Depression (low mood)

Humans have the same range of basic emotions. The fact that all humans, across the world, in different countries and cultures have the same emotions means that emotions evolved to serve a purpose related to survival. It might not seem obvious, but most emotions serve to connect us to others or to seek safety. For example, feelings of loneliness make us want to connect and create relationships. Feelings of fear make us seek safety.

It is important to understand that emotions are not good or bad, positive or negative. If we think of emotions in that way we fall into a trap of believing we can have just the ‘good’ feelings, that we must be happy, and that we can avoid or get rid of the ‘bad’. And that if we’re not happy, that there must be something wrong with us. 

Feeling sad or low in mood is a natural state of emotion that everyone has at times. Life is often challenging, and experiences, circumstances and events can cause people to feel low. Low mood can also happen for no obvious reason.

Depression develops when low mood becomes consistent and impacts the way we live our lives. For example, withdrawing and avoiding situations, like going out with friends.

Evolution and the mind

Our minds have evolved over many hundreds of thousands of years to be constantly watching out for threat.

The mind works on a ‘better safe than sorry’ principle.

Imagine that you are a tribal warrior crossing the savannah in 20,000 BC to get your village.

If you saw a shape in the grass and thought – ‘That’s a rock’ and it was actually a lion – you would be lion lunch and your careless genes would not be passed on.

BUT if you thought:

‘That’s a lion!!!’

The threat/self-protection system in your body would react automatically to keep you safe. E.g You would run, hide and wait until it was safe.

Here is a video that explains this in more detail:

Detecting ‘threat’ can be about the world being unsafe, which causes anxiety, or it can be about detecting faults and flaws in ourselves, looking for reasons why others might reject us, so that we can prevent that from happening and stay safe. If we believe the thought and see it as a truth – it can cause low mood, feelings of hopelessness, low self-esteem.

If you are a human then pain is inevitable, no one gets through life without experiencing distress and difficulty and challenging times.

While we will all experience the unavoidable reality of pain, we also suffer because of our capacity to ruminate about the past, worry about the future and get stuck inside unhelpful judgements of ourselves and others.

Our mind is constantly busy – telling us random things, rehearsing stuff we need to say or do, bringing up memories, predicting what might go wrong and making up things to worry about etc. When it is triggered into an unhelpful and emotionally laden thought, such as ‘No one will like me’, ‘I’m a loser’, it grabs our attention.

When we believe thoughts as truths, it affects the way we feel and behave.

Why are our thoughts often so negative? Watch this to find out:


Let your mind do its’ thing:

Set a timer for 2 minutes

Notice the activity of your mind. Even if your mind says, ‘I’m not doing this properly’, or ‘Nothing is happening, I’m not having any thoughts’.

Jot down briefly what comes into your mind during the minute

After 2 minutes

Take a look at what you wrote. What do you notice? Was it just a random jumble of thoughts or are you preoccupied with something? Were they profound life changing things or do you now know what you are having for dinner? Just notice.

The function of the mind is to pump out thoughts, like your heart pumps blood around your body.


Natural fears

One of the most common types of thought, especially for young people, is the concern about not fitting in, being rejected from the group or not liked by others. This is a hard-wired fear. Our brains and bodies have not changed in the last 100,000 years. Imagine what life was like 100,000 years ago – we lived in a harsh, unsafe environment. Babies don’t show a fear of heights until they are around 7 – 9 months of age. This is about the time when they can move independently and might harm themselves, so a fear of heights meant they were more likely to survive. In the same way. Adolescents would typically leave their family tribe and form a new tribe of same-age peers. Fears of not being included appear as self-criticism and reasons for others to reject us, of not being liked or approved of. This is the mind’s way of trying to protect us from putting ourselves at risk of rejection. Research shows that adolescents will change their opinion about something in order to match the opinion of others. Fitting in and being included in a tribe were vital to survival – if you were alone, you were vulnerable and likely to be killed or die. That fear still appears today because our stone-age brain hasn’t caught up with the changes in our environment. In fact, we are more likely to worry about it because of social media and the internet telling us how we should be and what we should look like. We ‘compare and despair’.

