Depression and Low Mood

Depression is a very common problem and any people feel low or down in the dumps at times. This is often due to life stresses such as bereavement, money or housing problems or difficulties in relationships. For some people the problem becomes much worse and gets in the way of normal life.

One approach to depression is called Cognitive Behaviour Therapy (CBT). CBT uses methods that been tried and tested and found to be effective. It involves looking at the way you think about things and what you do.

What is depression?

Depression is a common mental health problem. At least one in ten people will experience depression at some time. In its mildest form depression does not stop from leading a normal life, but the most severe depression can be extremely distressing, with thoughts of death and suicide.

There are some of the signs or symptoms that you may exprerience if you are depressed:

Emotions or feelings

- Feeling sad, guilty, upset, numb or despair

- Losing interest and/or enjoying in things

- Crying a lot or unable tocry when a truely sad event occurs

- Feeling alone even if your in company

- Feeling angry and irritable about the slightest thing

Physical or bodily signs

- Tiredness

- Lack of energy

- Restlessness

- Sleep problems, especially waking early

- Feeling worse at a particular time of day

- Changes in weight, appetite and eating

Thoughts

- Losing confidence in yourself

- Expecting the worst and having GNATS*

- Thinking that everything seems hopeless

Thinking you hate yourself

-Poor memory or concentration

- Thoughts of suicide

Behaviour

- Not making decisions

Can't be bothered to do everday tasks

- Putting things off

- Not doing things you used to enjoy - Avoiding seeing people

*Gloomy Negative Automatic Thoughts*

Most people feel some of these symptoms from time to time. But if the feeling don'tgo away after a few weeks, and are there most days for most of the of the time, then it may be that you are depressed. When you're depressed you may feel hopeless and alone in the world; you may blame yourself for all the faults you think you have and feel pretty worthless. In short, you feelnegative about yourself, about the world and about the future.

So you tend to lose interest in what's going on around you, you don't get any satisfaction out of the things you used to enjoy and you withdraw even further into yourself. Eventually it can become hard to make decisions or to carry out little little tasks that you once did no problem at all. People who are depressed often say they don't recognise themselves they feel so different. The good news is that there are many things that can help, and people do recover from depression.

What causes depression?

No single cause for depression can be found. Usually there is more than one reason and this differs from person to person. Life is sometimes difficult and sometimes it becomes too hard to handle alone. Some people may be more vunerable to depression, due to a family history of depression, early experiences, personalilty factors or body chemistry. Sometimes there's no obvious reason at all.

Whatever the causes of a person's depression, there is something that can help. Treatment is different for everyone. Some people may need medication, others may need to make some changes in their life, becoming more active may help, others may really benefit from changing their thoughts. Sometime it might be all of these, as you can see depression can be complex!

What does research tell us about depression?

Research has helped us understand depression much better. Both in terms of what leads people to become depressed, and what keeps it going. We now realise that our body, thoughts and behaviours play an important role in depression. The way a person is physically and emotionally, and how they think and act when they are depressed can very different to how they usually are.

Here's an example

The successful buisness person who thinks they are useless, stops enjoying work and withdraws friends and family and colleagues.

Most people have low mood at times. It usually if we never felt a bit low and unmotivated to face the day. However, when depression develops, this becomes more severe. There may be changes in body chemistry and energy levels, leading to lack of interest and enjoyment, which in turn leads to withdraw from activities mentally and physically. Once someone isn't doing the things they enjoy and value, their mood drops even more. And guess what? Yes, there is much more space in the mind for GNATs to flood in!

What treatment is available?

Most people are treated for depression by their family doctor. The doctor may suggest self help, a talking therapy, antidepressants tablets or a mixture of all three. You may just see a doctor, or be referred to a specialist. This could be a psychological therapist, counsellor, psychiatrist or other mental health worker.

Antidepressants are sometime prescribed by your family doctor or phyciatrist.They have been shown to be helpful for many people suffering with depression. Antidepressants work on the chemicals in your brain to make you feel less depressed. They are not addictive and once you begin to feel better, usually after quite a few months, you can plan, with your docto rto stop taking them. This should not be cause you any difficult and your doctor will gradually adjust and reduce the dose.

