For Depresion

7/29/2019 For Depresion

1/32

Treating depressionwithout using

prescribed medicationBooklet or patients and carers


2/32

Cover image

Simon Fraser / Science Photo Library

Scottish Intercollegiate Guidelines Network

ISBN 978 1 905813 56 8

First published January 2010

SIGN consents to the photocopying of this booklet for thepurpose of implementation in NHSScotland


3/32

1

Contents

What is SIGN? 2

Who is this booklet or and what is it about? 3

What is depression and how will I eel i I am depressed? 5

How will my GP know I have depression? 8

What might help me eel better? 10

Are psychological treatments sae? 20

What i the treatment I decide to try doesnt work? 21

Where can I fnd out more inormation? 22

Space or your notes 27

Other ormats 29


4/32

2

What is SIGN?

The Scottish Intercollegiate Guidelines Network (SIGN) write guidelines

which give advice to doctors, nurses, surgeons, physiotherapists,

dentists, occupational therapists and patients about the besttreatments that are available.

We write these guidelines by working with doctors, nurses and other

NHS sta and with patients, carers and members o the public. The

guidelines are based on the most up-to-date evidence.

You can read more about SIGN by visiting www.sign.ac.uk


5/32

3

Who is this booklet or and what is it about?

This booklet is or you i:

you think you may be depressed; or you have already been diagnosed with depression and are

considering your treatment options.

Your amily, riends and carers may also nd this booklet useul.

This booklet is based on the recommendations rom the Scottish

Intercollegiate Guidelines Network (SIGN) national clinical guideline

on non-pharmaceutical management o depression in adults.

Our guidelines are based on medical and scientic research, which

involves carrying out trials o dierent treatments and methods o

care.

The guideline development group are a group o people rom across

Scotland who wrote the clinical guideline on which this booklet is

based. They include NHS sta, sta rom areas such as social work, andpatients and members o the public.

The group looked at the research evidence available on how well

dierent treatments work, and we used this evidence to make

recommendations or healthcare proessionals on how best to treat

patients with depression.

Our booklet aims to help you to make positive treatment choices based

on the most up-to-date medical and scientic research.


6/32

4

The booklet explains:

what depression is; the treatment (aside rom drugs) that may be available; and what you can expect rom treatment.

It does not cover:

children who are depressed; psychotic depression (when a person is so depressed that they

lose touch with reality);

perinatal or postnatal depression (depression in women whoare pregnant or who have had a baby) see our guidelines on

postnatal depression and puerperal psychosis on our website at

www.sign.ac.uk/pd/sign60.pd

bipolar disorder (manic depression) see our guidelines onbipolar aective disorder on our website at www.sign.ac.uk/pd/

sign82.pd

personality disorder; addiction, such as drug addiction; brain injury or dementia see the patient version o our guidelines

on management o patients with dementia on our website at

www.sign.ac.uk/pd/pat86.pd; or

learning disabilities.Some o the support organisations on page 22 may be able to give you

inormation on these conditions.


7/32

Ian

Hooton

/SciencePhoto

Library

5

What is depression and how will I eel i I am

depressed?

Depression is a common health condition. One in ve people inScotland will experience depression at some point in their lives.

The exact causes are not clear and it can develop or no apparent

reason. Some people become depressed when something stressul or

upsetting happens in their lie, or example:

losing their job; losing a loved one; being diagnosed with a serious illness; or breaking up with a partner.


8/32

6

You may be experiencing other diculties in your lie which are

making you eel depressed. Some people become depressed even

when everything is going well.

Depression is a very personal experience, but here are some thoughts

rom people who are depressed.

Something is wrong but I cant explain how I feel.

I cant stop crying.

I feel so bad, I cant cry anymore.

Im in a room with no windows.

I want to be alone.

I dont want to be alone.

Why do I feel like this?

Help me. I feel really bad.

I feel really low.

I have no energy.

You may have had similar thoughts yoursel. Remember, these are just

examples and your experience may be dierent.

