Depression is common – and it can wreck lives. These days we often say we’re ‘depressed’ when the smallest thing hasn’t gone our way – maybe your favourite football team lost, or you missed that bargain in the sale. Consequently, it can be easy to underestimate how hugely debilitating depression can be. But these fleeting moments of low mood aren’t depression at all. In order for a doctor to diagnose depression, you have to have had at least two key symptoms on more than half of days, and they have to have interfered with your life. They are:
– Feeling down, depressed or hopeless and
– Lack of interest or pleasure in things you would usually enjoy.
In addition, symptoms of depression include changes in sleeping pattern and appetite; problems concentrating and loss of energy; feeling inappropriately guilty (that you’re a failure or that you’ve let others down); being generally slowed down (or on edge) to the extent that others have noticed; and thoughts that you might be better off dead.
One in 25 people suffer from depression in any given year, with one in four women and one in 10 men suffering over a lifetime. ‘Mild’ depression usually allows them to get on with their lives, even if it robs them of all the joy. Severe depression leaves sufferers paralysed and in a constant state of terror – sometimes with psychotic symptoms.
Much has been made in the media about how readily GPs hand out antidepressants – but on the whole, that’s anything but fair. Antidepressants do help many patient with moderate-severe depression, and for some they can literally be a life-saver. But they have little impact in mild depression, and like all medications they can cause side effects. Doctors don’t hand them out because they’re in the sway of vast pharmaceutical companies – the vast majority of antidepressants have been off patent for years, and cost only a few pennies a day, which doesn’t go to the company that developed them anyway.
The trouble is that until recently, we had little else to offer. Counselling and other talking therapies have long been a Cinderella service – but that is finally changing. A radical new approach to accessing services on the NHS in England – the IAPT (Improving Access to Psychological Therapies) – has seen much-needed investment in counsellors, psychologists and graduate mental health workers. Patients can be referred by their GP or refer themselves.
I’m a huge fan of talking therapies, including cognitive behavioural therapy (CBT) – Jeremy Vine and I have a constant running joke that he has yet to find a condition that I don’t recommend it for. So it’s not surprising that my eye was caught by a study out this week on mindfulness. Closely linked with Eastern philosophies, mindfulness involves paying close attention to our environment, and how we are feeling (or what we’re seeing, or tasting, or hearing or feeling or …) on a moment-by-moment basis. It’s about being centred in the here and now. Meditation,yoga or breathing exercises may form part of your mindfulness routine.
This week, a report in the international JAMA Psychiatry journal looked back at all the high-quality scientific studies it could find on mindfulness-based cognitive behavioural therapy (MCBT) in the treatment of recurrent depression since 2010. Patients treated with MCBT were compared with several alternative treatments, including antidepressants. They found studies on 1,258 patients and concluded that MCBT reduced the risk of depression having recurred a year later by 31%. Some of the studies involved comparing MCBT with ‘usual care’ – in other words, no medication, counselling or active follow-up. But even by comparison with active treatments, MCBT reduced the chance of depression recurring by over 20%.
Age, gender and social/economic factors didn’t seem to have any significant impact on the likelihood of MCBT performing better. But interestingly, there was some evidence that people were more likely to respond better to MCBT than to other treatments if they were severely depressed. Importantly, given past criticisms that MCBT can lead to anxiety or panic attacks, there was no evidence that it led to significant harm among the patients studied.
What does this mean for the millions of Britons who suffer from depression? For now, NHS access to MBCT is limited – although that may change as more evidence emerges. But you don’t need a therapist to practise mindfulness – there are all sorts of apps, yoga classes etc. Just getting into the habit of being more aware of your surroundings is a start. In fact, the evidence is that mindfulness can help many of us, whether we suffer from depression or not. It’s all about taking just a few minutes to sit back and smell the roses.