What's it like living with depression?

Some of you will have read my blog a few months ago about habits to help beat depression. You’ll know that this year I’ve had to face the challenge of living with depression for the first time in my life really. I thought I’d share with you a little about what it’s like so that you might better understand and be able to help others you know who will experience it. Of course, these are just my experiences and everyone is different so always bear that in mind and remember three things…

1) Nobody is defined by an illness, no matter what it is. They are not the illness, they are still themselves, they just happen to have a condition

2) Listen - never presume you know what it’s like, even if you’ve been through it yourself. Each person’s experience is different, so take time to listen to them

3) Ask - find out from them how you can best help and be patient, they won’t always know the answer straight away.

What is it like for me?

• Let’s start with what it’s not - it isn’t a constant thing, it comes and goes, sometimes suddenly, sometimes creeping up over days. Sometimes it lasts a few hours, sometimes it lasts a few days. Many days it isn’t there at all whilst on others it’s ever-present

• It also isn’t feeling sad, down or upset, rather it’s feeling empty, lacking in my usual drive to get on and do things which for me is a weird experience. All of my life has always been so driven thinking about my next work or exercise challenge, pushing myself to the next level. But when I feel like this, it’s a challenge to do more than a few hours of work each day, it exhausts me. Many people I’ve worked with find it hard to get the motivation to exercise when they feel this way; for me it’s the complete opposite - the simplicity of putting one foot in front of the other or jut turning those pedals appeals greatly, it’s the effort of thinking for work that’s the real challenge

• Some people might say ‘but you know how to deal with this as it’s you job to help people, so why don’t you just do the things you should and snap out of it?’ It doesn’t quite work like that; depression has many causes and the habits I talk about in balance are just one part of the process of recovery. They definitely help, I know they do - I exercise, I eat well, I drink very little and I don’t smoke or do drugs and all of these habits make me feel good

• The one area I have struggled with is socialising - it’s a strange contradiction as you know that being around people is good for you, yet the malaise you feel makes it hard for you to get out there. Withdrawal is a common challenge in depression and I’ve not quite worked out how to overcome this one yet. I find myself deliberately waiting in bed until my housemate has gone to work, not wanting to communicate. I think you also sometimes don’t want to be seen when you’re not on top of your game, or maybe that’s just me because I think I feel the pressure to always be energised and positive because of what I do

• That pressure to be ‘Mr Balance’ is a bigger one for me than I’d ever thought it would be. One of the main points of balance is that none of us is perfect, myself included - we all have days where we can’t be bothered to exercise, where we make poorer food choices, where we don’t feel perfectly balanced, but I’ve felt more expectation on me in recent times to be ‘perfect’. As an example, I recently posted a little rant on my personal page as I was just frustrated with the state of the world and with many people - I wasn’t feeling depressed or down that day, it’s normal to have a balance of emotions. We should feel positive, happy and energised at times, whilst at others we might feel anxious, sad or tired; most of the time we’ll probably just sit somewhere in the middle feeling not very much at all. For whatever reason, my whinge led to many well-meaning checks that I was ok - I guess it’s my own fault having created the persona of balance. Funnily enough, it was this that actually made me feel down that day, as if I was expected to be Mother Theresa or Nelson Mandela (and I don’t look like either of them…yet).

I started this short blog piece with some suggestions about things you should do with those challenged by depression, so I’ll finish with some considerations for what not to do:

1) I probably wouldn’t ask if they’re ok - they’re not right now. Instead, treat them as you normally would - talk about football, Love Island, the annoying lady at work, just be how you always are with them

2) Don’t make suggestions - ‘why don’t you…’ or ‘have you tried…’ aren’t always what’s required. As I said at the start, listen to them if and when they want to talk and then ask what would be most helpful for them.

Have a balanced week all (and remember, that means ups, downs and just fair to middling).

Paul

Habits to help beat depression

I’ve given many sessions over the years on mental health and wellbeing; it’s part of the courses I teach to Personal Trainers and I’m often asked to talk on the topic in workplaces too. I’ve written articles on it and done numerous pieces on social media, and in all of them, I’ve always argued that the statistic that 1 in 4 of us suffer mental health issues is just plain wrong. It’s undeniably 4 in 4; we all face challenges at some point or another, we don’t have or not have mental health problems, they simply slide up and down a scale. Sometimes we cope with them comfortably, at other times it’s harder.

In recent times, I’ve experienced what it’s like to be much further along that scale, challenged to the point that on some days it has gotten the better of me and I’ve felt unable to defeat it. Other days haven’t been so bad, and some have started well and got harder or started badly and become easier. I guess that’s the thing about it; the scale can move constantly.

