Depression

 

Depression is a common mental disorder that affects people of all ages.

Low modd is   both a symptom and a consequence of depression

According to the Royal College of Psychiatrists (RCPsych), one in five people in the UK becomes depressed at some point during their life. Even the young can be affected, says the NHS, with about four percent of children aged five to 16 in the UK thought to showsymptoms of anxiety or depression. Some people, however, may be more likely to develop depression than others. For instance, there’s evidence to suggest that those who are less well off, people with long-term illnesses and the unemployed are more likely to have depression than the rest of the population. Indeed, most people feel fed up or low from time to time, especially when things aren’t going as well. But often these feeling disappear after a few days.  Depression, on the other hand, is when you feel low for a few weeks or even months, when the feelings keep coming back again and again, or when the way you feel affects your day-to-day life.

 

Health issues

Unfortunately, depression doesn’t come on its own. According to experts at the RCPsych, there’s much evidence to suggest that depression doubles your risk of developing coronary heart disease. If you have a mental health disorder, you’re also more likely to smoke (it’s thought that people with mental health issues smoke almost half of all the tobacco used in the US and account for half of all smoking-related deaths).

 

Meanwhile, many things can cause depression, such as stress, illness or lifestyle changes such as divorce and separation, or a family history of mental health problems. Though sometimes it can happen for no obvious reason

 

Signs to look out for

There are many symptoms of depression, and they vary from one person to the next. Here are some of the main signs to look out for:

 

• Lack of energy or feeling tired all the time
• Restlessness and agitation
• Having difficulty sleeping (or sleeping more than usual)
• Poor appetite, which may lead to weight loss
• Lack of interest in sex
• Feeling sad and in low spirits all the time
• Not finding any pleasure in life
• Having difficulty making decisions
• Low self-confidence and self-esteem, withdrawing from family and friends
• Feeling generally helpless and hopeless

 

If you’ve been having one or more of these symptoms for a few weeks or more, make an appointment to see your GP.

 

What is CBT?

If your GP believes you’re suffering from depression you may be prescribed antidepressant drugs, which are believed to help around two-thirds of people with moderate to severe depression.

However, according to the Royal College of Psychiatrists, self-help and talking therapies are best for mild depression and are equally helpful for moderate depression. Currently one of the most popular self-help and talking therapies is Cognitive Behavioural Therapy (CBT).

CBT is a type of talking therapy that combines cognitive therapy and behaviour therapy. If you’re affected by negative patterns of thinking or behaviour, CBT aims to change the way you feel and break those patterns – which can make you feel and act more positively.

The government’s health guidance body, the National Institute for Health and Care Excellence (NICE), claims depression may be treated effectively with CBT, along with other mental health problems such as anxiety, bipolar disorder and obsessive-compulsive disorder (OCD). The mental health charity Mind also claims CBT may be effective for mood swings, phobias, sleep problems and even the management of chronic pain and general health problems.

 

How does it work?

During a CBT session, you’ll usually talk toa therapist to identify your issues and create a structured plan for achieving your goals. These sessions usually involve just you and your therapist. However, group sessions are often effective too, as are self-learning CBT programmes that you can complete online or by using interactive CDs. Self-help books that teach CBT techniques can also be very useful.

 

How can you access CBT?

If you’d like to find out more about accessing one-to-one CBT, speak to your GP. The NHS offers CBT as part of a government-funded programme called Improved Access to Psychological Therapies (IAPT), with some therapists operating out of general practices and others working as part of community mental health teams.

 

If, on the other hand, you live in an area where the IAPT programme doesn’t have a widespread service, you can find a private CBT therapist via the British Association of Behavioural and Cognitive Psychotherapies website.

 

Meanwhile, you can learn cognitive behavioural therapy skills online for free via the MoodGYM training programme. Alternatively, try browsing the recommended CBT self-help books and CDs at the Overcoming website, or ask about suitable titles at your local bookshop or library.

