What is grief?

Grief is a natural response to loss. It’s the emotional suffering you feel when something or someone you love is taken away. The more significant the loss, the more intense the grief will be. You may associate grief with the death of a loved one—which is often the cause of the most intense type of grief—but any loss can cause grief, including:

Divorce or relationship breakup Loss of health Losing a job Loss of financial stability A miscarriage Retirement

Death of a pet Loss of a cherished dream A loved one’s serious illness Loss of a friendship Loss of safety after a trauma Selling the family home

The more significant the loss, the more intense the grief. However, even subtle losses can lead to grief. For example, you might experience grief after moving away from home, graduating from college, changing jobs, selling your family home, or retiring from a career you loved.

Everyone grieves differently

Grieving is a personal and highly individual experience. How you grieve depends on many factors, including your personality and coping style, your life experience, your faith, and the nature of the loss. The grieving process takes time. Healing happens gradually; it can’t be forced or hurried—and there is no “normal” timetable for grieving. Some people start to feel better in weeks or months. For others, the grieving process is measured in years. Whatever your grief experience, it’s important to be patient with yourself and allow the process to naturally unfold.

Myths and facts about grief

MYTH: The pain will go away faster if you ignore it.
Fact: Trying to ignore your pain or keep it from surfacing will only make it worse in the long run. For real healing it is necessary to face your grief and actively deal with it.
MYTH: It’s important to be “be strong” in the face of loss.
Fact: Feeling sad, frightened, or lonely is a normal reaction to loss. Crying doesn’t mean you are weak. You don’t need to “protect” your family or friends by putting on a brave front. Showing your true feelings can help them and you.
MYTH: If you don’t cry, it means you aren’t sorry about the loss.
Fact: Crying is a normal response to sadness, but it’s not the only one. Those who don’t cry may feel the pain just as deeply as others. They may simply have other ways of showing it.
MYTH: Grief should last about a year.
Fact: There is no right or wrong time frame for grieving. How long it takes can differ from person to person.
Source: Center for Grief and Healing

Are there stages of grief?

In 1969, psychiatrist Elisabeth Kübler-Ross introduced what became known as the “five stages of grief.” These stages of grief were based on her studies of the feelings of patients facing terminal illness, but many people have generalized them to other types of negative life changes and losses, such as the death of a loved one or a break-up.

The five stages of grief:

• Denial: “This can’t be happening to me.”
  
• Anger: “Why is this happening? Who is to blame?”
  
• Bargaining: “Make this not happen, and in return I will ____.”
  
• Depression: “I’m too sad to do anything.”
  
• Acceptance: “I’m at peace with what happened.”
  

If you are experiencing any of these emotions following a loss, it may help to know that your reaction is natural and that you’ll heal in time. However, not everyone who grieves goes through all of these stages—and that’s okay. Contrary to popular belief, you do not have to go through each stage in order to heal. In fact, some people resolve their grief without going through any of these stages. And if you do go through these stages of grief, you probably won’t experience them in a neat, sequential order, so don’t worry about what you “should” be feeling or which stage you’re supposed to be in.
Kübler-Ross herself never intended for these stages to be a rigid framework that applies to everyone who mourns. In her last book before her death in 2004, she said of the five stages of grief: “They were never meant to help tuck messy emotions into neat packages. They are responses to loss that many people have, but there is not a typical response to loss, as there is no typical loss. Our grieving is as individual as our lives.”

Grief can be a roller coaster

Instead of a series of stages, we might also think of the grieving process as a roller coaster, full of ups and downs, highs and lows. Like many roller coasters, the ride tends to be rougher in the beginning, the lows may be deeper and longer. The difficult periods should become less intense and shorter as time goes by, but it takes time to work through a loss. Even years after a loss, especially at special events such as a family wedding or the birth of a child, we may still experience a strong sense of grief.
Source: Hospice Foundation of America

Common symptoms of grief

While loss affects people in different ways, many experience the following symptoms when they’re grieving. Just remember that almost anything that you experience in the early stages of grief is normal—including feeling like you’re going crazy, feeling like you’re in a bad dream, or questioning your religious beliefs.