Back to Low Mood. It exists on a continuum

  • The low mood continuum is the feeling of being sad through to depression. The severity depends on the persistence of unhelpful thoughts, the attachment to unhelpful thoughts, the impact on behaviour, including appetite and sleep. Most often is it connected to an unwanted life event or situations both real and imagined. Low mood is an important emotion that helps us to process things that have happened to us.Its function is also to alert others that we are vulnerable and need comfort and protection.
  • Signs– crying, withdrawing from others, finding it hard to talk, taking steps to prevent further loss so may lead to worry.
  • Helpful responses – comfort, soothing, compassion, listening, empathy
  • Unhelpful responses – telling them to stop crying/ being sad,, low or depressed minimising or invalidating their experience.
  • Although crying is often a helpful way to process sadness (crying is also a universally human behaviour), many people have had experiences of being told not to cry and therefore they may try to avoid crying. Other noticeable behaviour is being more hunched over, not making eye contact, withdrawing from others, speaking quietly. Anxiety can be closely related to sadness as the young person may be trying to avoid further loss- leading to avoidance due to worry about social rejection or failing to achieve.

Developing helpful responses

  • Helpfully responding to someone who is low in mood we first need to empathise - acknowledge the sadness and offer comfort to the young person. It is important that emotions are seen and validated by others.
  • It is important not to give the message that they should not be sad or that their loss is not real.
  • Don’t rush in to solve the problem or deny what the young person is thinking about themselves. Instead, reassure them that their mind is not stating facts and that they don’t have to be believed, they need to ask if the thoughts are helpful or unhelpful. For example, does the thought ‘I am a loser, no one will ever like me’ help them to live the life they want? If they value friendship and connection, that thought is likely to result in behaviour that isolates them and move away from the life they want.

Have a look at this video for more information on how to deal with unhelpful thoughts and feelings.


  • Comfort – using touch (appropriate – hold hand, hug with permission, back rub).
  • Self-Soothing soothing and nurturing activities, such as baths, warm drinks, other self-care, walking in nature.
  • Listening – focussed, non-judgemental listening without interruption.
  • Being (self) Compassionate noticing the suffering, acknowledging that we all suffer, being kind and caring.

Self-compassion is vital. Research shows that it is protective and far from stopping recovery, it actively promotes it. Unhelpful self-talk – criticising ourselves or judging ourselves harshly leads to activation of the threat self-protection (fight/flight) system. Our defences go up, our thinking becomes narrow and our body is flooded with stress hormones. We can’t get away from this internal bully so the ‘threat’ keeps going. We are both the attacked and the attacker.

Compassion activates the soothing system, the body is flooded with nurturing hormones that make you feel safe. You are more flexible in your thinking and calmer in your body. From here you are likely to make more helpful decisions and responses.

Link to self-compassion video:


Problem solving about the difficult situation/stress

Many situations can be improved by problem solving

  • Once a person feels validated, listened to and calmer, they can focus on how to overcome challenges they are facing.
  • Be clear on what the problem is: E.g I am stressed about exams and think I will fail and that my life will turn out badly.
  • Generate as many different solutions to the problem as you can: create a study plan with breaks included, revise, speak to my subject teachers, be more present when I notice my mind trying create a worry.
  • Choose one solution: I could notice when my mind makes unhelpful predictions, focus on what is important in the present moment and revise.
  • Make a specific plan for the solution

Supporting to maintain pleasurable and meaningful activity

  • Low mood leads to low motivation and withdrawal.It is important to maintain pleasurable, meaningful and social activity to prevent further deterioration in mood.
  • Developing an activity schedule and sticking to it is one of best ways to improve low mood.
  • The 6 ways of wellbeing - it is important to maintain the 6 areas of well-being as part of this activity scheduling. Even if the person does not FEEL like doing it, just doing it helps to improve mood.
    • Connection: be with friends, family, pets
    • Self-care – sleeping well, eating well, personal care etc.
    • Being active – going out for a walk, bike ride, doing PE
    • Giving – doing something for someone, a pet, your community etc.
    • Being present –use all of the senses to focus on the here and now
    • Learning – challenge yourself to learn something new

Self-Harm and suicidal thoughts

Finding a way to switch feelings off is the mind simply doing its work of figuring out how to escape or avoid what feels like unbearable emotional pain.


Suicide is offered as a solution to switching off feelings, by the clever, problem solving mind. Once you have the thought of it, you come to believe in the thought as an option. After all, you thought of it! And then you have the thought – ‘I am suicidal’ and feel scared by what that might mean.

Self-Harm and suicidal thoughts

The problem is that supressing unpleasant emotions or avoiding them in some way through self-harm, drug or alcohol use, or other forms of avoidance makes things worse.

