Depression is a serious illness. Health professionals use the words depression, depressive illness or clinical depression to refer to it. It is very different from the common experience of feeling miserable or fed up for a short period of time. When you’re depressed, you may have feelings of extreme sadness that can last for a long time. These feelings are severe enough to interfere with your daily life, and can last for weeks or months, rather than days.
Depression is quite common, and about 15% of people will have a bout of severe depression at some point in their lives. However, the exact number of people with depression is hard to estimate because many people do not get help, or are not formally diagnosed with the condition. Women are twice as likely to suffer from depression as men, although men are far more likely to commit suicide. This may be because men are more reluctant to seek help for depression.
Depression can affect people of any age, including children. Studies have shown that 2% of teenagers in the UK are affected by depression. People with a family history of depression are more likely to experience depression themselves. Depression affects people in many different ways and can cause a wide variety of physical, psychological (mental) and social symptoms. A few people still think that depression is not a real illness and that it is a form of weakness or admission of failure. This is simply not true. Depression is a real illness with real effects, and it is certainly not a sign of failure. In fact, famous leaders, such as Winston Churchill, Abraham Lincoln and Mahatma Gandhi, all had periods of depression.
Symptoms of depression
If you’re depressed you often lose interest in things that you used to enjoy. Depression commonly interferes with your work, social and family life. In addition, there are many other symptoms, which can be physical, psychological and social.
continuous low mood or sadness,
feelings of hopelessness and helplessness,
feelings of guilt,
feeling irritable and intolerant of others,
lack of motivation and little interest in things,
difficulty making decisions,
lack of enjoyment,
suicidal thoughts or thoughts of harming someone else,
feeling anxious or worried, and
reduced sex drive.
slowed movement or speech,
change in appetite or weight (usually decreased, but sometimes increased),
unexplained aches and pains,
lack of energy or lack of interest in sex,
changes to the menstrual cycle, and
disturbed sleep patterns (for example, problems going to sleep or waking in the early hours of the morning).
not performing well at work,
taking part in fewer social activities and avoiding contact with friends,
reduced hobbies and interests, and
difficulties in home and family life.
Grief and depression
Even though grief and depression share many of the same characteristics, there are important differences between them. Grief is an entirely natural response to a loss, while depression is an illness. However, sometimes, it can be hard to distinguish between feelings of grief and depression. People who are grieving find that feelings of loss and sadness come in waves, but they are still able to enjoy things and are able to look forward to the future. However, those who are depressed have a constant feeling of sadness; they do not enjoy anything and have little sense of a positive future. Treatment for depression usually involves a combination of drugs, talking therapies and self help. Hardly anyone with depression is admitted to a psychiatric hospital. Most get treatment from their GP and make a good recovery.
If you are diagnosed with mild depression but your GP thinks you’ll improve, you can have another assessment in two weeks' time to monitor your progress. This is known as 'watchful waiting'.
Antidepressants are not usually recommended as a first treatment. Exercise seems to help some people. While your progress is being monitored, your GP may refer you to an exercise scheme with a qualified fitness trainer. Talking through your feelings may also be helpful. You may wish to talk to a friend or relative, or your GP may suggest a local self-help group.
Your GP may recommend self-help books and computerised cognitive behaviour therapy (CBT).
Chronic mild depression
(present for two years or more) is called dysthymia. This is more likely in people over 55 years and can be difficult to treat. If you are diagnosed with dysthymia, your GP may suggest that you start a course of antidepressants.
If you have mild depression that is not improving, or you have moderate depression, your GP may recommend a 'talking treatment' or prescribe an antidepressant (see below for further details).
Your GP may recommend that you take an antidepressant, together with talking therapy. A combination of an antidepressant and cognitive behavioural therapy (CBT) usually works better than having just one of these treatments. You may be referred to a mental health team. These teams are usually made up of psychologists, psychiatrists, specialist nurses and occupational therapists. They often provide intensive specialist talking treatments, such as psychotherapy.
Cognitive behavioural therapy (CBT)
CBT is based on the principle that the way we feel is partly dependent on the way we think about things. It teaches you to behave in ways that challenge negative thoughts - for example, being active to challenge feelings of hopelessness.
Interpersonal therapy (IPT)
IPT focuses on your relationships with other people and on problems, such as difficulties with communication or coping with bereavement. There is some evidence that IPT can be as effective as medication or CBT, but more research is needed.
Counselling is a form of therapy that helps you to think about the problems you are experiencing in your life, in order to find new ways of dealing with them. Counsellors support you in finding solutions to problems, but do not tell you what to do.
Antidepressants take two to four weeks to take effect. If the first antidepressant you try is not effective or causes side effects, it may be necessary to change the dose. Sometimes, a different type of antidepressant will be recommended. Antidepressants are not addictive but withdrawal symptoms are quite common if you stop taking them suddenly, or you miss a dose.
If your GP thinks you would benefit from taking an antidepressant, you will usually be prescribed an SSRI (selective serotonin reuptake inhibitor).These are as effective as the older TCAs (tricyclic antidepressants) and have fewer side effects. Fluoxetine, citalopram and sertraline are all examples of SSRIs. SSRIs increase the level of a natural chemical in your brain called serotonin, which helps to lift your mood. You may have some side effects when you start taking SSRIs, such as nausea, headache, sleep problems and anxiety. However, these tend to improve over time.
Some SSRIs should not be prescribed for children under the age of 18 years. Research shows that the risk of self-harm and suicidal behaviour may increase if they are used to treat depression in this age range. Fluoxetine is the only SSRI that may be prescribed for under-18s, but only when specialist advice has been given.
Tel: 0845 123 23 20; email: email@example.com
Information, support and understanding for people who suffer with depression, and for relatives who want to help. Self-help groups, information, and raising awareness for depression.
