How to spot the signs of depression

Are we depressed AND how do we spot the signs of depression?

Covid is hitting our mental health hard. And as we endure another lockdown in the peak of a pandemic at the height of winter, it’s not hard to see why so many of us are feeling low. But are we actually depressed?

We spoke to Seed’s Clinical Psychologist, Dr Anouk Houdijk, to find out how to spot the signs of depression and what we can do to help safeguard our mental health.

A recent study showed that 1 in 5 adults are suffering with some form of depression compared to 1 in 10 before the pandemic. How do you think the pandemic has affected people’s mental health?

Covid has affected us all in many different ways. We have experienced a loss of our personal freedoms and many barriers now exist between ourselves and our outer world – masks, plastic screens at shop counters, the inability to physically connect with others. We are also experiencing unprecedented change and uncertainty in our work and home lives, as well as being concerned for those we love.

These accumulative and persistent stresses trigger the sympathetic ‘fight or flight’ side of our nervous systems which, over time, shows up in our bodies and minds in various forms, from inflammation and fatigue to anxiety and low mood.

Being in lock down can also exacerbate existing difficulties, where previously we had ways of distracting and even numbing ourselves from aversive feelings and situations, now we can’t get away from those niggles. This coupled with shorter days, less sunlight and Vitamin D is inevitably going to impact our state of mind.

In the mind, these accumulative and interacting stresses, can manifest in increased unhelpful thinking patterns such as rumination (going over and over a worry or thought), catastrophising (thinking of the worst outcome) and all or nothing thinking, which in turn affect behaviour. These patterns are universal and are a result of “quirks of the mind” so to speak; they are not our fault, but they can cause even further lowering of mood and difficulties.

How do you spot the signs of depression and subsequently diagnose it? What tells you that a person is depressed as opposed to feeling generally down due to current circumstances?

To be diagnosed with depression, practitioners use specific criteria set out by regulatory bodies such as WHO that look to identify a range of symptoms presenting in mood, thinking patterns, appetite and sleep. These symptoms have to have been ongoing / pervasive for at least 2 weeks, where the impact on your life has been significant.

Diagnosis is quite stringent. But that doesn’t mean you can’t or shouldn’t act if you are struggling with low mood. You don’t want to wait until you are in that clinical range before you ask for help.

We are all more vulnerable to poor mental health right now. How can we best bring ourselves out of a negative mindset so we don’t spiral downwards?

One of the first things you will be advised to do by a mental health practitioner is to be more active in order to start activating the body’s systems and to reconnect to things that are important to you. This will help you start to have more positive experiences, which in turn will support your body in releasing all those feel-good hormones that help shift you into a more positive mindset.

It’s important to remember however that we shouldn’t be apologising for ordinary emotional responses to an extraordinary situation. Actually, it’s very appropriate for all of us to feel lower in mood in this pandemic. This is real stuff. There’s a grieving that’s happening here with our loss of connection with others and our lives as they were before. Our fluctuating reactions to this – frustration, anger, sorrow, anxiety, confusion – are really normal and human. We don’t need to battle against that or think that we should somehow be coping in a different or “better” way.

Indeed, the most helpful response to these emotions would be to turn towards them with warmth and self-compassion. So, rather than criticising yourself for your low mood, use a warm, kind approach to yourself and speak inwardly with language that is positive, nourishing and soothing. Think about what you would you say to a friend if they were feeling low. Ultimately be your own best friend.

We are constantly bombarded with bad news. Would you say that an otherwise healthy mindset is vulnerable to this onslaught of negative narrative that is filling our airtime right now?

Absolutely. Why? Because it activates the stress response. And if this is being triggered all of the time, we know that’s not good for our bodies or our minds. For me, from personal experience, at the beginning of the first lockdown I was glued to the TV watching what was going on and this really affected my sleep and the knock-on effect on my mood and my perceived ability to cope was clear. Once I began managing my news intake it improved.

The focus is very threat-based in the media; we are literally counting the death toll on a day to day basis. Now I check headlines on my phone in the morning; not even every morning. I manage how much exposure I am getting to daily news and the fear that comes with that.

