Living with depression - Tips for self care

 When you have depression or are suffering a depressive episode, it's sometimes very difficult to remember to take care of yourself. You might feel like you aren't deserving of feeling good and find it hard to motivate yourself to do anything, even things you used to enjoy. Here I've compiled a few points containing tried and tested ideas that might make living your life with depression, or perhaps another mental illness, a tiny bit easier. 

1.) Do not be afraid to ask for help - repeatedly.
Maybe you're the only person that knows about how difficult you're finding it to keep going. Chances are, you've been feeling the way you are now for a long while. Feeling down may seem normal to you; you've forgotten what it's like to enjoy life. Even if on the outside you appear to be keeping it together, as soon as you're alone you might feel isolated and afraid. It will be very difficult to convince yourself to do this, but honestly, telling someone about how you're feeling will likely be the best thing you've ever done. It could be a close friend, a family member, a work colleague, or anybody else who you might feel comfortable talking to. If you can't say it, write it down, send a text or a letter - any form of communicating your struggles is perfectly acceptable if it means that you don't have to keep everything bottled up in your mind. 

Perhaps, on the other hand, you've suffered and treated an episode of depression before and have found yourself in relapse. Remember how much easier it was last time after you were able to confess your concerns about your mental health to someone else? I'm sure you also remember how difficult it was and how much courage it required - but right now you need to focus on how much talking about your struggles has helped you in the past. 

If you don't know how the person will react when you confess your worries, you could perhaps give them some ideas on how they could help support you through it all. If you're not sure on how they could help, maybe send them a link to one of my previous blog posts on "How to help a loved one who is struggling with mental illness" - this can be found here: http://ignoranceisyourchoice.blogspot.co.uk/2014/10/rachaels-top-10-tips-how-to-help-loved.html

If you've already reached out and asked for help, don't be afraid to ask again. If you're feeling down, let someone know. It's always better to talk to someone about it.

2.) Visit your GP - repeatedly.
There are a number of ways in which your GP can help you with depression, and it is important to understand that the help they can offer isn't just in the form of medication. If you feel like some help from a medical professional could be beneficial, book an appointment. They can offer advice, give you information and even assist with disclosing your struggles with your workplace or educational institution to make your daily life easier.

If you do think that some sort of medication might be helpful for you, you can discuss this too. You will not be placed on a psychiatric medication such as an antidepressant if it is not what you want to do in terms of your treatment - it is your choice. But you should never feel like you are "not unwell enough" for medication or as though medication is only "masking the problem." Medication has been proven to be very effective in the treatment of depression and other mental health conditions; in fact, the most successful treatments usually consist of a combination of medication and some form of talk therapy / counselling.

If you've already been to see your GP, and have changed your mind about your treatment since that point, don't hesitate to book another appointment. If your current medication isn't working (after the initial 6-8 weeks) don't be afraid to ask about changing to something different or altering the dosage. You can work with your GP to find a treatment that suits you best - but be a "patient patient", because not everyone reacts in the same way to certain treatments and it could take a few different attempts to find the right medication for you.

(It took 18 months, 5 different antidepressants each at a variety of doses and also a course of Cognitive Behavioural Therapy before I started feeling a little bit more in control. But holding on and persisting has been worth it. I remind myself of this every day.)

3.) Look after yourself - Remember to do little things that may help.
It can be so difficult to want to look after yourself when you're feeling low, but it's important to try and do the little things that help ease the symptoms of depression. Here's a few ideas:

• Immerse yourself in a hobby like drawing, craft, learning a language or playing a musical instrument - this will pass some time and help you to feel productive. 
• Turn on the lights or open the window. 
• Get dressed and go outside if you can, even just for a 5 minute walk or for a relaxing few minutes in your garden, because getting a bit of fresh air will probably do you some good. 
• Stretch or learn a little bit of Yoga to help your body feel well if you are physically able to.
• If you are able to, try to exercise regularly. Even just going for a walk a few times a week can really help increase your energy levels.
• Learn some techniques for relaxation such as deep breathing and meditation. This can help to make you feel calm and can also be used to combat stress or in distressing situations.
• Have a quick shower to refresh you or a nice long bath to relax you. 
• Listen to music, read a book, watch a film or find a comedy series to watch on TV. If nothing else, it passes some time and keeps you nicely distracted.
• Perhaps invite a friend round so you can spend some time together, or go out for an afternoon coffee with someone. Even if you don't think you want to, spending time with people will often make you feel better. 

All of these little things will hopefully make you feel slightly better within yourself.

4.) Keep track of your appetite.
It may be the case that you're barely eating anything or you might be overeating - if any of these apply to you, make sure you try and stay in control.

