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Having reviewed the Lifeplus: Attitudes to Mental Wellbeing Full Report conducted by Cambridge Market Research I recognise the concerns about use of antidepressant medications, including the frequency of use and long term effects, an increasing desire for alternative mental health support.
“Depression is the most common mental health disorder and is thought to be the second leading cause of disability worldwide. There are different types of depression and severity ranging from mild to severe. I believe it is important to ensure we recognise the nature of the problem and make sure that intervention or treatment is most appropriately pitched to the unique needs of the individual. I would always want to ensure that depression is taken seriously, and that an individual and others around including professionals, family/friends (as appropriate) look at how to get help to move forward. ”
There is good news in that there are lots of different treatment options available for depression, and importantly, there are lots of things that you can do yourself to deal with depression (if it arises) and take care of your mental health in the longer term.
I have worked in mental health for nearly 40 years, I have always been saddened by the stigma associated with mental health, including depression; however, I am heartened that the negative views on mental health are gradually being eroded, individuals are starting to recognise and report mental health issues more readily and look to seek help. This is a great step forward, although as a nation we do need to continue moving forward in this direction, as more work is needed.
So, what can you do to recognise if you are becoming depressed, and what you need to do to get things back on track? A good starting point is to carry out your own mental health check; pay attention to your mood including sadness and irritability, your energy, sleep, and appetite. Try to consider if this is typical of how you would usually feel, i.e. is this your “normal healthy self”?
If you believe things are not as they should be and you suspect depression, I would encourage you read a little more about depression (from websites such as the NHS, Young Minds, the mental health charity MIND, or the Royal College of Psychiatrists) and decide what you would like to do to deal with it. The important thing is to recognise that depression is an illness, not a weakness, it is a temporary state, there are many things you can do about it in order to feel better including several treatment options, it is about you considering what most appropriate step forward is for you. In managing this please make sure that you are kind to yourself.
Given that depression is so common and more people are recognising the need for treatment it is helpful to know there are numerous treatment options for dealing with depression; also, we are increasingly aware of what we can do ourselves to help deal with depression, and/or minimise its effect.
I often think of depression in the same way that I would diabetes type 2, with both disorders there are a range of interventions to help deal with it. In each case, I would not expect, “one size fits all”, for instance in diabetes type 2 some people manage their symptoms by carefully watching what they eat and when, others may need medication, and take tablets to deal with their diabetes type 2, unfortunately for some injections may be necessary in order to keep the diabetes type 2 under control to optimise their well-being. Depression is exactly the same; some people with depression could make particular changes in their life, use self-help, support from friends and manage to keep their symptoms under control, others may use psychological therapy such as interpersonal psychotherapy (IPT), or cognitive behavioural therapy (CBT) to get things back on track, others may need antidepressant medication, or a combination of psychological therapy and medication. Some individuals may experience depression which is tougher to treat and requires more potent intervention which involves different types of medication (including mood stabilising medication, medication for psychotic illnesses – both have antidepressant effects). People need to be aware that depression is treatable, but we need to work at ensuring treatment is pitched at the right level for the individual concerned to help the person get better.
There are several talking therapy treatment options available on the NHS, you can be referred by your GP, or can contact services directly to ask for help; the services are called Improving Access to Psychological Therapies (IAPT), they can direct you to self-help services, counselling support, IPT and CBT as outlined above.
It is just as important to pay attention to our mental health as it is our physical health, I have outlined a number of things you can think about below to help ensure you achieve and maintain a positive mental health.
If you can imagine yourself as a battery, what level of charge are you currently running on? Do you feel full of energy, operating on full power, do you feel you are running on half the power, or are you running on empty? Think carefully and be curious about what is going on in your life that drains your battery? How much does it drain your battery? Are there any changes you could make to limit this drain? Who else might be around to help limit the drain? On the other hand, what recharges your battery? Is there anyone else around who gives your energy levels a boost? Are you doing enough with them, or enough activity to keep your battery at the optimum charge?
Spend some time to think about all these aspects of your life and consider how much time you spend on each area, your level of satisfaction, enjoyment, any area of difficulty, or challenging area(s)? Do you feel you have the right balance of time and activity spent at work, at home and socially, including rest and relaxation? Are there any changes that you could make in your life in doing less or more in any of these areas? Is there anyone else, or any other support or help from others that would enable a better balance?
What do you do that gives you a boost/lift? What are the things that you enjoy, or a real sense of satisfaction? Sometimes elements of work, social/hobbies or relationships may on balance be an overall positive on how we feel about ourselves, and ultimately our mental health. Tune in to recognising what it is about this aspect of our life that contributes to a positive sense of self-worth, and positive mood, try to appreciate them and if possible do more. Conversely, be honest with yourself about the areas of concern in your life, what areas drain your mood and lead to negative feelings? Are there any changes that you can make, are you the only person that can deal with this, who else is around, do you readily ask the help?