• Shock and disbelief – Right after a loss, it can be hard to accept what happened. You may feel numb, have trouble believing that the loss really happened, or even deny the truth. If someone you love has died, you may keep expecting him or her to show up, even though you know he or she is gone.
  
• Sadness – Profound sadness is probably the most universally experienced symptom of grief. You may have feelings of emptiness, despair, yearning, or deep loneliness. You may also cry a lot or feel emotionally unstable.
  
• Guilt – You may regret or feel guilty about things you did or didn’t say or do. You may also feel guilty about certain feelings (e.g. feeling relieved when the person died after a long, difficult illness). After a death, you may even feel guilty for not doing something to prevent the death, even if there was nothing more you could have done.
  
• Anger – Even if the loss was nobody’s fault, you may feel angry and resentful. If you lost a loved one, you may be angry with yourself, God, the doctors, or even the person who died for abandoning you. You may feel the need to blame someone for the injustice that was done to you.
  
• Fear – A significant loss can trigger a host of worries and fears. You may feel anxious, helpless, or insecure. You may even have panic attacks. The death of a loved one can trigger fears about your own mortality, of facing life without that person, or the responsibilities you now face alone.
  
• Physical symptoms – We often think of grief as a strictly emotional process, but grief often involves physical problems, including fatigue, nausea, lowered immunity, weight loss or weight gain, aches and pains, and insomnia.
  

Coping with grief and loss tip 1: Get support

The single most important factor in healing from loss is having the support of other people. Even if you aren’t comfortable talking about your feelings under normal circumstances, it’s important to express them when you’re grieving. Sharing your loss makes the burden of grief easier to carry. Wherever the support comes from, accept it and do not grieve alone. Connecting to others will help you heal.

Finding support after a loss

• Turn to friends and family members – Now is the time to lean on the people who care about you, even if you take pride in being strong and self-sufficient. Draw loved ones close, rather than avoiding them, and accept the assistance that’s offered. Oftentimes, people want to help but don’t know how, so tell them what you need—whether it’s a shoulder to cry on or help with funeral arrangements.
  
• Draw comfort from your faith – If you follow a religious tradition, embrace the comfort its mourning rituals can provide. Spiritual activities that are meaningful to you—such as praying, meditating, or going to church—can offer solace. If you’re questioning your faith in the wake of the loss, talk to a clergy member or others in your religious community.
  
• Join a support group – Grief can feel very lonely, even when you have loved ones around. Sharing your sorrow with others who have experienced similar losses can help. To find a bereavement support group in your area, contact local hospitals, hospices, funeral homes, and counseling centers.
  
• Talk to a therapist or grief counselor – If your grief feels like too much to bear, call a mental health professional with experience in grief counseling. An experienced therapist can help you work through intense emotions and overcome obstacles to your grieving.
  

Coping with grief and loss tip 2: Take care of yourself

When you’re grieving, it’s more important than ever to take care of yourself. The stress of a major loss can quickly deplete your energy and emotional reserves. Looking after your physical and emotional needs will help you get through this difficult time.

• Face your feelings. You can try to suppress your grief, but you can’t avoid it forever. In order to heal, you have to acknowledge the pain. Trying to avoid feelings of sadness and loss only prolongs the grieving process. Unresolved grief can also lead to complications such as depression, anxiety, substance abuse, and health problems.
  
• Express your feelings in a tangible or creative way. Write about your loss in a journal. If you’ve lost a loved one, write a letter saying the things you never got to say; make a scrapbook or photo album celebrating the person’s life; or get involved in a cause or organization that was important to him or her.
  
• Look after your physical health. The mind and body are connected. When you feel good physically, you’ll also feel better emotionally. Combat stress and fatigue by getting enough sleep, eating right, and exercising. Don’t use alcohol or drugs to numb the pain of grief or lift your mood artificially.
  
