Coping with Depression: A Guide to What Works for Patients, Carers, and Professionals

By Costas Papageorgiou, Hannah Goring and Justin Haslam

Depression is the most common psychological problem in the UK with 1 in 5 people requiring treatment during their lives. Coping with Depression is their essential first port of call.

Depression can be an incredibly debilitating and isolating condition, with episodes recurring throughout a person's life. However, the good news is that with the right guidance it is possible to make a complete recovery. Drawing on a wealth of clinical expertise, the authors have created an easy-to-use manual that explains everything you need to know about the condition, from how to recognise the symptoms to the range of treatments currently available, including behavioural therapies, professional support, and medication. Individuals suffering from depression, as well as those around them, are encouraged to take an active role in getting better and are provided with the vital tools for staying well.

• Language: English
• Publisher: Oneworld Publications
• Release date: May 1, 2011
• ISBN: 9781780740126

Costas Papageorgiou

Dr Costas Papageorgiou is a Consultant Clinical Psychologist with extensive clinical and research experience in depression and anxiety disorders.

Book preview

Coping with

Depression

A Guide to What Works for Patients,

Carers, and Professionals

Dr Costas Papageorgiou

Dr Hannah Goring

Dr Justin Haslam

COPING WITH DEPRESSION

Published by Oneworld Publications 2011

This ebook edition published by Oneworld Publications 2011

Copyright © Costas Papageorgiou, Hannah Goring and Justin Haslam 2011

All rights reserved

Copyright under Berne Convention

A CIP record for this title is available

from the British Library

ISBN 978–1–78074–005–8

Typeset by Jayvee, Trivandrum, India

Cover design by vaguelymemorable.com

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Contents

Acknowledgements

Series Foreword

An introduction to this guide

1   A journey in and out of depression: a patient’s perspective

Becoming ill

Getting better

What worked for me

What I learnt about myself

Where I am now

2   What is depression and how can you check if you are depressed?

The experience of depression

How depression is diagnosed

Other types of depression

Depression and other mental health problems

Depression questionnaire

Key points covered in this chapter

3   What are the key facts and figures about depression?

How common is depression?

Men, women and depression

Depression and other socio-demographic factors

Causes of depression

Course of depression

Consequences of depression

Suicide

Key points covered in this chapter

4   Changing how you feel by changing your biology: a psychiatrist’s perspective

Normal sadness versus clinical depression

The option of taking medication

What happens at your first psychiatric consultation

Why can medication be necessary?

Misgivings about taking medication

Taking medication: process and expectations

The selective serotonin re-uptake inhibitors (SSRIs)

Common side effects of SSRIs

What happens after you start taking medication

What about Lithium Carbonate?

The serotonin and noradrenaline re-uptake inhibitors (SNRIs)

The tri-cyclic anti-depressants (TCAs)

The monoamine oxidase inhibitors (MAOIs)

Recovery from depression and maintenance medication

Final notes on electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS)

Key points covered in this chapter

5   Changing how you feel by changing how you behave

Behavioural theories of depression

Behavioural activation

Activity monitoring

Activity scheduling

Values and goals

Avoidance

Types of avoidance

Overcoming avoidance

Breaking tasks down into small steps

Self-soothing

Key points covered in this chapter

6   Changing how you feel by changing what you think

Cognitive theories of depression

Beck’s theory of depression

Types of thinking biases

Learning to talk back to negative automatic thoughts

Common difficulties with challenging negative automatic thoughts

Behavioural experiments

Using behavioural experiments to become more active

Key points covered in this chapter

7   Changing how you feel by changing your unhelpful assumptions

Origins of unhelpful assumptions

Identifying unhelpful assumptions

Challenging unhelpful assumptions

Key points covered in this chapter

8   Changing how you feel by changing how you relate

Origins and definition of IPT

Goals and characteristics of IPT

Therapeutic phases of IPT

Grief (complicated bereavement)

Interpersonal role disputes

Role transitions

Interpersonal sensitivity

Final phase of IPT

Key points covered in this chapter

9   Feeling well, staying well: preventing relapse and recurrence of depression

What makes depression return and how can it be prevented?

Staying well by continuing to take maintenance medication

Staying well by continuing ‘booster’ sessions of maintenance psychotherapy

Staying well by remaining behaviourally active and healthy

Staying well by continuing to challenge negative thinking

Staying well by continuing to relate well and develop healthy relationships

Staying well by continuing to challenge and test unhelpful assumptions

Staying well by practising mindfulness meditation

Staying well by solving problems effectively

Key points covered in this chapter

Brief concluding remarks

Notes

Appendix 1: Activity chart

Appendix 2: Thought record

Appendix 3: Downward arrow technique

Appendix 4: Problem solving steps

Appendix 5: Useful website addresses

Further reading

Index

Acknowledgements

We are especially grateful to all of our patients who we have worked with over the years. They give our work its value and sense of worth, and give us the satisfaction of being able to help.

