1. Managing Depression Friday 22 nd November 2013 14.00 – 15.00 KSW 1.04 Michael Bryant LSE Student Counselling Service

2. Depression: Living with the Black Dog

3. What is depression? Depression is common. Symptoms can affect day-to-day life and can become very distressing. Treatments include psychological (talking) treatments and antidepressant medicines. Treatment takes time to work but has a good chance of success. Some people have recurring episodes of depression and require long- term treatment to keep symptoms away.

4. Who gets depression? Cont. About 2 in 3 adults have depression at some time in their life. Sometimes it is mild or lasts just a few weeks. An episode of depression serious enough to require treatment occurs in about 1 in 4 women and 1 in 10 men at some point in their lives. Some people have two or more episodes of depression at various times in their life

6. Exhaustion Funnel

7. How is depression medically diagnosed? There are no physical tests for depression your GP may examine you and do some urine or blood tests to rule out other conditions that have similar symptoms, such as an underactive thyroid. The main way in which your GP will tell if you have depression is by asking you lots of questions about your general health and how the way you are feeling is affecting you mentally and physically.

8. What causes depression? Life events Loss Anger Childhood experiences Physical conditions

9. What causes depression? Cont. Side effects of medication Diet Street drugs and alcohol Genetics Chemical changes in the brain

10. What is the difference between low mood and depression? Low Mood can include: sadness an anxious feeling worry tiredness low self-esteem frustration anger Low mood will tend to improve after a short time.

11. What is the difference between low mood and depression? Cont. DEPRESSION SYMPTOMS ALSO INCLUDE: feeling irritable and intolerant of others having no motivation or interest in things finding it difficult to make decisions not getting any enjoyment out of life having suicidal thoughts or thoughts of harming yourself feeling anxious or worried

12. What is the difference between low mood and depression? DEPRESSION SYMPTOMS ALSO INCLUDE: continuous low mood or sadness feeling hopeless and helpless having low self-esteem feeling tearful feeling guilt-ridden

13. Symptoms of depression: psychological continuous low mood or sadness feeling hopeless and helpless having low self-esteem feeling tearful feeling guilt-ridden

14. Symptoms of depression: psychological cont. feeling irritable and intolerant of others having no motivation or interest in things finding it difficult to make decisions not getting any enjoyment out of life Feeling anxious or worried Having suicidal thoughts or thoughts of harming yourself

15. Symptoms of depression: physical moving or speaking more slowly than usual change in appetite or weight (usually decreased, but sometimes increased) constipation unexplained aches and pains lack of energy or lack of interest in sex (loss of libido) changes to your menstrual cycle disturbed sleep (for example, finding it hard to fall asleep at night or waking up very early in the morning)

16. Symptoms of depression: social not doing well at work taking part in fewer social activities and avoiding contact with friends neglecting your hobbies and interests having difficulties in your home and family life

18. Specific forms of Depression: SAD Seasonal affective disorder (SAD) : this is seasonal depression which is related to day length. It usually comes on in the autumn and winter, when days are short and the sun is low in the sky, and gets better as the days get longer and brighter.

19. Specific forms of Depression: BPD Bipolar disorder (manic depression): Some people have major mood swings, when periods of depression alternate with periods of mania. When manic, they are in a state of high excitement, and may plan and may try to carry out over-ambitious schemes and ideas. They often then have periods of severe depression.

20. Specific forms of Depression: Clinical Clinical depression: Depression ranges in seriousness from mild, temporary episodes of sadness to severe, persistent depression. Doctors use the term "clinical depression" to describe the more severe form of depression also known as "major depression" or "major depressive disorder." For a diagnosis of clinical depression, you must meet the symptom criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM is a guidebook used to diagnose mental illness in the United States.

21. Specific forms of Depression: Clinical Five DSM Criteria for Clinical depression – Depressed mood most of the day, nearly every day Loss of interest or pleasure in most activities Significant weight loss or gain Sleeping too much or not being able to sleep nearly every day

22. Specific forms of Depression: Clinical – cont. FIVE DSM CRITERIA FOR CLINICAL DEPRESSION: Slowed thinking or movement that others can see Fatigue or low energy nearly every day Feelings of worthlessness or inappropriate guilt Loss of concentration or indecisiveness Recurring thoughts of death or suicide

23. What can you do about Depression? Develop emotional intelligence Understand the concept of learned helplessness Talking therapies Develop a mindfulness practice

24. Developing emotional intelligence Understanding emotions ALEXITHYMIA : inability to identify / describe one’s emotions. Mad Bad Sad Glad

25. Learned helplessness Learned helplessness was discovered when researchers immobilized a dog and exposed it to electric shocks that could neither be avoided nor escaped. Twenty-four hours later, the dog was placed in a situation in which electric shock could be terminated by a simple response. The dog did not make this response; instead, it just sat passively. This behavior was in marked contrast to dogs in a control group that reacted vigorously to the shock and learned to turn it off.

26. Book: ‘The Mindful Way Through Depressio n’ Mark Williams

27. 8 week mindfulness programme

28. Talking Therapies: CBT (CBT) helps you understand your thoughts and behaviour and how they affect you. CBT recognises that events in your past may have shaped you, but it concentrates mostly on how you can change the way you think, feel and behave in the present. It teaches you how to overcome negative thoughts, for example being able to challenge hopeless feelings Computerised CBT is a form of CBT that works through a computer screen, rather than face to face with a therapist

29. Talking Therapies: Counselling Counselling is a form of therapy that helps you think about the problems you are experiencing in your life to find new ways of dealing with them. Counsellors support you in finding solutions to problems, but do not tell you what to do. Counselling is available at LSE from the Student Counselling Service. See our website: It is also available on the NHS usually consists of six to 12 hour-long sessions. You talk in confidence to a counsellor. The counsellor supports you and offers practical advice.

30. Talking Therapies: Interpersonal Therapies (IPT) IPT focuses on your relationships with other people and on problems you may be having in your relationships, such as difficulties with communication or coping with bereavement. There's some evidence that IPT can be as effective as antidepressants or CBT, but more research is needed.

31. NHS Care pathways for depression

32. NHS CARE FOR ADULTS WITH DEPRESSION

33. NHS TREATMENT FOR MILD TO MODERATE DEPRESSION TREATMENT

34. NHS TREATMENT FOR SEVERE ADULT DEPRESSION TREATMENT

35. Diagnostics Tests PHQ-9: Patient Health Questionnaire: Quick Depression Assessment GAD 7: Generalised Anxiety Disorder Assessment Quick Anxiety Assessment

37. Pleasantness Calendar

38. Unpleasantness Calendar

39. Resources /Referecnes LSE Student Counselling Service: NICE Guidelines for Treatment of Depression: http://www.nice.org.uk/CG090 I had a Black Dog Blogspot: http://ihadablackdog.blogspot.co.uk/

40. Depression: the Black Dog