The word depression is used in many different ways. Everyone can feel ‘blue’ when bad things happen. People with the 'blues' may be depressed short-term, but will generally manage to cope with their feelings and recover without treatment. The type of depression described on this course is clinical depression. Clinical depression lasts at least two weeks, and affects the person's behaviour and has physical, emotional and cognitive effects. Depression is a common but serious illness, and can be recurrent.

TWELVE common symptoms of clinical depression:

1. An unusually sad mood that doesn’t go away.
2. Bursting into tears or crying for no apparent reason.
3. Loss of enjoyment and interest in activities that used to be enjoyable.
4. Lack of energy and tiredness.
5. Loss of confidence.
6. Feeling guilty when they are not really at fault.
7. Suicidal thoughts.
8. Looking unkempt.
9. Be slow moving or speaking slowly.
10. Difficulty in concentration and decision making.
11. Difficulty in sleeping, or sleeping too much.
12. Loss of interest in food or eating too much. Changes in eating habits leading to loss of weight OR putting on weight.

LEVELS OF DEPRESSION

1. MILD DEPRESSION - FOUR out of at least 10 of the above symptoms over the last 2 weeks
2. MODERATE DEPRESSION - SIX out of at least 10 of the above symptoms over the last 2 weeks
3. SEVERE DEPRESSION - EIGHT out of at least 10 of the above symptoms over the last 2 weeks

EFFECTS OF DEPRESSION

There are FOUR main effects of depression:

1. EMOTIONAL - Effects on emotion include sadness, anxiety, guilt, anger, lack of emotional responsiveness, helplessness, hopelessness.
2. COGNITIVE - Effects of thinking include self-criticism, self-blame, worry, impaired memory and concentration, indecisiveness and confusion, tendency to believe that others view you negatively.
3. BEHAVIOURAL - Effects on behaviour include crying spells, withdrawal from others, neglect of responsibilities, loss of interest in personal appearance, loss of motivation.
4. PHYSICAL - Physical effects include chronic fatigue, lack of energy, sleeping too much or too little, overeating or loss of appetite, constipation, irregular menstrual cycle, loss of sexual desire, unexplained aches and pains.                                 

Also, if dealing with people from different nationalities or cultures, be aware of cross cultural variations; people from different cultural backgrounds may express signs and symptoms of depression differently, and often through expression of feelings of isolation, shame and/or guilt, or in physical terms.

FIRST AID FOR DEPRESSION

ACTION 1 - Approach the person. Assess and assist with any crisis.

If you think someone you know may be depressed and in need of help, approach the person about your concerns. Try and organise a suitable time and somewhere quiet where both of you feel comfortable. Let the person know that you are available to talk when they are ready. It can be helpful to let the person choose when to open up. However, if the person does not start a conversation with you about how they are feeling, you should initiate the conversation. Respect the person's privacy and confidentiality unless you are concerned this person is at risk. If you have no concerns that the person is in crisis, you can ask them about how they are feeling and how long they have been feeling that way then move on to:

ACTION 2 - Listen and communicate non-judgementally.

Listening and communicating non-judgementally is one of key basic steps in the mental health first aid action plan. Try to ask open-ended questions which allows the person the opportunity to deliver more relevant information to help you understand and assess the situation. Listen to really hear and understand exactly what is being said, and enable the person to talk freely and comfortably without the feeling of being judged. Professional mental health workers and counsellors are trained in non-judgemental listening. This course does NOT give you the same depth and experience as a professional mental health worker, however Mental Health First Aiders need to be aware of this type of approach and increase their skills in this area, and in doing so it will help your confidence and increase your experience when dealing with any crisis and assessing any situation. 

ACTION 3 - Give Support and Information

Once you have listened to their concerns and given them the chance to express their difficulties, you can begin to discuss options that may be available to them. Having listened to them will allow you to have a better understanding of what support or information could be helpful to them. Help the person to feel hope and optimism, and to realise depression is a common mental health issue and effective treatments from either a GP and/or other sources of support. It is important to remind them that they have a health issue and they are not to blame for feeling down. Depression is not laziness, and it can be difficult for them to feel motivated. People with depression have irrational fears. You should accept the person as they are and have realistic expectations for them. Offer empathy, compassion and patience. Ask the person if they would like any information about depression. If they do, it is important that you give them resources that are accurate and appropriate to their situation. It is important not to get over involved or over protective, as this will not help the situation, nor will the attitude of “snap out of it.” Resist the urge to try and cure the person's depression, or to come up with answers to their problems.

ACTION 4 - Encourage the person to get appropriate help

Everybody feels down or sad at times but it is important to recognise the signs of when depression has become more than temporary and should seek professional help. Professional help is necessary when depression has lasted longer than a few weeks and affects a person from functioning normally. Many people with depression will not seek professional help immediately. Even when people do decide to seek help, they could wait many years before doing so. These delays can affect their long term recovery. People with mental health issues are often more likely to seek help if someone close to them suggests it. You should ask the person if they need help to manage how they are feeling. If they feel they do need help, discuss the options available. If they don’t know where to start, offer to help them seek assistance. It is important to encourage the person to get appropriate professional and effective treatment as early as possible. Depression is not always recognised by a professional, so bear in mind that it might take some time to get a diagnosis and find a professional that they can find a good rapport with. You should encourage the person not to give up seeking appropriate professional help including asking for a second opinion if this is necessary.

ACTION 5 – Support and Support Groups

It is important for a Mental Health First Aider to promote support for the person experiencing depression by encouraging them to talk to friends and family. They can help by listening without judging or being critical, by checking to see if they are feeling suicidal and encouraging the person to get help. Some people who experience depression find it helpful to meet with other people who have had similar experiences. There is some evidence that such peer support groups can help with recovery of depression and anxiety. Hearing or reading about other people’s experiences can help validate their own feelings. Self help can include:

• Diet & Exercise
• Yoga Relaxation therapy
• Massage Therapy 
• Creativity - writing, drawing, painting, music

These are various different strategies a mental health first aider can suggest to someone who’s struggling with depression as a stepping stone to recovery before receiving professional help.

Professionals that can help with depression

Many people who experience depression will turn to their GP first for professional help. GPs can make a quicker diagnosis if the person tells them directly that they believe that they are depressed. A GP should take the time to listen to the person, and take into account the person's treatment preference. A GP can provide the following types of help:

• Look for a possible physical cause, e.g. side effects of medication or physical health conditions.
• Refer the person to a specialist mental health service, including psychological therapies and psychiatrists if necessary.
• Self- help material like books, computer-based therapies like Cognitive Behavioural Therapy.
• Prescribing medication like antidepressants. 

Other Treatments

• Counsellors, Psychotherapists and Clinical Psychologists - These professionals specialise in mental health issues. They are not medically qualified so cannot prescribe medication, but provide opportunities to talk about problems, listen to the person and provide specific methods for overcoming depression and preventing recurrence.
• Antidepressants - medications used to treat major depressive disorder, some anxiety disorders, some chronic pain conditions, and to help manage some addictions. 
• CBT Cognitive Behavioural Therapy - When people get depressed they tend to think negatively about most things and develop unhelpful thinking patterns. CBT helps to change those negative thoughts into positive and realistic thoughts.

What if the person does not want professional help?

The person may have various reasons why they do not want to seek help. These reasons could include:

• Cost
• How long they have to wait
• Not having a doctor they like
• They may be sent to hospital
• Stigma relating to depression and professionals being non- judgemental.

If the person still does not want to seek help after you have explored the reasons as to why, let them know if they change their mind in the future that they can contact you at any time. You must respect their right not to seek help unless you feel they are a danger to themselves or others.