Depression and low mood

Depression is a common, and increasing 'illness'. Some estimates suggest that up to 10% of the population suffer at any time, and women are twice as likely as men to be affected. It is experienced as a mood, sadness or gloom, accompanied by loss of interest and pleasure in life. People who suffer are not weak or lazy and the condition can be treated.

Your GP is probably the best and first place to go if you think you are suffering from depression. He or she will be able to make a diagnosis and, if the depression is deep or long lasting, may prescribe drugs and/or refer you for some form of 'talking therapy'. The services available will depend on a number of factors, including the manner in which services are comissioned by that practice. Many GP surgeries have a counsellor in the practice, or you may initially be offered 'guided self-help', structured group activity or computerised cognitive-behavioural therapy (cCBT) - usually employing a piece of software called 'Beating the Blues'. Many agencies, including some Primary Care Mental Health Teams accept self-referrals although with GP comissioning groups this may become a thing of the past. This means that if you want to follow up cCBT or talking therapies, you do not necessarily need to wait for your GP. However, he or she may be informed of treatment that you receive. Most agencies have a waiting list, often several months or more, and it is worth looking around for voluntary agencies and charities. If your personal finances permit you can also find a private counsellor. I work with depressed clients, either as a problem in itself or as part of more complex problems and issues.

Depression can be viewed in a number of ways. Your GP will use medical definitions to make a diagnosis. The main symptoms are depressed mood, loss of interest or pleasure, fatigue/loss of energy, feelings of worthlessness or guilt, negative or suicidal thoughts, diminished ability to think, changed level of activity, sleep disturbance and appetite or weight loss. Not everyone will have all of the symptoms and there are different levels of severity. Most people find that it is helpful to put a name to the way they are feeling - but depression is not a physical ailment and defies simple definitions. There is a high probablity that it will recur; sometimes it aggravates or causes other health problems; and it frequently complicates conditions such as diabetes. There are many psychological tests, but these are best administered by a qualified person and most are protected by copyright, so they are not easy to obtain. A number of websites offer tests, but usually ask for personal information and require payment in return for a detailed report.

In general, drugs are effective in treating the symptoms of depression, but less effective in preventing a relapse. They are relatively safe, not physically adictive, and for many people the side effects are tolerable. For the deeply depressed, they may be the only thing that helps in the short term, perhaps in combination with counselling or therapy, and long term medication works well for some. However, like all drugs, antidepressants have side effects and there is a small chance of an adverse reaction. Some people also think that they mask problems that need to be addressed more directly. Recently, there have been questions about long term effectiveness - but as with all research, there are issues of validity and interpretation. Your GP will be reluctant to prescribe antidepressants for mild or short term depression.

There is a large amount of self help material about depression and it is an area in which self-help can be effective. However, in the midst of a deep depression it is not always easy to find the necessary motivation. The depression may have deeper roots - current problems, issues from the past, life events, or there could be a medical cause. Depression often accompanies childbirth, bereavement or other losses; sometimes it follows a seasonal pattern; and it is more prevalent in older age. It may also be that depressive patterns of thinking have become deeply embedded. Self-help is unlikely to be enough, and the best time to think about self-help may be as the depression lifts, or after it has gone.

In situations where depression is part of a complex combination of current problems and issues from the past, sufferers are often confused and bewildered. They are afraid of being pulled back and want to look forward. However, sometimes it is necessary to work on these painful issues to find a way out of depression.

Whatever the approach, recovery will be helped by a number of practical common-sense steps and lifestyle changes, including:

Mindfulness may help to prevent a relapse, although it requires time and commitment.

A number of 'talking therapies' are used to treat depression. The most widely used approach is cognitive-behavioural therapy (CBT) which focuses on current thoughs and actions, and this is supported by clinical guidelines from the National Institute for Health and Clinical Excellence (NICE). The availability of CBT is being improved under the government funded IAPT initiative. A proportion of people fail to respond to CBT and some do not like the approach. There are other alternatives and there is no evidence to suggest that these are less effective. I use techniques from CBT in my practice, but my approach is probably more suitable for those who want to look deeper, or try an alternative. Many of my clients had an unsucessful experience with CBT. They had found that the approach was difficult to accept; did not get to the heart of the problem; or simply did not work for them. Some of my clients have found that after some deeper work, they are able to employ techniques they previously learned in CBT.

For some people, a more supportive approach can be more appropriate. A counsellor should be able to offer a safe environment; assist in establishing a way forward; provide support through the bad times; and help to contain anxieties about the future: while working on areas that will really make a difference.

There are many sources of information and help. I list a few below, and provide links to other websites in the right hand sidebar. Most are based on CBT or Mindfulness, which can be practiced alone (although it is better to have a guide). Exception are Dorothy Rowe's humanistic classic that has helped millions of sufferers, and Lewis Woperts readable and insightful book, based on his personal experience.


Sources of information and help:

Gilbert, P, (2000). Overcoming depression: A self-help guide using cognitive behavioral techniques (new revised edition). London: Robinson

Greenberger, D. & Padesky, C.A. (1995). Mind over mood: Change how you feel by changing the way you think. London: Guilford

NHS Manchester. (2007). A self help guide to: Depression and low mood.

Rowe, D. (1983). Depression: The way out of your prison. London: Routledge

Williams, C. (2009). Overcoming depression and low mood: A five areas approach (3rd ed.).

Williams, M. Teasdale, J. Segal, Z. & Kabat-Zinn, J. (2007). The mindful way through depression: Freeing yourself from chronic unhappiness. New York, NY: Guilford Press

Wolpert, L. (1999). Malignant sadness: The anatomy of depression. London: Faber and Faber


Copyright © 2011 George MacDonald. All rights reserved