Top questions: Depression

Depression is a mental health condition in which a person has a long-lasting low mood which affects his appetite, sleep, and activities. Most people experience feeling sad from time to time, and this is normal. In order for us to diagnose depression, there has to be a set of symptoms that endure almost daily for at least two weeks, and which show no sign of improvement.

Symptoms include loss of appetite, either being unable to sleep or sleeping too much, feeling worthless, feeling that life is pointless, feeling suicidal or that life isn’t worth staying alive for, inability to concentrate, a marked disinterest in the activities of daily life, finding no pleasure in anything, accompanied by a loss or gain of weight.

At least one of these symptoms would need to be present for a sustained period, but most cases have several, if not all, of the mentioned symptoms.

Clinical depression is the more severe level of depression, also known as major depression or major depressive disorder. Symptoms include feelings of sadness, tearfulness, emptiness or hopelessness, angry outbursts, irritability or frustration, even over small matters, loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports, sleep disturbances, including insomnia or sleeping too much, tiredness and lack of energy, so that even small tasks take extra effort, reduced appetite and weight loss, or increased cravings for food and weight gain, anxiety, agitation or restlessness, slowed thinking, speaking or body movements, feelings of worthlessness or guilt, fixating on past failures or self-blame, trouble thinking, concentrating, making decisions and remembering things, frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide, unexplained physical problems, such as back pain or headaches.

Symptoms are usually severe enough to cause problems in relationships and at work or school. Unlike depression, clinical depression isn’t linked to a loss or event. Depression after the loss of a loved one or job, for instance, isn’t as severe and doesn’t last for as long as clinical depression does. The symptoms aren’t as noticeable by outsiders, and many depressed people are able to “put on a happy face” around others. It can often be difficult to tell if a depressed person is actually sad because they can mask it with a bubbly appearance. Clinical depression is much more difficult to hide, and can cause real problems in the family unit, at work, or in other aspects of life.

Depression is a mental health condition which is experienced as low mood, lack of interest in the usual activities, sleeplessness or too much sleep, lack of appetite or eating too much, and lack of energy, to name a few. Stress, on the other hand, is negative tension that is a reaction to situations or environment, such as a difficult job or family situation.

Bipolar, sometimes known as manic depression, is a disorder that causes periods of depression mixed with periods of elevated mood. The elevated mood is more intense than a usual upbeat mood, and is called either manic or hypomanic depending on its severity or whether or not psychosis is present. During the manic period, the person behaves or feels abnormally happy, energetic, or irritable. This period will involve the person making very poor, impulsive choices, and getting little sleep.

Artists who have been bipolar have done their most amazing work during this period. The risk of suicide is high, and self-harm is present in around 35% of cases. Anxiety and substance abuse disorders are also commonly associated. Depression on its own doesn’t have periods of elevated mood, nor does clinical depression.

Almost all humans feel depressed at some point in our lives. We can get depressed after a loss, whether of a loved one or a job, or after a disappointment, such as not getting a place in a university or not getting accepted for that fabulous job that we really were hoping for. We get depressed if life isn’t turning out quite the way we planned, or even when we reach middle age and haven’t done all that we would have liked to do. Sometimes, we even just have days where we feel like we really can’t be bothered for some reason or no reason. However, if you’ve suffered a low mood almost every day for a couple of weeks, it’s time to talk to someone.

It’s best to make an appointment with a doctor to see if there are physical reasons for your low mood. If none can be found, and your mood isn’t getting better, then it’s time to talk to a counsellor who can guide you through the process of identifying what the problem is and how to treat it.

