Dealing with depression

Introduction
What is depression?
Depression and lung disease
What are the symptoms of depression
Dealing with depression
The thoughts that trigger depression
Coping thoughts for depression
Ways of coping with depression
Conclusion

Introduction

Depression is a serious illness. If you are depressed, the feelings of sadness that we all have from time to time are more long-lasting and intense.

Lung disease can affect every aspect of your life. It can affect your self-confidence and how much you worry about doing things you used to find easy.

While it is normal to feel sad or upset about the effect lung disease may have had on your life, it is important to try not to let yourself be trapped by negative feelings. These can make it more difficult for you to cope with your illness.

The information below is designed to help people who are living with a lung disease cope with feeling depressed.

What is depression?

Depression is a persistent low mood, characterised by feeling bad about yourself and feeling hopeless about the future. It is often associated with chemical changes in the brain.

Many different factors can trigger depression. For some people, upsetting or stressful life events such as illness, bereavement, redundancy and worries about your job or money can be the cause. For some people, learning they have a lung disease, and trying to learn to live with it, can be a trigger for depression.

Depression can make you less enthusiastic about being involved in your normal activities and interests - and this in turn adds to your depression.

Quite often, depression is triggered by more than one of these factors, which can influence and affect each other in complicated ways.

For some people, depression doesn't have an obvious cause.

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Depression and lung disease

Living with a lung disease can make you feel tired all the time, partly because it may be difficult to sleep. It can be exhausting to eat, and the medications can make food seem tasteless. You may become so self-conscious about your oxygen or a chronic cough that you become more reluctant to go out in public. You may have been active for all of your life and now can't do the things you once enjoyed. Dealing with these changes and difficulties can put you at risk of developing depression.

Depression is unpleasant. It can leave you feeling disconnected from your life. You not only feel bad, but you also have less energy to do the things you want to do, including taking care of yourself and managing your lung condition.

Depression can also make you feel as if things will never get any better. If you feel this way, you might feel reluctant to follow the treatment plan for your lung condition, which can lead to your health getting worse.

Depression is a common problem but it can be treated.

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What are the symptoms of depression?

Do you have any of the following symptoms?

• You feel sad more often than not, for several weeks in a row
• Your sleep is disrupted; you wake up early, or your sleep is restless, or you have difficulty falling asleep
• You're sleeping either much more or much less than usual
• You're less interested in favorite people or activities
• You have less energy and you don't feel like doing anything
• You find it hard to concentrate and solve problems
• You're eating much more or less than usual
• You feel bad about yourself or you feel worthless
• You feel hopeless - that you'll never feel better no matter what happens
• You cry much more easily and more often than usual
• You feel irritable with everyone and everything in your life
• You are much more sensitive to criticism than usual
• You feel really guilty
• You can't laugh or enjoy yourself
• You think about suicide, or you wish your life would end.

If you answer yes to five or more items on this list, you may have depression - please contact your doctor, nurse or health team and talk to them about your symptoms.

An example of depression - Stephen had to retire from his work as a storeman three years ago, due to ill health. He was 55. He lives with his wife, who still works. His children are grown up and have left home.

Stephen feels that he is useless and worthless. He no longer brings in any money to the household, other than benefits. He thinks he's useless because he's just sitting at home all day while his friends are at work. He thinks that they think less of him for having to retire early. He also had to stop playing football - he knew he wasn't very good at this but he did enjoy kicking a ball around. He can't even walk the length of a football pitch these days without stopping to rest!

He is dependent on his wife and family for company but can't even help out by looking after his young grandchildren. He is scared of what would happen if he suddenly got worse, or couldn't breathe when he was alone with them.

He's not sleeping well and he seems to be putting on weight, which makes it even harder to keep active, even around the house. He feels very low when he thinks about the future - it's only going to get worse for him. He knows everyone tries to be understanding and kind but he does fly off the handle with them quite easily. He feels guilty about this later.

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Dealing with depression

One of the symptoms of depression is hopelessness - feeling that nothing can help, so why bother? In fact, lots of things can help you fight depression.