Talking Therapies are usually counselling or CBT, although sometimes other therapies are offered. Therapy will help you understand your own difficulties and begin to work out ways of overcoming depression. This can usually be offered by phone or or face to face. Quite often your therapist may suggest using a booklet but they can offer extra support if you've struggledto use it on your own.

How can I help myself?

As mentioned, the way you think about things affects the way you feel, which affects the way you behave, and so it goes round and round. It's difficult to change the way you feel directly. Just telling yourself to cheer up and feel better doesn't ususally work! But you can change the things you do and the way you think, which will thenit turn change the way you feel. This can be with or without the help of medication, depending on what your GP and you both feel is best.

Increasing helpful activity

Research evidence tells us that increased activity is very helpful in overcoming depression. Withdrawing from the things and people we care about makes our mood much worse. Don't expect to enjoy things as you used to straight away. This will come later, and gradually. just do your best to do what you can.

Positive steps:

- Listthings to do

- Mix with people

- Join in activities

- Take exercise

- Do things you enjoy and value

1. Making a daily

When people are depressed they often don't feel like doing anything, find it hard to decide what to doeach day and can end up doing very little. Hours can pass just staring into space, or having GNATs. Begin to tackle this by making a list you might usually want to or need to do, even if you don't want todo them right now. Then plan out an action list, start off with the easiest task at first and don't aim too high. Try and have a mixture of activities, including some chores and some things you would usually enjoy. Work through your action list and tick offwhat you've done. At the end of each day you'll be able to look back and see what you've achieved . Freinds, family, pets; anyone you feel close to, can also help. In particular try to plan simple things you value, such as walking in the countryside, being creative, listening to music etc.

2. Achievements, pleasure and gratitude diary

When people are depressed they often forget what they've achieved and what they enjoy. Most people have more things going for them than they usually aware of. On your daily action plan write down all events of the day, put a 'P' next to those which have given you pleasure and an 'A' next to those activities where you felt you achieved something and did well. You can rate this from 1-10 so you can see whichthings please you most and can notice any changes with time.

Treat yourself, each evening, spend a few minutes jotting down 2 or 3 things that you are grateful for from the day. Some people find it helpful to have a nice notebook especially for this. This is called a gratitude diary and studies have improvements in mood from this simple act.

Reducing unhelpful activity

We tend to do things that we think mayhelp us feel better, suchas drinking alcohol, staying in bed, binge eating, zoning out in front of the TV.

Solving differicult problems

If you have a difficult problem, ask for helpfrom a friend or familymember, ask them what they would do. you could alsouse brainstorming, whereeven apparently silly solutions are written down to be considered. Choose the best approach.

Understanding depressive thinking

As we have said depression not only affects our behaviour but also our thoughts. Sometimes negative thoughts can stop you from doing the things that you would normally do. You might say to yourself "what's the point" "I can't face it" and this will have a real effect on your activity levels. As a result , you may then get self-critical thoughts about being lazy, or irresponsible, which make you feel even worse, and able to do less and less. In other words, you get caught up in a vicious cycle.

What do GNATs look like?

"They don't like me, what have I done to upset them?"

When you are feeling low the GNATs may be so familiar and happen so often to you that you just acceptthem as fact. GNATs are often about yourself, for example:

"I'm no good"

"People don't like me"

"I look ugly"

These thoughts are sometimes about other things such as the world around you or the future. For example:

" People are unkind"

"The world is a horrible place"

"Nothing will work ou well"

1. Catastrophising

This means we think things are much worse than they really are by jumping to the worst conclusion. For example: You a small mistake at work and fear you may be dismissed because of it, or you may spend a long time worrying that you've upset and lost a friend by something you've said only to find later they didn't even remember the comment.

2. Over-generalising

This is when we generalise from one small thing. For example, if someone isn't friendly to you, you may think "no one likes me, I'm a waste of space" or if one of your daily tasks hasn't been finished you may think " I've achieved nothing, today was pointless". In other words from one thing that has happened to you, you draw a negative conclusion which is much bigger and covers all sort of things.

