Introduction
What is depression
Depression and lung disease
What are the symptoms of depression
Dealing with depression
The thoughts that trigger depression
Coping thoughts for depression
Ways of coping with depression
Conclusion
Depression is a serious illness. It is very different from feeling miserable or fed up for a short period of time.
Lung disease can affect every aspect of your life. It can also affect your self-confidence and how much you worry about doing things you used to find easy.
It is normal to feel sad or upset about the effect lung disease may have had on your life. But it is important to try not to let yourself be pulled down by negative feelings. These can make it more difficult for you to cope with your illness.
The information below is designed to help people who are living with a lung disease cope with feeling depressed.
What is depression?
Depression is a persistent low mood, feeling bad about yourself and feelings of hopelessness about the future. It is caused by changes in levels of chemicals in the brain.
Lots of different factors can trigger depression. For some people, upsetting or stressful life events such as illness, redundancy and job or money worries can be the cause. For other people, learning they have a lung disease, and learning to live with it, can be a trigger for depression.
Depression can make you feel like doing fewer activities or having fewer interests - but this in turn adds to your depression.
Quite often, depression can be triggered by more than one of these factors, and they can influence and affect each other in complicated ways.
And for some people, depression doesn't have an obvious cause.
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Living with a lung disease can make you feel tired all the time, but it can make it difficult to sleep as well. It can be exhausting to eat, and the medications can take all the taste out of your food. You may be self-conscious about your oxygen or a chronic cough and become more reluctant to go out in public. You may have been active for all of your life and now can't do the things you once enjoyed. All of these difficulties can put you at risk of developing depression.
Depression is a miserable experience that can leave you feeling disconnected from your life and often without hope that anything will ever feel better again. You not only feel bad, but you also have less energy to do the things you want to do, including taking care of yourself and managing your lung condition.
Depression can also make you feel as if things will never get any better. If you feel this way, you might not bother following your treatment plan.
Depression is a very common problem. It can be treated.
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Do you have any of the following symptoms?
• You feel sad more often than not, for several weeks in a row
• Your sleep is disrupted; you wake up early, or your sleep is restless, or you have difficulty falling asleep
• You're sleeping either much more or much less than usual
• You're less interested in favorite people or activities
• You have less energy and you don't feel like doing anything
• You find it hard to concentrate and solve problems
• You're eating much more or less than usual
• You feel bad about yourself or you feel worthless
• You feel hopeless - that you'll never feel better no matter what happens
• You cry much more easily and more often than usual
• You feel irritable with everyone and everything in your life
• You are much more sensitive to criticism than usual
• You feel really guilty
• You think about suicide, or you wish your life would end
• You can't laugh or enjoy yourself.
If you say yes to five or more items on this list, you may have depression.
An example of depression - Stephen had to retire from his work as a storeman three years ago, due to ill health. He was 55. He lives with his wife, who still works. His children are grown up and have left home.
Stephen feels that he is useless and worthless. He no longer brings in any money to the household, other than benefits. He used to like going to his local every Thursday night to have a couple of drinks with his friends. But he finds he no longer enjoys this because it's too smoky. And he thinks he's useless because he's just sitting at home all day while his friends are at work. He thinks that they think less of him for having to retire early. He also had to stop playing football - he knew he wasn't very good at this but he did enjoy kicking a ball around. He can't even walk the length of a football pitch these days without stopping to rest!
He is dependent on his wife and family for company but can't even help out by looking after his young grandchildren. He is scared of what would happen if he suddenly got worse, or couldn't breathe when he was alone with them.
He's not sleeping well and he seems to be putting on weight, which makes it even harder to keep active, even around the house. He feels very low when he thinks about the future - it's only going to get worse for him. He knows everyone tries to be understanding and kind but he does fly off the handle with them quite easily. He feels guilty about this later.
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Dealing with depression
One of the symptoms of depression is hopelessness - nothing can help so why bother. In fact, lots of different things can help you fight depression.