Some people can become so severely depressed that they may pose

a signicant risk to themselves or others. They may repeatedly think

about death (not just ear o dying), suicide or have a specic plan or

committing suicide. Some people may have such severe depressionthat they can lose all ability to unction normally.

Severe depression is not covered in this booklet, but i you think you

may be experiencing severe depression please contact your general

practitioner (GP) straight away or phone NHS24 on 08454 24 24 24 or

Samaritans on 0845 790 9090.

Depression is more than just eeling unhappy or down in the dumps.


9/32

7

I you are depressed, you might notice that you are nding it harder to

cope with your everyday lie. You are likely to experience some o the

ollowing symptoms or more than two weeks.

little interest or pleasure in doing things eeling down, depressed or hopeless trouble alling or staying asleep, or sleeping too much eeling tired or having little energy poor appetite or overeating eeling bad about yoursel or that you are a ailure or have let

yoursel or your amily down trouble concentrating on things like reading a newspaper orwatching television

moving or speaking so slowly that other people could havenoticed, or the opposite being so dgety or restless that you

have been moving around a lot more than usual

thoughts that you would be better o dead, or o hurting yourselin some way

The more o these symptoms you have, the more important it is to

get help and speak to someone about how you are eeling. Having

depression doesnt mean that you are weak and you cant just pull

yoursel together. Depression is an illness, but the good news is that

there are things you can do to get better.

It is best to visit your GP or help, or talk to someone who can support

you to nd help. Depression can make you tired and orgetul, as well

as making some issues dicult to talk about. Keeping a ew notes and

giving them to your GP can help you to talk about your thoughts and

eelings. There is space at the back o this booklet to do this.

I you are not comortable talking to your GP, you should choose

another GP in your practice.


10/32

8

How will my GP know I have depression?

Your GP might ask about how you are coping and managing with

dierent parts o your lie, or example:

work; amily and riends; relationships; money problems; and hobbies.

They might also ask i people in your amily have experienced

depression in the past.

Asking you about these things will help you and your GP to understand

why you might be eeling depressed. Your GP might ask you to think

about how you have been eeling or the past month. They might ask

you the questions below to work out i you have depression and i you

would like help.

During the past month, have you been bothered by eeling down,depressed or hopeless?

During the past month, have you oten been bothered by havinglittle interest and pleasure in doing things?

These questions may help you to talk about your eelings. You may nd

it dicult, but it is important to answer them as honestly as you can soyour GP can help you.

I you answer yes to either o these questions, then your GP may ask

you more questions to nd out how bad your depression is. They may

ask you to ll in a questionnaire.

A common questionnaire is one called PHQ-9. You can see

this questionnaire and take the test at the Doing Well website

(www.doingwell.org.uk).


11/32

Chassenet / Science Photo Library

9

Your answers to the questionnaire will help your GP work out your

depression score.

Knowing your PHQ score will help you and your GP decide the best

treatment or you. You can monitor your progress by lling in the

questionnaire again. Your GP may also ask i you have thought about

harming yoursel or committing suicide.

I at any time you think about harming yoursel or committing suicide,

you should tell your GP straight away or phone NHS 24 on 08454 24

24 24. You can also talk to the Samaritans by phoning their condential

helpline on 0845 790 9090.


12/32

10

What might help me eel better?

You may eel that nothing will be able to help you, but there are dierent

treatment options that may help make you eel better. I you have mild

depression, you should not choose medication at rst. This bookletlooks at the other types o treatment or depression and explains what

your choices are.

Its important to remember that depression is a very personal

experience. You should choose treatment that ts with your ideas

about your problem and yoursel, and eel condent that it will help.

It is hard or even impossible to say which treatment might be best

or someone. There is not one eective treatment or everyone, some

therapies work better or some people at dierent times.

Based on the research evidence, some treatments are likely to be more

eective. Ways o improving depression which have not been proven

to be very eective on their own, may be helpul when used at the

same time as an eective treatment.

Will psychological therapies help me and how do I access

them?

