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Understand and Prevent Depression

(46) Depression

Requiem - A Short Film About Teen Suicide

Depresion46

Suicide

 Suicide is a tragic event and leaves the family with lots of unanswered questions.

 How often does depression lead to suicide?

Suicide is sadly sometimes the outcome of depressive illness. Some people can be terminally ill with their depression. No matter what the person tries to do, to overcome their illness, no matter what help and care relatives and friends give, and no matter how skilled the medical intervention, some people will killthemselves. Suicide is totally final. It is the one solution that offers no other options, no chance for change, no future. Those

left following the suicide of a loved one are left dealing with a huge range of feelings, many of which can never be fully resolved.

How to get help in an emergency

Call Emergency Hotline for general advice on how to get access to health services.

Make an appointment to see your doctor, for medical help, if you need to start talking to someone who may be known to you.

Ask to speak to your doctor urgently, that same day, if you feel like harming yourself.

Ask to see a psychiatrist. Your doctor will usually start the assessment and treatment process. He or she can contact psychiatric help in an emergency.

Ask to speak to a CPN (or other Mental Health Team member known to you). If you are in contact with an MHT, discuss what to do in the event of a crisis. There may be a crisis line number locally, or a Crisis Team. Some people will have a crisis plan.

Call the Samaritans, if you need to talk to someone now about how you feel. (Sometimes a stranger can be easier to talk to than someone you know.)

Call Emergency, if someone is about to, or has already attempted selfharm, or tried to harm another person.

Attend an Accident /Emergency Department, if injuries or an overdose have occurred, or if someone appears unsafe.

Call the police, if there seems to be any risk of violence or injury occurring.

Call the Social Services Emergency Team, if you are concerned about the care or well-being of children. Approved Social Workers will also help when an urgent Mental Health Assessment is needed.

About 5000 people die by suicide in the UK each year. Most will be linked with depressive illness. The suicide rate in the UK is one of the lowest in the world at approximately 11 male deaths per 100,000 and approximately 4 female deaths per 100,000. It ranks sixth as a cause of death. There are many more deaths from heart disease, cancer, chest disease, accidents and strokes. Suicide is most common in elderly, lonely men. The suicide rate in young men is, sadly, increasing rapidly.

What sort of people kill themselves? Is there a stereotype for suicide?

Not really. It is very dangerous to assume that just because someone does not fit stereotypes they are safe. It is estimated that approximately 95% of people who kill themselves are mentally ill, over two-thirds of them will be suffering from depression and about 15% will be suffering from alcohol dependence. Men are more likely to kill themselves than women and they are normally older men – nearly half of the male suicides occur in men over 50 years old. Rates of suicide are highest in the divorced and widowed – especially the recently bereaved. Married people have the lowest death rate. Suicide is more common in the spring. Nobody is really sure why this is. Perhaps the contrast of feeling so bad, when the rest of the world is changing and growing, is particularly painful. Being unemployed and living in the city rather than the country are also risk factors.

Social class has an effect – people in the highest and lowest social classes have increased rates of suicide. It is protective to be in the middle classes. Some professions are particularly at risk, for example doctors, dentists, vets and farmers, and people working in the hotel and bar trade. Strong religious convictions lessen the rate of suicide.

Will asking about suicidal thoughts make things worse for the depressed person?

No. Asking about it can be an enormous relief to someone struggling with suicidal thoughts. It will not encourage them to act on their thoughts. If you think somebody may be thinking about suicide, always ask and always encourage them to seek help urgently. Suicidal thoughts usually evolve fairly slowly. There can be a period of thinking in general terms about death, about how it may seem easier if, on sleeping, they never woke up. Accidents could seem to be ‘lucky accidents’ and a way out. These thoughts can then progress into more concrete plans. At no stage in the development of these thoughts is it too late to intervene and help. Always take statements about wanting to die by suicide seriously. Never assume that, because someone has talked about it, they will not do it.

People who talk about self-harm need to see a doctor; make sure that they do so. Talking to a friend or relative who feels like this is absolutely exhausting. Look after yourself very carefully too.

