By ANNA ALBRIGHT.
Daily Mail

A GP, usually the first port of call for someone suffering depression, may prescribe antidepressants.

However, the latest NICE guideline for treating depression is to use them alongside cognitive behavioural therapy (CBT), a talking treatment that focuses on current problems rather than the causes of your distress or symptoms in the past.

We answer the most commonly asked questions.

WHAT IS DEPRESSION?

Depression is an illness that affects the mind and body; it is not a weakness, nor is it a succession of bad days. Common symptoms of depression are: 

• Anhedonia (loss of pleasure)

• Inability to cope

•  Crying more than usual 

• Changes in appetite 

• Sleep disturbance 

• Change to sexual interest 

• Suicidal thoughts 

• Increased hopelessness 

• Increased irritability

It will affect your body's systems so that sleeping and eating are disrupted; it will affect your mind so that the future looks bleak and it will strip your life of meaning. Anyone who thinks that depression is self-indulgence needs to think again.

WHAT ARE THE MOST COMMON CAUSES?

Depression happens to different people for different reasons. Among the common causes are negative life events, physical illness, excess alcohol and your genes. You will probably prefer to identify the causes for your own depression. However, achieving this is not essential to your recovery. Depression can be treated in the absence of knowing what caused it.

HOW CAN CBT HELP?

When you become depressed, whatever the trigger, there will have been a build-up of stress in the body. You may have started waking at odd hours, unable to sleep, and your eating may be disordered. The body will become out of kilter, resulting in a chemical imbalance. While medication will address the underlying physical symptoms, CBT will address the underlying reasons why you are depressed and how to develop healthier responses to any future problems.

DOES IT HAPPEN OVERNIGHT?

No, it creeps up on you with a steady build-up of symptoms, such as a lack of interest, reduced ability to cope, changes to sleep and appetite, and loss of pleasure in activities that you would normally find pleasurable. If you are vigilant and you know what to look for, you can seek help sooner rather than later. You may also choose to be less vigilant and ignore the symptoms in the hope that they will pass and that, as if by magic, you will wake up one morning un-depressed. Depression doesn't happen overnight and, sadly, it won't go overnight, even if you think you can sleep it off.

IF I DON'T CRY, CAN I STILL BE DEPRESSED?

Yes, it is accompanied by a whole bunch of symptoms  -  whether you are tearful or not will form only part of the overall picture. Of greater importance is to assess whether you are crying more or less than usual, not whether at this point in time you are tearful.

WILL ANTI-DEPRESSANTS MAKE ME FEEL FOGGY?

They are prescribed to treat depression and not to make you foggy. Their job is to treat your bodily symptoms of depression and to lift your low mood. Depression comes about when chemicals in the brain have become imbalanced. These changes may be small but are vital in maintaining good mental health. Antidepressants are designed to correct the brain's chemical imbalances and, if anything, will make you sharper rather than foggier.

CAN OTHER PEOPLE TELL IF I'M ON THEM?

They will be able to tell about as easily as if you were on antibiotics. There are no outward signs  -  the only way others will know is if you tell them. To convince yourself that taking anti-depressants is not apparent to anyone other than you, it might help to test the reliability of your assumptions. Here is one way: it is estimated that in the UK alone, more than 35 million prescriptions are written for antidepressants every year. This means that the next time you are in a large group, it is likely a number of those around you are on anti-depressants. See if you can tell who is and who is not.

ARE THEY ADDICTIVE?

No  -  you will not need to take increasing doses over time to achieve the same benefit, and you will not experience cravings when you stop taking them. If you are prescribed antidepressants and your symptoms remain constant, the dose you take will not change today, tomorrow, the next day and so on. If you stop taking antidepressants, you will experience withdrawal symptoms just as you would if you stopped drinking coffee.

CAN I DRINK ALCOHOL WHILE ON ANTI-DEPRESSANTS?

It's not a good combination. When you're depressed, you will want to do all you can to get better, so it is best not to make a tough job even tougher. Alcohol on its own is trouble. It is a known depressant that can worsen your depressive symptoms. It may also counteract the effects of your medication. Think of it like climbing halfway up a mountain with hiking boots on, then taking them off for the last half.

CAN CHILDREN BE PRESCRIBED THEM?

Yes  -  but if you think your child is depressed, it is best to consult a child psychiatrist as there are other considerations to be factored in to treatment. The main concern is that anti-depressants may increase the risk of self-harm in children but the risk, although elevated, is small. It is important to weigh up the pros and cons of taking anti-depressants, as depression carries its own risk of self-harm if untreated.

