A Doctor’s Mind: Dealing with Depression

“Depression & Getting Help”

Working within in the NHS for the last three and a half years there is one condition that, as doctor, I often come across no matter what speciality I have worked in; Depression.

Over 300 million people worldwide are currently battling with depression and the World Health Organisation states that it is now the leading cause of ill health across the world [1]. In the UK, it is estimated that 1 in 10 people suffer from depression and the numbers continue to rise. These figures are reflected in my professional life where every day I encounter patients who suffer from depression.

The term ‘depression’ is defined as ‘a low mood and/or the absence of interest and pleasure in most activities accompanied by emotional, physical, cognitive and behavioural symptoms’. [2]

For people who wonder if they may be suffering from depression, the first thing I advise them to do is to make an appointment with their GP.

GP’s are the front line for healthcare within the UK and they are first point of call usually when a patient needs medical help. Here patients can be open and honest about how they are feeling in a safe and confidential environment.  Within a consultation GPs can use an assessment tool to assess if an individual has depression and if so, how severe.

The assessment is based on the signs and symptoms needed to diagnose depression medically. The most core symptoms exhibited in depression are a persistently low mood and/or lack of interest in the activities that one may usually like to do. Associated symptoms also include; constantly feeling tired, not being able to sleep or sleeping too much, unintentional weight loss or gain, the inability to concentrate or think, feelings of worthlessness and recurrent thoughts of death [2]. All of these symptoms need to have been present for a minimum of 2 weeks.

Depending on how many of the behaviours are exhibited doctors are able to scale your depression as mild, moderate or severe. Based on the severity there are a wide range of options to help you through your depression. It is important to discuss with your doctor about the treatments available and decide together the best plan for you. Roughly 80% of cases of depression are managed by GPs. Only in severe cases will admission into a mental health institution be required [3].

There has been a lot of investment into the treatment options available for depression with the UK government focusing on expanding the access and availability of psychological treatments for all mental health conditions. Psychological treatments are usually the first options to explore in those with mild depression. These include self-guided therapy, cognitive behavioural therapy, relaxation therapy, inter problem-solving therapy and counselling [2].

The most common treatments are self-guided therapy and cognitive behavioural therapy.

The self-guided help programme is a great option as it can be carried out in your own home. Usually a toolkit of coping strategies is provided to aid you in becoming your own therapist, so that you can manage your mood effectively and thus prevent future setbacks. This requires self-motivation and engagement in order to be effective.

Cognitive behavioural therapy is a form of psychotherapy that involves helping people identify and then change the way they think, feel and behave. The cognitive part looks at how people interpret events in their lives and how it shapes their beliefs about their themselves, others and the world. Often these beliefs are harmful thus cognitive therapy challenges these ways of thinking and helps to create healthier and more realistic thoughts and beliefs. The behavioural part looks at the way people act in response to their thoughts and beliefs and aims to alter these behaviours and create new positive actions [4].

In moderate to severe depression medications are also implemented alongside high intensity therapy sessions. These medications are known as anti-depressants. Anti-depressants aim to ease the symptoms of depression. As a result it can allow for people to return to their normal lives and manage any factors that may be contributing to your depression [5]. There are many different types of anti-depressants and it is important to discuss with your doctor all the pros and cons of each. Anti-depressants do not work straight away and usually doctors advise that at least 2 weeks of consistent use is required.

With those who suffer from severe depression, such as those with suicidal thoughts, it is important to be honest with your doctor so they can urgently refer you to acute mental health services.

One option that is also available to access mental health treatment is funding privately through self-funding or through private healthcare. Often there can be a delay in between the diagnosis of depression and access to the therapy services due to the overwhelming demand. For those interested in private therapy services the British Association for Counselling and Psychotherapy has a database of registered and qualified therapists.

Depression affects the lives of so many and thankfully the stigma surrounding mental health is slowly lifting with society encouraging people to speak up and seek help. There are treatment options, support groups, online resources available for all those who need.

The first and most important step in the journey is to ask for help.

[1] The global burden of disease: World Health Organization, 2004, update(2008).

[2] Depression in adults: recognition and management; NICE Clinical Guideline(April 2016)

[3] Mitchell AJ, Vaze A, Rao S; Clinical diagnosis of depression in primarycare: a meta-analysis. Lancet. 2009 Aug 22374(9690):609-19. Epub 2009 Jul 27.

[4] Cuijpers P, van Straten A, van Schaik A, et al; Psychological treatment of depression in primary care: a meta-analysis. Br J Gen Pract. 2009 Feb59(559):e51-60.

[5] Fournier JC, DeRubeis RJ, Hollon SD, et al; Antidepressant drug effects and depression severity: a patient-level JAMA. 2010 Jan 6303(1):47-53.