My daughter took an overdose. and was treated in Casualty. They had to wash her stomach out. It was a really horrible experience for all of us. Does such an awful experience make it less likely that she would do anything so silly again?

The psychiatrist saw her and said she was distressed rather than actually ill. Once people try to harm themselves, once they have gone that far and stepped over the limit that we all have built into ourselves, they are actually more likely to try to harm themselves again if their lives don’t change. The important thing for you to do is to see that your daughter knows she has other ways of letting out her bad feelings. Talking to family and friends can be just as important as seeing a counsellor. Experiences in the Casualty Department are unlikely to stop the behaviour. The underlying difficulties and problems need to be addressed.

How do psychiatrists decide who is really at risk of suicide? How do they tell when an overdose is serious?

We have to regard all overdoses as serious and everybody who takes an overdose, however small and apparently trivial, should be assessed in hospital.

People at risk include those who:

• have a diagnosable psychiatric illness, such as depression or psychosis;

• have had previous attempts at harming themselves;

• have actually caused them some harm;

• have other serious physical illnesses;

• misuse alcohol or drugs;

• have taken precautions against being found;

• have made preparations such as writing letters or notes;

• have made detailed plans;

• have given away possessions;

• have talked repeatedly about suicide;

• tend to be impulsive and aggressive, and

• are lonely and isolated without much social support.

The assessment after deliberate self-harm is an assessment of the balance of risk. All the above factors are examined and weighed up. This assessment is not, unfortunately, infallible.

We were terribly worried about my mother who was very depressed and tried to harm herself. She’s been in hospital for two weeks and already seems much brighter now that she’s started treatment. Does this mean that the risk of suicide has passed?

It is early days, and it’s too soon to be sure that the worst of the risk is over. If she had severe depression, she may improve quite noticeably in the first couple of weeks of treatment, but will not be safe yet. Sometimes getting more energy and drive can actually mean that she is actually at greater risk as she might get enough drive to carry out her wish to harm herself. Talk to the ward staff who are best placed to advise you how she isprogressing. It may be some time yet before they are happy to let her leave the ward, even briefly.

Will somebody who has taken an overdose go on to do it again?

Unfortunately some people will – about 15% will repeat it within the next year. There is more chance of repetition of deliberate self-harm if the episode was not obviously linked to a situational crisis or the use of alcohol or drugs. There is more chance of repetition if the person has few social supports, is in the lower social class and has been separated from a partner. There is an increased risk of repetition if there is a history of psychiatric treatment. It can be difficult sometimes to assess someone following deliberate self-harm. When people are referred to the casualty department, having taken an overdose, their medical state is dealt with and they are made physically safe. There then follows an assessment of their mental state. This is essentially weighing up the balance of risks. Another very important part of the assessment is deciding whether or not the person is currently mentally ill (rather than very distressed, without illness).

My mother had many spells of depression, and finally took a fatal overdose. What can we tell our children?

When somebody dies under tragic circumstances, such as a sudden illness, accident, or worst of all, by their own hand, then the loss is much tougher for everybody to deal with. Suicide is fortunately rare. We know that most people who do kill themselves are indeed suffering from depression (and in this book we repeatedly emphasise how important it is to have depression fully treated, because there is strong evidence that treatment can prevent self-harm and suicide). Sadly, in a small minority of cases, even when depression is treated, a depressed person will attempt self-harm, maybe fatally.

This is the sort of situation where there are no clear guidelines. You certainly won’t want to break this sort of bad news explicitly to a young person unless you are sure that they need to knowabout it – and are able to deal with it. Mature teenagers may want to find out for themselves what actually happened, and may well resent not being told the truth.

Family secrets are difficult things to keep. Very young children may have paid little attention to the loss of their grandmother. Older children and teenagers may have heard details of what happened at the time, or they may well pick up facts later. If you do need to explain to a young person what happened, remember that this will raise all sorts of painful feelings, not least of all anger.

