By Nancy Hine
These days hardly a week seems to go by without my hearing some news item relating to depression. You would have to have your head buried in the sand not to be aware that diagnosis is increasing, that prescription of antidepressants has reached an all time high and that the effectiveness of antidepressants is being challenged.
So how does all this affect you if you are depressed? Despite NICE guidelines recommending counselling rather than antidepressants for mild to moderate depression, you are still likely to find your GP offering you antidepressants. If your doctor is enlightened enough to refer you for counselling you are likely to face a wait of several weeks, or perhaps even months, for an initial assessment and then sometimes a further wait of weeks to start your therapy. The counselling itself is then likely to be limited to six to twelve weeks, although the Department of Health’s own report in 2001 stating that ‘often 16 sessions or more may be required for symptomatic relief and longer therapies may be required to achieve lasting change in social and personality functioning’.
The government is promising to pour money into the provision of more NHS counsellors, but this is going to take some time to have any impact on the patient in the doctor’s surgery. So if you are facing depression now what can you do to help your recovery?
This is an obvious alternative to waiting for limited counselling on the NHS and for those that can afford it and I would certainly recommend it as your first step. There is much talk today about Cognitive Behavioural Therapy (CBT). This has gained in status because it has been subjected to more scientific studies than other forms of therapy. This is largely because CBT has its roots in behavioural and cognitive science. Other forms of counselling have traditionally focused more on case studies, individual success stories, and so there is less scientific data to support their effectiveness. Governments like to look at hard data to make policy. However, a good therapist from any of the disciplines will be able to help you.
The most important factor in the effectiveness of counselling is the relationship between the client and the therapist. Sometimes therapy may be difficult and you may not always feel comfortable in the therapy room, but you should feel at ease with your therapist. There needs to be a degree of trust and you need to feel safe in order to explore your inner world and move forward. So if you don’t feel that the relationship with your therapist works then it may be better to try someone else.
I would recommend using the Therapist Directory on the BACP or UKCP websites to locate a therapist in your area. This ensures that your therapist has been properly trained and is following an appropriate Code of Ethics. Or, if you have found someone locally check whether they are a member of either of these bodies.
However, not everyone can afford to go private, so what other options are there?
Exercise is increasingly being recognised as a useful tool in aiding recovery from depression. We are not yet sure why it helps. It may be to do with the effect it has on body chemistry, the social impact of exercising with others or the psychological impact of getting out of the house and doing something. Any exercise is helpful, but it is particularly beneficial if you can get out in the open air and/or exercise with other people. It can be very difficult to motivate yourself to do anything when you are depressed, so it may be a good idea to recruit a friend to help you exercise. Perhaps arrange to go to a class with someone else, if you know that will make you more likely to make the effort. Yoga postures and breathing have been suggested as particularly helpful.
Diet and Nutrition
There is some evidence that diet may be a factor in depression for some people. Certain foods can have a direct impact on your body’s physiology and hence your mood and are best avoided or reduced when depressed. These include alcohol, caffeine and sugary foods. It is also thought that deficiencies in certain substances can contribute to depression e.g. omega 3 oil and the Vitamin B complex. Some people have even found that food intolerances have contributed toward their depression. I would recommend visiting a qualified nutritionist for advice on changing your diet. Food is often a difficult issue for those who are depressed as appetite is often affected and our relationship with food is highly emotional. You may therefore find that you need to make changes gradually if they are to be effective. It is best to discuss this with your nutritionist so that they can put together a schedule for change that is manageable for you.
The herb most commonly associated with the treatment of depression is St John’s wort. This has been widely researched and it is widely prescribed for depression in Germany where the most research has been done. Some people do seem to find it helpful, although (as with antidepressants) there is some debate over whether the effects are more of a placebo. If you want to try taking St John’s wort then you need to stop taking antidepressants first, as there are reports of negative interactions. In fact there is an increasing list of reactions with various medications, so if you are taking any medicine it is best to check with your GP for interactions first. You should also be aware that there are some reported side effects with St John’s wort, although these are relative minor e.g. dry mouth, dizziness, gut problems. As with all herbal medicines, the safest way to take them is to consult a qualified herbalist.
There are a number of complementary therapies that claim to be able to help with depression. The most common are probably homeopathy, acupuncture and reflexology. There is anecdotal evidence of success with all three of these, but little scientific evidence at this stage. More research is needed and new ways need to be found to gather evidence as many complementary therapies are not easily tested by traditional scientific method due to their nature. If you can afford it then there is no harm in trying any of these approaches and they may actually help.
There are things that you can do to support yourself whilst undergoing or waiting for treatment. Many of these are simple steps to surround yourself with positivity, rather than negativity. For example:
* Watch funny films, comedy TV shows, etc.
* Avoid watching the news
* Read inspiring books
* Listen to music that makes you feel good, avoid music that makes you feel bad
* Have a regular massage to help you relax
* Where possible avoid people who make you feel worse
* If you can spend more time with supportive family and friends See if there is a Depression Alliance local group in your area
Many of my clients talk about feeling guilty or lazy. They feel they should be able to ‘just snap out of it’, that they are letting other people down. There is often a lot of self hatred associated with depression. This will not help you. Accepting that you feel how you feel, that you are who you are, is the first step to recovery. This does not mean that you will never get better, or that you don’t want to get better, it’s not giving up, and it’s just accepting that in this moment this is how you feel and that’s ok. This level of self acceptance allows you to let go of a lot of guilt and negativity, which will have been using up a lot of energy and blocking your path to recovery.
Hopefully this has given you an insight into some of the steps you can take to aid your recovery. Just the act of taking a small step to help yourself can have a positive impact. However bad you may be feeling and however hard it is to believe right now, it is important to remember that most people do recover from depression.
Nancy Hine is a qualified counsellor and the author of ‘THE DEPRESSION TRAP: Ten Ways to Set Yourself Free.’ She also writes a blog on depression. For more information visit www.thedepressiontrap.com or www.nancyhine.co.uk
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