So what can be done about depression ?
The first thing to do is to make an appointment with your doctor. That is the easy bit. It’s only a quick telephone call and that is stage one over.
You could try and go it alone but there is absolutely no shame in going to see your doctor in total confidence and getting checked out. He or she can confirm whether you are suffering from simple anxiety or an anxiety disorder.
You will have a starting point, a base to work from – you will know what is wrong with you and that’s half the battle right?
Believe it or not, having a confirmed diagnosis can sometimes make the condition much less distressing!
Step two is actually keeping the appointment which may be a little harder but if you’ve completed step one i.e. made the appointment you might just as well carry through otherwise you will have wasted your valuable time at stage one !
Now your doctor will assess you and suggest a strategy for helping you. It is also important (step 3) to find out as much as you can about anxiety and you are doing a little of that by reading this.
With knowledge comes understanding and control can emerge from understanding.
It is very important to know that you are not alone. There will be hundreds if not thousands of people all feeling the same as you.
It may be possible to join some sort of local group get some release by talking to others. Your doctor may be able to help with this. You will find that your doctor is a good listener and make sure you tell him all of your symptoms and how they affect your life. Just talking to your doctor like this may help enormously.
If your doctor feels that your problem may be a little harder to tackle, he may decide to suggest one or both of two options and it is important that you decide together with your doctor which is best for you. If you are not happy about taking up his recommendation then it’s clearly not going to work. You have to “buy into” into the recommendation. He may suggest some sort of medication or talking to someone who specialises in this area; a therapist.
So help with anxiety disorders comes in three forms.
Helping yourself, therapy, or medication.
The choice will depend on the severity of your symptoms and your treatment strategy should be an agreement between you and your physician.
Antidepressant drugs are effective for treating moderate to severe depression associated with symptoms such as loss of appetite and sleep disturbance. Usually improvement in sleep is the first benefit of therapy. Antidepressant drugs are also useful for lower grade long term (chronic) depression of at least two years.
Antidepressant therapy should not be used routinely in mild depression and psychological therapy should be considered first. However, drug therapy can be used if psychological treatments do not work or if the depression is mild at the moment but has been moderate or severe in the past.
What Medicines are used ?
The groups of medicines used to treat depression are called the Tricyclic, Tricylic -related antidepressants, the selective serotonin re-uptake inhibitors (SSRIs), the serotonin and noradrenaline reuptake inhibitord (SNRI's) and the monoamine oxidase inhibitors (MAOI's). Finally there are a number of medicines used to treat depression which cannot easily be categorised.
Which is best ?
In terms of effectiveness, there is very little to choose between the different classes so the choice will depend on such things as the patient's other medication, and psychological state and prescriber's experience.
Different medicines within each group have different profiles for example the amount of drowsiness they cause and this can also influence the choice. But no one medicine is "better" at treating depression than another. It is just a case of finding one that suits.
One important point to make is that with all medicines used for depression there is not only a lag period between starting it and getting the benefits. This is most important to realise because many people stop taking the medicine as they don't feel any better straight away and we are all used to things working immediately.
To make things worse, it is very common to get side effects during this first stage for example, agitation, drowsiness, but rest assured that as the benefits kick in, the side effects go away.
Tricyclic medicines work as well as SSRI's but people often stop taking them because of side effects and they are dangerous in overdose. Examples of medicines used in the Tricyclic group are: Amitriptyline, Clomipramine, Dosulepin and Doxepin.
Examples of medicines used in the Tricyclic-related group are: Mianserin and Trazadone.
SSRI medicines are better tolerated and safer than the other groups which is why they are the medicines which are used as first choice. Examples of the SSRI's are: Citalopram , Escitalopram, Fluoxetine (Prozac which is probably the best known), Fluoxamine, Paroxetine and Sertraline.
The SNRI's inhibit both serotonin and noradrenaline re-uptake. Duloxetine and Venlafaxine are reported to weakly inhibit dopamine re-uptake.
Serotonin, noradrenaline and dopamine are chemicals which are essential for proper brain function. So these drugs are if you like prolonging the action of these chemical in the brain and because of this, mood is raised.