Psychological therapies is the name or a range o treatments that

usually involve talking one-to-one with a therapist.

Psychological therapies can help people with depression and are

provided by people who:

are trained in therapy; receive regular supervision to give the treatment; and have experience o working with people with depression.

Your GP will give you inormation to help you to make your choice.


13/32

11

It is important that you choose a therapy which eels right or you.

Beore you make your choice you should think about:

the positive and negative points o the treatment;

how long you will have to wait to get the treatment; how long the treatment lasts; what the risks are i you dont respond to the treatment; and whether you will have to pay anything.

It is extremely important that you choose a therapist who is registered

with a proessional organisation and who you eel comortable

speaking to.

Psychological therapies which are recommended or

depression

The ollowing treatments are supported by good-quality scientic

research evidence.

Behavioural activation

A therapist will try to help you nd activities you enjoy that you may

have stopped doing. They will help you to nd out why you have

stopped doing things that you previously enjoyed and work with you

to help you get back into these activities.

Cognitive behaviour therapy (CBT)

I you are depressed you may think negatively about situations. This

may cause you to stop doing activities that you used to enjoy. CBT

ocuses on how your thoughts, eelings and behaviour infuence your

mood. It involves working with a therapist who will help you challenge

your unhelpul thoughts and behaviour.


14/32

12

Couple-focused therapy

Couple-ocused therapy could help you i your relationship with your

partner is adding to your depression. It ocuses on any problems that

you may have in your relationship. A therapist will work with you to

change the way you and your partner interact so that you develop a

more supportive relationship.

Interpersonal therapy

Interpersonal therapy is when trained proessionals help you deal with

problems in your lie, such as relationships. It is based on the idea that

personal problems can contribute to psychological problems such asdepression.

Mindfulness-based cognitive therapy (MBCT)

I you have experienced depression three or more times, MBCT may

be an option or you. It is based on the idea o becoming at peace with

yoursel. This treatment can help reduce the chances o you becoming

depressed again. MBCT ocuses on helping you live ully in the present,rather than being bothered with negative thoughts about the past or

the uture.

Problem solving therapy

This therapy helps you nd out what your problems are, work out what

your aims are and come up with ways o achieving them.

Psychodynamic psychotherapy

Psychodynamic psychotherapy explores the problems that are in

your past and present relationships and everyday lie. It ocuses on

your relationship with the therapist to help you understand your

relationships with others.


15/32

13

The problems you have interacting with others will eventually show in

your relationship with your therapist.

Your therapist will help you to explore the thoughts and eelings

you are aware o (conscious) and those which you are not aware o

(unconscious). It can help you to understand how your problems may

have developed when you were a child.

Other psychological therapies

There is not enough evidence to say whether the ollowing treatments

are eective in treating depression.

Art therapy - This is when you express your eelings and emotionsthrough art such as painting and drawing.

Cognitive behavioural analysis system of psychotherapy(CBASP) - This has been developed or people who have chronic

(long-term) depression. It ocuses on helping you understand how

your behaviour can cause problems in your personal relationships.

Cognitive analytic therapy - A therapy which uses parts ocognitive behaviour therapy (CBT) and psychodynamic therapy. It

ocuses on discovering why you have had emotional problems and

looks back at their childhood.

Counselling - Counselling allows you to talk about your eelingswith a trained therapist. A counsellor will not give you advice, but

they will listen to you and support you to help yoursel.

Eyemovement desensitisation and reprocessing -This isusedwith people who have experienced trauma. You remember the

traumatic event while making very quick eye movements.

Family therapy -Family therapy aims to deal with problems aspart o the amily and ocuses on how the amily interacts.

Hypnotherapy -Hypnotherapy uses hypnosis. Hypnosis is amental state where you become more responsive to suggestions.


16/32

14

Music therapy -Music therapy ocuses on expressing youreelings and emotions through music to help you to interpret your

depression.

Neurolinguistic programming - A technique that detect andchanges unconscious thoughts and behaviours. It aims to helpyou to improve how you think, behave and eel.

