Download Psychological symptoms - Improving the patient experience

Avenue Medical Practice Neat Guidelines-Depression
Depression is a serious illness. Health professionals use the words depression, depressive illness or clinical depression
to refer to it. It is very different from the common experience of feeling miserable or fed up for a short period of time.
When you’re depressed, you may have feelings of extreme sadness that can last for a long time. The feelings are
severe enough to interfere with your daily life, and can last for weeks or months, rather than days.
Depression is quite common, and about 15% of people will have a bout of severe depression at some point in their lives.
However, the exact number of people with depression is hard to estimate because many people do not get help, or are
not formally diagnosed with the condition.
Women are twice as likely to suffer from depression as men, although men are far more likely to commit suicide. This
may be because men are more reluctant to seek help for depression.
Depression can affect people of any age, including children. Studies have shown that 2% of teenagers in the UK are
affected by depression.
People with a family history of depression are more likely to experience depression themselves. Depression affects
people in many different ways and can cause a wide variety of physical, psychological (mental) and social symptoms.
A few people still think that depression is not a real illness and that it is a form of weakness or admission to failure. This
is simply not true. Depression is a real illness with real effects, and it is certainly not a sign of failure. In fact, famous
leaders, such as Winston Churchill, Abraham Lincoln and Mahatma Gandhi, all had periods of depression.
Symptoms
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
and
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 well at
work
Taking part in fewer
social
activities
and
avoiding contact with
friends
Reduced hobbies and
interest, and
Difficulties in home and
family life
Grief and depression
Even though grief and depression share many of the same characteristics, there are important differences between
them. Grief is an entirely natural response to a loss, while depression is an illness. However, sometimes, it can be hard
to distinguish between feelings of grief and depression.
People who are grieving find that feelings of loss and sadness come in waves, but they are still able to enjoy things and
are able to look forward to the future. However, those who are depressed have a constant feeling of sadness; they do
not enjoy anything and have little sense of positive future.
Is it my fault that I have become depressed?
It is definitely not your fault. It may be difficult to avoid it, but there are certainly things you can learn to do to recognise
depression early so you can avoid becoming more severely ill.
If you have had depression before, this would involve learning how to recognise your early warning signs. Everyone has
their own particular early warning signs, such as not sleeping properly, starting to brood about things, or spending all
your time working and not enjoying yourself.
You learn that when you have these early warning signs, you have to reflect on your lifestyle and make changes where
necessary.
Treatment
Treatment for depression usually involves a combination of drugs, talking therapies and self help. Hardly anyone with
depression is admitted to a psychiatric hospital. Most get treatment from their GP and make a good recovery.
Mild depression
• If you are diagnosed with mild depression but your GP thinks you’ll improve, you can have another assessment
in two weeks’ time to monitor your progress. This is known as ‘watchful waiting’
• Antidepressants are not usually recommended as a first treatment
• Exercise seems to help some people. While your progress is being monitored
• Talking through your feelings may also be helpful. You may wish to talk to a friend or relative, or your GP may
suggest a local self-help group
• Your GP may recommend self-help books and computerised cognitive behaviour therapy (CBT) Chronic mild
depression (present for 2 years or more) is called dysthymia. This is more likely in people over 55 years and
can be difficult to treat. If you are diagnosed with dysthymia, your GP may suggest that you start a course of
antidepressants.
Moderate depression
• If you have mild depression that is not improving, or you have moderate depression, your GP may recommend a
‘talking treatment’ or prescribe an antidepressant (see below for further details)
Severe depression
Your GP may recommend that you take an antidepressant, together with talking therapy. A combination of an
antidepressant and cognitive behavioural therapy (CBT) usually works better than having just one of these treatments
You may be referred to a mental health team. These teams are usually made up of psychologists, psychiatrists,
specialist nurses and occupational therapists.
They often provide intensive specialist treatments such as
psychotherapy.
Cognitive behavioural therapy (CBT)
You normally have a fixed number of sessions – usually six to eight sessions over 10-12 weeks. Some GP practices
have counselors specifically to help patients with depression.
CBT is based on the principle that the way we feel is partly dependent on the way we think about things. It teaches you
to behave in ways that challenge negative thoughts – for example, being active to challenge feelings of hoplessness.
Counselling
Counselling is a form of therapy that helps you to think about the problems you are experiencing in your life, in order to
find new ways of dealing with them. Counsellors support you in finding solutions to problems, but do not tell you what
to do.