3. Ignoring the positive

People who are depressed tend to focus on the negative or bad events and ignore positive or good events. For example, you might have had a game of pool and missed the shot once, but played well in general. After the game you just think about the shot you missed and not the rest of the game played well. Or you may have many good friends who have known for years but you concentrate and worry about one that has fallen out with you rather than remembering all the other good friendships.

4. Taking things personally and being self-critical

Often if our mood is low we blame ourselves for anything that goes wrong, even if things have nothing to do us in reality. For example, you go into local shop and the assistant who knows is "off hand", your automatic thoughts is "she doen't like me... have I done something wrong?", but the most likely reason is that she's tired or upset or has had a "bad day". In this example you have taken blame personally. You may also be self-critical and put yourself down with thoughts such as "I'm an idiot" "I never get things right".

5. Mind reading or fortune telling

We sometimes believe we know what others are thinking and if our mood is low we may expect that they are thinking badly of us. For example if a friend is quiet you may think "that is because she thinks I am boring". Or we may predict the future by imagining a negative outcome before it even happens. So you may think " I know it's not going to be good to be good enough so I'm not going to even bother trying".

Balancing

A useful technique to try is called balancing. When you having a negative, critical thought, balancing it out by making a more accurate and positive statement to yourself:

Thought: "I'm no good at my job", could be balanced out with with"my boss said how much he appreciated the piece of work I did yesterday".

The double column technique

Another thing you could do is to write down your negative automatic thought in one column, then opposite dor each one, write down a more balanced positive thought.

It may helpful to keep a diary of events, feelings and thoughts. Use the approaches described to gain more balanced thoughts and look out for unhelpful thinking styles, this could help to fight the GNATs.

Try and remember details

Research tells us that people who who are depressed don't remember details of events but tend to think in general statements, such as "I've never been any good at anything". Try and train yourself to remember specific details so good times and experiences are easy to recall.

Challenge lomg term beliefs

Sometimes people have long held views about themselves that are very self - critical. For example, "I'm not a very clever person" or "I'm not a very lovable person". These beliefs are often a product of our past experience andmay hold no truth in present reality. Try to challenge this self-criticism, stop knocking yourself down and look for evidence that disproves the beliefs. What would you say to a friend that held that belief themselves?

Mindfulness and acceptance

Sometimes no matter how hard we try, our thoughts will not be changed. If you find youself getting in to endless arguments with your thoughts, this can then become part of the problem. You may start to feel useless for not being able to challenge your thoughts well enough and before you know it, there are a whole host more negative, self-critical thoughts in your mind.

Research has shown that a form of meditation called mindfulness can be really helpful such as headspace or insight timer.

Whenever you notice that your attention has drifted off and is becoming caught up in thoughts or feelings, simply note this without judgement, and then gently bring your attention back toyour breathing.

Thoughts will enter your awareness, and your attention will follow them. No matter how many times this happens, just keep bringing your attention back to your breathing. The more you practice this exercise the more it will help you not to get caught up in your negative thoughts.

Further Help

Try some of these tips and they may help you to begin to overcome your depression and get back in control of your thoughts, your depression and your life.

If you feel so depressed that you have thoughts of harming yourself or taking your own life plese reach out to your GP or one of theorganisations below

Association for post natal illness

Phone: 0207 386 0868

www.apni.org

For women who are experiencing depression following the birthof their baby.

Bipolar UK

Phone: 0333 323 3880

www.bipolaruk.org.uk

Works to enable people affected by bipolar disorder to take control of their life.

British association for counselling or pyschotherapy

Phone: 01455 883 300

www.bacp.co.uk

British association for behavioural and cognitive psychotherapies

Phone: 0161 705 4304

www.babcp.co.uk

The lead organisation for CBT in UK

CRUSE bereavement care

Phone: 0844 477 9400

www.crusebereavementcare.org.uk

Depression Allience

www.depressionallience.org/

Depression UK

www.depressionuk.org/

HealthWatch

www.healthwatch.co.uk

(health and social care)

Thanks for reading and remember to stay safe x