DEPRESSION

Depression is a very common experience. Everyone feels fed up, miserable or sad sometimes. Usually, the reason seems obvious - a disappointment, frustration, losing something or someone important - but not always. Sometimes we are "in a mood", "have got the hump", "feel blue", "got out of bed the wrong side", and we really do not know why.

In some people depression can be so severe that it dominates their lives, which seem barely worth living, and drags on, preventing them from coping as they used to. This is not "giving in", and being accused of self-pity or not "pulling themselves together" does not help in the least. Depression of this degree is an illness, and needs treatment.

As in the more ordinary, everyday depression, there is sometimes an apparent cause, and sometimes not. It may be a reaction to physical illness, bereavement, stress, overwork, unemployment, problems with relationships, money and housing worries, for example, but the reaction is much more intense and lasting than is usual or normal. Then again, quite severe, devastating depression can come right out of the blue.

Seeking help

So it is when depression is more severe than we might expect, or goes on and on, that we need some help. We also need help if the depression seems to affect our work, interests and feelings towards family and friends, or if we are starting to have thoughts that people might be better off without us.

Sometimes just talking things over with one or two of our relatives or friends in whom we can confide, and who can support and reassure us, may be enough to see us through this bad patch (Winston Churchill used to call it his "black dog"). But if the depression seems to have taken a stronger hold, then a visit to the GP is usually the most sensible course.

Of course, we may not actually realise how depressed we are, because it has come on so gradually, or because we blame ourselves for being lazy or feeble. We are determined to struggle on, and may need to be persuaded by others that it is not a sign of weakness to seek help. Or we may try to make up for or escape from our real feelings by rushing around and being over-active, and then wonder why we feel so stressed and exhausted.

Sometimes our disturbed feelings may not show themselves as unhappiness, which we might easily recognise, but in some physical form such as constant headaches, pain of one kind or another, or difficulty in staying asleep.

Symptoms

Characteristic symptoms can give you, your family, or your doctor a clue that you need professional help:

• a loss of interest and enjoyment in life
• a lack of drive and motivation, that makes even simple tasks and decisions difficult or impossible
• utter fatigue
• agitation and restlessness
• loss or gain in appetite, with loss or gain in weight
• sleeplessness or excessive sleeping
• loss of outward affection, going off sex
• loss of self-confidence, avoiding meeting people
• irritability
• feeling useless, inadequate, bad, helpless, and hopeless
• feeling worse at a particular time of the day, usually mornings
• thoughts of suicide; these are very common in depression and are much better admitted than covered up, as they are a certain sign that help is needed

Causes

Friends and relatives, as well as the depressed person are anxious to know why they should be depressed. Usually there is more than one reason, and these differ between one person and another.

It is quite normal to feel depressed after a distressing event, but normally we "work through" our feelings about what has happened after a time, and come to terms with them. But sometimes such events lead to more serious and persistent depression from which we find it harder to emerge.

Circumstances at the time we are stressed play a part. If we are alone, friendless, have many other worries or are physically debilitated, then we may get seriously depressed where in happier times we would cope.

One in ten women suffers persistent depression after childbirth. Depression is a common accompaniment to physical illnesses, especially those which threaten life, like cancer and heart disease, or are long and painful, like arthritis, bronchitis or stroke. Some depression may follow infections, like influenza.

Personality may also play a part in depression. Although anyone can become depressed under certain circumstances, some of us seem to be more vulnerable than others, because of our individual make-up (including our body chemistry) or because of certain early experiences.

It seems that women get depressed more than men. This may be because men are less likely to admit their feelings, bottle them up, or express them in aggression or through drinking heavily, or because women may be under more stress, say from having to work and at the same time look after a child.

About one in ten people who suffer from serious depression will also have periods when they are elated and overactive. This form of depression, known as manic depression affects equal numbers of men and women and tends to run in families.

Treatment

Most people with depression are treated by their family doctor. Depending on your symptoms, the severity of the depression and the circumstances, the doctor may suggest some form of talking treatment, antidepressant tablets, or both.