We would also like to thank Professor Steven Jones, editor of the Coping With series, for inviting us to write this book and Juliet Mabey and Fiona Slater at Oneworld Publications for their help and support during all the stages of manuscript preparation.

Dr Costas Papageorgiou – I am very grateful to my wife, Louise, my children Sofia, Eleni and Lucas, and my parents, for giving me the best tools for creating happiness in my life, and for their patience and encouragement during the preparation of this book. I would also like to thank Sue Thorgaard for her manuscript assistance.

Dr Hannah Goring – I would like to thank Anne Hook and Matt Kemsley for feedback on the manuscript, and I would also like to thank my parents and friends for their support in writing my chapters.

Dr Justin Haslam – Thank you to my wife Angela for her unstinting support and tolerance, to Julius and Lydia for enriching my life, and to Costas for believing I could ever apply myself to the task of summarizing my craft in this way.

Series Foreword

This series is intended to provide clear, accessible and practical information to individuals with a wide range of psychological disorders, as well as to their friends, relatives and interested professionals. As the causes of emotional distress can be complex, books in this series are not designed purely to detail self-treatment information. Instead, each volume sets out to offer guidance on the relevant, evidence-based psychological approaches that are available for the particular condition under discussion. Where appropriate, suggestions are also given on how to apply particular aspects of those techniques that can be incorporated into self-help approaches. Equally important, readers are offered information on which forms of therapy are likely to be beneficial, enabling sufferers to make informed decisions about treatment options with their referring clinician.

Each book also considers aspects of the disorder that are likely to be relevant to each individual’s experience of receiving treatment, including the therapeutic approaches of medical professionals, the nature of diagnosis and the myths that might surround a particular disorder. General issues that can also affect a sufferer’s quality of life, such as stigma, isolation, self-care and relationships, are also covered in many of the volumes.

The books in this series are not intended to replace therapists, since many individuals will need a personal treatment programme from a qualified clinician. However, each title offers individually tailored strategies, devised by highly experienced practising clinicians, predominantly based on the latest techniques of cognitive behavioural therapy, which have been shown to be extremely effective in changing the way sufferers think about themselves and their problems. In addition, titles also include a variety of practical features such as rating scales and diary sheets, helpful case studies drawn from real life and a wide range of up-to-date resources including self-help groups, recommended reading and useful websites. Consequently, each book provides the necessary materials for sufferers to become active participants in their own care, enabling constructive engagement with clinical professionals when needed and, when appropriate, enabling them to take independent action.

Dr Steven Jones

Series Editor

An introduction to this guide

Depression is one of the most common and disabling mental health problems and psychiatric disorders. It can affect women and men. Depression can occur across all countries, levels of education and employment, and among the famous, rich, poor and people of all races and ethnic backgrounds. As well as the considerable suffering it causes to the individual concerned, depression can have negative consequences on work, family life and relationships. By far the most serious possible consequence of depression is suicide. However, there is good news. Despite its characteristics and consequences, depression can be treated effectively and individuals can stop suffering from it. People can recover from depression and seeking help or treatment for it is not a sign of defeat, failure or weakness. It is a first step in getting better.

Whether treatment for depression is sought through public or private health services, what is really important is that such treatment is widely recognized to be effective and delivered by appropriately trained, qualified and experienced professionals. In England and Wales, the National Institute for Health and Clinical Excellence (NICE) was established as ‘an independent organization responsible for providing national guidance on promoting good health and preventing and treating ill health’ for all healthcare professionals. Clinical guidelines are recommendations for good practice. The guidelines produced by NICE are prepared by groups of healthcare professionals, patients, carers and their representatives, and scientists. The groups examine scientific evidence available on the best way of treating a condition, such as depression, and make specific recommendations based on this evidence. As specialist depression clinicians and researchers, we believe that the better informed patients, their carers and healthcare professionals are about what treatments work best for depression, the better the chances of overcoming this devastating problem.