 

Lifestyle tips for low mood

As well as any help your GP may give you for relieving depression, there are lots of things you can do yourself that may help you cope with your feelings, including the following:

 

Get some exercise

There’s plenty of evidence to suggest being physically activemay help lift your mood, especially if you have mild depression. Indeed, according to the NHS, exercise can be as effective as antidepressants at reducing depression symptoms. That may be because physical activity stimulates your brain to produce feel-good hormones. Most types of exercise will be beneficial, whether it’s walking, cycling, swimming, doing yoga or Pilates, or working out to a fitness DVD. Even doing some housework and gardening may help.

 

Watch your alcohol intake

When you feel down, it may feel natural to have a drink to lift your spirits. However, alcohol is believed to make depression worse. The World Health Organisation also suggests alcohol may play a contributing role in the development of depression. That’s why it’s important to avoid drinking more than the government’s maximum alcohol recommendations, which are 3-4 units a day for men and 2-3 units a day for women (one unit equals half a pint of beer, a small glass of wine or a single shot of spirits).

 

Get into a routine

Low mood and depression can affect your daily routine because you may be staying up late and not sleeping very well, for instance, or you may be skipping meals because you don’t feel like eating. But straying from your usual routine make you feel worse, so try to stick to your normal meal and bed times whenever possible.

 

Try to be positive

If your mood is low, you’ll probably see everything in a negative light. But thinking more positively may help you to see your situation from a more constructive viewpoint. Surround yourself whenever possible with people who have a positive outlook, and try to notice the things that go well, rather than the things that go badly. Even if you’re a born pessimist, you can learn to be more positive. For example, at the end of every day make a list of three positive things that happened or three things you’re grateful for.

 

Soak up some sunlight

Some people find they feel more depressed during the winter months than in the summer, which experts believe is caused by a lack of sunlight. So during the winter, get outdoors as often as possible in the daytime, especially during a bright, crisp day.

 

Talk about it

If you have friends and family you can confide in, tell them about your feelings and why you’re finding life a little harder than usual. Most people are more than happy to listen to those they care about, and you may even find that they’ve had similar feelings too.

 

If you don’t have anyone to talk to – or anyone you feel you can confide in – ask your GP about counselling. Many doctors’ surgeries have counselling services these days. Alternatively, you could contact your local branch of Mind, the mental health charity, as many offer counselling services.

 

Food mood boosters

If you feel depressed, it can affect your appetite and you may not feel like eating. Eating well, however, is important for maintaining your general health. So try to have three meals every day, including breakfast.

You may well feel like eating unhealthy foods when you feel low, but comfort eating doesn’t help in the long run. So try to eat as healthily as possible, including five or more portions of fruit and vegetables every day, plus have some protein at each meal too. And remember to drink plenty of fluids, as being even mildly dehydrated may affect your mood.

There’s currently a lot of interest in how food may affect mental health, says the charity Mind. For instance, it’s widely thought that changes in blood sugar levels can affect mood and energy levels, while some of the foods you eat may affect your brain’s production of mood-altering chemicals such as serotonin and dopamine.

So to help boost your mood, try the following:

Get your five a day

Eating five portions of fruit and vegetables every day helps to make sure you’re getting the nutrients your body needs, which will also support your emotional health.

 

Go for slow carbohydrates

If your energy level is low, your mood may often follow. That’s why it may be important to eat foods that release their energy slowly. Slow-release foods include unrefined carbohydrates such as whole grains (oats, brown and wild rice, barley, corn, quinoa, rye and whole wheat).

Fill up on fish

The omega-3 fatty acids found in oily fish are thought to be important for healthy brain functioning, as well as a range of other health benefits. According to the NHS, a healthy diet should include at least two portions of fish a week, one portion of which should be oily fish (though women of childbearing age should eat no more than two portions of oily fish a week).

You can get the omega-3 fatty acids you need by eating oily fish, such as salmon, fresh tuna, trout, mackerel, pilchards and sardines. Omega-3 oils are also found in vegetarian foods such as rapeseed oil, flaxseed oil, soya oil and soya-based foods, many nuts and seeds, and omega-3 fortified eggs.

Have a banana

Certain foods are believed to help boost the body’s production of the feel-good chemical serotonin. That’s because they contain an amino acid called tryptophan, which is converted into serotonin in your brain. These foods include bananas, turkey, chicken, fish, cottage cheese, eggs, nuts, wheat germ, avocados, milk, cheese and pulses.