If you have little to no appetite, just try and eat small things that you think you can manage. If you're not really in the mood for anything, try having soup or making fruit smoothies to drink; it will at least give you a little bit of energy and nourish your body. Depression can already contribute to low energy levels so not eating can make this worse. It's always best to try and eat several small nutritious meals instead of one very large meal - but if occasionally the only thing you can face is a huge, greasy takeaway then go ahead and treat yourself!

If, on the other hand, you're struggling with having "too much" of an appetite, try to eat slightly smaller portions so that you're not increasing your food intake too significantly. Slow down when you eat, so that you take time between each bite and notice yourself getting full.

Whether your appetite is affected by your mood or not, make sure you always try to eat well and drink plenty of cold water. Staying nourished and hydrated is very important for maintaining your energy levels and in turn your overall health.

5.) "Sleep Hygiene" - get into good habits.
With depression often comes insomnia (lack of sleep), hypersomnia (sleeping too much), or excessive daytime sleepiness. You know how much sleep you need to function normally, and you know when you're not sleeping well. "Sleep Hygiene" consists of a variety of practices that may be necessary for you to get a normal sleep that leaves you feeling refreshed. Here are a few ideas:

• Try not to nap during the day as it may help you to sleep better at night time
• Avoid caffeine - especially after 3:00PM. Remember that it isn't just coffee that contains caffeine - tea, coca cola, chocolate and some ice creams contain it too.
• Try to go to sleep and wake up at roughly the same time every day so that you establish a routine
• Make sure your bed is associated with sleep - it's preferable to not watch TV, do work, read books or listen to music in your bed because your brain may subconsciously associate your bed with these things instead of being asleep
• Try not to eat large meals just before you go to bed
• Take a (non-caffeinated) warm drink to bed, like hot chocolate or chamomile tea.
• Go outside during the day so that you have had some exposure to natural light. This will help your body and it's natural clock.
• Try to do a small amount of light exercise each day if you are capable, such as Yoga, Pilates, or walking.
• Try to resolve any current worries or anxieties before getting into bed so that you don't need to think about them whilst you're trying to go to sleep. You could do this by talking about them, writing them down and putting them away, or by a number of other methods. There is plenty of information available on various websites about this. 

Hopefully these tips can help you establish good sleep habits. If your sleep habits are disrupting your daily life it's important to speak to your GP about it in case there are any underlying health issues causing your problems.

6.) Keep some little things that make you feel good in an easily accessible place.
It might be that certain books, films, or music albums make you feel happy or distract you when you're feeling down. Maybe you have a favourite snack or drink that you can treat yourself to in order to cheer yourself up. Keep nice cards and notes from friends all together and read through them to remind yourself that you are loved. You could even put your favourite photographs into a photo album to remind you of happy memories. You could compile all of these "positive" items in a box or a bag that you can try to remember to look through when you're feeling low. The idea of a "Happy Box" was given to me by my good friend Sophie, who, when I was feeling very low with depression, filled a box full of happy things for me as a gift. (Sophie is awesome and everyone needs a Sophie in their life! Unfortunately though, my Sophie is mine, so you can't share her.)

Another idea could be to form a list of people who you can speak to if you're feeling low. If you have a few specific friends or family members who know about your difficulties and may be able to help cheer you up, have their names and contact details on a list or in a notebook so that you can always remember that you have people there for you. Call them, or send them a text or an email. They will likely be pleased that you thought of going to them for help; they won't think you're a burden or a nuisance.

7.) Challenge your negative thoughts
I've taken the following ideas for challenging your negative thoughts from http://www.helpguide.org/articles/depression/dealing-with-depression.htm because I feel that they've summed it up more effectively than I can! 

Ways to challenge negative thinking:

• Think outside yourself. Ask yourself if you’d say what you’re thinking about yourself to someone else. If not, stop being so hard on yourself. Think about less harsh statements that offer more realistic descriptions.

• Allow yourself to be less than perfect. Many depressed people are perfectionists, holding themselves to impossibly high standards and then beating themselves up when they fail to meet them. Battle this source of self-imposed stress by challenging your negative ways of thinking

• Socialize with positive people. Notice how people who always look on the bright side deal with challenges, even minor ones, like not being able to find a parking space. Then consider how you would react in the same situation. Even if you have to pretend, try to adopt their optimism and persistence in the face of difficulty.

• Keep a "negative thought log." Whenever you experience a negative thought, jot down the thought and what triggered it in a notebook. Review your log when you’re in a good mood. Consider if the negativity was truly warranted and ask yourself if there’s another way to view the situation instead.

Hopefully this post has shed some light on how to help yourself fight through your depression - or maybe it's given you an idea of what you can suggest to a friend who is suffering with their mental health. Self-care is very important for everyone and it can be very difficult to remember this when you're feeling depressed.

Remember to look after yourself! - Rachael x

Top 10 Tips: How to help a loved one who is struggling with mental illness.

