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.

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:

https://youtu.be/MZJw3_ILEwY

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.

depression graph .png

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

https://youtu.be/0BF1hJaNtms

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.

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’.

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.

  • 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.

https://youtu.be/vyxc889gQtY

  • 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:

https://youtu.be/-kfUE41-JFw

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

  • 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

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.

feelings switch.png

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:

  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.
  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).
  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).
  4. Young Minds Crisis Messangers; 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.
  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.

Downloads

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

Green 

Coping / needs support; These are experiences that most young people will have from time to time

Type and nature of mood issue

It is common for children and young people to experience episodes of feeling sad, low or down as they develop through childhood and adolescence. The typical mood issues children and young people experience tend to be situation specific, short term and can be managed with the love and support of parents/ carers. Examples of situations that may cause/ contribute to a young person to feel down or low in mood might be:

  • Adjusting to changes (such as a new school)
  • Friendships or relationship issues
  • Episodes of being teased or bullied (including being or feeling left out or excluded)
  • Being physically poorly or in pain
  • Family breakdown or conflict
  • Grief or loss (of a pet, family member or friend)
  • Struggling with academic work

What you might see or a young person might report

  • Being clingy and not wanting to be separated from a parent/ carer
  • Not wanting to be left alone
  • Seeking verbal reassurance and checking things are ok
  • Not wanting to go to school
  • Avoidance of seeing friends or doing activities they ordinarily enjoy
  • Having mild sleep disturbance
  • Feeling tired or appearing lethargic and unmotivated and disinterested
  • Appearing withdrawn and less communicative
  • May appear more challenging or oppositional/ argumentative
  • Crying

Things to try, support and Next Steps

  • Normalise that feeling sad or down is a natural emotion particularly in response to a sad, disappointing or difficult event
  • Activity helps; encourage a young person to do a range of tasks and activities including one they need to do such as school work to fun things.
  • Keep a routine and have nice things planned
  • Break things down into small steps and do one at a time so tasks do not seem so overwhelming
  • Use distraction techniques, here are some strategies to try;

A-Z of coping strategies: https://youtu.be/5EXpkVw3fh

How to make and use a coping box: https://youtu.be/OyfgodSSdV4

  • Role model and demonstrate that you can do things even when you’re feeling sad or down
  • Be compassionate by validating how a young person is feeling
  • Support a young person to problem solve any obvious triggers
  • Watch our parent/ carer workshop on Coping and Resilience Skills here:  (to be uploaded)

Useful Resources:

  • Stuff That Sucks, by Ben Sedley
  • Little Blue book of sunshine - a mental health booklet that has been developed for children and young people living in Hampshire, Southampton and the Isle of Wight. The book aims to help children and young people by sharing tips on how to deal with many problems, such as anxiety, body image, relationships and anger. It also includes information about where to get help when needed, including information about local services. Click here to access the PDF or access the booklet via Apple Books or Google Play Books. 

 

Amber

Needs help; These are challenges that some young people experience and may need some support with

Type and nature of mood issue

The degree to which a young person feels low or depressed appears out of context or disproportionate to the reason why they might be feeling sad. Episodes of low mood might be more frequent or prolonged and cause the young person distress or might have some mild impact on their ability to cope with everyday life such as going to or coping at school, seeing friends or taking part in leisure activities. Examples of situations that may cause/ contribute to a young person feeling low in mood or depressed:

  • Being routinely teased or bullied (including being or feeling left out or excluded)
  • Grief or loss (including romantic relationships ending)
  • Witness or experience of conflict (at home or school)
  • Change and uncertainty (such as family breakdown)
  • Family and relationship stressors (parent/ sibling ill-health, financial or social stressors)
  • Academic pressures/ demands including exam stress and worry about the future

Please note, there are occasions when there is no apparent trigger/ cause/ contributory factor as to why a young person may be experiencing episodes of low mood/ depression. A young person can still be low in mood without clear reason.

What you might see or a young person might report

As well as the features in Green, the following might also be present:

  • Disrupted sleep (difficulties getting to or staying asleep, waking very early in the morning and not being able to get back to sleep)
  • Seeking physical or verbal seeking reassurance or wanting to withdrawn from social contact and communication
  • Resistance to doing things; appearing unmotivated and disinterested
  • Poor personal hygiene (not washing or changing clothes regularly)
  • Emotionally labile; frequent changes of emotion, more sensitive (e.g., irritable, upset, confused)
  • Thoughts or urges to harm self or some thoughts to end life; some infrequent or superficial (not requiring medical attention) self-harm may occur.

Please note that not all young people who engage in self-harm behaviour are depressed or suicidal. There are many reasons why a young person may engage in self-harm behaviour.

