By Dr Adam Simon

Mental Health Awareness: Ask The Doctor


Mental health isn't easy to talk about. Often, taking that first step of getting help is the most difficult part of the process.

We sat down with Dr Adam Simon to answer some of your most common questions about depression, anxiety and mental health.

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1. How common are mental health issues in the UK?

2. What are the warning signs of depression?

3. What causes mental illness?

4. Is depression anything to do with genetics?

5. Who is most likely to be affected by depression

6. How is depression treated?

7. How can mental health issues be prevented?

8. What should you do if you think someone you know is suffering from depression?

9. What happens if that person rejects your help?

10. What can a GP do for me?

11. How long does it take for treatment to work?



How common are mental health issues in the UK?


Mental health issues in the UK are very common. The two main mental health problems are anxiety and depression.

About 1 in 20 people suffer from depression each year. Sometimes it can be mild and last just a short time, but sometimes it can be so bad that it requires treatment.

Around 1 in 4 women and 1 in 10 men will require treatment at some point in their life.

Anxiety occurs in about 1 in 50 people, often in their early 20s, but it's being seen a lot more now in older people.


What are the warning signs of depression?


I'm going to split this, if I may, into symptoms and signs.

The depression symptoms that someone might have include feeling down or upset. They're finding no pleasure or enjoyment in life and they may appear restless, agitated or even irritable. Sometimes they're feeling worthless or guilty for feeling the way they do.

They often have very low self-esteem and self-confidence. They may feel empty, numb, isolated and unable to relate to other people around them. They can often feel hopeless, helpless and sometimes suicidal.

The signs of depression are the things you might notice in other people. You might find that they're avoiding social activities or events. They may be self-harming or talking about suicide. You might notice that they're struggling to concentrate.

They may even find speaking quite difficult, because they're finding it hard to think clearly. This might also affect their ability to do things quickly, even walking. They often find it hard to make decisions.

They can be sleeping too much or too little. Sometimes they're eating less and losing weight, while other times they're eating more and gaining weight. Overall, they're generally negative towards both themselves and other people. This makes them less effective at home, at school or at work.

You might find that people with depression are smoking or drinking more than usual and sometimes they'll use drugs to try and reduce the symptoms they're feeling.


What causes mental illness?


Sometimes it can be experiences. For example, people may have suffered physical abuse or neglect in childhood. It can be losing someone close to you, or something traumatic that you've experienced or witnessed.

Even an unstable situation at home, such as losing your job, the end of a relationship or any major life change can trigger the development of mental health problems.

If you've got a pre-existing mental health problem, such as anxiety, depression, or an eating disorder, this can make you much more likely to develop another mental health issue.

If your physical health is not very good, it can make you more prone to mental health problems, especially people who have chronic pain or a disability that affects their home life or ability to carry out a job.

Some medication has depressive side effects, while of course alcohol or street drugs can cause depression. If you're not getting enough sleep, your diet is poor or you're not exercising, this can also make you more prone to mental health problems.


Is depression to do with genetics?


They've not found a specific gene that causes depression, but a lot of research has shown that if you have a family member with depression, you're much more likely to experience it yourself.

It might be because of biology, or the environment you're in and the shared circumstances, but it does seem to be that genetics plays a role in development of all mental health problems.


Who is most likely to be affected by depression?


Depression affects a lot of people. People who have Seasonal Affective Disorder (SAD) find that winter or dark days make them feel low, which can lead to depression.

Pregnancy can be a time when people are more prone to depression, whether it be before the baby is born or afterwards. This means that in most studies, women have a higher risk of depression than men.

Other at risk groups include people with a history of depression, significant physical problems and other mental health problems, including dementia. Certain ethnic groups are also more prone to depression.


How is depression treated?


I think first of all we should look at things people can do themselves. We certainly want to encourage activity. This can take many forms - it could be walking, swimming, running, yoga, pilates or tai chi. Things that are done in teams can increase social interaction.

We want to encourage healthy eating. A nutritious diet can help with energy, concentration and stamina, whereas a poor diet can cause fatigue, lethargy and poor concentration.

We want to ensure that people are sleeping well. Sleeping too little or too much can cause depression and low mood. It's good to have a healthy sleep routine.

Avoiding alcohol and drugs is important. Both of these can cause depression and make it worse. When people are feeling depressed, their self-esteem is very low, so I also think it's important that people take time to look after themselves and be nice to themselves.

The other types of treatment can be split into two. There's talking treatment and medication.

With talking treatment, the purpose is to understand your thoughts, how they cause feelings and how these feelings might alter your behaviour.

This therapy is carried out by a trained person who can explore how you're feeling and how this leads into the way you're behaving. They'll help you find a way of stopping the link between the abnormal thoughts and the way you're feeling. This can help lift your mood and make you feel much happier. It's as successful, if not more successful than medication.

There are several different types of medication. Most of them work by affecting the chemicals that help the brain send signals around itself. They tend to make the signals move more efficiently and effectively. It also reduces depression and anxiety.

