Understanding

Depression
‘I felt detached from the world around me. All emotions –
love, affection, anger – were gone. Actually, I can’t say I had no
emotions, I did, but they all seemed desperately negative. Most
involved fear. Fear that I would never escape the condition.’

‘I was so scared of being alone with my thoughts. At night

everything seemed so bleak. I couldn’t concentrate on anything;
I couldn’t read or watch TV. I couldn’t relax or unwind. Sleep
seemed impossible – so many thoughts were racing through my
mind. I could spend hours fantasising about ways of killing
myself.’

‘Everything to do with everyday life seemed like such hard work.

I simply didn’t have the energy to go to work, to see friends,
to shop, cook or clean. It all seemed pointless! What was the
point in eating when I didn’t even want to be alive?’

Depression can affect different people in different ways and there are a wide
variety of symptoms, both psychological and physical. If you are depressed you
may feel that nothing can help. But there are things you can do which can make
a difference. Deciding to do something is the most important step you can take.
Most people recover from bouts of depression and some even look back on it as a
useful experience which forced them to take stock of their lives and make changes
in their lifestyle.

w hat is depression?
Depression is a medical term which covers a broad range of psychological distress.
In its mildest form depression can cause lowered mood, which does not stop you
leading your normal life, but it makes everything harder to do and seem less
worthwhile. At its most severe, depression can be life threatening. You may feel
like killing yourself or simply give up the will to live.

Anxiety
People who are depressed often experience anxiety too. You become anxious when
you feel threatened, whether the threat is real or imagined. Anxiety can be
expressed through physical symptoms such as headaches, aching muscles, sweating

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and dizziness. The mind of someone who is anxious is often full of busy, repetitive
thoughts. These can make it hard to concentrate, relax, or sleep. In the long term
anxiety can cause physical exhaustion and general ill-health. Anxiety is more fully
explained in Mind’s booklet Understanding Anxiety (see Further reading p.10 for
information about the publications mentioned in this booklet).

Seasonal Affective Disorder (SAD)

This type of depression is thought to be due to the lack of daylight during the
winter months which makes some people more prone to depression. For further
information see Mind’s booklet Understanding Seasonal Affective Disorder.

Postnatal depression
This is the depression which some mothers experience after their babies are
born. It is thought to be brought on by the large changes in hormone levels in
the mother’s body after birth. For further information see Mind’s booklet
Understanding Postnatal Depression.

Manic depression
This is a condition which causes people to have episodes of depression and mania.
Mania is a state of highly excited and uncontrolled behaviour. Manic depression is

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explained more fully in Mind’s booklet Understanding Manic Depression.

hat are the symptoms of depression?

Depression affects different people in different ways. Depression can produce a
broad range of symptoms which can be emotional or physical.

People suffering from depression may:

l experience a pervasive low mood
l have poor self-esteem and self-confidence
l be preoccupied with negative thoughts
l feel numb, empty and despondent
l blame themselves and feel unnecessarily guilty about things
l find it difficult to concentrate or make decisions
l be unusually irritable or impatient
l wake early, or have problems getting to sleep
l eat more and put on weight, or not eat properly and lose weight
l not enjoy normally pleasurable activities
l experience a loss of libido
l use more tobacco, alcohol or other drugs than usual

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l consider, or commit, acts of self-harm or suicide
l have reduced energy and reduced activity
l cut themselves off from others rather than asking for help or support

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l have bleak, pessimistic views of the future.

hat causes depression?

There is no one cause for depression; it varies very much from person to person.

In many cases, depression is triggered by life-events, especially in a first episode of

depression. What happened to you as a child can have a profound effect on how
you feel about yourself in the here and now. Traumatic experiences such as a
physical attack or rape can trigger depression, as can bereavement. It is not just the
negative experience which causes depression, but how you deal with it. Negative
experiences are more likely to contribute towards depression if your feelings about
the experience are not expressed or explored.

Depression can also be linked to physical causes. Poor diet, lack of physical fitness
and illnesses such as influenza can all leave you feeling depressed. Frequent use of

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some recreational drugs can also lead to depression.

hat treatments are available?

A wide range of treatments for depression are available. However, the availability
of some of these treatments can be restricted depending on where you live. For
example, talking treatments are more readily available in London and the South-
East than they are in rural areas of Northern England.