• Don’t let anyone tell you how to feel, and don’t tell yourself how to feel either. Your grief is your own, and no one else can tell you when it’s time to “move on” or “get over it.” Let yourself feel whatever you feel without embarrassment or judgment. It’s okay to be angry, to yell at the heavens, to cry or not to cry. It’s also okay to laugh, to find moments of joy, and to let go when you’re ready.
  
• Plan ahead for grief “triggers.” Anniversaries, holidays, and milestones can reawaken memories and feelings. Be prepared for an emotional wallop, and know that it’s completely normal. If you’re sharing a holiday or lifecycle event with other relatives, talk to them ahead of time about their expectations and agree on strategies to honor the person you loved.
  

Using social media for support

Memorial pages on Facebook and other social media sites have become popular ways to inform a wide audience of a loved one’s passing and to reach out for support. As well as allowing you to impart practical information, such as funeral plans, these pages allow friends and loved ones to post their own tributes or condolences. Reading such messages can often provide some comfort for those grieving the loss.
Of course, posting sensitive content on social media has its risks as well. Memorial pages are often open to anyone with a Facebook account. This may encourage people who hardly knew the deceased to post well-meaning but inappropriate comments or advice. Worse, memorial pages can also attract internet trolls. There have been many well-publicized cases of strangers posting cruel or abusive messages on Facebook memorial pages.
To gain some protection, you can opt to create a closed group on Facebook rather than a public page, which means people have to be approved by a group member before they can access the memorial. It’s also important to remember that while social media can be a useful tool for reaching out to others, it can’t replace the face-to-face connection and support you need at this time.

When grief doesn’t go away

It’s normal to feel sad, numb, or angry following a loss. But as time passes, these emotions should become less intense as you accept the loss and start to move forward. If you aren’t feeling better over time, or your grief is getting worse, it may be a sign that your grief has developed into a more serious problem, such as complicated grief or major depression.

Complicated grief

The sadness of losing someone you love never goes away completely, but it shouldn’t remain center stage. If the pain of the loss is so constant and severe that it keeps you from resuming your life, you may be suffering from a condition known as complicated grief. Complicated grief is like being stuck in an intense state of mourning. You may have trouble accepting the death long after it has occurred or be so preoccupied with the person who died that it disrupts your daily routine and undermines your other relationships.
Symptoms of complicated grief include:

Intense longing and yearning for the deceased Intrusive thoughts or images of your loved one Denial of the death or sense of disbelief Imagining that your loved one is alive

Searching for the person in familiar places Avoiding things that remind you of your loved one Extreme anger or bitterness over the loss Feeling that life is empty or meaningless

The difference between grief and depression

Distinguishing between grief and clinical depression isn’t always easy as they share many symptoms, but there are ways to tell the difference. Remember, grief can be a roller coaster. It involves a wide variety of emotions and a mix of good and bad days. Even when you’re in the middle of the grieving process, you will have moments of pleasure or happiness. With depression, on the other hand, the feelings of emptiness and despair are constant.
Other symptoms that suggest depression, not just grief:

Intense, pervasive sense of guilt Thoughts of suicide or a preoccupation with dying Feelings of hopelessness or worthlessness

Slow speech and body movements Inability to function at work, home, and/or school Seeing or hearing things that aren’t there

Can antidepressants help grief?

As a general rule, normal grief does not warrant the use of antidepressants. While medication may relieve some of the symptoms of grief, it cannot treat the cause, which is the loss itself. Furthermore, by numbing the pain that must be worked through eventually, antidepressants delay the mourning process.

When to seek professional help for grief

If you recognize any of the above symptoms of complicated grief or clinical depression, talk to a mental health professional right away. Left untreated, complicated grief and depression can lead to significant emotional damage, life-threatening health problems, and even suicide. But treatment can help you get better.
Contact a grief counselor or professional therapist if you:

• Feel like life isn’t worth living
• Wish you had died with your loved one
• Blame yourself for the loss or for failing to prevent it
• Feel numb and disconnected from others for more than a few weeks
• Are having difficulty trusting others since your loss
• Are unable to perform your normal daily activities

Are stress and worry interfering with your ability to cope with grief and loss? The FEELING LOVED book can help you.

