Low Mood and DepressionDraft for consoltation November 2011

2

Contents

3

Low Mood and DepressionEveryone’s mood changes. Sometimes we feel sad, unhappy, fed up, feel down or ‘have the blues’. With time our mood usually changes again and we feel better.

However, if our low mood carries on or becomes more severe it could mean that have become depressed. Long-lasting negative thoughts about ourselves and our future are common in depression and, along with the other symptoms, these can affect our ability to function in our day to day lives. Depression is very common, affecting roughly 5% (1 in 20) adults in the UK and it occurs in all groups of people. Depression can also affect children and teenagers.

Why Do People Get Depressed?The causes of depression are complex and not yet fully understood. It may run in families or be due to trauma in childhood. It can be caused by stressful life events or changes, such as unemployment, illness, the end of a relationship or the death of a loved one. (However, depression is different from grief following the death of a loved one).

Depression may happen just once, or may return over again – sometimes throughout our lifetime.

4

Does any of this fit with your experiences?……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..

What are the Signs of Depression?Depression has a wide range of symptoms affecting our thoughts, feelings, body and behaviour. For example:

Thinking FeelingsLoss of interestPoor concentrationMemory lossNegative thoughts about selfThinking about suicide

Fear/WorryGuilt/ShameSad/despairFeeling hopeless/helplessLoss of confidence

Body (physical) BehavioursChanges in appetiteFeeling tiredFeeling tense/agitatedReduced sex driveIncrease in physical discomfort e.g. pain

Over/under eatingIncrease/decrease in sleepAvoiding friends/familySelf-harmMis-use of alcohol and / or drugs

What have you noticed?……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..

5

Sometimes these symptoms can be caused by medical problems e.g. an under

active thyroid, diabetes, head injury, stroke, chronic pain, and nutritional

deficiencies e.g. low vitamin D. If you are experiencing a number of these

symptoms, it is good see your GP.

The Vicious Cycle of DepressionDepression leads to a series of changes in the way we think, our emotions,

how our bodies feel and in our behaviour. It can also lead to changes in our

environment or our situation eg. relationships, finances, housing and work.

Environment or situation (e.g. housing, finances, relationships etc)

Negative Thinking(e.g. “I am a bad person”)

Changes in behaviour(e.g. Stay in bed/avoid people)

Changes in emotions(e.g. feel sad/hopeless)

Bodily Changes(e.g. Feel tired)

6

Each of these ‘five areas’ (thoughts, feelings, body, behaviour and situation)

can affect each other and keep the depression going. We call these processes

vicious cycles, for example:

p Poor coping

p Poor motivation/low energy

p Negative beliefs/hopelessness

Poor Coping: some ways people cope such as alcohol or calling in sick to

work can make the situation worse in the long term, for example by causing

addiction, financial or relationship problems. This makes the situation worse

and the depression stays

Poor motivation/Low energy: people often stop doing things they used to enjoy.

Another vicious cycle develops as they do less and less and become more and

more withdrawn.

Negative Beliefs/Hopelessness: some people do not seek help, maybe due to

the feelings of worthlessness eg “why should anyone help me, I’m worthless”,

or from a sense of helplessness e.g. “Nothing can change the way I feel”.

Sometimes depression goes unrecognised and untreated.

7

Do you notice any vicious cycles in your life?

Environment or situation

Negative Thinking

Changes in behaviour Changes in emotions

Bodily Changes

8

Overcoming depressionTo get better from depression we can work each of these ‘five areas’ (thoughts, feelings, body, behaviour and situation) in order to break the vicious cycles that keep it going.

So getting better can mean making small changes in one or more of the five areas and taking small steps at a time.

Working with our body / physical symptomsIt’s important to remember that depression affects our bodies as well as our thoughts and feelings e.g. changes in appetite and eating (eating more or eating less), changes in sleep patterns (sleeping more or sleeping less), lack of energy and tiredness. Some people find they experience more ‘aches and pains’ or become more aware of any physical pain that they already had previously.

