Thursday, 3 December 2009
Depression Quotes: Collection of depression quotes
Depression Quotes: Collection of depression quotes: "Depression is like a drug that turns you into a person opposite of yourself. Whatever you think while you are on depression is false. Depression makes you believe that everyone hates you and you hate yourself and also that things are really bad.this is not TRUE. Understand that depression exists in the mind and it takes over a person, just think how some people are alcoholics
or drug addicts. The same things happen to them just start praying and also forgive yourself and your enemies, you will feel alot better trust me. Then just tell people you know and people that like and love you. You tell them you have a problem and explain to them then go get help. Help is all around you. Tell your family, tell your friends parents ETC, remember that whatever you think they belive its not probably true. They dont hate you trust me in your mind you hate verything and everyone including yourself all that is not true.go to people you can trust, go to church and talk to a priest, you got to communicate, just remember, it took you awhile to GET depressed, its gonna take time to get undepressed, its just like a addiction, its gonna take time.
(Sent in by Dylan Jan 12, 2006 )"
Depression Quotes: Collection of depression quotes
Depression Quotes: Collection of depression quotes: "Depression to me is like a deep dark pit that once you have reached bottom there is no escape.
At first began to feel yourself slding into the shadows and then complete isolation from life. Things begain to lose their color. yellows of the sunshine, and blues of the sky fade to a grey and bleak shadow that seems to ovewhelm me. I can no longer see or hear things that are pleasing to me anymore. Dark thoughts of fear and failure dwell within my mind almost constantly. I feel numb to the world and people around me. I want to be left alone because it takes so much work to hide the true pain and sadness I am feeling. The guilt for not being able to handle simple conversations. It is so hard and exhausting to pretend with people that I am ok when in fact I have spiraled downward into what I call THE PIT. It is deep, dark, lonely and inescapable for me sometimes.
(Sent in by Mercedes Jan 18, 2006 )"
At first began to feel yourself slding into the shadows and then complete isolation from life. Things begain to lose their color. yellows of the sunshine, and blues of the sky fade to a grey and bleak shadow that seems to ovewhelm me. I can no longer see or hear things that are pleasing to me anymore. Dark thoughts of fear and failure dwell within my mind almost constantly. I feel numb to the world and people around me. I want to be left alone because it takes so much work to hide the true pain and sadness I am feeling. The guilt for not being able to handle simple conversations. It is so hard and exhausting to pretend with people that I am ok when in fact I have spiraled downward into what I call THE PIT. It is deep, dark, lonely and inescapable for me sometimes.
(Sent in by Mercedes Jan 18, 2006 )"
Depression Quotes: Collection of depression quotes
Depression Quotes: Collection of depression quotes: "You cry... you feel sad... you get 'help'... but its still there... only now you hide it... you want everyone to believe it is ok... but its not, i'm not ok- its a rollercoaster of emotions, you slowly start to feel better and then all of a sudden you crash again... then it starts all over.
(Sent in by Mallisa March 6, 2006 )"
(Sent in by Mallisa March 6, 2006 )"
Do I Have Depression?
Do I Have Depression?: "Do I Have Depression?
If you or someone you love is struggling with depression, you've probably got questions—lots of them. We’ve got answers. At this stage, although your energy level may be low, gathering knowledge is crucial. Below you’ll find articles written by individuals who have been where you are. They’ll help you figure out whether you're dealing with clinical depression or just sadness. Our experts will also help you decide what steps you should take to feel better."
If you or someone you love is struggling with depression, you've probably got questions—lots of them. We’ve got answers. At this stage, although your energy level may be low, gathering knowledge is crucial. Below you’ll find articles written by individuals who have been where you are. They’ll help you figure out whether you're dealing with clinical depression or just sadness. Our experts will also help you decide what steps you should take to feel better."
Antidepressants That Aren't Antidepressants
Antidepressants That Aren't Antidepressants: "ntroduction
Although this page will repeat some ideas you'll find elsewhere on this website, they seemed worth presenting together. After all, these may be the most important concepts on this website. Consider the following logic:
1.
Depression is the most common symptom in bipolar disorder.
2.
Antidepressant medications (Prozac, Paxil, Celexa, Effexor, etc.) can be very effective against depression.
3.
Result: antidepressants are commonly used in bipolar disorder.
That's where we are at the present time, in practice. But here is more logic to consider.
1.
Antidepressants can make bipolar disorder worse (some of these are controversial; here are the data on that).
*
They can cause hypomania where there was none.
*
They can induce cycling, or make it worse.
*
They may keep a person from becoming truly stable.
*
And they might, just might, cause some long-term harm, perhaps even irreversible harm.
2.
Therefore: antidepressants should be avoided, as much as possible, in bipolar disorder treatment.
(This statement in particular is controversial).
Now, let's combine these two bits of logic:
1.
Some antidepressant tool is commonly necessary in bipolar disorder.
2.
Yet true 'antidepressants' should be avoided, if possible, in bipolar treatment.
3.
Therefore, one should maximize use of all other antidepressant approaches before using typical 'antidepressants'.
(Again, this is my personal conclusion, not an expert opinion or mandate).
Fortunately, there are at least nine such approaches to consider. These approaches are not associated with increasing cycling, long-term destabilizing, or the concerns about possible long-term harm which have been raised about typical antidepressants. They all have other risks, but so do any treatments you might consider. For any approach you take, you will always be balancing risks versus possible benefits.
Before we turn to that list of nine options, however, there is an even more important principle to consider -- because it might make those eight options unnecessary.
First, Stop The Cycling
For many people, their depressions are not constant. Instead, they 'cycle' into depression, and out again -- although the respite is often brief. However, if it is clear that your moods do indeed cycle, then the first thing to do is stop the cycling. A lot of people will find that their mood smoothes out at an acceptable level.
I hope you see what this means: if you stop the cycling, you might stop having depressions entirely -- so you wouldn't need an antidepressant, of any kind. And this makes bipolar treatment a lot simpler, because you can stop the cycling with 'any old mood stabilizer', not just the ones with antidepressant effects. This allows you to choose from the entire menu, not just the ones (shown below) which have antidepressant effects. That's good, because sometimes you'll want that entire menu available, to pick the one with the least troublesome side effects for you.
After that step is complete, when you are no longer having cycling, then, if you are still depressed, you should consider options from the list below. Then, when you have considered these options and perhaps used one or several, then you may be one of those people who really need to add an antidepressant, with caution, to your mood stabilizers -- in my opinion. (There are exceptions, including especially people who have been on an antidepressant for years and doing well, with no cycling. These people may do best to stay on their antidepressant, although even that is controversial: see Controversy 3 on this page.)
(A note for people with pleasurable hypomania -- which may be less than half of those with Bipolar II: you may be disappointed to see that the 'stable place' is not up there at the top of where you used to sometimes find yourself. Surprise -- those higher places were 'hypomania', on your personal scale. Yet most folks like you prefer 'stable' to cycling, which almost inevitably includes phases of depression that are longer than the ups, more disabling, and ultimately just not worth going through for those brief higher phases.)