We become lower in mood and more anxious.

In addition, adolescence is the time when we are old enough to start thinking about our existence and a young person with low mood might start to wonder about the meaning of life – “What’s the point when we all die anyway?”

Self-Harm and suicidal thoughts: How to handle it

Normalise > Validate > ReFrame > Activate

Normalise –

“We all have thoughts like that”. “Many people feel that way”.

Validate the distress-

Acknowledge it, say what you see using empathy and compassion, ‘I can see this is really tough for you’. Sitting alongside rather than face to face is better.

Reframe –

Frame the issue as an effort to deal with pain.

“Life is tough sometimes and your mind is trying to figure out what you can do to make the feelings you don’t want, go away”

Activate –

Encourage active steps that will help the young person deal with their pain in a healthy way. Identify it, where do they feel it in their body, what emotion is it? Allow it to be there – it will pass in its own time.

Follow the steps above for dealing with low mood.

Devise a plan for what to do instead of self-harming.

Seeking more help

Sometimes young people need help in addition to what their family, friends and school can offer.

•Specialist mental health in school’s teams (MHSTs)

Kooth is a free online counselling and emotional wellbeing support service offered to young people aged 11 - 25 years (up to their 26th birthday) living in Dorset, Hampshire and the IoW with a safe and secure means of accessing support with their emotional and mental health needs from a professional team of qualified counsellors.

•GP

•Counselling

•Youth work

CAMHS: This help might come in the form of psychological therapy and/or medication.

Summary

•       Life is challenging and we will all experience pain.

•       Sadness is an inevitable and healthy part of life

•       Low mood is normal in situations where people are under stress or have had a difficult life event. We will recover when the stress is over or the difficult life event has been processed if we are able to maintain self-care, connection and activity during these times.

•       A person can be said to have depression when they are no longer able to function in some parts of their life due to ongoing unhelpful thinking and low mood that impacts especially on self-care, sleep, eating, motivation and concentration. 

•       People who experience depression recover through re-establishing self-care, connection, activity, purpose, gratitude and care for others and managing unhelpful thought by noticing them and asking ‘Is this helpful to me? Is it taking me closer to the life I want or further away? Then choosing a thoughtful response. And repeat, repeat, repeat.

•       If a person does not recover from a depressed state over the course of a few weeks more help can be sought through primary care services and CAMHS where psychological therapy and / or medication may be needed.

 

Top Tips

  • Tip 1

    It is important to tell someone how you are feeling so that you are not alone. You could talk to a parent/ carer, teacher, health professional (school nurse or your GP). This is particularly important if you are having thoughts or urges to harm yourself or end your life.

  • Tip 2

    Following a basic daily routine and making sure that you still do the activities you need to do and do some other activities that you used to enjoy but have perhaps stopped doing because you are feeling depressed. Plan activities for the morning, afternoon and evening and try to stick to these even if you do not feel like it. Avoiding or withdrawing from activity is known to lower mood so make sure that you see friends, go to school/ college, do things you enjoy (or used to).

  • Tip 3

    Look after yourself; eat well, sleep, get some fresh air daily, do exercise and avoid self-medication (for example using alcohol, drugs or caffeine).

  • Tip 4

    YOUNG MINDS CRISIS MESSENGER

     

    This service provides free, 24/7 crisis support across the UK. If you are experiencing a mental health crisis and need support, you can text YM to 85258.

    They will listen to you and help you think through how you’re feeling, and will aim to help you take the next steps towards feeling better.

    Texts are free from EE, O2, Vodafone, 3, Virgin Mobile, BT Mobile, GiffGaff, Tesco Mobile and Telecom Plus.

  • Tip 5

    If you live in Hampshire or on the Isle of Wight, the NHS 111 mental health triage service can provides advice, support and guidance, 24 hours a day, seven days a week. The Mental Health Triage Team has a wide range of skills, including on the phone brief psychological support and has access to key services and organisations that can offer mental health support to you and your child in your time of need. Just dial 111 or online at www.111.nhs.uk.

 

CAMHS Depression (low mood) Referral Guidance

 What we do, what we don’t do and what you can do if you are worried about your child:

All young people will feel low in mood from time to time. Here’s a guide to help you know how best to support your young person if they are experience symptoms of low mood or depression. This is not an exhaustive list; young people will experience other types of mood issue and symptoms which may not be included on this guide

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