Talking

Simply talking about your feelings is helpful, however depressed you are. But exploring and confronting the possible reasons for being depressed takes energy and motivation, and is difficult while depression is still severe.

If the depression seems connected with a special problem such as your relationship with your partner, then a specialised agency, such as the local Relate (former Marriage Guidance Council), may be most helpful in enabling you to sort out your feelings. If it seems about, say, suffering from a disability or caring for a relative, then sharing experiences with others in a self-help group may provide just the support you need.

Sometimes it is hard to express your real feelings even to close friends. Talking things through with a trained counsellor or psychotherapist, who can ready listen and understand and in no way judges you, can bring tremendous relief. Also, having another person's undivided attention can do a lot for your self-esteem, which has probably been lowered by the depression. Talking through one's grief is especially effective if the depression is caused by not getting over the death of someone close.

Antidepressants

If your depression is severe or goes on for a long time your doctor will probably suggest that you take a course of antidepressants. These are not tranquillisers, although they may help you feel less anxious, and they are not addictive either. They are very effective at getting depressed people back to normal, and they need not usually be taken for more than a few months. Your doctor would want to see how you are getting on, adjust the dose and to ask you about any side-effects.

It is important to realise that, unlike aspirin, antidepressants do not begin working as soon as you take them. Their action is slow, and you need to be patient for the first week or two, though you may notice some improvement from the first day, especially in sleep and feeling less tense and anxious. Once you do feel better, it is important not to stop the tablets straight away, as you may then relapse into depression. Your doctor will advise you when to stop.

Like all medicines, antidepressants do have some side-effects, though these are usually mild and tend to wear off as the treatment goes on. A dry mouth and constipation are quite common. At least they indicate that the tablets are working, and your doctor is likely to tell you to carry on with them. Different antidepressants have different effects. Your doctor can advise you what to expect, and will want to know if you experience anything which worries you. "Will the tablets make me drowsy?" is an important question. Generally they are taken at night, so any drowsiness then can help you to sleep. However, if you feel sleepy during the day you should not drive or work with machinery till the effect passes off.

You can eat a normal diet on most of these tablets (if not, your doctor will tell you) and they are compatible with pain-killers, antibiotics and the Pill. You should avoid alcohol, though, since this may make you too drowsy.

Not getting better

A small number of depressed people do not get better with these treatments. These people are likely to be referred to a psychiatrist for more specialised help. A psychiatrist is a medical doctor who specialises in the treatment of emotional and mental disorders. The first interview with a psychiatrist will probably last about an hour, and you may be invited to bring a relative or friend with you if you wish.

There is no need to feel nervous; the sort of questions asked are likely to be practical rather than deeply probing. The psychiatrist will want to find out about your background, medical history, current situation, the way your depression has developed and affects you, and what treatment you have had so far in order to gain some idea of the kind of person you are, and the sort of new or extra treatment likely to help. This might include different tablets, more specialised and intensive "talking" treatment (possibly bringing in your partner or members of your family, if that seems appropriate), or, occasionally, "electrical" treatment (ECT). Usually the treatment will be as an out-patient, but if the depression is severe or the treatment needs to be intensive it could be in a day hospital or a psychiatric ward. However, admission to hospital only comes about once for every 100 people with depression.

ECT sounds awful to those who have never had it, or seen its benefits, but is a very effective treatment for severe depression and acts more quickly than antidepressant tablets. It is used for those who are exceptionally depressed and in mental anguish, and for those who are not responding to tablets. It involves giving a light anaesthetic and a drug to relax the muscles of the body, and an electric current is then passed through the brain for a split second. The whole business takes about a quarter of an hour, and all the patient is aware of is having gone to sleep. A course amounts to 6 to 12 treatments, usually given twice a week.

We do not know precisely how ECT works, but we know that it does. However, the great majority of people who suffer from depression never need it.

How to help yourself

Even when a doctor is involved in the treatment of depression, there are things you can do to help yourself.

Do not bottle things up. If you have recently had some bad news, or a major upset in your life, try to tell people close to you about it and how it feels. It helps to re-live the painful experience several times, to have a good cry, and talk things through. This is part of the mind's natural healing mechanism.

