The 3 Minute Test for Depression, Anxiety, Bipolar Disorder and PTSD

These are serious conditions that affect, not only your quality of life, but your physical health.

Did you know that having a mood disorder may increase your heart attack risk and decrease your ability to recover from other illnesses like stroke, diabetes, multiple sclerosis and cancer?

Your M3 score is a number that will help you and your doctor understand if you have a treatable mood disorder, like depression, anxiety, bipolar disorder, or post traumatic stress disorder. You can even monitor your score to see how your mental health is changing over time.

What's my M3? Knowing can help you take control of your mental health, and you can discover yours in about three minutes with our free, confidential test.

Source:  https://whatsmym3.com/

Fighting Depression

This is an information only website that has brought together lots of information about dealing with depression, beating depression various types of depression, and other mental health issues.
After personally suffering from depression I feel it is very important for people to share their experiences in the hope that someone else can benefit from reading them.

My personal journey though depression

From a very early age, I can remember being very agitated about some of the smallest things. What’s important to a child can of course be nothing of consequence to an adult, but at the time I can remember asking questions that seemed very important to me. Are we late? Is there going to be anybody there? I would be seriously worried about the outcome of the answer to would it rain on school sports day? What would we do? Would it be cancelled? If it didn’t rain, would everyone turn up? Did I look OK in my new sports strip? Were we on time? Being late for an occasion opened the door to a whole new set of worries. This sort of worrying may not sound too extreme, but I was only five or six years old.
As far as I can remember, my parents – who 99% of the time were great, never picked up on my excessive anxiety. I always felt fobbed off with a half-baked answer to most of my questions. I honestly feel that if it had been spotted and helped by them, then things may have been easier for me as a child. I’m conscious with my own children today that children need lots of support and lots of love and reassurance from their parents.
One of the more unusual things I used to worry about in my teenage years was the weather. The weather, in particular the wind, used to send shivers down my spine. It caused me to worry and fret about the slightest little thing. As an adult I’ve done a lot of reading, but have never come across this particular problem – I call it Weather Affective Disorder. It’s a close cousin of Seasonal Affective Disorder or SAD, except that while SAD only affects people for a few months of the year, WAD affected me all year round. It could be wind, rain or even the blue sky that bothered me.
Despite my anxieties as a child, I was very good at sport and problem solving – I was also very creative.

  Bipolar starting

I joined the army when I was 16 and was happy to be involved in lots of sport and activities but I found the constant change, lack of information and constantly living in fear of the unknown hard to cope with. Where was I to be sent next and when? Would I like it as much as what I was doing currently? I worried constantly.
After being in the army for about six years I had had enough of the constant change and upheaval, so I decided to leave and have a go at something else. I gave my one year’s notice to leave. At that time the army had just made a lot of people redundant so I knew that I would still be sent out on active service in that year. Sure enough, I was sent to Northern Ireland on a six-month tour. On the whole that was a fun trip, and I had some good times with a good bunch of lads. After the six months we arrived back in our barracks in Germany to be told we had two weeks’ leave, after which we were to prepare to go to Bosnia for another six-month tour of duty. At this point I was due to leave the army and was going to start my resettlement training, so I was unhappy about this. This event seemed to act as a psychological trigger for me.
Our work in Bosnia was to build a runway so that NATO could launch air strikes if it needed to. When we arrived I knew something inside me was different, but still to this day I don’t know what it was – I just didn’t feel right. Our job was to build our own living area first, then to start on the runway. We started to build a tented camp the size of a small village which resembled something from MASH. When we got there it was the back end of summer and very hot, and the working days were short and bearable (with the occasional visit to the beach thrown in). The showers we built were just cattle shed frames with water pumped into the hollow metal frame, then we punched a hole into the frame with a nail and there you had a shower. The toilet was one long trench dug into the floor, right next to the road so all the passing traffic could see you (most of the traffic was military).
After two months the summer had gone and the wet season was upon us, and this is when my life began to change forever. The days were wet, windy and dark. Our uniform was always wet, our tents had lots of  water running through them and my sleeping bag and all my possessions were wet. It’s impossible to describe the feeling of getting into a wet sleeping bag with water still dripping on you, the tent being blown over night after night in the torrential downpours. Getting up in the morning having not slept a wink all night due to being soaking wet was horrendous, everything was wet or extremely damp for three months. My morale was at an all-time low. Then a ray of light; our troop commander said that it was our turn for a bit of rest and recuperation. Just what the doctor ordered – or was it?
We were sent to accomodation about 20 miles from camp, two single beds per room, en-suite shower and toilet, clean towels, dry clean beds, hot quality food, hot running water. It was heaven. To feel such comfort after such squalor was an amazing high, words cannot explain my elation.
For four whole days and nights we lived in relative luxury and ate good food. When the four days were up, we were bussed back to our tents. On the way back it started to dawn on me that I had left a very wet sleeping bag and clothes behind. When we arrived it was worse than I had expected. Whilst we were away the camp had been flooded and our tent was under a foot of water. I felt a terrible sinking feeling. It came over me suddenly; I just wanted to kill myself there and then. Life had no meaning at that point. I just burst into tears and sat there with my head in my hands wishing I was dead. As every second passed, I was going further down into a bottomless pit. I had been sitting there for what felt like hours when a medic came, picked me up and walked me to the tented medical centre.
That was the start of my bipolar life – a dizzying high followed by a catastrophic low. The treatment which followed was very basic, just a load of tablets to keep me quiet until I left the army in three months’ time.

