Download - For Depresion
-
7/29/2019 For Depresion
1/32
Treating depressionwithout using
prescribed medicationBooklet or patients and carers
-
7/29/2019 For Depresion
2/32
Cover image
Simon Fraser / Science Photo Library
Scottish Intercollegiate Guidelines Network
ISBN 978 1 905813 56 8
First published January 2010
SIGN consents to the photocopying of this booklet for thepurpose of implementation in NHSScotland
-
7/29/2019 For Depresion
3/32
1
Contents
What is SIGN? 2
Who is this booklet or and what is it about? 3
What is depression and how will I eel i I am depressed? 5
How will my GP know I have depression? 8
What might help me eel better? 10
Are psychological treatments sae? 20
What i the treatment I decide to try doesnt work? 21
Where can I fnd out more inormation? 22
Space or your notes 27
Other ormats 29
-
7/29/2019 For Depresion
4/32
2
What is SIGN?
The Scottish Intercollegiate Guidelines Network (SIGN) write guidelines
which give advice to doctors, nurses, surgeons, physiotherapists,
dentists, occupational therapists and patients about the besttreatments that are available.
We write these guidelines by working with doctors, nurses and other
NHS sta and with patients, carers and members o the public. The
guidelines are based on the most up-to-date evidence.
You can read more about SIGN by visiting www.sign.ac.uk
-
7/29/2019 For Depresion
5/32
3
Who is this booklet or and what is it about?
This booklet is or you i:
you think you may be depressed; or you have already been diagnosed with depression and are
considering your treatment options.
Your amily, riends and carers may also nd this booklet useul.
This booklet is based on the recommendations rom the Scottish
Intercollegiate Guidelines Network (SIGN) national clinical guideline
on non-pharmaceutical management o depression in adults.
Our guidelines are based on medical and scientic research, which
involves carrying out trials o dierent treatments and methods o
care.
The guideline development group are a group o people rom across
Scotland who wrote the clinical guideline on which this booklet is
based. They include NHS sta, sta rom areas such as social work, andpatients and members o the public.
The group looked at the research evidence available on how well
dierent treatments work, and we used this evidence to make
recommendations or healthcare proessionals on how best to treat
patients with depression.
Our booklet aims to help you to make positive treatment choices based
on the most up-to-date medical and scientic research.
-
7/29/2019 For Depresion
6/32
4
The booklet explains:
what depression is; the treatment (aside rom drugs) that may be available; and what you can expect rom treatment.
It does not cover:
children who are depressed; psychotic depression (when a person is so depressed that they
lose touch with reality);
perinatal or postnatal depression (depression in women whoare pregnant or who have had a baby) see our guidelines on
postnatal depression and puerperal psychosis on our website at
www.sign.ac.uk/pd/sign60.pd
bipolar disorder (manic depression) see our guidelines onbipolar aective disorder on our website at www.sign.ac.uk/pd/
sign82.pd
personality disorder; addiction, such as drug addiction; brain injury or dementia see the patient version o our guidelines
on management o patients with dementia on our website at
www.sign.ac.uk/pd/pat86.pd; or
learning disabilities.Some o the support organisations on page 22 may be able to give you
inormation on these conditions.
-
7/29/2019 For Depresion
7/32
Ian
Hooton
/SciencePhoto
Library
5
What is depression and how will I eel i I am
depressed?
Depression is a common health condition. One in ve people inScotland will experience depression at some point in their lives.
The exact causes are not clear and it can develop or no apparent
reason. Some people become depressed when something stressul or
upsetting happens in their lie, or example:
losing their job; losing a loved one; being diagnosed with a serious illness; or breaking up with a partner.
-
7/29/2019 For Depresion
8/32
6
You may be experiencing other diculties in your lie which are
making you eel depressed. Some people become depressed even
when everything is going well.
Depression is a very personal experience, but here are some thoughts
rom people who are depressed.
Something is wrong but I cant explain how I feel.
I cant stop crying.
I feel so bad, I cant cry anymore.
Im in a room with no windows.
I want to be alone.
I dont want to be alone.
Why do I feel like this?
Help me. I feel really bad.
I feel really low.
I have no energy.