(A note for people with constant depression and cycling: you too may be disappointed to see that your mood levels out at a familiar place, namely that constant background level of depression. Nevertheless, the same series of steps seems to me to apply: first try to stop the cycling, because if you add an antidepressant to go after the background depression, you'll commonly make the cycling worse or at least less stop-able; whereas if you stop the cycling first, some of the approaches below may boost your whole 'baseline' depression up towards where you see everyone else apparently living (some really are living there, some are faking it, as you know)).
Nine Antidepressants Options That Are Not 'Antidepressants'
(Each of the 'pill' options in this table has its own page of additional information; see Mood Stabilizers table of all the options.)
No Pills
Risk or Problems
'Natural' pills
Risk or Problems
Mood Stabilizers With
Antidepressant Effects
Possible Risks (not all get them)
Exercise
Possible Injury
omega-3 fatty acids
(fish oil)
Lots of pills
Lamictal (lamotrigine)
Severe skin problems 1/3000
Cognitive-Behavioral Therapy
Cost, Time; Finding a Good Therapist
optimize thyroid
Blood tests, hyperthyroidism
Seroquel (quetiapine)
Weight gain, diabetes
Light manipulations
(dark therapy, light box, dawn simulator)
Cost; Routines Are Limiting
lithium
blood tests, hypothyroidism, long-term kidney risk
Zyprexa (olanzapine)
Weight gain, diabetes
Okay, I admit, dark therapy doesn't quite belong on this list, as it does not have direct antidepressant effects, only mood stabilizing effects, but it's such a cool idea, I think everybody needs to know about it -- because some limited version of it is within reach for almost everyone. If you're interested in how mood is affected by light, see my essay on Bipolar Disorder: Light and Darkness. You'll see how the biological clock is affected very directly by both (and find interesting links about how the clock works and how lithium affects it; and about why blue light appears to be more important than any other wavelength when it comes to mood effects).
Similarly, optimizing thyroid -- getting near the hyperthyroid side of normal, or at least making sure you're not near the hypothyroid side of normal -- is not directly antidepressant but may allow whatever antidepressant things you're doing to work better. It too is on the list because I think it is so nice to be able to offer options which carry zero, or near zero risk (as long as you don't end up becoming hyperthyroid, which should be relatively easy to avoid). For more, see Thyroid and Bipolar disorders, including the references on which this approach is based and a reminder that this is not even an experimental approach, just a working guess.
Finally, lithium is listed in the 'natural' column. Okay, that's a stretch, perhaps, as it is made by pharmaceutical companies and must be handled just like other medications, with caution (possibly excepting lithium orotate, a very long story in itself; it may actually work, theoretically, but safety remains to be demonstrated after one study suggested risk) . But it does come from the earth, after all...
(A brief word on some medications that other psychiatrists might have included in this table: valproate (Depakote) and risperidone (Risperdal); perhaps aripiprazole; and maybe even ziprasidone (Geodon). I have not included risperidone and valproate in the table above because: a) I find risperidone actually has too much antidepressant-like action and may induce a subtle agitation/insomnia/cycling that is hard to manage, because one will always be wondering if it is coming from the patient or from the risperidone; and b) although Depakote has a recent pilot studyDavis demonstrating an antidepressant effect, as well as a small study of less direct designWinsberg, it has not impressed me with its antidepressant effects as have those three listed.)
Conclusion: Why is there such reliance on antidepressants?
I hope this essay may have led you to wonder: with all these options to manage depression in bipolar disorder, and with the risks antidepressants pose (or may pose, depending on how you interpret the current controversies), why does anyone persist in using antidepressants in bipolar patients -- at all?
Obviously I wonder that myself. As I listen to doctors talk about this, it seems there are several factors:
*
Habit: we've been using them for a long time, and they do help quite a few people (even many people with bipolar disorder -- initially).
*
A short-term view of treatment, focusing on the symptom du jour, instead of the long-term goal of stopping cycling as a means of addressing repeated episodes of depression. It's easy to get drawn into treating today's symptom, when you're sitting with a patient who is really depressed, who wants an antidepressant, and who has not learned all you have learned about antidepressants' possible risks.
*
A different interpretation of the available data on risk. You might hope this would be the main explanation. However, I fear that many doctors are unaware of the data we have on the risk controversies.
You may have seen Dr. Ghaemi's data about use of antidepressants in patients with bipolar diagnoses:
To me this suggests that the more one learns about bipolar disorder, from treating patients long-term, the less one uses antidepressants. The good news is that we have at least nine other options to consider! Go read more about them, starting with the table on the the mood stabilizer page."
Although this page will repeat some ideas you'll find elsewhere on this website, they seemed worth presenting together. After all, these may be the most important concepts on this website. Consider the following logic:
1.
Depression is the most common symptom in bipolar disorder.
2.
Antidepressant medications (Prozac, Paxil, Celexa, Effexor, etc.) can be very effective against depression.
3.
Result: antidepressants are commonly used in bipolar disorder.
That's where we are at the present time, in practice. But here is more logic to consider.
1.
Antidepressants can make bipolar disorder worse (some of these are controversial; here are the data on that).
*
They can cause hypomania where there was none.
*
They can induce cycling, or make it worse.
*
They may keep a person from becoming truly stable.
*
And they might, just might, cause some long-term harm, perhaps even irreversible harm.
2.
Therefore: antidepressants should be avoided, as much as possible, in bipolar disorder treatment.
(This statement in particular is controversial).
Now, let's combine these two bits of logic:
1.
Some antidepressant tool is commonly necessary in bipolar disorder.
2.
Yet true 'antidepressants' should be avoided, if possible, in bipolar treatment.
3.
Therefore, one should maximize use of all other antidepressant approaches before using typical 'antidepressants'.
(Again, this is my personal conclusion, not an expert opinion or mandate).
Fortunately, there are at least nine such approaches to consider. These approaches are not associated with increasing cycling, long-term destabilizing, or the concerns about possible long-term harm which have been raised about typical antidepressants. They all have other risks, but so do any treatments you might consider. For any approach you take, you will always be balancing risks versus possible benefits.
Before we turn to that list of nine options, however, there is an even more important principle to consider -- because it might make those eight options unnecessary.
First, Stop The Cycling
For many people, their depressions are not constant. Instead, they 'cycle' into depression, and out again -- although the respite is often brief. However, if it is clear that your moods do indeed cycle, then the first thing to do is stop the cycling. A lot of people will find that their mood smoothes out at an acceptable level.
I hope you see what this means: if you stop the cycling, you might stop having depressions entirely -- so you wouldn't need an antidepressant, of any kind. And this makes bipolar treatment a lot simpler, because you can stop the cycling with 'any old mood stabilizer', not just the ones with antidepressant effects. This allows you to choose from the entire menu, not just the ones (shown below) which have antidepressant effects. That's good, because sometimes you'll want that entire menu available, to pick the one with the least troublesome side effects for you.