We will look at these in more detail below, and they are:
- Using a problem-solving approach to deal with stresses and worries
- Trying to identify negative thoughts and change them to positive thoughts
- Trying to exercise more. Exercise can trigger the release of the brain chemical serotonin, which boosts your mood
- Learning how to relax
- Eating a well balanced diet. The British Lung Foundation produces a leaflet called 'Healthy eating and your lungs', which you can order from us for free
- Joining a support group such as Breathe Easy and discussing your feelings and concerns. You are not alone
- Taking any anti-depressant medicines, as your doctor tells you to (see later), without skipping any doses or days.
In depression, people think the worst and put themselves down. They think "It's hopeless", "I'm useless", "I can't do anything", or "There is nothing I can do to change things."
It's not surprising people are depressed when they think like this. But it is possible to learn to think in a different way.
Depression has a vicious cycle, you think:
 | I am depressed, I am not good enough |  |
| It will never be any different | | I lack energy. I have no motivation |
 | I avoid everything. I do nothing. I am becoming more sad. I always look for negative explanations |  |
or:
 Depressive symptoms like loss of sleep and poor concentration mean we cope less well and things go wrong | | Depressive symptoms like loss of sleep and poor concentration mean we cope less well and things go wrong |  |
| | Which leaves us less able to cope and so on | |
You can break this cycle, and reduce your depression. The key is to change how you interpret and react to depressed thoughts. These are often called 'automatic negative thoughts' as you do not plan to have them - they just pop into your head automatically.
Breaking the cycle involves:
• Noticing when you have these automatic negative thoughts
• Looking at the evidence for and against them
• Finding ways to change these to more realistic thoughts, and cope better
Write down the event that is making you feel depressed. Then write your thoughts about the event (e.g. "I should never have started smoking", "I should have been able to do that without help", "I don't look ill - they'll think I'm trying it on").
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It's time to question the (automatic) thoughts you wrote down. To do so, write down any facts or experiences that support or contradict your automatic thoughts.
Ask yourself these key questions:
- What evidence have I got to support that? You may be exaggerating something bad, or only looking at part of the picture, or making assumptions.
- Is there another way of thinking about this situation?
- What would my husband/wife, best friend, brother or sister (or anyone you admire) say to themselves in this situation?
- What would I say to my husband/wife, best friend, brother or sister if they were thinking the same thing I am?
- How could I look at this situation so I would feel less depressed? Is this view as reasonable as what I was thinking in the first place?
- Try to think of alternatives to your negative thoughts, the ones that are making you feel bad about yourself. Write these down.
- You need to keep working at writing down your thoughts and arguing with them. This is a new way of thinking, and only practice makes perfect!
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Ways of coping with depression
After you have listed all the evidence you can think of, move on to 'Coping'. This is your action plan to help you deal with feeling bad.
Don't keep it to yourself
Try to talk with someone close to you. Tell them how you feel. It often helps to talk things over with someone, maybe someone who also has a lung condition.
Do something
Try to walk around the house and garden, get out of doors, even if only for a short, slow walk. This will help you to keep physically fit, and you may sleep better. Try to keep active. This could be housework, or any part of your normal routine. It can help take your mind off painful thoughts which make you more depressed.
Just doing one thing each day (e.g. going for the paper, doing the washing up) can make you feel a lot better about yourself. Think about when in the day you feel best (e.g. lunchtime, first thing in the morning), and try to do something then.
Do something you enjoy
Arrange to meet friends, or ask a friend to visit you, even just for a coffee. Phone someone you haven't seen for a while. Cook a simple meal.
Eat well
Try to eat a good, balanced diet, even though you may not always feel like eating. Eat small meals more often rather than just three big meals. This can be much more comfortable for people with a lung condition.
Beware of alcohol
Resist the temptation to drown your sorrows with a drink. Alcohol actually makes depression worse. It may make you feel better for a few hours, but you will feel worse again afterwards.
Sleep
Try not to worry about finding it difficult to sleep. It can be helpful to listen to the radio or watch TV while you're lying down and resting your body, even if you can't sleep. If you can occupy your mind in this way, you may find it easier to get off to sleep.
Keep hopeful
Remind yourself that depression is an experience which many other people have gone through, and recovered from.