That depends on the severity of the depression. If your depression is mild, a counselling therapist can help you with processing what has caused the depression, and with gaining the tools to be more resilient when difficulties happen. More severe depression will require more treatment and possibly medication. The best thing is to be as proactive as you can regarding the recommended treatments. Some people have found that the CBT group therapy which tends to be the go-to treatment of the NHS works fine, whereas for others, it doesn’t work at all. Some people need one-on-one support with less activities and more talk. The best result will be gained from your treatment if you are able to actively be a part of deciding what works best for you. Self-care is important when working on your depression, and can involve such things as finding a hobby that you can enjoy, getting some exercise by taking a walk, going to the gym, or whatever else works for you, and even pampering yourself sometimes.

More men are suffering from depression these days, or it may simply be that more of them are beginning to admit to it instead of keeping everything in with the “stiff upper lip” that our older generations grew up with, and men need to be pampered just as much as women do. Pampering will take different forms for everyone…the main point of pampering is to do something for yourself that you really enjoy and that makes you feel good. That can take the form of a warm bath, a massage, a foot massage, whatever….anything that is relaxing and enjoyable. Just as we all need to take care of ourselves physically, we all need to take care of ourselves mentally and emotionally. A man who wants to make sure that he gets his pampering in a manly way could consider getting a gentleman’s shave once a month, for instance. Everyone can find something to do.

There are many causes of depression. Depression can be caused by physical illness, or it can be a reaction to aging. It can be caused by loss of direction in life, loss of purpose. The loss of a job, the loss of a relationship, losing your home, the death of a loved one, a move away from family and friends……the causes are many. Hormonal changes happen both for men and women, and those changes can cause depression.

Medications can have depression and low mood listed as side affects. Imbalances in vitamins in your body, family history, genetics….there are many different things that can cause depression, which is one reason why it’s so very common. The one thing to remember is that it isn’t your fault, and the answer isn’t to suck it up, man up, or any other such thing. Depression isn’t caused by weakness. The toughest among us will get depression at some point in their lives.

Men can have difficulty feeling secure in our changing world. I pin it to the four S’s that men are forced by global culture to live with: Strong, silent, successful, and stable. Big boys don’t cry. Man up. Be gainfully employed and reliable, etc. However, men are simultaneously told that they have to be more open about their feelings, cry when they’re sad, change nappies, push prams, talk about things. No matter which way they go, they can be in the wrong. There are also pressures on them from instability in the work place, stresses from toxic work environments that they can’t escape (any job is better than no job), and wages being lower than the cost of living in most places. Being a man in these times can be a very lonely and trying experience. They can’t really risk being seen as weak, and there aren’t many places that they can turn for support. Men experience depression differently from women in that men can suffer from more irritability, sudden anger, loss of control, greater risk-taking, and aggression. This is why they are sometimes misdiagnosed as having anger management issues instead of depression. The pressure from having these problems and not feeling able to talk to anyone about it without being seen as weak results in men being most likely to commit suicide.

In a number of these cases, people don’t even realise that the man is depressed until he kills himself, because of the need to keep to the “strong and silent” code of manhood. Men tend more towards self-medicating with alcohol or drugs than women do, which makes the anger and aggressive behaviours worse. This can ruin jobs and relationships, which makes the depression worse, and all of these things are why men are more vulnerable to depression. Women attempt suicide. Men are successful in committing suicide. For men, depression is likely to be fatal if not treated early.

Women are under a great deal of pressure from society to be a “perfect 10”. It’s long been established that the fashion industry has much to answer for in terms of the extreme body image that it produces, where women are dangerously thin. Malnutrition causes vital vitamins and nutrients to be missing from the body, which can result in depression. The pressure to live up to that impossible ideal leads to women feeling like fat, ugly failures. For women, depression can lead to comfort eating, excessive sleeping, and weight gain. A great deal of pressure is put on women to be the perfect mother, the perfect partner, successful in their careers, and to have the perfect hair and body. Since you would have to be three perfect people to live up to half of that, it’s easy to see why women can give up, take to their beds, and eat litres of ice cream. Women also have to deal with hormones that do more up-and-down swinging every month than a roller coaster ride at Disney World. The imbalances of hormones can cause depression and irritability; however, a great deal more damage is done when they’re abused or ridiculed by others for being “hormonal”.

