From despair to where
You have aches and pains and feel low, but you’re too embarrassed to go to your doctor and ask for help. Yet more than 80 per cent of the most serious depressions can be quickly helped, says the support group Aware.
With effective psychotherapies (talking treatments and counselling) and non-habit forming antidepressant medications, people can recover from depression and can help prevent recurrences.
Last week, we looked at the stark and shocking figures for depression in this country – one in 10 of the population is thought to be affected by depression – more than 400,000 people.
This means you shouldn’t feel embarrassed, because doctors are well used to treating sufferers of depression. And you’re also far from being alone: a huge number of people out there know what you’re going through. In fact, one in three of us will be affected by depression at some point in our lives – either directly, or as a family member.
As a woman, you are three to four times more likely than men to have depression, but men are more likely to die by suicide. The Irish suicide rate has doubled since the 1980s. According to Aware, depression can follow setbacks in life, such as the death of a loved one, relationship or financial difficulties, or problems at work or being diagnosed with a medical illness.
An inherited tendency towards depression is a major factor in determining how depressed a person will become following a loss. Professor Patrick McKeon, a consultant psychiatrist with St Patrick’s Hospital, has summed up the illness as a disturbance of feeling, energy, sleep, thinking, interest, value (especially selfvalue), and one that can include physical aches and pains associated with anxiety, stress and tension, as well as a distortion of how people view their life and their desire to live.
For those who are in the midst of elation – associated with bi-polar disorder which was previously known as manic depression – there will be little need for sleep as well as boundless energy and speeded-up thinking, In a manic episode, sufferers may also have an inflated sense of self and a feeling of being invincible. A GP is the first person most people turn to for help, according to Mental Health Ireland.
So GPs are well used to assessing problems associated with depression. They may provide medication and monitor a sufferer. A GP may also refer a patient to a specialist in the area of mental health – for example, a psychiatrist, a psychologist or a counsellor if necessary.
A psychiatrist will normally work in a psychiatric hospital, or unit, or as part of a community care team, and will assess a patient, often at a hospital out-patient clinic, and form a diagnosis and treat accordingly.
Treatment may involve medication and/or referral to the mental health team – a mental health social worker, a psychiatric nurse, or an occupational therapist.
Admission to hospital, in a small number of cases, may be suggested if a person’s mental health difficulties are severe. A psychologist – who is trained in the study of human behaviour and experience – may specialise in mental health, and if so usually works as a clinical, community or counselling psychologist.
Unless also medically qualified, a psychologist will not prescribe medication. A psychologist may be a counsellor, but not all counsellors are psychologists. Those who are not, may have a basic degree or training in other areas and/or relevant work experience – for example, teaching or nursing, plus a counselling qualification.
The idea behind talk therapy is to help the depressed person take control of their lives. Selfreferral is the usual route to counselling, although a GP, or a psychiatrist or even a trusted friend, may be able to recommend someone suitable.
Drugs may be prescribed for depression, to relieve the symptoms and stabilise the condition – the main groups are antidepressants, tranquil- lisers and mood stabilisers. Medicines such as antidepressants can bring the levels of serotonin back to normal – low levels of the chemical serotonin are thought to be a cause of depression and other related conditions.
The full benefits may take two to three weeks to kick in, and it is important to take prescribed medication even when you feel completely well as early discontinuation may cause a relapse.
Tranquillisers are used to treat illnesses such chronic anxiety, depression, schizophrenia and psychotic depression. These drugs may suppress a chemical, dopamine, thought to be over produced in people with schizophrenia.
Mood stabilisers are drugs used in the treatment of excessively “high” moods, irritability, increased energy and activity. Although ongoing depression requires medical attention – always see your doctor if you feel you may need help – there are ways you can improve your own mental health.
? Be aware of your stress triggers, for example, if ten-hour working days leave you feeling down, it may be a sign you need to reconsider your working life.
? Pay attention to your lifestyle – all work and no play/relaxation leads to stress, resentment and depression.
? Spend time with people whose company you enjoy.
? Keep active - in a recent study, 90pc of sufferers said that a 30-minute walk in the park boosted their self-esteem.
? Have someone to go to with your problems. Aware – www.aware.ie; Mental Health Ireland – www.mentalhealthireland.ie; Feeling blue? The Samaritans can help. Call 1850 609090.