I have provided therapy to many clients over the years and have never underestimated the impact of talking to others, sharing worries/concerns and the beneficial effects this can bring. In fact, many people have made comments to me that this has been invaluable and does help them move forward. I would urge you to think about this, it sounds simple but can make a world of difference in terms of dealing with stressful and distressing events and can help contribute to a positive mental health/well-being. It is important to recognise that you do not always need to get help from a professional therapist, a good, supportive friend who shows compassion and understanding are worth their weight in gold.
“Be kind to yourself and recognise that it is entirely normal to feel bad when bad things happen; often people give themselves a hard time, view themselves as weak, and sadly may state or feel that they do not want to be a burden to others, by offloading their worries. I believe that many people do not share or talk about their worries for these reasons, which leads to an increased risk of developing mental health issues such as depression.”
There is a lot in the saying, “a problem shared is a problem halved”, having someone else to share any problems or worries, off load any worries is always beneficial. It is important to recognise that although feelings are distressing it is healthy to express and share them with people who you trust.
I have already talked about tuning your body and noticing what may help or hinder positive feelings you may have, and crucially, what the “running charge” is in your overall battery pack. We do know that exercise releases feelgood hormones which will contribute to a positive impact on our mood; likewise, attention to regular eating, making sure you do not under eat or overeat comfort foods as this leads to fluctuations in energy levels which can impact depression. We do know that alcohol and drugs can lead to depression and other mental health problems, with regard to alcohol I usually ask clients to think about managing their depression and tuning into what effect alcohol has; sometimes the social interactions associated with having a drink leads to a net gain, for others however there may be more negative effects. I believe it is an individual decision on what should be done to deal with the symptoms assuming you are not taking medication which is prohibited with alcohol.
I would encourage you to proactively think about what you can do for rest, relaxation, enjoyment and fun; all things that recharge our batteries, improve our sense of well-being and can optimise our sense of wellbeing and mental health. Sometimes life can take over, we lose the ability to prioritise making time for ourselves in this area, try to keep this on your radar, making time for these activities, believe me, it can make a huge difference in terms of your mental well-being.
We live in a social world and are surrounded by many relationships at home, work and in our social lives, some relationships may be difficult or challenging, and others may be supportive and/or rewarding. In simple terms I like to think of this as our “radiators and drains”: who is there to bring warmth, support and are likely to recharge our batteries, and make us feel better about ourselves? Who causes a drain and makes us feel less good about ourselves? How can you make the best of the radiators in your life? Are you having enough contact, asking for help, doing enough “fun” or relaxing activity? Is there anything that you can do to deal differently with the “drains” in your life?
Despite your best efforts, and attempt to manage your mental health, medication may still be necessary and appropriate to treat depression. In this instance, I would encourage you to read information about depression and treatment, be assertive in asking professionals for help and advice, this can include your GP, mental health professional or pharmacist as well as looking at information from professional websites online. If medication is offered do not be frightened about asking what medication is needed, for how long, and what would be the expected outcome from the treatment. Tune in to your body in recognising symptoms of depression as outlined above, and notice any changes with the treatment, the aim is ultimately to feel back to your “usual self”, the aim is for the medication to treat the symptoms without causing any intolerable side effects. If you have any concerns about either return to your GP to ask about other options.
Dr Elizabeth Robinson is a psychotherapist and has worked in the field of mental health for over 35 years. Her initial professional training was as a psychiatric nurse, she then studied Health Sciences (BSc.Hons) followed by a PhD at the University of Durham. Her research examined functional brain imaging in depression with interpersonal psychotherapy.
She has worked with acute mental health problems, forensic psychiatry and as a senior researcher in mental health research. Her initial training in interpersonal psychotherapy was in Geneva in 1997 after which she completed her supervised cases and research training in 1998 from expert interpersonal psychotherapists from New York. Whilst working as a researcher she was the lead interpersonal psychotherapist for a number of clinical trials.
She currently provides training in interpersonal psychotherapy, has organised numerous courses nationally, and provides ongoing supervision to therapists such as psychiatrists, psychologists, nurses, social workers and occupational therapists. Within research, she was involved in the assessment, psychiatric ratings and treatment for randomised clinical trials in schizophrenia, depression, anxiety, social functioning, suicide, sexual dysfunction, interpersonal psychotherapy and brain imaging. Although her special interest is in depression, trauma and sexual and relationship difficulties she has considerable experience working with anxiety and phobias and uses a number of psychological treatment models including interpersonal psychotherapy, psychosexual counselling, eye movement desensitisation and reprocessing, anxiety management and cognitive behavioural therapy.
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