Workshop 2 -Depression: Break The Cycle

What is it and what can I do about it

Introduction

Depression is common. We will get depressed through a range of routes. There are different types, a range of symptoms and different levels of severity. Most importantly, regardless of what type or severity it is, it will get in the way of your life. It will make some things a bit harder, or at its worst will stop you from doing things where the long term impact can be significant. Sometimes it’ll linger, sometimes it happens as life throws a curveball, sometimes it goes and never returns, or comes back later in life. It’s not just feeling down or sad every now and then, that’s just being human. It’s more.

Think of the term ‘depress’; pulling or pushing something down. It’s a bit like that, but for everything; your mood, your thoughts, how you feel physically and what you do.

The FACTS - Mental Health Foundation (2016)

It’s the predominant mental health problem worldwide
In 2013, depression was the second leading cause of years lived with disability worldwide, behind lower back pain. In 26 countries, depression was the primary driver of disability
In 2014, 19.7% of people showed symptoms of anxiety or depression. This percentage was higher among females (22.5%) than males (16.8%)
Depression is common alongside ADHD, Self harm, PTSD, anxiety disorders, being a new father, emotional difficulties, history of being bullied, abuse, physical health problems.

Symptoms (NICE 2022)

Feelings of being down, depressed or hopeless
Little interest/pleasure in doing things
Disturbed sleep (decreased or increased compared to usual).
Decreased or increased appetite and/or weight.
Fatigue/loss of energy.
Agitation or slowing of movements.
Poor concentration or indecisiveness.
Feelings of worthlessness or excessive or inappropriate guilt.
Suicidal thoughts or acts.

Is it just a chemical imbalance?

Maybe, maybe not. Chemical imbalance is a very loaded term. It’s often said it’s an ‘imbalance’, and serotonin is often the chemical that’s cited. However, a recent publication in a journal (Moncrieff et al, 2022) says there is little evidence of association between depression and serotonin. Maybe this emphasizes that depression might be because someone thinks a certain way and acts a certain way, not just a low concentration of serotonin. For example, take someone who was bullied in school. Maybe for whatever reason that person developed long held beliefs that they aren’t good enough and assumptions that people are horrible. How would this shape their life? Think about how their experiences, how they act and think may lead to depressive symptoms. Maybe then there may be some sort of imbalance of something, but it’s far more complicated that just a ‘chemical imbalance’.

In summary, we all come to depression from a range of different routes. Depression probably is not caused by a ‘chemical imbalance’, but more thinking and interacting in the world in a way that leads to depressive symptoms. Often this way of interacting in a maladaptive way stems from difficult life events over years that has changed the way we think.

This is not information to stop or not try medication. Robust evidence from NICE guidance suggests the SSRI medication does help with symptoms . Do not stop anything, speak to your GP about it.

What keeps it going?

Depression is maintained often because something is keeping it going. When we are depressed we feel pretty rubbish/low/numb/sad. When we are feeling like this, it’s very easy to think in a more negative way (think unhelpful thinking styles from session 1). If we are thinking more negatively and feeling more negatively we often fall into a bit of a trap. We do less, feel worse, do less, feel worse then our world gets that bit smaller and we succumb to more negative consequences.

Here is an example, if you’re feeling down, and you start to doubt yourself and predict that going out with friends is a waste of time or that it’s better or easier to stay in, you’ll probably be more inclined to cancel a plan. Now you feel temporary relief, and have now listened to all your self doubts and have learned that avoiding is the best way to get relief. But this is temporary. Now you’ve missed out. Next time, you cancel. Missed out. Now you missed out on a number of possible experiences all the while training yourself to avoid. Fast forward a few months or a year and friends stop texting you and now you are more isolated and lonely. Chances are, if you weren’t depressed to start with, you’re probably gonna feel a bit depressed now.

Now, you’re emotionally feeling depressed, feel physically drained and exhausted, your thoughts are a bit more pessimistic and negative and you are acting a bit like someone who is depressed. This spiral is referred to as the lethargy spiral.

The Lethargy Spiral

How do I get out of this spiral?