What I have had to do though is to use my resources, the knowledge I have about things that might just help me move to a better place on the scale and bit by bit, I’ve found myself moving in the right direction again, back towards a better balance. Here are some of those things that have worked for me…

1) Do something small

One of the most powerful things about depression is its ability to leave you feeling flat, paralysed, unable to do anything. Even the most mundane of tasks can seem like a challenge and you can experience whole days unable to get anything done.

At this point, setting big, challenging goals might not be the best idea as they’ll often take sustained effort and it’s easy to lose motivation along the way, even when you manage to have a good day or even a good few days. Try instead using micro-goals, tiny stepping stone challenges you can set yourself to provide a sense of achievement. The great thing about achieving things, however small, is that your brain recognises it and fires off pleasure-giving chemicals as a reward. That’s why when people make lists, they put things on they’ve already done so they can tick them off straight away and get the feel-good factor response!

This reminded me of the ‘making your bed’ speech from the US Navy Admiral that went viral in recent times. His point is very clear, start small and take it one step at a time. If you have five minutes and you’ve never seen it, I’ve included it below for you. It’s well worth a watch.

2) Move

For people with mild to moderate depression the NHS says that exercise is known to have definite benefits. Studies suggest that the benefits, in particular of cardiovascular exercise, are comparable to medications or talking therapies. Depression often goes hand in hand with fatigue, but by using low-to moderate intensity exercise that you enjoy, you can actually increase your energy levels. Strange isn’t it? You’d assume that if you’re tired, exercise would only exacerbate this, but as long as it’s kept to a sensible level, it has the opposite effect.

There’s no need to worry about exactly what to do or how much to begin with, just pick something; it could be walking, dancing, jogging, swimming, yoga, weightlifting, gardening or anything else you enjoy. Aim to gradually build to up towards the 150-minutes per week of moderate intensity exercise recommended (if you work harder, every minute done counts double towards this target).

3) Even better, move outside

• Two thirds of volunteers for the Wildlife Trust, given tasks like helping to dig ditches or make bird tables, reported improved mental wellbeing within six weeks

• A Norwegian study of 30,000 participants found that just 1-2 hours movement outdoors each week could prevent depression

• In one study of those with depression, a short outdoor walk fared much better than an indoor session on an exercise bike, with participants larger reductions in depression and fatigue

• Exercising in green spaces has been shown to reduce the perceived difficulty of the exercise, increase people’s perception of their own health, leads to lower blood pressure after the workout when compared to exercise in urban environments, and also decrease stress hormones like adrenaline and cortisol post-session too.

• Some studies have shown increased rates of depression in the darker months of the year and shown strong correlations between vitamin D levels and the ability to predict episodes of depression. Exposure to sunlight also affects hormone levels, your body’s ability to utilise energy stores, cell function, blood flow and your body clock, all of which can impact energy levels and mood

• Streams, rivers, lakes and the sea can also boost your mood. A study in Hong Kong showed that people who spent more time by natural water reported greater wellbeing and had a lower risk of depression. A review of studies into the subject identified 35 others that backed up these findings, consistently showing positive mental health and stress-reducing effects

Basically, my point is, get outside into natural light where there are trees, plants and water. Your body, and your mind love it!

4) Spend time with friends

When you’re feeling low, it’s common to withdraw. A 2012 study of 100 adults found that 20% had no contact with friends, 33% never interacted with their neighbours, 35% lived alone and 50% never attended social groups. The study supported these people to become more socially active through things like going to see a film, a play, a concert, visiting museums or simply going out for a coffee or a bite to eat. ALL of the 100 participants reported feeling better about themselves, having more confidence and experiencing less symptoms of depression.

People are ok, most of them anyway! ;-)

5) Choose healthier food and drinks whenever you can

A wide range of foods and drinks have been linked to depression, for better and worse. Things that might be helpful to increase include:

• Plant foods - fruit, vegetables, beans, legumes, herbs and spices (aim for your 5-a-day)

• Nuts/seeds - 1-2 handfuls per day

• Oily fish - 1-2 portions per week

• Wholegrains like unrefined rice and other grains, and lean proteins like chicken, turkey, eggs, yoghurt and soya produce - make these a staple part of most meals.

Minimise the more processed foods although there’s never a need to cut these out completely, it’s all about balance remember.

Summary

There are a range of habits that can help prevent or improve symptoms of depression. You can take actions that over time can lead you to a better place. Start small, remember that progress isn’t always linear, sometimes we have better days, sometimes worse, but that just the feeling of doing something can in itself boost your sense of confidence , mood and self-worth.