Signs of depression
? Loss of interests or pleasure
? Fatigue or low energy
? Disturbed sleep
? Poor concentration or indecisiveness
? Low self confidence
? Decrease (or increase) in weight
? Agitation or slowing of move ments
? Feelings of guilt or self blame
? Suicidal thoughts or acts
The abc of talking to a professional
Lindie Spain
ONE OF the most effective treatments for mild to moderate depression is counselling.
By counselling, I mean talking to someone who is properly trained. The person may be called a counsellor or a psychotherapist.
The difference between these two is sometimes difficult to distinguish. Some people use the terms to mean the same thing, as much of their work does overlap.
The differences are usually to do with the type of training and special interests of the individual counsellor or psychotherapist. Whether you see a counsellor or a psychotherapist doesn’t usually matter.
What matters is that they have done the appropriate training and are properly accredited by a recognised organisation, such as the IACP (www.irishcounselling.ie. Address: 8 Cumberland St, Dun Laoghaire, Co Dublin, 01 2300061)
Acceptance and respect for the client are essentials for a counsellor and, as the relationship develops, so too does trust between the counsellor and client, enabling the client to look at many aspects of their life, their relationships and themselves which they may not have considered or been able to face before.
The counsellor may help the client to examine in detail the behaviour or situations which are proving troublesome and to find an area where it would be possible to initiate some change as a start. The counsellor may help the client to look at the options open to them and help them to decide the best for them.
Counselling does not involve giving advice or solutions, and a counsellor cannot prescribe medication. Cognitive behaviour therapy is used with great success in treating clients suffering with depression; however, it is just one of many different therapies offered by qualified counsellors.
A counselling session typically last 50 minutes to an hour. The price of counselling can vary widely and you may be entitled to free counselling – and some counsellors operate a sliding scale of charges that will take into account your financial situation.
You may begin to simplify your search for the right counsellor by first identifying your personal priorities. Perhaps, you may prefer to see a female or a male therapist. Perhaps, you want to see someone who is not too far away… Before you choose a counsellor, however, it is crucial you understand that in Ireland, anyone can call themselves a counsellor and be paid to provide their “counselling services”. This means Buyer Beware. The IACP can assist you in finding a qualified and accredited counselor in your area.
Sometimes it’s simply about whether you’re eating right
Dr Niamh Houston
A DEPRESSIVE episode is diagnosed when a patient suffers from combination of psychological and physical symptoms that are significantly different from how the person felt previously. It requires more than just a sad mood for the diagnosis to be made.
Although it is often normal to experience sad moods in response to a major event in your life, such as bereavement, a person with depression usually has sadness out of proportion to the event. Poor diet, nutritional deficiencies, and even inadequate sunlight can contribute to a persistent low mood. If you suspect that you are clinically depressed, first consult a doctor to rule out any other underlying cause (such as a thyroid problem).
Your doctor may then may want to monitor your mood for a few weeks, before deciding on the appropriate treatment. Conventional antidepressants are effective in treating depression, and most people can expect to see an improvement in their mood within two to three weeks. If you have any concerns about taking such medications, it is always important to discuss these with your doctor.
Antidepressants work best when used with professional counselling. Get your GP to refer you. Counselling will help you develop skills to deal with current stresses but changes to your diet can help recovery also.
Eat a good balanced diet with plenty of whole grains, vegetables, and legumes. These complex carbohydrates are high in serotonin, a deficiency of which can lead to depression and insomnia. Soy, beans, lean poultry, eggs, nuts (walnuts are excellent), and seeds are excellent sources of protein, which will help boost your energy levels. Try to include cold-water fish, such as salmon, mackerel, cod in your diet three times a week.
Cut out your intake of hydrogenated and saturated fats – found in convenience, processed or fatty/fried foods – which leave you feeling worse still. To keep your sugar levels regulated, try eating 5-6 smaller meals.
Avoid alcohol
Alcohol is a depressant, so avoid this. Herbal teas can help you relax: take Valerian tea at night to help you sleep. Hops or passionflower tea can also help alleviate tension.
The herbal medicine St John's Wort is used to treat mild to moderate depression. Take 300mg (of a product standardised to 0.3 % hypericin) three times a day. Always tell your doctor if you are taking this, as it can interact with other medications.
Diet supplements that help depression also include fish oil – take a daily dosage of between 500mg to 1,000 mg of EPA/DHA(essential fatty acids ).
Also take 50 mg twice a day of a vitamin B complex – B vitamins such as B12, folic acid, and B6 are essential for neurotransmitter metabolism. And of course, regular exercise and touch have been shown to be effective in improving depression.