Family may feel deserted or hurt by their dead relative, and may feel guilty or angry about what happened – angry with the deceased person, with other family members, or with themselves. Young people may show this in different ways, by changes in mood or by difficult behaviour. If the time does come when you have to discuss this with your family, emphasise that she had an illness, and that it was the illness that is to blame for taking her life. Remind your family to recall happy times they had together in the past, rather than today’s sadness, and make sure that you are around to give support to each other.

Grieving after bereavement is a natural process that takes time. If difficult feelings are not settling as the months go by, organizations such as Cruse can help the bereaved to resolve their loss.

My father died by suicide. I badly need to talk about it but my brothers won’t discuss it. What can I do?

We know that most people who die by suicide are definitely suffering depressive illness. Alcohol or drug misuse and other mental illness are also causes. Few people kill themselves without being seriously ill in one of these ways. Although your father’s death was caused by an illness, just as directly as heart disease or cancer causes people to die, he has left behind survivors – family and friends – who will carry the scars of what happened to him for the rest of their days. Depression leads people to live increasingly inward-looking lives, with less and less thought about other people. Sufferers may come to overlook the hurt that they will cause the family and act in a way that ignores other people’s feelings. Your brothers are, of course, going to be shocked and distressed by his death, but this sort of death is the most difficult to grieve over. His act of suicide may seem aggressive, a direct attack on the survivors. They may well be angry at what happened: angry at him for doing it, angry at his doctors for not somehow stopping him, and even angry – and guilty – at themselves for not realising how unwell he was.

Death is our last taboo, people will talk about anything else. There is much stigma attached to someone who has committed suicide, and so it won’t be easy to talk about his death outside your family. People grieve in different ways: some express themselves loudly and clearly, others deal with their grief in a quieter and more private way. Neither way is wrong. Perhaps you can make a start with them by saying that you feel angry too. If they are not ready to talk yet, do seek help for yourself from Cruse, the voluntary group skilled at helping the bereaved.

Every day I chose, sometimes gamely, sometimes against the moment’s reason, to be alive. Is that not a rare joy?

 

 

 

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(47) Depression

How Your Brain Can Turn Anxiety into Calmness - University of California

ANXIETY - WORLD HEALTH ORGANIZATION

An47

Anxiety states

 Feeling anxious is a natural human response to protect ourselves from harm. If you’re in a risky situation, your body releases adrenaline, a hormone that raises your pulse rate, opens your pupils, increases your circulation and alerts you to be physically ready for ‘fight or flight’. This primitive response was very useful in the primitive world when you might suddenly have to fight off a sabre-toothed tiger or run into the jungle carrying your baby.

Adrenaline gives us drive and alertness, which helps us react to any stressful situation.

Nowadays our stresses tend to be mental rather than physical ones. Home worries, relationship disappointments, family tensions, money problems, unfulfilled dreams are all sources of worry and anxiety. Sometimes these problems can be resolved and then our anxiety goes but, if left unresolved, they can cause illness. Perhaps together with an exhausting job or some physical ill-health, they can then combine to make one feel persistently anxious.

Our underlying personalities matter too. Some people have very placid unruffled personalities, whilst others are more highly tuned and sensitive. Some of us are life’s worriers, others seem to take everything in their stride, but everyone has their limits and nobody is immune. We can’t expect to transform our underlying personalities and change ourselves into different people, but we can accept ourselves for what we are, recognise our ownpotentials and strong points, and live with or work on our own weak areas.

Anxiety can be useful, or can be incapacitating and cause suffering and loss of function. The term anxiety disorder covers the mental and physical manifestations of anxiety.

Anxiety can be of several types. It can be:

Persisting: a generalised free-floating anxiety

Focused: on a particular situation or animal, as in phobia

Overwhelming: as in panic.

There is a feeling of fear and this may be accompanied by a feeling of impending doom. There is physical and mental discomfort. It is a feeling about the future – what might happen (not what has happened). There is a feeling of threat about the situation. The emotion it causes is out of proportion to the reality of the circumstances.

My wife just worries and worries about the slightest thing. It’s got right out of proportion. You can’t reassure her and she makes herself ill with it.