Depression Alliance Cymru
Welsh organisation whose sole purpose is to support people affected by depression.
Depression UK (Previously the Fellowship of Depressives Anonymous)
Organisation run as a source of support for people with depression, or their carers. A national mutual support group for people suffering from depression
Tel: 08457 90 90 90 (ROI 1850 60 90 90); email: firstname.lastname@example.org Confidential, non-judgmental support 24 hours a day by telephone and email for anyone who is worried, upset, or suicidal.
An Irish organization that assists and supports those suffering from depression and their families. A helpline is available as well as support groups, lectures and current research on depression.
POST-TRAUMATIC STRESS DISORDER
Post-traumatic stress disorder (PTSD) is a psychological and physical condition that is caused by very frightening or distressing events. It occurs in up to 30% of people who experience traumatic events. Traumatic events
PTSD can occur after experiencing or witnessing traumatic events such as:
serious road accidents,
natural or man-made disasters,
being held hostage,
violent deaths, and violent personal assaults, such as sexual assault, mugging or robbery.
PTSD may also occur in any other situation where a person feels extreme fear, horror or helplessness. However, it does not usually develop after situations that are upsetting, such as divorces, job losses or failing exams.
Someone with PTSD often relives the traumatic event through nightmares and flashbacks. They may also have problems concentrating and sleeping, and feel isolated and detached. These symptoms are often persistent and severe enough to have a significant impact on a person’s day-to-day life.
PTSD is a mental health condition
PTSD first came to prominence during the First World War after soldiers suffered harrowing experiences in the trenches. Their condition became known as shell shock or battle fatigue syndrome. It has not been until fairly recently that it has been accepted that traumatic events outside of war situations have similar effects. The term ‘post-traumatic stress disorder’ was first used after the Vietnam War. In 1980, PTSD officially became recognised as a mental health condition when it was included in the Diagnostic and Statistical Manual of Mental Disorders, which was developed by the American Psychiatric Association (APA).
How common is PTSD?
PTSD affects up to 30% of people who experience a traumatic event. It affects around 5% of men and 10% of women at some point during their life, and can occur at any age, including during childhood. Approximately 40% of people with PTSD develop the condition after someone close to them suddenly dies. PTSD can be successfully treated even when it occurs many years after the traumatic event. Depending on the severity of your symptoms, and how soon they develop after the traumatic event, a number of different treatment strategies may be recommended. These include:
watchful waiting: waiting to see if the symptoms improve or get worse without treatment,
psychological treatment, such as trauma-focused cognitive behavioural therapy (tfCBT), or eye movement desensitisation and reprocessing (EDMR), and
medication, such as paroxetine or mirtazapine.
Symptoms of post-traumatic stress disorder
The symptoms of post-traumatic stress disorder (PTSD) usually develop immediately after the traumatic event. However, in some cases (less than 15%), the onset of symptoms may be delayed for weeks, months or years. In PTSD, there are often periods of time when symptoms are reduced (symptom remission). These are followed by periods when symptoms increase. Some people with PTSD have symptoms that are severe and constant. Most people who witness a traumatic event experience some of the symptoms of PTSD. The nature and severity of symptoms can vary widely between individuals. Some of the main symptoms associated with PTSD are described below.
If you have PTSD, you may frequently relive the traumatic event in the form of flashbacks, nightmares, or repetitive and distressing images or sensations. However, some aspects of the traumatic event may be forgotten in time.
Constantly reliving a traumatic experience can be very upsetting. If you have PTSD, you may try to avoid circumstances, situations or people that remind you of the traumatic event. You may also refuse to discuss your experience with others.
If you have PTSD, you may find it very difficult to relax, and you may be anxious all the time. You may be hypervigilant (constantly aware) to threats, and be easily startled. Irritability and angry outbursts are also common symptoms of PTSD. You may have sleeping problems, and find it difficult to concentrate.
Sometimes, people with PTSD deal with their feelings by trying not to feel anything at all. This is known as ‘emotional numbing’. If you have PTSD, you may feel detached or isolated from others. You may also experience feelings of guilt. People with PTSD often seem deep in thought (introspective) and withdrawn. They may give up activities and pastimes that they used to enjoy.
Other common symptoms of PTSD include: depression, anxiety and phobias, drug or alcohol misuse, and unexplained physical symptoms, such as sweating, shaking, headaches, dizziness, chest pains and stomach upsets.
As with many mental health conditions, PTSD sometimes leads to the breakdown of relationships, and causes problems at work.
PTSD in Children
PTSD sometimes affects children who have witnessed a traumatic event, such as a road traffic accident. They may repeatedly re-enact the traumatic event through play, and they may have frightening and upsetting dreams. Like adults, children with PTSD may lose interest in activities that they used to enjoy. They may also experience headaches and stomach aches.
If you have experienced a traumatic event, you may develop post-traumatic stress disorder (PTSD) in the days, weeks or months after the incident. Although such events can be very difficult to come to terms with, confronting your feelings and seeking professional help is often the only way of effectively treating PTSD. In treating PTSD, the National Institute for Clinical Excellence (NICE) recommends psychotherapy (talking treatments) as the first choice of treatment, before medication is used. PTSD can be treated for many years after the traumatic event occurred, so it is never too late to seek help.
Treatment for PTSD usually begins with a detailed evaluation and a treatment plan tailored to your individual needs. Your GP may feel that you would benefit from seeing a mental health specialist, such as: a counsellor, who is trained to listen sympathetically and can help you to deal with any negative thoughts and feelings, a psychologist, who is an expert in the workings of the mind, a community psychiatric nurse, who specialises in mental healthcare, or a psychiatrist: a mental health specialist who diagnoses and treats mental health conditions. The healthcare professionals you are referred to should always treat you with sensitivity and understanding. Your treatment plan should be discussed with you. Any decisions regarding your treatment will be clearly explained.