Antidepressants
Antidepressants take two to four weeks to take effect. If the first antidepressant you try is not effective or causes side
effects, it may be necessary to change the dose. Sometimes a different type of antidepressant will be recommended.
Your GP or specialist nurse should see you every one to two weeks when you start taking antidepressants. You should
continue taking the antidepressants for at least four weeks (six weeks if you are elderly) to see how well they are
working. If your antidepressants are working, treatment should be continued at the same dose for at least four to six
months (12 months if you are elderly) after your symptoms have eased. If you have a history of depression, you should
continue to receive antidepressants for up to five years, or longer.
Antidepressants are not addictive but withdrawal symptoms are quite common if you stop taking them suddenly or you
miss a dose.
SSRI’s
If your GP thinks you would benefit from taking an antidepressant, you will usually be prescribed an SSRI (selective
serotonin reuptake inhibitor). These are as effective as the older TCA’s (tricyclic antidepressants) and have fewer side
effects. Fluoxetine, citalopram and sertraline are all examples of SSRI’s.
SSRI’s increase the level of a natural chemical in your brain called serotonin, which helps to lift your mood. You may
have some side effects when you start taking SSRI’s such as nausea, headache, sleep problems and anxiety.
However, these tend to improve over time.
Some SSRI’s should not be prescribed for children under the age of 18 years. Research shows that the risk of selfharm and suicidal behaviour may increase if they are used to treat depression in this age range. Fluoxetine is the only
SSRI that may be prescribed for under 18’s but only when specialist advice has been given.
Side effects
SSRI’s
You may experience some side effects when you start taking SSRI’s including:
•
nausea • headache
• sleep problems
• and anxiety
However, the above side effects tend to improve over time
Complications
Mental disorders, particularly depression and substance abuse, are associated with more than 90% of all cases of
suicide.
The warning signs of suicide
Some of the warning signs that people with depression are considering suicide are:
• Making final arrangements – such as giving away possessions, making a will or saying goodbye to friends.
• Talking about death or suicide – this may be a direct statement, such as ‘I wish I was dead’, but often
depressed people will talk about the subject indirectly, using phrases like, ‘I think dead people must be happier
than us’, or ‘wouldn’t it be nice to go to sleep and never wake up’.
• Self-harm – such as cutting their arms or legs, or burning themselves with cigarettes
• A sudden lifting of mood – this could mean that a person has decided to commit suicide and feels better
because of this decision
• Helping yourself – if you feel you may be suffering from mild to moderate illness, there are lots of
organisations to give you the support and advice you need. The NHS, voluntary organisations and private
organisations can all help.
Visit your family doctor to find out if general counselling is available in your area. Your GP can advise whether a referral
would help you. If you’re having relationship or marriage difficulties, contact Relate (0845 130 4010). Its counsellors
can talk things through with you and your partner. You will normally be expected to pay a fee to cover the costs of the
sessions, although some Relate centres offer subsidies.
The mental health charity SANE has a dedicated helpline on 0845 767 8000. The service offers practical information,
crisis care and emotional support. It is open from 1pm to 11pm every day.
Prevention
To deal with depression, and help prevent repeated bouts of depression, you should:
• Take your medicines regularly as directed, without skipping days
• Discuss reducing or stopping medication with your GP before you make any changes
• Gradually try to increase the activities that you enjoy
• Avoid smoking, illegal drugs and alcohol – these may seem to make you feel better in the short term, but can
make you feel worse in the long term
• Use a problem-solving approach to deal with stress and worry
• Try to identify negative thoughts and change them to positive thoughts
• Assess your symptoms regularly and consult your GP or consellor if problems arise
• Increase the amount of exercise that you do – this can trigger the release of the brain chemical serotonin, which
boosts mood
• Learn how to relax using relaxation exercises and tapes
Depression and diet
There is increasing evidence that changes in your diet can help prevent depression occurring, or if you are depressed,
can help in the treatment of your depression.
• Omega-3 fatty acid
It is thought that a chemical found in fish – omega-3 fatty acid – may help your brain work more efficiently, so serotonin
(which can boost your mood) has more of an effect on you.
Fish that contains a lot of omega-3 fatty acid includes salmon, sardines and mackerel. Vegetarian alternatives include
walnuts and tofu, and omega-3 food supplements are also available over the counter (OTC) from health shops
• Protein and serotonin
Serotonin is made up of an amino acid called 5-HTP, which is made from another amino acid called tryptophan. Both of
these are found in protein-rich foods, such as meat, fish, beans and eggs.
Dr W Conrad MRCGP, August 2010, Based on NHS Clinical Knowledge Summary