It is ironic that when seeking help for depression, it can seem like an added burden
to choose between a range of treatment options at a time when you may well find
making decisions difficult.

People experiencing depression should be able to choose freely between the

range of treatment options, or combinations of treatments. In practice, the
majority of people attending GP surgeries are offered antidepressants as the first

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treatment option. For many people a combination of talking treatments and
antidepressants is the most effective way of coping with depression.

Counselling
Counselling involves talking with someone who is trained in the art of listening so
that you can express how you feel in order to begin to find your own solutions to
your problems. Talking and being listened to by someone who shows empathy and
acceptance can help you to explore issues which are troubling you. The counsellor
may be able to help you to develop a greater understanding of your feelings,
thoughts and behaviours.

Your GP practice may have a counselling service attached to it, or your GP may be able
to refer you to another counselling service within the NHS. Counselling can also be
obtained from a variety of voluntary and private organisations (see Useful organisations
p. 8). Further information on counselling is available in Mind’s Counselling factsheet and
Mind’s booklet Getting the Best from your Counsellor or Psychotherapist.

Psychotherapy
Psychotherapy is a talking treatment which helps you to find ways of coping with
problems you may be experiencing. It aims to provide you with an opportunity to
work towards living in a more satisfying and resourceful way. The psychotherapeutic
process goes deeper than counselling: you may be encouraged to look closely at your
past, particularly your childhood, and your relationships with significant people in
your life.

Some short-term psychotherapy is available on the NHS, but most psychotherapists

work in private practices. Further information on psychotherapy is available in
Mind’s Psychotherapy factsheet and Mind’s booklet Understanding Talking
Treatments.

Cognitive behaviour therapy

Cognitive behaviour therapy, or CBT, is a talking treatment which helps you to
recognise problems and overcome emotional difficulties. The therapist enables you
to identify connections between your thoughts, how your thoughts affect you and
how you behave. CBT helps you to develop practical skills useful to go on to explore
what lies at the root of your feelings and behaviour.

Cognitive behaviour therapy is usually practised by psychologists, therefore a referral

from your GP is normally necessary. Further information on CBT is available in Mind’s
Cognitive Behaviour Therapy factsheet.

Self-help groups
Self-help groups work on the principle that it can be useful to meet with other
people who are experiencing depression. It can break down feelings of isolation
and at the same time show you how other people have coped. Finding that you can

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support others can help you too. These groups are often led by people who have
overcome depression themselves (see Useful organisations p. 9).

Drugs
Antidepressant drugs are the most common medical treatment for depression.
They work on chemicals in the brain to lift your mood. They do not cure
depression, but they do alleviate the symptoms so that you may feel able to
take action to deal with the depression yourself. Antidepressants do not work
for everyone and frequently cause unpleasant side-effects. It often takes between
two to four weeks before the drugs take effect. Some antidepressants can be
dangerous when used with other drugs and you may experience withdrawal
symptoms when you stop taking them. For further information on antidepressants
see Mind’s booklet Making Sense of Treatments and Drugs: Antidepressants.

Hospital admission
If you are severely depressed, you may need the shelter and protection offered
by the psychiatric ward of a hospital. It can also give your psychiatrist the
opportunity to monitor the effects of different treatments. Hospital can provide
a safe and supportive environment if you are in a state of distress, and it may
be comforting to have other people around you and to know that you are being
cared for. However, it can be distressing to be on a ward where you have little
privacy, where you have to fit into routines which may not suit you, and where
you may be upset by the behaviour of other patients. Generally, doctors want to
keep patients out of hospital, but some patients are compulsorily detained if it
is thought to be necessary for their own health or safety, or the protection of
others.

Community care
If you have long-term severe depression and require support to live independently
in the community, a number of services may be available to you. The Care
Programme Approach aims to ensure that health authorities and social services
departments assess your needs and provide the right services for you. A key
worker may be allocated who will try to co-ordinate the services provided to
support you. Community mental health teams (CMHTs) and community psychiatric
nurses (CPNs) can provide support for people living in their own homes. For
further information on Community Care and the services which may be available
to you see Mind’s booklet A-Z of your rights under the NHS and Community Care
Legislation.

Electro-convulsive therapy (ECT)

This treatment is usually only given to people who are severely depressed and have
not responded to drug treatment. You are given a general anaesthetic and then an
electric current is passed through your brain, causing a convulsion like an epileptic
fit. It is a controversial treatment which can have severe side-effects such as memory

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loss. There is more information on ECT in Mind’s booklet Making Sense of Treatments
and Drugs: ECT.