There followed two disastrously unsuccessful stays in two different psychiatric wards. I won’t go into details just in case you need to have a short stay in one yourself. If you do, remember to never get angry, to keep smiling and telling them you’re OK or your stay will be longer than you think. After this I resigned myself to self-diagnosis. I did a lot of reading and came to the fairly easy conclusion of bipolar disorder (manic depression ), involving massive ups and massive downs.
Ten years later I had tried every antidepressant drug under the sun, none of which seemed to work for me – the side-effects were just as described in the leaflet, but the positive effects never materialised.

The Quest To Find Balance Begins!

So after many failed treatments from the doctors including herbal remedies, I decided to try and give my whole life and daily regime a good overhaul. This started with many hours of research to find the ultimate health plan, after these many hours of research they all led me to the same paths which were general lifestyle, diet and exercise.
So I decided to make a plan to start exercising again. This was really easy as I was used to it from the Army, so I made a conscious effort to visit the gym at least 3-4 times per week. I was off to a great start so no problem there.

The next thing that was really obvious was my diet. Wow although I am relatively slim and in shape my diet was shocking, so with the use of the internet it is now really easy to research how to eat properly. This again was relatively easy, it went something like this:
•    Swap black coffee with 2 sugars for Wulong tea ( in fact I cut out almost all caffeine and only drunk Wulong tea)
•    Swap breakfast fry ups for Jordans luxury muesli (except Sundays)
•    Swap  mid morning bacon buttie for a fruit salad (tough that one)
•    Swap egg and chips for lunch for salad bowl and fruit
•    Swap pie and chips for any lean protein with tons of any veg for evening meal
•    No fizzy crap drinks, or flavoured water, just sparkling mineral water
•    No alcohol mid week and only in moderation at the weekends
In fact I went as far as trying to reduce sugar in my diet to as low as possible
The same can be said for high carbohydrate food as well (Not that Atkins rubbish, just eating more lean protein). After doing all this I started to feel like things were really falling into place for me and I began to feel a lot better. I don’t know why but I still felt that one component was missing and it took me ages and ages to find out what it was.  So I kept a diary of my weeks activities and food intake and showed it to a friend of mine who is a nutritionist. She took one look and was quietly impressed, but she spotted right away that I had zero omega 3 in my diet at all!

The Omega 3 Hunt

So after sorting out my lifestyle my highs are now fairly manageable; they tend to upset those around me more than they upset me. As for the downs – I have them under control too.
After hearing that I was deficient in omega 3, I did some more research into what kinds of foods I needed to be eating to obtain this in my diet. Now apart from Hemp seed the only really natural food that is abundantly high in Omega 3 is fish … Noooo way, I can’t stand fish!  So I had to find an alternative to try and get this into my diet and the natural choice was Fish oil supplements as I was not prepared to eat fish!
I went along to my local supermarket and bought some fish oil. I sat back and waited for my more balanced moods that everyone talks about regarding omega 3, but there was no change.
In the mean time I was given a book to read about the benefits of Omega 3 fish oils, and about the benefits of something called EPA, an omega 3 nutrient. Having found a fish oil with a high EPA content, I again waited for the balance in mood to occur. Disappointed, I wondered if I was immune to fish oil, or if I still had the wrong type.
So I set about studying EPA fish oil in great depth, and what I found was to change my life.
I found that there are many grades of fish oil, from the old-fashioned cod liver oil right up to the Rolls Royce of fish oil – high-grade EPA concentrates. I searched for the highest grade of EPA that I could find. All the oils seemed to have unique selling points, but because of all the research I had done I could tell the hype from the truth. The biggest pointer I was given was that oil, like alcohol, has strength, and that the quantity wasn’t as important as the strength.
Again I searched for this elusive high-grade oil. It was apparent that all websites would use terms like ‘high-grade’ and ‘ultra strong’, which hampered my progress for genuine high grade oil. I eventually found a product that had some independent reviews and was allegedly one of the strongest oils available. I hoped this would be my solution, but again I felt no effect.
I rang the company involved and asked if I was doing something wrong, they asked how long I had been taking the oil for and how many capsules per day. They told me it was not a miracle cure, and that I would have to take four capsules per day for a minimum of three months for the oil to be fully absorbed. They also said that there were other things that could put the brakes on the absorption process, mainly your diet, (I had this under control).
So I upped my dose to four caps in the morning and stayed with my good eating habits, trying to cut out all the rubbish. Four weeks later I started to notice some very strange things happening to me; I was behaving a little out of character. My anxiety levels about very stupid things had all but gone. I had stopped worrying about my car breaking down when it was raining, and about low-level fast-moving clouds. I also started to notice that my anger levels aimed at my children were also rapidly disappearing; I was talking to them rather than ranting at them. Not to mention the rapid growth of my hair and nails.
Over the following months I noticed many things starting to fall into place. My moods were more balanced then they had been for 15 years. I found myself laughing at comedy on the TV, which was not normal for me. I started not to care about little things, and I found it easier to let things go whereas before they would nag at me for weeks on end. My concentration was nothing short of awesome, the ability to focus on a task was so much better, but the biggest thing had to be the balance of mood that this fish oil seemed to be giving me.
Absolutely 100% cured? No, but I am 95% better for having added it to my diet. If my old moods could be compared to a tidal wave, my moods now are gentle waves lapping on the shore, and they are very easy to manage.
I hope by writing about my experiences that something somewhere has fallen into place for someone else and that it may help.
I strongly suggest you go and have a look at adding this oil into your diet, the oil I am using at the moment is called Pura Apa it’s the strongest one I have found with an EPA concentration of 90% and contains no DHA (I found that some English Docs were suggesting there maybe a competing mechanism between EPA and DHA) and it seems to be working very well. If I switch in the future I will post the details of why and what to on this site.