Related HelpGuide articles

• Supporting a Grieving Person: Helping Others Through Grief, Loss, and Bereavement
• Coping with Pet Loss: Grieving the Death of a Dog or Cat and Moving On
• Coping with a Breakup or Divorce: Moving on After a Relationship Ends

 

Resources and references

General information about grief and loss

Life after Loss: Dealing with Grief – Guide to coping with grief and loss, including normal grief reactions to expect. (University of Texas Counseling and Mental Health Center)
Death and Grief – Article for teens on how to cope with grief and loss. Includes tips for dealing with the pain and taking care of yourself during the grieving process. (Nemours Foundation)

Death of a loved one

Grief: Coping With Reminders After a Loss – Tips for coping with the grief that can resurface even years after you’ve lost a loved one. (Mayo Clinic)
On Being Alone: A Guide for the Newly Widowed – A comprehensive series of articles on grief and loss offering practical, as well as psychological advice. (AARP)

Support for grief and loss

GriefNet.org – Online support community for people dealing with grief, death, and major loss, with over fifty monitored support groups for both kids and adults. (GriefNet.org)
Compassionate Friends – National, self-help organization for those grieving the loss of a child. Includes a Chapter Locator and supportive online brochures on various aspects of grief. (The Compassionate Friends)
Using Facebook to Grieve – Article about using Facebook memorial pages to grieve a loved one. (Coping with Loss and Grief)

Stages of grief

TheKübler-Ross Grief Cycle – Details each stage as it applies to persons facing death or other negative life change. Note that the cycle as presented includes seven stages, including initial shock. (ChangingMinds.org)
What is Grief? – Lays out general stages of grief with tips for helping someone who is grieving. (University of Illinois Counseling Center)

Complicated grief and depression

Major Depression and Complicated Grief – Lists the warning signs and symptoms that suggest grief has progressed to major depression or complicated grief. (American Cancer Society)
Complicated Grief – Learn the difference between the normal grief reaction and complicated grief. Includes information about symptoms, risk factors, and treatment. (Harvard Medical School Family Health Guide)

Grief after suicide

Grief after Suicide – Understanding your emotions, as well as suicide in general, may ease your grieving after suicide. (Buddha Dharma Education Association)

What other readers are saying

“I have had a hard time today, because I just lost my forever soul mate. Your articles on suicide and grief gave me the hope I have so desperately needed. Thank you for caring about others and being willing to share articles during a difficult time. I am encouraged and feel so much better after finding your site.” ~ Colorado

“Yours was the first article I turned to, in order to confirm that I was going through stages of grief, and it gave me greater clarity and hope.” ~ Canada

“I'm . . . becoming a professional grief counselor using solution-focused grief therapy and am finding your material and site inspirational.” ~ Canada

"My [relative] died suddenly this last weekend and the news has generated a very complex mix of intense emotions. The clear, intelligent and unbiased guidance you offer on your site has proven helpful beyond measure. Thank you so much." ~ California

“I recently lost my grandma and you helped me a lot.” ~ New Hampshire 

Source:  http://www.helpguide.org/articles/grief-loss/coping-with-grief-and-loss.htm

The Anxiety Trick

The Anxiety Trick is behind most of the trouble people have with chronic anxiety. Have you struggled to overcome an anxiety disorder, only to get disappointing results, or even feel worse over time? You're being fooled by the Anxiety Trick.
This is a terribly common occurrence, and people mistakenly blame themselves for it. Here's a more accurate, and helpful, way to understand this common and frustrating problem.
What is an anxiety disorder? It's you getting tricked into feeling powerful fear in the absence of any danger.
It's because there's no danger that people seek help for these fears. People recognize that they're getting afraid when they're not in danger. If they were actually in danger, they would just protect themselves as best they could, and be better off for it.
With an anxiety disorder, people get afraid when they're not in danger. Their struggle to protect themselves from fear leads them down a path of increasing trouble. That's the anxiety trick.
How does this happen, that you feel fear in the absence of danger? This is the Anxiety Trick at work.