Alternative/complementary therapies
A wide range of alternative/complementary treatments are available which
may be of some benefit in treating depression. Herbal antidepressants such as
Hypericum (St John’s Wort) can help lift your mood. Other treatments such as
acupuncture and homoeopathy are also used for treating people with depression.
Many complementary therapies do not see the mind and body as separate, they see
you as a whole person and are not concerned with merely treating symptoms. For
further information on the full range of alternative and complementary therapies

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available see Mind’s booklet A-Z of Complementary and Alternative Therapies.

hat can I do to help myself?

Depression has a major characteristic which you need to be aware of when thinking
about what you can do to defeat it – depression can feed on itself, in other words,
you get depressed and then you get more depressed about being depressed.
Negative thoughts become automatic and are difficult for you to challenge. Being
in a state of depression can then itself become a bigger problem than the
difficulties which caused it in the first place.

An important thing to remember is that there are no instant solutions to problems

in life. Solving problems involves time, energy and work. When you are feeling
depressed, you may well not be feeling energetic or motivated to work, but if you
are able to take an active part in your treatment, for example by participating in
talking treatments, it should help your situation.

It is important to try and break the hold which the depression has on you. You need
to break the cycle of negative thoughts. Try and recognise when you are doing it,
and replace it with a more constructive activity.

Look for things to do which occupy your mind. Although you may not feel much
like it, encouraging yourself to take part in physical activities is very therapeutic.
Playing sports, running, dancing, cycling, even brisk walking can stimulate
chemicals in the brain called endorphins, which can help you to feel better about
yourself.

You need to do things which will make you feel better about yourself. Try and treat
yourself kindly. You need to look after yourself physically, eat well, exercise and

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don’t abuse your body with tobacco, alcohol or other drugs. Pay attention to your
personal appearance and give yourself treats. For further information see Mind’s

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booklet How To Look After Yourself.

hat can friends or relatives do to help?

People who are depressed often withdraw from the friends and relatives
around them rather than asking for help or support. However, this is a time
when they need your help and support most. Perhaps the most important
thing which family and friends can do is to encourage the depressed person
to seek appropriate treatment. The very nature of depression, the feelings of
helplessness, hopelessness and worthlessness, can keep the depressed person
from seeking help.

Supporting a friend or relative who is depressed can be an opportunity to build a

closer and more satisfying relationship. However, it can also be hard work, it can
feel frustrating at times, and unless you look after yourself, it can make you feel
depressed yourself.

What people who are depressed need most is someone who cares for them.
You can show that you care by listening sympathetically, by being affectionate,
by appreciating the person, or simply by spending time together. You can help by
encouraging them to talk about how they are feeling and help them to work
out what they can do, or what they need to change, in order to deal with
their depression.

If the person you are supporting is severely depressed you may be faced with some
hard decisions about how much to do on their behalf. If, for example, they are not
looking after their physical needs, should you take over and do the shopping,
cooking and cleaning for them, if you are able to? Or should you try and encourage
them to do it? There are no easy answers to this situation. It will help if you can find
someone with whom you can discuss these and other issues.

When supporting a friend or relative, you must try not to blame them for being
depressed or tell them to ‘pull themselves together’. They are probably already
blaming themselves and criticism is likely to make them feel even more depressed.
Praise is much more effective than criticism. You can remind them that it is possible
to do things to improve their situation, but it needs to be done in a caring and
sympathetic way to work.

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It is important that you pay attention to your own needs. If you can, try and share
the responsibility of supporting your friend or relative with as many people as
possible. Try and find people to whom you can express your frustrations. There may
be a local support group for people in your situation which you can join. There is

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more information for carers in Mind’s booklet Understanding Caring.

seful organisations
The Association For Postnatal Illness
25 Jerdan Place, London SW6 1BE, tel. 020 7386 0868, fax: 020 7386 8885,
e-mail: [email protected], website: www.apni.org.uk.
Offers information and advice on overcoming postnatal depression. They can put
you in touch with volunteers who have experienced this distress themselves. Also
offers support to husbands and partners of depressed mothers.

British Association for Counselling (BAC)

1 Regent Place, Rugby, Warwickshire CV21 2PJ, tel. 01788 550899,
e-mail: [email protected], website: www.counselling.co.uk
BAC can give information on counselling and psychotherapy. Send an SAE for a list
of practitioners in your area.

