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Decoding Depression: how to spot it and help

A year of cohabiting with Covid is a grim milestone - the struggle to eat, WFH, sleep, repeat every day is real. Our mental health has never been more under the cosh and rates of depression have soared to an all time high. But help is at hand. We talk to the experts about how to spot the signs and help when it hits.

To say the pandemic has not been great for our collective mental health is an understatement. Let’s face it, everybody is feeling it in some way. Whether it’s panic attack-level anxiety about keeping a business afloat, making the next mortgage payment or the 7th circle of hell that is working and schooling from home.

Everyday life has never felt so damn exhausting, and it’s toll is starkly shown in official figures. The number of adults with depression in Britain has doubled during the pandemic to almost 20%, with female, younger and disabled adults most affected (Office for National Statistics). It means that almost 1 in 5 people reading this right now will be experiencing some level of depression.

Finding solace at the bottom of a prescription bottle has also risen. In the three months to September last year (2020) more than six million people in England received antidepressants – the highest ever on record.

As we while away the hours in our lonely bubbles, eating and drinking more, sleeping and exercising less (yep, four ticks here), cut off from friends and family, it’s scant wonder many of us are losing our footing and falling into a mental health mire.

Having a low mood is undeniably a 2021 baseline setting for us all. But what if that slump shifts into something more serious, something that starts to affect everything you do, and your ability to function?

And how do we spot the signs of the Big D in ourselves, a partner, or our children, and how do we tackle it?

Dr Alka Patel is a lifestyle physician, GP, author and podcaster of The Lifestyle First Method®, she says:

“Lockdown has resulted in a surge of depression and no one group is immune from its effects.

“Childhood is a period where mental health is particularly vulnerable to reduced peer interaction, and a study from Cambridge has reported an increase in depressive symptom amongst school age children, aged 8 to 12 years.

“Women of all ages have also been found to be particularly vulnerable as have those with low incomes and people under the age of 35. Another study has reported depression in the over-50s with increased loneliness and reduced physical activity as contributors.

“Some of this can be related to our resilience and ability to bounce back from crises – and the pandemic has certainly challenged our resilience. After a tough day at work a coffee with a friend was all it often took to help us bounce back. Or if you’d had an argument with a partner, spending the day apart at work allowed personalised thinking space and helped us navigate our relationships. All those crutches have disappeared.

“The news and social media are greeting us with daily negative news and we have fewer outlets available to us to express our feelings with friends, family or colleagues during lockdown, instead holding many of our emotional responses to ourselves.

“It’s no wonder that our mental health is feeling the impact. Lockdown depression probably deserves it’s own terminology because our usual strategies to be able to manage life’s challenges are themselves being challenged like never before.”

Dr Alka’s 10-step plan to spot, tackle and help the signs of depression using the keyword D.E.P.R.E.S.S.I.O.N.

D: Doctor

The first thing to make sure you do if you are feeling down or depressed is to see your doctor. If you experience symptoms of feeling low for most of the day for more than two weeks, seek help from a GP. I had a patient recently tell me she made three appointments but cancelled at the last minute because she was too scared to get help. Take that first step and every other step after that you will have someone to support you. It can feel hard to imagine there is anything that can be done to help, but the sooner you reach out, the sooner your depression will improve.

E: Eating

Loss of appetite or increased eating can both signal depression and if your weight starts to change in parallel with your mood, this is a sign to seek help. This can be a key sign in children, so if your child is eating less or has become fussier about food, a gentle conversation to find out if there is anything else on his/her mind can help. What you eat can have a significant impact on your mood. The SMILE trial showed depression can be reduced or reversed by increasing the amount of fibre you eat. Fuel up on things to uplift your mood – fruit, vegetables, whole grains – these all increase diversity in your gut bacteria and increase serotonin, our mood-lifting neurotransmitter.

P: Physical

The signs of depression are not just related to your mood but can also show up as physical effects. Increased agitation and restlessness or the opposite with significant slowing down of your movements can both indicate depression. Exhaustion and tiredness are both important not to ignore. Your doctor may do some tests to rule out other conditions that may have similar symptoms such as an underactive thyroid.