Some of us are just ‘born worriers’. One person said she had to do all the worrying in her family because, if she didn’t, nobody else would. If worry and anxiety become a major part of your life, you can make yourself ill with it. The picture of an overanxious person can include symptoms such as physical tension (headaches, exhaustion, poor sleep), physical overarousal (palpitations, excess sweating), or mental tension (poor concentration, nervousness, irritability). Stresses – major or minor – may set these off, and so can too much alcohol.

Its important to avoid using tranquillisers in this situation.

They may give temporary relief but, unless your wife’s ability to cope changes, she will feel the need to keep taking them. Start off by helping to build herself up, both physically and psychologically. Going to a sports club, aerobics class, yoga session or gym will relax her physically and increase her sense of well-being and self-confidence. Encourage her to do sports or pastimes that she may have enjoyed in the past.

Counsellors or therapists may use structured problem-solving techniques to help with excess anxiety. They might challenge her anxious thoughts and worries by asking her to write them down, and producing some rational solutions to them. People then choose their own best solution, and the therapist then helps them to put their plan into practice, and reviews their results.

Again, anxiety management classes, relaxation groups, or cognitive behaviour therapy are all recognised as being helpful therapy for generalised anxiety disorder. Medication can also help anxiety.

Generalised anxiety

Generalised anxiety can become a problem at any time of life, but often begins in early adult life. Women are more often affected than men. Anxiety accounts for just over a quarter of the psychiatric complaints that are seen by general practitioners. About 4% of the population is affected.

You are continually apprehensive and worried. You feel tense, particularly in the muscles of the head and neck. The autonomic nervous system (outside our control) is overaroused. Part of this arousal is expressed as ‘hypervigilance’ – being on the alert, and scanning the environment for possible dangers. You might have difficulty sleeping, particularly difficulty in getting off to sleep, and interrupted sleep. There is a continuing feeling of ‘being on edge’. It is common to feel tired with anxiety – not just because of loss of sleep, but because being on the alert for long periods are exhausting.

What causes it?

There are many factors that are thought to contribute. There is some genetic influence – anxious families producing anxious children. Past experience of separation from parents can predispose to anxiety states in adult life. There is sometimes a background of an expectation to achieve, and also conform, excessively. Then there are more obvious links, such as current stressful situations, particularly uncertain situations. Uncertainty gives rise to a feeling of lack of control over one’s destiny, and this is uncomfortable and draining.

Treatment of generalised anxiety

Practical intervention

When someone is troubled with anxiety, it is worth looking at very basic intervention to try and help deal with the current situations that might be causing the anxiety. Money - or its lack - may be a grinding difficulty and anxiety. Seeking help from a debt counsellor at the Citizen’s Advice Bureau can transform financial chaos and worry into a manageable task to be worked out systematically.

Psychotherapy

Psychotherapy can be helpful, particularly cognitive behaviour therapy. This is especially helpful in panic disorder (see below). The question is asked, ‘What are the thoughts that lead to panic?’ Work is done to replace these unhelpful thoughts with more realistic thoughts. You might be asked to consider how likely it is that you really will have a heart attack if you stand up and give a presentation at work. You will be encouraged to structure your thoughts differently and replace previously anxious thoughts with more realistic and helpful thoughts.

Anxiety management training

The techniques used are clear and easily learnt. They give sufferers skills to learn, and to go on using themselves. The techniques include the use of distraction (moving on to different thoughts), the control of anxious thoughts, relaxation and breathing exercises, and education. If you have learnt about the effects of anxiety on the mind and body, the manifestations it has can be much less frightening.

Drug treatment

The old-fashioned (but still effective!) tricyclic antidepressants such as dothiepin or doxepin are efficient anti-anxiety drugs, as well as being antidepressant in action. The newer antidepressant group, the SSRIs, can be very useful in the treatment of anxiety.

Both these groups of drugs are of course non-addictive, and can be taken for as long as is necessary.

Beta-blockers are drugs that are used in the treatment of high blood pressure. They can also be used in anxiety. Probably the most effective way to use them is in short bursts for helping to control anxiety (and perhaps tremor) when performing – for performance anxiety such as a musical performance or giving a lecture. They are not really so good in helping with anxiety in the long term. Another problem is that continued use of betablockers can sometimes cause a lowering of mood.

