Seasonal Affective Disorder (SAD)
This type of depression is associated with the start of winter and can last until spring when longer days bring more daylight. When it is mild, it is sometimes called “winter blues”. SAD can make the sufferer feel anxious, stressed and depressed. It may interfere with their moods and with their sleeping and eating patterns.
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Depression often makes you feel helpless. Taking action to make yourself feel more in control will have a positive effect, whether it’s going to see your GP for treatment, joining the local gym, or doing something that you are interested in or good at. If you don’t feel up to starting something new or joining a local group on your own, ask a friend if they will join with you.
There are many things you can do to help manage your symptoms yourself and a wide range of treatments, both medical and non-medical, available through your GP.
The sections below should help you to work out what you could be doing yourself and what information or support you may want to ask your GP about.
How you see yourself
The way you think about yourself will affect your frame of mind and feelings of depression. It is common to have feelings of worthlessness or guilt with depression. Try to be aware of any negative thoughts you have about yourself and how they might be affecting how you see yourself and how you feel. If you can, try to think about how realistic these thoughts are and how you might change them into something more positive. You can speak to your GP practice about counselling.
Social networks
If you feel depressed it can be difficult to be sociable. Feeling alone may make you feel worse, so it’s important to keep in touch with friends and family. Having people around you or groups that you are involved with will help to reduce feelings of isolation.
If you do not have many social networks you could find out about local community groups or befriending schemes by contacting your local library or speaking to your GP surgery.
Worries about work, money or a legal situation
Making sure that you do not feel overwhelmed by your work responsibilities is important because it gives you a sense of being in control. It’s important to make time for yourself so that you have space to do things you want to do or to be with friends and family. If you are struggling to cope with work pressures and you have access to an occupational health department, you can speak to them about how you are feeling.
They may be able to help you to review your work commitments or address specific issues that are affecting your work.
If you are having financial difficulties, speak to your local Citizens Advice Bureau about how you might get financial help.
The National Debtline on 0808 808 4000 provides free, confidential and independent advice for people with debt problems. If you are out of work or want to change your job, your local job centre may offer support in finding work.
Both the Citizens Advice Bureau and your local social services department can also help you with advice about benefits if you are unemployed or perhaps unable to work because of depression. But, where possible, you should always try to keep working as people with depression often find that this is very helpful. Seeing other colleagues, having some routine to the day, and the sense of achievement in getting a job done, can all be beneficial.
Close relationships
Experiencing problems with close personal relationships can have a devastating effect on how you feel about yourself and the world. If you are struggling to cope with a difficult relationship or your depression is causing problems in your relationship you can contact Relate on 0845 456 1310 (this marriage guidance group also helps couples who are not married) or you could speak to your GP or practice nurse about getting support and help through other forms of relationship counselling.
Physical activity
There is good evidence that exercise can lift your mood because it can take your mind off your depression as well as stimulate the release of endorphins in the brain. Endorphins are chemicals that make you feel happier.
If you have mild or moderate depression your GP might recommend an exercise referral scheme. Ideally you should be aiming for 50 minutes of exercise 3-5 times a week. You can break this time down into more manageable amounts so that you can fit it into your everyday life.
If you want advice about what exercise you should be doing and how it might help your depression, speak to your GP or practice nurse.
Diet
Some studies have suggested a link between what you eat and depression, but there isn’t enough conclusive evidence to say whether or not it can definitely make a difference. One suggestion is that foods which are rich in some essential fatty acids found in oily fish, like salmon, help to relieve some depressive symptoms.
Whether there is a direct link or not, eating healthily will help you generally feel better and give you more energy, especially if you are also exercising.
Avoiding too much alcohol and drugs
Alcohol acts as a depressant on the brain and if you drink too much or too often, you are more likely to become depressed. If you are already suffering from depression, drinking alcohol can make you feel worse instead of better. With such a vicious circle it is best to drink moderately, if at all. Recreational drugs should also be avoided.
Managing anxiety
Around half of those people who experience depression will also experience anxiety. Taking steps to manage your anxiety can help to give you the mental space to begin to deal with your depression. Talking about the things that are making you anxious, as well as a healthy diet and exercising, will all help you to stay in control of anxiety.
Some people, especially those with mild depression, find that relaxation techniques such as massage and yoga help them to feel less anxious.
Complementary medicine
There is some evidence that St John’s Wort can help with mild to moderate depression. However, this drug is known to interact with other substances so you need to get advice from a pharmacist or other health professional before taking it.
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The first step in getting treatment will normally be to visit your GP practice. They will ask you a number of questions about how your depression is affecting you mentally and physically.
The first appointment can feel difficult so it might be helpful if you write down what you have been experiencing before you go. Make a note of any questions or worries you might have. Some people find it helpful to bring a friend or family member.
It is important for both you and your doctor to be happy with decisions about your treatment.
Being as open as you can about your symptoms and how they are affecting you will really help. Your GP may suggest you see a specialist such as a mental health nurse, psychiatrist or psychologist.
For mild depression, medication is not recommended because the risks could outweigh the benefits. Your GP has guidelines for treating depression and these recommend waiting to see if the depression goes away. Using some of the self-help ideas mentioned above can help and your GP surgery can offer you support.
Talking therapies such as Cognitive Behavioural Therapy (CBT) work well for depression but they are in short supply in some areas and you may have to wait to see someone on the NHS. You can pay to see someone privately and your GP may be able to recommend someone.
For more severe depression your GP will probably recommend antidepressants. Antidepressants do work but they have side effects. A combination of talking therapies and antidepressants will often be the most effective approach for more severe depression.
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About medication
Medication will not always be the first choice, especially if your depression is mild. There are a number of medications available which work in different ways and will be prescribed depending on the type and severity of depression you have.
If one medication does not work you may be prescribed something else, however it takes a few weeks before your medicine starts to work so your GP will want to ensure that you allow enough time to see if it is going to be effective.
It is important that you take the medicine for the period of time recommended by your GP because if you come off your medicine too soon (even if you feel better) this can lead to a relapse where the depression returns. As a rough guide, you will usually have to remain on treatment for at least six to nine months and in many cases it could be longer. You need to work with your GP when you are coming off your medicine as it can be harmful if this is done too quickly.
There are a number of different types of antidepressants available. Some are used for particular types of symptoms and some are newer than others. Your GP can explain which they believe is the best for you and why. Remember if you experience problems taking your medicine or have any concerns, speak to your GP.
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About talking therapies
Talking therapies work by exploring the underlying causes of your depression. They can help you work out what caused it in the first place, what keeps you feeling depressed and ways of making things better. There is evidence that some talking therapies work. However, there may be a waiting list for seeing someone on the NHS. Your GP can advise you.
Counselling
Counselling gives people the chance to talk through everyday issues that may be behind their depression, rather than trying to address more deep-rooted problems. The counsellor may sometimes provide practical advice on problems.
Cognitive Therapy
Cognitive Therapy (sometimes called Cognitive Behavioural Therapy or CBT) addresses the underlying causes of depression. It challenges the kinds of behaviour and thoughts which are causing you problems.
Psychotherapies
These therapies are not always available on the NHS. The therapy is usually more frequent and intensive than counselling. It often looks at how past experience may be affecting your life now, so it may involve delving more deeply into early experiences and key relationships. Interpersonal therapy focuses on how you relate and behave towards others. It helps you to build a better self image and communicate more effectively with others.
Other talking therapies used to treat depression include:
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group therapy
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family therapy
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bibliotherapy
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music
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art therapy.
Adapted from the booklet 'Dealing with Depression' in 2009.
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