Help to find feelings of good cheer

It may be a wonderful time for many of us, but Christmas and New Year can be emotionally difficult for those who suffer with depression, says Dr Sarah Brewer, who offers her guidance

Dr Sarah offers her advice to those suffering with depression

Most of us experience changes in mood. One day we feel cheerful and energetic, while the next, we’re gloomy and withdrawn. These mood swings are a normal part of everyday life, but when you have a depressive illness, you feel down most of the time.

Depression causes a persistent low mood and a loss of pleasure in activities. It is the third most common reason for seeing a GP in the UK, with one in 20 adults suffering from an episode of depression each year. It is more common in women than men – probably due to hormone fluctuations – and can last from six to eight months, making life a misery. A patient once told me that if they had the choice between breaking every bone in their body or experiencing depression again, they would prefer the physical pain of all those fractures to the emotional pain.

Why it happens

Depression occurs when the levels of chemical messengers in the brain called neurotransmitters – which pass messages from one brain cell to another – become unbalanced, or fall too low. Mild depression is surprisingly common. It can be triggered by emotional upsets,

such as arguments, money worries or bereavement, and these often accompany other symptoms of stress or illness. It can also be triggered by hormone imbalances (for example, postnatal depression affects at least one in 10 women after childbirth), and it may also accompany long-term health problems, such as diabetes. Seasonal affective disorder (SAD) is linked to primitive hibernation responses when exposure to sunlight is reduced. According to the Royal College of Psychiatrists, SAD is three times more common in women than in men. Using

a light box for 30 minutes to an hour each day at breakfast time may help. Otherwise, treatment is the same as for other forms of depression.

Recurrent brief depression (RBD) affects as many as one in eight people and lasts for two to 14 days before suddenly lifting. It recurs at least once a month, and can strike up to 20 times per year, coming on with little warning. The cause is poorly understood but may be due to sudden drops in brain activity.

Long-term illness Not surprisingly, people struggling with long-term health

conditions, such as mobility, respiratory or heart problems, are prone to depression, too. People with type 2 diabetes are three times more likely to experience depression than people without diabetes, for example. If you’re caring for someone with a long-term health condition, it’s important to consider whether they could have depression, too.

Time to get help

A depressive illness is as much a medical condition as a physical illness is, and it’s important to visit your GP for a proper assessment. Don’t feel like you’re wasting their time. Your doctor may suggest one of the following approaches, depending on the nature and severity of your symptoms. Active monitoring If your symptoms are mild, your doctor may provide information about the nature and course of depression and arrange a follow-up within two weeks to see if you are getting better or worse. Active monitoring involves assessment, advice and support.

Psychological therapies, such as cognitive behavioural therapy (CBT), are often effective for mild to moderate depression. New services are being developed for delivery online or through mobile apps to improve access and to reach more people. You can find services in your area by visiting nhs.uk/ Service-search/psychological.

Antidepressant drugs are not used routinely but may be needed by someone with moderate to severe depression, in addition to psychological therapy. Several classes of antidepressant drug are available, which raise levels of brain chemicals such as serotonin, or noradrenaline, or both. These drugs take time to work and you may not feel any benefit for two to four weeks. If you have not noticed any benefit after four to eight weeks of treatment, you may benefit from another class of antidepressant medicine – talk to your doctor. Treatment with antidepressants should be continued for at least six months after your symptoms have improved to reduce the chance of a relapse.