Depression Management Strategies

What is depression?
People experience depression in many different ways; however a depressed
person will normally have at least two of three of the following core symptoms
for more than two weeks:
An unusually sad mood or anxious state that does not go away (may
be worse in the morning).
Loss of enjoyment and interest in activities that used to bring pleasure.
Lack of energy and tiredness despite rest.

Other typical signs of depression include trouble with sleeping or early

wakening, feeling constantly tired or overwhelmed, pessimistic negative
thoughts, difficulty concentrating or making decisions, change in appetite, loss
of interest or avoidance behaviours.

There are different types of depressive reaction ranging from mild to moderate
to severe clinical depression. At the severe end of the scale people often
experience more marked physical symptoms and it is thought that this is
related to biochemical changes in the brain.

For most people a depressive reaction is triggered by a set of life events

which they are finding difficult to cope with. For example, bereavement,
relationship breakdown, financial difficulties, physical illness etc. Depression
is not easy to overcome, but there are ways that you can gradually free
yourself from depression.
Vulnerability to depression
Some people are more vulnerable to depression than others. A number of
protective factors have been identified which can decrease vulnerability to
depression. These include:
A high self-esteem based on self-worth, not achievements.
Practising positive thinking habits.
Assertively expressing your needs, thoughts and feelings.
Using an established social support network.
Stress management balancing demands and resources/ coping skills
and looking after yourself

The depressive spiral thoughts, mood, behaviour

Research has established that depressed people are prone to continuous,
automatic, negative thoughts. Thinking becomes distorted and they practice
recognised thinking errors such as: catastrophising, personalising, focusing
on the negative and jumping to conclusions.

These negative patterns of thinking produce a low mood state which results in
reduced activity. Reduced activity produces less rewarding experiences,
which leads to further negative thoughts and low mood.
A vicious spiral of thoughts, feelings and behaviour is created.

To stop this downward spiral a number of things are necessary:

Understand the problem. Understand the many factors both in the

present and the past that have led you to feel the way you do. Educate
yourself about the illness. The more you know the easier it may be to
feel in control of your recovery.
Challenge negative thinking. Recognise that the way you think
determines the way you feel. Identify distorted thinking patterns and
replace with more rational thoughts. Keep a thought mood diary.
 Increase activity levels. Gradually increase your activity levels
particularly physical activity. Identify and work towards short and
longer-term goals and develop a routine.
Use support systems. A close confiding relationship is the single most
effective protection against depression. Talk about how you feel with
someone you trust. Tell a friend, partner, relative, GP. Try not to
isolate yourself.
Assert yourself. Express yourself assertively. Say no to excessive
demands. Look after your own needs.
Expect setbacks. Be aware that you will have good days and bad days
and that this is normal in recovery.

If you are feeling very bad or desperate you may need to talk to someone
immediately. You could consider the following:
Try to get an emergency appointment with your GP explaining the
circumstances.
If it is out of hours contact on-call GP services or visit your local A&E.
If in work speak to a Welfare Officer/ Carecall/ Line Manager or contact
OHS for advice.
Phone the Samaritans UK 08457 909090 or ROI 1850609090 or
Lifeline NI 0808 808 8000.

How feelings change

Beliefs and thoughts

Events themselves do not cause us to feel upset or depressed; it is our beliefs
about these events that determine our emotional reaction. These personal
beliefs influence our view of the world and our thinking patterns.
It is important to be mindful about what we are thinking and to examine our
underlying beliefs. We are thinking all the time.
Selective bias in depression
When we feel low in mood our thinking takes on a selective bias and we are
more likely to think about negative experiences from the past. Low mood
reactivates old negative thinking patterns. We then view the present more
negatively and view the future through a selective bias.

Recognise negative thinking.

If you are feeling low you are more likely to interpret events negatively and
ignore any other possibilities/ circumstances. The challenge when you are
depressed is to step back and become mindful of this process. Challenge the
process of thinking negatively automatically.

Types of treatment

Medication Your GP may prescribe an anti-depressant. Ensure you read

the information leaflet and raise any queries with your GP. Anti-depressants
usually take between two and six weeks to begin to work and should be taken
in the correct dosage as prescribed and continued for at least 4 months after
the depression has lifted or otherwise advised by your doctor.

Counselling/ Therapy Also known as talking treatment/ therapy, it will also

you the opportunity to share and explore your thoughts, emotions and
behaviours. Ask your GP about counselling or your employer may have an
Employee Assistance Programme to provide counselling.

Computerised Cognitive Behavioural Therapy (CCBT) This is a type of self-

help guided by the use of CD, DVD or website and is based on the principles
of Cognitive Behavioural Therapy. Your GP may be able to provide access to
the CCBT programme called Beating the Blues. It has been shown to be
effective in the treatment of mild or moderate depression and anxiety
conditions. Users work through modules identifying and challenging
automatic thoughts, negative thinking errors, maladaptive behaviours,
distractions and core beliefs which in some way feed into their depression or
anxiety.
Seven keys to mental health
1. Take responsibility
You are responsible for your own life and everything in it, including your own
happiness. Try not to blame your parents, your childhood, society, others or
life events.

2. Be flexible in your thinking

Beware of absolutist, all or nothing, black and white, rigid thinking, with an
over-emphasis on the words should, must, ought and cant. Loosen up
your thinking, look at alternative views, avoid perfectionism.

3. Confront rather than avoid difficulties and frustration

Treat problems as challenges, as useful in helping you build up tolerance and
experience. Expect change and challenges and for life to be unfair at times.

4. Look after your own needs

Be assertive in identifying and meeting your own needs, whether it be for
food, exercise, relaxation, work or pleasure. Have good self-care skills.

5. Express yourself
Feel free to express both positive feelings of enjoyment and excitement, but
also negative feelings of anger, sadness and disappointment. Be willing to,
try not bottle things up or avoid issues.

6. Strive for balance

Feel in control of your life by making active choices and decisions about how
spend your time. Fill your life with a balance of work and play, time alone and
with others, and physical and mental activity.

7. Develop and maintain relationships

Value and work on relationships. Develop a network of social support and
confiding relationships as they act as an insulator against stress. Accept
others for how they are, rather than trying to change them.
Activity planning

Keeping an activity diary can be especially useful when you are depressed
because it helps to focus on how you are spending your time, reminds you
what you have done, and is a useful way of planning ahead.

1. Plan what you are going to do the next day.

2. Plan activities that are absorbing and not too difficult.

3. Plan a mixture of activities that have a balance between duty and

pleasure.

4. Prioritise: identify what needs to be done first.

4. Break tasks down into smaller steps.

5. Plan activities that increase your physical activity levels.

6. Be flexible: if you have missed an activity proceed to the next one.

7. Increase frequency: build up the number of activities gradually.

8. Work towards goals: this helps increase motivation.

9. Anticipate difficulties and try to overcome them.

10. Reward yourself for your success. Tick off the things that you have
achieved and add small rewards throughout the day such as coffee, watching
a TV programme or reading the newspaper.

Make copies of and use the weekly diary sheet on the next page.

(The Mental Health Handbook T Powell 2009)

WEEKLY ACTIVITY SCHEDULE WEEK BEGINNING:

MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY

Wake - 9am

9am 10am

10am 11am

11am 12 noon

12 noon 1pm

1pm 2pm

2pm 3pm

3pm 4pm

4pm 5pm

5pm 6pm

6pm 7pm

7pm 8pm

8pm 9pm

9pm - bed