Reminiscence therapy -Reminiscence therapy involves reviewingexperiences and emotions you may have had in the past and

seeing how they are aecting your current lie and relationships.

Will sel-help be useul?

There are various types o sel-help treatments and most are based on

cognitive behavioural therapy. Guided sel-help has been shown to be

eective.Guided sel-help and guided sel-help using a computer are

recommended or treating depression.

Guided self-help

Guided sel-help uses CBT to help you change your thoughts andbehaviour. Your GP can recommend sel-help books and help you to

access these. You could work through them yoursel or you could work

with a therapist. The therapist will regularly check i your symptoms o

depression are improving and will help you understand the inormation

in your books.

Computerised self-help (self-help using a computer)

You can have CBT using a computer. The computer programme will

guide you through the various stages o therapy just as a therapist

would in a ace-to-ace session. As with using books, having someone

to support you while using a sel-help computer programme may be

helpul. These programmes can help you to understand depression

and develop the skills you need to deal with your problems. Some

examples are Beating the Blues and Moodgym. Your GP can reer youto local services or these programmes.


17/32

15

Self-help support groups

There is no evidence to tell us how useul sel-help support groups are

as a treatment or people with depression, but it may be helpul to

speak to people in similar situations who will know what you are going

through.

Many organisations oer inormation and support groups to people

who have depression. The helplines listed on page 22 can help you

to get in touch with a support group. By asking your GP to put you in

touch with support groups or by using the helplines listed, you can be

sure the support groups you contact have a good reputation. Sel-help

support groups should be:

linked to an organisation or well-established group that can oerresources and support and promote the support group;

regularly reviewed; held in places that are easy to get to; ocused on helping people get better; have clear condentiality policies; and led by people (acilitators) who are trained in listening, managing

dicult situations and acilitation skills (skills to help groups

understand and achieve their aims, without taking part in

discussions). Facilitators should be supervised and supported. All

support group acilitators should have a disclosure check carried

out by Central Registered Body in Scotland (CRBS). A disclosure isa document which police or government departments hold and

contains inormation on your criminal history. Organisations use

a disclosure check to make sure they are making a sae decision

when they employ someone.


18/32

Dr P. Marazzi / Science Photo Library

16

Can exercise help?

Research shows that exercise can help improve symptoms o depression

and lit your mood. By doing exercise you enjoy you can build your

sel-condence, meet other people and improve your mental health at

the same time. Exercise includes:

walking; swimming; playing ootball; going to the gym; and many other activities.

Your GP can give you inormation on how to contact local services or

exercise activities. I you are worried about your tness, you should

talk to your GP who will be able to help you. It might be helpul to

talk to someone about the best exercise or you, or example a tness

instructor. Your GP can give you advice on how to do this.


19/32

17

Are herbal remedies and nutritional supplements

helpul?

St Johns wort

St Johns wort is a plant used in herbal medicine. People with depression

are advised not to use this because:

St Johns wort can stop some medications such as thecontraceptive pill and wararin rom working properly;

it is not clear what is the right dose or treating depression; and

dierent St Johns wort products vary greatly in what they contain.There is not enough scientic evidence that the ollowing nutritional

supplements help to relieve the symptoms o depression.

Chromium - A mineral ound in oods such as meat, sh,vegetables, ruits and whole grains.

Folate - A vitamin ound in oods such as dark green leayvegetables, cereals and orange juice. Ginseng - A plant grown in eastern Asia. Glutamine - One o the amino acids which help build proteins in

the body.

Ginkgo biloba - A tree whose ruits and seeds are used intraditional Chinese medicine.

Inositol - A natural sugar ound in animal and plant tissue. Polyunsaturated fatty acid - A at ound in oily sh such as

mackerel, salmon and trout.

S-Adenosyl-l-methionine - A chemical that occurs naturally in thebody.

Selenium - A mineral ound in some oods such as meat, sh andnuts.


20/32

18

Will changing my lifestyle help?