We will look at some of the methods to combat depression in more detail later in the booklet, but the main strategies are:

• Learning techniques such as breathing control to reduce anxiety, which is a barrier to activity
• Trying to exercise more and stay active. Exercise can trigger the release of a chemical in the brain called serotonin, which boosts your mood
• Learning how to relax
• Eating a well balanced diet. Read our a guide to Healthy eating and your lungs
• Joining a support group such as Breathe Easy and discussing your feelings and concerns. You are not alone
• Taking any antidepressant medicines, as prescribed by yourdoctor (see later), without skipping any doses or days
• Trying to identify negative thoughts and change them topositive thoughts
• Using a problem-solving approach to deal with stresses and worries.

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Ways of coping with depression

This is your action plan to help you deal with feeling bad.

Don't keep it to yourself
Talk with someone close to you. Tell them how you feel. It may help to talk to someone who also has a lung condition.

Breathing techniques
People with lung disease often find their breathing getsdifficult when they are upset, angry or anxious. Worries about breathing can stop people from doing things they would like to, and this can add to feelings of isolation and hopelessness. Breathing techniques can help overcome feelings of breathlessness and control anxiety.

You can ask your respiratory nurse or a physiotherapist for more information about breathing exercises. Or, if you have COPD please see our page on COPD: living with chronic obstructive pulmonary disease for suitable breathing exercises.

Do something
Try walking around the house and garden. Get outside, even if only for a short, slow walk. This will help you to keep physically fit, and you may sleep better. Try to keep active. This could be housework, walking to the local shop, or any part of your normal routine. It can help take your mind off painful thoughts which make you more depressed.

Just doing one thing each day (e.g. going out for the paper, doing the washing up) can make you feel a lot better about yourself. Think about when in the day you feel best (for example lunchtime, first thing in the morning), and try to do something then.

Do things you enjoy
Arrange to meet friends, or ask a friend to visit you, even just for a coffee. Phone someone you haven't seen for a while. Cook a simple meal.

Starting a new hobby can also be a good way to meet people, focus your mind and have some fun.

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Eat well
Try to eat a good, balanced diet, even though you may not always feel like eating. Eat small meals more often rather than just three big meals. This can be much more comfortable for people with a lung condition.

Beware of alcohol
Resist the temptation to drown your sorrows with a drink. Alcohol actually makes depression worse. It may make you feel better for a few hours, but you will feel worse again afterwards and it does not mix with antidepressant tablets.

Sleep
Try not to worry about finding it difficult to sleep. It can be helpful to listen to the radio or watch TV while you're lying down and resting your body, even if you can't sleep. If you can occupy your mind in this way, you may find it easier to get off to sleep.

Keep hopeful
Remind yourself that depression is an illness which many other people have gone through, and recovered from.

Relaxation
You can help yourself relax using simple techniques likehaving a bath or making a warm milky drink. Take time out. It's good to spend some time on yourself. Or try this quick relaxation technique:

• Loosen your clothing and get comfortable
• Tighten the muscles in your toes. Hold for a count of 10
• Relax and enjoy the sensation of release from tension
• Flex (spread out) the muscles in your feet. Hold for a count of 10. Relax
• Move slowly up through your body - legs, stomach, back,neck, face - tightening and relaxing muscles as you go
• Breathe deeply and slowly
• You might find doing all this to some relaxing music will help as well.

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Distract yourself
Doing something like a crossword or sudoku puzzle can help take your mind off things.

Pulmonary rehabilitation
Pulmonary rehabilitation is a course (usually six - eight weeks) of twice-weekly classes. It is usually run by a physiotherapist with help from doctors, pharmacists, nurses, etc. It involves learning about your lung condition and doing gentle exercise at a level that is safe for you. It also provides an opportunity to meet other people with lung conditions and share experiences. We know that pulmonary rehabilitation improves your fitness and your mood. In other words, it can make you feel less depressed, more able to cope and less hopeless aboutthe future.

Pulmonary rehabilitation isn't available everywhere, and it isn't suitable for everyone. You should speak with your nurse or doctor about it.

Medication for depression

Your doctor may consider giving you medication fordepression, called 'antidepressants'. These antidepressants can be helpful if you are feeling low or depressed and it is important to discuss them with your doctor.

There is a wide range of antidepressants available. Some of the most common ones are:

• Citalopram • Paroxetine • Sertraline • Fluoxetine • Venlafaxine

Each of these medications is made by a number of manufacturers, so the name on the packet will probably be different from the names above. It will be a brand name which the manufacturer has given the medication. You can check what drug your medication is by looking at the back of the packet, or by checking the leaflet inside the packet.