Relaxation and breathing techniques
These can be helpful.
You can help yourself relax using simple techniques like having a bath or making a warm milky drink. Take time out. It's good to spend some time on yourself. Or try this quick relaxation technique:
Quick relaxation
Loosen your clothing and get comfortable.
• Tighten the muscles in your toes. Hold for a count of 10.
• Relax and enjoy the sensation of release from tension
• Flex the muscles in your feet. Hold for a count of 10. Relax.
• Move slowly up through your body - legs, stomach, back, neck, face - contracting and relaxing muscles as you go
• Breathe deeply and slowly
• You might find doing all this to some relaxing music will help as well
People with lung disease often find their breathing gets difficult when they are upset, angry or anxious, so breathing techniques can be useful to aid relaxation.
Try this exercise sitting, standing and lying down:
1. Breathe out deeply, contracting your belly
2. Breathe in slowly as you expand your abdomen
3. Continue breathing in as you expand the chest
4. Continue breathing in as you raise your shoulders up towards your ears
5. Hold for a few comfortable seconds
6. Breathe out in reverse pattern, slowly. Release shoulders, relax chest, contract your belly
7. Repeat
If you have COPD please see ‘COPD: living with chronic obstructive pulmonary disease’ (BLF booklet) for suitable breathing techniques.
Distract yourself
Doing something like a crossword or sudoku puzzle can help take your mind off things.
Pulmonary rehabilitation
Pulmonary rehabilitation is a course (usually 8-10 weeks) of twice-weekly classes. It is usually run by a physiotherapist with help from doctors, pharmacists, nurses, etc. It involves learning about your lung condition and doing gentle exercise at a level that is safe for you. It also provides an opportunity to meet other people with lung conditions and share experiences. We know that pulmonary rehabilitation improves your fitness and your mood. In other words, it can make you feel less depressed, more able to cope and less hopeless about the future.
Pulmonary rehabilitation isn't available everywhere, and it isn't suitable for everyone. You should speak with your nurse/doctor about it.
Medication for depression
Your doctor may consider giving you medication for depression, called 'anti-depressants'. Anti-depressants can be helpful if you are feeling low or depressed, so it is important to discuss this with your doctor.
There is a wide range of anti-depressants available. Some of the most common ones are:
• Citalopram • Paroxetine • Sertraline • Fluoxetine • Venlafaxine
Each of these medications is made by various manufacturers, so the name on the packet will probably be different from the names above. It will be a brand name the manufacturer has given the medication. You can check what drug your medication is by looking at the back of the packet, or by checking the leaflet inside the packet.
Your doctor will consider many different factors when deciding which anti-depressant would be suitable for you. She/he will take into account things like your individual symptoms, any past experience of depression, your lung condition, other illnesses and physical problems you may have and, very importantly, what other medication you are on.
Anti-depressants do not start to work immediately - you won’t feel the benefits as soon as you start taking them! Usually you need to take anti-depressant medication (as directed by your doctor) for four to six weeks before you will notice a difference. Doctors tend to start people on low doses, so if you don't notice a difference in four to six weeks, your doctor may consider increasing the dose a little bit, or changing you to another medication. Getting the right anti-depressant and the right dose can take a bit of experimentation - be patient. It's also worth knowing that anti-depressants tend to take longer to start working the older you are.
Some people experience side-effects when they start on anti-depressants. Mild side-effects include indigestion, upset bowels, changes in appetite, dry mouth, drowsiness. Do read the information leaflet that comes with each medication to see what side effects are common - this can be reassuring. If any side-effects become troublesome for you, or last a long time, you might want to discuss them with your doctor or nurse.
There is lots of evidence that ‘talking’ therapies also work for depression. You can discuss this with your GP or consultant, who may be able to refer you to a counsellor or psychologist who is experienced in talking therapies.
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As we said at the start - depression is an illness which can be treated. Many people living with lung conditions are also dealing with depression. You are not alone. There are ways of helping yourself feel better, and there are people ready to help you work towards feeling better.
Page last medically reviewed: August '06