After that step is complete, when you are no longer having cycling, then, if you are still depressed, you should consider options from the list below. Then, when you have considered these options and perhaps used one or several, then you may be one of those people who really need to add an antidepressant, with caution, to your mood stabilizers -- in my opinion. (There are exceptions, including especially people who have been on an antidepressant for years and doing well, with no cycling. These people may do best to stay on their antidepressant, although even that is controversial: see Controversy 3 on this page.)
(A note for people with pleasurable hypomania -- which may be less than half of those with Bipolar II: you may be disappointed to see that the 'stable place' is not up there at the top of where you used to sometimes find yourself. Surprise -- those higher places were 'hypomania', on your personal scale. Yet most folks like you prefer 'stable' to cycling, which almost inevitably includes phases of depression that are longer than the ups, more disabling, and ultimately just not worth going through for those brief higher phases.)
(A note for people with constant depression and cycling: you too may be disappointed to see that your mood levels out at a familiar place, namely that constant background level of depression. Nevertheless, the same series of steps seems to me to apply: first try to stop the cycling, because if you add an antidepressant to go after the background depression, you'll commonly make the cycling worse or at least less stop-able; whereas if you stop the cycling first, some of the approaches below may boost your whole 'baseline' depression up towards where you see everyone else apparently living (some really are living there, some are faking it, as you know)).
Nine Antidepressants Options That Are Not 'Antidepressants'
(Each of the 'pill' options in this table has its own page of additional information; see Mood Stabilizers table of all the options.)
No Pills
Risk or Problems
'Natural' pills
Risk or Problems
Mood Stabilizers With
Antidepressant Effects
Possible Risks (not all get them)
Exercise
Possible Injury
omega-3 fatty acids
(fish oil)
Lots of pills
Lamictal (lamotrigine)
Severe skin problems 1/3000
Cognitive-Behavioral Therapy
Cost, Time; Finding a Good Therapist
optimize thyroid
Blood tests, hyperthyroidism
Seroquel (quetiapine)
Weight gain, diabetes
Light manipulations
(dark therapy, light box, dawn simulator)
Cost; Routines Are Limiting
lithium
blood tests, hypothyroidism, long-term kidney risk
Zyprexa (olanzapine)
Weight gain, diabetes
Okay, I admit, dark therapy doesn't quite belong on this list, as it does not have direct antidepressant effects, only mood stabilizing effects, but it's such a cool idea, I think everybody needs to know about it -- because some limited version of it is within reach for almost everyone. If you're interested in how mood is affected by light, see my essay on Bipolar Disorder: Light and Darkness. You'll see how the biological clock is affected very directly by both (and find interesting links about how the clock works and how lithium affects it; and about why blue light appears to be more important than any other wavelength when it comes to mood effects).
Similarly, optimizing thyroid -- getting near the hyperthyroid side of normal, or at least making sure you're not near the hypothyroid side of normal -- is not directly antidepressant but may allow whatever antidepressant things you're doing to work better. It too is on the list because I think it is so nice to be able to offer options which carry zero, or near zero risk (as long as you don't end up becoming hyperthyroid, which should be relatively easy to avoid). For more, see Thyroid and Bipolar disorders, including the references on which this approach is based and a reminder that this is not even an experimental approach, just a working guess.
Finally, lithium is listed in the 'natural' column. Okay, that's a stretch, perhaps, as it is made by pharmaceutical companies and must be handled just like other medications, with caution (possibly excepting lithium orotate, a very long story in itself; it may actually work, theoretically, but safety remains to be demonstrated after one study suggested risk) . But it does come from the earth, after all...
(A brief word on some medications that other psychiatrists might have included in this table: valproate (Depakote) and risperidone (Risperdal); perhaps aripiprazole; and maybe even ziprasidone (Geodon). I have not included risperidone and valproate in the table above because: a) I find risperidone actually has too much antidepressant-like action and may induce a subtle agitation/insomnia/cycling that is hard to manage, because one will always be wondering if it is coming from the patient or from the risperidone; and b) although Depakote has a recent pilot studyDavis demonstrating an antidepressant effect, as well as a small study of less direct designWinsberg, it has not impressed me with its antidepressant effects as have those three listed.)
Conclusion: Why is there such reliance on antidepressants?
I hope this essay may have led you to wonder: with all these options to manage depression in bipolar disorder, and with the risks antidepressants pose (or may pose, depending on how you interpret the current controversies), why does anyone persist in using antidepressants in bipolar patients -- at all?
Obviously I wonder that myself. As I listen to doctors talk about this, it seems there are several factors:
*
Habit: we've been using them for a long time, and they do help quite a few people (even many people with bipolar disorder -- initially).
*
A short-term view of treatment, focusing on the symptom du jour, instead of the long-term goal of stopping cycling as a means of addressing repeated episodes of depression. It's easy to get drawn into treating today's symptom, when you're sitting with a patient who is really depressed, who wants an antidepressant, and who has not learned all you have learned about antidepressants' possible risks.
*
A different interpretation of the available data on risk. You might hope this would be the main explanation. However, I fear that many doctors are unaware of the data we have on the risk controversies.
You may have seen Dr. Ghaemi's data about use of antidepressants in patients with bipolar diagnoses:
To me this suggests that the more one learns about bipolar disorder, from treating patients long-term, the less one uses antidepressants. The good news is that we have at least nine other options to consider! Go read more about them, starting with the table on the the mood stabilizer page."
I am a depressed agoraphobic - Agoraphobia - MedHelp
I am a depressed agoraphobic - Agoraphobia - MedHelp: "I am 20 years old and for the last 2 years I have been a concealed depressant. I have told no one, in or out of my familyBirth control and family planning
Choosing a primary care provider
Ewing’s sarcoma
Family troubles - resources, of my dailyDaily combo
Daily multiple for men 50+
Daily multiple for women
Daily multiple for women 50+
Daily multiple vitamins
Daily vite
Daily-vite men's formula
Daily-vite weight control thoughts of suicideSuicide and suicidal behavior nor of my intentions of suicideSuicide and suicidal behavior. I am rather good at not letting anyone know how I feel and pretending that I am completely fine. Since my freshman year of highschool I have been scared of social events and imbarassing or making myself look stupid in front of people. Rather than looking foolish in front of others I decided to hide myself away from the world and become my own best friend. I spent the entirety of my highschool days playing video games online in my parents basement, which made my only friends those in the online world. I went into college hoping for a better life but found myself seemingly unlikeable and undesirable to be around. I don't have any friends now and I can't remember the last time I left the house on a Friday night. I have spent the vast majority of my time concealed inside my own house playing video games, only now I have given up on the online friendships as well. I realize that there are people I could probably call and with some sympathy they would probably hang out with me. Afraid of when I am with people however I will often find myself thinking of not looking stupid and awkward, often leading me to panicPanic disorder
Panic disorder with agoraphobia and unable to carry a normalNormal saline flush conversation thus in term looking even more stupid. I have come up with about a half dozen ways to kill myself and nearly attempted over a dozen times, most of an unconvincing nature of success. I am absolutely positive I am going to kill myself but in fear of hurting my parents in a delicate time of their own I wait anxiously. I don't want to hear any sob stories about how their is so much to live for and that it is stupid to kill myself. I'm sorry I don't believe there is any possible way our souls are transported through magical gateways to heaven or hell set by rules from long told fairy tales. I have found myself in fear of life, begging for a soon coming quick and painless death. I do not fear death as I believe that my energy simply will become part of another energy. In a planet that is being overrun and consumed by my species, I don't think the stopping of consumption and the giving of my energy to another is stupid. The world would probably be a better place if a few hundred million of us were just dropped off of it. I am tired of people and I am tired most of my incompetence."