Your doctor will consider many different factors when deciding which antidepressant would be suitable for you. She/he will take into account things like your individual symptoms, any past experience of depression, your lung condition, other illnesses and physical problems you may have and, very importantly, what other medication you are on.

Anti-depressants do not start to work immediately - you won’t feel the benefits as soon as you start taking them! Most people find they need to take antidepressant medication (as directed by their doctor) for about four to six weeks before they notice a difference to their mood. Doctors tend to start people on low doses. If you don't notice a difference in four to six weeks, your doctor may consider increasing the dose a little bit, or changing you to another medication. Getting the right antidepressant and the right dose can take a bit of experimentation - be patient. It's also worth knowing that antidepressants tend to take longer to start working the older you are.

Some people experience side-effects when they start onantidepressants. Mild side-effects include indigestion, upset bowels, changes in appetite, dry mouth or drowsiness. Do read the information leaflet that comes with each medication to see what side-effects are common - this can be reassuring. If any side-effects become troublesome for you, or last a long time, you might want to discuss them with your doctor or nurse. If your doctor asks you to stop taking antidepressant tablets, ask whether you should gradually reduce the dose before stopping them. It is generally advisable to do so to avoid withdrawal symptoms. Depending on the type of tablet, these symptoms may include, anxiety, agitation, low mood, dizziness, flu-like symptoms, nausea or bowel disturbance.

There is plenty of evidence that ‘talking’ therapies also work for depression. You can discuss this with your GP or consultant, who may be able to refer you to a counsellor or psychologist who is experienced in talking therapies.

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The thoughts that trigger depression

In depression, people think the worst and put themselves down - "it's hopeless", "I'm useless", "I can't do anything", "There is nothing I can do to change things."

It's not surprising people are depressed when they think like this. But it is possible to learn to think in a different way. This method of changing your thoughts is most successfully done with the support of a nurse, doctor or counsellor, but you can also try it yourself at home.

Depression has a vicious cycle:

	I am depressed, I am not good enough
It will never be any different		I lack energy. I have no motivation
	I avoid everything. I do nothing. I am becoming more sad. I always look for negative explanations

or:

Depressive symptoms like loss of sleep and poor concentration mean we cope less well and things go wrong		Depressive symptoms like loss of sleep and poor concentration mean we cope less well and things go wrong
		Which leaves us less able to cope and so on

You can break this cycle, and reduce your depression.

The key is to change how you interpret and react to depressed thoughts. These are often called 'automatic negative thoughts' as you do not plan to have them - they just pop into

your head automatically.

Breaking the cycle involves:

• Noticing when you have these automatic negative thoughts
• Looking at the evidence for and against them
• Finding ways to change these to more realistic thoughts and cope better.

Write down the event that is making you feel depressed.Then write down your thoughts about the event (for example “Ishould never have started smoking”, “I’ll never be able to do that without help”, “I don’t look ill - they’ll think I’m trying it on”).

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Coping thoughts for depression

It's time to question the (automatic) thoughts you wrote down. To do so, write down any facts or experiences that support or contradict your automatic thoughts.

Ask yourself these key questions:

• What evidence have I got to support that? You may beexaggerating something bad or only looking at part of thepicture or making assumptions.
• Is there another way of thinking about this situation?
• What would my husband/wife, best friend, brother or sister or anyone you admire) say to themselves in this situation?
• What would I say to my husband/wife, best friend, brother or sister if they were thinking the same thing I am?
• How could I look at this situation so that I would feel lessdepressed? Is this view as reasonable as what I was thinkingin the first place?
• Try to think of alternatives to your negative thoughts, the ones that are making you feel bad about yourself. Write these down.
• You need to keep working at writing down your thoughts and arguing with them. This is a new way of thinking and only practice makes perfect.

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Conclusion

As we said at the start - depression is an illness which can be treated. Many people living with lung conditions are alsodealing with depression. You are not alone. There are ways of helping yourself feel better and there are people ready to help you work towards feeling better. If you are worried about your symptoms and think you may have depression, it’s a good idea to seek help from your doctor, nurse or health team.

Page last medically reviewed: January '09