 Today it's World Mental Health Day 2014! Personally I think that every day should be World Mental Health Day; in fact, every day should be "World Every-Person-Ever Day" because there shouldn't only be one specific day in a year on which we recognise the needs of other people. We should always be aware of the difficulties, discrimination and challenges that people different to ourselves face, and we should work to make others aware of this too. However, since the main focus of my blog as of late is mental health and the stigma surrounding it, I wanted to publish more posts on Mental Health to mark World Mental Health Day. 


 This is the first "Top Tip" post that I've written. I've put together my 10 top tips for those of you supporting someone who is suffering from mental health difficulties. You may have a friend, relative, or colleague who is struggling and you want to know how you can help - hopefully these suggestions can give you an insight into what you can do. Please note, though, that these tips are from my point of view - if you want to support your friend / relative further, ask THEM what they would like you to do in terms of helping them. Everyone is different and what may help one person won't necessarily work for someone else. 

1.) Let them know that you're there to listen whenever they need to talk about what's going on.

Don't pressure them into opening up to you, but make them aware that you care about them and you wouldn't mind listening if they would like to discuss how they're feeling. It likely won't just be once that they choose to talk to you about it - be prepared to listen to their worries regularly. Don't tell them only once that you want to help - tell them over and over; make sure they know that your offer to help hasn't "expired." People who struggle with mental illness often find it difficult to understand that other people are willing to listen to their thoughts, and they may feel like they're just repeating themselves. They may also be likely to withdraw from social groups or isolate themselves, so be persistent with expressing your concerns and willingness to help. Hopefully this will allow them to open up to you, and both of you will probably feel better for it!

2.) Don't feel like you need to give advice when they are talking to you about their feelings. Being a good listener is far more important than trying to "solve" their problems.

You may have some advice to give, but just remember that the most important thing is that you listen. "A problem shared is a problem halved" as the phrase goes, so by being there and listening you ARE being a huge help, whether you feel like you are or not. Don't judge them for what they're saying, don't challenge them unnecessarily - just listen and be supportive. By all means offer your own viewpoint on what they are saying, as this may encourage them to see the situation in a different light, but don't make their feelings seem invalid. Remind them that their feelings are completely real, and acknowledge their point of view; if you can, state a more rational or positive way of looking at it and encourage them to think about it that way too.

3.) Ensure them that it IS possible for them to feel better than they are feeling currently, even if they can't imagine it right now.

Not all mental health conditions can be completely recovered from, but they can be effectively managed with the right support and treatment. The sufferer may be nervous that they will feel the way they currently do for the rest of their life; inform them that this won't necessarily be the case. Acknowledge that they may not be able to imagine or believe it now, but let them know that it IS possible for them to feel better.

4.) Suggest that they make a visit to a GP, Mental Health Professional, or Counsellor; If they already use these services, regularly encourage them to continue using them even if they feel like they don't want to / can't be helped. 

It may be that your loved one has never spoken to a professional about how they're feeling - if they haven't, and have been feeling like they have a problem for more than a couple of months, then you should perhaps encourage them to make an appointment with their GP. Reassure them that going to see their GP doesn't necessarily mean that they will be put on medication or referred to a mental health team, The idea of these things may seem quite daunting at first - remind them that their treatment plan is in most cases their choice. Offer to go to their appointments and wait outside, or ask them if they'd like you to sit with them throughout. Sometimes the person might be too nervous or unwilling to go alone.
If they already see their GP, therapist, or other professional - encourage them to keep attending their appointments. If one doctor or counsellor didn't have the intended effect, encourage them to see a different one. Sometimes people might see several GP's or therapists before finding someone who they can feel comfortable talking to. And if they're on medication, make them aware that not all medications have the same effect in different people, so if one drug hasn't worked it doesn't mean that no drug is going to help.

5.) Set an example - Don't be a hypocrite! 

This is perhaps more important for those who spend extended amounts of time with an individual struggling with mental health problems. Take care of yourself, talk about your own concerns and problems, keep up hobbies, and eat well. This will show your loved one who is struggling that it is OK to need to take care of themselves and talk about their problems - and it may encourage them to keep or find new hobbies and eat well too.

6.) Make plans to do activities with them that you know they'll enjoy, but be understanding if they later cancel because they don't feel up to it.

