Recovery from most mental health problems comes about as a result of a mixture of professional help and self-help through lifestyle changes. Working closely with your doctor to find the right strategy is usually the key to success.
Counselling and psychotherapy can help people to understand the factors that may underlie anxiety and depression. Working with a therapist can enable you to develop coping strategies and ways of interpreting feelings to make them more bearable.
Your doctor will be able to advise you on the various options for talking therapy for a range of mental health problems including anxiety, depression and schizophrenia, available in groups or one-to-one sessions. Painful experiences can be hard to talk about, but professionals understand this. Be as open as you can so that you can receive the best help.
Counselling may be available via your GP. Short-term counselling consists of 6 to 12 hour-long, one-to-one sessions. The counsellor will listen and, depending on the type of counselling, may ask questions. The counsellor won’t provide answers but will encourage you to find your own solutions. It may be appropriate to continue with longer-term counselling. This therapy may be suitable for mild anxiety and depression and can help you cope with problems such as anger, relationship issues, bereavement, panic attacks, generalised anxiety disorder and social phobia.
Cognitive behavioural therapy (CBT) works by helping you to identify unhelpful and unrealistic thoughts and shows you how these can lead to problematic emotional and behavioural patterns. Once identified, you can learn to replace unhelpful thoughts with more realistic and balanced ones. This can help you react more positively to situations that may cause anxiety and depression. Treatment usually involves a 1 to 2-hour session, once a week. It is available on the NHS for people with depression, anxiety and some other mental health problems. CBT may be delivered as individual or group therapy.
Computer cognitive behavioural therapy (CCBT) is a form of counselling that is appropriate for the treatment of mild-to-moderate depression. There are now a number of interactive CBT programs that can be used at home. A popular one is called Beating the Blues, usually available free through your GP. FearFighter, is a programme for panic or phobia that is also available through your GP.
Psychotherapy looks into past experiences to find their relevance to present difficulties. Different forms of psychotherapy include interpersonal therapy (IPT), which focuses on relationship and communication problems; family therapy, in which the therapist works with the whole family; and couples therapy, which involves both partners.
Finding somebody to help
Ask your GP if the practice provides any mental health services directly. If not, ask to be referred to a therapist. You could also look at registers of practitioners at your local library or on the internet.
Being on a register does not ensure quality, but it does mean that if you have a problem, you can take the matter up with the organisation. The British Association for Counselling and Psychotherapy (BACP) provides a list of registered therapists. And if you know someone who has seen a therapist, ask for a recommendation.
What happens next?
It may be worth seeing several people before you choose a therapist.
The key question to ask yourself is, “Do I trust this person and can I communicate with them?” Ask the therapist the following questions:
- Can you explain what type of talking treatment you provide and how do you think it could help me?
- What are your qualifications?
- How much do you charge (if not NHS)?
Prescribed drugs can be an important part of your recovery process, particularly if your mental health problems are severe or long term.
There are many drugs available and it can take a while for your doctor to find the right one for you. You’ll need to be patient because it may also take time for the benefits to be felt. For example, antidepressants take at least two weeks to start working and up to six weeks to be fully effective, though you may feel less anxious and be able to sleep better after only a few days. It is very important to continue a prescribed dose, and you should on no account stop taking the drug because you feel better. This is a sign that the drug is working and stopping it may cause a relapse.
If you are worried about how a medication is making you feel or think, go to your doctor or hospital as soon as you can. You may also find it helpful to talk to a friend or family member about your medication so that they can alert you to any changes in your behaviour.
There are four main types of antidepressant medication that your doctor may prescribe. Each type is used for different forms and degrees of severity of depression:
- Selective serotonin reuptake inhibitors (SSRIs) are the first choice for mild depression. They can also be used for particular types of anxiety, such as panic attacks, social phobia and obsessions.
- Serotonin-noradrenaline reuptake inhibitors (SNRIs) are among the newest classes of antidepressants. Your doctor may prescribe these if SSRIs don’t have the desired effect within a reasonable time.
- Tricyclic antidepressants (TCAs) were the most commonly prescribed antidepressants but are used less often now due to the risk of serious side effects. They are sometimes still used in cases of moderate to severe depression.
- MAOIs (monoamine oxidase inhibitors) are used only when other medications have not worked, because they can cause severe adverse reactions with some types of food and other drugs. If you are prescribed an MAOI, ask your doctor for details of what you can and cannot eat.
This class of drugs includes medications, such as chlorpromazine and haloperidol, that were originally developed to calm patients before surgery.
They are used mainly to treat serious mental illnesses such as schizophrenia as well as psychotic depression and bipolar disorder (manic depression).
These drugs tend to be prescribed for the short-term relief of anxiety, especially if there are no symptoms of depression.
