Monday, 26 January 2015

January Blues: What help is available?

 
In my previous post on where to get help if you think you may have depression I referred to a questionnaire that your GP should supply you in order to form an assessment of how much depression is affecting you. You can see an online copy of the questionnaire here http://www.nhs.uk/Tools/Pages/depression.aspx  It is important that you fill it out honestly and that you can provide as much other information as possible in order for your GP to suggest treatments they feel will most help you.
 
Possible Treatments
 
See how it goes:
If your depression is relatively mild then after your initial talk with your GP you may feel a bit more empowered and much lighter for having got things off your chest. If this is the case then make a follow up appointment for a week or two to see if this continues. But remember if you continue to feel worse then go back to see them sooner. Furthermore speak to someone that you can trust and open up to regularly. Also remember if you are feeling at the end of your tether with it all then seeing how it goes might to you sound like a cop out. In which case work with your doctor to come up with a more proactive care plan.
 
Self care:
 
Your GP may also write you a book prescription for a self help book about depression/ anxiety that they recommend. You simply take the prescription to your local library and they get a copy of that book for you to lend for a few weeks. It doesn't matter if you are a member of that library or not. You may find it difficult at times to  concentrate but take it bit by bit. Alternatively they could recommend good websites to use that have detailed and useful information. Sometimes just knowing you are being that bit more pro active can lift your mood slightly.
Other tips that may help you is to try and see a bit more day light and get more fresh air. To do gentle excercise. Eat more healthy foods. Even just pampering yourself a bit. Having a bubble bath, putting on a face mask or painting your nails. Listening to your favourite songs or watching your favourite tv show or film. Many a counsellor will tell you to avoid the news and soap operas as they can often make you feel worse. They might sound trivial but they can work to help boost your self esteem and also as a distraction technique, to prevent you thinking as much about your troubles. I would also recommend keeping a diary to help you rate your mood and to notice if anything helps to improve your mood. Even if you simply write:
 
Mood before activity (going for a walk):
Mood after activity:
 
Assigning your mood a number. 1 being the lowest mood imagineable and 10 being the best mood.
 
Talking Therapy:
 
As mentioned in my former post counselling is one of the most recommended forms of treatment available for all kinds of patient and problems. It can help you to gain perspective and to make you feel that you are not alone in dealing with your emotions, feelings and problems. You may benefit from talking to a friend or family member however the added advantage of receiving counselling is that you can talk to someone who is trained to listen and have specific advice to help you cope with this difficult time. Plus, because they don't know you they do not have any preconceptions of you nor pass any judgement. Usually counselling is one on one but there is also the options of relationship counselling, family counselling and group therapy depending on your needs. I spoke in more detail on what types of counselling are available and where you can find counselling that is right for you in my previous post (linked above).
 
Cognitive Behavioural Therapy
 
Or CBT as it is known, whilst controversial for it's choice as a treatment for physical illnesses, can be an effective treatment for mental health problems. It may be used alongside counselling or often combined with it in each session. It is a way of analysising the way in which you think about things and how we form patterns of thought. It looks at ways to prevent some thought patterns that lead to feelings of depression and anxiety from occurring.
 
For example I found CBT extremely useful in helping me to stop negative thoughts from escalating into depression or anxiety and panic and each time it did I would automatically think about self harming. So through using CBT in my counselling sessions and other help I recieved I was able to identify triggers to these feelings and with time learn to rechannel those thoughts. And I can honestly say now, 5 years later I'm still very grateful for each time I can feel down in the dumps or alone etc etc and not have thoughts of self harm. So I think this is a good treatment for anyone that as a consequence of their feelings wants to harm themselves (or others) in anyway be it through cutting to starving yourself. Obviously the greater the feeling to do harm is CBT may only be part of a treatment plan and combined with other treatments.
 
It is also a good treatment for anyone that is having real difficulty in coping with change in their lives. Be it feeling lost after retiring to having to cope with being diagnosed with a long term illness. It won't improve the symptoms of a physical illness but it may help you to have the strength to adjust to having your life uprouted. For example if you feel that as a result of your illness that your life no longer has meaning. In some ways I think had I not learned to have greater control of my thoughts (even though it was a while before being diagnosed with M.E) I would struggle more emotionally and be at greater risk or relapasing into depression.
 
Medication
 
Many people have opposing views on the use of medications such as antidepressants and benzodiapozines (such as xanax and diazapam) to treat depression or anxiety. Some will say they disliked them, that they gave them a false sense of reality and simply masked their emotions; leaving the feelings unresolved and likely to return. While others, myself included, will say that they were a big help in winning back the emotional fight. That they help calm things down so that you can deal with the emotions and any triggers that you identify through talking therapies. Either way using talking therapies too will allow you to deal with any triggers to the way you are feeling that antidepressants alone can't solve. Of course it is entirely your own choice if you want to go down that route. And I do not wish to influence anyones choice as everyone is different.
 