Source:  http://www.fightingdepression.co.uk/?utm_source=Bing&utm_medium=CPC&utm_term=supplements%20to%20help%20with%20depression&utm_campaign=fighting%20depression%20old%20url

I may never have received the support I needed if I hadn’t relapsed

A few months back I wrote about my time in hospital and the fears I had around my discharge and reintegration back into the community. Aside from being concerned about what people would think when they found out about my diagnosis of bipolar, I was worried about what care I would have in the community. When I was discharged the first time, after a 2-month stint, my psychology sessions ceased as I was no longer a patient. I was to continue seeing a care coordinator in the community once a week to discuss the week’s events. Unfortunately I found this support inadequate and one month later I was back In the Wedgewood Psychiatric unit as a result of taking an overdose.
‘I was worried about what care I would have in the community..’
When I next returned to the community the care package was increased. I was to see my care coordinator twice a week and have phone calls on the days in between as well as see a clinical worker once a week. I found talking about the previous week’s events wasn’t resolving the underlying psychological issues I was having at the time and when I raised this with my care co I was told that it was hard find a Psychologist who worked in our local area of Suffolk on the NHS. Because of this I had to settle for my care co acting as a Psychologist by consulting with a psychologist before each session. Unfortunately this support wasn’t enough and I relapsed and returned to Wedgewood for another month.
Finally the psychiatrists at the hospital put their feelers out and found an NHS psychologist willing to carry out the work with me. This time when I was discharged, things started to improve and I felt there was little chance of a relapse as I felt properly supported and my issues were being explored and managed in a way that fitted my individual needs. I often wonder if I had not relapsed would I ever have received the support I needed. What do other people with mental health conditions do for support in the community? Is the only way we can get the support, through hospitalisation?
‘..I found this support inadequate and one month later I was back In the Wedgewood Psychiatric unit..’

Reading back over my article, I realise that, in the end, the system did not work. What I now see is that the process required me to play a pivotal role. Without my feedback how can true and lasting progress be possible? I could have remained a victim of my condition allowing others to present me alternatives while I choose to accept or reject their suggestions on a whim or, be proactive in my recovery, become self aware and test out what feels right for me and if I feel I need a different support or intervention, then to ask for it. Maybe we’ve been brainwashed into expecting things to be right first time and that those with the knowledge should be mind readers and get it right first time.
It’s all too easy to have expectation of others without putting the same criteria on ourselves. To fail, or in my case relapse, was perhaps a necessary part of my recovery. In the words of Thomas Edison when struggling with his electrical experiments,
‘I have not failed. I’ve just found 10,000 ways that won’t work’.

Afrika Green is a musican and blogger, she is a guest contributor for GBC and recently started a blog called http://www.my-bipolar.com which documents her feelings about her recent stay in Wedgewood Psychiatric hospital coming to terms with her diagnosis as Bipolar.

Disclaimer:The opinions expressed by the guest writer/blogger and those providing comments are theirs alone, and do not necessarily reflect the opinions of Link Up (UK) or any employee thereof. Link Up (UK) is not responsible for the accuracy of any of the information supplied by the Guest writer/bloggers. This work is the opinion of the blogger. It is not the intention of Link Up (UK) to “malign any religion, ethnic group, minority, club, organization, company, or individual.

Source:  http://greatbritishcommunity.org/i-may-never-have-received-the-support-i-needed-if-i-hadnt-relapsed/

Pattern Recognition Technology May Help Predict Future Mental Illness in Teens

A technique combining computer-based pattern recognition and brain imaging data accurately distinguished teens at risk for mental disorders from those with low risk and may someday be useful in predicting risk in individuals, according to an NIMH-funded study published February 15, 2012, in the journal PLoS One.