How You Get Tricked

* If you have Panic Disorder or Agoraphobia, you keep getting tricked into believing that you're about to die, go crazy, or lose control of yourself.
* If you have Social Phobia,you keep getting tricked into into believing that you're about to look so unreasonably nervous in front of people that you will be completely humiliated and be cast aside by your community.
* If you have a Specific Phobia, you keep getting tricked into believing that you're likely to be overcome by some external object (like an elevator) or animal, or by your fear of it.
* If you have OCD, you keep getting tricked into believing that you've set in motion a terrible calamity. You might fear that your neighborhood will burn because you left the stove on, or that your family will get poisoned because you mishandled the insecticide.
* If you have Generalized Anxiety Disorder, you keep getting tricked into believing that you're about to be driven mad by constant worrying.
In each case, the episode of fear passes without the expected catastrophe. You're none the worse for wear, except that you're more worried about the next episode. The details seem different, but it's the same anxiety trick.

What is the Anxiety Trick?

The Anxiety Trick is this: You experience Discomfort, and get fooled into treating it like Danger.
What do we do when we're in danger? We only have three things: Fight, Flight, and Freeze. If it looks weaker than me, I'll fight it. If it looks stronger than me, but slower, I'll run away. And if it looks stronger and faster than me, I'll freeze and hope it doesn't see so good. That's all we have for danger.
When people experience the fear of a panic attack, or a phobic encounter, or an obsessive thought, they instinctively treat it as a danger. They try to protect themselves, with some variation of Fight, Flight, or Freeze.

How People Get Tricked

People's natural instincts to protect themselves are what lead them to get tricked. See if you recognize your responses in these examples below.
A person with Panic Disorder gets tricked into holding her breath and fleeing the store (highway, theater, or other locale), rather than shifting to Belly Breathing. and staying there until the feelings pass.
A person with Generalized Anxiety Disorder gets tricked into trying to stop the unwanted "what if?" thoughts, rather than accepting them and taking care of present business as thoughts come and go.
A person with Social Phobia gets tricked into avoiding the party, or hiding in the corner if he attends, rather than say hello to a stranger and see what happens.
A person with OCD gets tricked into repeatedly washing his hands, or returning home to check the stove, rather than accepting the intrusive thoughts of contamination and fire and returning his energies to the present activities at hand.
A person with a dog phobia gets tricked into avoiding the feelings by avoiding all dogs, rather than spending time with a dog until the feelings pass.

What Maintains the Anxiety Trick?

You might wonder, why don't people come to see this pattern, of repeated episodes of fear which don't lead to the feared outcome, and gradually lose their fear?
The answer is this. They took these protective steps, and there was no catastrophe. They tend to believe that these steps "saved" them from a catastrophe. This thought makes them worry more about "the next time". It convinces them that they are terribly vulnerable and must constantly protect themselves.
The actual reason they didn't experience a catastrophe is that such catastrophes are typically not part of a fear or phobia. These are anxiety disorders, not catastrophe disorders. People get through the experience because the experience isn't actually dangerous. But it's understandably hard for people to recognize that at the time. They're more likely to think they just had a "narrow escape". This leads them to redouble their protective steps.
It's the protective steps which actually maintain and strengthen the Anxiety Trick. If you think you just narrowly escaped a catastrophe because you had your cellular phone, or a water bottle; or because you went back and checked the stove seven times; or because you plugged in your iPod and distracted yourself with some music, then you're going to continue to feel vulnerable. And you're going to get more stuck in the habit of "protecting" yourself by these means.
This is how the problem gets embedded in your life. You think you're helping yourself, but you've actually been tricked into making it worse. That's how sneaky this Trick is.
This is why my patients so often say, "the harder I try, the worse it gets". If the harder you try, the worse it gets, then you should take another look at the methods you've been using. You've probably been tricked into trying to protect yourself against something that isn't dangerous, and this makes your fear worse over time.