Choosing a primary care provider
Ewing’s sarcoma
Family troubles - resources, of my dailyDaily combo
Daily multiple for men 50+
Daily multiple for women
Daily multiple for women 50+
Daily multiple vitamins
Daily vite
Daily-vite men's formula
Daily-vite weight control thoughts of suicideSuicide and suicidal behavior nor of my intentions of suicideSuicide and suicidal behavior. I am rather good at not letting anyone know how I feel and pretending that I am completely fine. Since my freshman year of highschool I have been scared of social events and imbarassing or making myself look stupid in front of people. Rather than looking foolish in front of others I decided to hide myself away from the world and become my own best friend. I spent the entirety of my highschool days playing video games online in my parents basement, which made my only friends those in the online world. I went into college hoping for a better life but found myself seemingly unlikeable and undesirable to be around. I don't have any friends now and I can't remember the last time I left the house on a Friday night. I have spent the vast majority of my time concealed inside my own house playing video games, only now I have given up on the online friendships as well. I realize that there are people I could probably call and with some sympathy they would probably hang out with me. Afraid of when I am with people however I will often find myself thinking of not looking stupid and awkward, often leading me to panicPanic disorder
Panic disorder with agoraphobia and unable to carry a normalNormal saline flush conversation thus in term looking even more stupid. I have come up with about a half dozen ways to kill myself and nearly attempted over a dozen times, most of an unconvincing nature of success. I am absolutely positive I am going to kill myself but in fear of hurting my parents in a delicate time of their own I wait anxiously. I don't want to hear any sob stories about how their is so much to live for and that it is stupid to kill myself. I'm sorry I don't believe there is any possible way our souls are transported through magical gateways to heaven or hell set by rules from long told fairy tales. I have found myself in fear of life, begging for a soon coming quick and painless death. I do not fear death as I believe that my energy simply will become part of another energy. In a planet that is being overrun and consumed by my species, I don't think the stopping of consumption and the giving of my energy to another is stupid. The world would probably be a better place if a few hundred million of us were just dropped off of it. I am tired of people and I am tired most of my incompetence."
Hard Depression, Soft Bipolar
Hard Depression, Soft Bipolar: "Jim Phelps MD is an Oregon psychiatrist in private practice The name of his new book is 'Why Am I Still Depressed?: Recognizing and Managing the Ups and Downs of Bipolar II and Soft Bipolar Disorder.' A better title might have been, 'Screw the DSM: Let’s Discuss What’s Really Going On.'
'In the DSM mode of thinking,' Dr Phelps tells us, 'making an accurate diagnosis requires determining whether the patient with depression symptoms is unipolar or bipolar, whereas in the Mood Spectrum approach, we clinicians don’t ask what might be the most accurate label for you. Instead, we ask where might your symptoms lie on the Mood Spectrum. … Instead of saying yes or no as to whether you might have bipolar disorder [we] try to determine how much bipolarity you have.'
The diagnostic threshold for bipolar II is hypomania, but here’s the catch: Hypomania is often barely discernible, especially in a population that may spend 50 days depressed for every one day hypomanic. A walk on the wild side for some may be using real butter on their toast.
Dr Phelps cites Hagop Akiskal MD of the University of California at San Diego and other leading authorities in support of the proposition that there can be bipolar disorder without hypomania or mania, what some experts are calling 'soft' bipolar disorder.
Basically, look at the nature of the depression. Short and frequent recurrent depressions (as opposed to chronic depression) are a potential giveaway. Rather than view these depressions as discrete episodes that come and go, it may be more helpful to see them as part of a cycle. So what if 'up' is more like normal? We still have evidence of a roller coaster, albeit one of a subterranean variety.
Other indicators are depressions with atypical features (such as mood reactivity), and postpartum and psychotic depressions. A first degree relative with bipolar disorder is also a good sign.
Are We Really Talking About Recurrent Depression Instead?
Frederick Goodwin MD, co-author of the definitive book on bipolar disorder, is inclined to classify these soft bipolar cases as depression, but not in the ordinary sense. The DSM distinction between unipolar and bipolar, in his words, 'turned Kraepelin on his head.'
Emil Kraepelin is the legendary diagnostician who first coined the term manic depression (not to be confused with the term bipolar disorder). In Kraepelin's system, Dr Goodwin explained to this writer, 'affective disorders were divided into the highly recurrent and the less recurrent or non-recurrent forms.'
So what Kraepelin meant by manic depressive illness was 'recurrent affective disorder.' There was no distinction between 'uni' and 'bi.' It was more useful, instead, to conceive of one's illness as occupying part of a continuous spectrum..
But this is not the same as saying all depressions are alike, much less to be treated the same. All the research groups that did the original work on unipolar-bipolar differences were working with recurrent patients. This included Dr Goodwin and his colleagues, who, in a seminal 1976 study, teased out a group of patients with characteristics they defined as 'bipolar II.'
Dr Goodwin used bipolar II to distinguish this form of mood disorder from unipolar disorder and bipolar I. Nevertheless, in all cases it was understood by all concerned that they were dealing with various types of recurrent depression. The original meaning of unipolar, says Dr Goodwin, 'was one form of recurrent affective disorder.'
Later investigators separated manic depressive disorder into unipolar and bipolar, based on the presence or absence of mania or hypomania. But, as Dr Goodwin explains:
'Once the DSM separated bipolar disorder out from the beginning, it left unipolar as a relatively meaningless term - that is, everything that's not bipolar. The DSM-IV residual category of 'recurrent unipolar' is not much help because all that means is more than one episode.'
One of the implications of abandoning Kraepelin, according to Dr Goodwin, is 'that my friend Hagop Akiskal is more or less forced to put the highly recurrent unipolar patients in the 'bipolar spectrum' even though they are not bipolar. Given the DSM-IV, that seems to be the only way to emphasize their close relationship to bipolar disorder (family history of mania, early age of onset, multiple episodes).'
Focus on the Cycling
So we are talking about a group of patients with highly recurrent depressions, who may or may not have bipolar disorder but who have a lot in common with those who do.