Background

Research on risk for mental disorders generally describes risk factors that apply to groups. To date, no biological measures can accurately predict an individual’s risk of future mental disorders.
Mary Phillips, M.D., of the University of Pittsburgh School of Medicine, and colleagues evaluated the use of computer-based techniques that automatically find patterns in data—these techniques are collectively called machine learning—with functional magnetic resonance imaging (fMRI) data. The researchers obtained fMRI data from 32 teens, half of whom had at least one biological parent diagnosed with bipolar disorder and were therefore at genetic risk for future psychiatric disorders. The other half of teens had no history of mental disorders either personally or in their immediate families.
The teens’ brain activity was assessed as they identified the gender of actors depicting various emotional facial expressions (happy, fearful, or neutral) in a series of photographs. Previous research has linked various mental disorders, especially depression and bipolar disorder, with abnormal patterns of brain activity during this task. Based on this fMRI data, the researchers used machine learning to calculate each participant’s odds for future mental illness.
The participants were also assessed clinically and with fMRI at the start of the study, and clinically assessed again about two years later, on average. Long-term follow up is ongoing, with successive face-to-face assessments occurring every other year.

Results

Machine learning combined with fMRI accurately identified most of the healthy teens at genetic risk of future mental disorders vs. healthy teens with low genetic risk. Four of the 16 at-risk teens were misidentified as having low risk.
At the two-year follow up, none of the at-risk teens had developed bipolar disorder, but six were diagnosed with major depression or an anxiety disorder. Among all the at-risk teens identified through machine learning, these six had received the highest odds for belonging to the at-risk group.
Three of the four at-risk teens misidentified as belonging to the low risk group at the start of the study remained healthy at the second assessment. Clinical information for the fourth teen was not available at the time of follow-up.

Significance

Though still a very preliminary study, according to the researchers, machine learning combined with fMRI shows promise for predicting individual risk of developing future mental disorders, especially in at-risk populations.
The ongoing follow-up may also yield further insights into the relationship between depression, anxiety disorders, and bipolar disorder. Many studies have shown that bipolar disorder is often preceded by depression or anxiety disorders, and that these disorders may affect the course of subsequent bipolar disorder.

What’s Next

Larger studies using machine learning and fMRI will help to better define the extent to which pattern recognition techniques can accurately identify people at risk for future mental disorders. Research in this area may also inform early treatment or prevention efforts.
Source:  http://www.nimh.nih.gov/news/science-news/2012/pattern-recognition-technology-may-help-predict-future-mental-illness-in-teens.shtml

What is Depression if not a Mental Illness?

Sometimes you might hear a person talking about mental disorders like depression or bipolar disorder without really understanding what they mean. What is depression? What is bipolar disorder? Why do we refer to these things as mental health issues or mental disorders rather than a medical disease? And does it matter what we call a thing?

Depression is a Mental Disorder, not a Disease

While psychiatric medications and their resulting television commercials in the 1990’s and this decade have done much to help people seek treatment for a mental disorder like depression, they haven’t done much to help people understand the complexities of things like “depression” and “bipolar disorder.” These things are called disorders, not diseases, for a reason. A disorder simply means something that is out of the ordinary, which depression and other mental disorders are. They are more specifically a cluster of symptoms that research has shown to correlate highly with a specific emotional state.

A medical disease, on the other hand, according to Webster’s, is

a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms

Diseases are manifestations of a problem with some physical organ or component within the body. And while the brain is also an organ, it is one of the least understood and easily the most complex organ within the body. Researchers and doctors refer to a diseased organ when something is clearly wrong with it (via a CAT scan or X-ray or laboratory test). But with our brains, we have no test to say, “Hey, there’s something clearly wrong here!”
One could make the argument, as many have, that because brain scans show abnormalities in certain biochemical levels within the brain when they suffer from depression or the like, this “proves” that depression is a disease. Unfortunately, research hasn’t gotten quite that far yet. The brain scans show us something, that much is true. But whether the scans show the cause or the result of depression has yet to be determined. And more tellingly, there is a body of research that shows similar changes in brain neurochemistry when people are doing all sorts of activities (such as reading, playing a video game, etc.).

The Bio-Psycho-Social Model of Mental Disorders

While brain biochemistry and genetic makeup are important components of most people’s battle with a mental disorder, there are two other equally important components that are all too often left out of the picture – the psychological and the social. The most commonly accepted model of mental illness today takes these three components into account – the biopsychosocial model. This is the model most mental health professionals who practice subscribe to.
Source:  http://psychcentral.com/lib/what-is-depression-if-not-a-mental-illness/000896?all=1

Depression

Depression is common. Symptoms can affect day-to-day life and can become very distressing. Treatments include talking (psychological) 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.

What is depression?

The word depressed is a common everyday word. People might say "I'm depressed" when in fact they mean "I'm fed up because I've had a row, or failed an exam, or lost my job", etc. These ups and downs of life are common and normal. Most people recover quite quickly. With true depression, you have a low mood and other symptoms each day for at least two weeks. Symptoms can also become severe enough to interfere with normal day-to-day activities.