The diazepam family of drugs (such as Valium) is very good at reducing anxiety. However, there is a big and very important disadvantage to their use, and that is that they are habit-forming. They are difficult to stop, and their dose has to be increased over time to achieve the same result. They are useful drugs in the treatment of anxiety but they should be used for short periods only (days, or a few weeks, rather than months).

Very occasionally, when none of the above drugs is helpful and behaviour therapy has not dealt with the whole problem, the MAOI group of antidepressant drugs may be used. They are effective in severe anxiety but they do have to be used with great care. You would have to stop eating any tyramine-containing foods, the most common of which is cheese - and they have potentially very serious interactions with some other drugs. TheMAOIs are used only occasionally in the treatment of severe anxiety.

My doctor has started me on antidepressants. I certainly am depressed but there are times when I experience severe spells of anxiety. She says the antidepressants will help the anxiety in time, but I wonder if tranquillisers such as Valium wouldn’t help too.

Depression and anxiety are often found together. Treating the depression will lower the level of anxiety.

In recent years doctors have been increasingly cautious about prescribing tranquillisers. They were overused by the previous generation, before we became aware of their side-effects and their habit-forming potential. This can develop after only 2–3 weeks of daily use.

Some people are certainly particularly vulnerable to the habitforming potential of tranquillisers and, if we could be clearer as to who is at risk of this sort of problem, then perhaps the pendulum of treatment could swing back a little.

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(48) Depression

What Causes A Panic Attack And Dealing with Anxiety attacks

Panic Attacks and Panic Disorder - Symptoms, Causes, and Treatment

Panic Disorder Symptoms

Depression48

Panic disorder

Recurring panic attacks can occur with no warning, although they can be linked with specific situations, e.g. an open space, a crowded shop, or heights. There is a sudden intense feeling of fear and apprehension with a variety of bodily sensations that may include palpitations, shortness of breath, sweating, faintness, nausea, chest discomfort and pins and needles in the hands and feet (sometimes around the mouth). This is such an unpleasant experience that, not surprisingly, a so-called ‘anticipatory fear’ develops – a fear of panic occurring and a fear of loss of control.

Approximately one-third of people who experience panic attacks are clearly clinically depressed. For the two-thirds who are not, the response to antidepressant medication is still impressive.

I had a sudden choking feeling for no reason at all at college the other day. I’ve had several since term started. I feel I can’t breathe, my pulse races, and I think that I’m going mad. The doctor said it’s not my heart, but a panic attack. What causes these panic attacks?

Some small, perhaps scarcely noticeable thought or feeling triggers anxiety. The body picks this up and reacts to it in an exaggerated way. Adrenalin is released, which raises your pulse rate and alerts you. You then perceive this and interpret it as something badly wrong, something physical. This in turn causes more anxiety and a vicious cycle results of anxiety, arousal and terror. It tends to happen to people who are highly stressed, and may occur with depressive illness, when your coping reserves are low.

People may get chest pains, dizzy attacks, trembling, sweating, palpitations, choking, or feelings of unreality and detachment. They may breathe extra fast and breathe off too much carbon dioxide from their bloodstream, causing tingling in their arms and face. This experience may be terrifying. One useful trick to stop hyperventilation is to breathe in and out of a big paper bag for five minutes. This restores the normal balance of blood gases, and will stop your hands and face tingling.

Maybe 1 person in 10 has a panic attack at some time – they are quite common. Panic attacks, although very unpleasant, do not cause lasting physical harm.

How can I deal with these panic attacks? What can I do to prevent them?

See your doctor for a physical checkover, to exclude any other physical causes of these symptoms. Panic disorder can be mimicked by some medical problems, such as an overactive thyroid or disturbance of heart rhythm. Your doctor may want to do a blood test and possibly an ECG.

You can help yourself by reducing alcohol, caffeine, and nicotine (all these can increase anxiety). Be particularly careful not to use alcohol as a tranquilliser. Remember it is habit-forming; italso causes rebound anxiety, i.e. later, the anxiety is worse than before you had the drink. Do not avoid places or situations where panic attacks have happened. This could reinforce your anxiety and make it worse.

