However, life isn’t always as simple as this. Anyone who has suffered from deep depression will tell you that no amount of positive thinking makes the depression go away. Positive thinking seems to help in certain situations – when depression is mild, when we are feeling a bit down, when we were previously unaware that negative thinking could make us feel bad etc. In other cases it doesn’t help and can even make us feel worse. People can end up feeling guilty or a failure because they can’t manage to change their thoughts, or because changing thoughts doesn’t work in the way they are told it should. Or trying to force ourselves to think positively can lead to suppressed emotions which lead to problems later on.

There are also times when our emotions seem to emerge without a related thought. We may suddenly feel wonderful as we take a walk in the sunshine, with no particular thought in our head. We may suddenly be overwhelmed with sadness while writing our shopping list. Where do these emotions come from? Are they from somewhere deeper – beyond thought? Are the triggered by unconscious thought? These emotions may themselves give rise to thoughts. On feeling wonderful we may suddenly think ‘isn’t the world beautiful’. On feeling overwhelmed with sadness we may find ourselves thinking ‘ everything is pointless’.

So it appears that sometimes thought leads to emotion and sometimes emotion leads to thought. This can lead to a re-enforcing effect – positive emotion leading to positive thoughts which lead to more positive emotions which lead to more positive thoughts etc. Certainly thoughts are not the only things that can affect our mood, consider music, sunshine, a hug, the smell of flowers, images, etc.

Many suffering from severe depression find the idea that positive thinking could cure them insulting. They know that their condition is much more complex than that. This doesn’t mean that there is no place for positive thinking, but there are times when we need to allow our emotions to play out. This is particularly the case where our depression or low mood is caused by an external event. It is only natural to feel sad, hopeless, despairing when a loved one has died, at the break up of a relationship, or after some other major loss. Here our emotions are part of a natural grieving cycle that needs to play out. To try to force ourselves to be happy too quickly can just lead to repressed emotions that will come back to haunt us later on. There are times when we need to allow ourselves to go into the depths of despair in order to emerge on the other side.

So when do we need to let ourselves experience our emotions and when is positive thinking more appropriate? I think that for many of us this is a natural progression. In a healthy grieving cycle when we aren’t being rushed by ourselves or others there will come a time when we naturally feel ready to move on. The problems occur when this natural cycle is disturbed, when we get stuck in our grief, or stuck in depression for some other reason. When this happens it can be difficult to know when to try the positive thinking approach and when to allow ourselves to fully experience our emotions.

I think it can be helpful for everyone to understand how their thoughts can influence their emotions and to practice observing how their thoughts and emotions are linked. At this level you don’t have to make any changes that feel inappropriate, you are just observing what is. It may then become obvious to you that some thoughts aren’t helpful and you may choose to change them. Or, you may discover that your emotions are not linked to particular thoughts and that some deeper process seems to be taking place. Where emotions are not linked directly to thoughts then some other way of tapping into the emotions may be useful, such as drawing, painting, writing a journal, writing poetry, etc. The point here is not to create a masterpiece, but to find an outlet for your emotions.

Science is a long way from understanding how our emotions arise. There are various theories, but no one really knows for sure. The best expert on your emotions is you. By studying yourself, how your emotions arise, how your thoughts arise, what helps you, what hinders you; you can gain even more knowledge. Perhaps what you learn about yourself may help others.

What do you think? What has worked/failed for you? Post a comment to share your experience and ideas with others.

Please post your comments and feedback on the book. Also any suggestions for future editions or future books on depression. What do you think would be helpful?

Firstly it can lead to a lot of misunderstandings. We all have periods in our life when we are unhappy, perhaps due to bereavement, or a relationship break up. It is natural in such circumstances to go through a period of feeling really down. We may feel as though things will never get better, our life is over or just incredible sadness. In such circumstance we may well describe ourselves as depressed, but most of us are not actually clinically depressed. We are going through a natural, healthy period of sadness or mourning and we will recover on our own in due course. However, if we think of this as depression and call it depression then this can lead to us misunderstanding true clinical depression. This can be very painful for those who are clinically depressed.

Many people with clinical depression suffer from well meaning friends and relatives telling them to snap out of it, think positive, or try taking up a new hobby. These tactics may have worked for people who were just feeling down, but they don’t work for those who are truly depressed. If we had different words to express feeling deeply sad and being clinically depressed then we might avoid some of these misunderstandings.