Also, our bodies (and consequently our depression) are affected by what we do, or don’t do, with our bodies and what we put into them. This includes:

p Medication p Alcohol and other drugs p The quality and quantity of food p Exercise and activity generally p Sleep and relaxation p Pain p Illnesses p Even the amount of daylight we get

So it’s worth considering each of these factors in turn and seeking advice and support to make sure that we are addressing our depression on a physical level.

9

Working with behavioursTypically people with depression do less and they may cut back on some of the activities that they used to enjoy, they may become more withdrawn and less sociable, they may begin putting jobs off and may also start doing things to cope that are unhelpful e.g. drink more alcohol, stay in bed more, over eat.

As their behaviour changes – doing less of what is helpful and enjoyable, and maybe more of what is unhelpful (but may seem enjoyable!) – then their mood is made worse and they feed the vicious cycle.

To get better, it can be useful to notice what has changed, reduce any unhelpful ways of coping that you may be using, and start introducing more positive activity into your routine (even if you don’t feel like it!), for example:

Increase overall activity levels and get more exercise Maintain supportive relationships e.g. with friends and family Engage in enjoyable and pleasurable activities Get out of the house and maintain contact with the outside world.

Make a list of things that you may have to do and a list of things that you enjoy doing.

Things that I need to do:…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Things that I enjoy or would like to do:…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

10

Doing more can seem like an enormous burden when you’re feeling down - for many reasons. Maybe you’re not sleeping well or you’re not eating as well. This is typical of depression and can sap energy and make you feel tired and lethargic. Your thoughts may be telling you ‘there’s no point’ or ‘I’ll do it tomorrow’. These are all barriers to increasing activity levels and getting into healthy and enjoyable routines. The good news is that increasing activity levels has been proved to be a great way of combating depression.

But when you feel tired and your head’s telling you not to bother, then how do you get motivated to start doing more? Here are some ideas worth remembering: ‘Motivation follows action’ and ‘it’s a small step at a time’.

Motivation follows action means when we feel down it is a real effort to get going but once we actually do make a start, no matter how small, then we often feel more inclined to want to do a little bit more. If we wait until we feel like doing something before we start, then we may wait for a long time! ‘I’ll do it tomorrow’… and tomorrow never comes!

But you don’t need to take anyone’s word for this, you can try it yourself. Think of a small job that you have been putting off. If you can, break it down into even smaller parts. Then taking the smallest bit first just start to have a go at it and see what happens.

Another tip for success is to plan activities or schedule them in e.g. use a diary or a calendar, or ask someone to remind you – anything that helps you to remember to begin, because our memories are also affected by depression.

A small step at a time means that we’re not looking to get better overnight or do everything all at once. Getting out of the depressive cycle takes time and we tackle the things that need doing in small stages. Doing tasks may seem like an enormous effort when you consider them in their entirety but if we break them down into much smaller stages they may seem less daunting e.g. before we get back to going out with friends again, we may need to speak to them on the phone first, or even text them if that seems easier. Maybe, once we get a bit more confidence, we may ask them to come round to see us at home before we consider going out somewhere with them.

11

Similarly, to maximise the possibility of you starting the job in the first place, you could limit yourself to a certain amount of time e.g. 5 minutes. And time yourself! Use a clock to make sure you don’t go over the five minutes (unless you want to, after you begin)!

It can be useful to make a daily plan to both help you remember the activities that you want to do and also to encourage you to mix up pleasurable activities, things that you enjoy, along with things that you might have to do e.g. household chores. You could use an activity schedule like this:

Mon Tues Wed Thurs Fri Sat Sun

9-11am Breakfastshower

11-1pm Phone a friend

1-3pm LunchGet paper

3-5pm 10 minscleaning

5-7pm DinnerTV

12

Working with thoughtsWith depression there is a tendency for our thinking to become more negative. We might experience so called negative automatic thoughts (NATS). These just pop into our mind and make us feel more depressed e.g. ‘I’m no good’, they don’t like me’, ‘nothing will help’.