How Can You Overcome
The Anxiety Trick?

The thing that makes fears and phobias so persistent is that virtually anything you do to oppose, escape, or distract from the anxious feelings and thoughts will be turned against you, and make the anxiety a more persistent part of your life.
This is why people notice "the harder I try, the worse it gets". They're putting out fires with gasoline.
If you come to see that you've been putting out fires with gasoline, you may not have any idea what to do next. But the first step is always the same: put down the buckets. Stop throwing gasoline on that fire.
This is where the cognitive behavioral methods of desensitization and exposure come in. They're intended as methods by which you can practice with (not against) the symptoms, and become less sensitive to them. As you lose your fear of the symptoms, through this practice, that's when the symptoms will fade.
All too often, people get the idea that exposure means going to a place or situation where you're likely to get anxious, perhaps a highway or an elevator, and take a ride without getting anxious. That's not the point! The point is to actually go there and feel the anxiety, being sure to stay there and letting the anxiety leave first. This is what Claire Weekes called floating.
The way to disarm the Anxiety Trick is to increasingly spend time with anxiety, to expose yourself to the thoughts and sensations, and allow them to subside over time.
What can you do to make the experience of exposure more tolerable? You can use the AWARE steps as a general guide for how to conduct yourself while doing exposure. If you want a more specific, step by step guide for overcoming panic attacks and phobias, my Panic Attacks Workbook is full of tools and techniques that will help you keep moving forward. If your problem is Generalized Anxiety Disorder, or involves a lot of worrying without regular panic attacks, The Worry Trick is a book that will help you reduce the role worry plays in your life.
Always keep in mind that exposure is practice with fear, and do nothing to oppose, avoid, or distract from the fear during exposure.

Source:  http://www.anxietycoach.com/anxietytrick.html

Is Exercise "Useless" In Treating Depression?

This article explains what the researchers did and what they found, while pointing out that some of the older established research in this area is coming under increasing scrutiny, and so perhaps there is a need for a new wave of rigorous, specific studies. In the meantime there are lots of experts who support the idea that exercise can help patients with depression, particularly if they have or are at high risk of developing other conditions such as obesity, cardiovascular disease or diabetes, which can often be the case.

What Did The Researchers Do?

The BMJ study researchers, from the Universities of Bristol, Exeter and the Peninsula College of Medicine and Dentistry, wanted to find out whether adding a specific physical activity intervention to the "usual care" that patients with depression receive through their general practitioners (GPs) in the UK, would significantly reduce their symptoms.

The intervention, called TREAD (TREAtment of Depression with physical activity), is based on theory, and provides a trained facilitator who gives "individually tailored support and encouragement to engage in physical activity", write the researchers.

This kind of study helps healthcare providers make decisions about what services to offer through primary care.

The researchers wanted to test TREAD because while there is evidence to suggest exercise is beneficial for people with depression, it is mostly from small, less rigorous studies examining programmes the National Health Service (NHS) may not find practical to deliver.

TREAD is designed to "improve long term adherence to physical activity", and a key feature is encouraging patients to select their own activities, depending on their individual needs and what they can readily do in their own environments. The patients receive up to three face to face meetings with the facilitator, who is trained in motivational interviewing techniques, and they can also have up to 10 telephone calls.



In the BMJ study the intervention lasted for up to 6 to 8 months, with most of the facilitator involvement being in the first four.

The participants were 361 adult patients aged 18-69 who had recently been diagnosed with depression at several different centers in the UK. They were randomly assigned to one of two groups: one group received the usual care, and the other group received the usual care plus TREAD.

The trial followed the participants for 12 months, with measures taken at 4 months, 8 months, and 12 months. For depression symptoms the key measure was the Beck depression inventory, and participants were also asked about use of antidepressants.