You may have had similar thoughts yoursel. Remember, these are just
examples and your experience may be dierent.
Some people can become so severely depressed that they may pose
a signicant risk to themselves or others. They may repeatedly think
about death (not just ear o dying), suicide or have a specic plan or
committing suicide. Some people may have such severe depressionthat they can lose all ability to unction normally.
Severe depression is not covered in this booklet, but i you think you
may be experiencing severe depression please contact your general
practitioner (GP) straight away or phone NHS24 on 08454 24 24 24 or
Samaritans on 0845 790 9090.
Depression is more than just eeling unhappy or down in the dumps.
-
7/29/2019 For Depresion
9/32
7
I you are depressed, you might notice that you are nding it harder to
cope with your everyday lie. You are likely to experience some o the
ollowing symptoms or more than two weeks.
little interest or pleasure in doing things eeling down, depressed or hopeless trouble alling or staying asleep, or sleeping too much eeling tired or having little energy poor appetite or overeating eeling bad about yoursel or that you are a ailure or have let
yoursel or your amily down trouble concentrating on things like reading a newspaper orwatching television
moving or speaking so slowly that other people could havenoticed, or the opposite being so dgety or restless that you
have been moving around a lot more than usual
thoughts that you would be better o dead, or o hurting yourselin some way
The more o these symptoms you have, the more important it is to
get help and speak to someone about how you are eeling. Having
depression doesnt mean that you are weak and you cant just pull
yoursel together. Depression is an illness, but the good news is that
there are things you can do to get better.
It is best to visit your GP or help, or talk to someone who can support
you to nd help. Depression can make you tired and orgetul, as well
as making some issues dicult to talk about. Keeping a ew notes and
giving them to your GP can help you to talk about your thoughts and
eelings. There is space at the back o this booklet to do this.
I you are not comortable talking to your GP, you should choose
another GP in your practice.
-
7/29/2019 For Depresion
10/32
8
How will my GP know I have depression?
Your GP might ask about how you are coping and managing with
dierent parts o your lie, or example:
work; amily and riends; relationships; money problems; and hobbies.
They might also ask i people in your amily have experienced
depression in the past.
Asking you about these things will help you and your GP to understand
why you might be eeling depressed. Your GP might ask you to think
about how you have been eeling or the past month. They might ask
you the questions below to work out i you have depression and i you
would like help.
During the past month, have you been bothered by eeling down,depressed or hopeless?
During the past month, have you oten been bothered by havinglittle interest and pleasure in doing things?
These questions may help you to talk about your eelings. You may nd
it dicult, but it is important to answer them as honestly as you can soyour GP can help you.
I you answer yes to either o these questions, then your GP may ask
you more questions to nd out how bad your depression is. They may
ask you to ll in a questionnaire.
A common questionnaire is one called PHQ-9. You can see
this questionnaire and take the test at the Doing Well website
(www.doingwell.org.uk).
-
7/29/2019 For Depresion
11/32
Chassenet / Science Photo Library
9
Your answers to the questionnaire will help your GP work out your
depression score.
Knowing your PHQ score will help you and your GP decide the best
treatment or you. You can monitor your progress by lling in the
questionnaire again. Your GP may also ask i you have thought about
harming yoursel or committing suicide.
I at any time you think about harming yoursel or committing suicide,
you should tell your GP straight away or phone NHS 24 on 08454 24
24 24. You can also talk to the Samaritans by phoning their condential
helpline on 0845 790 9090.
-
7/29/2019 For Depresion
12/32
10
What might help me eel better?
You may eel that nothing will be able to help you, but there are dierent
treatment options that may help make you eel better. I you have mild
depression, you should not choose medication at rst. This bookletlooks at the other types o treatment or depression and explains what
your choices are.
Its important to remember that depression is a very personal
experience. You should choose treatment that ts with your ideas
about your problem and yoursel, and eel condent that it will help.
It is hard or even impossible to say which treatment might be best
or someone. There is not one eective treatment or everyone, some
therapies work better or some people at dierent times.
Based on the research evidence, some treatments are likely to be more
eective. Ways o improving depression which have not been proven
to be very eective on their own, may be helpul when used at the
same time as an eective treatment.
Will psychological therapies help me and how do I access
them?