Go easy on caffeine

According to Mind, caffeine is arguably the most widely used behaviour-modifying drug in use worldwide. But while a strong cup of coffee may give you a boost – which can be helpful in certain situations – drinking too caffeine much may cause symptoms such as anxiety, nervousness and depression. 

Caffeine is also found in tea, chocolate and some fizzy soft drinks. So if you suffer from low mood it’s a good idea to switch to decaffeinated and non-caffeinated varieties (or at least try to limit yourself to one or two cups of caffeinated drinks a day).

Other foods that may cause low mood problems include those that contain alcohol and sugar, so try to limit these in your diet too. Mind also suggests that wheat, dairy products, hydrogenated fats and certain artificial additives (E numbers) may also have an effect on mood.

Natural remedies for low mood

There are several natural remedies designed to treat low mood, including the following:

 

St John’s Wort

A traditional herbal remedy used for low mood and mild anxiety, St John’s wort also has strong scientific evidence behind it to support these claims. Many studies involving thousands of volunteers suggest not only that St John’s Wort may be more effective than placebo in treating mild to moderate depression (i), but others also claim the herb is as effective – at least – as conventional antidepressants (ii).

However, St John’s Wort may interact with other conventional medicines, so speak to your GP before taking it if you’re on any kind of medication, including the oral contraceptive pill, tricyclic antidepressants, statins or warfarin.

5-HTP

Many conventional antidepressant medicines work by increasing serotonin levels in the brain. The non-essential amino acid 5-hydroxytryptophan (5-HTP) is a natural compound that’s converted in the brain to serotonin, which may explain why it’s been studied as a natural remedy for depression and low mood. Indeed, there are studies that suggest it may be as effective as some standard antidepressants (iii).

Fish Oils

The omega-3 fatty acids EPA and DHA found in oily fish have been studied extensively in relation to a wide range of health problems. However, one of the areas it has shown a lot of promise in is that of treating depression.

For example, one particular study involved older women suffering from depression. After taking high doses of EPA and DHA for eight weeks, their symptoms of depression had improved significantly compared to other women who received a placebo (iv). Other studies have investigated the benefits of EPA in treating depression, with many suggesting it may be helpful (v).

High-Strength Multivitamin and Mineral

Since low levels of certain nutrients have been linked with symptoms of depression, taking a high-strength multivitamin and mineral with good amount of B vitamins, zinc and vitamin D may also help.

 

References:

(i) Kasper S, Anghelescu I, Szegedi A, et al. Superior efficacy of St Johns wort extract WS® 5570 compared to placebo in patients with major depression: a randomized, double-blind, placebo-controlled, multi-center trial. BMC Med. 2006 Jun 23.

 (ii) Singer A, Schmidt M, Hauke W, Stade K. Duration of response after treatment of mild to moderate depression with Hypericum extract STW 3-VI, citalopram and placebo: a reanalysis of data from a controlled clinical trial. Phytomedicine. 2011;18(8-9):739-742.

(iii) Byerley WF, Judd LL, Reimherr FW, et al. 5-hydroxytryptophan: a review of its antidepressant efficacy and adverse effects. J Clin Psychopharmacol. 1987;7:127-137. Poldinger W, Calanchini B, Schwarz W. A functional-dimensional approach to depression: Serotonin deficiency as a target syndrome in a comparison of 5-hydroxytryptophan and fluvoxamine. Psychopathology. 1991;24:53-81.

(iv) Rondanelli M, Giacosa A et al. Effect of omega-3 fatty acids supplementation on depressive symptoms and on health-related quality of life in the treatment of elderly women with depression: a double-blind, placebo-controlled, randomized clinical trial. J Am Coll Nutr. 2010 Feb;29(1):55-64.

(v) Jazayeri S, Tehrani-Doost M, Keshavarz SA, et al. Comparison of therapeutic effects of omega-3 fatty acid eicosapentaenoic acid and fluoxetine, separately and in combination, in major depressive disorder. Aust N Z J Psychiatry. 2008;42:192-198. Rogers PJ, Appleton KM, Kessler D, et al. No effect of n-3 long-chain polyunsaturated fatty acid (EPA and DHA) supplementation on depressed mood and cognitive function: a randomised controlled trial. Br J Nutr. 2007 Oct 24.