These drugs cause less side effects like drowsiness, blurred vision and constipation and for these reasons, the SNRI's are becoming more popular amongst prescribers.
Examples of the SNRI's are: Duloxetine, Milnacipran and Venlafaxine.
MAOI's have dangerous interaction with some foods and other medicines so are not used often and when they are you have to be careful. An example of the MAOI's is Phenelzine.
"Other Antidepressants" Include: Flupenthixol, Mirtazapine and Reboxetine.
Whichever Medicine is prescribed, patients should be monitored by the physician and reviewed every one to two weeks at the start of treatment and the medicine should be trialled for at least 4 weeks before thinking about changing to another medicine if it is not working.
Where the medication is working, treatment should be continued for at least 6 months.
Where the medicine is not working after 4 weeks or only partially after 8 weeks, consideration will be given to changing to another SSRI medicine or one in another group.
Coming off (withdrawing) from antidepressants is usually not a problem and any bad effects are usually mild and don't last long. Some of the shorter acting drugs for example paroxetine can cause problems if stopped abruptly and a longer period of reduction is needed sometimes of up to 6 months. It is recommended that you get your doctor's advice before stopping your medication.
In many cases there may be a reason why you are feeling depressed.
Is there a significant event that has depressed you ? The loss of a loved one for example? A physical injury ? Continuing emotional strain? Problems with a relationship or divorce or even the way you see yourself or the way in which you think others see you ? Is there something bleak for you on your horizon? Or maybe a major life change coming that you cannot get your head around ?
It may help to sit down quietly and write down what is troubling you; not the way you are feeling but try to describe the root cause. Can you define the cause ?
There may not be a cause or a trigger. There may not be anything that you can put your finger on but it is a useful exercise to start with.
If there is something coming your way which is depressing you and you know that before you knew it was coming that you were not depressed then you need to try and adjust now rather than waiting for it to happen and then trying to adjust.
If there is something that happened in your past that triggered the depression and you know that before the event you were not depressed then you will need to reflect on why the event triggered the depression in you.
Talking to relatives or friends may help. There is some truth in the old saying - “a trouble shared is a trouble halved”. It's good to “unload” from time to time even if you aren't depressed !
Sometimes you may find that a friend or relative may have gone through the same experience as you and found a way to cope or get over it. Words or sympathy make us feel better. Also, knowing that we are not the only one in the world going through whatever it is gives us re-assurance. So talking to other people with the same feelings can often help. There may be a depression support group in your area.
Care for yourself
Do you care ? One of the problems of depression is that there is a tendency to withdraw. This can happen both emotionally and socially.
You may not feel like getting involved in anything and that can include caring for yourself. You may stop washing for example, but what does it achieve ? Not caring for yourself is not you but a symptom of your depression.
You may care about yourself so little that you really dislike yourself or even hate yourself. Many people with depression cut themselves or harm themselves in other ways as a punishment.
You may certainly hate your situation so why not blame yourself?
But this is just your depression distorting your view of life. You need to find a reason outside of yourself to care for yourself or your physical health will start to be affected.
What is the cost to you if you neglect yourself ? Will you lose friends? Will your family lose patience with you ? Why has depression suppressed your self-esteem? The answer is that it is a symptom of your depression.
Grasping the fact that you are depressed is the first step in overcoming it. You need to come into a realisation that the reality you have now, one of being in a state of depression is not one that you have always been in.
As we said earlier, there may or may not have been a cause of your depression but it doesn't alter the fact that your depression has a start so you know how you felt before you were depressed.
You may be “stuck” emotionally. See that then as not only a temporary thing- a phase perhaps, but also one which given the right structure and direction be overcome. It has been said that Depression is unresolved emotional conflict. Resolve the conflict and the depression lifts.
Unfortunately, depression incapacitates to such an extent that rational thought and the ability to resolve such emotional dilemmas is almost impossible. By separating yourself from the depression is the only way to overcome this. Know that the depression is not “you”. It is something that has come upon you which is inhibiting, incapacitating and a burden. It is a burden which may not be so simply “shrugged” off like a back-pack however it may weigh you down like one !