R: Relaxation

Stressful events can often trigger depression – loss of work, breakdown of a relationship and of course the stress or grief of the pandemic. Relaxation techniques can help switch off the body’s stress response and activate the relaxation response to increase feelings of calm and control. Deep breathing has been shown to reduce negative thinking, so often linked to depression.

Try this simple breathing exercise called coherent breathing for learning how to breathe deeply.

1. Lie on your back with your head on a pillow or sit in an upright position.

2. Place one hand below your ribs and the other on the top of your chest.

3. As you breathe in feel your stomach rise against your hand. As you breathe out feel your stomach move away from your lower hand.

4. Breathe in for 5 and out for 5. This slows down your breathing rate to 6 breaths a minute – the number needed to activate the relaxation response.

6. Try this for 1 minute – that’s 6 deep breaths. In any stressful situation or whenever you need an emotional reset, take 6 deep breaths. Over time build this to 5 minutes, then to 15 minutes. Set your emotional tone for the day in the morning – instead of pressing the 10 minute snooze button, use those 10 minutes to relax your breathing.

E: Exercise

Exercise is very beneficial if you have depression. It helps with concentration and memory which are often impaired in depression and reduces muscle tension.

It can be very hard to find the motivation to exercise when you are feeling low. The thought of a half hour run can be daunting. So instead, think about the smallest thing you can do. Can you take 60 seconds to stretch your neck and back? Can you take three minutes to do squats in the kitchen waiting for the kettle to boil? Can you go up and down the stairs five times?

Start with what feels easy. With time you’ll notice your exercise levels naturally increase as you see benefits to your mood through the endorphins which are released. If you can, exercise with a smile on your face! Facial expressions are connected to your mood – it’s hard to feel sad when you are smiling.

S: Sleep

Sleep is intimately connected with your mood because as we sleep we process our emotions and set our emotional tone for the day. A change in your sleep patterns, particularly waking in the early hours of the morning can be an indicator of depression. Watch out for disrupted sleep in children too.

One of the commonest reasons for waking too early, having difficulty falling asleep or waking through the night is worry. This psychological activity wakes up your amygdala, your emotion centre, and floods your body with wakeful arousal hormones, cortisol, adrenaline and noradrenaline, increasing your heart rate and body temperature and making it harder to sleep.

Changing the focus of your thoughts can help create a positive, calm mind, allowing your activation centres to switch off. To do this, start a gratitude journal. Last thing at night write down 3 things you noticed that day that made you happy, that you felt grateful for – even a small thing like the warmth of a coffee cup in your hands or the freshness of the air on a walk.

Write them down, as you drift to sleep allow your mind to become immersed in uplifting, calming thoughts.

S: Self harm

This is often a hidden feature of depression, a sign of vulnerability which people are reluctant to share. There are no fixed reasons why people self-harm. If you are self-harming, learn the triggers that give you the urge to hurt yourself and learn ways to distract yourself. Spend time with a pet, letting yourself cry, listening to music or looking at a positivity book filled with things that have made you happy can all help reduce self-harm.

And if you are worried about someone you think is self-harming, ask them about it. Talking about self-harm doesn’t mean you’re going to cause it to happen and it may be a relief for your friend or colleague to have someone to talk to. Try asking “do you try and hurt yourself when you are feeling down?”

Drugs, alcohol and tobacco can also be considered self-harming behaviour. If you have had thoughts that you want to die please keep a suicide safety plan visible and accessible. Help is always available 24/7 (see below for more info).

I: Interest

Losing interest in things you used to enjoy is a common sign of depression. What’s important is to restart them anyway. You’ll develop a sense of achievement and over time the increase in activity will help the depression to lift and the enjoyment to slowly return. Aim for small, increases in meaningful enjoyable activities rather than a boom-and-bust approach. Try out new things – painting, drawing, writing a song.