Some advice for a panic attack

If you have an attack:

  • Do not rush off or run away (that would increase your adrenaline output and make you more excited), but stay put.
  • Practise deep, controlled, steady breathing.
  • Try to concentrate on some outside object rather than thinking about how you feel.
  • Learning meditation techniques can help distract your mind from its own anxiety.

Cognitive behavioural therapy (CBT) has been shown to be a good treatment. Consider also contacting one of the self-help organizations such as No Panic, or Triumph over Phobia.

  • Try to stay put, do not run off.
  • Practise deep, slow, controlled breathing.
  • Use a paper bag if you are hyperventilating (breathing very quickly).
  • Focus your thoughts on some outside object, not on your own symptoms.
  • Keep reminding yourself that it will soon pass off.

 What to do during a panic attack

  • Try to stay put, do not run off.
  • Practise deep, slow, controlled breathing.
  • Use a paper bag if you are hyperventilating (breathing very quickly).
  • Focus your thoughts on some outside object, not on your own symptoms.
  • Keep reminding yourself that it will soon pass off.
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(49) Depression

20 Unreasonable Phobias, Some We Might Already Have

Phobias and Fears - Symptoms, Treatment, and Self-Help for Phobias and Fears

The Phobia List

Depression49

Phobias

A phobia is a focused, extreme anxiety beyond what is a reasonable response for the situation. The fear cannot be reasoned away - you cannot tell a spider phobic a spider will not hurt them, and expect them to relax. The fear response is out of your voluntary control, and it is so unpleasant that it leads to avoidance of the feared situation or animal.

Agoraphobia is the commonest phobia prompting treatment. Agoraphobia means a fear of open spaces from the Greek word agora for a market place. The term is also used for a fear of shopping and crowded places. It most often develops between the ages of 15 and 25 years, and may be trigged by a big life-event (such as having a baby).

Social phobia is also common. This is a persistent fear of situations where you might be scrutinised. There is often an associated fear of doing something embarrassing or out ofcontrol, such as blushing, fainting or being sick. More women than men are affected. It often begins around puberty - when self-consciousness tends to be at its peak in all of us.

Animal phobias tend to start earlier than the other phobias. They may start in childhood.

Treatment of phobias

Drug treatment is not usually helpful (unless there is an accompanying depressive illness – which is not uncommon). Behaviour therapy is the cornerstone of the treatment of phobias – behaviour is modified with several different techniques. If you gradually expose someone to the feared situation, and teach them to relax at the same time, their anxiety will slowly fall – you learn to do it without fear.

This relearning can be done gradually, or in big chunks of exposure called flooding. The feared response is generated and you ‘stay with it’. Your body cannot sustain very high levels of extreme anxiety for long periods – you start to get used to it, or ‘habituate’.

Finally fear can be overcome by ‘modelling’ behaviour on the therapist – the therapist touches a snake and shows no sign of alarm or retreat. The patient then follows the example of behaviour in the therapist.

All these treatments are safe and are appealing in many ways – we know they work and they are logical with a very clear outcome.

I’m terrified of flying. I shake like a leaf as soon as I get on the bus to the airport. It’s ridiculous really as I’m usually up for anything. I’m grand as soon as I get there.

In this situation tranquillisers just for your flight there and back can be very helpful, or some beta-blockers. Elsewhere in this texts you’ve seen how frightfully mean we are nowadays about giving out tranquillisers like Valium. This sort of setting, however, is a ‘one-off’. Beta-blockers are helpful too, but they cannot be used if you have asthma – they can make it worse. Drinkingexcessively on the plane is not good and can compound the problem.

People who need to fly regularly for a living and have a phobia about it can be treated by behaviour therapy. Treatment involves ‘deconditioning’ you by gradual exposure to the source of your worry. A typical programme would involve learning relaxation techniques, and then making a series of supported visits to an airport, leading up to a trial flight.

My mum is afraid to go out of our home. She can get to the local shop, but can’t get into town to see us. It’s a real nuisance, and she can’t go out to work. What can we do to help her?