Take time to reflect in a way dissociated from your depression as, if you like, an observer or onlooker. Relax in a chair, or in bed and clear you mind. Close your eyes, concentrate on your breathing. Relax and let go. Feel your breathing become slow and regular. In your mind think of your depression as a burden – a back-pack if you like. Feel the weight of it on your shoulders. Think of all the ways that it impacts on your life and causes you problems, all those aspects of depression that make your life poor, and dark and lonely. See the problems all inside the backpack. In your mind, climb a mountain. Take as long as you like. Imagine it as real as you can. Breath the fresh, cool , mountain air. See the beautiful lush green grass beneath your feet. Feel the grass, soft under your feet. Feel the warmth of the yellow sun shining brightly in an azure blue sky. Hear the birds sing to you as they fly overhead.
Your back-pack is heavy. You yearn to take it off. Climb onwards and upwards.
Your pack gets heavier and heavier. The weight is unbearable but you must reach the top.
Now take off the pack and set it down beside you. Without looking down at it, move forward and upwards.........you are so close !
Now you reach the mountain top.. Sit for a while and take in the view. Make it the most beautiful scene you can imagine. How good do you feel that your back-pack is off ! Rub your aching shoulders where the straps cut in. Breathe deeply and enjoy the freedom of not carrying that thing. Fill yourself with the joy that all your senses are sending you. The touch of the grass, the beautiful colours and sights filling your eyes, the sounds in your ears and the smells of the flowers. How lucky you are to be here. The pack you carried would have stopped you reaching the top and experiencing all that you have. Sleep if you wish.........
You should repeat this exercise everyday until you come to view your depression as something that is external to “you” - the REAL you. It is something imposing on you and preventing you from progressing in this life.
“Your” life should be controlled by “you” shouldn't it ?
By beginning to resent the way that your depression in controlling you, I want you to come to the point at which you say-
“ENOUGH IS ENOUGH”. Whatever it takes.........I am going to change this thing!
If that means medication, therapy or whatever then I want to be free of it !
But something else will happen. Realising that “you” should be the one in control you will also come to resent the way in which your life has become poorer because of the depression.
It was not “you” that wanted to not bother shaving or washing or eating or whatever. It was not “you” that needed to drink a bottle of whiskey every day. It was your depression. In fact..........it was not even “your” depression ! It was just this thing called depression that has been taking you over and turning you into a zombie ! Not caring for yourself is not “you” not wanting to care for yourself but the thing controlling you.
Taking Back Control
An old Chinese proverb says that “a journey of a thousand miles starts with just one step” and maybe, just maybe, I have managed to nudge you enough into taking that first step – going to see your doctor. In a difficult undertaking, like a long journey of a thousand miles or a battle against depression, to be a winner, you need friends and allies and all the provisions, equipment or weapons you can get hold of !
Think about how depression has stopped you from finding happiness.
Think about what made you happy when “you” ran your life. You may not FEEL like doing those things but that is depression controlling you.
By making yourself do those things again you are taking more steps into the “I'm in charge” territory.
Make a decision to do those things that you know gave you pleasure in the past. What are they ?
Going to the cinema? Going to a nightclub? Going to the gym? Going to a nice restaurant? Reading a good book, partying with friends, listening to music ? You name it.
There are three key areas that you MUST focus on and take some action towards improving. They are DIET, EXERCISE and REST.
Anxiety, stress and depression can all lead to changes in weight. Sometimes weight will go up but usually people with these conditions will lose weight.
If the bodyweight falls below the ideal weight range for height (Ideal Body Mass Index or BMI 20-25) then at the minimum there will be weakness and tiredness which does nothing for energy levels and motivation.
If the weight continues to fall there can be further medical complications. People with depression often eat the wrong things which although may be high in calories, do not give the body the nutrients it needs to function properly so we say that the diet is not balanced.
Aim for a diet which is low in fatty foods and sugary foods.
Sugary foods give the body and brain an instant boost and energy highs which are immediately followed by a low. Carbohydrate foods should be “slow-release” energy carbs like pasta and brown rice rather than potatoes and bread. Chicken is good and fish is particularly good.
