Depression

When young people spend time in hospital or have health problems they can have times when they feel down, or depressed.

The leaflet below explains low mood and depression and provides some ideas for coping.

Low moods often begin with feelings of sadness. These tend to get bigger and people feel overcome with a sense of hopelessness and misery. People often feel tense and worried a lot of the time as well.

Some people describe feeling numb and unable to feel anything. It is as though the feelings have become so overwhelming that the mind switches off from feeling anything.

Thoughts

• Losing confidence in yourself.
• Having lots of negative or gloomy thoughts.
• Thinking everything seems hopeless or is a waste of time.
• Thinking you hate yourself.

Events can affect us in different ways depending on how we think about them.

When people feel low or depressed, particular ways of thinking are triggered and can make you feel a lot worse. When people are feeling low, they tend to interpret situations in certain ways including:

• Focusing on the negative parts of their situation and ignoring any other parts that might be more positive.
• Thinking about themselves in a very critical way and judging themselves in a harsh or unfair way.
• Thinking that the way they are feeling will go on forever and nothing will ever change.

Not surprisingly, these ways of thinking about things can make people feel even more down.

Most people who are feeling low find that they don’t enjoy things that they usually like doing, such as going on the computer, playing games, chatting to friends.

Feeling isolated from other people can have a big influence on your mood. People who are feeling down often believe other people are not interested in spending time with them.

When people are experiencing low mood they often can’t be bothered with things like getting up, washed and dressed. They take less care of how they look. This often makes people feel even worse.

How do feelings, thought and behaviour fit together?

When you are feeling down or depressed you may believe that you are helpless and alone in the world. You often blame yourself for things that aren’t your fault.

Underneath all of this you feel negative about yourself and about the world. So you tend to lose interest in what is going on around you and you don’t get any pleasure out of things that you used to enjoy and may do these things less often. It can become hard to make decisions or carry out little tasks that you used to do with no problem.

The way you think affects the way you feel, which affects the way you behave.

When you are feeling down you might have negative thoughts a lot of the time. With each negative, or gloomy thought the negative feelings are likely to get bigger. You can get caught up in a cycle.

How can I recognise these gloomy thoughts?

When you are feeling low the gloomy thoughts may happen so often that you just accept them as fact. Gloomy thoughts are often about yourself, the world around you or the future.

Everyone has negative thoughts at times. People generally put them out of their mind and try not to think about them. When you are feeling really down, these gloomy thoughts are around most of the time.

• The negative thoughts just seem to pop into your head for no reason.
• The thoughts make you feel bad and get in the way of what you really want to do. If you think about them carefully you realise that the thoughts are not reasonable and they do not give you an accurate picture of what things are really like. For example, thinking someone hates you just because they haven’t contacted you recently.
• Even though the thoughts are unreasonable they probably seem believable at the time.
• The more you believe and accept the negative thoughts, the worse you are likely to feel.

When people are feeling down, their thinking often changes, they tend to:

Overgeneralise

This is when you see a single negative event as a never-ending pattern of defeat. For example, if one person doesn’t get on with you, you may think “no one ever likes me” or if one of the things you were meant to do that day wasn’t finished you may think “I’ve achieved nothing all day”.

Ignore the positive

People who are feeling down tend to focus their negative thinking on bad events and ignore any positive or good events. You may have many good friends but you concentrate and worry about the one who has fallen out with you, or you may have got okay grades in some exams but you focus on the one you didn’t do so well on.

Take things personally

Often if we are feeling low we blame ourselves for anything that goes wrong, even when it has nothing to do with us in reality. We also tend to be short tempered and then feel guilty about shouting or getting annoyed with someone.

Have unrealistic expectations

When we are feeling low, we often set unrealistically high expectations of ourselves and then blame ourselves when we don’t reach these high standards. For example, someone thinking “I am stupid” when they don’t get top marks in some of their exams, even though they have missed a lot of time off school because of their illness.

How can I help myself?

Strategies that aim to change our thoughts, feelings and behaviours can break the cycle of low mood and help us to feel less depressed. Here are some ideas that might help you cope with low mood.

Have a plan for the day

When people are feeling down they often can’t be bothered doing anything, and then end up doing very little. This can often lead to feeling like time is dragging slowly and that you haven’t achieved anything all day.

Make a list of things you think you could do. Then plan out an action list, starting with the easiest things first. Work through your list and tick off what you have done.

This strategy improves your mood by changing your behaviour. If you can do more and increase enjoyment, it will hopefully have a positive effect on your feelings and how you think about yourself.

Recognise events, thoughts and feelings

Think of a recent time when you felt really upset or when you felt really down. You should be able to divide it into three parts:

Most people are only normally aware of the event and their feelings.

Can you think of an example?

• The event
• Your thoughts
• Your feelings

The important point is that we can change how we feel about something by changing how we think about it. Our thoughts can be changed by trying different techniques such as:

Balancing technique

A useful thing to try is something called balancing. When you have a negative thought, try to balance it out by making a more positive and realistic statement.

For example, the thought “I’m no good at school work” could be balanced with “I’ve missed a lot of school but that is not my fault. I’ll have time to catch up with school work when I’m feeling better”.

Be proud of your achievements – whatever they are!

Try and remember your achievements, and say positive things to yourself (you can say them in your head – you don’t need to talk to yourself out loud!). People often believe that saying positive things and being proud of your achievements makes you seem big headed and like you are “showing off” but this is not true. Everyone deserves to be proud of what they have achieved.

People in hospital or who are ill often discount their achievements, such as managing to get out of bed and get dressed, as being “nothing, everyone should be able to do that” (this is an example of having unrealistic expectations, as was discussed earlier).

But these are real achievements for anyone who is ill and you deserve to be proud and recognise how well you have done if you manage to meet any goal that you have set yourself.

Some people find it useful to keep a diary of these achievements. This is because research has shown that when we are feeling low, we do not always remember the details of events. Having these written down will mean that we can look back a week or a month down the line and remember what we have achieved.

Summary

Young people who are in hospital or who have a long term illness often can feel low in mood, down, depressed or fed up. This leaflet helps you to understand your thoughts, feelings and behaviours and gives you some tips as to how to improve your mood.

There are lots of people here to support you. You can talk to a relative, a friend, your GP or a member of your medical team.