Depression Calculator

Use this app to assess whether you may be depressed and make a tentative diagnosis of the severity of the depression.

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Who gets depression?

About 5 in 100 adults have depression every year. Sometimes it is mild or lasts just a few weeks. However, 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.

What are the symptoms of depression?

Many people know when they are depressed. However, some people do not realise when they are depressed. They may know that they are not right and are not functioning well but don't know why. Some people think that they have a physical illness - for example, if they lose weight.
There is a set of symptoms that are associated with depression and help to clarify the diagnosis. These are:

Core (key) symptoms

• Persistent sadness or low mood. This may be with or without weepiness.
• Marked loss of interest or pleasure in activities, even for activities that you normally enjoy.

Other common symptoms

• Disturbed sleep compared with your usual pattern. This may be difficulty in getting off to sleep, or waking early and being unable to get back to sleep. Sometimes it is sleeping too much.
• Change in appetite. This is often a poor appetite and weight loss. Sometimes the reverse happens with comfort eating and weight gain.
• Tiredness (fatigue) or loss of energy.
• Agitation or slowing of movements.
• Poor concentration or indecisiveness. For example, you may find it difficult to read, work, etc. Even simple tasks can seem difficult.
• Feelings of worthlessness, or excessive or inappropriate guilt.
• Recurrent thoughts of death. This is not usually a fear of death, more a preoccupation with death and dying. For some people despairing thoughts such as "life's not worth living" or "I don't care if I don't wake up" are common. Sometimes these thoughts progress into thoughts and even plans for suicide.

An episode of depression is usually diagnosed if:

• You have at least five out of the above nine symptoms, with at least one of these a core symptom; and:
  • Symptoms cause you distress or impair your normal functioning, such as affecting your work performance; and
  • Symptoms occur most of the time on most days and have lasted at least two weeks; and
  • The symptoms are not due to a medication side-effect, or to drug or alcohol misuse, or to a physical condition such as an underactive thyroid or pituitary gland. (However, see section later on depression and physical conditions.)

Many people with depression say that their symptoms are often worse first thing each day. Also, with depression, it is common to develop physical symptoms such as headaches, palpitations, chest pains and general aches. Some people consult a doctor at first because they have a physical symptom such as chest pains. They are concerned that they may have a physical problem such as a heart condition when it is actually due to depression. Depression is in fact quite a common cause of physical symptoms. But, the opposite (converse) is also true. That is, people with serious physical conditions are more likely than average to develop depression.
Some people with severe depression also develop delusions and/or hallucinations. These are called psychotic symptoms. A delusion is a false belief that a person has, and most people from the same culture would agree that it is wrong. For example, a belief that people are plotting to kill you or that there is a conspiracy about you. Hallucination means hearing, seeing, feeling, smelling, or tasting something that is not real.

Severity of depression

The severity of depression can vary from person to person. Severity is generally divided as follows:

• Severe depression - you would normally have most or all of the nine symptoms listed above. Also, symptoms markedly interfere with your normal functioning.
• Moderate depression - you would normally have more than the five symptoms that are needed to make the diagnosis of depression. Also, symptoms will usually include both core symptoms. Also, the severity of symptoms or impairment of your functioning is between mild and severe.
• Mild depression - you would normally have five of the symptoms listed above that are required to make the diagnosis of depression. However, you are not likely to have more than five or six of the symptoms. Also, your normal functioning is only mildly impaired.
• Subthreshold depression - you have fewer than the five symptoms needed to make a diagnosis of depression. So, it is not classed as depression. But, the symptoms you do have are troublesome and cause distress. If this situation persists for more than two years it is sometimes called dysthymia.

What causes depression?

The exact cause is not known. Anyone can develop depression. Some people are more prone to it and it can develop for no apparent reason. You may have no particular problem or worry, but symptoms can develop quite suddenly. So, there may be some genetic factor involved that makes some people more prone than others to depression. 'Genetic' means that the condition is passed on through families.
An episode of depression may also be triggered by a life event such as a relationship problem, bereavement, redundancy, illness, etc. In many people it is a mixture of the two. For example, the combination of a mild low mood with some life problem, such as work stress, may lead to a spiral down into depression.
Women tend to develop depression more often than men. Particularly common times for women to become depressed are after childbirth (postnatal depression) and the menopause.

Related articles q

• Seasonal Affective Disorder
• Social Anxiety Disorder
• Cognitive Behavioural Therapy (CBT)

Depression and physical conditions

Although the cause of depression is not clear, there are some useful things to remember about depression in relation to physical conditions.

• Depression is more common in people who are known to have certain physical conditions.
• The diagnosis of depression is sometimes confused with some undiagnosed diseases caused by physical conditions.

Known physical conditions

Depression is more common than average in people coping with serious or severe physical diseases. Although the treatment of the physical disease may take priority, the treatment of depression is also useful to improve overall well-being.