Watchful waiting 'Watchful waiting' involves carefully monitoring your symptoms to see whether they improve or get worse. It may be recommended in cases of PTSD where symptoms are: mild, and have been present for less than four weeks after the traumatic event. If watchful waiting is recommended, you should have a follow-up appointment within one month.
Psychotherapy is a type of talking therapy that is often effective in treating emotional problems and mental health conditions, including: depression, anxiety, obsessive compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). A psychotherapist is a trained mental health professional who will listen to your problems and suggest strategies that may help you to resolve them. In cases of severe or persistent PTSD, a combination of psychotherapy and medication may be recommended.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) is a type of psychotherapy that teaches you skills that will help you to change any negative thought processes you may have. Trauma-focused CBT uses mental imagery of the traumatic event to help you work through the trauma and gain control of your fear and distress. You may be offered trauma-focused CBT if: you have severe symptoms of PTSD, which develop within one month of a traumatic event, or you still have PTSD symptoms within three months of a traumatic event. Between 8-12 weekly sessions of trauma-focused CBT are usually recommended, although fewer (about five) may be needed if the treatment starts within a month of the traumatic event.
Eye movement desensitisation and reprocessing (EMDR)
Eye movement desensitisation and reprocessing (EMDR) involves making several sets of side-to-side eye movements while recalling the traumatic incident.EMDR aims to help your brain process flashbacks so that you can come to terms with the traumatic experience and think more positively. EMDR has been found to help many people with PTSD reduce their distress.
NICE suggests that paroxetine, which belongs to a group of medicines known as selective serotonin reuptake inhibitors (SSRIs), or the antidepressant mirtazapine, should be considered for treating PTSD in adults. However, these medications should only be used when: the person chooses not to have trauma-focused psychological treatment, the person cannot start psychological treatment due to a high risk of further trauma, the person has gained little or no benefit from a course of trauma-focused psychological treatment, or there is severe depression or hypersensitivity, which significantly affects the person’s ability to benefit from psychological treatment alone.
Amitriptyline or phenelzine may also be used under the supervision of a mental health specialist. The above criteria also apply.
SSRIs and antidepressants are also prescribed to reduce associated symptoms of depression and anxiety, and help with sleeping problems. SSRIs are not usually prescribed to people who are under 18 years old, unless they are recommended by a specialist. If medication is prescribed for PTSD and it proves to be effective, it is usually continued for a minimum period of 12 months before being gradually withdrawn (over the course of four weeks or longer). If a medication is ineffective, your dosage may be increased. Before you are prescribed medication for PTSD, you doctor should inform you about any potential side effects and symptoms when the medication is withdrawn.
UK Trauma Group: clinical network of UK Traumatic Stress Services.
PILOTS database of the National Center for PTSD (USA): published international literature on PTSD.
Anxiety is a feeling of unease, such as worry or fear, that can be mild or severe. Everyone experiences feelings of anxiety at some point in their life. For example, you may feel worried and anxious about sitting an exam or having a medical test or job interview. Feeling anxious is sometimes perfectly normal. However, people with generalised anxiety disorder (GAD) find it hard to control their worries. Their feelings of anxiety are more constant and often affect their daily life.There are several conditions for which anxiety is the main symptom. Panic disorder, phobias and post-traumatic stress disorder can all cause severe anxiety. These pages are about generalised anxiety disorder (GAD).
Generalised anxiety disorder (GAD)
GAD is a long-term condition which causes you to feel anxious about a wide range of situations and issues, rather than one specific event.People with GAD feel anxious most days and often struggle to remember the last time they felt relaxed. GAD can cause both psychological (mental) and physical symptoms. These vary from person to person, but can include feeling irritable or worried and having trouble concentrating or sleeping.
How common is it?
GAD affects approximately 1 in 20 adults in Britain.Slightly more women are affected than men, and the disorder is most common in people in their 20s.
GAD can significantly affect your daily life, making it difficult to perform everyday tasks. However, several different treatments are available to ease your psychological and physical symptoms.
Symptoms of anxiety
The symptoms of general anxiety disorder (GAD) often develop slowly and can vary in severity from person to person. Some people experience only one or two symptoms, while others experience many more. Anxiety can affect you physically and psychologically (mentally).
GAD can cause a change in your behaviour and the way you think and feel about things.
Psychological symptoms of GAD include:
restlessness a sense of dread feeling constantly 'on edge' difficulty concentrating irritability
impatience being easily distracted
Your symptoms may cause you to withdraw from social contact (seeing your family and friends) to avoid feelings of worry and dread. You may also find it difficult and stressful going to work and may take time off sick These actions can make you worry even more about yourself and increase your lack of self-esteem.
The physical symptoms of GAD can include:
dizziness drowsiness and tiredness pins and needles irregular heartbeat (palpitations) muscle aches and tension dry mouth excessive sweating shortness of breath stomach ache nausea diarrhoea headache excessive thirst frequent urinating painful or missed periods difficulty falling or staying asleep (insomnia)
There are two main forms of treatment for generalised anxiety disorder (GAD): psychological therapy and medication
Depending on your circumstances, you may benefit from one of these types of treatment or a combination of the two. Studies of different treatments for GAD have found that the benefits of psychological treatment last the longest, but no single treatment is the best for everyone. Before you begin any form of treatment, your GP should discuss all of your treatment options with you, outlining the pros and cons of each, while also making you aware of any possible risks or side effects. With your GP, you can make a decision on the treatment most suited to you, taking into account your personal preferences and circumstances.