Psychological therapies is the name or a range o treatments that
usually involve talking one-to-one with a therapist.
Psychological therapies can help people with depression and are
provided by people who:
are trained in therapy; receive regular supervision to give the treatment; and have experience o working with people with depression.
Your GP will give you inormation to help you to make your choice.
-
7/29/2019 For Depresion
13/32
11
It is important that you choose a therapy which eels right or you.
Beore you make your choice you should think about:
the positive and negative points o the treatment;
how long you will have to wait to get the treatment; how long the treatment lasts; what the risks are i you dont respond to the treatment; and whether you will have to pay anything.
It is extremely important that you choose a therapist who is registered
with a proessional organisation and who you eel comortable
speaking to.
Psychological therapies which are recommended or
depression
The ollowing treatments are supported by good-quality scientic
research evidence.
Behavioural activation
A therapist will try to help you nd activities you enjoy that you may
have stopped doing. They will help you to nd out why you have
stopped doing things that you previously enjoyed and work with you
to help you get back into these activities.
Cognitive behaviour therapy (CBT)
I you are depressed you may think negatively about situations. This
may cause you to stop doing activities that you used to enjoy. CBT
ocuses on how your thoughts, eelings and behaviour infuence your
mood. It involves working with a therapist who will help you challenge
your unhelpul thoughts and behaviour.
-
7/29/2019 For Depresion
14/32
12
Couple-focused therapy
Couple-ocused therapy could help you i your relationship with your
partner is adding to your depression. It ocuses on any problems that
you may have in your relationship. A therapist will work with you to
change the way you and your partner interact so that you develop a
more supportive relationship.
Interpersonal therapy
Interpersonal therapy is when trained proessionals help you deal with
problems in your lie, such as relationships. It is based on the idea that
personal problems can contribute to psychological problems such asdepression.
Mindfulness-based cognitive therapy (MBCT)
I you have experienced depression three or more times, MBCT may
be an option or you. It is based on the idea o becoming at peace with
yoursel. This treatment can help reduce the chances o you becoming
depressed again. MBCT ocuses on helping you live ully in the present,rather than being bothered with negative thoughts about the past or
the uture.
Problem solving therapy
This therapy helps you nd out what your problems are, work out what
your aims are and come up with ways o achieving them.
Psychodynamic psychotherapy
Psychodynamic psychotherapy explores the problems that are in
your past and present relationships and everyday lie. It ocuses on
your relationship with the therapist to help you understand your
relationships with others.
-
7/29/2019 For Depresion
15/32
13
The problems you have interacting with others will eventually show in
your relationship with your therapist.
Your therapist will help you to explore the thoughts and eelings
you are aware o (conscious) and those which you are not aware o
(unconscious). It can help you to understand how your problems may
have developed when you were a child.
Other psychological therapies
There is not enough evidence to say whether the ollowing treatments
are eective in treating depression.
Art therapy - This is when you express your eelings and emotionsthrough art such as painting and drawing.
Cognitive behavioural analysis system of psychotherapy(CBASP) - This has been developed or people who have chronic
(long-term) depression. It ocuses on helping you understand how
your behaviour can cause problems in your personal relationships.
Cognitive analytic therapy - A therapy which uses parts ocognitive behaviour therapy (CBT) and psychodynamic therapy. It
ocuses on discovering why you have had emotional problems and
looks back at their childhood.
Counselling - Counselling allows you to talk about your eelingswith a trained therapist. A counsellor will not give you advice, but
they will listen to you and support you to help yoursel.
Eyemovement desensitisation and reprocessing -This isusedwith people who have experienced trauma. You remember the
traumatic event while making very quick eye movements.
Family therapy -Family therapy aims to deal with problems aspart o the amily and ocuses on how the amily interacts.
Hypnotherapy -Hypnotherapy uses hypnosis. Hypnosis is amental state where you become more responsive to suggestions.
-
7/29/2019 For Depresion
16/32
14
Music therapy -Music therapy ocuses on expressing youreelings and emotions through music to help you to interpret your
depression.
Neurolinguistic programming - A technique that detect andchanges unconscious thoughts and behaviours. It aims to helpyou to improve how you think, behave and eel.