There is a way to try and reverse this cycle. Imagine a bucket. When this bucket is full, that’s when your body is working optimally and all the bodily functions, hormones and chemicals are doing their job. When it’s full, that’s when you experience life and what it throws at us in an appropriate way. So when we experience sadness/anger/happiness, it’s appropriate to do so. When you get stressed it’s because you actually have something stressful to deal with and when your bucket is full, when you can take that stress on and bounce back. But the problem is, our bucket has holes in. These holes could be caused by anything, life stressors, relationship difficulties, money worries, physical health problems, mental health problems, you name it. So our bucket’s drained. When that bucket is empty, that’s when you might feel depressed and the way your mind and body works is out of whack. When that bucket is empty, feeling joy, pleasure, being content and being more resilient is very fleeting and the negative thoughts, low mojo and depressed emotions are more present.

Here is the tricky part. You need to find ways to fill that bucket up, even though you don’t want to and don’t feel like it. Doing stuff that is ordinarily fun or pleasurable just won’t feel as good. But you do it anyway. When your bucket starts to refill quicker than it empties, the positive feelings will slowly return.

Don’t’s: What empties your bucket	Do’s: What fills your bucket
Cancel Plans, make excuses and generally avoid.	Where you can, go through with a meetup or social event. Text your mate; ‘I really don’t feel like it, but I’m going to give it a go’. Then leave it at that.
Wake up each day without a routine schedule. When depressed, making a decision can be impossible and it’s easy to coast through a day doing nothing.	Schedule opportunities to connect to others, have fun and do stuff to be proud of. Even though you may not feel it. Treat having a walk with a friend as if it were paying a bill; something you have to do. Be gentle and plan stuff you know you won’t forget by writing it down and using a diary/planner
Worry and rumination. The more time you spend in your head, the worse you feel and contribute to the lethargy spiral	Find a method of writing things down that work you. Iphone notes. Journaling. Write down 3 good things at the end of day. Make a list. Put the diary down and do something else that isn’t worrying or ruminating
Stay up late and/or mess with your 24 rhythm. (see session on sleep)	Practice good sleep hygiene. Routine Routine. Routine. Avoid Caffeine after midday. Think back to session on sleep
Eat less or eat more.	Eat regularly. Eat well
Stay inside, stay in bed and lonely	Get connected to others and nature. Where possible, get outside in the sun.do it with others or whilst exercising if possible.
Kick the can down the road.	Find a way to address stressors there and then. This might be dealing with it or planning to deal with it.. Try the 10 minute procrastination hack. Do that thing you need to do for 10 mins. Set a timer. At the end of that 10 mins, if you want, carry on. If not, dont. See what happens.
Pull yourself up by your bootstraps and crack on. Go to the gym everyday, drink kale smoothies and paint the entire house and burnout.	Take it easy and rest. Just not all the time. We can try and do too much to compensate for how we feel. Be compassionate to yourself. Your body and mind are functioning sub optimal, so being motivated and driven is very unlikely.

Has it been a while?

Some people will be struggling with symptoms that might not immediately seem like depression, but it’s been going on for a couple of years. Others will have bouts that last just a couple of weeks and may come and go. There are so many little factors at work and everyone is different. However, If you think you have been experiencing some of the symptoms of depression and its lingering, or is having a big impact on your day to day life, please see your GP or mental health workers at your surgery. There are a range of options that could be considered such as self help, accessing local resources and further for therapeutic interventions.

Further Resources

Stepiau – www.stepiau.org

NHS – www.nhs.uk

Online CBT – Silvercloud

Clinical Centre for Interventions – Looking after yourself

Helplines

Community Advice and Listening Line (CALL) helpline – 0800 132 737 TEXT HELP TO 81066

Samaritans – Call 116 123 or email jo@samaritans.org

Further Listening

The Huberman Lab – Episode #34

Stand tall Podcast – Episode 2

References

Mental Health Foundation, nd. Depression: Statistics. Available at https://www.mentalhealth.org.uk/explore-mental-health/mental-health-statistics/depression-statistics [Accessed 04/01/2022]

Mental Health Foundation., 2016. Fundamental Facts About Mental Health, London: Mental Health Foundation. Fundamental facts about mental health 2016 | Mental Health Foundation

Moncrieff, J., Cooper, R.E., Stockmann, T. et al., 2022. The serotonin theory of depression: a systematic umbrella review of the evidence. Mol Psychiatry. https://doi.org/10.1038/s41380-022-01661-0

NICE, 2022. Clinical Knowledge Summaries: Depression. [Online] Available at: https://cks.nice.org.uk/topics/depression/diagnosis/diagnosis/ [Accessed 01 August 2022].