If you have been diagnosed with GAD, you will usually be advised to try psychological treatment before you are prescribed medication. The main form of psychological treatment for GAD is cognitive behavioural therapy (CBT).
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) is one of the most effective types of treatment for GAD. Research suggests that CBT improves the symptoms of over half of all people with the condition. CBT works by helping you identify unhelpful and unrealistic beliefs and behavioural patterns. Your therapist then shows you ways that you can replace these beliefs with more realistic and balanced ones. This type of therapy does not concentrate on dealing with events from your past, but instead focuses on the difficulties that you are experiencing in the present. CBT teaches you new skills and helps you understand how to react more positively to situations that would usually cause you anxiety.
The National Institute for Health and Clinical Excellence (NICE) recommends that you should have a total of 16-20 hours of CBT over four months. Your treatment will usually involve a one- to two-hour session, once a week.
Your GP can prescribe a variety of different types of medication to treat GAD. Some medication is designed to be taken on a short-term basis, while other medicines are prescribed for longer periods. Depending on your symptoms, you may require medicine to treat your physical symptoms as well as your psychological ones. If you are considering taking medication for GAD, your GP should discuss the different options with you in detail, including the different types of medication, length of treatment, side effects and possible interactions with other medicines before you start a course of treatment.
Benzodiazepines are a type of sedative that help ease the symptoms of anxiety within 30-90 minutes of taking the medication. Although benzodiazepines are very effective in treating the symptoms of anxiety, they cannot be used for long periods of time. This is because they have the potential to become addictive if used for longer than four weeks. Benzodiazepines also start to lose their effectiveness after this time. For these reasons, you will usually only be prescribed benzodiazepines to help you cope during a particularly severe or intense attack of anxiety.
Benzodiazepines can cause side effects, including:
loss of balance
drowsiness and light-headedness
Due to the above side effects, benzodiazepines can affect your ability to drive or operate machinery. Therefore, avoid these activities when taking the medication. Speak to your GP if you experience any of the side effects listed above. They may be able to adjust your dose of medication or prescribe an alternative.
Antihistamines are usually prescribed to treat allergic reactions. However, some are also used to treat anxiety on a short-term basis. Antihistamines have a calming effect on the brain, helping you to feel less anxious. As with benzodiazepines, antihistamines are only effective when used for a short period of time and will only be prescribed for a few weeks. Hydroxyzine is the most commonly prescribed antihistamine or treating anxiety. This antihistamine can make you feel drowsy, so it is best not to drive or operate machinery when taking the medication.
Other side effects of hydroxyzine include:
Selective serotonin reuptake inhibitors (SSRIs)
Selective serotonin reuptake inhibitors (SSRIs) are a form of antidepressant that increase the level of a chemical in your brain called serotonin. They can be taken on a long-term basis. As with any antidepressant, an SSRI will usually take several weeks before it starts to work. You will usually be started on a low dose, which is then gradually increased as your body adjusts to the medicine. Paroxetine is the most commonly prescribed SSRI for the treatment of GAD.
Common side effects of SSRIs include:
nausea low sex drive
diarrhoea or constipation
loss of appetite
insomnia (not being able to sleep)
When you start taking an SSRI, see your GP after two, four, six and twelve weeks to check your progress and to see if you are responding to the medicine. Not everyone responds well to antidepressant medicines, so it is important that your progress is carefully monitored. If your GP feels it is necessary, you may require regular blood tests or blood pressure checks when taking antidepressant medication. If, after 12 weeks of taking the medication, you do not show any signs of improvement, your GP may prescribe an alternative SSRI to see if that has any effect.
When you and your GP decide that it is appropriate for you to stop taking your SSRI medication, you will gradually be weaned off the medication by slowly reducing your dose. Never stop taking your medication unless your GP specifically advises you to.
Fear or phobia? Find out what the difference is and the treatments that can help you overcome them. A phobia is an anxiety disorder. It is an extreme or irrational fear of: an animal, object, place, or situation. Phobias are more than simple fears. They develop when a person begins to organise their life around avoiding the things they are afraid of. If you have a phobia, you will have an overwhelming need to avoid all contact with the source of your anxiety. Coming into contact, or even the thought of coming into contact, with the cause of your phobia will make you anxious and may cause you to panic.
If the cause of your phobia is an object or animal, such as snakes, and you do not come into contact with it regularly, it is unlikely to affect your day-to-day life. However, if you have a more complex phobia, such as agoraphobia (the fear of open spaces and public places), you may find it very difficult to lead a normal life.
Types of phobia. There are many different phobias, which can be divided into two main categories: simple phobias, and complex phobias.
Simple phobias are fears about specific objects, animals, situations or activities. Some common examples include: dogs, spiders, snakes, enclosed spaces, dentists, and flying. Phobias affect different people in different ways. Some people only react with mild anxiety when confronted with the object of their fear, while others experience severe anxiety or have a severe panic attack.
Complex phobias tend to be more disabling than simple phobias because they are often associated with a deep-rooted fear or anxiety about a particular circumstance or situation. Two common examples of complex phobias are: agoraphobia, and social phobia.
Agoraphobia is a fear of open spaces or public places and can involve anxieties about leaving the home, going into shops or travelling on public transport. It can also involve a fear of being unable to escape immediately to a place of safety, usually the home.
Social phobia is a fear of social situations, such as weddings, or performing in social situations, such as public speaking. People with a social phobia have a fear of embarrassing themselves or of being humiliated in public.
How common are phobias?