As a counsellor I try not to ‘misuse’ the word depression, but then I sometimes find myself struggling to describe how I’m feeling. Sometimes when I’ve been going through difficult periods in my life I have felt tremendously sad, as though my life had no purpose and I was just waiting to die. In the moment I can see no purpose, no reason to go on and it feels as though the sun will never shine again. However, I don’t feel that I can say I feel depressed because I know I’m not clinically depressed. These bouts don’t last long enough for me to qualify, plus I usually only have 3 or 4 rather than 5 of the required symptoms (see below for DSM4 definition of depression). So I am left feeling that I must in some way minimise the importance of my feelings, as I can’t use the only word I know that ‘feels’ right.

So do we need to invent a new vocabulary? There is already enough confusion about clinical depression, non clinical depression, major depression, atypical depression, dysthymia, weepy depression, anxious depression etc. This ever increasing list of types of depression seems to me to have more to do with the human obsession with categorising things than with the condition itself. What I’m thinking of here is new word for the type of ‘depression’ that doesn’t need clinical intervention. The sort that we all go through, that’s a natural part of being human. So that we can express how bad we feel without stepping on the toes of those who are clinically depressed. What do you think? Any suggestions?

The official definition of clinical depression is given in the Diagnostic and Statistics Manual-IV (DS4), as:

‘Five or more of the following symptoms present during a two week period (at least one of the symptoms is either depressed mood or loss of interest or pleasure):

• depressed mood
• loss of interest or pleasure
• poor or increased appetite/weight loss or gain
• insomnia or hypersomnia
• psychomotor agitation or retardation
• loss of energy/fatigue
• feelings of worthlessness, guilt or self reproach
• poor concentration/indecisiveness
• thoughts of death or suicide attempts’

They took brain scans of patients diagnosed with major depression and compared them to scans of control subjects who were not depressed. One group was tested for 5HT1 receptors which respond to serotonin and a second group were tested for mu-opioid receptors which respond to endorphins (’feel good’ hormones involved in stress responses, pain control and reinforcing rewarding experiences). The test group selected had not previously taken antidepressants.

In both cases they found:

a) Those with depression had fewer receptors.

b) The fewer receptors the more serious the depression.

c) The number of receptors was a good indicator of whether or not antidepressant treatment would be effective.

This suggests that how we respond to life events may be at least in part determined by the receptors in our brain. Whether or not we become depressed, how severe and long lasting our depression is and whether or not we respond to antidepressants may be linked to the number of receptors we have.

So what determines the number of receptors found in the brain? Is it genetic, are we born with it? Is it a result of early childhood experiences? In her book ‘Why Love Matters’ Sue Gerhardt explains how early experiences can have a significant impact on how a child’s brain develops including how many receptors of various types develop.

Equally importantly, can we change the number of receptors in our brain, or are we stuck with what we’ve got? If the number of receptors can change then this might be a possible cure. The scientist don’t specifically cover this in their press release. However, the reason they give for selecting test subjects who had not taken antidepressants was that the antidepressants might have led to more receptors being produced. So this does seem to suggest that the creation and destruction of receptors is possible.

If receptors can be created and destroyed then this also means that the low numbers of receptors may be a symptom of depression rather than a cause. Although once the number of receptors has decreased it seems likely that this would work to re-enforce the depression and perhaps make it worse.

As is so often the case the study raises many new questions. The Michigan team plan to carry out further research and hope that their work will help us to better understand depression. They aim to recruit depressed volunteers who are not taking medication for more brain-imaging studies. You can find out more at www.umengage.org.

What do you think? Post a comment to have your say.

This is just the latest study to link some sort of deficiency to depression. Other supplements that have been linked to improvements in depression include omega 3, most of the B Vitamins, Vitamin C, Vitamin D, magnesium, iron, zinc and potassium. (Although interestingly this latest study did not show any improvement with Vitamin C or folic acid.) It is possible that being deficient in a whole range of vitamins and minerals could be a contributory factor in depression.

It certainly seems sensible to make sure that you eat a healthy balanced diet and take a multivitamin and mineral supplement. If the deficiency theories are correct then this could help you overcome your depression. In any case it will help to ensure you are in good general physical health and that in turn may help you to feel a little better.

However, many people who feel depressed find healthy eating difficult. They may loose their appetite, or ‘comfort eat’. If you are finding it difficult to eat healthily then it may help to speak to a nutritionist for advice on what to eat, and/or a counsellor for help with the emotional side of eating. A long list of dietary changes can be very intimidating and it’s not surprising that many people give up before they start. Try taking small steps, perhaps one a week or one a month. Don’t worry if you slip up, just keep going.