- Benzodiazepines, such as diazepam and temazepam, are very effective but they can cause dependency and should be used only as a temporary measure for severe or disabling anxiety.
- Beta-blockers can reduce some of the physical symptoms caused by anxiety, rather than the anxiety itself. For example, they can reduce shaking (tremor) and a fast heart rate.
- Buspirone is sometimes prescribed for feelings of anxiety, tension and fear, but it can take longer to work than some other drugs.
Coming off medication
Deciding when and how to stop taking medication is an important step in the recovery process. You should never stop taking your medication without first talking to your doctor; neither should you alter your dose without advice.
Discuss with your doctor whether it is the right time for you to stop the medication. Some medications, especially those, such as benzodiazepines, that carry a risk of dependency, need to be tapered off over a period of weeks or months to avoid side effects.
Make sure you keep in touch with your doctor as you are coming off medication to monitor any problems that may arise.
Eat to boost your mood
People turn to comfort food in moments of distress and without doubt feel better as a result, but do specific foods really have the power to lift the spirits or bring them down? Although the precise cause-and-effect relationship between different foods and mood has yet to be scientifically established, the answer seems to be “yes”.
Studies link poor diet with a host of mood problems including depression, anxiety, bipolar disorder and attention deficit hyperactivity disorder (ADHD) in children.
Research published in The American Journal of Psychiatry in June 2010 found that of a randomly chosen group of 1,046 women aged 20-93, those who consumed a typical Western diet—high in processed or fried foods, refined cereals, sweet foods and beer—were more likely to suffer depression, anxiety and other mood problems. By contrast, those who ate a diet rich in vegetables, fruit, meat, fish and whole grains had much better mental health. Numerous other studies back this up.
Exercise to keep your spirits high
Even thinking about exercise when you are mentally distressed can seem out of the question, but research shows that regular activity can help increase wellbeing, alleviate stress, lift depression, ease anxiety and enhance mood and self-esteem.
Understanding how activity can improve your mental health may help motivate you to get moving. Here are some very positive reasons to start exercising:
- Boosts levels of feel-good brain chemicals. For years exercise was thought to improve mood by causing the release of relaxing chemicals called endorphins. The latest research, however, suggests that exercise also increases the availability of brain messenger chemicals such as serotonin, dopamine and noradrenaline, which are lowered in depression and other mood disorders.
- Increases self-esteem. According to research, exercise can improve self-confidence and reduce depression. The improved muscle tone and weight loss that may come about with regular exercise can also make you feel good—an extra boost if you have negative feelings about your body.
- Takes your mind off things. Distraction can lead to greater improvement in mood than more inward-looking activities such as journal keeping or reading.
- Warms up your body. The rise in body temperature—both the core temperature and that in certain regions of the brain, such as the brain stem—following exercise helps to reduce muscle tension and aids relaxation, a factor that may be especially useful in alleviating anxiety, according to some research.
- Helps you sleep better. Regular exercise can help ease insomnia and other sleep problems that often accompany emotional distress.
Back to work
Returning to work either full time or part time after any kind of mental illness can help recovery by lifting confidence and self-esteem, but it can be daunting. Here are some practical things you can do to ease yourself back into the workplace:
- Drop in. Visit your workplace before going back, to say hello to colleagues and re-familiarise yourself with the work environment.
- Ease back slowly. Ask your boss or HR department if you can build up your hours slowly or even work part-time.
- Consider changes. Ask if you can change your hours or job description if you think that such adjustments might help you cope.
If you are thinking of looking for a new job, Rethink has compiled a list of questions to ask yourself:
- Where do I want to work?
- What type of work do I want to do?
- What support will I need?
- Who can help me look for a job?
Your local job centre, which should have a special department for dealing with people with mental health difficulties, will be able to help you answer these and any other questions you may have. However, they may not be experienced in dealing with mental illness, so be prepared to talk about your condition and any impact you think it could have in the workplace.
Getting help in a crisis
You may find yourself in a situation where you feel you need immediate help. Be reassured that there are several sources of advice and support:
- GP. He or she may be able to visit you at home.
- Community mental health nurse (CMHN). They often work with GPs or in community mental health centres.
- Community mental health team (CMHT). These include psychiatrists, psychiatric nurses, social workers, occupational therapists, clinical psychologists and others who work with individuals to provide support.
- Crisis resolution team. They can help avoid the need for hospitalisation and provide home assessment and treatment. They can also arrange admission to hospital if necessary. They may operate a local psychiatric crisis line.
- A&E. There may be a duty psychiatrist who can help, although you may have to wait a long time and this can add to stress.
- NHS Direct. In some circumstances, they can call the GP and request a home visit.
- Voluntary agencies. Local voluntary groups may be able to help you access help.