HOW DO I EXPLAIN TO FAMILY THAT I AM NOT JUST 'DOWN'?

Feeling 'down' describes those times when your mood is lower than normal but will respond to something pleasurable. When you're feeling 'down', you will be able to experience pleasure and a full spectrum of emotions. Depression as an illness affects your brain chemistry, which affects your psychology and physiology. In short, it hijacks your body and mind.

ARE THERE DIFFERENT SORTS OF DEPRESSION?

Confusingly, depression is a single word covering various states of mind. Least troublesome is the 'I'm feeling blue' sort. It tends to react well to a massage or a good night out and calls for neither therapy nor medication. The 'I feel really low and don't feel like myself' sort of depression is a level up. If this persists for more than two weeks and comes with changes in sleep, appetite, libido, concentration and coping, along with an inability to experience pleasure from regular activities, it is called clinical depression and responds to medication. Finally, there is bipolar depression, marked by greater swings from intensely high to intensely low. It can be treated with medication and CBT.

WHAT IS THE DIFFERENCE BETWEEN A THERAPIST AND A PSYCHIATRIST?

A psychiatrist is the specialist able to prescribe medication to correct any imbalances in brain chemistry that are responsible for your depression. A therapist is not qualified to prescribe medication, but they will help you to identify the ways in which your thinking and behaviour may be contributing to your depression. Once this has been achieved, they will help you to develop alternative thinking and behaviours that will aid your recovery.

IF SOMEONE IS DEPRESSED BUT DOESN'T KNOW, CAN I HELP?

There are do's and don'ts when it comes to helping someone with depression. First the do's: talk to them, believe in them, remain optimistic about their recovery and congratulate them for their achievements even if it is for just getting through another day. Don't badger them with good advice about what they should be doing, don't tell them to pull themselves together and don't encourage them to think of people worse off than them in the hope that they will make a spontaneous recovery. When you're depressed, you retain the ability to think and you know that there are people worse off than you. However, this will not bring relief  -  depression is not a problem of flawed intellect but of flawed chemistry.

IF I'VE HAD AN EPISODE, WILL I GET RECURRENCES?

Anyone can get depressed at any point during their lifetime. Having had depression, you do have a greater chance of getting it again but a greater possibility is different from a 'dead cert'. Having had it once does not mean you will definitely have recurrences for life. It may be helpful to think of recurrent depression in terms of a slipped disc. While you may not slip the disc continually throughout your life, you will have a vulnerability that others will not have. Depression is like slipping a psychological disc.

HOW CAN I TELL IF I'M HAVING A BREAKDOWN?

A 'breakdown' is not a medical term. It is an everyday term to describe different states of distress. The best medical explanation for a ' breakdown' is a state in which you are distressed to the extent that you are unable to function as you normally would. It may be accompanied by physical symptoms that are similar to depression but it does not necessarily mean you are depressed. The best way of telling whether you are having a breakdown is not to self-diagnose, ask a friend or go to the internet, but to seek out a professional who will carry out a proper medical assessment.

CAN ANOTHER PERSON MAKE YOU DEPRESSED?

Depression is not a virus. You cannot get it by breathing the same air as someone who is depressed. It's not bacterial, so you won't catch it by touching someone who has it.

IF I HAVE AN ADDICTION TO ALCOHOL OR DRUGS, CAN I BE DEPRESSED AS WELL?

There is a strong possibility that you are depressed too. However, if you are taking drugs and drinking excessive alcohol, it may not be very obvious that you are depressed as you will be feeling drunk, high or hung over much of the time.

IS POST-NATAL DEPRESSION THE SAME THING?

Post-natal depression affects up to 15 per cent of new mothers. It is different from regular depression but shows many of the same symptoms, such as elevated hopelessness and a reduced ability to experience pleasure. It may be caused by hormonal changes, a family history of depression or a poor support network, but it is treatable.

DON'T WE ALL GET IT?

We all get to feel down, fed-up and 'depressed'. Most of the time these feelings pass and do not stop us carrying on as normal. At times, they do not subside after a few days. They persist for weeks and are gradually joined by unpleasant physical symptoms. At this point, you have joined the 'depression as an illness club'.

How to Handle the Winter Blues

By Anna Albright

I can always tell the week it happens. A subtle dip. A collective shift. The sun edges a little further south and, almost without noticing, so too does our mood. We’re obsessed with the weather. We talk about it endlessly.

Track it. Complain about it. Plan around it. Yet underestimate just how much it affects our mood and how much influence we actually have over it.

Winter blues or SAD?

