Depression - RDaSH NHS Foundation Trust · Depression is a very common problem. It can affect...
Transcript of Depression - RDaSH NHS Foundation Trust · Depression is a very common problem. It can affect...
Depression
Information for service users and carers
RDaSH leading the way with care
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.
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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withdrawn, others show their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.
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Thinking stylePeople 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.
BehaviourStopping doing activities or seeing
people we used to enjoy can
lead to and increase depressive
symptoms. Generally life becomes
less satisfying and less rewarding.
BiologySome 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.
What keeps depression going?Depression keeps going because
of how we behave, think and feel.
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.
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.
4 | Depression
Life situationLoss: of job / releationship / money
Depressed negative thinkingIt’s all my fault
Things will never change
BehaviourWithdraw from others
Avoid doing thingsDrink more alcohol
FeelingsDownWeepy
Physical symptomsTired
Poor appetitePoor sleep
Cycle ofDepression
Challenge unhelpful thinkingWhen 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
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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?
• If I were not depressed would I
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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
improve your sleep pattern, even if
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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 activitiesTry 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.
List things you would like do: .........
.....................................................
.....................................................
.....................................................
.....................................................
.....................................................
Recording your activityUsing 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.
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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 feelingsPeople 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 wellbeingIt 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.
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Monday Tuesday Wednesday Thursday Friday Saturday Sunday
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 therapiesThe 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.
AntidepressantsAntidepressants 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
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: 0207 3860868.
Office open: Mon - Fri 10am - 2pm
• CRUSE Bereavement Line – help
line for bereaved people and those
caring for bereaved people.
Tel: 0808 808 1677
• MIND – Tel: 0300 123 3393
MIND – Text on 86463
• National Debt Line - help for
anyone in debt or concerned they
may fall into debt.
Tel: 0808 808 4000 (freephone)
• Relate – help with marital or
relationship problems.
Tel: 0300 100 1234 (local rate)
• Samaritans Linkline (local rate).
Confidential support for anyone in
a crisis.
Tel: 116 123 (free).
Useful websites:• www.bemindful.co.uk
information about mindfulness
• www.mentalhealth.org.uk
for wellbeing podcasts
downloadable to mp3 players or
burn on to CD
• www.mind.org.uk/foodandmood
for information about food and its
impact on mood
• www.bbc.co.uk/health/
healthy minds website – useful
information on all aspects of
mental health.
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geta p p r o v e d
WZT723/DP2834/02.17
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This information is correct at the time of publishing Last Reviewed: June 2012