Do something. Get out of doors for some exercise, even if only for a long walk. This will help you to keep physically fit, and you may sleep better. While you may not feel able to work, it is always good to try to keep up some activity - housework, do-it-yourself (even changing a light bulb) or part of your normal routine. This will help take your mind off those painful feelings which only make you more depressed when allowed to sweep over you. You may also feel a little less helpless.

Eat a good balanced diet, even though you may not feel like eating. Fresh fruit and vegetables are especially recommended. People with severe depression can lose weight and run low in vitamins, which only makes matters worse.

Resist the temptation to drown your sorrows. Alcohol actually depresses mood, so while it may give you immediate relief, this is very temporary and you may end up more depressed than ever. Too much alcohol stops you from seeking the right help and from solving problems; it is also bad for your bodily health.

Do not get into a state about not sleeping. Listening to the radio or watching TV while you are resting your body will still help, even if you are not actually asleep, and you may find that you drop off because you are no longer worrying about not doing so.

Remind yourself that you are suffering from depression - something which many other people have gone through - and that you will eventually come out of it, as they did, even though it does not feel like it at the time. Depression can even be a useful experience, in that some people emerge stronger and better able to cope than before. Situations and relationships may be seen more clearly, and you may now have the strength and wisdom to make important decisions and changes in your life which you were avoiding before.

Relatives and friends

Family and friends often want to know what they can do to help. Being a good listener (and a patient listener if you have heard it all before) is very important. Spending time with depressed people, encouraging them (but not bullying them) not only to talk, but to keep going - to take exercise and do things instead of moping and languishing - are worth while. Reassurance that they will come out the other side is invaluable, though it will usually have to be repeated often, as depressed people lack confidence and are prone to worry and doubt. Ensure that they get enough food of the right sort and help them stay away from alcohol.

If the depressed person is getting worse and has started to talk of not wanting to live or even hinting at self-harm, take these statements seriously and insist that their doctor is informed. Try to help the person to accept the treatment, and do not say "I wouldn't take the tablets if I were you" or "You don't want to go to a psychiatrist - you're not mad!". If you have doubts about the treatment, discuss them with the doctor before you express them to someone who is depressed.

Support groups and caring organisations

Association For Post-Natal Illness
25 Jerdan Place
Fulham
London
SW6 1BE
020-7386 0868

Depressives Anonymous
36 Chestnut Avenue
Beverley
Humberside
HUI7 9QU
01482 860619

Depressives Associated
PO Box 5
Castledown
Portland
Dorset
DT5 1BQ

The Manic Depression Fellowship
8-10 High Street
Kingston-upon-Thames
Surrey
KT1 1EY
01208-974 6550

MIND
Granta House
15-19 Broadway
London
E15
01208-519 2122

RELATE (Marriage Guidance Council)
Herbert Gray College
Little Church Street
Rugby
Warwickshire
CV21 3AP
01788 573241

The Samaritans
10 The Grove
Slough
Berks
SL1 1QP
01753 532713

National organisation offering support to those in distress who feel suicidal or despairing and need someone to talk to. The Samaritans have 184 branches around the country, open 24 hours a day, every day of the year. The telephone number of your local branch can be found in the telephone directory.

"Help is at hand" leaflets

This leaflet is one of a series for the general public entitled "Help Is At Hand". The other leaflets are entitled "Anorexia and Bulimia", "Anxiety and Phobias", and "Bereavement". Individual copies of these leaflets are available (please send a stamped addressed envelope) from:
The Royal College of Psychiatrists
17 Belgrave Square
London
SW1X 8PG

A series of leaflets for the general public have also been produced by the Mental Health Foundation on:

• Seeing a Psychiatrist
• The Anxious Child
• Schizophrenia And The Family
• Handling Stress
• Problems With Tranquillisers
• Problems Of Alcohol
• Dementia And The Family
• Mental Health And The Family

For further information write to:
The Mental Health Foundation
8 Hallam Street
London
WC1N 6DH