Don't assume that because they're not feeling too great, they don't want to do anything. Quite often this is the exact opposite of the truth! Suggest a day out to somewhere that they'll like, a trip to the cinema, a movie night or even just a long walk. They might want to use this opportunity to talk about how they're feeling; conversely they might want to use it to forget about how they're feeling just for a little while. Not every conversation or activity has to be something related to their difficulties - sometimes putting their struggles to the back of their mind for a day is exactly what a person with mental health difficulties needs. If your loved one cancels a day out on short notice, be understanding about it. Suggest a less taxing thing to do, or offer to spend the day with them at their own house instead - but don't be offended if they decline. Chances are that they would rather just take some time to themselves, and sometimes this is completely necessary. Be persistent, though - rearrange for another day and don't just stop asking. If you had something special planned for a particular day and your struggling loved one doesn't want to go, take someone else instead - there isn't any reason that you should miss out too.

7.) Make sure they are aware of helplines they can call or actions they can take in a mental health crisis. The exact advice you give for this will depend on their specific condition and you may need to do some research yourself.

I've taken the definition of a Mental Health Crisis from 'Mind', found here. 

Mental health crises include:

suicidal behaviour or intention

panic attacks/extreme anxiety

psychotic episodes (loss of sense of reality, hallucinations, hearing voices)

other behaviour that seems likely to endanger yourself or others.

If you go onto the local council website for your loved one, you'll be able to find a contact number for their local crisis team. They are usually 24/7 helplines for anyone experiencing the symptoms listed above, or similar, to use. Another helpful one is The Samaritans. They can be contacted via email, telephone, in person or by post, and information on how to do so can be found if you click here. If your loved one has no minutes or credit on their phone, they can ring and ask for their freephone number. 

8.) Take the risk of suicide very seriously.

If you are worried about someone and think they may be feeling suicidal, don't worry that asking them if they are considering suicide may give them the idea. If anything, asking them whether they are having thoughts like that may actually encourage them to talk to you about it instead of keeping it to themselves - and that may just save their life.It is a myth that those who speak about suicide are not likely to attempt it. In fact, the majority of people who complete suicide have tried to ask for help with their thoughts prior to their death. To be considering suicide your friend / relative must be in a very difficult place in their mind, and the last thing they need is for you to be angry or dismissive of their thoughts. Oftentimes, the suicidal person does not want to die; rather, they just want their pain to end - remind them that suicide is permanent and their pain may not be.

If your friend or relative is talking about suicide, make sure you do not shun their feelings or make them feel like they are overreacting. Listen to them, and if you think they are at immediate risk then ask them to go to the hospital or use one of the contact points listed in (7) above. If they tell you that they have already taken actions that are harmful, take them to the hospital or if this is not possible, encourage them to do so or ask someone else to take them. If no one can take them and they are refusing to go themselves, and you know their address, ring an ambulance or paramedic team and tell them that you believe someone at the address may have tried to complete suicide. Don't do this without telling your friend - make sure they are aware of the actions that you have taken. They may lash out in anger - don't take it personally, they will understand later why you have tried to help.

Warning signs of suicide include: preoccupation with death, having an overall negative attitude towards their life, or withdrawing from friends and family. Strangely, though, another common warning sign is sudden contentment after a long period of feeling suicidal. They may have the idea in their head that they won't be in pain for much longer if they have already made the decision to attempt to end their life, and this might be comforting to them. If you are worried, talk to them and tell them so.

9.) Make sure your expectations are reasonable. Don't expect them to feel better quickly and don't blame them if they are not making progress.

Mental illness is, in a lot of cases, a persistent problem. If you are expecting your loved one to improve overnight, you're going to be disappointed. Similarly if you're expecting that your help and support will "fix" them then again, you are wrong. It may be very frustrating for you if they are not improving, especially when you are helping them as much as you can, but chances are it's much more frustrating for them! It is not your responsibility to make them feel better, so don't feel like you are failing them if they are still not feeling good. And remember that it isn't their fault that they aren't better. Sometimes a persons lifestyle doesn't help with their mental health conditions - if this is the case, perhaps suggest improvements to their lifestyle. An example of this would be, if they drink a lot of alcohol or have a tendency to take drugs, you could encourage them to cut down on their intake. Either way, make sure that you are patient with them throughout their recovery, and if they appear to be taking steps backwards, don't blame them for it. 

10.) Take care of yourself too! Don't do more for your loved one than you are comfortably capable of doing. You know your own limits - don't exceed them. 

Gently talk to them if they are asking too much of you - don't think you will offend them, they will respect that you need to take time for yourself too. Sometimes when a loved one is depressed, your own emotional health can suffer - and that is the last thing you need! Set boundaries that are clear if you feel that you are at risk of pushing yourself too hard to help them, and don't hesitate to seek support yourself. It might help you to confide in someone else about how you are helping a friend / relative that is struggling - that way, they know to look out for you too. Some people find it useful to speak to a counsellor themselves about how to support their loved one through their mental health problems - don't feel like this isn't an option available to you. It would definitely benefit both of you. 

Good luck, and I really hope this either enables someone to start helping their loved one, or confirms for someone that they are doing the right things to help. 
- Rachael x