It is generally believed that a healthy liestyle will help patients with

depression. As well as discussing treatment options with you, your

GP will oer you some general liestyle advice. Your GP will ask you

about:

whether or not you drink alcohol or take drugs; your eating habits; the contact you have with your riends and amily and activities

you enjoy and are involved in; and

i you are having trouble sleeping.Will complementary therapies help?

Complementary therapies are techniques used to treat a disorder or

disease and are used alongside traditional medicines. There is not

enough evidence to say that the ollowing treatments are eective in

treating depression.

Acupuncture - A Chinese medical therapy which involves havingne needles placed into your skin to help you relax.

Animal-assisted therapy - Animals are used to give peoplecompanionship and aection. Animal therapy is oten used in

nursing homes.

Aromatherapy - A therapy based on using very strong essentialoils rom the fowers, leaves, bark, branches, rind or roots o plants

which people think can heal illnesses.

Emotional-reedom technique - A needle-ree version oacupuncture. It involves tapping certain points o your body while

you are thinking o a negative emotion.

Homeopathy - A system which involves using diluted substancesto stimulate natural deenses in the body. Light therapy - Involves exposure to bright light or a ew hours a

day.


21/32

19

Massage therapy - This is manipulating sot tissues in the body the muscles, tendons and ligaments.

Reexology - A therapy where rm pressure is applied to refexpoints on the body using the thumb or ngers.

Reiki - Where a therapist channels energy into your body throughtouch.

Tai Chi - A Chinese exercise system that uses slow bodymovements to help you relax your body and mind.

Thought-eld therapy - A technique which uses specialisedtapping with the ngers at certain points on your upper body and

hands. Yoga - Based on an ancient system o breathing practices. Itincludes exercises that aim to give you greater control o the body

and mind.


22/32

20

Are psychological treatments sae?

All psychological treatments could cause side eects, and it is important

to know about these. Your therapist should give you advice about the

positive and negative parts o all treatments. You should never bearaid to ask about the possible harmul side eects and how likely it is

that the treatment will help you.

Oten, people eel that a particular therapy isnt working or them but

they cant explain why. This can be because the therapy deals with

matters that are uncomortable or you or, oten, it is down to how

comortable you eel with your therapist.

It isnt worth continuing with a therapy that you do not think is helping

you, but you should remember that treating depression can raise issues

in your mind that can be unpleasant to deal with and this may show

that the treatment is having a positive eect.

It is important that you have a good relationship with your therapist

and eel comortable with them. I you are not comortable with yourtherapist, you should not be embarrassed about asking to see someone

else.

I you eel upset ater seeing your therapist or rom the treatment, you

should act on this straight away by talking to your riends, amily, carers

and healthcare proessionals. We have listed some national helplines

on page 22.


23/32

21

What i the treatment I decide to try doesnt

work?

It is important to accept that some treatments you try might not work

or you straight away, but you shouldnt give up. All treatments take

time to work, and while you might eel that it is hopeless you should

speak to your GP or therapist beore stopping any treatment.

Many people ully recover rom depression. For others it is a long-term

condition that comes back over time.

Most people with depression will see an improvement in symptoms

ollowing treatment, but how long this will take depends on the

individual. With an agreed care plan and regular monitoring, you can

nd a treatment that suits you and helps with your progress.

I your symptoms dont improve, you need to try a dierent treatment.

I you have tried a number o treatments and they dont seem to behelping, your healthcare proessional can help you to change treatment

or nd combinations o treatments.


24/32

22

Where can I ind out more inormation?

Helplines

Breathing SpacePhone: 0800 838 587

Breathing Space is a ree and condential service to help you i you

are eeling down or experiencing depression and need someone to

talk to. Breathing Space also oers a ree and condential British Sign

Language (BSL) service you can access using their website at www.

breathingspacescotland.co.uk

Carers UK s advice line

Phone: 0808 808 7777

Carers UKs advice line is a ree and condential helpline, oering

inormation to carers.

NHS24

Phone: 08454 24 24 24

NHS 24 can answer questions on any health matter and give you

advice.