Undiagnosed physical conditions

Various physical conditions may at first seem to mimic depression. Doctors aim to be on the lookout for these diseases and may order tests to rule them out if one is suspected. Perhaps the most common examples are:

• An underactive thyroid gland (hypothyroidism) - can make you feel quite low, weepy and tired. A blood test can diagnose this.
• An underactive pituitary gland (hypopituitarism) - the pituitary gland is just under the brain. It makes various hormones which have various actions. Sometimes one hormone can be deficient; sometimes more than one. There are various symptoms that can develop. These include loss of sex drive, sexual problems, infertility, uncontrollable weight gain and feeling low, depressed and even suicidal. Blood tests can help to diagnose hypopituitarism. There are various causes of hypopituitarism, including head injury.
• Head injury - even a relatively mild one, even many years ago. For example, studies have shown that rates of suicide (presumably related to depression) are more common than average in people who have previously had a head injury. The reason for this is not fully understood. However, one factor that may be significant in some cases is that a head injury may result in hypopituitarism, as discussed above.
• Polymyalgia rheumatica - this condition mainly affects older people. Typical symptoms include stiffness, pain, aching, feeling depressed and tenderness of the large muscles around the shoulders and upper arms. Feeling depressed can be the first main symptom before the other symptoms predominate.
• Early dementia - is sometimes confused with depression.
• Certain drugs, both prescribed and street (illicit) drugs - can cause side-effects which may mimic depression.

The rest of this leaflet is about depression of unknown cause that is not associated with any physical condition.

Some myths and other points about depression

Depression is common but many people don't admit to it. Some people feel there is a stigma attached, or that people will think they are weak. Great leaders such as Winston Churchill have suffered depression. Depression is one of the most common illnesses that GPs deal with. People with depression may be told by others to "pull their socks up" or "snap out of it". The truth is, they cannot,and such comments by others are very unhelpful.
Understanding that your symptoms are due to depression and that it is common, may help you to accept that you are ill and need help. Some people ask "Am I going mad?". It may be a relief to know that you are not going mad and that the symptoms you have are common and have been shared by many other people.
You may 'bottle up' your symptoms from friends and relatives. However, if you are open about your feelings with close family and friends, it may help them to understand and help.

What are the treatment options for depression?

In general, treatments are divided into those used for mild depression and those used for moderate and severe depression.

Decision Aids

Doctors and patients can use Decision Aids together to help choose the best course of action to take.
Compare the options for Depression.p

What if I don't have any treatment?

Most people with depression will get better without treatment. However, this may take several months or even longer. (The average length of an episode of depression is 6-8 months.) Meanwhile, living with depression can be difficult and distressing (and also for your family and friends). Relationships, employment, etc, may be seriously affected. There is also a danger that some people turn to alcohol or illegal drugs. Some people think of suicide. Therefore, many people with depression opt for treatment.

Treatment options for moderate or severe depression

Antidepressant medicines

Antidepressant medicines are commonly used to treat moderate or severe depression. A medicine cannot alter your circumstances. However, symptoms such as low mood, poor sleep, poor concentration, etc, are often eased with an antidepressant. This may then allow you to function more normally and increase your ability to deal with any problems or difficult circumstances.
An antidepressant does not usually work straightaway. It can take 2-4 weeks before the effect builds up fully. A common problem is that some people stop the medicine after a week or so as they feel it is not helping. You need to give it time. Also, if it is helping, follow the course that a doctor recommends. A normal course of an antidepressant lasts for at least six months after symptoms have eased. Some people stop their medication too early and the depression may then quickly return.
There are several types of antidepressants, each with various pros and cons. For example, they differ in their possible side-effects. (The leaflet that comes in the medicine packet provides a full list of possible side-effects.) If the first one that you try does not suit, then another may be found that will suit. So, tell your doctor if you have any problems with an antidepressant. Antidepressants are not tranquillisers and are not thought to be addictive.
People with moderate or severe depression have a good chance of improving within a few weeks of starting an antidepressant. But, they do not work in everybody. However, some antidepressants work better in some people than in others. Therefore, tell your doctor if symptoms do not start to improve after about 3-4 weeks of taking an antidepressant. In this situation it is common to advise either an increase in dose (if the maximum dose is not yet reached) or a switch to another type of antidepressant.
At the end of a course of treatment it is usual to reduce the dose gradually over about four weeks before finally stopping. This is because some people develop withdrawal symptoms if an antidepressant is stopped abruptly.

Psychological (talking) treatments

Various psychological treatments have been shown in research trials to be good treatments for depression. These are briefly listed below. In general, a combination of an antidepressant plus a psychological treatment is thought to be better than either treatment alone. However, further research is required to work out the best option. Typically, most psychological treatments for depression last in the range of 12-20 weekly sessions of 1-2 hours per session.
Those most commonly used for moderate or severe depression are:

• Cognitive behavioural therapy (CBT). Briefly, cognitive therapy is based on the idea that certain ways of thinking can trigger, or fuel, certain mental health problems such as depression. The therapist helps you to understand your thought patterns. In particular, to identify any harmful or unhelpful ideas or thoughts which you have that can make you depressed. The aim is then to change your ways of thinking to avoid these ideas. Also, to help your thought patterns to be more realistic and helpful. Behavioural therapy aims to change any behaviours which are harmful or not helpful. CBT is a combination of cognitive therapy and behavioural therapy. In short, CBT helps people to achieve changes in the way that they think, feel and behave.
• Interpersonal therapy (IPT). This is sometimes offered instead of CBT. IPT is based on the idea that your personal relationships may play a large role in affecting your mood and mental state. The therapist helps you to change your thinking and behaviour and improve your interaction with others. For example, IPT may focus on issues such as bereavement or disputes with others that may be contributing to the depression.