Your mum is showing signs of a phobic condition. Agoraphobia is defined as fear of open spaces, although phobia sufferers may be afraid of people, heights, crowds, going into public places, using public transport, speaking in public, or leaving home. There are also some specific phobias.

Some sufferers may lead progressively more limited lives. These conditions can certainly be helped by treatment. Start by helping her to define exactly what she can and cannot do,

However irrational it may seem.

Where, or how far, can she go? Can she go to some shops but not others?

Make a list so that you understand her boundaries. Start with something she really wants to do but cannot, so that she is well motivated. An example might be a visit to her favourite store to buy herself an outfit, or a Christmas present for someone.

Plan a series of small steps towards this goal: start out with a brief walk each day with someone there to reassure her. Once she gets used to this and is no longer anxious, start to do a little more each time you go out. Sometimes it can be helpful to have someone walking a little way behind when she first goes out – gradually make the distance between them longer. If she feels overwhelmed, practise some breathing and relaxation exercises with her until it passes. If she is using medication such as betablockers or tranquillisers to reduce anxiety, try to avoid using these while you are working on these steps (but never stopantidepressants if she is taking them). Keeping a diary record of how far you go is useful. Gradually increase this until she can reach the goal you set, first with you, then on her own.Self-help groups can be very helpful with tackling these symptoms.

 Since my early teens I’ve had what I thought were panic attacks in restaurants and canteens. My doctor tells me I have social phobia. What is this condition?

Social phobia is an exaggerated and irrational fear of social situations. These can include visiting restaurants, the theatre, travelling on public transport, and ‘socially dense’ work situations. Although it can be considered an extreme form of social shyness, it is subtly disabling and quite difficult for others o sees and understands.

Sufferers often self-medicate their anxiety with alcohol, and there is therefore a high risk of alcohol dependence. Alcohol should be discouraged, not only because of its inherent health risks, but because of rebound increased anxiety during the hangover phase when the alcohol effect wears off. True panic attacks with hyperventilation, racing heartbeat, shaky hands, and feelings of terror or impending doom can occur in social situations. Your circulation can be affected causing fainting. You may become disabled because of panic attacks, phobic avoidance of social situations, and secondary depression.

What treatment can I have for it? The doctor suggests I try an antidepressant. Why is this?

Whether or not depression is obviously present, moclobemide (a reversible MAOI) and paroxetine (an SSRI) are licensed for treatment of social phobia. Probably all SSRIs are effective in social phobia, but only paroxetine at present is licensed for it. Besides medication, psychological therapy, namely cognitive behaviour therapy (CBT), is helpful.

How can I change my thoughts and feelings?

If your social phobia occurs in restaurants, for example, your thinking sequence might be:

• I am going to a restaurant, I am going to shake.

• I am in a restaurant; I am shaking and going red.

• I am verging on having a full-blown panic attack.

• People can see me doing this.

• They are scrutinising me, and will laugh and judge me.

• I will look a fool, be ridiculed and humbled.

CBT aims to analyse how true each of these thinking stages are, and to explore the emotions that the thoughts are associated with.

For example:

• You may indeed be shaky when in a restaurant, but how noticeable is it?

• Even if it is present, why should others be interested enough to notice?

• Even if they do notice, why should they be judgmental?

By challenging ‘negative automatic thoughts’ like these, initially guided by a therapist and then by you while in the anxiety-provoking situation, cognitive therapies aim to reduce the disability associated with social phobia.

 

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(50) Depression

 Burnout - Causes, symptoms and treatment (Video)

Preventing Burnout

Stress and Burnout: Burnout Symptoms and Causes

10 Signs You're Burning Out -- And What To Do About It

Depression50

Burnout and stress

I work as a teacher and I have had so many demands lately on my time because of a forthcoming OFSTED inspection that I just don’t seem to have any go left in me and I make silly mistakes. Is this burnout?

Burnout is a popular term, rather than a clearly defined medical diagnosis. It is widely used to describe a syndrome (a collection of symptoms) of emotional exhaustion, in a context of overwork and depleted resources.