Phobias are the most common type of anxiety disorder. In the UK, an estimated 10 million people have phobias. Phobias can affect anyone, regardless of age, sex and social background. Simple phobias, such as a fear of going to the dentist, usually start during early childhood, often between the ages of four and eight. Simple phobias often disappear on their own as the child gets older and usually do not cause problems in adulthood. Complex phobias usually start later in life. Social phobias often begin during puberty and agoraphobia in the late teens to early twenties. Sometimes, complex phobias continue for many years. Almost all phobias can be successfully treated and cured. Treating simple phobias involves gradually becoming exposed to the animal, object, place or situation that causes fear. This process is known as desensitisation or self-exposure therapy.
Treating complex phobias often takes longer and involves talking therapies, such as counselling, psychotherapy and cognitive behavioural therapy (CBT). Medication is not usually used to treat phobias. However, it is sometimes prescribed to help people cope with the effects of anxiety.
Symptoms of phobias
A common factor of phobias is a need to avoid contact with the thing that causes fear and anxiety. How far someone with a phobia will go to avoid contact varies considerably from person to person.
For example, someone with a fear of spiders (arachnophobia)may not want to touch a spider, whereas someone else with the same fear may not even want to look at a picture of one. All phobias, particularly complex phobias such as agoraphobia (a fear of open spaces and public places), can limit your daily activities and may cause severe anxiety and depression.
Panic attacks are common among people with phobias. They can be very frightening and distressing.The symptoms often occur suddenly and without warning. As well as overwhelming feelings of anxiety, a panic attack can cause physical symptoms including: sweating, trembling, hot flushes, chills, shortness of breath, difficulty breathing, a choking sensation, rapid heartbeat (tachycardia), chest pain or a feeling of tightness in the chest, a sensation of butterflies in the stomach, nausea, headaches and dizziness, feeling faint, numbness or pins and needles, dry mouth, a need to go to the toilet, ringing in your ears, and feeling confused or disorientated.
In severe cases, you may also experience psychological symptoms such as: fear of losing control, fear of fainting, feelings of dread, or fear of dying.
Like simple phobias, complex phobias, such as agoraphobia and social phobia, can affect your wellbeing. Agoraphobia often involves a combination of several interlinked phobias. For example, someone with agoraphobia may also have a fear of being left alone (monophobia), a fear of situations where they feel trapped (claustrophobia) and a fear of going outside or leaving their home (agoraphobia). The symptoms experienced by agoraphobics vary in severity. Some people feel very apprehensive and anxious if they have to leave their home to visit the shops, whereas others may feel relatively comfortable travelling a short distance from their home.
If you have a social phobia, the thought of being seen in public or appearing at social events can make you feel very anxious and frightened. This is because these situations can make you feel vulnerable. Intentionally avoiding meeting people in social situations, such as at a dinner party, is a sign of social phobia. As with agoraphobia, in extreme cases of social phobia, some people are too afraid to leave their home.
Many people with a phobia do not need treatment and find that avoiding the object of their fear is enough to control the problem. However, with certain phobias, such as a fear of flying, avoidance may not always be possible, so you may want to get professional help and advice to find out about treatment options. Most phobias are curable, but no single treatment is guaranteed to work for all phobias. In some cases, a combination of different treatments may be recommended. The main types of treatment are outlined below.
Talking treatments are often very effective for people with phobias. There are several different types of talking therapy, including:
Counselling: a trained counsellor listens to your problems, such as feeling anxious in certain situations, and helps you to overcome them.
Psychotherapy: a psychotherapist uses an in-depth approach to find the cause of your problem and suggests ways to deal with it.
Cognitive behavioural therapy: a type of psychotherapy that explores your thoughts, feelings and behaviour in order to develop practical ways of effectively dealing with the phobia.
Many simple phobias can be treated using a form of behaviour therapy known as desensitisation or self-exposure therapy. It involves being gradually exposed over a period of time to the object or situation of your fear so that you start to feel less anxious about it. Sometimes, a combination of behaviour therapy and medication may be recommended.
Medication is not usually recommended for treating phobias because talking therapies are normally successful. However, medication is sometimes prescribed for treating the effects of phobias, such as anxiety. Three types of medication are recommended for treating anxiety. These are: antidepressants, tranquilisers, and beta-blockers.
Antidepressants are often prescribed to help reduce anxiety. Paroxetine (Seroxat), a selective serotonin reuptake inhibitor (SSRI), is licensed to treat social phobia. Citalopram (Cipramil) and escitalopram (Cipralex) are licensed for the treatment of panic disorder. Venlafaxine (Efexor) is licensed for generalised anxiety disorder (GAD). Common side effects of these treatments include: nausea, headaches, and sleep problems. Initially, they may make your anxiety worse. Clomipramine (Anafranil) is a type of tricyclic antidepressant (TCA) that is licensed to treat phobias.
Side effects include: dry mouth, drowsiness, blurred vision, tremors (shaking), palpitations (irregular heartbeat), constipation, and difficulty urinating. Moclobemide (Manerix) is a type of antidepressant from the monoamine oxidase inhibitors (MAOIs) group of antidepressants. It is sometimes prescribed to treat social phobia. Moclobemide interacts with certain types of food, so if you are prescribed this medication, read the information leaflet that comes with it to find out which foods you should not eat.
Other possible side effects include: sleep problems, dizziness, stomach problems, headaches, restlessness, and agitation. Antidepressants can cause withdrawal symptoms. If you are prescribed antidepressants, do not suddenly stop taking them. See your GP, who will lower your dose gradually over time.
Benzodiazepines are a group of medicines that are also known as minor tranquilisers. They are sometimes used to treat severe anxiety, but are usually only prescribed in the lowest possible dose for the shortest possible time. This is because they are associated with withdrawal and dependence problems. Benzodiazepines are usually only prescribed for a maximum of four weeks at a time. Like antidepressants, their use should be stopped gradually. Benzodiazepines that are commonly used include: diazepam (Valium), alprazolam (Xanax), chlordiazepoxide, clorazepate (Tranzene), lorazepam (Ativan), and oxazepam.
