Winter months and January in particular can be a difficult time for people who have depression but there is advice available to help sufferers cope at this stressful time of year. Michelle McDonaghreports
While most of us will experience dark days from time to time, the winter months and January in particular can be a very difficult period for those coping with depression.
According to specialists in the field, it is vital to have simple coping mechanisms in place to get through such difficult periods. The advice of fellow sufferers who understand exactly what you are going through can often be invaluable.
It is estimated that for every one person who experiences depression, up to five other family members and friends will be significantly affected. More than 400,000 people in the Republic are estimated to experience depression at any one time.
A depressive illness is an overwhelming feeling which dulls thinking, impairs concentration, saps energy, interest in food, sex, work and everyday activities and disrupts sleep.
Public relations officer with Aware, Sandra Hogan, explains: "The impact of the Christmas festivities is most keenly felt in January - the financial cost becomes apparent and the start of a new year can cause us to wonder if this one will be any better than previous ones.
"The general focus seems to be on physical health and resolutions to lose weight, get fit and so on. Little attention is given to our mental health, yet it is essential to mind it to stay well."
For anyone who is concerned about depression, Hogan stresses that it is vital to get information about the condition and to utilise available support services. Aware offers emotional support for those with direct experience of depression and also for relatives. The Aware loCall Helpline (1890 303 302) is available 365 days a year and the trained volunteers provide a confidential listening service.
"The most important thing to do is to find ways of dealing with the dark days, either by relying on the support of a family member or friend or an organisation like Aware. And of course it is important to put these skills in place during a period of wellness, so that when you need them, they are already in place," Hogan says.
If someone in your family is unwell at this time, Aware advises not to pressurise them into taking part in all the celebrations, but just try to support them and be there for them if they wish to talk. For those who find Christmas and the start of the New Year a difficult and stressful time, there are a number of things Aware recommend which might help:
Don't put yourself under excessive pressure - if you do not like social occasions, accept only the minimum of invitations.
Take some time out for yourself.
Try to get some exercise, even if it's just a stroll in the fresh air after dinner.
Get enough sleep.
Try to keep your diet balanced as all the rich food associated with this time of year can make anyone feel sluggish.
If you have been diagnosed with depression, it is important to stick to whatever treatment you have been prescribed by your doctor.
It is also vital that anyone affected by depression tries to keep their alcohol intake to a minimum (or indeed, do not drink at all).
Terry Rooney was diagnosed with bipolar depression (also known as manic depression) in 1972. Now aged 70, he has developed his own coping strategies over the years which help him to control the highs and lows of his illness.
"To understand manic depression, you need to understand that the disease is divided into three parts," he says. "There is the euphoric elation or happy energy and the dysphoric elation where things are still speeded up but you are irritable and don't feel good. Then there is the depression which is usually worse first thing in the morning. When you are depressed, everything slows down. You walk slower, talk slower and feel totally helpless and hopeless," he explains.
The Leitrim man uses a scale of zero to 10 to gauge the severity of an incident of elation and depression. A former alcoholic, it wasn't until two years after he became sober through AA that his illness was diagnosed.
"I was sent to St Patrick's Hospital under Dr Patrick McKeown, the founder of Aware. He really has an extraordinary ability to keep it simple. Once he explained my illness to me, it was never the same afterwards. He gave us patients a great insight into the illness, he knew exactly what we were dealing with. We learnt things we wouldn't have known otherwise," he says.
When Terry was high during the worst years of his illness, he was constantly coming up with ambitious schemes, convinced he could do anything he set his mind to. However, once the elation had passed, he could not cope with all he had taken on.
"My wife says she dreads the elation far more than the depression because we are capable of anything in elation. I remember one time getting an idea that I could back horses successfully and I was convinced I could do it better than anybody else. I wasted a lot of money. You are very impulsive when you are high and this is followed by such a sense of shame and embarrassment afterwards which is made even worse when you go into depression. You find it hard to understand how you could have behaved in such a way," he explains.
Unable to hold down a job due to his illness, Terry set up his own accountancy service but he had to give that up too due to regular hospitalisations in St John of God Hospital and St Patrick's Hospital in Dublin. He eventually got a taxi licence which meant that if he was unable to work, he could just walk away when he had to.
At 70 years of age, Terry is prepared to stand up at public meetings and speak about his illness, something he would never have done when he was a younger man. He is keen to do what he can to help people who are in the position he was in before he gained insight into his illness.
"It would be extraordinary if I did not have mood swings until the day I die but by practising self-help therapy, I am able to lower the height of the elations and bring up the depth of the depression on the scale. Today, I am feeling quite positive. Using my self-help techniques and everything I learnt from my fellow sufferers, I have been able to manage both my euphoric and dysphoric elations for quite some time but I am not able to manage my depression as well."
Terry now plans to start a mindfulness course in St Patrick's to try to help him to manage his depressive periods better. His advice to anybody who thinks they may be suffering from depression in any of its forms is to first seek medical help and, secondly, to get involved in self-help therapy on a consistent weekly basis.
"I go every Wednesday night to the Aware meetings at St Pat's. There I am with people who understand me like nobody else. You can pick up little nuggets to help you get through the difficult times and equally what not to do. The bond between us is very special, it's one place in the week where we can be most comfortable for a couple of hours. There are all kinds of people at the meetings - young and old, rich and poor, male and female."
Dr Pat McKeown, former medical director of St Patrick's Hospital in Dublin, explains that people with a history of depression or bipolar disorder often experience quite a shift in mood around the Christmas/New Year period.
"There are typical heightened expectations coming up to Christmas when people who are prone to go higher than normal and there is a corresponding big dip afterwards. There is another group of people who, if they are depressed, find it hard to engage in the season of goodwill. They may find there is quite a gap between them and their friends who are full of the joys of the season."
McKeown points out that the disruption of the normal working week routine around the holiday period can be difficult for people with depression. It can also be a very lonely time for them, even when they are surrounded by others.
"People should just think back on what impact Christmas has had on them over the years. Some people don't enjoy Christmas, maybe because of some trauma that occurred in their early years or they remember family fights or friction. You should make a purposeful attempt to plan ahead and do something you enjoy like going off somewhere for a day or going for a nice walk. It's about making time for yourself."
He highlights the importance of maintaining some structure in the day while also getting plenty of rest and exercise. Research has shown that getting out for a brisk walk in daylight even in the wind and rain is as effective as light therapy for the winter blues, he points out.
"People who are prone to depression are much more likely to get depressed after drinking alcohol. If you consume alcohol on a number of consecutive days, the effect is remarkable. People often do not realise this until it is pointed out to them and they stay off the drink for a few weeks. I am not talking about people who drink alcohol to excess, but people with depressive tendencies which are worsened by alcohol in quite a subtle way."
While McKeown believes goal setting for the New Year has its place, he advises people with depression to be more moderate in their expectations and to "endeavour to be average".
Many people with depressive tendencies tend to be too demanding of themselves and set themselves unrealistic goals, he explains.