottling up a problem or an addiction or perhaps have a mental health problem such as bipolar disorder. Talk to your GP.
- Make sure you're eating properly
- Make sure you're sleeping properly
- Exercise to blow off the blues
- Sing, dance and laugh - they all boost and singing helps you take back control of your breathing
- Avoid isolating yourself - stay in touch with family and friends
- Be creative - play music, paint. Any one can write and putting down on paper how you feel can help you make sense of it.
- Turn off autopilot - try to enjoy the moment you're in rather than regretting the past or freeting about the future
- Volunteer - helping others helps us
- Learn - take a class or learn a new skill
- Keep it simple - sticking to a simple daily routine will help you regain control
What about therapy?
There are many talking therapies. From one-off counselling sessions to long-term, in-depth psychotherapy, each uses a slightly different approach. Some are one-to-one with a therapist, others are done in groups. Some men prefer the privacy of individual therapy; others find hearing from others with similar experiences useful. Your call.
Recently the NHS has become interested in Cognitive Behavioural Therapy (CBT). It works by enabling you to recognise the patterns of thoughts, feelings and behaviour that lead to difficulties in your life, and looking at ways of shifting these patterns through the way you think and what you do. It doesn’t focus on the past but on improving the present. Unlike some therapy, it may only take a few sessions to help you understand your stress - a bit longer (12 sessions) to help with depression. The website Living Life to the Full offers a free introduction to CBT online.
Mindfulness-based Cognitive Therapy combines meditation techniques with CBT. Great if you want a more practical approach.
If you think that talking therapy might be useful for you, do some research into the various types and talk to your GP.
Tell me about Mindfulness
If you feel like you’re always in a headlong rush, Mindfulness (or Mindfulness-based Cognitive Therapy or Mindfulness-based stress reduction) can teach you to recognise when your auto-pilot is dragging you into unhelpful thoughts and to return your attention to the moment, often using the breath as an ‘anchor’. Sounds weird? Possibly - but there’s a growing body of evidence that it works. Anyone can do it - there are books and local groups. Ask your GP about it.
What about drugs?
In 2012, the number of prescriptions in England for anti-depressants topped 50 million for the first time. But drugs (usually anti-depressants called SSRIs) are no longer the automatic choice for GPs when people go to them with mood or stress problems. Some people find them useful but it’s worth doing a bit of research first:
- What are the side-effects?
- How long before they should start working? (Most take 6-8 weeks.)
- How long are you likely to have to take them for?
- Are there alternatives to medication that might work better for you?
- How easy are they to come off?
Their benefits in cases of severe depression are generally accepted but there is debate about how useful they are for mild to moderate cases. Depending on your symptoms, you may need medication to stabilise mood before talking therapies and some of the other ideas discussed in this booklet will begin to help. Discuss it with your GP. Your local pharmacist may also be useful.
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Date of last review 08/04/14
Date of next review 08/04/17
- NHS Depression
- Mental Health Foundation statistics
- Altered stress responses in children (Stress, November 2011)
- Oxytocin receptor genetic variation (PNAS, December 2009)
- Center on the Developing Child
- All Together Now (Daily Telegraph, July 2013)
- Mental Health Foundation - peer support
- NHS CBT
- NICE CBT guidelines
- NHS Counselling
- NHS Psychotherapy
- Mindfulness evidence
- Mental Health Foundation - medication