There are several different types of drugs. The most common ones are called Selective Serotonin Re-uptake Inhibitors (SSRIs). You may have heard of these, as they include prozac, citalopram, sertraline and paroxetine. They work effectively for both anxiety and depression, as well as panic and obsessive compulsive disorders.

They do have side effects and they unfortunately don't always work straight away. The side effects can occur early in the course of treatment, which can put some people off. When you're on this medication, it can be up to three months before they're working fully and you may need to remain on them for at least 12 months.


Can mental health issues be prevented?


Sometimes it's difficult to prevent them, but what you certainly can do is pick up on mental health problems early in the course of the illness. If this is done, often it's a lot easier to treat and the symptoms are shorter than they would otherwise be.

Don't bottle up your mental health problems. Most of the people that I see have had symptoms for two to three months at least and this tends to make them feel a lot worse than if they'd come to see earlier. So don't bottle it up and do talk to people.

It's true that a problem shared is a problem halved. Whilst these people that you talk to may not have depression themselves, the ability to talk to someone, to trust them and confide in them, definitely helps improve your own mental health.

It's important that you're active and doing lots of exercise. This has been shown to promote good mental health. As I mentioned earlier, a good diet can boost your mood, energy and concentration.

A stable sleep routine is important, too. You want to relax before bed, avoiding all electronic devices for one hour before bed. Listen to music, have a bath, read a book or do relaxation exercises in that hour.

Try and go to bed and wake up at the same time each day and make sure that the environment that you're sleeping in is the best it can be. The temperature, the noise level and the light must be right. Read our 43 ways to get a good night's sleep.

Stay away from alcohol and drugs as both of these tend to promote mental health problems.

Don't tell yourself that it's your fault these things are happening, because it really isn't. Do try and do nice things that you enjoy and try to think about those rather than dwelling on the negative.




I think the most important thing you can do is talk to them. Be open about depression. A lot of people find it hard to talk about. They feel somehow it reflects on them as being a failure, or that they've done something wrong. Well this is absolute rubbish!

No one can choose to become depressed and people can't control it. Therefore, if they have the ability to talk to someone about depression, it can really help.

Support that person to get help. Don't push them too much, but guide them in the right direction. People are often reluctant to go and seek help, so it's good if you can help them do that early in the course of the illness. Keep in touch with them. Make sure that you have contact regularly, so that they know you're thinking about them and supporting them.

Don't be critical of them. People who've never experienced depression sometimes find it hard to understand what it means. They feel it's a coat you can just shrug off and suddenly you're back to normal, but that's not the case with depression. People sometimes find it hard to explain to other people how they feel, so don't be overly critical. Be supportive. Listen. Don't talk.

You may want to support somebody with depression, but you also want to encourage them to try and do things themselves. Don't try and do everything for them. Encourage them to do as much as possible.

Make sure you're looking after yourself too. don't let your own health suffer because you're looking after somebody else.


What happens if that person rejects your help?


In that case, the most important thing you can do is not walk away from them. Keep in touch. It may be hard to do this with someone who does things that go against what you'd like them to do, but it's important for them to know you're supporting them.

If you feel that this person is at risk of doing harm to themselves or others, it's important that you raise this with the appropriate authorities. This might be their GP, community mental health services, or the crisis team in your community, who deal with people who are quite unwell with mental health problems.

Don't keep it to yourself. You're doing them a favour if you get them help.


What can a GP do for me?


It's very interesting that on many occasions that people have come to me with anxiety or depression symptoms, I've talked to them about how they're feeling and they've gone away to consider whether or not they'd want to start medication or be referred for therapy.

When they've come back to see me, they've felt that they no longer need treatment, because the process of talking to someone was really helpful to them.

So I think it's important to see a GP, explain how you're feeling and how it's affecting you. The GP can take a full history of your problem and talk to you about the different options available.

No one will be forced to go on medication against their will, but they can talk about the pros and cons of medication and the other types of therapy available, whether it be a talking therapy or self-help. A GP can talk about the lifestyle changes you can make to ensure your mind and body are healthy.

If it does come to medication, a GP can talk you through the options, the pros and cons, the side effects, how they work and how quickly they work.

The GP can also be the place you go to if your symptoms are getting worse, as they can direct you to a specialist that will be able to support you.


How long does it take for treatment to work?


That's an interesting question and it varies from person to person.

When it comes to medication, unfortunately the tablets don't work straight away. They tend to take one to two weeks to begin working. In that time, often people will get side effects, which can be a little upsetting. The side effects pass away in around seven to 10 days.

Once the tablets start working, they tend to work best after about three months. People will need to remain on the tablets for about six months after that to prevent them from going back into depression or anxiety, so the total amount of time that someone will be on medication is around 12 months.

When it comes to the talking therapies, this is where it becomes more variable. Most talking therapies will involve a series of sessions. There might be six, 12, or it may be indefinite, depending on the severity of your symptoms.

Each session will last about one hour and you'll be given homework to do in between sessions. It seems to me that the average number of sessions a depression or anxiety sufferer might require is six to 12.

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