Based on the NICE guidelines for the treatment of depression, an overall aim of this book is to describe the most essential facts about depression and help readers learn how to overcome it. Although there are numerous published books on the subject of depression, in writing this book we have attempted to provide several unique features. In particular, a key aim of this book is to provide a clear, user-friendly, multi-professional (clinical psychologists and psychiatrist) and jargon-free overview of currently recommended effective, as opposed to speculative or experimental, treatments for depression in one book rather than just having several separate books dedicated to single treatments. We believe that this is very important, as there is no one treatment that is effective for all patients or all types of depression. If one particular treatment does not appear to work for an individual after a period of time, it is important for them to know that there are other effective treatments available. Therefore, individuals need to know what these effective treatments are and what they should expect from them, so that they are able to make informed decisions about the best way to cope with and overcome depression.

In this book, we endeavour to provide helpful information on what treatments work best for people who might be suffering from depression, or who have done so in the past, as well as their relatives, friends, carers and anyone else who is interested in learning about this common problem. Another key feature of this book is that it provides several examples and case histories of individuals with depression who were able to overcome their problems using treatments described in the book, and it includes a complete and unedited chapter written by an individual who suffered from depression. However, this book is not intended to replace professional help from a psychiatrist, clinical psychologist, therapist or doctor, or to provide comprehensive self-help guides for individual treatments. It is specifically intended to encourage people to take an active part in understanding their depression and in helping themselves to cope with and recover from it by using effective methods that have been scientifically proven and found to help people overcome their depression. Another key goal of this book is not only to focus on helping individuals feel well, but also stay well.

Following this brief introduction, the book proceeds with a chapter written by a patient who suffered from recurrent episodes of depression over a number of years and was able to benefit considerably from both pharmacological and psychological treatments. This is a helpful chapter detailing a person’s unique experiences of depression and its treatment. If you, or someone you care about, is currently suffering from depression or have had previous episodes of depression, we would encourage you to read chapter 1 to start with because this chapter provides hope, inspiration and motivation through a patient’s journey in and out of depression. Chapter 2 provides descriptions of the nature and experience of depression, its diagnosis, the different types of depression, depression and other mental health problems, and a brief and simple questionnaire designed to help you check whether you could be suffering from depression. The next chapter covers some essential facts about depression, such as how common it is, who can be affected by it, the typical course of depression and the effect it can have on people’s lives. Chapters 4 to 8 describe in detail how you can effectively overcome depression and change how you feel by changing your biology (medication), how you behave (behavioural activation), what you think and your unhelpful assumptions (cognitive therapy), and, as a unique addition to the above treatments, how you relate (interpersonal psychotherapy). The chapters on psychological treatments for depression (chapters 5 to 8) aim to give a flavour of what these therapies involve and some ideas and methods of the strategies and techniques they suggest can help. If you are currently depressed, you might find it helpful to try out some of the strategies and techniques described. Finally, the book ends with chapter 9, which provides specific advice on how to stay well following recovery from an episode of depression, including an overview of recent developments, such as mindfulness-based cognitive therapy, in the prevention of relapse or recurrence of depression. If you have recently recovered from an episode of depression, you might find it helpful to use chapter 9 to help you to stay well. In appendix 5, we have provided details of some relevant and useful addresses, which can help you to find appropriate professional help. We have also provided a further reading section at the end of the book, and for specific chapters, if you are interested in finding out more about a particular topic. We have written this book with the intention that it will be read in sequence, from beginning to end. However, some people prefer to dip into books or go straight to the topic that particularly interests them, and that is fine too.

Dr Costas Papageorgiou

Dr Hannah Goring

Dr Justin Haslam

1

A journey in and out of depression: a patient’s perspective

When I became ill with depression a few years ago, I read everything I could lay my hands on as part of my many attempts to get better. In most of the books I read, authors were telling me about their patients, the problems they had and the progress they had made, and occasionally there might be a few quotes from patients themselves. But these people never seemed ‘real’ to me. Did they actually exist or were they an amalgam of several patients mixed together for the benefit of the book?

What I needed was to read an ordinary person’s account of what had happened to them, their experiences of treatment, what worked and what didn’t, and how they had got better, but in their own words not somebody else speaking for them. So, when Dr Costas Papageorgiou asked me if I would be interested in writing a chapter for this book from a patient’s perspective, I was delighted and saw it as an opportunity to provide something that would have been enormously helpful, comforting and positive to me when I was at my worst. What I haven’t written about here are the signs and symptoms of depression as this is covered comprehensively in chapters 2 and 3 of this book. I have written about my unique and individual experiences of depression, which, of course, may be different for other people. So, here it is, the story of my depression and my recovery in my own words.

Becoming ill

I was in my early 40s when I was first diagnosed with depression. It took my general practitioner (GP) some considerable time to convince me of this. I had been seeing him with all sorts of ailments