BLOG POST – Winter 2020

Posted on November 25th, 2019

DEPRESSION                                            

It’s cold, dreary, and freezing – welcome to winter, UK style!  Sometimes, when we are struggling through these, the most depressing months of the year, it can be hard to find an upside to life. It’s no wonder that so many of us occasionally feel a bit low, a bit depressed. However, for most of us, most of the time, feeling a bit low is just a perfectly normal reaction to life’s downsides. Things go wrong and we get fed up, sad even. That’s all there is to it. That’s life! However, when our gloomy reactions to life’s adversities are excessive, (whatever the season), when they interfere with our lives, when they don’t have an obvious cause, when they are long-lasting, then that’s when depression becomes ‘a matter of clinical concern’.

Mental health professionals recognise a number of different types of depression and classify them according to severity, frequency, and how long the symptoms have lasted. However, carrying out a detailed diagnostic evaluation of depression is an exacting and time-consuming job. Busy GPs cannot afford to be so finicky – they just don’t have the time. In the UK most GPs diagnose depression using the National Institute for Health and Care Excellence, (NICE), Guidelines. However, some diagnosticians prefer to use the World Health Organisation’s mental health check list. These two diagnostic protocols are very similar to each other, easy to use, take only moments, and are reasonably accurate, (at least to begin with). GPs who use the Nice Guidelines check their patients on a yes/no basis against the following criteria.      

Key Symptoms:

Persistent sadness or low mood

Marked loss of interests or pleasure

Associated Symptoms:

Fatigue or loss of energy or slowing of movements

Disturbed sleep (decreased or increased compared to usual)

Decreased or increased appetite and/or weight

Poor concentration or indecisiveness

Feelings of worthlessness or excessive or inappropriate guilt

Suicidal thoughts or acts

The rough rule of thumb is that the more positives scored on the Associated Symptoms list, the more the patient is depressed. In the UK’s National Health Service, depression is usually graded mild, moderate and severe. Treatment is usually offered on a stepped basis depending on how the patient’s needs evolve.  

            Step 1             No action, (most depressives recover within 6 months, treated or not)

            Step 2             Medication and low-intensity psychological therapy, (basic CBT)

            Step 3             Medication and high-intensity psychological therapy (advanced CBT)

            Step 4             Hospitalisation and multi-professional in-patient care

Of course there are many mental health professionals who disagree with the NHS approach to treating depression. They would argue that depression is a much more complex condition than the NICE protocols suggest and therefore the treatments required are equally more complex. Nevertheless, if pushed, many of these dissenting professionals would probably accept that the NHS stepped-care system gives some relief to some people – at least on a short-term basis. However they would also claim that treatments based on medication and/or CBT often only serve to alleviate the symptoms of depression; that they don’t properly address the causes of depression.    

My own approach to depression is multi-faceted from the onset. Being what is known as a ‘Pluralistic’ or an ‘Integrative’ practitioner, I don’t allow myself to be limited to any given treatment model for depression or to exclusively subscribe to any given causative theory. I prefer to tailor each individual’s treatment plan to suit that person’s needs. So, for any particular client I’ll use whichever approach, (or package of approaches), that seem likely to be the most helpful. Not only that, but I will change my treatment plans if my patient’s needs change. Flexibility is the name of the game.

If a do-nothing, time-is-the-great-healer, approach, (NICE – Step 1) seems to be the right one then OK. However the patient’s progress over the next few months needs to be properly monitored. It’s not just ‘file and forget’. There is still a lot that therapist can do and should do to help. For example, carefully applied positive psychological reinforcements will at least encourage recovery and in many cases will help to speed it up. In all cases patients should be helped to review their lifestyles and to make suitable adjustments.

Traditionally, psychotherapists and GPs have been at the opposite ends of the prescribing spectrum. Supposedly, GPs irresponsibly ‘handed out pills like Smarties’ and psychotherapists were far too ‘holier than thou’ to ever consider medication. Fortunately, these outdated, competing, professional orthodoxies have largely disappeared. Modern psychotherapists and doctors collaborate. I often refer patients who present with depression to their GPs. That’s because it is not unusual for patients to need the ‘chemical lift’ that medication can provide before they can even begin therapy. Not only that, but therapists must always remember that all sorts of medical problems, (a defective thyroid for example), can cause depression-like symptoms in people. It is always good practice to get prospective clients medically checked first.     

In many cases my treatment model for depression includes medication and psychotherapy together. Have a look at the information leaflets supplied with any anti-depressant medication – they all say ‘use pills and talk’.  It’s also a good idea if both the doctors and psychotherapists are prepared to adopt a ‘suck-it-and-see’ approach. After all, different pills work, (or not), for different people and that‘s equally true for the wide variety of psychotherapeutic approaches that claim to have a positive impact on depression.. My advice to any patient is to shop around and find the treatment package that suits you and to stay away from any medic or ‘ologist’ who has a ‘one-size-fits-all’ attitude.

So, in sum what I am saying about depression is this. It’s OK, it’s normal to feel low or sad, (generally dispirited), when the circumstances demand it. What is not OK is for those feelings to disrupt your life. So, when your life is getting a bit out of hand, when your life no longer has an upside, get some help – that’s what psychotherapists are for.