You might like to try some of the following small steps to get you started.

1. Start by taking a basic multivitamin and mineral supplement. Make sure that it contains at least the RDA (Recommended Daily Amount) of all the vitamins and minerals listed above.
2. Add fresh fruit and vegetables to your diet. Eat as much of these as you can.
3. Enlist the help of friends and family to support you in making the changes. Perhaps eating with someone else if you have problems eating and usually eat alone or asking people not to eat ‘forbidden’ foods in front of you. Maybe the whole family could start to improve their diet.
4. You could try keeping a food diary to track your progress. This could include how you feel about the changes you make as well as what you eat and drink.
5. Try to cut down on coffee or switch to decaffeinated – caffeine promotes anxiety and disrupts sleep patterns.
6. Try to cut down on sugary foods. Sugar gives you an artificial ‘high’ making you feel better, but this is then followed by an artificial ‘low’. You can become stuck in this cycle needing more and more sugar just to feel ok.
7. Try to cut out alcohol or at least cut down. It is a depressant and destroys some vitamins in the body.

If you have found ways to help support yourself eating a more healthy diet then please share them.

Levels of parathyroid increase as a result of Vitamin D deficiency. In this study levels were found to be 5% higher in those with mild depression and 33 % higher for those with severe depression (compared to the non depressed group).

It is not possible to tell from this study whether the deficiency actually causes the depression. It could be that Vitamin D deficiency is a side effect of depression. However, it is not unreasonable to suggest that a lack of Vitamin D could have an impact on mood as it plays a key role in a number of hormonal and neurological processes.

Further study is needed, but it could be that supplements of Vitamin D and exposure to sunlight could be helpful. What do you think?

Source: Archives of General Psychiatry

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

How Widespread is Depression?

According to the Depression Alliance:

• * One in five people suffer from depression at some point in their life.
• * More than 2.9 million people are diagnosed as having depression at any one time.
• * As many as three in four cases are neither recognised nor treated.
• * The World Health Organisation says that by 2020 depression will be second only to chronic heart disease as an international health burden.
• * More than 80% of people with depression can be helped with the appropriate treatment.

Depression and Employment

This year the theme is employment. Many people suffering from depression find it difficult to keep working. Some are signed off on Disability Benefit, others struggle to keep going and keep their jobs. Some employers are supportive and understanding, but not everyone reacts in a sympathetic manner, so it can be difficult to broach the subject. Many fear the stigma that can still be attached to mental health problems and so try to keep their condition secret, making recovery even harder.

‘In almost any workplace – anywhere in the world – the number of employees suffering an undiagnosed mental health problem (probably depression) is 10 to 20 per cent of the total workforce. This is a conservative estimate.

The known prevalence of depression is growing and the average age at which it affects people is dropping, mostly striking people in their prime working years. In 40 per cent of the cases the average age of onset is 20 and the average age overall is 27.’ Depression Alliance

By raising awareness about depression we can help to make employers more knowledgeable about the condition and more sympathetic to employees who are affected.

ACAS, the employment relations organisation, has issued advice to employers and managers ahead of this year’s Depression Awareness Week. They point to research which suggests that almost 3 out of 10 employees will suffer from a mental health problem this year. The financial impact of lost hours and productivity on a company can be significant. They encourage employers to train their managers to spot potential mental health problems and take appropriate action to ensure that employees get help early on, before the problems become more severe. Read more here.

12 Steps to Tackle Depression at Work

The Depression Alliance has also provided guidance on improving mental health strategies at work. The 12 Steps in summary are:

1. Leadership. The business leader (MD, owner etc) needs to understand the importance of this issue in order to provide effective leadership.

2. Financial Incentives. Assess the impact of lost hours/reduced productivity on the business – e.g. cost of hiring temporary replacements, customer complaints, lost sales etc. Then set targets – such as reduced sick days, reduced spend on temporary staff etc. so that you can measure improvement. Achieving these targets will require an early detection strategy.

3. Referral System. The company will need to identify appropriate mental health workers to form their referral team (this could be through an Employee Assistance Programme, a team of local counsellors, etc.). A written policy is needed to ensure that employees are approached sensitively and that the correct support is provided in offering referrals. This should include training for managers and staff (see Step 4).

4. Training. Training is required for managers to help them deal appropriately with someone suffering from a mental health problem. This would include communication skills, spotting potential problems, confidentiality, who to refer to, remaining calm and dealing with situations appropriately etc.