The lack of a healthy diet, caused by being too busy to have a proper meal, or too afraid of calories to eat much, adds to the problem, as well as the lack of good rest and down time. There can also be physical causes, such as thyroid disorders. Women do tend to be so busy living up to all of the demands of perfection that they don’t really take care of themselves the way they should. Going to the gym or having a warm bath is all very well and good, but we need more rest and more food. Taking care of ourselves and pampering ourselves are two very different things.

The teen years are a turbulent time at best. Pressures to succeed at school, the overload of course work, homework and revision, peer pressure about everything from smoking to hairstyle, romantic relationships, hormones gone wild, family problems, and the feeling of being powerless in the face of all of these seemingly unending stresses make the teen years a nightmare. Teens are growing and developing at a rapid rate, so they need more sleep and rest than they usually get. Not only are their bodies changing, but they themselves are changing, becoming adults, but not yet possessing the maturity and knowledge needed to be adults. Everything around them is a question mark, making it probably the most difficult time of life.

Given the pressures that adult men and women face which can cause depression, the pressures on young boys and girls who are in the process of becoming adult men and women are significant. They can very quickly become overwhelmed with the belief that it is all more than they can have any hope of coping with. Not eating properly, not resting properly, not getting enough exercise and fun, and having far too much schoolwork to do is bound to lead to mental health issues.

Top questions: Stress and anxiety

Stress is generally accepted to mean the tension we feel due to stressful situations in our lives. Everyone experiences a certain amount of stress at some point in their lives, and the level of tension caused by the stressful situations will vary with the person, as well as with the severity of the situation. Some stress can be experienced in a positive way, such as the stress associated with your first day on a job that you really wanted and would like to do well in. However, people more often associate stress with the negative tension generated by difficulties.

When people have a difficult time coping with the level of tension that they’re experiencing, they describe themselves as stressed out. That term has come to mean that they’ve reached an uncomfortably high level of stress, and have maintained it for an uncomfortably long period of time.

The tension we feel as stress is caused by situations that are difficult for us to manage or control, such as a toxic work environment, a rocky relationship, financial difficulties, daily gridlock and delayed commuter trains. Normally, people will have one situation in life that is stressful, but the stress of that situation will cause them to have little tolerance for any more tension that might be generated by other little things going on in their day.

People who are worried about work will tend to have more difficulties at home, and vice versa. People who are worried about work, family, school, etc., will tend to be more irritable if a train is delayed than people who aren’t having any such concerns at the moment, because their coping level is stretched too tightly. This will often result in a compounding of the problems that are causing the stress, in turn causing greater stress, until the boiling point is reached. Usually, by the time people decide that something must be done about their stress levels, their physical health has begun to be affected, as well as their relationships and their work. Stress simply keeps building on itself until it explodes somewhere.

Put quite simply, stress is tension caused by situations that are difficult to cope with in our daily lives, whereas anxiety is a fear, an apprehension of what lies ahead that can become so intense that it results in physical illness. A person can experience heart palpitations, dizziness, nausea, and panic attacks with anxiety, and it can be so severe that it is considered to be a legitimate mental disorder. Stress is not considered to be a mental disorder. A diagnosis for anxiety requires a set of criteria be met over a period of six months, which prevents it from being confused with stress.

People who suffer high levels of stress can have headaches and slight dizziness, upset stomach, etc., but not panic attacks. Whereas the two do share common symptoms, stress can go away when the stressful events go away, but anxiety has no causal root and is more difficult to treat. Anxiety can cause a person’s life to be very limited by preventing that person from being able to go out and do normal activities. Stress doesn’t do that. Coping techniques, relaxation, and exercise can all help to manage stress levels. However, anxiety isn’t that simple.

First, we have to identify what the source of our stress is. For many of us, there are legitimately multiple sources. However, bear in mind the possibility of there being actually only one or two root causes of the stress in your life, with everything else simply being more sensitive due to the stress at the root of it all.