Eat as much fruit and veg as you can and keep well hydrated – aim to drink between 1 and 2 litres of water each day.
Avoid sugary drinks and sodas, excessive alcohol and keep coffee and tea to a minimum (again to reduce the highs and lows that caffeinated drinks can give you).
Eat a whole range of foods to try and soak up as many vitamins and trace elements as possible. Try something new – what about mixed nuts and seeds? They are packed with vitamins and essential oils.
If your appetite is poor, try smaller portions but try to eat three good meals a day. If this is impossible then by all means graze throughout the day but make sure it is healthy grazing and not junk food grazing.
Even if you are eating it is worth buying an unbranded multivitamin, mineral and trace element dietary supplement form the pharmacy or health food store. Remember however, a supplement is important but NOT a replacement for eating properly.
When you eat, don't rush your food. Chew each mouthful well before swallowing and drink some of your water with your meal.
Your body is IMPORTANT. You need it to function as well as it can in the battle ahead. Treat your body with respect. Put good things into it.
If you are very overweight, please check with your doctor before undertaking any exercise regime and whatever your condition, start slow and build up slowly.
But you won't want to exercise will you? Or will you? Is it really “you” that doesn't want the benefits? Or is it what is controlling you that dosen't want the effort ?
Think of the benefits that exercising will bring you.
If you persevere, your body will change. You will become fit and strong. You will feel healthy. You will look good. You will be physically attractive and best of all, your mood will improve.
All these things will improve your self-esteem.
You will be stronger then, much stronger in your fight to regain control of your life.
You could research your own fitness regime. Draw up a plan. Get a friend to help or make one for you. Whatever exercise you do, aim for at least half an hour per day, preferably one hour to day or at least aim to build up to that level even if you start with five minutes a day. Maybe you could plan a walking route and then build up to running it and then trying to run it faster each time or extending the length of the route. Ideally ask a friend to join you or if you can, join a running group After each session you should be slighly out of breath and you heart rate should be up. You don't need to be sweating all over the place at least in the early stages.
If you can afford to, then you could join a gym. There you can get your own program and there will be people there to motivate you and monitor your progress. Just being around other people exercising is a huge motivator.
Rest for the body is as important as diet and exercise.
Rest is when the body repairs and renews itself. Rest and relaxation is so important but the most important part of rest is sleep.
Unfortunately, Stress, anxiety and depression make is very hard to relax let alone sleep. Not sleeping well is one of the symptoms of all of these afflictions.
Lack of sleep causes us to be irritable and moody. Our brains don't function well without enough sleep and we lose our ability to concentrate and remember things.
Lack of sleep has a major impact on quality of life because if you are never functioning at your best, then every aspect of your life is affected.
Without sleep our functions start to break down. We become physically and emotionally vulnerable. This is precisely why sleep deprivation is one of the favoured methods of torture. Ultimately, without sleep for a couple of weeks we could even die.
There is a strong link between lack of sleep and depression.
If you are depressed then you will almost certainly have some sleeping problems and prolonged lack of sleep (insomnia) can lead to depression.
Ultimately, you may need to see your doctor for some medicine to help you either get off to sleep or stay asleep but it is worthwhile checking these things first.
Sleep hygiene does not mean having clean sheets and pyjamas ! Sleep hygiene is all about properly preparing the sleeper and the sleeping environment for sleep.
Preparing the sleeper for sleep involves a wind down routine. A wind down routine will help to signal the brain that it is time for sleep. Try taking a warm bath or shower half an hour before bedtime as this will raise body temperature and then it will fall which helps to bring on sleep.
Other ways of preparing the mind for sleep involve listening to relaxing music, taking a stroll or practising yoga.
It is advisable to avoid stimulants such as caffeine and nicotine, six hours before bedtime as they prevent deep. Research shows that smokers can take up to an hour to get to sleep compared with non-smokers who typically drop off within fifteen minutes.
Alcohol will relax you and help you drop off but the time that you have it is important. In the short term alcohol is a stimulant so it will actually make it more difficult to get off to sleep if you have drunk alcohol within an hour of going to bed. After this time, alcohol becomes sedative however it is not a great idea to use alcohol as a sleeping aid as it seems to disrupt sleep and you won't get the full benefit of a nights rest.