Side effects of these medications include: drowsiness, tiredness, and confusion. Two other types of tranquilisers that are licensed to treat severe anxiety are buspirone and meprobamate. Like benzodiazepines, they are only prescribed on a short-term basis. The side effects of meprobamate are similar to those of benzodiazepines. Side effects of buspirone include: nausea, dizziness, headaches, nervousness, and light-headedness.
Beta-blockers are commonly used to treat cardiovascular conditions, such as heart problems and high blood pressure (hypertension). They are also sometimes prescribed to help reduce the symptoms of anxiety, such as palpitations (irregular heartbeat). Beta-blockers slow down your heart rate and decrease your blood pressure. Propranolol (Inderal) is a beta-blocker that is commonly used to treat anxiety. Side effects include: stomach problems, cold fingers, tiredness, and sleep problems.
OBSESSIVE COMPULSIVE DISORDER
Obsessive compulsive disorder (OCD) is a chronic mental health condition that is usually associated with both obsessive thoughts and compulsive behaviour.
An obsession is defined as an unwanted thought, image or urge that repeatedly enters a person’s mind.
A compulsion is defined as a repetitive behaviour or mental act that a person feels compelled to perform. Unlike some other types of compulsive behaviour, such as an addiction to drugs or gambling, a person with OCD gets no pleasure from their compulsive behaviour. They feel that they need to carry out their compulsion to prevent their obsession becoming true. For example, a person who is obsessed with the fear that they will catch a serious disease may feel compelled to have a shower every time they use a public toilet.
How common is OCD?
OCD is one of the most common mental health conditions. It is estimated that about 1-3% of adults and 2% of children and teenagers have OCD. In men, OCD symptoms usually begin during adolescence. In women they generally start later, usually in the early 20s. OCD symptoms can begin at any time, including childhood. The symptoms of OCD can range from mild to severe. For example, some people with OCD will spend around one hour a day engaged in obsessive compulsive thinking and behaviour, while for others, the symptoms completely dominate their life.
The causes of OCD are unknown.
If left untreated, the symptoms of OCD may not improve and, in some cases, they will get worse. With treatment, the prognosis for OCD is good, and some people will achieve a complete cure. Even if a complete cure is not achievable, treatment can reduce the severity of a person’s symptoms and help them to achieve a good quality of life. A form of psychotherapy, cognitive behavioural therapy (CBT), can be very successful in helping many people with OCD.
Patterns of thought and behaviour
Most people with obsessive compulsive disorder (OCD) generally fall into a set pattern or cycle of thought and behaviour. This pattern has four main steps which are described below.
Obsession: your mind becomes overwhelmed by a constant obsessive fear or concern such as the fear that your house will be burgled.
Anxiety: this obsession provokes a feeling of intense anxiety and distress.
Compulsion: you then adopt a pattern of compulsive behaviour in order to reduce your anxiety and distress, such as checking that all your windows and doors are locked at least three times before leaving your house.
Temporarily relief: the compulsive behaviour brings temporary relief from anxiety, but the obsession and anxiety soon returns, meaning that the pattern or cycle begins again.
Almost all people have unwanted and unpleasant thoughts, such as a nagging worry that their job may not be secure, or a brief suspicion that a partner may have been unfaithful. Most people can usually put these type of thoughts and concerns into context and are able to carry on with their day-to-day lives. However, if you experience a persistent, unwanted and unpleasant thought that dominates your thinking to the extent that it interrupts your other thoughts, you may have developed an obsession. Some common obsessions that affect people with OCD are listed below.
Fear of being harmed.
Fear of causing harm to others.
Fear of contamination by disease, infection, or other unpleasant substance
A need for symmetry, or orderliness. For example, someone with OCD may feel the need to ensure that all the labels on the tins in their cupboard face the same way. Fear of committing an aggressive, or unpleasant, act.
Fear that you will commit an act that would seriously offend your religious beliefs.
Fear that other people will consider you to be a sexual deviant.
Fear that you will make a mistake that has serious consequences. For example, your house will burn down because you left the gas on, or all your possessions will be stolen because you forgot to lock your door.
Most compulsions arise from the initial obsession. In some cases, the type of compulsive behaviour is in some way logically connected to the obsession, such as repeated hand washing in order to prevent disease. However, in many cases of OCD, the compulsion has no logical connection to the obsession. Instead, it is a type of ‘magical’ or superstitious behaviour that the person believes has the power to prevent the object of their obsession from occurring.
For example, a person with OCD may feel compelled to count every red car that they see on the road because they believe that doing so will prevent their mother from dying in a car crash.
This type of ‘magical’, compulsive behaviour is particularly common in children with OCD. Although most people with OCD realise that such compulsive behaviour is irrational and makes no logical sense, they're unable to stop acting on their compulsion. Some common types of compulsive behaviour found in people with OCD include:
Checking that doors are locked, and that gas taps and light switches are turned off.
Cleaning and washing.
Repeating certain acts or rituals such as having to touch every second lamp post while walking down the street.
Constantly repeating certain words or phrases in your mind.
Hoarding or collecting objects that usually have no value, such as supermarket bags and junk mail.
If you have obsessive compulsive disorder (OCD), your recommended treatment plan will depend on how badly your OCD is affecting your ability to function. OCD that causes mild functional impairment is usually treated using a short course of cognitive behavioural treatment (CBT).
OCD that causes moderate functional impairment can be treated with a more intensive course of CBT, or the type of antidepressants known as selective seretonin reuptake inhibitors (SSRIs). Such cases may also require referral to a specialist mental health service. OCD that causes severe functional impairment will require referral to a specialist mental health service for a combination of intensive CBT and a course of SSRIs. Children with OCD are usually referred to a health professional with experience in treating OCD in children.