Why we ALL have mental health problems...and what we can do about it

Mental wellbeing - more grey than black and white

According to recent statistics, one in four people in the UK experiences mental health problems, or rather, one in four of us gets diagnosed with mental health problems. What if though, WE ALL suffered from mental health issues?

In times gone by, you'd often hear talk of 'mental illness' and the simplified notion was that you were mentally ill or not. In reality, it's just not that simple. In the same way that physical health sits on a sliding scale, with excellent at one end and well, to put it bluntly, at death's door at the other, mental wellbeing can also be imagined on a continuum. It can fluctuate towards better or worse mental health and wellbeing on a weekly, daily and even hourly basis. And it doesn't matter who you are or what you do, where you live or how much money you earn, it does affect you.

There are of course differences between us, with some more at risk of sliding the wrong way along the scale due to genetic influences and uncontrollable life circumstances, but there are also many actions most definitely within your control that affect where you are on the continuum at any one time. It is these behaviours that form the focus of this blog piece and that are the target when I work with individual clients or when helping larger number of people through employee wellbeing initiatives. 

A few principles of mental wellbeing

When you think of mental health challenges, you might often conjure up words like stress, depression and anxiety. You may imagine these to be bad, and they certainly can be, but that's not always the case. Stress can be very good; imagine a lion escapes from the local zoo and appears on your driveway. The stress response that enables you to quickly run inside and shut the door is very helpful! Equally, exercise is a stress on your body; you know the saying 'no pain, no gain' or as I prefer to say, 'no challenge, no change', meaning that you only get fitter when you put your body under stress. Too little stress from exercise and you become unfit and unhealthy, too much and again you can get problems. It's all about finding the right balance for you. Depression and anxiety can have their place too; it's normal to grieve for a lost loved one and part of the healing process, and it's absolutely fine to be anxious about a big exam or interview, in fact science is quite clear that, up to a point it raises performance. 

The problems occur when the stress, anxiety or depression become too much, too severe and also when they go on continuously. Mental wellbeing is present when you have a healthy balance of emotions but if the balance is tipped too far, we can have issues. One of the big difficulties about recognising mental health problems is that for each of us, these issues can be different. This definition of stress by Hans Selye, a scientist famous for his work in this area in the mid-20th century, helps to explain this:

"Stress is the non-specific response of an individual to any demand for change."

What he was saying is that stress could be caused by a multitude of things, basically anything that calls for adaptation from a person. A new form to fill in at work, a house move, changes in job circumstances, a closed road meaning you must drive somewhere unknown or any other number of stressors. 

He was also saying that the way in which we all respond to this stress is unique. There might be a physical response like increased heart rate, sweating or trembling, or a mental response and for some that stress may bring about good changes whilst for others it might cause issues. 

This is what makes mental health problems so hard to recognise and understand. When you get stressed you may lose your appetite, whilst another may comfort eat. One might withdraw from their social circle whilst another might go out and party hard. One person may present with physical symptoms like poor skin or a raised blood pressure, whilst another may suffer psychologically. Always bear these two points in mind when thinking about mental health and wellbeing:

1) What leads to stress, depression or anxiety for one person may not for another.  

The triggers for each individual are unique; it doesn't mean they are weak or 'that's just them', it's a complex interplay of genetics, previous experiences and all of the things that are going on in someone's life at any one time. I've heard a number of times in a work setting, 'How can they be signed off with stress? I do the same job as them and I'm fine.' It simply doesn't work like that.

2) The unique response of each individual to mental health pressures can make them hard to recognise.

It's generally impossible to look at someone and see a mental health problem. Again I've heard lines like 'Well they didn't look/seem ill to me' when referring to colleagues signed off work, but as we've seen above, how the issue shows itself can differ from person to person and over time. Doctors will weigh up all of the signs and symptoms when making a diagnosis; sleep patterns, energy levels, mood, behavioural changes, appetite, thought processes and physical checks of heart rate and blood pressure are just a few of the areas that are factored in.

Load and resilience

Your mental health and wellbeing can be influenced by two major factors; firstly, how much load or stress you are faced with at any one time. In the picture above, this is represented by the jug of water...the more that gets poured in the greater the challenge for you. The second is your ability to cope with these challenges, known as your resilience, represented by the glass. If you reach the point where you've poured more in than your glass can cope with, you overflow and, just like the water leaking over the sides of the glass, it can head in any direction, or in other words, it can represent itself in any number of ways unique to you.

This means there are two things you can do to stay well balanced with our mental wellbeing...