25/32

23

Samaritans

Phone: 0845 790 9090

Samaritans is available 24 hours a day to provide condential and

emotional support i you are distressed and thinking about suicide.

SANEline

Phone: 0845 767 8000

This is a national out-o-hours helpline oering emotional support

and inormation or people aected by mental-health problems.

The ollowing organisations can give you inormation on particular

areas o mental health. We do not accept responsibility or the

inormation they may provide.

Carers Scotland

91 Mitchell Street

Glasgow G1 3LN

Phone: 0141 221 9141

Email: [email protected] Website: www.carerscotland.org

Carers Scotland aim to improve support or carers by giving policy

makers and proessionals working with carers relevant inormation.

Cruse Bereavement Care

PO box 800

Richmond

Surrey TW9 1RGPhone: 020 8939 9530

Website: www.crusebereavement.org.uk

Cruse Bereavement Care oers ree inormation and advice to people

who have lost someone to help them to understand their grie and

help them to cope.


26/32

24

Depression Alliance Scotland

11 Alva Street

Edinburgh EH2 4PH

Phone: 0131 226 1846

Website: www.dascot.org

Depression Alliance Scotland is a national charity or people with

depression in Scotland. They oer a range o inormation and support

including sel-help groups, an inormation service by phone, post and

email and a wide range o leafets and act sheets.

Health Professions Council (HPC)

Park House184 Kennington Park Road

London SE11 4BU

Phone: 020 7582 0866

Website: www.hpc-uk.org/index.asp

The HPC can give you the latest inormation and background on how

healthcare proessionals are regulated. They can also tell you about

registered therapists who meet their standards.

Scottish Association for Mental Health (SAMH)

Cumbrae House

15 Carlton Court

Glasgow G5 9JP

Phone: 0141 568 7000

Email: [email protected] Website: www.samh.org.uk

SAMH provides direct services including accommodation, support,

employment and rehabilitation to people who experience mental-

health problems. They also oer a range o leafets and act sheets on

mental-health conditions.


27/32

25

see me

1/3 Great Michael House

14 Links Place

Edinburgh EH6 7EZ

Phone: 0131 554 0218Email: [email protected] Website: www.seemescotland.org.uk

see me is Scotlands national campaign to end the negative image

around mental-health problems and discrimination. They provide a

range o act sheets about mental health and the negative image it

has.

Voices of Experience Scotland (VOX)c/o Mental Health Foundation (Scotland)

5th Floor, Merchants House

30 George Square

Glasgow G2 1EG

Phone: 0141 572 1663

Email: [email protected] Website: www.voxscotland.org.uk

VOX aims to develop, support and maintain a national organisation o,

or and by people who have or have had a mental-health problem. VOX

oer people who have had a mental-health problem the opportunity

to communicate with each other and with other organisations so they

can support each to make their voice heard.


28/32

26

Helpful websites

We do not accept responsibility or the content o the websites

listed.

www.bluepages.anu.edu.au

www.livinglietotheull.com

www.moodjuice.scot.nhs.uk

www.moodgym.anu.edu.au/welcome

www.moodcae.co.uk

www.healthscotland.org.uk/smha/

Financial information and practical issues

www.cas.org.uk

www.dwp.gov.uk

www.direct.gov.uk


29/32

27

Space or your notes


30/32

28

Space or your notes


31/32

29

Other ormats

I you would like a copy o this booklet in another language or ormat

such as large print, please phone Karen Graham, Patient Involvement

Ocer, on 0131 623 4740, or e-mail her at [email protected]


32/32

This booklet is based on a clinical guideline issued to all

NHS staf.

You can download the ull clinical guideline rom our

website at www.sign.ac.uk/pd/sign114.pd

A short version is also available at www.sign.ac.uk/pd/

qrg114.pd

SIGN Executive

Elliott House

8 -10 Hillside Crescent

Edinburgh EH7 5EA

Phone: 0131 623 4720 Fax: 0131 623 4503

Website: www.sign.ac.uk

For Depresion

Documents

Transcript of For Depresion