5. Work Environment. Helping to prevent mental health problems developing by ensuring a healthy work environment – reducing stress, employee surveys, listening to staff, healthy work culture, addressing morale issues etc.

6. Tackling Information Overload. Emails can be a significant source of stress if staff feel they must be dealt with immediately and are therefore constantly interrupted. This can be tackled by reviewing the impact of emails/voicemail etc. on staff and consulting them on how to improve matters. Perhaps introducing technical filtering, restricting email delivery to urgent messages only at certain times, training on how to prioritise etc.

7. Understanding Depression. Raising awareness amongst managers and staff of depression as a physical illness, rather than a personal failing. Also of the impact of depression on the physical body e.g. increased risk of stroke and second heart attack, compromised immune system etc.

8. Inventory of Emotional Work Hazards. Understanding what motivates employees to come to work and what makes them want to stay away. Are there chronic customer service problems? Are there constant interruptions? Do managers waste staff time? Is office politics part of the problem?

9. Work-Life Balance Policies. ‘ A chronic imbalance between the work and home lives of individuals is believed to be the root source of one-third of all cases of depression recorded in the United States.’ Depression Alliance Policies to tackle overwork can include changes in work culture, options for part time and flexible working, onsite services (e.g. dry cleaning, pharmaceutical) etc.

10. Rule out Rule. When a person suffers from depression their performance at work may suffer. The Rule out Rule ensures that mental health is ruled out as a possible cause of deteriorating performance before disciplinary procedures are considered.

11. Productivity. Monitoring productivity as an indicator of the mental health of your work force. ‘It is estimated that the “downtime cost” of depression in the U.S. is 172 million person-years based on conservative six-month prevalence rates of the disease…’ Depression Alliance.

12. Eliminate Top 10 Sources of Stress at Work

1. Time and Space : stress caused by staff feeling they have to do everything now.
2. Make sure employees know what is expected of them.
3. Job Fulfilment.
4. Sharing Success at work: making sure all members of staff feel their contribution is valued.
5. Tackling email and voicemail overload.
6. Clarity from the top: where is the company going etc.
7. Distributing work wisely so no one is overloaded.
8. Listening to others at work: including face to face contact, not just email.
9. Feeling included: in consultation, decision making etc.
10. Trusting your employees: giving them some control.

You can read the full text here.

Of course the work place is not the only cause of depression, but it is a factor for many people. By raising awareness in the work place and improving working conditions we can help to reduce the occurrence of depression and help those who are affected to recover more quickly.

Special Offer

As a special offer for Depression Awareness Week I am giving away free copies of my Ebook. Just send me an email and I will email you a copy. This week I will also be doubling my usual donation to the Depression Alliance for each paperback copy sold.

I decided to look up the actual statistics to check the facts and found the highest rates for the UK seem to be in January, March and April, with the lowest rate being for December. In fact variations overall are not enormous ranging from about 9 a day to 11 a day (allowing for reading off an online graph that only shows even numbers). So I’d probably interpret this graph rather differently. Overall we seem to see generally higher rates in the first half of the year and lower in the second half of the year, with the exception of February. So maybe the lower rates are the result of the summer weather kicking in and cheering us up and then the excitement of looking forward to Christmas seeing us through Autumn and the start of winter. (Graph courtesy of Chew, KSY and McCleary, R, 1995, “The Spring Peak in Suicide: A Cross- National Analysis”, Social Science Medicine, Vol 40 No 2, pp223-30).

Is such speculation meaningful or helpful? You can read pretty much anything you like into statistics like these. Many of my clients talk about committing suicide but none have actually done so. What is it that makes the difference between contemplating taking your own life and actually doing so? Could factors like the weather, birthdays, Christmas be the final straw for some people? Can such a personal decision be analysed in this general way.

Whilst we may not understand the seasonal variations the link between depression and suicide is pretty well established. Many people suffering from depression have suicidal thoughts, although only a minority actually attempt to kill themselves. If you find yourself thinking about suicide it’s important to get help. Here are some simple steps.

1. Find someone supportive to talk to; it could be a counsellor, the Samaritans, a friend or relative, your doctor, or a religious advisor. Just talking to someone about how you feel can make a big difference.
2. If you don’t know who to talk to then find more information on how to get help on these websites:

http://www.metanoia.org/suicide/

http://www.samaritans.org/

http://www.befrienders.org/

Remember that however bad you feel there are people out there who care and who want to help you.