Adult and Child Mental Health

What is depression?
How common is depression?
What are the symptoms of depression?
Symptoms and signs can include:
What are symptoms of anxiety?
What causes depression?
How do we diagnose depression?
How do we treat depression?
What are life-style changes and self-care treatment options?
What is Cognitive Behavioural therapy?
What is counselling?
What are anti-depressant medications?
What are the side effects of anti depressants?
What to do in an emergency?

Self Help Videos

What is depression?

Depression is a mental health condition that can presents with a persistent low mood that can affect your day to day life. It can become very distressing at times. The main presenting symptom is low mood (feeling sad) but it can also cause other symptoms.

There are treatments available to help with depression symptoms and these can include: talking therapies and medications. Treating depression can take a bit of time before you see a improvement in you mood but it has a good chance of success, especially when undergoing different forms of treatment simultaneously.

Sometimes you may find that the symptoms can come back after completing treatment and may need to be treated again.

How common is depression?

 Depression is very common. About 5 in 100 adults experience depression every year and about 15 in 100 people will experience depression at some stage in their life. It can be more common in women than in men however, depression in men is more likely to go unrecognised.

What are the symptoms of depression?

 In order to diagnose depression, symptoms need to be present for at least 2 weeks. Depression can interfere with normal day to day activities in some way, such as affecting your work, studying or social life. Depression can affect people in different ways and present in with a wide variety of symptoms. Many people who struggle with depression also struggle with anxiety.

Symptoms and signs can include:

 Core symptoms:

• persistent sadness or low mood, feeling tearful
• marked loss of interest or pleasure in activities, including those that you normally enjoy

Other symptoms:

• Disturbed sleep in comparison to your normal sleep pattern. This may include difficulty falling asleep, early waking, struggling to fall back asleep, other times you may find that you are sleeping more than usual
• Change in appetite – this can present as poor appetite and weight loss or the reverse could happen with comfort eating and weight gain
• Tiredness, loss of energy
• Agitation or slowing of movements
• Poor concentration or indecisiveness
• Feeling worthless, feeling guilty
• Recurrent thoughts of death and despairing thoughts of no longer wanting to be around

Physical symptoms:

It is also common to develop physical symptoms which can include:

• Headaches
• Palpitations or feeling like you heart beat is racing
• Chest pains
• General aches
• Feeling short of breath

What are symptoms of Anxiety?

 Anxiety is considered a different condition to depression but is very common for people to present with symptoms of both anxiety and depression at the same time. Usually symptoms of anxiety or depression tend to be more prominent than the other but sometimes they can present equally for example in mixed anxiety and depression.

Symptoms of anxiety can include:

• Feeling worried, tense or afraid
• Worrying about things that might happen in the future
• Panic attacks of which symptoms can include: chest pains, rapid breathing (hyperventilation), tingling in fingers/hands, shortness of breath, nausea, feeling sensation of dread

Symptoms of psychotic depression:

Severe depression can cause symptoms of psychosis (loosing contact with reality) and symptoms of this can include:

• Delusions which are strongly held beliefs that are false or unlikely to be
• Hallucinations: hearing, seeing or smelling things that are not really

What Causes Depression?

 There is no known cause of why people become depressed. It is likely that many different factors are involved that could cause someone to be feel depressed and this can vary from person to person. Some people can be more likely to get it and it can sometimes develop for no apparent reason.

However, there can be some triggers that may cause you to become depressed. These can include:

• Genetics
• Live events – relationship problems, bereavement, redundancy, illness, etc
• Pregnancy
• Alcohol and drugs
• Menopause
• Loneliness

Often it can be difficult to identify a single trigger that has cause an episode of depression. It is usually caused by multiple triggers. Women are more likely to develop depression especially after childbirth ( this is called postnatal depression) and during menopause.

The severity of depression can vary for person to person and is classified as below:

Mild depression:

Usually presents with low mood or loss of interest in routine activities alongside other depressive symptoms listed above. It can cause some difficulty with functioning in some parts of your daily life.

Moderate Depression:

Presents similarly to mild depression but can present with a large amount of milder depressive symptoms or a smaller number of more severe symptoms. It can cause significant difficulties in day to day functioning.