The bottom line tends to be how these individuals react to antidepressants. An individual with highly recurrent depression or soft bipolar may run a similar risk of switching into mania or hypomania as one with more obvious bipolar symptoms. Or, as in the case with many bipolar patients, the antidepressant may poop out or have no clinical benefit whatsoever, even after three attempts on different antidepressants.
'By its very nature,' Dr Phelps tells us, 'bipolar disorder is a problem of cyclic changes in mood and energy.' Therefore, Dr Phelps advises, focus on the long-term goal of stopping the cycling and 'try to avoid treating your symptom du jour.' The object is to keep depression from returning and not make the cycling worse.
It’s helpful to start, Dr Phelps advises, by being mindful of the stabilizing influences in our lives, such as adequate sleep, good social connections, proper diet, and exercise. Lord knows, we can count on a host of destabilizing influences to arrive on our doorsteps.
It may be best to ride out a depression, if possible, Dr Phelps suggests, rather than try an antidepressant. Bipolar depressions tend to be of shorter duration, so once the depression resolves, meds strategies can concentrate on keeping depressions from returning. Mood stabilizers are the treatment of choice, some with demonstrated efficacy in preventing relapse into a depressive episode.
Intriguingly, Dr Goodwin notes: 'It's quite revealing to look at the old lithium data; it's as effective in the prevention of highly recurrent unipolar as it is in bipolar; so this particular mood stabilizer should be viewed as an anti-cyclic agent, not just an antibipolar agent.'
For those with bipolar (and highly recurrent) depressions, antidepressants need to be regarded with suspicion, as these meds tend to treat the symptom at the expense of the cycle. Switches into mania and hypomania are common. Ironically, Dr Phelps maintains, antidepressants may result in more depression. This is because antidepressants, as well as causing cycling, may shorten the intervals between cycles.
Psychotherapy is also crucial. These include cognitive-behavioral therapy and interpersonal therapy. Dr Phelps also urges 'prodrome detection,' which involves being acutely attuned to early warning signs of an impending episode, and 'social rhythm therapy' for normalizing sleep."
'In the DSM mode of thinking,' Dr Phelps tells us, 'making an accurate diagnosis requires determining whether the patient with depression symptoms is unipolar or bipolar, whereas in the Mood Spectrum approach, we clinicians don’t ask what might be the most accurate label for you. Instead, we ask where might your symptoms lie on the Mood Spectrum. … Instead of saying yes or no as to whether you might have bipolar disorder [we] try to determine how much bipolarity you have.'
The diagnostic threshold for bipolar II is hypomania, but here’s the catch: Hypomania is often barely discernible, especially in a population that may spend 50 days depressed for every one day hypomanic. A walk on the wild side for some may be using real butter on their toast.
Dr Phelps cites Hagop Akiskal MD of the University of California at San Diego and other leading authorities in support of the proposition that there can be bipolar disorder without hypomania or mania, what some experts are calling 'soft' bipolar disorder.
Basically, look at the nature of the depression. Short and frequent recurrent depressions (as opposed to chronic depression) are a potential giveaway. Rather than view these depressions as discrete episodes that come and go, it may be more helpful to see them as part of a cycle. So what if 'up' is more like normal? We still have evidence of a roller coaster, albeit one of a subterranean variety.
Other indicators are depressions with atypical features (such as mood reactivity), and postpartum and psychotic depressions. A first degree relative with bipolar disorder is also a good sign.
Are We Really Talking About Recurrent Depression Instead?
Frederick Goodwin MD, co-author of the definitive book on bipolar disorder, is inclined to classify these soft bipolar cases as depression, but not in the ordinary sense. The DSM distinction between unipolar and bipolar, in his words, 'turned Kraepelin on his head.'
Emil Kraepelin is the legendary diagnostician who first coined the term manic depression (not to be confused with the term bipolar disorder). In Kraepelin's system, Dr Goodwin explained to this writer, 'affective disorders were divided into the highly recurrent and the less recurrent or non-recurrent forms.'
So what Kraepelin meant by manic depressive illness was 'recurrent affective disorder.' There was no distinction between 'uni' and 'bi.' It was more useful, instead, to conceive of one's illness as occupying part of a continuous spectrum..
But this is not the same as saying all depressions are alike, much less to be treated the same. All the research groups that did the original work on unipolar-bipolar differences were working with recurrent patients. This included Dr Goodwin and his colleagues, who, in a seminal 1976 study, teased out a group of patients with characteristics they defined as 'bipolar II.'
Dr Goodwin used bipolar II to distinguish this form of mood disorder from unipolar disorder and bipolar I. Nevertheless, in all cases it was understood by all concerned that they were dealing with various types of recurrent depression. The original meaning of unipolar, says Dr Goodwin, 'was one form of recurrent affective disorder.'
Later investigators separated manic depressive disorder into unipolar and bipolar, based on the presence or absence of mania or hypomania. But, as Dr Goodwin explains:
'Once the DSM separated bipolar disorder out from the beginning, it left unipolar as a relatively meaningless term - that is, everything that's not bipolar. The DSM-IV residual category of 'recurrent unipolar' is not much help because all that means is more than one episode.'
One of the implications of abandoning Kraepelin, according to Dr Goodwin, is 'that my friend Hagop Akiskal is more or less forced to put the highly recurrent unipolar patients in the 'bipolar spectrum' even though they are not bipolar. Given the DSM-IV, that seems to be the only way to emphasize their close relationship to bipolar disorder (family history of mania, early age of onset, multiple episodes).'
Focus on the Cycling
So we are talking about a group of patients with highly recurrent depressions, who may or may not have bipolar disorder but who have a lot in common with those who do.
The bottom line tends to be how these individuals react to antidepressants. An individual with highly recurrent depression or soft bipolar may run a similar risk of switching into mania or hypomania as one with more obvious bipolar symptoms. Or, as in the case with many bipolar patients, the antidepressant may poop out or have no clinical benefit whatsoever, even after three attempts on different antidepressants.
'By its very nature,' Dr Phelps tells us, 'bipolar disorder is a problem of cyclic changes in mood and energy.' Therefore, Dr Phelps advises, focus on the long-term goal of stopping the cycling and 'try to avoid treating your symptom du jour.' The object is to keep depression from returning and not make the cycling worse.
It’s helpful to start, Dr Phelps advises, by being mindful of the stabilizing influences in our lives, such as adequate sleep, good social connections, proper diet, and exercise. Lord knows, we can count on a host of destabilizing influences to arrive on our doorsteps.
It may be best to ride out a depression, if possible, Dr Phelps suggests, rather than try an antidepressant. Bipolar depressions tend to be of shorter duration, so once the depression resolves, meds strategies can concentrate on keeping depressions from returning. Mood stabilizers are the treatment of choice, some with demonstrated efficacy in preventing relapse into a depressive episode.
