Overcoming Depression by Dr Windy Dryden and Sarah Opie

'It's just the blues.'

'It's only my hormones.'

'It's a phase I'm going through:'

'Well, you'd be depressed if you'd experienced what I have.'

"Depression is a common problem, and anyone can be affected at any time. There are many different causes and symptoms of depression, and this book will help you to realize what's wrong, to find out who you can talk to and, most importantly, to think about what you can do to help yourself.

In this informative and practical book, Dr Windy Dryden and Sarah Opie bring their experience in psychotherapy and counselling to bear on a complex subject. They present case studies and simple exercises, together with clear, concise information, to help you understand and change your situation. This book will be useful to anyone who is suffering with depression or who knows someone who may be depressed. It provides insight, practical suggestions and encouragement for a positive way forward, helping the sufferer to move away from damaging and destructive thoughts towards a sense of wholeness and well-being."

 Contents

• What is depression?
• Using the ABC model to assess depression and sadness
• Depressed behaviour
• Challenging your irrational beliefs
• How to integrate rational beliefs into your belief system
• Overcoming the thinking consequences of depression
• Overcoming emotional problems about depression
• Preventing future episodes of depression
• Prescriptions for an anti-depressant philosophy
• How seven people overcame depression

Index

Introduction
Depression is a common problem but it is frequently misunderstood. Depression is in fact an umbrella term for a group of discrete emotional problems that have similar core symptoms. In this first chapter we will describe some of the different types of depression as well as providing some information about help that is available.

How common is depression?
At any one time approximately 5 per cent of the population meet the criteria for depression. This is likely to be a modest figure as there may be members of the depressed population who have not revealed that they are depressed. Unfortunately the number of people with depression is on the increase. Research has found that some people are more at risk of developing depression, and a number of important factors have been discovered. One factor is that depressed people can have an imbalance of chemicals in the brain. These chemicals are known as neurotransmitters, and the action of anti-depressant medication is to rebalance them. The cause of the imbalance is not certain though some contributors may be genetics, upbringing, severe loss during childhood, disruption in the sleep/ wake cycle, and chronic low self-esteem. For this reason it is important that you contact your GP.

Certain groups in society appear to be more vulnerable to depression. If members of your family have been depressed then you are twice as likely to be depressed than if none were depressed. This may be because of genetic make-up (though no one has found the gene responsible) or it may be a result of environmental factors such as stressful life events. Women are twice as likely to suffer from depression as men, though this figure may be misleading as in some cultures this may be the result of the fact that men tend to hide their depression. For example, rather than classical symptoms of depression men may be more likely to show their depression through alcoholism, substance abuse and anti-social behaviour.

Types of depression
Depression was identified as a separate entity from other psychiatric disorders in the late nineteenth century, and after the Second World War different types of depression were classified (largely because of increased access to health care). The development of treatments in the 1950s meant that more research was conducted into depression and into the biological, psychological and sociological aspects that influence depression. On closer examination it was found that depression was not one condition but a group of problems. The latest edition of the Diagnostic and Statistical Manual for psychiatric disorders (DSM-1V) cites over 20 discrete manifestations of depression. This is significant, as treatment can vary depending on the type of depression and it may be necessary to seek advice as to the type of help that you need. The basics of some of the common types of depression are introduced in this book but it should not be used as an alternative to professional advice.

Sadness and grief
Sadness and grief are a natural reaction to a life event involving loss or change. This condition is described as normal because ordinarily the person adjusts and recovers after a period of mourning. The recovery time is influenced by the severity of the loss. There may be some temporary physical changes to sleep patterns and appetite. There may also be some changes in thinking patterns. For example, it is not uncommon after a bereavement to have obsessive thoughts about the lost person. However, those who are experiencing sadness and grief are able to see both positive and negative aspects of their lives; they are able to seek help and can look to the future with some hope.

Adjustment disorder
Adjustment disorder accompanied by a depressed mood occurs because life changes and the adjustments to these changes can be difficult. Instead of being able to see both positive and negative aspects to life, you see predominantly negative. In addition, there is less hope in the future and you feel less able to ask for help or express your feelings with the appropriate people. Learning new and helpful ways of thinking and behaving can help you adjust to the change. You may not need help from a doctor to tackle the adjustment disorder. However, if your mood has deteriorated without any life change, if your emotional reaction seems over whelming and is having a big impact on your life, then you do need to contact your GP.

Dysthymia
This is the term used to describe a chronically depressed mood with the symptoms of major depressive disorder (see next section) but less severe. Dysthymia may or may not have a triggering life event, and as such it can be confusing and frustrating for both the depressed person and their loved ones.

Major depression
Major depression is serious because it can lead to despair and hopelessness that result in people losing interest in life, being incapable of experiencing pleasure, isolating themselves and failing to look after themselves. According to DSM-1V, major depression involves at least two weeks of low mood and/or marked loss of pleasure with at least four of the following symptoms:

• sleep problems: insomnia or sleeping all the time;
• appetite problems: loss of appetite or major weight gain;
• lack of energy: apathy, lethargy, no interest in anything;
• feelings of worthlessness, hopelessness and/or terrible guilt;
• difficulty concentrating or unusual indecisiveness;
• suicidal thoughts or suicide attempts.

