Counselling

From Dr Phil Hammond of embarrassingproblems.com

In Warwickshire, the local councelling service is called IAPT (Improving Access to Psychological Therapies) and you can refer yourself to them by clicking here.

Dr PhilDepression should not be an embarrassing problem. It is so common it could almost be considered a normal part of being a human being.

Am I depressed?

If you're interested enough to be reading this article then possibly not. Each year, about 40% of the population have feelings of depressed mood, unhappiness and disappointment, and 1 in 5 of us will experience clinical depression at some stage in our lives. The term "depression" is often misused as a blanket term to cover everything from being a bit peeved because Arsenal didn't win to feeling you're a worthless piece of burnt out blubber who doesn't deserve to be on God's earth a moment longer. The latter is more serious.

Am I clinically depressed?

You're likely to be if you've lost interest or pleasure in almost all usual activities (anhedonia) and you're feeling despondent, disenchanted, irritable, indecisive, negative and exhausted. You may also experience some or all of the following:
  • Loss (or sometimes gain) of appetite and weight
  • Early (3am) wakening with a worse mood in the morning
  • Sluggish spontaneous movements and thoughts
  • Decreased libido
  • Difficulty in concentrating
  • Ideas of worthlessness, guilt or self-reproach
  • Recurrent thoughts of death and suicide

More serious depression may be accompanied by delusions (odd, usually false beliefs that are unshakeable in the face of rational counter-argument), hallucinations (experiences that exist only in the mind) and episodes of mania (unaccountably elevated mood and activity with feelings of self-importance).

Why am I depressed?

It's hard to say. As with most illnesses we don't fully understand, a variety of causes have been proffered from which you can take your pick. Your genes probably have a lot to do with it (if your identical twin is depressed, it's very likely to happen to you) and losing a parent in childhood, unemployment and chronic ill health don't help. Women seem to suffer more from depression than men, although this is partly due to men's macho refusal to even consider the possibility. People who lack a sense of humour, are obsessive or who are natural pessimists may also be prone to gloom, as may those who make a living out of their humour. Freud deduced that those who turn their anger inwards rather than letting it out are more likely to loathe themselves and might benefit from some of his psychoanalysis.
 
At the biochemical level, depressed people seem to be short of certain brain neuro-transmitters, such as serotonin, dopamine and noradrenaline, and antidepressant drugs may work by replenishing them. Other hormones such as thyroxine, cortisol and melatonin also play a part and drugs which interfere with their secretion can precipitate depression. Not everyone with a tendency to depression will become depressed; often a trigger factor is needed too. Loss of job, driving licence, loved one, marriage, money, health or favourite pet are common triggers, as are viral infections, professional isolation, having a baby and being mugged or burgled. However, depression can often creep up on you out of the blue.

Should I admit to depression?

I don't know. In a perfect world where mental illness carried no social stigma then the answer would of course be yes. But those who admit to depression may still be discriminated against, even if they’ve recovered. So think carefully before you discuss your depression with people who are not close to you and whose reaction may be unhelpful.

Will a GP be able to help?

GPs should be able to diagnose your depression, though this isn’t always the case in a busy surgery with six minutes a patient. And because of the difficulty many of us have owning up to mental illness, we often talk about physical symptoms (constipation, poor sleep) and leave it to the doctor to guess our mood. If you can, it's better to be up front about how you’re feeling, and it can help to take a friend or relative in with you for support. ‘I think I’m depressed’ is a good opening line.

What treatments are available?

At the Arsenal end of the depressive spectrum, talking things through may be all that's needed. However, for moderately severe depression that doesn't look like lifting on its own, an antidepressant is likely to be prescribed. These are not the same as tranquillisers, although they can have side effects especially if you come off them too quickly. Like all drugs, they’re not as effective as the drug companies would have us believe but they do work, particularly for severe depression. They aren’t a miracle cure and they do take a few weeks to kick in. Often, they need to be taken for six months or more.
 
There are lots of different antidepressants and people have individual responses to them, so if one tablet isn’t working for you, or makes you feel worse, go back and see a doctor, preferably the one who prescribed it. Continuity and talking things through are equally important in treating depression, and in the longer term talking therapies such as CBT (Cognitive Behavioural Therapy) may be most beneficial. It’s slowly becoming more widely available, but there are still long waits and you might be offered an interactive computer version first. In very severe depression that’s resistant to other treatments, suicidal thoughts can often be averted by electro-convulsive therapy.

Is depression contagious?

No. Being in the company of a depressed person can make you a bit ratty if your tolerance of mental illness is low, but it won't make you depressed. Psychiatrists do seem prone to depression and suicide, although less so than anaesthetists, dentists and farmers, but it is probably the overall stress of their jobs that triggers it rather than anything they catch from their patients. 

What shouldn't I say to a depressed person?

"Worse things happen at sea"
"These things were sent to test us"
"But you've got everything any man could possibly want"
"You're a bit of a grumpy chops today, aren't you?"
"Cheer up, it might never happen"
"Stop feeling sorry for yourself"
"You're not the only one with problems"

What should I say then?

If you want to help a depressed friend, first you have to accept that they feel abysmal and that this feeling may elude your rational analysis. The trick is to be empathic. "I'm sorry you feel like shit - why don't you tell me about it?". Then listen to them, avoiding the temptation to interrupt and offer simplistic or judgmental solutions. Once they've told you their story, you can point out that medical help is available and it works, and that most episodes of depression get better. Practical help with the shopping, cooking and the accounts can be very useful, but above all keep in touch. Take suicidal threats seriously and get urgent help.

Where can I get more information?

Depression Alliance (www.depressionalliance.org), the Mental Health Foundation (www.mentalhealth.org.uk) and Depression UK (www.depressionuk.org) all offer support and information for sufferers and carers.