Intriguingly, Dr Goodwin notes: 'It's quite revealing to look at the old lithium data; it's as effective in the prevention of highly recurrent unipolar as it is in bipolar; so this particular mood stabilizer should be viewed as an anti-cyclic agent, not just an antibipolar agent.'
For those with bipolar (and highly recurrent) depressions, antidepressants need to be regarded with suspicion, as these meds tend to treat the symptom at the expense of the cycle. Switches into mania and hypomania are common. Ironically, Dr Phelps maintains, antidepressants may result in more depression. This is because antidepressants, as well as causing cycling, may shorten the intervals between cycles.
Psychotherapy is also crucial. These include cognitive-behavioral therapy and interpersonal therapy. Dr Phelps also urges 'prodrome detection,' which involves being acutely attuned to early warning signs of an impending episode, and 'social rhythm therapy' for normalizing sleep."
Sunday, 22 November 2009
Depression - Symptoms
Depression - Symptoms: "Symptoms of depression
If you’re depressed you often lose interest in things that you used to enjoy. Depression commonly interferes with your work, social and family life. In addition, there are many other symptoms, which can be physical, psychological and social.
Psychological symptoms:
* continuous low mood or sadness,
* feelings of hopelessness and helplessness,
* low self-esteem,
* tearfulness,
* feelings of guilt,
* feeling irritable and intolerant of others,
* lack of motivation and little interest in things,
* difficulty making decisions,
* lack of enjoyment,
* suicidal thoughts or thoughts of harming someone else,
* feeling anxious or worried, and
* reduced sex drive.
Physical symptoms:
* slowed movement or speech,
* change in appetite or weight (usually decreased, but sometimes increased),
* constipation,
* unexplained aches and pains,
* lack of energy or lack of interest in sex,
* changes to the menstrual cycle, and
* disturbed sleep patterns (for example, problems going to sleep or waking in the early hours of the morning).
Social symptoms:
* not performing"
Saturday, 14 November 2009
about depression
Introduction
We all feel fed up, miserable or sad at times. These feelings don't usually last longer than a week or two, and they don't interfere too much with our lives. Sometimes there's a reason, sometimes not. We usually cope - we may talk to a friend but don't otherwise need any help.
However, in depression:
- your feelings don't lift after a few days – they carry on for weeks or months
- are so bad that they interfere with your life.
What does it feel like?
Most people with depression will not have all the symptoms listed below, but most will have at least five or six.
- Feel unhappy most of the time (but may feel a little better in the evenings)
- Lose interest in life and can't enjoy anything
- Find it harder to make decisions
- Can't cope with things that you used to
- Feel utterly tired
- Feel restless and agitated
- Lose appetite and weight (some people find they do the reverse and put on weight)
- Take 1-2 hours to get off to sleep, and then wake up earlier than usual
- Lose interest in sex
- Lose your self-confidence
- Feel useless, inadequate and hopeless
- Avoid other people
- Feel irritable
- Feel worse at a particular time each day, usually in the morning
- Think of suicide.
You may not realise how depressed you are for a while, especially if it has come on gradually. You try to struggle on and may even start to blame yourself for being lazy or lacking willpower. It sometimes takes a friend or a partner to persuade you that there really is a problem which can be helped.
You may start to notice pains, constant headaches or sleeplessness. Physical symptoms like this can be the first sign of depression.
Why does it happen?
As with our everyday feelings of low mood, there will sometimes be an obvious reason for becoming depressed, sometimes not. It can be a disappointment, a frustration, or that you have lost something - or someone – important to you. There is often more than one reason, and these will be different for different people. They include:
Things that happen in our lives
It is normal to feel depressed after a distressing event - bereavement, a divorce or losing a job. You may well spend a lot of time over the next few weeks or months thinking and talking about it. After a while you come to terms with what's happened. But you may get stuck in a depressed mood, which doesn't seem to lift.
Circumstances
If you are alone, have no friends around, are stressed, have other worries or are physically run down, you are more likely to become depressed.
Physical Illness
This is true for life-threatening illnesses like cancer and heart disease, and also for illnesses that are long and uncomfortable or painful, like arthritis or bronchitis. Younger people can become depressed after viral infections, like flu or glandular fever.
Personality
Some of us seem to be more vulnerable to depression than others. This may be because of our genes, because of experiences early in our life, or both.
Alcohol
Regular heavy drinking makes you more likely to get depressed – and, indeed, to kill yourself.
Gender
Women seem to get depressed more often than men. It may be that men are less likely to talk about their feelings and more likely to deal with them by drinking heavily or becoming aggressive. Women are more likely to have the double stress of having to work and look after children.
Genes
Depression can run in families. If you have one parent who has become severely depressed, you are about eight times more likely to become depressed yourself.
What about bipolar disorder (manic depression)?
About one in 10 people who suffer from serious depression will also have periods when they are too happy and overactive. This used to be called manic depression, but is now often called Bipolar Disorder. It affects the same number of men and women and tends to run in families (see leaflet on Bipolar Disorder).
Isn't depression just a form of weakness?
Other people may think that you have just 'given in', as if you have a choice in the matter. The fact is there comes a point at which depression is much more like an illness than anything else. It can happen to the most determined of people – even powerful personalities can experience deep depression. Winston Churchill called it his ‘black dog'.
When should I seek help?
- When your feelings of depression are worse than usual and don't seem to get any better.
- When your feelings of depression affect your work, interests and feelings towards your family and friends.
- If you find yourself feeling that life is not worth living, or that other people would be better off without you.
It may be enough to talk things over with a relative or friend. If this doesn't help, you probably need to talk it over with your family doctor. You may find that your friends and family have noticed a difference in you and have been worried about you.
Helping yourself
Don't keep it to yourself
If you've had some bad news, or a major upset, tell someone close to you - tell them how you feel. You may need to talk (and maybe cry) about it more than once. This is part of the mind's natural way of healing.
Do something
Get out of doors for some exercise, even if only for a walk. This will help you to keep physically fit, and will help you sleep. Even if you can't work, it's good to keep active. This could be housework, do-it-yourself (even as little as changing a light bulb) or any activity that is part of your normal routine.
Eat well
You may not feel like eating - but try to eat regularly. Depression can make you lose weight and run short of vitamins which will only make you feel worse. Fresh fruit and vegetables are particularly helpful.
Beware alcohol!
Try not to drown your sorrows with a drink. Alcohol actually makes depression worse. It may make you feel better for a short while, but it doesn't last. Drinking can stop you dealing with important problems and from getting the right help. It's also bad for your physical health.
…. and cannabis
While cannabis can help you to relax, there is now evidence that regular use, particularly in teenagers, can bring on depression.
Sleep
If you can't sleep, try not to worry about it. Try listening to the radio or watch some TV while you're lying in bed. Your body will get a chance to rest and, with your mind occupied, you may feel less anxious and find it easier to get some sleep.