Psychological treatments for OCD.
CBT is the most widely used psychological treatment for OCD. It is based on the idea that most unwanted thinking patterns, beliefs, and emotional and behavioural reactions are learnt over a long period of time. The aim of CBT is to identify the thinking patterns that are causing you to have unwanted feelings and behaviour, and to learn to replace this thinking with more realistic and useful thoughts and beliefs.
Exposure and response prevention.
A particular type of CBT called exposure and response prevention (ERP) has successfully achieved this aim. ERP involve ‘exposing’ yourself to situations or objects that are currently causing you fear and anxiety. Exposure can be: Actual, such as handling dirty plates or using a public toilet. Mental, such as mentally picturing yourself forgetting to lock your door or leaving the oven on. Once exposure has taken place, most people with OCD will feel the need to engage in compulsive behaviour in order to reduce the anxiety that the exposure has caused them. However, the CBT therapist will work with you in order to prevent, or at least delay, this compulsive response. Over time, the exposure to an unpleasant object or situation will cause less anxiety and the need for a compulsive response will become weaker.
To begin with, your therapist will set targets for exposure that are relatively easy to cope with before moving on to targets that are currently causing you considerable anxiety. People with mild to moderate OCD will usually require about 10 one-hour sessions with a CBT therapist. Those with moderate to severe OCD may require a more intensive course of CBT lasting more than 10 hours.
Medication for OCD.
Selective serotonin reuptake inhibitors (SSRIs). SSRIs are a type of antidepressant that are usually recommended for people with moderate to severe OCD. You will normally need to take a SSRI for 12 weeks before you begin to notice any benefit.
Side effects of SSRIs include:
These side effects usually pass within a few weeks. There is a small chance that SSRIs will increase your feelings of anxiety, which may lead to you experiencing related suicidal thoughts and the desire to self-harm. Contact your GP immediately if you are taking a SSRI and you experience suicidal thoughts or the desire to self-harm. Most people with moderate to severe OCD are required to take SSRIs for at least 12 months. After that time your condition will be reviewed. If the condition is causing you no, or very few, troublesome symptoms, you may be able to stop taking SSRIs.
Clomipramine is a tricyclic antidepressant (TCA) that can be used as an alternative to SSRIs for the treatment of OCD. TCAs are not as commonly used as SSRIs because they cause more side effects. They can be effective in treating people with OCD who are unable or unwilling to take SSRIs.
Side effects of clomipramine include:
Clomipramine is not suitable for people with low blood pressure (hypotension) or heart disease. Therefore, if you are at risk of either of these two conditions, your GP may recommend a blood pressure test and an electrocardiogram (ECG) before you begin your treatment. As with SSRIs, you will usually be recommended to take a 12-month course of clomipramine, after which your symptoms will be reviewed.
Eating disorders are characterised by an abnormal attitude towards food that causes someone to change their eating habits and behaviour. A person with an eating disorder may focus excessively on their weight and shape, leading them to make unhealthy choices about food with damaging results to their health.
Types of eating disorders
Eating disorders include a range of conditions that can affect someone physically, psychologically (mentally) and socially (their ability to interact with others). The most common eating disorders are:
when someone tries to keep their weight as low as possible, for example by starving themselves or exercising excessively
when someone tries to control their weight by binge eating and then deliberately being sick or using laxatives (medication to help empty their bowels) binge eating, when someone feels compelled to overeat.
Eating disorders that do not fit with the above definitions may be described as: atypical eating disorders
eating disorders not otherwise specified
Causes of eating disorders
Eating disorders are often blamed on the social pressure to be thin, as young people in particular feel they should look a certain way. However, the causes are usually more complex. There may be some biological or predisposing (influencing) factors, combined with an experience that may provoke the disorder, plus other factors that encourage the condition to continue. Risk factors that can make someone more likely to have an eating disorder include:
having a family history of eating disorders, depression or substance misuse
being criticised for their eating habits, body shape or weight
being overly concerned with being slim, particularly if combined with pressure to be slim from society or for a job (for example ballet dancers, models or athletes)
certain characteristics, for example, having an obsessive personality, an anxiety disorder, low self-esteem or being a perfectionist
particular experiences, such as sexual or emotional abuse or the death of someone special difficult relationships with family members or friends
stressful situations, for example problems at work, school or university
How common are eating disorders?
Around 1 in 250 women and 1 in 2,000 men will experience anorexia nervosa at some point. The condition usually develops around the age of 16 or 17. Bulimia is around five times more common than anorexia nervosa and 90% of people with bulimia are female. It usually develops around the age of 18 or 19. Binge eating usually affects males and females equally and usually appears later in life, between the ages of 30 and 40. Due to the difficulty of precisely defining binge eating, it is not clear how widespread the condition is.
If it is not treated, an eating disorder can have a negative impact on someone’s job or schoolwork, and can disrupt relationships with family members and friends. The physical effects of an eating disorder can sometimes be fatal. Treatment for eating disorders is available, although recovering from an eating disorder can take a long time. It is important for the person affected to want to get better, and the support of family and friends is invaluable. Treatment usually involves monitoring a person’s physical health while helping them to deal with the underlying psychological causes.This may involve:
cognitive behavioural therapy (CBT): therapy that focuses on changing how someone thinks about a situation, which in turn will affect how they act
interpersonal psychotherapy: a talking therapy that focuses on relationship-based issues
dietary counselling: a talking therapy to help people maintain a healthy diet
psychodynamic therapy: counselling that focuses on how a person’s personality and life experiences influence their current thoughts, feelings, relationships and behaviour.