Reminiscence therapy -Reminiscence therapy involves reviewingexperiences and emotions you may have had in the past and
seeing how they are aecting your current lie and relationships.
Will sel-help be useul?
There are various types o sel-help treatments and most are based on
cognitive behavioural therapy. Guided sel-help has been shown to be
eective.Guided sel-help and guided sel-help using a computer are
recommended or treating depression.
Guided self-help
Guided sel-help uses CBT to help you change your thoughts andbehaviour. Your GP can recommend sel-help books and help you to
access these. You could work through them yoursel or you could work
with a therapist. The therapist will regularly check i your symptoms o
depression are improving and will help you understand the inormation
in your books.
Computerised self-help (self-help using a computer)
You can have CBT using a computer. The computer programme will
guide you through the various stages o therapy just as a therapist
would in a ace-to-ace session. As with using books, having someone
to support you while using a sel-help computer programme may be
helpul. These programmes can help you to understand depression
and develop the skills you need to deal with your problems. Some
examples are Beating the Blues and Moodgym. Your GP can reer youto local services or these programmes.
-
7/29/2019 For Depresion
17/32
15
Self-help support groups
There is no evidence to tell us how useul sel-help support groups are
as a treatment or people with depression, but it may be helpul to
speak to people in similar situations who will know what you are going
through.
Many organisations oer inormation and support groups to people
who have depression. The helplines listed on page 22 can help you
to get in touch with a support group. By asking your GP to put you in
touch with support groups or by using the helplines listed, you can be
sure the support groups you contact have a good reputation. Sel-help
support groups should be:
linked to an organisation or well-established group that can oerresources and support and promote the support group;
regularly reviewed; held in places that are easy to get to; ocused on helping people get better; have clear condentiality policies; and led by people (acilitators) who are trained in listening, managing
dicult situations and acilitation skills (skills to help groups
understand and achieve their aims, without taking part in
discussions). Facilitators should be supervised and supported. All
support group acilitators should have a disclosure check carried
out by Central Registered Body in Scotland (CRBS). A disclosure isa document which police or government departments hold and
contains inormation on your criminal history. Organisations use
a disclosure check to make sure they are making a sae decision
when they employ someone.
-
7/29/2019 For Depresion
18/32
Dr P. Marazzi / Science Photo Library
16
Can exercise help?
Research shows that exercise can help improve symptoms o depression
and lit your mood. By doing exercise you enjoy you can build your
sel-condence, meet other people and improve your mental health at
the same time. Exercise includes:
walking; swimming; playing ootball; going to the gym; and many other activities.
Your GP can give you inormation on how to contact local services or
exercise activities. I you are worried about your tness, you should
talk to your GP who will be able to help you. It might be helpul to
talk to someone about the best exercise or you, or example a tness
instructor. Your GP can give you advice on how to do this.
-
7/29/2019 For Depresion
19/32
17
Are herbal remedies and nutritional supplements
helpul?
St Johns wort
St Johns wort is a plant used in herbal medicine. People with depression
are advised not to use this because:
St Johns wort can stop some medications such as thecontraceptive pill and wararin rom working properly;
it is not clear what is the right dose or treating depression; and
dierent St Johns wort products vary greatly in what they contain.There is not enough scientic evidence that the ollowing nutritional
supplements help to relieve the symptoms o depression.
Chromium - A mineral ound in oods such as meat, sh,vegetables, ruits and whole grains.
Folate - A vitamin ound in oods such as dark green leayvegetables, cereals and orange juice. Ginseng - A plant grown in eastern Asia. Glutamine - One o the amino acids which help build proteins in
the body.
Ginkgo biloba - A tree whose ruits and seeds are used intraditional Chinese medicine.
Inositol - A natural sugar ound in animal and plant tissue. Polyunsaturated fatty acid - A at ound in oily sh such as
mackerel, salmon and trout.
S-Adenosyl-l-methionine - A chemical that occurs naturally in thebody.
Selenium - A mineral ound in some oods such as meat, sh andnuts.
-
7/29/2019 For Depresion
20/32
18
Will changing my lifestyle help?