What else can people do to help themselves? Should we all be creating more robust filters to protect our own mental health / state of mind?

• Manage your news intake. Step away from the barrage of bad news, particularly if you know it’s affecting your mental wellbeing. While you can’t control what goes on outside, you can control what goes on inside.
• Manage your time on devices, ie how much you use your phone and spend time on social media (research shows that too much time on the likes of Facebook actually dampens mood). Think about when you use your phone. For instance, at the end of the day or when you are already in bed will inevitably impact your sleep.
• Have quality down time. Go for a mindful walk. Lie down to breathe and rest rather than jumping on Facebook.
• Build your self-compassion. This doesn’t necessarily come naturally. But being kinder to yourself is something you can cultivate over time. Acknowledge that you deserve to be happy
• Take a look at these “top tips” from myself and my Seed colleagues, for supporting your mental health.

What further tips, tools and techniques can you suggest for coping with / alleviating depression or low mood? 

• Connect with others in a meaningful way. Reach out to someone you miss and let them know you are thinking of them. By design, we are not meant to be so disconnected from others. This will help them too; doing things for others is a great way to boost our happiness.
• Focus on the 4 Pillars of Health – good nutrition, quality sleep, regular exercise and mindful relaxation
• Practice mindfulness. With depression, we see specific types of negative thinking patterns. For instance, we label things and ourselves negatively and this affects our confidence and self-esteem. The best way to get out of these unhelpful thinking traps is to first become aware of them. Mindfulness helps you do that. If you spot a negative thought, you can challenge it, look at it more objectively and subsequently shift the dialogue. A wonderful side effect of mindfulness is feeling relaxed and calm.
• Engage with activities you love and which make your life more meaningful such as Tai Chi, painting, cooking, singing or whatever else you enjoy. You Tube is a great free resource for learning new skills
• Use activity as your medicine. Even those things that may not be enjoyable such as cleaning out a cupboard, going for a walk or even having a shower can give you a sense of mastery and satisfaction.
• Use positive affirmations. What we think translates into how we feel. The good news is we can train our thoughts, which is empowering. Ultimately, we are not our thoughts. For example, try the mantra, “May I be happy, may I be healthy, may I be free from suffering’. Repeat 10 times. Affirmations are found in Buddhist and Eastern teachings, which draw on age-old wisdoms in a way that is helpful for the human mind.
• Challenge negative thoughts. Call out your catastrophies as such and make a commitment to stop rubbishing yourself. Once you get onto the treadmill of negative thinking, it’s hard to get off. Even if you don’t feel positive inside, over time, thinking positively will become your default setting. It may not feel natural to start with. But anything you do that is new such as learning an instrument or a dance takes practice before it doesn’t feel alien anymore.
• Gratitude Journaling. Keeping notes of 3-5 things that you are grateful for each day has been shown to have a positive effect on mood. You can collect these in a jar / in a book (perhaps get he family involved – kids say the most wonderful things for this) so you have a resource to turn to in darker moments. The depressive mind tends to look in one direction at things that will confirm its depressive state. Logging those positives will help to reframe your perspective.
• Engage in more helpful rather than harmful thoughts and actions. Ask yourself “Is this (thought/ action) helpful or harmful?”. This technique can be really powerful in helping you grow your awareness around behaviours and thinking patterns which are not serving you and may be making things worse.
• Journal your thoughts. Keeping notes of things that you are happy about is an effective tool. Write down what is going well and what you are grateful for. The depressive mind tends to look in one direction at things that will confirm its depressive state. Logging those positives will help to reframe your perspective

Not everyone can afford to visit a mental health practitioner. Which charities people can turn to if they don’t have the funds for a therapist?

There are some great charities out there that can help. Don’t suffer alone. Reach out for help if you need it.

• Buckinghamshire Mind
• Depression alliance.org
• Bucks Recovery College – free courses to those who fit the eligibility criteria to help them recover from mental health difficulties. Don’t be alone. Go and link in with others.
• To learn more about cultivating compassion, visit the Compassionate Mind Foundation website.

Dr Anouk Houdijk is Seed’s Clinical Psychologist based in Marlow. Please get in touch if you would like help spotting the signs of depression & support in dealing with it.