Once you’ve identified the stressful situation, then you can begin to determine how to deal with it. For instance, if your life experience is like sitting in a pressure cooker, you might find that all of that stress is down to one thing: your job. If you didn’t have that particular job, you wouldn’t have to spend two or three hours each way five days a week fighting with overcrowded, late or cancelled trains, gridlock traffic, etc. By the time you get home, you’re exhausted and tense from the long day, so you have no patience or energy left for your family. As a result, the family relationships break down, and you have more tension from that. Right about the time you think you’d like to quit that job, you get to sit down and do the bills for the month, and realise that you haven’t got enough money to pay them, pay for your commute each week, or even breathe. It feels like a huge mountain on your back that you can’t see your way out of. In this case, if you were to unravel where the stress is coming from, you’d be able to trace it right back to that job. This would then enable you to think about how to deal with the situation. If all the conditions are right, you can quit the job and get something closer to home, better for family life, etc. However, most of us don’t have the right conditions, so we have to think of something else.

Taking care of ourselves isn’t just important, it’s imperative. If you can’t change the facts of your life, such as the difficult commute, then focus on how you can change other things in order to gain control over your life enough to be able to take care of yourself. If your stress is at a high level, and your time is so completely taken up that you have to make an appointment to breathe, you might need to have a few visits with a counselling therapist who can help you to sort through the chaos and find some space for yourself. If you’re still at a low level, though, there are a few things you can do. When we’re tightening up our financial budget, we look for money-wasters to get rid of, and are often shocked at how quickly little things build up to large amounts of money. The same is true of time. If we sit down to find out where our time is going every day, we might find that we’re spending some valuable time spinning our wheels like a hamster in a cage. Once we identify the time-wasting things, we can better budget our time to give ourselves room to breathe. Then, make sure that you budget time to do important things to take care of yourself and your family.

Simple things like a walk at the end of the day, ten minutes of stretching exercises, listening to quiet music, or creating something can make a big difference in your life. You can also work on controlling your emotional reaction to situations. When you feel tension building up, stop, breathe, listen to your breathing, slow down, and be realistic about how much of it you can control. If you can’t control it, let it go. The bulk of stress comes from not being in control of situations that are in some way unpleasant and negative. We can’t control everything, but we can learn to control how we react to things.

Yes, it does. The mental energy taken up being stressed out saps our physical energy, and robs us of sleep. When you lie there at night, brain spinning with all of the stressful situations going on, you can’t sleep. Then, you get stressed because you can’t sleep. Armed with that inadequate amount of rest, you go off to work and begin another busy day of stress.

Mental energy can actually be more tiring than physical energy anyway, and when you add to it the lack of rest that comes with inadequate sleep, you’re going to be exhausted. This makes you less able to stand up to the stress, making the stress worse, which in turn makes it more difficult for you to rest. It’s a vicious circle.

Talking therapy is very helpful, and you probably won’t need it for longer than a few months. This can help to bring clarity to what you can actually control, and how to go about regaining that control. Exercise is actually a very important part of self-care, and people who are most susceptible to stress are those who aren’t getting any exercise. Exercise doesn’t have to involve going to the gym, but there’s much to be said for the stress relief that comes from getting your heart pumping. Power walking is good, as well as stretching. Journalising has for many years been thought of as the thing that girls do, but in recent years, people are realising just how helpful it is to put your thoughts and feelings into words and onto paper. There’s something about writing things down that helps you to process them better, and I almost always assign journalising to my clients, whether they’re men or women. For men, it can take some getting used to, especially in terms of learning how to write about feelings rather than just making a list of what they did that day. However, once they get the sense of it, they begin to realise just how valuable a tool it is for helping us to not only process stress, but to recognise more of what causes us stress, and how to find solutions. Journals are not the toys of 13-year-old girls any more. They’re valuable tools for processing stress and problem-solving.