It is generally believed that a healthy liestyle will help patients with
depression. As well as discussing treatment options with you, your
GP will oer you some general liestyle advice. Your GP will ask you
about:
whether or not you drink alcohol or take drugs; your eating habits; the contact you have with your riends and amily and activities
you enjoy and are involved in; and
i you are having trouble sleeping.Will complementary therapies help?
Complementary therapies are techniques used to treat a disorder or
disease and are used alongside traditional medicines. There is not
enough evidence to say that the ollowing treatments are eective in
treating depression.
Acupuncture - A Chinese medical therapy which involves havingne needles placed into your skin to help you relax.
Animal-assisted therapy - Animals are used to give peoplecompanionship and aection. Animal therapy is oten used in
nursing homes.
Aromatherapy - A therapy based on using very strong essentialoils rom the fowers, leaves, bark, branches, rind or roots o plants
which people think can heal illnesses.
Emotional-reedom technique - A needle-ree version oacupuncture. It involves tapping certain points o your body while
you are thinking o a negative emotion.
Homeopathy - A system which involves using diluted substancesto stimulate natural deenses in the body. Light therapy - Involves exposure to bright light or a ew hours a
day.
-
7/29/2019 For Depresion
21/32
19
Massage therapy - This is manipulating sot tissues in the body the muscles, tendons and ligaments.
Reexology - A therapy where rm pressure is applied to refexpoints on the body using the thumb or ngers.
Reiki - Where a therapist channels energy into your body throughtouch.
Tai Chi - A Chinese exercise system that uses slow bodymovements to help you relax your body and mind.
Thought-eld therapy - A technique which uses specialisedtapping with the ngers at certain points on your upper body and
hands. Yoga - Based on an ancient system o breathing practices. Itincludes exercises that aim to give you greater control o the body
and mind.
-
7/29/2019 For Depresion
22/32
20
Are psychological treatments sae?
All psychological treatments could cause side eects, and it is important
to know about these. Your therapist should give you advice about the
positive and negative parts o all treatments. You should never bearaid to ask about the possible harmul side eects and how likely it is
that the treatment will help you.
Oten, people eel that a particular therapy isnt working or them but
they cant explain why. This can be because the therapy deals with
matters that are uncomortable or you or, oten, it is down to how
comortable you eel with your therapist.
It isnt worth continuing with a therapy that you do not think is helping
you, but you should remember that treating depression can raise issues
in your mind that can be unpleasant to deal with and this may show
that the treatment is having a positive eect.
It is important that you have a good relationship with your therapist
and eel comortable with them. I you are not comortable with yourtherapist, you should not be embarrassed about asking to see someone
else.
I you eel upset ater seeing your therapist or rom the treatment, you
should act on this straight away by talking to your riends, amily, carers
and healthcare proessionals. We have listed some national helplines
on page 22.
-
7/29/2019 For Depresion
23/32
21
What i the treatment I decide to try doesnt
work?
It is important to accept that some treatments you try might not work
or you straight away, but you shouldnt give up. All treatments take
time to work, and while you might eel that it is hopeless you should
speak to your GP or therapist beore stopping any treatment.
Many people ully recover rom depression. For others it is a long-term
condition that comes back over time.
Most people with depression will see an improvement in symptoms
ollowing treatment, but how long this will take depends on the
individual. With an agreed care plan and regular monitoring, you can
nd a treatment that suits you and helps with your progress.
I your symptoms dont improve, you need to try a dierent treatment.
I you have tried a number o treatments and they dont seem to behelping, your healthcare proessional can help you to change treatment
or nd combinations o treatments.
-
7/29/2019 For Depresion
24/32
22
Where can I ind out more inormation?
Helplines
Breathing SpacePhone: 0800 838 587
Breathing Space is a ree and condential service to help you i you
are eeling down or experiencing depression and need someone to
talk to. Breathing Space also oers a ree and condential British Sign
Language (BSL) service you can access using their website at www.
breathingspacescotland.co.uk
Carers UK s advice line
Phone: 0808 808 7777
Carers UKs advice line is a ree and condential helpline, oering
inormation to carers.
NHS24
Phone: 08454 24 24 24
NHS 24 can answer questions on any health matter and give you
advice.