Tackle the cause
If you think you know what is behind your depression, it can help to write down the problem and then think of the things you could do to tackle it. Pick the best things to do and try them.
Keep hopeful
Remind yourself that:
- Many other people have had depression.
- It may be hard to believe, but you will eventually come out of it.
- Depression can sometimes be helpful – you may come out of it stronger and better able to cope. It can help you to see situations and relationships more clearly.
- You may be able to make important decisions and changes in your life, which you have avoided in the past.
What kind of help is available?
Most people with depression are treated by their family doctor. Depending on your symptoms, the severity of the depression and the circumstances, the doctor may suggest:
- self-help
- talking treatments
- antidepressant tablets
Guided self-help
This can include:
- Self-help leaflets or books, using CBT principles (see below)
- Self help computer programmes or the internet
- Exercise - 3 sessions per week for 45 minutes to 1 hour, for between 10 and 12 weeks
Whichever of these is right for you depends on your personality and lifestyle.
Talking treatments
There are many different sorts of psychotherapy available, some of which are very effective for people with mild to moderate depression. They include:
Counselling
Simply talking about your feelings can be helpful however depressed you are. Sometimes it is hard to express your real feelings even to close friends. Talking things through with a trained counsellor or therapist can be easier. It can be a relief to get things off your chest and it can help you to be clearer about how you feel about your life and other people. There may be a counsellor at your GP surgery with whom you can talk, or your GP can refer you to a local counselling service.
Cognitive behavioural therapy (CBT)
Many of us have habits of thinking which, quite apart from what is happening in life, are likely to make us depressed and keep us depressed. CBT helps you to:
- identify any unrealistic and unhelpful ways of thinking
- then develop new, more helpful ways of thinking and behaving.
See our leaflet on CBT for further information.
Problem-solving therapy
This helps you to be clear about your key problems, how to break them down into manageable bits and how to develop problem-solving skills.
Couple therapy
If your depression seems connected with your relationship with your partner, then RELATE can be helpful in enabling you to sort out your feelings – it is an organisation that specialises in working with couples. (see 'other organisations' for contact details).
Support groups
If you have become depressed while suffering from a disability or caring for a relative, then sharing experiences with others in a self-help group may give you the support you need.
Bereavement Counselling
If you are not able to get over the death of someone close to you, you need to talk about it with a specialist bereavement counsellor.
Interpersonal and psychodynamic psychotherapy
This may be more suitable if you have had long-standing difficulties with your life or relationships. This tends to be a longer-term treatment and helps you to see how your past experiences may be affecting your life here and now.
Group therapy
Talking in groups can be helpful in changing how you behave with other people. You get the chance, in a safe and supportive environment, to hear how people see you and the opportunity to try out different ways of behaving and talking.
Talking treatments do take time to work. Sessions usually last about an hour and you might need anywhere from five to 30 sessions. Some therapists will see you weekly, others every two to three weeks.
Problems with talking treatments
These treatments are usually very safe but they can have unwanted effects. Talking about things can bring up bad memories from the past and this can make you feel worse for a while. Others have reported that therapy can change their outlook and the way they relate to friends and family. Therapy can put a strain on a close relationship. Make sure that you can trust your therapist and that they have the necessary training. If you are concerned about having therapy, talk it over with your doctor or therapist. Unfortunately, talking treatments are still in short supply. In some areas, you may have to wait for several months.
Antidepressants
If your depression is severe or goes on for a long time, your doctor may suggest a course of antidepressants. These are not tranquillisers, although they may help you to feel less anxious and agitated. They can help people with depression to feel and cope better, so that they can start to enjoy life and deal with their problems effectively again. Although there is a continuing debate about how much more effective they are than placebo (‘dummy drug’), they seem to be most helpful with more severe depressions.
If you do start taking antidepressants, you probably won't feel any effect on your mood for two or three weeks. You may notice that you start to sleep better and feel less anxious after a few days.
How do antidepressants work?
The brain is made up of millions of cells which transmit messages from one to another using tiny amounts of chemical substances called neurotransmitters. Upwards of 100 different chemicals are active in different areas of the brain. It is thought that in depression two of these neurotransmitters are particularly affected – Serotonin, sometimes referred to as 5HT, and Noradrenaline. Antidepressants increase concentrations of these two chemicals at nerve endings and so seem to boost the function of those parts of the brain that use Serotonin and Noradrenaline. Even so, it is not certain that this is the actual mechanism that improves your mood.
Problems with antidepressants
Like all medicines, antidepressants have side-effects, though these are usually mild and tend to wear off after a couple of weeks. The newer antidepressants (called SSRIs) may make you feel a bit sick at first and you may feel more anxious for a short while. The older type of antidepressants can cause a dry mouth and constipation. Your doctor can advise you on what to expect, and will want to know about anything that worries you. You will also get written information on the medication from your pharmacist.
If an antidepressant makes you sleepy, you should take it at night, so it can help you to sleep. However, if you feel sleepy during the day, you should not drive or work with machinery till the effect wears off. Alcohol can make you very sleepy if you drink while taking the tablets, so it is best avoided.
You can eat a normal diet while taking most of these tablets and they don't cause problems with pain-killers, antibiotics or the contraceptive pill.
Your GP, not a psychiatrist, will usually be the one who prescribes an antidepressant. At first, he or she will need to see you regularly to make sure the tablets agree with you. If they do help, it is advisable to stay on them for at least four months after you feel better. If you have had more than one episode of depression, you may have to stay on them for longer than this. When it is time to stop, you should come off them slowly with the advice of your doctor.
People often worry that antidepressants are addictive. Certainly, you may get withdrawal symptoms if you stop an antidepressant suddenly. These can include anxiety, diarrhoea and vivid dreams or even nightmares. This can nearly always be avoided by slowly reducing the dose before stopping. Unlike drugs such as Valium (or nicotine or alcohol), you don't have to keep taking an increasing amount to get the same effect, and you will not find yourself craving an antidepressant.
Antidepressants and young people
There are some limits to the use of antidepressants for younger people, in their teens. There is some evidence that SSRI antidepressants can increase suicidal thoughts in young people, so there are limits on their use in this age group. In the UK:
- Fluoxetine is the only SSRI antidepressant licensed for use with young people.
- It should usually be used only in addition to a psychological therapy.
- It should be given under the direction of a psychiatrist
- The young person should be seen every week at least for the first 4 weeks.
You can find more detailed information in the our leaflet on antidepressants.
Alternative remedies
St John's Wort is a herbal remedy available from chemists. It is widely used in Germany and there is evidence that it is effective in mild to moderate depression. There are now one-tablet per day preparations available. It seems to work in much the same way as some antidepressants, but some people find that it has fewer side-effects. One problem is that it can interfere with the way other medications work. If you are taking other medication, you should discuss it with your doctor.
Which is right for me - talking or tablets?
It depends on how your depression has developed and how bad it is. On the whole, talking treatments have been found to help in mild and moderate depression. Medication is not thought to be helpful in mild depression. If your depression is severe, you are more likely to need antidepressant medication, usually for a period of 7-9 months.
