The Richard Nicholls Podcast

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Episode 163: Dealing With Depression

First off, treatment for depression isn’t like buying a scarf, one size does not fit all. One person’s experience isn’t going to be the same as anyone else’s, there may be some similarities from one patient to the next but to listen to this episode and think that you come close to understanding everyone’s depression wouldn’t be fair.
If you have a friend or family member with depression what I hope this will do for you is help you to realise that there are no rules as such on how to help them. I’m afraid you have to work out what’s required for yourselves.
So, let’s look at the word “Depression.” Because it’s an overused word really, and means one thing outside of the psychiatric clinic and another thing inside. People often describe themselves as feeling depressed when they’re actually unfulfilled, that’s not to say that unfulfilled folk won’t get clinical depression, but be aware that using a clinical word to describe the fact that your fed up with your job might just undermine the person you sit opposite who has been on medication for 15 years following a suicide attempt and has never mentioned it to their colleagues.
I know it sounds a bit pedantic because words do change their meaning over time. But I do wonder if overusing the word Depression minimises the benefits that are being done in trying to end the stigma of mental health problems.
In clinical terms what we think of as depression as a mental illness is referred to as MDD, Major depressive disorder. If, despite the fact that everything is fine, you’ve had weeks and weeks and weeks of feeling really low, it could well be the onset of MDD. If on paper you have every reason to be happy, friends, family, purpose, fulfilment, yet still you have no enthusiasm to take part in life then it’s worth questioning whether this is more than just a bad mood.
Basically, depression is a mood disorder, and the word disorder is the important part here, because we can be in bad moods and not have depression, we can be a grumpy old sod and it not be a disorder, Everyone has overwhelming periods and depressive times, but it becomes a disorder when there’s no real reason for the mood being so low. Tired even though you’ve slept, no enthusiasm to take part in anything, no energy at all.
Depression can feel a lot like flu, especially as the immune system can drop quite considerably and so you might even get a cold. But if these symptoms are bundled together with feelings of hopelessness and an inability to feel good about things that you normally would feel good about then it’s worth asking the question, “Is this depression?”
And that’s scary, sometimes we don’t like to ask that of ourselves incase we don’t like the answer that we give ourselves, because what if we say “Yeah, I think it is.” Well, sometimes this happens to us because we’re doing something that our body and mind can’t handle for very long but we’ve sustained it. So it’s often useful to look at your lifestyle and take stock to figure out where unnecessary emotional responses are too frequent.
Are there things that make you more anxious than they should? Or more angry? Or more belittled, stupid or insignificant. If these feelings become chronic, they can feel as if they’ve become part of our personality, part of who we are and there’s nothing worse than thinking “It’s just the way I am” about something that causes great pain. So maybe take stock, stop and look at your job, your friends, your family, your relationship because maybe your depression was trying to tell you something.
It can be useful to think of your depression as something external, to think of it as a thing, a voice, a black dog that tells you what to do, it was Winston Churchill who called his depression his black dog that would sit in the corner of his room and influence his mood for a few months. In thinking of it as something separate from yourself it can be easier to override what it suggests.
Sometimes depression will try to tell you things that aren’t true, just as a way of trying to keep you safe.

“Everyone hates you”
“You’re a dreadful parent”
“You’re an awful friend”
“You need to eat”
“You shouldn’t eat”
“Stay in bed.”
“Sit in silence”

Thinking of your depression as external to yourself makes it easier to ignore. Often people will say that they realised that their partner was depressed rather than just in a mood when they noticed that they hadn’t had a shower for 4 days. I know it’s a lot of effort to ignore the pull of the depression and force yourself out of bed, to shower, to shave to get dressed. When depressed it’s like climbing Everest just taking the kids to school. But try and do the opposite of what your depression tells you to do, if your black dog wants you to hide away from your friends then be aware that it’s not you it’s the depression.
See it from the perspective that despite the depression you still have control over your reactions and behaviour even though it’s hard. You might have to make plans with a friend that it would be difficult to get out of. Just so as to find the balance between doing too much and doing too little, because you can’t do negative things and expect a positive result.

It’s worth recognising that depression isn’t all about sitting in a corner rocking backwards and forwards for the whole day. Sometimes the symptoms are less intense and so feel almost acceptable. If low level depression becomes a chronic condition it’s sometimes called Dysthymia, and can be a mild depression that prevents pleasure, but doesn’t stop you from functioning. You can still go to work, still watch a funny film and even laugh. You can be happy in the moment yet be depressed. But it’s as if everything is foggy and the world seems harder to navigate. But because someone with dysthymia can still function quite well it often goes undiagnosed and so people don’t seek help.