Severe depression:

Severe depression usually presents with many or all of the symptoms of depression at a high degree, or they may have a smaller number of very intense depressive symptoms. It can cause serious difficulties functioning in day to day life.

Patient Health Questionnaire 9 (PHQ-9) can help estimate the severity of depression symptoms. Link to PHQ-9 questionnaire:

https://med.stanford.edu/fastlab/research/imapp/msrs/_jcr_content/main/accordion/ accordion_content3/download_256324296/file.res/PHQ9 id date 08.03.pdf

Link to GAD-7 questionnaire for anxiety: https://adaa.org/sites/default/files/GAD-7_Anxiety-updated_0.pdf

How do we diagnose depression?

Depression is diagnosed based off of your symptoms. Some people have physical symptoms like being tearful, withdrawn or having panic attacks.

Sometimes additional information from other people, such as family, close friends and/or carers, can help when making the diagnosis.

Sometimes blood tests can be arranged if the symptoms are not typical for depression. This can be helpful to rule out other cause that can present similarly.

How do we treat Depression?

Treatment usually involves a combination of medication, therapy and life style changes.

Treatment options will be based off of your circumstances, preferences and the severity of the depression.

The treatment options for depression include:

• Self-care and lifestyle changes
• Talking therapy, including cognitive behavioural therapy and other types of psychological support
• Medications

What are life style changes and self-care treatment options?

 Living with depression can be very difficult. It is important that you make time for self care. Lifestyle chance can be very helpful especially in mild depression and can involve simple changes like: eating a balanced diet, relaxation techniques, exercise, going out with friends and family, engaging in activities that you enjoy. This can also include mediation and mindfulness.

What is Cognitive behavioural therapy?

 It is a type of talking therapy for depression and anxiety that usually consists of 8-12 regular sessions, either in groups or alone. It focuses on the “here and now” and on how you are thinking and behaving currently. It teaches coping skills to manage how to deal with things in your life differently to help with how you feel. It can help break negative thought patterns and how to reframe the situation to help prevent negative thought spiralling.

What is counselling?

 This is usually regular sessions for people with multiple mental health or physical problems or complex social needs. The focus is on emotional processing and finding the meaning behind interactions with others to help people find their own solutions and develop coping mechanisms.

What are anti-depressant medications?

 The most used anti-depressants are selective serotonin reuptake inhibitors (SSRIs) such as sertraline, citalopram, fluoxetine, escitalopram, paroxetine. They can take a few weeks (usually up to 4 weeks) to take effect and before you notice any change in you mood or anxiety symptoms. They should be taken for a minimum of 6 months after the symptoms improve to reduce the risk of them coming back, although some people can take them for longer. It is important to remember to take the medication daily.

Other commonly used antidepressants are serotonin-norephinephrine reuptake inhibitors (SNRIs) such as venlafaxine. Older antidepressants like tricyclic antidepressants (amitriptyline) are not used very often any more but can be used for other medical conditions.

What are the side effects of antidepressants?

 The main side effects of antidepressants are nausea, upset stomach, tremor, anxiety, jittery feeling, weight gain, sleep disorders, sexual dysfunction. Most of the side effects tend to settle after you have been on the tablets for a few weeks. However, if they are don’t settle or are intolerable we might need to switch you onto a different tablet instead.

A very rare but important side effect to be aware of is increased suicidal thoughts. If you have these side effects you must stop your medication immediately and seek review.

Most people see the most benefit with a combination of tablets and therapy.

What to do in an emergency?

 If your mental health has deteriorated significantly and you or a loved one is worried that you are going to harm yourself the best thing to do would be to go to an area of safety or ring 999 or the crisis phone numbers

Self Help Videos     

https://www.youtube.com/watch?v=3cXGt2d1RyQ     How to cope with anxiety – a relaxation technique | NHS   

https://www.youtube.com/watch?v=qKcRUOWYQ9w-    Self-help for low mood and depression | NHS

https://www.youtube.com/watch?v=wN4u4tVEDZg    How to improve low confidence and assertiveness | NHS

https://www.youtube.com/watch?v=TaLFBTvB1iQ     Sleep problems | NHS

https://www.youtube.com/watch?v=jLgv0E1k6hs&t=82s     Treatment for depression and anxiety | NHS Talking Therapies