*Dr Dillner’s health dilemmas: How do I get the right treatment for
depression?*
Published on Science: Psychology |
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New research suggests mental health issues are more common than previously
thought, but that people aren’t getting the help they need

Alastair Campbell is busy promoting his latest political
diaries,
but if you email him a question about depression, he gets back to you in
half an hour. “I ended up in hospital when I had my breakdown,” he says.
“Up until then I had resisted all attempts to persuade me that I needed
help. When people started to write about this side of my life I made a
conscious decision always to be open and to hope that people who have a bad
breakdown can see it does not have to mean your life is over.”

Mental health needs this kind of public discussion. A
reportpublished
last week by the London School of Economics said that a third of
families have a member with mental health problems but only one in four
people who need treatment are getting
it.
This is partly due to people not realising that they have got a mental
illness but also because of a lack of resources to treat them.

The most common mental health problems are depression and anxiety, which
often co–exist. The report points out that other mental health problems
such as schizophrenia are also under treated but are rarer and a higher
proportion of people get help. Depression is a relapsing condition for half
of people who have it, but the other half can be cured
How can you tell if you have depression?

It seems that few of us diagnose ourselves as depressed. “People often come
to see me not with a mental health problem, but with the impact it has on
their lives,” says Dr Andrew Jones, a sessional GP in Surrey and head of
clinical engagement at the BMJ Group. “They’ll be struggling at work, not
sleeping, drinking too much alcohol or getting headaches. But they know
somewhere that it’s not really the problem.”

This may be because it is hard to recognise your own depression. “We all
know what it is like to feel sad when something bad happens but with
depression the feelings go on for much longer and you don’t bounce back,”
says Dr Jim Bolton, a psychiatrist in south-west London. “If you think you
are depressed or anxious you should see your GP. It won’t be an
uncomfortable conversation.”

In fact GPs can detect depression by running through a short questionnaire, the
PHQ-9>,
in which you are asked if you are feeling tired, having difficulty
concentrating or if you have thought about ending your life.
What causes depression?

There is no neat theory to explain depression. “A lot of sadness is
entirely appropriate,” says Dr Bolton, “but depression seems to carry on
when the events have resolved. We all have a certain resilience and
vulnerability. One person might see something as a challenge while another
will feel overwhelmed by it and that will depend on their life experiences,
upbringing and genetic factors.”

Helen Lester, GP and professor of primary care at the University of
Birmingham says: “We don’t know enough about depression to explain it. The
evidence is unclear about the interaction between genes and the
environment
.”
How do you know if you need treatment?

“Depression is divided into mild or moderate and severe,” says Lester. “If
someone has mild depression, I talk about changes they can make to their
lifestyle such as reducing how much they drink, advising them to sleep
properly and to exercise. (The National Institute for Health and Clinical
Excellence recommends three 45- to 60-minute sessions a
weekalthough recent
research suggests this won’t
necessarily help.)
They can also be prescribed online cognitive behavioural therapy to do once
a week for two to three months. It is quite hard work: people have to note
their negative thoughts and learn how to think about positive things.”

If the depression is more severe, antidepressants are suggested, such
as selective
serotonin re-uptake
inhibitors(SSRIs),
eg Prozac or Citalopram, which increase the amount of serotonin in
the brain and seem to help lift your mood. “I rarely prescribe on the day,”
Lester says. “I would ask you to look up antidepressants and the
side-effects,
for example 5% will get diarrhoea, and to chat to friends and family
about whether
you should take
them.
Then a week later I would ask you to come in for a review. Often women in
particular will say they hadn’t realised some of their friends had been on
them. This normalises it – mental illness is not this terrible scary thing
that means you are going mad.” If you do take SSRIs it can take two months
to feel different and you will need to continue to see your GP while you
are taking them. “I say from the start that they will need to take them for
12 months,” Lester says.

If you want face-to-face CBT you may have to wait a couple of months
(depending on your area). But there are things you can do to improve your
mood in the meantime. Sheila Gill, a psychological therapist in north
London and co-author of Therapy for
Beginnerssays
it can feel as if tackling depression is an impossible task. “When
people are depressed they can debride their lives of activities, which
makes them feel even worse. We try to get them up, moving about and doing
things. Normally when you’re tired you need to rest more but the fatigue of
depression is such that going to the gym or other physical activity, even
walking to the corner shop, may help you to feel better.”

Doing something
new,
no matter how small, may help to lift your mood. “If you walk home along a
different street, choose a different kind of sandwich or sit in a different
chair, you may begin to feel that you can begin to change bigger things.”

“I also tell people to begin to adopt an attitude of kindness towards
themselves,” says Gill. “In depression, the single most important thing to
challenge is negative thought processes.”

When you have CBT you may be surprised how much you’re involved in it –
there’s no sitting back and being “therapised”. “We give people homework
such as keeping weekly thought journals. When your mood is low, your
thoughts don’t reflect reality. We help people to challenge their thoughts
as in a court case. If you say you’re a failure we will ask if there is any
evidence in your life that contradicts that view. I encourage people to put
a distance between themselves and their thoughts.”

Part of the role of a therapist, says Gill, is to bring out your patient’s
inner resilience. Campbell has certainly kept his, writing extensively on
depression despite having recurrent bouts of the condition. “I am actually
very proud of my breakdown,” he says. “Or the recovery at least. And of the
fact I have sort of learned to live with depression.”

*For more information or help dealing with depression, visit:
**mind.org.uk*
* or **samaritans.org*

– Depression
– Mental health
– Health
– Psychology
– Health & wellbeing
– NHS

Luisa Dillner

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