Dr Sarah Jarvis
my Weekly’s favourite gp from tv and radio writes for you
Three in 5 people in the UK have depression at some point in their lives, and for 1 in 5 women and 1 in 10 men it is severe enough to have a major impact on life. But there is help – you just have to ask.
If I’m assessing depression I ask two simple questions. In the last month, have you often been bothered by 1) feeling down, depressed or hopeless or 2) having little interest or pleasure in things you usually enjoy? If the answer to either question is “yes” on more days than not, you may be depressed. Other symptoms to look out for include change in appetite (being off your food or being more hungry): trouble concentrating, or sleeping (problems getting to sleep, waking in the night, waking early or sleeping too much); feeling you’re a failure or have let others down; feeling unduly tired; or thoughts that you would be better off dead. Very sadly, lots of my patients put off coming to see me about depression because they feel it’s “their fault”, or because they don’t want to be put onto tablets they think are addictive. Neither has any truth at all. Depression is as much of a real medical problem as asthma or a broken leg. Your doctor certainly won’t tell you to “pull yourself together”. But you only get help if you ask. If you have mild or moderate depression, it’s very unlikely you’ll be offered tablets. However, in more severe depression they can be very effective. Like all medicines, antidepressants can cause side effects, but they’re not addictive in the way Valium or alcohol are.
You don’t need more and more as time goes on. You never crave them if you miss a dose. Common side effects include feeling sick, diarrhoea or constipation, dry mouth and feeling anxious. These often settle within weeks. They take a few weeks to work, so do stick with them. You need to take them for at least 6 months after you start to feel better, to reduce the chance of the depression returning when you stop.
In recent years the government has put more emphasis on providing talking therapy services. It’s still not ideal, with a bit of a “postcode lottery” where counselling is concerned. But it’s much easier than it was to access help. For instance, all counselling on the NHS is now available through a single service called IAPT (Improving Access to Psychological Therapies). You can find services near you and refer yourself at WWW.IAPT.NHS.UK, or your GP may have a local number.
You’ll usually be offered a telephone assessment first, and your counsellor will decide with you what talking therapy would work best for you. CBT (Cognitive Behavioural Therapy) is best known, but not the only kind. CBT works on the principle that if you’re depressed or anxious, your mind will automatically think of the worst case scenario in any situation (eg if a friend cancels coffee for a hospital appointment, you wonder if it’s an excuse to get out of seeing you). This in turn affects the way we act. CBT aims to help you challenge these unhelpful thoughts so you can change your thoughts and behaviour. It’s often more effective than medicines, and helps even if you need medicine too.
If you’re depressed, you may feel tired and lacking motivation. But exercise boosts natural “feel good” hormones – so do take that first step. Next week: Chest Infections