Managing Depression

Friday 22nd November 201314.00 – 15.00

KSW 1.04

Michael BryantLSE Student Counselling Service

Depression: Living with the Black Dog

What is depression?Depression is common. Symptoms can affect day-to-day life and can

become very distressing. Treatments include psychological (talking) treatments and

antidepressant medicines. Treatment takes time to work but has a good chance of success.

Some people have recurring episodes of depression and require long-term treatment to keep symptoms away.

Who gets depression? Cont.About 2 in 3 adults have depression at some time in their life.

Sometimes it is mild or lasts just a few weeks. An episode of depression serious enough to require treatment occurs in

about 1 in 4 women and 1 in 10 men at some point in their lives. Some people have two or more episodes of depression at various times

in their life

Exhaustion Funnel

How is depression medically diagnosed?

There are no physical tests for depressionyour GP may examine you and do some urine or blood tests to rule out

other conditions that have similar symptoms, such as an underactive thyroid.

The main way in which your GP will tell if you have depression is by asking you lots of questions about your general health and how the way

you are feeling is affecting you mentally and physically.

What causes depression?

Life eventsLoss

AngerChildhood experiences

Physical conditions

What causes depression? Cont.

Side effects of medicationDiet

Street drugs and alcoholGenetics

Chemical changes in the brain

What is the difference between low mood and depression?

Low Mood can include:• sadness

• an anxious feeling• worry• tiredness

• low self-esteem• frustration• anger

Low mood will tend to improve after a short time.

What is the difference between low mood and depression? Cont.

DEPRESSION SYMPTOMS ALSO INCLUDE:

feeling irritable and intolerant of others having no motivation or interest in things

finding it difficult to make decisionsnot getting any enjoyment out of life

having suicidal thoughts or thoughts of harming yourselffeeling anxious or worried

What is the difference between low mood and depression?

DEPRESSION SYMPTOMS ALSO INCLUDE:

continuous low mood or sadnessfeeling hopeless and helpless

having low self-esteem feeling tearful

feeling guilt-ridden

Symptoms of depression: psychological

continuous low mood or sadnessfeeling hopeless and helpless

having low self-esteem feeling tearful

feeling guilt-ridden

Symptoms of depression: psychological cont.

feeling irritable and intolerant of others having no motivation or interest in things

finding it difficult to make decisionsnot getting any enjoyment out of life

Feeling anxious or worriedHaving suicidal thoughts or thoughts of harming yourself

Symptoms of depression: physical

moving or speaking more slowly than usual change in appetite or weight (usually decreased, but sometimes increased)

constipation unexplained aches and pains

lack of energy or lack of interest in sex (loss of libido) changes to your menstrual cycle

disturbed sleep (for example, finding it hard to fall asleep at night or waking up very early in the morning)

Symptoms of depression: social

not doing well at worktaking part in fewer social activities and avoiding

contact with friendsneglecting your hobbies and interests

having difficulties in your home and family life

Specific forms of Depression: SAD

Seasonal affective disorder (SAD) :this is seasonal depression which is related to day

length. It usually comes on in the autumn and winter, when days are short and the sun is low in the sky, and

gets better as the days get longer and brighter.

Specific forms of Depression: BPD

Bipolar disorder (manic depression):Some people have major mood swings, when periods of

depression alternate with periods of mania. When manic, they are in a state of high excitement, and may

plan and may try to carry out over-ambitious schemes and ideas. They often then have periods of severe depression.

Specific forms of Depression: Clinical

Clinical depression: Depression ranges in seriousness from mild, temporary episodes of

sadness to severe, persistent depression. Doctors use the term "clinical depression" to describe the more severe form of depression

also known as "major depression" or "major depressive disorder."

For a diagnosis of clinical depression, you must meet the symptom criteria spelled out in the Diagnostic and Statistical Manual of Mental

Disorders (DSM). The DSM is a guidebook used to diagnose mental illness in the United States.

Specific forms of Depression: Clinical

Five DSM Criteria for Clinical depression – • Depressed mood most of the day, nearly every day• Loss of interest or pleasure in most activities

• Significant weight loss or gain• Sleeping too much or not being able to sleep nearly every day

Specific forms of Depression: Clinical – cont.

FIVE DSM CRITERIA FOR CLINICAL DEPRESSION: • Slowed thinking or movement that others can see

• Fatigue or low energy nearly every day• Feelings of worthlessness or inappropriate guilt

• Loss of concentration or indecisiveness• Recurring thoughts of death or suicide

What can you do about Depression?

Develop emotional intelligenceUnderstand the concept of learned helplessness

Talking therapiesDevelop a mindfulness practice

Developing emotional intelligence

Understanding emotionsALEXITHYMIA : inability to identify / describe one’s emotions.

Mad Bad Sad Glad

Learned helplessnessLearned helplessness was discovered when researchers immobilized a dog and exposed it to electric shocks that

could neither be avoided nor escaped. Twenty-four hours later, the dog was placed in a situation in

which electric shock could be terminated by a simple response.

The dog did not make this response; instead, it just sat passively. This behavior was in marked contrast to dogs in a

control group that reacted vigorously to the shock and learned to turn it off.

Book: ‘The MindfulWay Through Depression’

Mark Williams

8 week mindfulness programme

Talking Therapies: CBT

(CBT) helps you understand your thoughts and behaviour and how they affect you.

CBT recognises that events in your past may have shaped you, but it concentrates mostly on how you can change the way you think, feel

and behave in the present.It teaches you how to overcome negative thoughts, for example being

able to challenge hopeless feelingsComputerised CBT is a form of CBT that works through a computer

screen, rather than face to face with a therapist

Talking Therapies:Counselling

Counselling is a form of therapy that helps you think about the problems you are experiencing in your life to find new

ways of dealing with them. Counsellors support you in finding solutions to problems, but do not tell you what to

do.Counselling is available at LSE from the Student Counselling

Service.See our website:

It is also available on the NHS usually consists of six to 12 hour-long sessions. You talk in confidence to a counsellor. The counsellor supports you and offers practical advice.

Talking Therapies:Interpersonal Therapies (IPT)

IPT focuses on your relationships with other people and on problems you may be having in your relationships, such as

difficulties with communication or coping with bereavement.

There's some evidence that IPT can be as effective as antidepressants or CBT, but more research is needed.

NHS Care pathways for depression

NHS CARE FOR ADULTS WITH DEPRESSION

NHS TREATMENT FOR MILD TO MODERATE DEPRESSION TREATMENT

NHS TREATMENT FOR SEVERE ADULT DEPRESSION TREATMENT

Diagnostics Tests

PHQ-9: Patient Health Questionnaire: Quick Depression Assessment

GAD 7: Generalised Anxiety Disorder AssessmentQuick Anxiety Assessment

Pleasantness Calendar

Unpleasantness Calendar

Resources /ReferecnesLSE Student Counselling Service:

NICE Guidelines for Treatment of Depression:http://www.nice.org.uk/CG090

I had a Black Dog Blogspot:http://ihadablackdog.blogspot.co.uk/

Depression: the Black Dog