women

Depression comes in many guises. So why do we treat them all the same way?

The black dog. The blues. A bit down. There are almost as many descriptions for depression as there different experiences. And right now, it’s the most common mental health problem in the world, with 10% of us here in the UK suffering with it at any one time.

But, unlike other illnesses, there isn’t a one-experience fits all when it comes to symptoms. From stress through to all-encompassing grief, and taking in post natal illness and Seasonal Affective Disorder depression comes in many guises. Go to your doctor, though, and the diagnosis is likely to be startlingly simple you’re depressed. But The Lancet, the world’s leading general medical journal, recently voiced concern that all these conditions are being lumped together and ‘medicalised’ to such an extent that treatment is becoming uniform, and this ‘simplistic and flawed’ approach is resulting in people receiving the wrong treatment.

‘Most GPs don’t get sufficient training in all the emotional illnesses’

‘GPs have a tendency to oversimplify depression’, agrees Dr Jonty Heaversedge, GP and presenter of BBC’s Street Doctor. ‘Different forms of emotional illness may share symptoms like loss of libido, poor sleep or lack of appetite, but the root causes and the way we experience it are never the same, so the treatment needs to be individual, too’.

‘Most GPs don’t get sufficient training in all the emotional illnesses’

‘Most GPs don’t get sufficient training in all the emotional illnesses’

Ask around and it doesn’t take long to discover stories of same symptoms, same advice yet very different conditions. When Sarah Robson, 34, lost her mum, for instance, her GP diagnosed her as depressed when she admitted she was struggling to cope. ‘I went to my GP when, after three or four months, I still couldn’t sleep, lacked appetite and almost constantly felt on the brink of tears. He immediately prescribed antidepressants’, she says. Anita McLagan, 28, received very similar advice for a very different problem. ‘I went to my doctor last year’, she says. ‘Looking back, I was going through a really stressful period with mass redundancies at work but, at the time, I didn’t recognize that as the cause for how I was feeling. I was struggling with tearfulness, insomnia and frequent headaches. My doctor asked a few questions, then suggested I think about counseling or try a course of antidepressants. I felt uncomfortable with taking medication, so I joined the waiting list to see a counselor. In the meantime, I signed up for a one-day mindfulness workshop my friend recommended. That helped me realize it was work that was stressing me out, and I learned a few techniques on how to cope in a high-stress situation. In the end, I didn’t need either the counseling or antidepressants. In fact, I’m a bit shocked the drugs were even suggested’.

‘It is possible to generalise a little with some types of depression – for example, grief is reactive, so you should be offered psychotherapy’, says Dr Heaversedge. ‘Whereas depression with no apparent trigger is more likely to have come from a chemical imbalance in the brain and may need a more medical approach, potentially including antidepressants’.

‘Feeling down is the third most common reason for GP appointments’

But there’s a difference between ‘generalising’ and providing blanket treatments for a range of experience that couldn’t be more unique. So why do patients so often experience a carbon copy response? ‘Unfortunately, many GPs don’t get sufficient training for all the different emotional illnesses’, says Dr Heaversedge. ‘Most would refer patients to a general counselor without thinking about the different types of therapy available, and what’s most likely to help that particular patient’.

‘Feeling down is the third most common reason for GP appointments’

‘Feeling down is the third most common reason for GP appointments’

When you consider that feeling depressed is the third most common reason for people to see their GP, it’s not so surprising that doctors offer the same tried and tested services. But you don’t have to accept their first treatment suggestion; you can insist on discussing all the options available. After all, you know better than anyone else how you’re feeling and what you’re comfortable with.

Professor Cary Copper, president of the British Association of Counselling and Psychotherapy (bacp.co.uk) agrees that matching a patient’s emotional problem to a specific therapy is crucial. ‘For example, we know the main driver of grief is loss, so bereavement counselling, with specific techniques for loss, is the only answer’, he says. Even then, it’s important to find a counselor who specialises in your type of grief. ‘A couple who’ve lost a young child will have a different experience from someone who’s lost a parent’, he says. In short, the way to beat your strain of the blues is to find the cause and treat that, not just the symptoms.

The good news is that there are just as many treatments available out there as are shades of blue. Here’s how to work out which will suit you best and how to get it, whether with suit you best and how to get it, whether with your GP’s help or going it alone.

Stress

‘The human body has a biological physical stress response, which kicks in when you perceive a threat, for example, your boss demanding a document you know you won’t have ready in time’, says Gladeana McMahon, co-director for The Centre of Stress Management (managingstress.com). ‘Once the threat has been dealt with, your body starts its recovery process. But if the stress continues over longer periods say your boss repeatedly sets demands you can’t meet you’re likely to suffer emotionally and physically’.

Treat it: treatment depends on how severe your stress is and what’s causing it:

‘The human body has a biological physical stress response, which kicks in when you perceive a threat, for example, your boss demanding a document you know you won’t have ready in time’

‘The human body has a biological physical stress response, which kicks in when you perceive a threat, for example, your boss demanding a document you know you won’t have ready in time’

Stage 1 mild

Symptoms are normally physical feeling tired and achy, the odd tummy problem or allergy flare-up.

Try looking at your schedule and building in more relaxation time. Increase your exercise, too, even if it’s something low impact like walking or, better still, yoga.

Stage 2 moderate

You’re more forgetful than usual, losing keys and belongings more easily. You may be more tearful, irritable and accident prone, too.

Try writing a list of all the demands on your time, then consider how you can enlist help at work, at home or both. Ask yourself if you’re trying to do too much and, if so, work out what’s essential and what’s not.

Stage 3 severe

You’re on edge all the time and feel anxious and upset. You may have panic attacks and your appetite and sleep may be affected.

Try a stress management class. Speak to your GP as lots of doctors’ surgeries and community centres run groups that help you identify the cause of your stress and teach you coping techniques.

Another option is solution-focused brief therapy (brief.org.uk), which you would have to pay for. These targeted, one-on-one sessions will teach you practical solutions and coping strategies. Many people learn enough in just three sessions to change the way they handle stress for good.

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