The exercise data came from diaries the participants completed about their physical activity. A subset of participants also wore accelerometers, and this data confirmed that the diaries were sufficiently reliable and accurate.

"Usual care" meant that the participants in both groups were asked to follow the advice of their GP for their depression. So they were free during the trial to take up any of the treatment options usually available in primary care: this includes counselling, use of antidepressants, and "exercise on prescription".

Thus, a distinguishing feature of this study is that all patients were free to take up prescribed exercise, but only some were encouraged to do so.

Another distinguising feature is that the study was not comparing the effectiveness of exercise encouragement with other forms of treatment such as counselling and medication, but as an adjunct to these.

The current government guidelines in the UK suggest adults should do 150 minutes of moderate or vigorous physical activity per week, so the researchers explain that:

"The aspiration was for the participants [in the TREAD group] to engage in moderate or vigorous activity for 150 minutes a week in bouts of at least 10 minutes, but if that seemed unrealistic then the facilitator encouraged any increase in physical activity, whatever the intensity."

What Did They Find?

The results showed that the patients in the TREAD intervention group fared no better than those who only received the usual care.

For instance, there was "no evidence that participants offered the physical activity intervention reported improvement in mood by the four month follow-up point compared with those in the usual care group".

And, "similarly, there was no evidence that the intervention group reported a change in mood by the eight and 12 month follow-up points".

The results also showed no evidence of reduced antidepressant use in the TREAD group compared to the usual care only group.

In their conclusion, the authors write:

"The addition of a facilitated physical activity intervention to usual care did not improve depression outcome or reduce use of antidepressants compared with usual care alone."

However, the researchers did find that the participants in the TREAD group reported more physical activity during the follow-up period, even months after they stopped having contact with the facilitator.

Thus the researchers did not conclude that exercise is "useless" for depression, as some of the headlines would suggest, but their findings could provide useful information for healthcare staff making decisions about which exercise programmes to include in primary care services.

Lead author Melanie Chalder, from University of Bristol's School of Social and Community Medicine, told the press:

"Numerous studies have reported the positive effects of physical activity for people suffering with depression but our intervention was not an effective strategy for reducing symptoms."

"However, it is important to note that increased physical activity is beneficial for people with other medical conditions such as obesity, diabetes and cardiovascular disease and, of course, these conditions can affect people with depression."

The researchers said they now plan to study whether TREAD has potential to treat conditions other than depression.

What Happens Now?

The government guidelines are set by the National Institute for Health and Clinical Excellence (NICE). These were last revised in 2009 and suggest patients with mild to moderate depression should be offered group-based physical activity programmes, with support from a competent facilitator, "guided by the person's preference". This should consist "typically of three sessions per week of moderate duration (45 minutes to 1 hour) over 10 to 14 weeks".

It remains to be seen whether the BMJ study will lead to a change in these guidelines. One reason to suggest it will not, is summarized in a comment made in an NHS Choices article by Bazian, a group that analyzes the research evidence behind daily healthcare stories:

"This study assessed just one type of exercise intervention that involved facilitating greater activity levels. Therefore, this study does not tell us whether other types of support or exercise programme may have a positive effect on depression."

They suggest the study may be useful to NHS staff who need to know which types of interventions might help patients with the condition.

However, there are also reasons to suggest the study may prompt some to question the guidelines, because they are based on older evidence that is now coming under increasing scrutiny.

For example, in 2009, a Cochrane review that updated an earlier widely-cited systematic review by others, concluded that the findings of the earlier review were statistically weak and did not support the idea that exercise is effective in the treatment of depression.

Other reviews have also suggested that more conclusive research is still needed into the use of exercise to treat depression, and such research should also look at the use of exercise as an adjunct to recognized treatments, and examine its ability to hold the gains in the longer term.

These points were raised in a Dutch paper published in BMC Public Health in January, that describes the design of a new study to examine the effect of running therapy on depression. The authors said by taking notice of the criticisms raised in these recent reviews, they see their trial as the "first well conducted add-on randomised controlled high-quality trial into the effect of aerobic exercise on depression".