Depending on the severity and nature of the particular anxiety disorder, treatments vary. Anorexia is an anxiety disorder, for instance. So, the first port of call is your gp. Sometimes medication is needed. CBT has proven to be a successful treatment option for anxiety, as well. Learning relaxation techniques to help you relax your muscles when you feel anxious is sometimes helpful, and exercise is beneficial.

The exact cause of anxiety disorders isn’t actually known. The only thing we can say with any real certainty is that whether the cause is due to physical ill-health or mental ill-health, it is not the fault of the person suffering from it. It isn’t a character flaw or personal weakness. It is a legitimate disorder that can be crippling. Research is ongoing, and there are some discussions on the topic of chemical or hormonal imbalances being a part of the cause.

Excessive pressures or demands at work can cause stress. Toxic workmates can also cause a bit of stress. Workloads, bullying or harassment, long hours, lack of job security, poor working environment, poor organisation, lack of structure in the workplace, and lack of job support are common causes of stress at work.

Stress can over the long term have negative affects on the body, such as sleeplessness, depression, high blood pressure, heart burn or acid reflux, stomach aches, back aches, and even irregular menstrual cycles in women.

Top questions: PTSD

PTSD (post-traumatic stress disorder) is a mental health disorder that many people develop after being a victim of or a witness to a life-threatening or deeply traumatic event.

For instance, soldiers who experience combat, medics who have to try to rescue and help wounded soldiers, police officers and prison officers who have to put themselves in the line of fire or deadly attack to protect the public, car crashes that are significant in scope, rape or any other such personal attack, domestic violence that is long-lasting (emotional or physical), etc.  The criteria for PTSD have to be met for more than a couple of months for it to be diagnosed.

Symptoms include intrusive thoughts, which are memories or thoughts about the event which the person doesn’t want but which are persistently present, nightmares, night terrors, flashbacks, triggers, sleeplessness, anxiety, hyper-arousal (a state of constant vigilance), and  avoidance (avoiding any situation or place that reminds you of the event).

People who suffer from severe levels of PTSD can experience not being able to concentrate or focus, not being able to finish a thought, “pinging” in many different directions in the course of a conversation, getting lost because their mind wandered, not being able to finish watching a film, not being able to remember what they just did, etc., loss of control over temper, and depression.  The disorder can be profoundly crippling in its worst form.

Yes, PTSD can be disabling because it affects how a person is able or unable to function in daily life. Lack of rest, lack of focus, flashbacks and triggers, depression and a short fuse combine to make it virtually impossible to function in daily life with any degree of success. Many sufferers require medication to help them to be able to cope with the symptoms, as well as therapy.

PTSD is classified as a mental health disorder, which is different from an illness. It is in it’s most severe form recently begun to be recognised as a brain injury, because some of the “scars” (symptoms) never completely go away in such cases. The need for medication is done away with through therapy, and most people are completely cured.

Those who have the most severe level of PTSD can still reach a point where they’re able to manage any triggers that might be left, and most of the symptoms will be cured. It isn’t biological in nature, and can’t be inherited like illnesses such as bipolar can. So, it doesn’t qualify as an illness in that sense.

There is quite a bit of heated debate on this question, to be honest; however, the result depends on how badly injured the brain is.  Those who suffer the most severe level of complex PTSD will find that some symptoms will remain with them, even though to a much lesser degree as compared to before therapy, and they shouldn’t continue to need medication.  I suffered a very severe level of PTSD, which was compared to that suffered by a soldier on the front line of combat for years.  I required 25 CBT sessions with a consultant clinical psychologist who is an authority on PTSD, after which I needed another year for everything to settle down.  I do occasionally get triggered into some significant flashbacks still, but I can recognise them and I know what to do to ride them out.  That’s the source of the debate: am I cured or not?  Most people don’t suffer that intensely, and many will find that symptoms disappear entirely, so they would classify themselves as cured.  Others who have symptoms still would say that they’re not cured.  Personally, I feel that compared to the 24/7 agony I was living with before treatment, I’m “cured”, but have scars.  I suppose that at the end of the day, it’s purely a matter of individual perception, and should be based on how the individual feels.  The important thing to realise is that no one can cure PTSD in just a few sessions, or even one, as I have seen some people claim they can do, so be very careful when choosing therapy.  One thing to bear in mind is that if someone could completely eradicate PTSD in one session, the NHS and the military would be all over it, saving millions of pounds and thousands of lives.  It pays to find someone who is genuinely qualified and can be realistic in their assessment.