The bed and bedroom should be as comfortable as you can make it. You might invest in a pair of earplugs and make sure that the shades really do block out light from outside. Your bedroom should ideally be around 18 to 20 degrees C, dark, quiet and clutter free.
Don't use your bedroom for anything else other than sleeping and sex, as this causes the brain to associate being in bed with being alert. There is also evidence that sleeping surrounded by electronic devices could negatively affect sleep.
Here are some other ideas to help get to sleep.
- Exercise during the day (but not in the evening just before bed)
- Do not eat just before going to bed
- Try reading a book
- Try getting up earlier in the morning
- Have a hot milky drink before bedtime
- Sexual intercourse before sleep can help you relax
- Try yoga or relaxation techniques before going to bed.
Visualisation can sometimes help: After getting into bed and fully relaxing, rather than letting your thoughts drift, focus your mind on completing a task or activity. For example you might imagine yourself going for a run. But you need to do this in such detail that the whole process is in slow motion. From where you are in bed you would need to imagine yourself getting up and changing into running kit. So first imagine moving your arm u and grabbing the edge of the bed cover and uncovering yourself. Imagine the change in temperature as you are uncovered and feel the weight lift off you. Imagine how you would get out of bed. Imagine drawing up your legs and swinging them over the side of the bed at the same time imagining your head rising from the pillow and raising you body off the bed and swivelling around. Feel the floor covering under your bare feet. Think about where you might find your imaginary running gear. Slowly slowly slowly imagine every single detail (including sounds, how things feel etc) of how you would get changed and make your way out of the house and get on with your run. If you imagine in enough detail, this process will seem to take forever. Your brain may well try to jump ahead. For example from leaving the bedroom you may in your mind find yourself downstairs. If this happens, rewind back to where you were before and try again. This technique is quite hard to do at first as the brain is impatient and keeps wanting to skip the detail. Try hard to slow things down and the more you practice the easier you will find it.
The psychological therapies or “talking therapy” can really help a lot. Your doctor can arrange a series of sessions with a trained professional or you can organise this yourself privately but beware, you should check out the credentials of the therapist.
Therapists should be properly trained and belong to a recognised professional association.
Many people are so depressed that they lack the motivation to even go to therapy. In this case, your doctor may prescribe medication to lift your mood to a degree so that you can benefit form therapy.
Those with mild or moderate depression may be referred directly into therapy or may be offered a combination of mediation and therapy.
In mild depression, medication alone is often not suitable because the side effects of the medication can outweigh the relatively modest symptoms of mild depression.
How long will it take ?
It is hard to give an answer to this because so much depends on the degree and complexity of the depression. You can expect up to around 20 sessions of an hour over a period of 6 to 9 months.
Types of Therapy
The range of therapies available is enormous and your doctor will help you decide which one is best for you.
This is a form of therapy which is performed by psychoanalysts who delve deep into the subconscious and this process takes a long time. It is believed that many problems or beliefs stem form early experiences where things may have been interpreted wrongly or stored away or suppressed. Psychotherapy aims to brings these things to the surface so that they can be dealt with.
Cognitive Behavioural Therapy
CBT is a very powerful technique which can work quickly in as little as four sessions of an hour. Some people require more usually up to about 20 -25 sessions.
CBT is a technique which uses two approaches.
The cognitive bit refers to where the therapist tackles your perceptions about things. the therapist attempts to make you see things the way they really are rather than how you think they are. he or she will use logic to try and make you realise that your
perceptions are wrong or at the least exaggerated.
The behavioural bit is where the therapist tries to modify your behaviour. An example of this would be persuading you to take better care of yourself, improving sleeping and eating patterns etc.
CBT is very successful therefore extremely popular with doctors and is often the first choice of therapy.
Counsellors listen to you. They are like a listening friend and although they will direct the conversation and therefore the focus of the conversation into those difficult areas, they will not give any advice. Their role is to prompt you into coming to your own decision and resolutions. This type of therapy is suitable for mild depression.
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