-
7/29/2019 For Depresion
25/32
23
Samaritans
Phone: 0845 790 9090
Samaritans is available 24 hours a day to provide condential and
emotional support i you are distressed and thinking about suicide.
SANEline
Phone: 0845 767 8000
This is a national out-o-hours helpline oering emotional support
and inormation or people aected by mental-health problems.
The ollowing organisations can give you inormation on particular
areas o mental health. We do not accept responsibility or the
inormation they may provide.
Carers Scotland
91 Mitchell Street
Glasgow G1 3LN
Phone: 0141 221 9141
Email: [email protected] Website: www.carerscotland.org
Carers Scotland aim to improve support or carers by giving policy
makers and proessionals working with carers relevant inormation.
Cruse Bereavement Care
PO box 800
Richmond
Surrey TW9 1RGPhone: 020 8939 9530
Website: www.crusebereavement.org.uk
Cruse Bereavement Care oers ree inormation and advice to people
who have lost someone to help them to understand their grie and
help them to cope.
-
7/29/2019 For Depresion
26/32
24
Depression Alliance Scotland
11 Alva Street
Edinburgh EH2 4PH
Phone: 0131 226 1846
Website: www.dascot.org
Depression Alliance Scotland is a national charity or people with
depression in Scotland. They oer a range o inormation and support
including sel-help groups, an inormation service by phone, post and
email and a wide range o leafets and act sheets.
Health Professions Council (HPC)
Park House184 Kennington Park Road
London SE11 4BU
Phone: 020 7582 0866
Website: www.hpc-uk.org/index.asp
The HPC can give you the latest inormation and background on how
healthcare proessionals are regulated. They can also tell you about
registered therapists who meet their standards.
Scottish Association for Mental Health (SAMH)
Cumbrae House
15 Carlton Court
Glasgow G5 9JP
Phone: 0141 568 7000
Email: [email protected] Website: www.samh.org.uk
SAMH provides direct services including accommodation, support,
employment and rehabilitation to people who experience mental-
health problems. They also oer a range o leafets and act sheets on
mental-health conditions.
-
7/29/2019 For Depresion
27/32
25
see me
1/3 Great Michael House
14 Links Place
Edinburgh EH6 7EZ
Phone: 0131 554 0218Email: [email protected] Website: www.seemescotland.org.uk
see me is Scotlands national campaign to end the negative image
around mental-health problems and discrimination. They provide a
range o act sheets about mental health and the negative image it
has.
Voices of Experience Scotland (VOX)c/o Mental Health Foundation (Scotland)
5th Floor, Merchants House
30 George Square
Glasgow G2 1EG
Phone: 0141 572 1663
Email: [email protected] Website: www.voxscotland.org.uk
VOX aims to develop, support and maintain a national organisation o,
or and by people who have or have had a mental-health problem. VOX
oer people who have had a mental-health problem the opportunity
to communicate with each other and with other organisations so they
can support each to make their voice heard.
-
7/29/2019 For Depresion
28/32
26
Helpful websites
We do not accept responsibility or the content o the websites
listed.
www.bluepages.anu.edu.au
www.livinglietotheull.com
www.moodjuice.scot.nhs.uk
www.moodgym.anu.edu.au/welcome
www.moodcae.co.uk
www.healthscotland.org.uk/smha/
Financial information and practical issues
www.cas.org.uk
www.dwp.gov.uk
www.direct.gov.uk
-
7/29/2019 For Depresion
29/32
27
Space or your notes
-
7/29/2019 For Depresion
30/32
28
Space or your notes
-
7/29/2019 For Depresion
31/32
29
Other ormats
I you would like a copy o this booklet in another language or ormat
such as large print, please phone Karen Graham, Patient Involvement
Ocer, on 0131 623 4740, or e-mail her at [email protected]
-
7/29/2019 For Depresion
32/32
This booklet is based on a clinical guideline issued to all
NHS staf.
You can download the ull clinical guideline rom our
website at www.sign.ac.uk/pd/sign114.pd
A short version is also available at www.sign.ac.uk/pd/
qrg114.pd
SIGN Executive
Elliott House
8 -10 Hillside Crescent
Edinburgh EH7 5EA
Phone: 0131 623 4720 Fax: 0131 623 4503
Website: www.sign.ac.uk