They also intend to measure the effect of aerobic exercise, which in this case comprises running therapy and nordic walking, on other diseases and conditions that often accompany depression, such as metabolic syndrome.

Exercise and other forms of physical activity are relatively cheap and non-harmful treatment options that don't have the side effects of medication and do not require "the introspective ability necessary for most psychotherapies", write the authors.

Source:  http://www.medicalnewstoday.com/articles/246391.php

10 Natural Depression Treatments

Being depressed can make you feel helpless. You're not. Along with therapy and sometimes medication, there's a lot you can do on your own to fight back. Changing your behavior -- your physical activity, lifestyle, and even your way of thinking -- are all natural depression treatments.

These tips can help you feel better -- starting right now.

1. Get in a routine. If you’re depressed, you need a routine, says Ian Cook, MD. He's a psychiatrist and director of the Depression Research and Clinic Program at UCLA.

Depression can strip away the structure from your life. One day melts into the next. Setting a gentle daily schedule can help you get back on track.

2.Set goals. When you're depressed, you may feel like you can't accomplish anything. That makes you feel worse about yourself. To push back, set daily goals for yourself.

"Start very small," Cook says. "Make your goal something that you can succeed at, like doing the dishes every other day."

As you start to feel better, you can add more challenging daily goals.

3. Exercise. It temporarily boosts feel-good chemicals called endorphins. It may also have long-term benefits for people with depression. Regular exercise seems to encourage the brain to rewire itself in positive ways, Cook says.

How much exercise do you need? You don’t need to run marathons to get a benefit. Just walking a few times a week can help.

4. Eat healthy. There is no magic diet that fixes depression. It's a good idea to watch what you eat, though. If depression tends to make you overeat, getting in control of your eating will help you feel better.

Although nothing is definitive, Cook says there's evidence that foods with omega-3 fatty acids (such as salmon and tuna) and folic acid (such as spinach and avocado) could help ease depression.

5. Get enough sleep. Depression can make it hard to get enough shut-eye, and too little sleep can make depression worse.

What can you do? Start by making some changes to your lifestyle. Go to bed and get up at the same time every day. Try not to nap. Take all the distractions out of your bedroom -- no computer and no TV. In time, you may find your sleep improves.

 6. Take on responsibilities. When you’re depressed, you may want to pull back from life and give up your responsibilities at home and at work. Don't. Staying involved and having daily responsibilities can help you maintain a lifestyle that can help counter depression. They ground you and give you a sense of accomplishment.

If you're not up to full-time school or work, that’s fine. Think about part-time. If that seems like too much, consider volunteer work.

7. Challenge negative thoughts. In your fight against depression, a lot of the work is mental -- changing how you think. When you're depressed, you leap to the worst possible conclusions.

The next time you're feeling terrible about yourself, use logic as a natural depression treatment. You might feel like no one likes you, but is there real evidence for that? You might feel like the most worthless person on the planet, but is that really likely? It takes practice, but in time you can beat back those negative thoughts before they get out of control.

8. Check with your doctor before using supplements. "There's promising evidence for certain supplements for depression," Cook says. Those include fish oil, folic acid, and SAMe. But more research needs to be done before we'll know for sure. Always check with your doctor before starting any supplement, especially if you’re already taking medications.

9. Do something new. When you’re depressed, you’re in a rut. Push yourself to do something different. Go to a museum. Pick up a used book and read it on a park bench. Volunteer at a soup kitchen. Take a language class.

"When we challenge ourselves to do something different, there are chemical changes in the brain," Cook says. "Trying something new alters the levels of [the brain chemical] dopamine, which is associated with pleasure, enjoyment, and learning."

10. Try to have fun. If you’re depressed, make time for things you enjoy. What if nothing seems fun anymore? "That's just a symptom of depression," Cook says. You have to keep trying anyway.

Source: http://www.webmd.com/depression/features/natural-treatments