Things to try, support and Next Steps

As well as the steps in Green the following might be helpful:

  • Watch our parent/ carer workshop on how to support a young person with self-harm or in crisis here: https://youtu.be/qBAZQVjSmQU
  • Share concerns with your child’s school/ college
  • See your child’s GP
  • Access pastoral support from school
  • Consider accessing help from a local counselling service. 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.
  • Seek advice, guidance and support from Young Minds Parent Helpline: 08088025544
  • Depending on the context and/ or the origins of the low mood being experienced, other services may be helpful e.g., family guidance if there is family breakdown or conflict

Useful Resources:

  • Stuff That Sucks, by Ben Shelly
  • Am I Depressed? And What Can I Do About It? by Shirley Reynolds and Monika Parkinson
  • Beyond The Blues; A Workbook To Help Teens Overcome Depression, by Lisa Schab
  • Stopping The Pain; A Workbook For Young People Who Cut and Self-Injure, by Lawrence Shapiro
  • Little Blue book of sunshine - a mental health booklet that has been developed for children and young people living in Hampshire, Southampton and the Isle of Wight. The book aims to help children and young people by sharing tips on how to deal with many problems, such as anxiety, body image, relationships and anger. It also includes information about where to get help when needed, including information about local services. Click here to access the PDF or access the booklet via Apple Books or Google Play Books. 

 

Red

Needs Specialist Treatment or a Crisis Response; These are difficulties that cause a significant impact and a young person may need specialist support.

Type and nature of mood issue

Episodes of low mood/ depression are severe and enduring. These cause significant distress to a young person and significantly disrupt daily coping such as school/ college, socialising and even self-care activities (e.g., sleep, bathing, eating). Despite trying advice in the green and amber stages, the young person still experiences depression symptoms. Examples of situations that may cause/ contribute to a young person feeling low in mood or depressed:

  • Chronic bullying or abuse (including neglect, emotional, physical, sexual)
  • Social or family financial stressors (such as family breakdown, conflict or parental/ sibling ill-health)
  • Grief or loss
  • Witnessing or experiencing a traumatic event
  • Overwhelmed by pressures and stressors including individual factors e.g., health, social factors e.g., relationships, occupational factors e.g., school/ college and environment e.g., living circumstances

Please note, there are occasions when there is no apparent trigger/ cause/ contributory factor as to why a young person may be experiencing episodes of low mood/ depression. A young person can still be acutely depressed without clear reason.

What you might see or a young person might report

As well as the features in Green and Amber, the following might also be present:

  • Isolating self from friends and family
  • Withdrawn and uncommunicative or not wanting to be left alone at all- this may seem uncharacteristic or age inappropriate for some teenagers
  • Refusal to leave the house or attend/ take part in activities such as school, hobbies, interests, seeing friends
  • Significant impact on health and wellbeing such as not sleeping or eating for a sustained period of time. May show signs of physical compromise as a result.
  • Appearing uncaring or unbothered about people or activities they previously would have cared about- may not honour commitments or responsibilities which is uncharacteristic
  • Lack of insight or awareness that others may be concerned- this may lead to arguments or conflict at home
  • May on occasion becoming agitated, distressed, oppositional or aggressive towards others
  • Reactive and impulsive behaviour such as running away which may place them or others in danger
  • Feeling hopeless about the future- not being able to see a future and appearing to give up on dreams, goals and hopes
  • Thoughts, feelings, urges, plans or intent to harm self or end their life or harm others. 

Please note that not all young people who engage in self-harm behaviour are depressed or suicidal. There are many reasons why a young person may engage in self-harm behaviour.

Things to try, support and Next Steps

As well as the steps in Green and Amber the following might be helpful:

  • Speak with your child’s GP
  • Speak with the School Nursing Team
  • Depending on the context and/ or the origins of the low mood/ depression being experienced, other services may be helpful. There may be a role for other services such as Children’s Services or other statutory or voluntary organisations that can support if there are clear triggers for anxiety e.g., abuse, domestic violence, bullying, being a young carer etc.
  • 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.
  • Seek advice, guidance and support from Young Minds Parent Helpline: 08088025544

Consider making a self-referral to a CAMHS Service. If your young person is at risk of harm, please make this clear when making the referral.

Useful Resources:

  • Stuff That Sucks, by Ben Edley
  • Am I Depressed? And What Can I Do About It? by Shirley Reynolds and Monika Parkinson
  • Beyond The Blues; A Workbook To Help Teens Overcome Depression, by Lisa Schab
  • Stopping The Pain; A Workbook For Young People Who Cut and Self-Injure,  by Lawrence Shapiro

 

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