1) Pour less in (decrease the load) 

It's important that you're aware of just how much you have going on and ensure that you're never pouring so many challenges in that you start to overflow. That's easier said than done these days with lives business than they've ever been and the constant bombardment of tasks and information that come out us in all aspects of life. In the 'What can you do?' section below, you'll find a range of suggestions to help you lighten then load.

2) Work on your glass (increase your resilience) 

Alongside pouring less in, you can also work on coping better with what comes your way. This means upgrading your glass from a shot glass to a tumbler or even better still, a pint glass (don't race down the pub just yet)! There are many things you can do to help both your body and mind cope better with the pressures you face. You can also learn ways to tip a little of what's being poured in back out again. This keeps you from overflowing and helps you stay balanced.

What can you do?

Pouring less in - just being aware of the volume of stuff you have going on is a good start. Sometimes you'll find that you only notice you have too much going on when it's already overloaded you and you're struggling mentally or physically as a result. Being consciously aware of how much is going on is a great place to start. Remember too that even things that are enjoyable still count as load. For example, you know how much I love exercise and sometimes I forget that doing a long run or bike ride is still load being poured into my glass. I'll then try to also do loads of work on the garden, catch up on all my emails, write a new chapter of my next book, get my accounts up-to-date and catch up with friends. Then after all that, I'll wonder why I'm feeling exhausted! 

You have to learn some important lessons to get this bit right; how to prioritise some things at the expense of others and also, often, how to say no. You'll know how much you can pour in before you start to feel the effects, so have it in the forefront of your mind when you're planning the days and weeks ahead. This applies both to work and life; here's a little table going you some examples of how you might prevent overload in both situations.

Making your glass bigger and tipping some back out - there are a myriad of tools you can use to do this and for simplicity, I divide them into four categories:

1. Psychological

2. Physical

3. Social

4. Recreational

Psychological tools are any that help to alter your mindset. This might include breathing techniques, meditation, mindfulness, counselling or learning to change your inner dialogue to be more helpful. 

Physical tools include all the things that help your body to cope better and be physically as well as mentally healthier; exercise, better diet, getting more sleep and reducing or quitting smoking and alcohol.

Social tools involve getting help from others. Generally, people are awesome and when it comes to mental health, being sociable is proven to make a difference. How you achieve this can vary from talking about your challenges to joining a club, helping someone else or doing something for a good cause. 

Recreational tools are all the things you can do for enjoyment like your hobbies, listening to music, reading books, playing games, learning and spending time with your pets (I often include this last one in with the social tools because pets are people too right?). All are known to have a positive impact on your mood and send you the right way along the continuum towards better mental health.

Here's a nice little summary of all of them for those of you who prefer pictures to words:

There is without a doubt a crossover between these four areas; for example you might join a Quidditch team...yes you really can do that! That will give you some exercise, time with friends and you get to play a game which all help to distract you from the stresses of daily life and boost your mental wellbeing. The categories are simply meant to guide you towards the many possible tools you already have at your fingertips that can help you find more balance.

All of these tools work through a range of powerful mechanisms, including:

• Altering the levels of feel-good chemicals in your brain that help to make you feel better

• Distracting you from the pressures of daily life

• Enabling you to escape, take a step back and maybe evaluate things in a different way

• Getting help; as the saying goes...'a problem shared is a problem halved'

• Boosting your self-image, self-worth and self-confidence

Key considerations

• There are lots of things you can do to improve your mental wellbeing. You do not have to do them all in one go; just one small change will make a difference and it really doesn't matter what you decide to do. Just pick something that feels right and that you think you'll be able to stick to. No matter if it doesn't work, pick something else and go again.

• Health comes when behaviours are repeated consistently over time. Try to do it just for a day at first, then when you've nailed that, aim for a week, then another week and so on until it's just a normal part of everyday life.

• Managing your mental wellbeing is a constant journey. There is a principle in exercise known as reversibility. This is best described by the phrase 'if you don't use it, you lose it'. You know this well from fitness regimes and diets. If you stop doing your running after that 10k race you lose fitness; if you give up the diet you were following the weight can come back. The same principle applies to mental wellbeing too. If you stop practising the behaviours that help you to manage how you feel, you stop getting the benefits. Life will inevitably throw in challenges that mean some days and weeks aren't as good as others but the great news is, you can always start doing the right things again and get yourself back to balance.

Please do get involved in the conversation below. What do you do that helps you balance your mental health and wellbeing? What tips would you offer others? Anything you'd like to share that helps people to be fitter, healthier and happier.

Thanks, 

Paul

This blog was adapted from a seminar I gave recently for Origin Workspace, an exciting new co-working and start-up support business based in Bristol. You can find out more about them here.

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