O: Open

It’s important not to try and avoid negative thoughts. This may sound counter-intuitive, but we are all meant to experience a range of human emotions. The more you find ways to avoid difficult thoughts then what will start to dominate what you do is the act of trying to avoid or get rid of negative thoughts.

Instead, be open to all your thoughts and emotions. The trick is to not let them dominate you but not try to get rid of them either.

N: Notice, Name and Neutralise

This is a very useful technique to help you recognise your thoughts are not who you are. Depression is characterised by negative thinking – ‘I’m not good enough, I’m worthless’. Start by noticing what you’re thinking. What thoughts are popping up? Then name the thought and distance yourself from it. ‘I’m worthless’ becomes ‘I am thinking that I am worthless’ which becomes ‘I am noticing that I am thinking that I am worthless.’ You can then neutralise the unhelpful thought by pulling yourself away from the thought and bringing yourself back into the present.

Use mindfulness techniques such as focusing on your 5 senses – what are 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell and 1 thing you can taste. This re-focuses on what’s important to you instead.

Lockdown depression can affect all of us. Tune in to the signals your mind and body are giving you that tell you that you may be affected and reach out for help and support if you need to – you are not alone.

Charlotte Fox Weber is a psychotherapist, writer and co-founder of therapy consultancy

She says: “We know how unbearable the pandemic has been emotionally, and yet there’s a real sense of helplessness about this. We know we are suffering but what can we do? Not only are people suffering from depression, people are depressed about the depression.

“As a psychotherapist I know the suffering doesn’t need to be so isolating, and resisting help is part of the problem when it comes to depression. There’s some feature of humans that makes us struggle to reach out. We feel desperate but stuck and making that call, saying the words aloud, it’s so incredibly hard for some of us. But it can be transformative when we do. My suggestion is to say the words aloud – whatever they may be – describing, in your own way, what you’re going through, where you are. Ideally it can be a psychotherapist you talk to, but if that isn’t possible, talk to someone.

“There’s a lot of guilt at the moment around feeling like we’re ‘complaining’. As if we don’t have to the right to ask for help because others have it much worse. We all have our own response to this historic moment, and whatever the circumstances and level of hardship, we still need to acknowledge where we are, and take care of ourselves.”

Charlotte’s tips for spotting and combating depression

1. Feelings are not facts! If you are feeling washed over with strong, dark feelings, notice them and acknowledge them, but also recognise your feelings are not facts. So when you feel hopeless, that doesn’t mean things actually are hopeless. When you feel frightened, that doesn’t necessarily mean there’s something terrifying happening.

2. Are you listless at things that usually give you pleasure? This is called anhedonia – and is a symptom of depression. It’s helpful to spot, because it also means you can feel relief knowing that your joy will return when you get to the other side of depression (and you will).

3. Are you less energetic than usual? Depression is exhausting. Suffering is exhausting. It’s helpful to know that you’re sleepy in part because your mind is hurting. Remember, you won’t feel this way forever.

4. Insist on self-compassion. Being extra gentle with yourself helps. It’s tempting for some of us to self-flagellate when we feel low – we think we just need to push ourselves. While motivating ourselves does help, it’s important to be kind to ourselves. It’s a hard and vulnerable place to be and a forgiving approach makes us feel calmer and safer in our own company.

5. Pick up the phone. Call someone who loves you and tell them what’s happening. Maybe you can’t say it all but say something. Admit that life feels hard right now. Maybe it does for this other person too. Whatever the case, say the words, or some words, to another person.

6. Trust that this is isn’t permanent. It’s very easy to catastrophize right now – to worry and dread things going terribly wrong. However things play out, try and remember depression isn’t permanent, and how you’re feeling right now is not how you’ll feel forever.

If you are experiencing symptoms of depression seek help from your GP, or, ring the Samaritans on 116 123 or Childline on 0800 1111 for children and young people under 19. If you don’t want to talk to someone, send a text to the Shout Crisis Text Line on 85258. Contact CALM (with webchat support from 5pm to midnight) or get in touch with MIND who offer lots of numbers for support with depression.

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