Both involve a drop in mood over the winter months. But seasonal affective disorder (SAD) is a clinical depression with a seasonal pattern. It’s persistent, heavy, and interferes with functioning. The winter blues are milder. You’re still getting on with life, but your mood will be flatter, and things will take extra effort.

Different in severity.
Both worth addressing. So how do you handle the winter blues?

Dress brighter than you feel

You may have lost the sun but dressing as if you’re in mourning won’t help. Colour nudges mood. Not dramatically, but enough. Let your clothes do some of the heavy lifting.

Limit talk time

Say “it’s miserable” often enough and your brain will start to believe you. Limit weather complaints to once a day. Ruminating on the loss of sunlight impacts your mood. Collect daylight See the light. Sit by a window. Get outside early. Morning light matters. It helps regulate your body clock and stabilise mood.

Aim to get outside within two hours of waking. Add movement and you get an extra lift from endorphins. Nothing heroic required. A brisk walk is enough.

Use music
Music can shift mood if you use it intentionally. Choose tracks to match how you want to feel, not how you do feel.

Consider a SAD light.
A good light box can make a noticeable difference, especially on dark mornings. It mimics natural light and supports energy and mood. It’s not a magic bulletcbut use it every day. It’s a key member of the team.

Keep life “normal enough.

Winter has a way of shrinking life. Fewer plans. Less spontaneity. More staying in. Resist the drift. See people. Keep showing up. Do what you know is best. Ride it out. The sun will make its way around again.

When to get help

If your mood is low, your sleep or appetite changes, or your concentration or ability to cope is reduced for more than two weeks, speak to your GP. SAD is real and not something to push through. Treatment helps.

CBT is a highly effective therapy, on its own or alongside medication, depending on what’s needed.

There are no prizes for going it alone.

by Anna Albright

Depression is a condition full of paradox and irony.

You get yourself through it, but YOU are the very thing that you feel you do not have. The YOU that you remember as strong enough to fight an imposter such as depression, is, unfortunately, the YOU that has temporarily left town. In its place is a ‘you’ that can’t sleep, can’t eat, and can’t concentrate, a ‘you’ who is highly uncomfortable to ive with and who you most certainly do not want to be.

From my observations, there are two kinds of depression. The ‘I can’t get out of bed” kind and the ‘I’m so agitated I can’t settle’ kind. It is largely irrelevant which kind you have, as both will strip your life of pleasure and meaning, and living with either will be one of the hardest things you have ever had to do.

It follows then that navigating a route through depression will by no means be an easy task. However, the holy grail is to develop healthy and realistic ideas of what to do with yourself and what to expect from yourself. Of equal importance, you will ideally want to figure out what not to do with yourself and what not to expect from yourself. In short, with your very imbalanced mind you want to try to cultivate a balanced approach.

So how can you find your way through depression despite the ironies, paradoxes and vicissitudes of the depressed mind?

Scaling down expectations to the bare necessities, and congratulating yourself for the smallest of achievements helps you through, even though when depressed, nothing is ever good enough and most notably, you are very definitely not good enough. By and large, connection with others can help you through depression, yet ironically, feeling disconnected is a hallmark feature of the condition. Exercising a healthy degree of self-care helps you through, yet treating yourself like a worthwhile human being when your self-worth is taking a constant pounding is a big ask. Depression is very practised at taking your historic view of yourself as a worthwhile human being and placing it under ongoing attack.

When it comes to negotiating life’s uncertainties, even the non-depressed mind finds this a big deal. At best, the non-depressed mind manages to accept uncertainty or simply avoid it. The depressed mind has no such luxury of choice.

It does, however, have a dire need for certainty, and what tops the list, is the dire need to know for sure that this depression will most definitely and absolutely come to an end.

Knowledge of your condition, because it is a condition, will also help.

Being able to differentiate the symptoms of your illness from what you may believe is the new ‘you’ can be invaluable. It may just give you the chance of some small measure of perspective on your current predicament, and help at the very least to keep the memory of the old ‘you’ alive until the time arrives for it to make a comeback.

No discussion of depression would be complete without reference to anxiety. Just in case dealing with depression were not hard enough, it is common to feel highly anxious at the same time, and the two together make quite some pair.

By far and away the most helpful stance to adopt when dealing with anxiety is to accept it without liking it. Whilst this may sound simple, in practice it isn’t! It is generally understood that anxiety will persist if it gets your attention. Therefore, when anxious, focusing on trying to rid yourself of the highly unpleasant symptoms, will paradoxically perpetuate the problem. In other words, resist it and it will persist all the more. If, however, you can do your best to accept it without liking it, it will in time, behave just like the Duracell bunny and gradually wear itself out.