Some of the signs (in alphabetical order) are apathy, denial, depressed moods, exhaustion, forgetfulness, guilty feelings, indecisiveness, insomnia, irritability, lack of enthusiasm, loss of sex drive, loss of interest in usual pastimes and hobbies, paranoid feelings, social isolation, stress, temper outbursts, working later and later.

The term ‘burnout’ isn’t a formal psychiatric diagnosis. It is commonly used to describe professionals, particularly those from the caring professions, who have become exhausted to the stage of indifference, perhaps in a climate of complaints and imposed changes. Once you, or a colleague, have gone this far, you may then be at risk of making all sorts of mistakes, which will cause you, and others, progressive trouble, which you then are unable to cope with. The situation can worsen.

Perhaps the best treatment is not to let it happen in the first place. Recognise the signs of stress in yourself and colleagues, and see that you step away from your pressures as early as possible. Support your colleagues if you see that they are flagging. A few kind words can make all the difference on one of those days when nothing goes right.

• Lower your horizons accept and set some quite modest goals.

• Watch out for warning signs: irritability, not bothering, taking it out on undeserving colleagues, inability to relax.

• If you have symptoms of depression, acknowledge this and seek help.

• Take advice, and get support, from your peers and colleagues.

• Many professionals dealing with people’s problems have work ‘supervision’. If you don’t have this available, organize it for yourself.

• One-to-one or group support can be very helpful.

• Polish up existing skills, and develop some new ones. Take pleasure from them.

• Play to your own strengths. Do what you’re good at, and enjoy it.

• Reward yourself; make sure that you get away for regular coffee and lunch breaks.

• Make sure that you take your annual leave.

• Can you take a sabbatical?

• Don’t neglect your family, your spare time, or your hobbies.

• Investigate early retirement, but don’t give up too easily.

I’m a workaholic. All my nervous energy goes into thinking about my job, morning, noon and night. My wife and family complain, and perhaps they’re right. What can I do?

Some people do really start to act as if they’re addicted to their work, just as you can get addicted to harmful substances. As with other addictions, family and friends can suffer as a result. Perhaps it’s a question of remembering to keep a balance between your life at work and life at home, and remembering what you really value in life. Try to invest some of your drive into activities away from work, at home or in your local community.

Try and find yourself rewards outside the world of work and use some pointers from the list above.

I know that, if I get too worked up about things, it really takes it out of me, and then I start to feel very low. How can I deal with stress better?

You’re right to recognise that you shouldn’t push yourself too far. The commonest sources of stress in people’s lives are probablyrelationships, money, work-related issues, and family – singly or in combination. These may affect us in the form of immediate crises, or as chronic, long drawn-out worries. Boredom is also stressful – ask anybody who has been unemployed. We often have blind spots to how these things affect us. Ill health and stress do go together: we know that stress raises your blood pressure and heart rate. The symptoms of stress – poor sleep, tension, irritability, mood changes, poor concentration – if prolonged, merge into those of anxiety and depression.

Here is a list of antistress tactics:

• It’s down to you; you have, in fact, more control over the situation than you think.

• Don’t burn the candle at both ends; make sure that you get proper time off.

• Look after yourself properly: have a sensible diet and have proper meal breaks.

• Have an early night now and then, and an occasional late one too.

• Watch out for overuse of caffeine, alcohol, nicotine, (and other, worse, substances).

• Take some exercise regularly, just a few minutes every day is a start.

• Enjoy a creative hobby – take one up if necessary.

• Walk away from trivial disputes and disagreements.

• Watch out for signs of pressure: driving too fast, being irritable. Then slow down.

• Agree with people sometimes – you’ll make some useful allies.

• Talk to someone about how you feel.

• Put something back in for someone else.

• Can you learn assertiveness skills (rather than aggressiveness)?

• Accept what you cannot change, and change what you need to.

• Plan ahead; allow yourself time for things – especially time off and leave.

• Delegate things. Learn to say no

• Settle for ‘good enough’ rather than perfect sometimes.

• If you’re sick, go off sick.

• Give yourself a treat sometimes.

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