It's a decision that should be made solely between you and your doctor. You might be worried that by taking antidepressants your problems seem to be much more frightening. A kind of "well I must be really bad if I need loony pills". Or you may be scared in case someone sees you taking this medication and will therefore associate you with being mad. Another fear may be that you are worried about the side effects, which some patients may experience. However each patient will react in different ways. The same goes with fear of the withdrawal process, which can cause it's own problems. It can be helpful to reassure yourself that it is your body readjusting to less chemicals and not be filled with fear that you are adjusting. Be sure to thoroughly discuss likely side effects with your doctor so that you can be fully aware of what to expect. And when the time comes that you feel you could cope without them your doctor will advise you on how to do so gradually and safely. But be aware that it may take some time. It could even be years in some cases (I'm still on a low dosage, 5 years later.) And if you want to make the decision about proceeding with medication at a later date then it's up to you.
 
Types of medication
 
There are several types of antidepressants. However they are all designed to act on the same brain chemicals. I won't go in to chemical speak but basically they work on prolonging serotonin, the chemical associated with good mood, as people suffering from depression can have low levels. These are known as SSRIs. More modern antidepressants also work on norepinephrine another chemical that is responsible for energy and alertness. These are known as SNRIs. These may also have less side effects.
 
Tricyclic and tricyclic-related antidepressants were invented in the 1950s and work by prolonging the action of seratonin as well as noradrenaline in the brain. These can cause a few more side effects.
There are also Monoamine oxidase inhibitors (MAOIs) however these are less common, mainly after other types of antidepressants have been tried and are only prescribed by specialists.
 
Benzodiazepines are sometimes used to help manage anxiety, panic attacks and obsessive compulsive disorders and sometimes during alcohol withdrawal. They work on the chemical in the brain that helps us to feel calm and to help the cells pass on the message that we are not in any danger, that has been triggered with an anxiety or panic attack. However they will only ever be prescribed for short term use due to their association with addiction.Also because they do not help with the route cause of anxiety nor help you to feel better in the long term. They're only effective for a short time when your body is at peak distress. Other treatments such as counselling, CBT or antidepressants will be recommended as more effective ways to stop the anxiety from building and help you cope more long term.
 
Other Treatments
 
Arts therapies
 
Arts therapy is a less intrusive more complimentary treatment. And is designed to allow people that have difficulty in expressing their feelings to do so in a different way. It is often used when treating children, for example to help them come to terms with grief or divorce. It can be useful with this age group due to them not having the learned the right words to express how they feel or how to process the new information. But can also be effective for people of any age. Different art forms such as   music, art, dance or drama can be utilised to help the sufferer to express their feelings in a way that does not feel like therapy. Each session will be run by a trained therapist who will help you to interpret your work and be there if you want to talk about the emotions it has conjured up. Your GP, specialist, counsellor or local MIND centre should be able to tell you where you you can locally access this kind of therapy.

Alternative medicine
 
Depending on your beliefs you may wish to try alternative medicine or treatment. It will also depend on the GP that you are with what information they have about this. Some way have recommendations and others won't because it doesn't necessarily fall within their remit. However like with anything you undertake be sure to know how it will impact you and whether it will interfere with any medication you take. Just because something is natural or alternative does not mean it won't give you side effects (again it differs with each case). I would recommend that anything you do try you disclose to your doctor as a way to regulate how the treatment is going. Also remember that you will need to pay for any medication or treatment yourself.
 
The treatments I have mentioned here are for relatively moderate depression or anxiety. If your condition becomes worse or you become more at risk of doing harm to yourself then there are further options available. Also if you are diagnosed with another type of mental illness such as bipolar disorder, paranoid schitzophrenia or Obsessive Compulsuve Disorder then more specialized help is available. But in the most instances most depression or anxiety patients will be treated with one or a combination of the above treatments and will find them effective. And if any time you feel you are getting worse or experience nasty side effects then be sure to get back to your doctor as soon as you can.
 
Of course what is important to remember is there are no quick fixes, getting better will take time. And that may be incredibley frustrating at times. Try to have patience and think that each day is a step in the right direction. Think of it like a physical illness or injury if needs be. If you broke your leg or had appendicitis you would need at least 6 weeks to be heeled again. Having a mental health problem is no less real and the mind is a much more complex place.
 
Sian
 
* The information contained within this blog post is for self education purposes and should only be used in conjunction with that of a doctor that understands your personal circumstances.  All information in this blog post has been researched from MIND's website and the NHS website. With some personal experience. Please note that every patient is different  and all medical choices are best decided between you and your medical professional. I do not wish to influence anyone's choices, as it is down to each individual. This post only stands to point out what help is available out there.

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