Other types of therapy sometimes used, depending on circumstances, include:

• Behavioural activation. The basis of this therapy is that behaviours such as inactivity and ruminating on certain thoughts can be key factors in maintaining depression. The therapist aims to help you to combat these unhelpful behaviours.
• Couple therapy. This may be an option for people who have a regular partner and where the relationship contributes to the depression. Or, where involving the partner is considered to be of potential useful benefit.

Other treatments

Electroconvulsive therapy (ECT) may be advised as a last resort if you have severe depression which has not improved with other treatments.

What about exercise?

It is difficult to give firm advice about exercise as a treatment. Some people claim that regular exercise helps to lift their mood and combat depression. But, there is conflicting evidence about this from research trials. The national guideline published in 2009 by the National Institute for Health and Care Excellence (NICE) advises regular exercise as a possible treatment. A large review published in 2012 supports this advice. It concluded that exercise, on average, seems to improve depressive symptoms. In contrast, a large research trial published in 2012 found that addition of an exercise programme to the usual care for depression neither improved the depression outcome nor reduced the antidepressant use compared with usual care alone.
But also bear in mind that regular exercise is generally a good thing to do anyway.

Treatment options for mild depression

The following are the commonly used treatment options for people with mild depression. They are also used for people with long-standing subthreshold depression that has shown no signs of improving. Some people prefer one type of treatment to another. So, personal preference for the type of treatment used should be taken into account when discussing the best treatment for yourself with your doctor.

A guided self-help programme

There are various pamphlets, books and CDs which can help you to understand and combat depression. The best are based on the principles of CBT, as described earlier. Ideally, a guided self-help programme is best. That is, a programme where the materials are provided by a trained practitioner such as a doctor and where a practitioner monitors your progress. A self-help programme takes some motivation and effort to work through - a bit like doing homework. A typical guided self-help programme consists of 6-8 sessions (face-to-face and via telephone) over 9-12 weeks.

Computer-based CBT

Computer- and internet-based self-help CBT programmes are recent innovations. They are supported by a trained practitioner who monitors progress. A programme typically takes place over 9-12 weeks and you are given tasks to try out between sessions.

Group-based CBT

This is CBT but in a group setting of 8-10 participants. Typically, it consists of 10-12 weekly meetings.

Group-based peer support

This is an option for people with depression who also have an ongoing (chronic) physical problem. This allows sharing of experiences and feelings with a group of people who understand the difficulties and issues facing group members. Typically, it consists of one session per week over 8-12 weeks. Ideally, it should be supported by a facilitator who has knowledge of the physical health problem and reviews progress with people taking part in the group.

Antidepressant medicines

Antidepressant medication is not usually recommended for the initial treatment of mild depression. However, an antidepressant may be advised for mild depression in certain circumstances. For example, in people:

• With mild depression that persists after other treatments have not helped.
• Whose depression is associated with a physical illness.
• Who have had an episode of moderate or severe depression in the past.

Second-line treatment

For mild depression, the above treatments often work well and symptoms improve. However, if symptoms do not improve much with the above treatments, it is usual to move on to treatments usually advised for moderate or severe depression, as discussed earlier. That is, an antidepressant and a more intensive psychological treatment such as individual one-to-one CBT.

6 Dr Sarah Jarvis talks about Christmas Depression

What about St John's wort (hypericum)?

This is not advised. St John's wort is a herbal antidepressant that you can buy, without a prescription, from pharmacies. It became a popular treatment for depression. However, national guidelines for depression do not advise that you take this because:

• It is not clear how well it works. Although some studies suggest that it may help depression, other studies have failed to confirm this.
• Side-effects sometimes occur. (Some people think that because St John's wort is 'natural' then it is totally safe. This is not true. It contains many chemicals which sometimes cause problems.)
• It may react with other medicines that you may take. Sometimes the reactions can cause serious problems. For example, you should not take St John's wort if you are taking warfarin, ciclosporin, oral contraceptives, anticonvulsants, digoxin, theophylline, or certain anti-HIV medicines. Also, you should not take it at the same time as certain other prescribed antidepressants.

Some promising possible new treatments

Some newer treatments have recently had some press coverage. None of those listed below is currently routine treatment for depression. However, further research may clarify how useful they are for depression:

• Eating a Mediterranean diet may help to prevent depression. One theory as to why this may help is that a diet high in olive oil may increase the amount of brain chemical called serotonin. This is similar to the effect of some antidepressants.
• Magnetic stimulation therapy. A study (cited below) that looked at magnetic stimulation of the brain showed promise to improve depression symptoms.
• Omega-3 supplements. One research study (cited below) has reported that some people with depression (but not people with depression and anxiety) had an improvement in symptoms after taking omega-3 supplements (fish oil supplements).
• Ketamine. A small study reported that an injection of ketamine improved symptoms for a few days in some people with otherwise treatment-resistant depression.