Our thinking may also become distorted or biased in unhelpful ways eg taking things more personally, jumping to conclusions or exaggerating how bad things are (catastrophising).

These thoughts seem believable and reasonable, when we feel down, but are unrealistic, inaccurate and just plain unhelpful. So it can help to question our thoughts, to make sure that we aren’t making ourselves feel worse.

One way to keep a check on thoughts or ideas that bother us is to look for ‘alternative evidence’. So instead of just accepting whatever negative thought pops into our mind, we take another look at it and see if it is backed up by reality and whether it is helpful.

For example: A friend walks past us in the street and ignores us. Our first reaction may be to think they have fallen out with us, are ignoring us, and so we may feel sad or angry. However, maybe they just didn’t notice us or maybe they have things on their mind. If we reconsidered our initial reaction we might feel better and might come to a more accurate interpretation of what actually happened.

This might sound too simple and when we feel down our heads might say things like ‘I can’t do that’ or ‘it sounds like rubbish’, but if we give it a go we may notice a small change.

13

You could use the following table to question any NATS that trouble you.

Negative automatic thought Feeling Alternative

thought New feeling

‘These ideas will never work’

Down, hopeless, demoralised

‘I’ve got nothing to lose trying and it might take my mind off my problems’

A bit more hopeful, curious

Another way of working with depressive thoughts is to practice becoming aware of biased or distorted thinking patterns. For example, keep an eye out for when you may be using any of the following unhelpful thinking styles:

pPersonalising: being overly sensitive, taking things too personally, blaming ourselves for things that are outside of our control.

p Catastrophising: exaggerating the negative aspects of a situation, blowing them up out of proportion so that you miss the positive elements.

p Mind reading: thinking that you know what is going on in other people’s minds.

p Over generalising: thinking that because one person doesn’t get on with you then it means that no one will like you. Or if you don’t get one of several jobs done then you have ‘not done anything’.

Of course, some thoughts that we have may be connected to long term beliefs that we hold about ourselves, about other people or about the world. These may be holding us back in our recovery and may need to be discussed with someone else e.g. GP, counsellor, therapist etc.

14

Working with our environment or situation‘No man (or woman!) is an island’, as the saying goes. Each of us is connected to the world and the people around us and we all influence and are influenced by these surroundings. Our environment or situation includes things other than our thoughts, feelings, bodies and behaviour e.g. other people, relationships, finances, housing, work, organisations, support etc.

Our situation can have an important affect on our depression and vice versa. For example, people often get depressed because of things that happen in their life e.g. redundancy / unemployment, bereavements, ill-health or disability, poverty, poor housing, discrimination, trauma, debts, and caring responsibilities.

And, when people are depressed, their normal functioning is affected, which can have a knock-on affect on their situation and on the people around them e.g. their caring roles, their work responsibilities, keeping the house going etc. So when tackling depression it is important to take these things into consideration.

For example, ask your self these questions:

What has helped me in the past?…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

What may help this time? …………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

15

To help consider what to do, a simple problem solving method can be used:

p What is the problem. p List all possible solutions. p Discuss each possible solution – advantages and disadvantages. p Choose best solution or combination of solutions. p Plan how to carry out the best solution(s). p Review implementation and praise all efforts.

You may need to seek the right kind of extra support and advice to address any problems.

Would do you think could help? …………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

About antidepressant medication*Note* this section still to be added

Here is a list of other people who may be able to help:

Health Trainers ……………………………. PARS ……………………………. CAB ……………………………. Lifeline ……………………………. Community Alcohol Team ……………………………. Expert Patient Program …………………………….

Things to do in a crisis or emergency:

See your GP Samaritans ……………………………. Crisispoint ……………………………. A&E …………………………….

Websites:

www.mhim.

16