The key risk in the case of major depression is suicide: within five years of suffering a major depressive episode approximately a quarter of sufferers will try to kill themselves. Some people make known their intention to kill themselves, so it is important to take any talk of suicide seriously. It is important that you seek professional help from your doctor if you believe that you or a loved one may have a major depressive disorder.

Bi-polar disorder or manic depression
This affects about 1 per cent of the population. It is characterized by periods of depression, contrasted with periods of mania (high energy and unrealistic wild activity). Typically there are no clear triggers and treatment of the condition should be under the supervision of a psychiatrist.

Atypical depression
Atypical depression refers to unusual presentations of depression: for example, a person with atypical depression may appear deeply depressed, then fine for a few days, then anxious or irritable. As with other forms of depression there may be no obvious trigger to the depression.

Seasonal affective disorder (SAD)
This is a reaction to lack of sunlight. Typically, mild or major depression starts in the autumn and finishes in the spring months. The incidence of SAD increases in line with the distance from the equator. Special types of lights have been developed for the treatment of SAD.

Post-natal depression (PND)
PND is a condition that occurs after childbirth because of the hormonal changes effected by delivery and the challenges of dealing with a new baby. Two-thirds of women experience temporary sadness, 10—15 per cent become clinically depressed and about one woman in a hundred becomes so severely depressed that she needs to be hospitalized for her own safety and the safety of her babies.

The different types of depression don't always have clear boundaries and it requires professional judgement to know where, for example, a normal grief reaction may stop and a severe depression begins, so if in doubt contact your doctor. There are, however, some core symptoms of depression and these are: sadness, loss of interest, poor appetite, sleep difficulty, pessimism or guilt, and suicidal thoughts. If these symptoms have been persistent for a two-week period, then you need to see your doctor.

What this book can and cannot help
The aim of this book is to present a method of dealing with depression in terms of tackling those aspects you can influence, particularly your behaviour and your thoughts. This approach is called Rational Emotive Behaviour Therapy and will be described in more detail later. Part of dealing with depression can be to accept that there are aspects with which you may need help and then to seek out that help. Researchers into depression have found that influencing one's behaviours and thoughts can be helpful but that, with certain types of depression, this approach may not be enough: sometimes medication is necessary in combination to help lift the mood enough to reach a point where you can engage in therapy. Some types of depression are best treated medically. As a result this book will not be dealing with manic depression, severe depression, seasonal affective disorder or post-natal depression.

Who can help?
The aim of this book is to help you overcome depression. An initial step for anyone who thinks they may be depressed is to recognize when you need the help of a professional. There are a number of different services available to help you deal with depression. Often the first port of call is your GP. He or she can help you manage your depression by offering support and assessing what type of treatment is best for you. They may prescribe you some anti-depressant medication, they may suggest you have a course of talking therapy or they may decide you need to have time away from work or even some time in hospital. Your GP may recommend that you consult someone who specializes in mental health and refer you to a psychiatrist. Indeed, in some cases of depression, especially where it is severe, the involvement of a psychiatrist may well be necessary.

Other professionals allied to psychiatrists and GPs who may be involved are psychiatric nurses, occupational therapists and social workers, who can all play a vital role in helping you to deal with depression.

Clinical and counselling psychologists can provide psychological therapy for depression, as can counsellors and psychotherapists. There are many different approaches to counselling and therapy.

This book adopts a psychological approach to dealing with depression known as Rational Emotive Behaviour Therapy (REBT), which involves identifying the connection between thoughts, feelings and behaviours and learning and practising techniques that help you change those thoughts and behaviours that can contribute to or maintain your depression. Access to therapists can be gained by a referral from a professional, typically a GP or psychiatrist who considers that therapy can be beneficial to you. Alternatively, you can seek out a private therapist. If you want to take this route then there are professional bodies that have a register of therapists who have completed a required level of training and experience. You may also wish to contact self-help and voluntary organizations (such as MIND or the Depression Alliance) for support.

About the authors
Windy Dryden was born in London in 1950. He has worked in psychotherapy and counselling for over 25 years, and is the author or editor of over 130 books, including How to Accept Yourself (Sheldon Press, 1999) and Overcoming Envy (Sheldon Press, 2002). Dr Dryden is Professor of Psychotherapeutic Studies at Goldsmiths College, University of London.

Sarah Opie was born in Leeds. After training as a psychiatric nurse, she worked in a variety of mental health departments for the NHS before specializing in affective disorders. She attended Goldsmiths College and completed an MSc in Rational Emotive Behaviour Therapy and then worked in the NHS and private sector employing REBT techniques. She currently works for Surrey Oaklands NHS Trust supporting staff with continuing professional development. She also maintains a small private practice.