Smart Thinking

Eight things you need to know about mental health (but were afraid to ask)

Truth or myth? We asked a panel of medical experts to tackle today’s most common mental health taboos.

Can depression be clinically diagnosed, and if so, how?

To diagnose depression we have to satisfy diagnostic criteria: inability to enjoy enjoyable activities, plus any four of these – loss of appetite, sleep disturbance, lack of energy, fatigue, feeling worthless or hopeless, a diminished ability to concentrate, recurrent thoughts of suicide – and they need to be present for at least two weeks. We do blood tests when we assess people to see if there are physical causes like hypothyroidism. But we all have different vulnerabilities, and mental health is biological, psychological, and social.

Dr Dmitri Popelyuk, Consultant adult psychiatrist based at 25 Harley Street Clinic

How can someone know they’re depressed rather than just feeling sad?

Sadness is an emotion and often an appropriate one depending on what’s going on in our lives. It’s tempting to label our emotions as ‘good’ or ‘bad’, but our emotions have a purpose as signposts to our internal state. Suppressing what we’re feeling is rarely effective, and undesired emotion often surfaces in another way. Depression is something else – many people comment on the absence of feeling, and it tends to be persistent and enduring, while sadness is an emotion, and like all emotions, subject to change.

Hilda Burke, Integrative psychotherapist, couples counsellor and life coach

What has more impact on mental health – genetics or life experience?

It’s probably not dependent on your genetics. What happens to us and what we learn from those experiences are more likely to predict our mental health than biological differences. There are major causal factors: abuse, bullying, violence, racism, unemployment, poverty. If you’ve had any of the common adverse childhood experiences – growing up in poverty, social inequality, exposure to racism, bullying, or sexual abuse – you’re much more likely to experience mental health problems in adulthood. That likelihood is greater than the link between smoking and lung cancer. Even in adulthood, negative life events, and the way you respond emotionally, psychologically and socially, is what has the major effect on your mental health.

Professor Peter Kinderman, Professor of Clinical Psychology at the University of Liverpool

Is depression hereditary?

There is a genetic predisposition. If your first degree relative, a parent or a sibling, has depression, you’re four times more likely also to suffer depression. You might be temperamentally predisposed, or have a propensity for negative thinking. Environmental factors such as childhood events, and difficult experiences such as divorce, other relationship problems or problems around work, and bereavement also have an impact. DP

If you’re worried about your mental health, where should you go?

People should go to their GP. If the GP recommends a lifestyle change in the first instance, go with it. In the same way you probably shouldn’t have your leg amputated for an ingrown toenail, you probably don’t need years of therapy or medication if what would help is a few days off work and more exercise. Don’t dismiss straightforward interventions. Your GP is also the right place to go for greater psychological and social interventions, whether that’s basic therapy through to psychiatry and medication. They can point you in the right direction for what you need. PK

Does therapy really work? How?

It’s not just talking about things, though good therapy might seem as simple as that. Of course, talking to friends can be of therapeutic value, but talking to a professional person helps us understand ourselves and gives us the ability to see the patterns that are dysfunctional. Different therapies act as tools to gain insight about ourselves and then lead to changes for the better. DP

How can we stay mentally healthy?

We can respond to mental health challenges in our lives rather than being buffeted about by them. One of the things we can do is identify the snags and feedback loops we get into. For example, when people get depressed, they lose interest in enjoyable activities, withdraw from friends, and stop exercising – exactly the very things we need to keep doing, because positive feedback is a natural antidepressant. We can break negative feedback loops by maintaining our activities, addressing rather than avoiding problems, and maintaining our exercise and relationships, even when we feel rubbish. You don’t have to see yourself as ill, just maintaining good mental health. There are also five evidence-based ways to wellbeing: connect with others, be active, take notice, keep learning, and give. When problems do develop, get professional help to stop you falling into traps or worsening mental health. PK

Are antidepressants addictive?

Antidepressants are long-term treatments. They aren’t addictive. When they’re used well, they’re very necessary. Depression has significant potential for morbidity: it disrupts interpersonal relationships, leads people to self-medicate with alcohol and drugs, and to take time off work, all of which can lead to further depression. It’s a serious condition with serious consequences especially as it gets more severe. Antidepressants are important tools in helping patients to recover. They make therapy more accessible. For example, if you’ve a lack of energy and concentration because of your depression, antidepressants can help mitigate these symptoms so you can get to your therapy session. They work as part of a holistic treatment plan. DP