The Depression Trap

Last week I went to an evening of of talks on non medical approaches to treating depression. What stood out for me was the idea of a multi-focused approach to treatment, probably because it’s in line with my own thinking. Depression is not a one size fits all condition, there are many causes and different people respond to different treatments. So what are the factors that we need to consider?

Practical Problems

Practical problems can make depression more likely. Some of my clients have needed practical help as much as they have needed counselling. Inadequate housing, dead end jobs, debt, noisy neighbours, etc. According to Professor Chris Thompson evidence from a recent study points to a link between deprivation (especially unemployment) and depression. Sometimes sorting out the practical problems can be enough to lift depression, in other cases it can help as part of a package of measures.

Relationships

In a similar way unsatisfying or destructive relationships can lead to, or at least contribute towards depression. This can be a relationship with a partner, a parent, a child, a sibling or anyone else who is emotionally significant. Some of my clients have found their depression lifted when they decided to end a relationship, others improved when they made a definite decision to stay, but to create clearer boundaries and start living their own lives, rather than trying to change the other person. Often seeing a counsellor can help people to see things more clearly and work out what they want to do.

Beliefs and Thinking Patterns

Of course not everyone who lives in poor housing, is unemployed, or in a bad relationship becomes depressed. The impact that these events have on us will depend on other things. One of the factors is how we think about things, our beliefs and values. If we tend to think negatively about things that happen to us then we may be more likely to think ourselves into a negative spiral of depression.

Negative thinking often dates back to childhood and can be tackled through self help, positive thinking, CBT and other talking therapies. Other approaches such as meditation and spiritual exploration can also be helpful for some people.

Deeper Emotional Issues

Learning to think more positively is not always enough. Sometimes depression dates back to early childhood or a particularly traumatic event and may be linked to neglect, abuse or other deep rooted issues. Here a deeper shift is required. We may be able to see how destructive our negative thinking is and learn to substitute more positive thoughts, but the emotional trauma continues to seep though. In these cases longer term therapy is needed to work through our emotional issues.

Physical Health

There is increasing evidence to indicate that exercise can have a positive impact on depression. What we eat is also being seen as increasingly important. So a healthy eating plan and exercise programme should be seen as a basic part of any depression treatment package. This should include avoiding alcohol and cutting down on sugary foods and junk food. Supplements may also be useful, especially Omega 3 EPA. There is increasing evidence to show that fatty acids can be useful in treating conditions related to mood, not just depression, but ADHD, Schizophrenia and Dementia.

Stress

Stress has also been linked to depression, so reducing stress in our lives should be part of our package of treatments. This could include practical measures to de-stress our lives (e.g. changing jobs, time management skills, delegating tasks etc.) and techniques in stress reduction e.g. mediation, massage, yoga breathing, etc.

Maybe in the future we will see the NHS providing a package of care taking into account all of the above as well as providing any necessary medication. In the meantime you can use this checklist to make sure you are doing everything you can to aid your own recovery.

Checklist for Depression Care

1. Getting help with practical Problems. Ideally there would be a health care team linked in to social services and other professionals to provide the support that you need. In reality you may need to find help yourself. Some suggestions are – social services, friends, family, Citizen’s Advice, National Debt Line, Connexions (for young people).
2. Relationships – try counselling to help you resolve relationship problems. There are also some good books on the basics of relationship problems.
3. Beliefs and Thinking Patterns – There are numerous books on positive thinking and CBT that may be useful, as well as computerised CBT programs that may help (see the Depression Alliance website and the Resources page on this site). If you need more help then try a counsellor or psychotherapist .
4. Deeper Emotional Issues – try counselling to help you work through these issues.
5. Exercise – make sure you are getting exercise – at least 20-30 minutes three times a week. A class is ideal as you will also be meeting people and getting out of the house. If you find it difficult to motivate yourself then arrange to go with a friend, it’s harder to drop out at the last minute. Exercising outside is also great as sunlight is thought to help with depression too. Find a group to walk /run/cycle with. Yoga is also thought to be beneficial. If all that is too much then go for a short walk every day. Whatever you can manage is better than nothing. Read more in our Resources secton.
6. Diet – many people find changing their diet emotionally very difficult. We all have some sort of emotional relationship with our food. If you find changing your diet intimidating then just make one small change at a time. You may want to see a nutritionist for a more tailored diet plan, but here are some basic steps.
   • In general stick to unprocessed foods.
   • Eat plenty of fresh fruit and veg.
   • Cut down on sugary snacks.
   • Avoid caffeine and alcohol.

   Read more in our Resources secton.

7. Supplements – Consider taking an omega 3 supplement. This will usually be fish oils (vegetarians can take flax seed oil, but note that most research has been done on fish oil supplements, so the effects may not be the same). Make sure that you use a good quality source, as some of the high street store versions don’t seem to be as effective. You can be tested for deficiencies in omega 3 and also vitamins thought to be related to depression. Your nutritional therapist should be able to arrange this for you and give advice on supplements generally. (Unfortunately this is not yet available on the NHS).
8. Practical Stress Reduction – Remove any negative stress that you can from your life. Get help in doing this if you need to from friends, family, a counsellor, coach, time management classes, etc.
9. Stress Management – Find ways to deal with the stress that you can’t get rid of. Try meditation (start with a class, book, CD etc.), go for a regular massage, take up yoga, set aside ‘me time’, have fun, etc.

You can find more information on many of these steps on our Resources page.

Acknowledgements to the speakers at ‘The value of non-medical interventions in the treatment of depression’ organised by the Depression Alliance.

Dr Liz Miller MB BS MRCS LRCP – Mood and Food
Professor Chris Thompson MD FRCPsych – Work Opportunities for Depressed Patients
Dr David Purves Consultant AFBPsS CSci C.Psychol – CBT
Dr Diane Lefevre MB ChB FRCP FRCPsych – Psychotherapy and Nutrition