Anorexia Nervosa and Related Eating Disorders (ANRED).
Self-help tips: www.anred.com/slf_hlp.html
Advice beat (formerly the Eating Disorders Association) Helpline: 0845 634 1414 (Mon- Fri, 10:30-8.30pm, and Saturday 1.00- 4:30pm. beat youth helpline: 0845 634 7650 (Mon- Fri, 4.00-6.30pm and Saturday: 1.00-4:30 pm.) beat is an organisation that campaigns, that challenges the stigma faced by people with eating disorders and that gives people the help and support they need.
Eating Disorder Hope
American website offering information, eating disorder treatment options, recovery tools and resources to those suffering from eating disorders, their treatment providers and loved ones.
Tel: 0845 4647 (24hr)
Advice from a nurse on all health topics.
Bipolar disorder - previously known as manic depression - is a condition that affects your moods, which can swing from one extreme to another. If you have bipolar disorder you will have periods, or ‘episodes’, of depression and mania.
Depression and mania
The depression and mania that are associated with bipolar disorder are characterised as follows: depression - where you feel very low, and mania - where you feel very high; slightly less severe mania is known as hypomania. Both extremes of bipolar disorder have a number of other associated symptoms. Unlike simple mood swings, each extreme episode of bipolar disorder can last for several weeks or longer. The high and low phases of the illness are often so extreme that they interfere with everyday life. The depression phase of bipolar disorder often comes first. Initially, you may be diagnosed with clinical depression before having a manic episode some time later (sometimes years later), after which your diagnosis might change. During an episode of depression, you may have overwhelming feelings of worthlessness which often lead to thoughts of suicide. During a manic phase of bipolar disorder, you may feel very happy and have lots of ambitious plans and ideas. You may spend large amounts of money on things that you cannot afford. Not feeling like eating or sleeping, talking quickly, and becoming annoyed easily are also common characteristics of bipolar disorder. During the manic phase, you may feel very creative and view mania as a positive experience. However, during the manic phase of bipolar disorder, you may also have symptoms of psychosis (where you see or hear things that are not there).
How common is bipolar disorder?
Bipolar disorder is a relatively common condition with around one person in 100 being diagnosed with the condition. Bipolar disorder can occur at any age, although it often develops in people who are between 18-24 years of age. Both men and women, and people from all backgrounds, can develop bipolar disorder. The pattern of mood swings in bipolar disorder varies widely between individuals. For example, some people will only have a couple of bipolar episodes in their lifetime, and will be stable in between, while others may experience many episodes. Bipolar disorder is characterised by mood swings. The mood swings can range from extreme happiness (mania) to extreme sadness (depression). Episodes of mania and depression can often last for several weeks or more.
During a period of depression (low phase) your symptoms may include:
feeling sad and hopeless, lacking in energy, difficulty concentrating and remembering things, a loss of interest in everyday activities,
feelings of emptiness or worthlessness,
feelings of guilt and despair,
feeling pessimistic about everything,
being delusional, having hallucinations, and disturbed, or illogical thinking,
lack of appetite,
difficulty sleeping and waking up early, and suicidal thoughts.
The manic (high) phase of bipolar disorder usually follows 2-4 periods of depression and may include:
feeling very happy, elated, or euphoric (overjoyed),
talking very quickly,
feeling full of energy,
feeling full of self-importance,
feeling full of ‘great’ new ideas and having ‘important’ plans,
being easily distracted,
being easily irritated, or agitated,
being delusional, having hallucinations, and disturbed, or illogical thinking,
not feeling like sleeping,
not eating, and doing pleasurable things which often have disastrous consequences, such as spending large sums of money on expensive and, sometimes, unaffordable, items.
If you have bipolar disorder, you may have episodes of depression more regularly than you have episodes of mania (or vice versa). Episodes of depression and mania are sometimes punctuated by periods or ‘normal’ mood. However, some people with bipolar disorder can swing from highs to lows very quickly without having a ‘normal’ period in between. This is known as ‘rapid cycling’.
Bipolar disorder is a condition of extremes
A person with bipolar disorder may be totally unaware of being in the manic phase of the condition. After the episode is over, they may be shocked at their behaviour. However, at the time, they may think that others are being negative, or unhelpful. Some people with bipolar disorder experience more frequent and severe episodes than others. Due to the extreme nature of the condition, holding down a job may be difficult, and relationships may become strained. There is also an increased risk of suicide. During episodes of mania and depression, someone with bipolar disorder may experience strange sensations, such as seeing, hearing, or smelling things that are not there (hallucinations). They may also believe things that seem irrational to other people (delusions). These types of symptoms are known as psychosis, or a psychotic episode.
Treating bipolar disorder
If left untreated, episodes of bipolar-related depression, or mania, can last for between 6-12 months. On average, someone with bipolar disorder will have five or six episodes over a 20 year period. However, with effective treatment, episodes usually improve within about three months.
The majority of people with bipolar disorder can be treated using a combination of different treatments. These include: medicines to prevent episodes of mania, hypomania (less severe mania) and depression - these are known as ‘mood stabilisers’ and are taken every day, on a long-term basis, medicines to treat the main symptoms of depression and mania as and when they occur, learning to recognise things that ‘trigger’ an episode of depression or mania, and learning to recognise the signs of an approaching episode.
A number of medications are available to help stabilise mood swings. These include:
anti-convulsant medicines, and
Other treatments for bipolar disorder include:
psychological treatment (CBT) - to help you to deal with your depression and your other symptoms, and to provide you with advice about how to improve your relationships,
taking regular exercise - has been found to be an effective method of dealing with depression, planning activities that you enjoy and that give you a sense of achievement, and dietary advice - particularly in relation to effective weight management.
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