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.

2 | Depression

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withdrawn, others show their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

6 | Depression

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.

8 | Depression

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

We are a smokefree organisation.Please provide a smoke free environment for your healthcare provider

This information is correct at the time of publishing Last Reviewed: June 2012