People often find that it is useful to have some form of psychotherapy after their mood has improved with antidepressants. It can help you to work on some of the things in your life that might otherwise make you become depressed again.
So, it may not be a case of one treatment or the other, but what is most helpful for you at a particular time. Both talking treatments and antidepressants are about equally effective in helping people get better from moderate depression. (see references). Many psychiatrists believe that antidepressants are more effective in treating severe depression.
Some people just don't like the idea of medication, some don't like the idea of psychotherapy. So, there is obviously a degree of personal choice. This is limited by the fact that proper counselling and psychotherapy are not readily available in some areas of the country.
When you are low it can be difficult to work out what you should do. Talk it over with friends or family or people you trust. They might be able to help you decide.
Will I need to see a psychiatrist?
Probably not. Most people with depression get the help they need from their GP. If you don't improve and need more specialist help, you will be referred to a psychiatrist or a member of the Community Mental Health Team. A psychiatrist is a medical doctor who specialises in the treatment of emotional and mental disorders. Community team members may be a nurse, psychologist, social worker or occupational therapist. Whichever profession they belong to, they will have specialist training and experience in mental health problems.
The first interview with a psychiatrist will probably last about an hour. You may be invited to bring a relative or friend with you if you wish. The psychiatrist will want to find out about your general background and about any serious illnesses or emotional problems you may have had in the past. He or she will ask about what has been happening in your life recently, how the depression has developed and whether you have had any treatment for it already. It can sometimes be difficult to answer all these questions, but they help the doctor to get to know you as a person and to get an idea of what would be good options for you.
This might be practical advice, or suggesting different treatments, perhaps involving members of your family. If your depression is severe or needs specialist treatment, you might need to come into hospital – but this is only needed for one in every 100 people with depression.
What will happen if I don’t get any treatment?
The good news is that 4 out of 5 people with depression will get completely better without any help in about 4-6 months - sometimes more. So, why bother to treat depression?
Although 4 out of 5 people get better in time, this still leaves 1 in 5 who are still depressed two years later. As yet, we can't accurately predict who will get better and who will not. Even if you get better eventually, the experience can be so unpleasant that you may feel that you want to shorten the time you are depressed. Moreover, if you have a first episode of depression, you have a roughly 50:50 chance of having another one. A small number of people with depression will eventually commit suicide.
Taking up some of the suggestions in this leaflet may shorten a period of depression. If you can overcome it by yourself, then that will give you a feeling of achievement and confidence to tackle such feelings again if you feel low in the future. However, if the depression is severe or goes on for a long time, it may stop you from being able to work and enjoy life.
How can I help someone who is depressed?
- Listen. This can be harder than it sounds. You may have to hear the same thing over and over again. It's usually best not to offer advice unless it's asked for, even if the answer seems perfectly clear to you. If depression has been brought on by a particular problem, you may be able to help find a solution or at least a way of tackling the difficulty.
- It's helpful just to spend time with someone who is depressed. You can encourage them, help them to talk, and help them to keep going with some of the things they normally do.
- Someone who is depressed will find it hard to believe that they can ever get better. You can reassure them that they will get better, but you may have to repeat this over and over again.
- Make sure that they are buying enough food and eating enough.
- Help them to stay away from alcohol.
- If they are getting worse and start to talk of not wanting to live or even hinting at harming themselves, take them seriously. Make sure that they tell their doctor.
- Encourage them to accept help. Don't discourage them from taking medication, or seeing a counsellor or psychotherapist. If you have worries about the treatment, then you may be able to discuss them first with the doctor.
References
Randomised controlled trial of problem solving treatment, antidepressant medication, and combined treatment for major depression in primary care.
British Medical Journal (2000); 320:26-30
Natural history and preventative treatment of recurrent mood disorders.
Thase FE. Annual Review of Medicine (1999); 50:453-468.
NICE Clinical guideline 23 Depression - Management of depression in primary and
secondary care. December 2004 National Institute for Clinical Excellence, London
NICE Clinical guideline 23 The treatment of depression in children and young people. September 2005, National Institute for Clinical Excellence, London
Effectiveness of antidepressants: evidence based guidelines for treating depressive disorders with antidepressants
Anderson IM et al. (2000); Journal of Psychopharmacology 14 (1): 3-20.
Problems stopping: antidepressant discontinuation reactions
British Medical Journal; (1998) 316:1105-1106.
Cannabis and mental health (2002) Rey and Tennant, BMJ 325 (7374): 1183.
Other organisations
Association for Postnatal Depression: Helpline: 020 7386 0868 (10am- 2pm Mon, Weds and Fri and 10am- 5pm, Tues and Thurs). http://apni.org/
Provides support to mothers suffering from post-natal illness. It exists to increase public awareness of the illness and to encourage research into its cause and nature.
Aware- Helping to defeat depression: Helpline: 00 353 1 90 303 302; Tel: 00 353 1 661 7211. http://www.aware.ie/ Provides information and support to people affected by depression in Ireland and Northern Ireland.
Information, support and understanding for people who suffer with depression, and for relatives who want to help. Self-help groups, information, and raising awareness for depression.
Depression UK: (Previously the Fellowship of Depressives Anonymous) http://www.depressionuk.org/; Email: info@depressionuk.org
A national mutual support group for people suffering from depression.
A user-led charity working to enable people affected by bipolar disorder (manic depression) to take control of their lives.
MDF The Bipolar Organisation Cymru: Helpline: 08456 340 080; Tel: 01633 244244; Fax: 01633 244111; http://www.mdfwales.org.uk/; Email: info@mdfwales.org.uk
Works to enable people affected by manic depression to take control of their lives through self-help groups and information on all aspects of the condition.
Medical charity providing information, advice and support to women affected by PMS, their partners and families.
UK's largest and most experienced relationship counselling organisation.
Samaritans: Helpline: 08457 90 90 90; (Ireland): 1850 60 90 90; http://www.samaritans.org/; e-mail: jo@samaritans.org
National organisation offering support to those in distress who feel suicidal or despairing and need someone to talk to. The telephone number of your local branch can be found in the telephone directory.
A national out-of-hours telephone helpline offering emotional support and information for people affected by mental health problems. Open from 6pm to 11pm every day of the year.
A national charity committed to improving the mental health of all children and young people under 25. Special web pages for young people at http://www.youngminds.org.uk/young-people/
Saturday, 21 March 2009
Depressing
also check this out
You know depression is ready to set in
When you wake up hating the life you have created within
Look into the sun filled sky
Let the warmth deeply apply
To fill your heart and your soul
Get rid of the deppression that has a hold
Don't let it sink far enough in
For if you do you will not win
Don't let it touch your precious life
Or your family, friends and loved one
Don't let it drag you way down low
Get the sun's warmth to let it go
Fight the fight
And you will win
You will beat
The depression sneaking
in
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