So that’s the first thing to do, get help. Step one is to find a therapist. Most people don’t, it’s been suggested that only 1/4 of people with depression actually ask for help and talking to a professional about it really does help. So find a therapist you like, someone who you feel you can connect with. If you’re in the UK go to the BACP website or the UKCP website and see what counsellors and psychotherapists there are in your area. See which ones you connect with and if it’s hard to decide because you like them all then it doesn’t matter, don’t let depression prevent you from making a decision. Just chose the one that can see you soonest or is closest to you or cheapest, whatever is important. And go and talk.

The next big step if you need it is medication, it’s not for everyone, and you might find talk therapy can replace that, but a lot of my clients do both. There’s a reason why we call counselling complementary therapy, because it complements medication. It’s not alternative therapy, counselling and psychotherapy run alongside the medical path. And it can take a while to get to see your GP, so make the call as soon as you can.

Then there are the things that you can do for yourself, like looking after your body. We often forget that the brain is part of our body, we seem to think that we have a mind and a body without seeing that they’re part of the same system, so make sure that you treat yourself right. Eat healthily but not to the point of denying yourself the nice things, don’t rely on unhealthy food to try and boost your mind. Cut down on your alcohol if you drink. Maybe quite significantly, alcohol and depression do not mix well because the alcohol slows down conscious thinking and brings out the unconscious habits that normally we can hold back when sober so try not to get drunk.
Exercise, you’d be surprised just how much a benefit exercise has on depression, it’s been shown in dozens and dozens of studies and we shouldn’t ignore it. I know exercise is literally hard work, but it really can help. Although no-one really knows exactly why, because it’s made up so many different things. Jogging gets us out of the house and into the world so that we don’t feel so isolated, the gym’s the same to a degree, but swinging kettle bells around the front room watching tutorials on youtube is also going to have some benefit too. Not as much, because the social aspect of exercising is really quite important, but anything is better than nothing.
By getting your heart pumping it seems to remind the brain that you can move, that you’re alive, that there are no sabre tooth tigers looking for you and even there was you’ve got a body that works and could get away.
For all we know there’s some other reason why exercise seems to help mental health so well and we just don’t know what it is yet, but we can’t ignore the fact that it does help, so use it.

The prevalence of depression is difficult to measure, but every seven years a survey is done in England to measure the number of people who have different types of mental health problems, the last time it was published was in 2016.

Currently have depression: 3.3% of the population.
Currently have mixed anxiety and depression 7.8%.
Suicidal thoughts at some point in life: 20.6%

So it might not be you that has problems, but it might be your best friend and they might need you to find a balance between being there for them and giving them distance. We’re very complicated us humans, and what someone needs when depressed is going to be different for everyone.

If you have a close friend who is depressed what they might need is simply for you to simply be there for them when they need you. To understand that they’re struggling, to empathise. Not sympathise. Sympathy isn’t going to make someone feel any better about themselves as it can so easily come out as pity, but empathy will help.

Empathy means to listen to them, to make an effort to understand how they feel by putting yourself in their position and try to think like them for a moment. Rather than thinking about what you think YOU might need if you were unwell, see what THEY need. Empathy is not about YOUR perspective, that’s sympathy, which can come across as pity. Sympathy can be trying to say the right thing by putting YOUR view of the world onto them which may well isolate them even further. You’re not there to try and fix them, you’re there just to be there.

One thing that is important is to show them that you care by being authentic, be a genuine friend. Don’t just text them with “How are you?” Because there’s a strong chance all you’ll get back is “Fine, how are you?”
That’s what we do isn’t it? We rely on default questions and answers to make life easier, and someone with depression is likely to try and deflect any conversation away from themselves and back to you anyway. So instead you probably need to ask them:
“How are you doing today?”
And if all you get back is “Fine, how are you?” Then ask them again, be authentic, reply with:
“Yeah, I’m alright. Are you sure you’re fine or was that just a default answer?”
Follow it up with something authentic such as “Really though, how are you today? I’m free for a chat for a couple of minutes if you want?”
It was World Mental Health Day on 10th October. And the organisation Time To Change made this wonderful video that really hits the nail on the head, they call it Ask Twice.

Working with depression is such a big issue but I hope I’ve helped you to gain a bit of extra insight into it and I encourage you to read up on it if it’s something that you feel you need to understand more about.
But in short if you need a therapist get one, if you need medication get it, if you need help ask for it.
And if you think that someone else needs help, ask twice.