And if you remember a single piece of information when it comes to anxiety, remember this: whilst anxiety may be highly undesirable, whilst it may be highly uncomfortable and may help you to imagine all sorts of possible future catastrophes, it will reach its peak and come down. Admittedly this will be very difficult to remember when highly anxious, but it’s worth the effort. If you can manage to live with wanton disregard for your anxiety, it will ultimately give up on you. Try to banish it, however, and you will inadvertently give those long-lasting batteries some extra juice!

Having depression means that you not only have yourself to deal with, but you also have other people to deal with, or more accurately, other people’s opinions about depression and how you should get better. The worst advice usually comes from people who have never experienced the condition. Curiously enough, though they have never had any professional training whatsoever, they expect their advice to be just the ticket when you have depression.

Most commonly delivered advice is ‘snap out of it’, ‘get over it’ or ‘deal with it’. What they don’t appreciate is that the ‘it’ they are referring to is an illness that affects brain chemistry just like diabetes affects blood chemistry. They will also say that it’s all in the mind, which is in fact correct. However, what is incorrect is to conclude that because it is all in the mind, you ought to be able to think your way out of a major depressive episode. The view from a professional with a first hand experience of the condition is this: give everyone the chance to offer help but only take the help that helps.

Aside from the offers of help from others around you, thankfully there are real professionals available offering real professional help. In tackling depression it is best to opt for treatments that have been rigorously tested and where the results indicate that they work. Currently, the results indicate that psychotherapy and psychiatric medication are the front line treatments for depression.

So who are the professionals and what do they do?

Firstly psychotherapy. This is the talking treatment that tackles depression. Evidence based psychotherapy claims that it is our unhealthy thinking about difficult events that is largely responsible for our psychological problems. A psychotherapist practices psychotherapy, and will help you to develop healthy thinking in the face of problematic life events. These might include what you say to yourself in the face of adversity, as well as your thinking response to being depressed.

Secondly psychiatry. This involves the use of drugs to tackle depression and is practiced by a psychiatrist. Strong evidence exists to support the claim that depression is also a biologically based condition. A psychiatrist will be able to diagnosis your depression through asking lots of questions.

Then, if necessary, they will be able to prescribe psychiatric medication to redress any imbalances in brain chemistry.

There are a few top tips to keep in mind when you see the

professionals. Don’t be surprised if you are anxious before

your first appointment, as there are a number of commonly

held misconceptions which may play on your mind.

The first one is that a psychiatrist will prescribe pills that make you

crazy, change your personality and turn you into a zombie who will be

unable to feel anything at all. Now the reality: psychiatrists are there to

prescribe drugs that treat your illness - they are not there to make you

crazy, turn you into a different person or a zombie devoid of feeling.

Secondly, you may be anxious that a psychotherapist is going to take years to examine every moment of your life to date, and find a tenuous link between how your shoelaces were tied and your current depression. And now the reality: psychotherapists are there to deal with any unhelpful thinking that may have contributed to your current depression, and that may be maintaining it.

Their aim is to help you get better in the shortest time possible.

Thirdly, though you may have convinced yourself that you are a medical enigma with a unique and untreatable condition. Psychotherapists and psychiatrists treat people with depression all day every day, and whilst ‘you’ may be unique, your depression is definitely not.

Fourthly, it is best to seek out professionals with a good reputation and ideally, have been recommended by someone you trust. Meet them and see if you like them. If you don’t, move on and keep looking until you find the right ones for you.

And finally, a few words about how your treatment will help to you to get better. You may hope that the combination of treatments will work overnight and you will wake up one morning un-depressed.

Regretfully for all of us this is not how the ‘getting better’ happens.

However, what you can look forward to is gradual change, where you feel less depressed, less often and for briefer periods of time, until one day you realize that you feel like your ‘old’ self again.

When depressed it is common to imagine that everyone else is fine and you are the only person feeling lousy. Whilst understandable, this is not only untrue but also unhelpful.

Without doubt, writing ‘Depression and how to do your best when you feel your worst’ called upon my professional know-how. However, it also drew upon my first-hand experience of the condition. Why make reference to this? Simply to highlight that even though you may think you are the only one to have been hit with depression, you are in fact in very good company. So much so that even Churchill managed to lead the country to victory between his bouts of depression!

So what is the best response to the conundrum of depression?

Do your best when you feel your worst; keep on trying without having to achieve; and remember that none of us is likely to make medical history. Depression passes, and yours will pass too.