Careline
Ilford, Essex, tel. 020 8514 1177.
Confidential general telephone counselling on many issues including depression.

Depression Alliance
35 Westminster Bridge Road, London SE1 7JB, tel. 020 7633 0557, fax: 020 7633 0559,
e-mail: [email protected], website: www.depressionalliance.org
Provides information, support and understanding to people affected by depression.
Member-led organisation co-ordinating a network of self-help groups. Publications.

Family Crisis Line UK

Woking, Surrey, tel. 01483 722533. Helps anyone experiencing any kind of personal
problems. Aims to provide local contacts.

Fellowship of Depressives Anonymous

Box FDA, Self-help Nottingham, Ormiston House, 32-36 Pelham Street, Nottingham
NG1 2EG, tel. 01702 433838, fax: 01702 433843.
A self-help organisation run by people who have been, or are depressed. Support
and encouragement for depressives, family or friends via newsletter, public meeting
and leaflets. Send an SAE for more information.

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Health Information Service
Helpline 0800 665544.
Information on which organisations or services deal with specific health problems.

The Institute For Complementary Medicine

PO Box 194, London SE16 7QZ, tel. 020 7237 5165.
Provides information and can send a list of practitioners on receipt of an SAE and
two loose stamps.

Manic Depression Fellowship

21 St George Road, London SE1 6ES, tel. 020 7793 2600, fax: 020 7793 2639.
Self-help organisation with many local branches offering support and advice.
Send an SAE for information.

SAD Association
PO Box 989, Steyning, West Sussex BN44 3HG, fax: 01903 879939, website:
www.sada.org.uk
Offers information and advice about Seasonal Affective Disorder. Write in with
an SAE for basic details.

United Kingdom Council for Psychotherapy (UKCP)

167-169 Great Portland Street, London W1N 5FB, tel. 020 7436 3002,
e-mail: [email protected], website: www.psychotherapy.org.uk
For a list of properly accredited psychotherapists. Send an SAE for a list of

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practitioners in your area.

urther reading and order form

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Qty:
A-Z of Your Rights under the NHS and Community Care Legislation (Mind 1993) £3

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A-Z of Complementary and Alternative Therapies (Mind 2000) £3
Chinese Medicine Cures – Depression (Foulsham 2000) £7.99
Climbing out of Depression – A practical guide for sufferers S. Atkinson

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(Lion Publishing 1993) £7.99
Coping with Anxiety and Depression S. Trickett (Sheldon 1997) £6.99

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Depression: The Way Out of Your Prison D. Rowe (Routledge 1996) £10.99
Factsheet: Counselling (Mind 1999) 35p

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Factsheet: Psychotherapy (Mind 1998) 35p
Factsheet: Cognitive Behaviour Therapy (Mind 1999) 35p

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Getting the Best from your Counsellor or Psychotherapist (Mind 1995) £1
How to Help Someone who is Suicidal (Mind 2000) £1

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oo How to Look After Yourself (Mind 1999) £1

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How to Survive Family Life (Mind 1998) £1
Hypericum (St John’s Wort) and Depression H. Bloomfield, M. Nordfors,

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P. McWilliams (Robinson 1996) £5.99
Making Sense of Treatments and Drugs: Antidepressants (Mind 1998) £3

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Making Sense of Treatments and Drugs: ECT (Mind 1999) £3
Mind Guide to Managing Stress (Mind 2000) £1
Overcoming Depression – A Practical Self-Help Guide to Prevention

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and Treatment R. Gillet (Dorling Kingsley 1997) £9.99
Overcoming Depression – A self-help guide using cognitive-behavioural

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techniques P. GIlbert (Constable 2000) £7.99
Surviving Breakdown E. Wilde McCormick (Vermilion1997) £9.99

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Understanding Anxiety (Mind 2000) £1
Understanding Caring (Mind 2000) £1

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Understanding Manic Depression (Mind 2000) £1
Understanding Postnatal Depression (Mind 1999) £1

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Understanding Seasonal Affective Disorder (Mind 1998) £1
Understanding Talking Treatments (Mind 2000) £1

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This booklet was written by George Stewart

ISBN1 874690 66 9. First published by Mind 1989. Revised edition © Mind 2000
No reproduction without permission
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