Not for the bulk of sufferers.  Most people will be able to become free of symptoms.  However, for those who suffer the most significant complex PTSD, not all of the symptoms will go away completely.  Some people will occasionally still have some mild flashbacks when faced with situations that trigger them, but they will be able to recognise and manage those things.  They will be able to talk themselves through it very successfully, and the people close to them might not even be aware that there was anything going on.  The symptoms that remain will be much milder, and will occur rarely.

Yes. PTSD is classified as an anxiety disorder due to the high level of anxiety involved in the symptoms.

No. About 50 years ago, research into PTSD still focused very much on soldiers and how they reacted over the short and long terms to exposure to combat, and for many years people did believe that it was something that only soldiers could experience.

However, in recent years, they’ve recognised that people who are exposed to severe domestic violence, sexual assault or abuse, stalking, or even one-off events such as terrorist attacks or car crashes can suffer from PTSD. It’s even being now recognised in children who have suffered traumatic events

That depends very much on the client and the severity of the PTSD the client is suffering. Severity ranges from mild cases that can be treated in a series of 10 to 12 CBT treatments, and then there are very severe cases of complex PTSD which require 20-30 CBT treatments. CBT is not proven to be a successful or advisable way to treat PTSD in soldiers. For soldiers in particular, there is strong reason to advise against any reliving work, and group therapy isn’t always enough. Support groups of fellow soldiers are very important before, during, and after therapy. Many soldiers find that support groups form a lifelong network that they can build on. One-on-one therapy is also necessary in order for the soldier and his/her family to be able to come to terms with the situations that he/she lived through and somehow survived, especially when some of their buddies didn’t. It’s a work that needs to be done with sensitivity and care. Most soldiers will find it difficult at first to talk to anyone who isn’t a soldier herself, but I’ve been successful in getting some of them to open up. Their two main concerns are that A. their story would be too intense for most therapists to hear (and they would be right), and B. that the therapists wouldn’t really be able to understand. It does take someone with a familiarity of the military mindset and the combat experience to truly relate, and I do have that. I also have the ability to listen to any story of a battle experience with empathy, without breaking down myself. There aren’t enough therapists out there who can do that for soldiers, and they find it extremely difficult to get the help that they need. PTSD can be successfully treated without the use of CBT.

Some might argue that any other method might take too long or not be as successful, but having spoken to soldiers who have been put through three or four unsuccessful courses of CBT in a row, I would have to respond that it doesn’t take more time to get it right than it takes to get it wrong….and it rather begs the question of how many unsuccessful courses it takes before one realises it isn’t going to work while the soldier continues to suffer. I’m hoping to do more work in this area.

Unfortunately, no. PTSD left untreated never goes away, and the sooner treatment is obtained, the better. Soldiers enduring endless waiting lists and lack of resources not only don’t get better, but the frustration can make things worse. Those who aren’t soldiers but have survived domestic violence, rape, or a one-off traumatic event such as a car crash or terrorist attack will also continue to have symptoms if symptoms do develop.

Not everyone who lives through a car crash will get PTSD, and many people who have been through domestic violence don’t develop PTSD. There is much to be said for the character/personality framework of the individual when it comes to these kinds of events, and no one should ever fail to take seriously an individual who tries to get help for symptoms that persist for more than a couple of months after an event.

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