Some dos and don'ts about depression

• Don't bottle things up and 'go it alone'. Try to tell people who are close to you how you feel. It is not weak to cry or admit that you are struggling.
• Don't despair - most people with depression recover. It is important to remember this.
• Do try to distract yourself by doing other things. Try doing things that do not need much concentration but can be distracting, such as watching TV. Radio or TV is useful late at night if sleeping is a problem.
• Do eat regularly, even if you do not feel like eating. Try to eat a healthy diet.
• Don't drink too much alcohol. Drinking alcohol is tempting to some people with depression, as the immediate effect may seem to relieve the symptoms. However, drinking heavily is likely to make your situation worse in the long run. Also, it is very difficult either to assess or to treat depression if you are drinking a lot of alcohol.
• Don't make any major decisions whilst you are depressed. It may be tempting to give up a job or move away to solve the problem. If at all possible you should delay any major decisions about relationships, jobs, or money until you are well again.
• Do tell your doctor if you feel that you are getting worse, particularly if suicidal thoughts are troubling you.
• Sometimes a spell off work is needed. However, too long off work might not be so good, as dwelling on problems and brooding at home may make things worse. Getting back into the hurly-burly of normal life may help the healing process when things are improving. Each person is different and the ability to work will vary.
• Sometimes a specific psychological problem can cause depression but some people are reluctant to mention it. One example is sexual abuse as a child leading to depression or psychological difficulties as an adult. Tell your doctor if you feel something like this is the root cause of your depression. Counselling may be available for such problems.

Will it happen again?

A one-off episode of depression at some stage in life is common. However, some people have two, three, or more episodes of depression. You can have treatment for each episode. But, if you are prone to recurring episodes of depression, options that may be considered by you and your doctor include the following:

• To take an antidepressant long-term to help prevent depression from recurring.
• Mindfulness-based cognitive therapy. This may be advised (if available) for people who are currently well but have had three or more episodes of depression. This therapy is a specialist type of talking treatment. There is good evidence that it can help to prevent the recurrence of depression. The therapy is typically done in groups of 8 to 15 people. It consists of weekly two-hour meetings over about eight weeks. There are then four follow-up sessions in the 12 months after the end of treatment.

Some related conditions

Postnatal depression

Some women develop depression just after having a baby. See separate leaflet called Postnatal Depression for details.

Bipolar disorder

In some people, depression can alternate with periods of elation and overactivity (mania or hypomania). This is called bipolar disorder (sometimes called manic depression). Treatment tends to include mood stabilising medicines such as lithium. See separate leaflet called Bipolar Disorder for details.

Seasonal affective disorder (SAD)

Some people develop recurrent depression in the winter months only. This is called seasonal affective disorder (SAD). For people in the UK with SAD, symptoms of depression usually develop each year sometime between September and November. They then continue until March or April. You and your doctor, may not realise for several years that you have SAD. This is because recurring depression is quite common. You may have been treated for depression several times over the years before it is realised that you have the seasonal pattern of SAD. Treatment of SAD is similar to other types of depression. However, light therapy is also effective. See separate leaflet called Seasonal Affective Disorder for details.

Other mental health problems

Depression sometimes occurs at the same time as other mental health problems:

• People with anxiety, panic disorder and personality disorders quite commonly also develop depression. As a rule, depression should be treated first, followed by treatment of the other disorder. In particular, anxiety will often improve following treatment of depression.
• Eating disorders such as anorexia and bulimia may accompany depression. In this situation the eating disorder is usually the main target of treatment.

Source: http://www.patient.co.uk/health/depression-leaflet

Depression

What is depression?

We often use the expression ‘I feel depressed’ when we’re feeling sad or miserable about life. Usually, these feelings pass in due course. But, if the feelings are interfering with your life and don't go away after a couple of weeks, or if they come back, over and over again, for a few days at a time, it could be a sign that you're depressed in the medical sense of the term.

In its mildest form, depression can mean just being in low spirits. It doesn’t stop you leading your normal life, but makes everything harder to do and seem less worthwhile. At its most severe, major depression (clinical depression) can be life-threatening, because it can make you feel suicidal or simply give up the will to live.

There are also some specific forms of depression:

 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. (See Understanding seasonal affective disorder.)

Postnatal depression – many mothers have ‘the baby blues’ soon after the birth of their baby, but it usually passes after a day or two. Postnatal depression is a much more serious problem and can occur any time between two weeks and two years after the birth. (See Understanding postnatal depression.)

 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. (See Understanding bipolar disorder.)

Source: http://www.mind.org.uk/information-support/types-of-mental-health-problems/depression/?gclid=CPq1jr_TzboCFfHItAodDXoAcw#.UnjlRlOqJXc