1
00:00:00,420 --> 00:00:04,140
Hello and welcome to the new psychology of Depression.

2
00:00:04,140 --> 00:00:11,760
A series of programmes with me, Dr. Danny Penman and Professor Mark Williams of Oxford University.

3
00:00:11,760 --> 00:00:17,970
We live in a world filled with material wealth. We have never had so much political and economic freedom.

4
00:00:17,970 --> 00:00:25,950
We live longer and healthier lives. And yet anxiety, stress, unhappiness and depression have never been more common.

5
00:00:25,950 --> 00:00:33,660
Why is this? Or perhaps more importantly, what can we do to stem the rising tide of these mental health problems?

6
00:00:33,660 --> 00:00:39,330
Mark, why exactly is depression? Well, depression is a syndrome.

7
00:00:39,330 --> 00:00:43,080
It's a combination of symptoms that occur at the same time.

8
00:00:43,080 --> 00:00:48,930
So most people know what sadness is. Most people know sometimes how difficult it is to get up out of bed, out of the morning.

9
00:00:48,930 --> 00:00:57,690
This sort of thing. Depression is different from that. It's low mood, feeling hopeless, feeling very sad and listless.

10
00:00:57,690 --> 00:01:04,950
But also it can be lack of energy and enthusiasm for things that you used to actually quite enjoy.

11
00:01:04,950 --> 00:01:08,130
And those are the core symptoms of depression.

12
00:01:08,130 --> 00:01:15,390
But even then, if you get those for a couple of weeks and they go on and on and on, that's not enough to get you a diagnosis of depression.

13
00:01:15,390 --> 00:01:17,340
So there are other symptoms as well.

14
00:01:17,340 --> 00:01:24,240
And any combination, four or five of these other symptoms are often considered necessary for a diagnosis of a clinical depression.

15
00:01:24,240 --> 00:01:32,840
And there are things like changes in appetite, perhaps even weight loss, or sometimes people eat too much in weight gain, changes in sleep.

16
00:01:32,840 --> 00:01:40,650
So that some people don't get to sleep at night or they can't sleep in the middle of the night or they wake up very early in the morning occasionally,

17
00:01:40,650 --> 00:01:48,660
especially with something called seasonal affective disorder. It's sleeping too much and not feeling that, you know, you want endless sleep.

18
00:01:48,660 --> 00:01:53,190
But generally with depression, it's not sleeping. It's it's insomnia.

19
00:01:53,190 --> 00:02:02,340
And then there are things like feeling guilty, lacking concentration, feeling agitated or very slow down, feeling tired all the time.

20
00:02:02,340 --> 00:02:08,320
And even many people get suicidal ideas, ideas they'd rather be dead, that they're just a burden to the family.

21
00:02:08,320 --> 00:02:15,420
That's what depression is. Is these symptoms coming together most days for at least two weeks.

22
00:02:15,420 --> 00:02:20,580
In general, however, they go on for months and that's when you'd get a diagnosis,

23
00:02:20,580 --> 00:02:27,480
depression at the point at which these things prevent you from living your life as you want to live.

24
00:02:27,480 --> 00:02:34,920
So it's it's what might be called functional impairment. You can't function and you can't explain it in terms of illness or physical illness.

25
00:02:34,920 --> 00:02:43,080
You can't explain it in terms of a recent bereavement. This comes and stays and you don't seem to have to get rid of it.

26
00:02:43,080 --> 00:02:48,630
So how does it interrelate with other problems that we all suffer from from time to time,

27
00:02:48,630 --> 00:02:54,180
such as anxiety, stress and, you know, things like mental exhaustion?

28
00:02:54,180 --> 00:03:01,710
Well, they're very closely related. So you very rarely get a depression without having other things like high anxiety at the same time.

29
00:03:01,710 --> 00:03:05,730
Depression is often characterised by dwelling on the past a lot,

30
00:03:05,730 --> 00:03:12,840
but you hardly ever get that without people also worrying about the future and being anxious about the future.

31
00:03:12,840 --> 00:03:17,910
Psychiatrist or psychologist usually put anxiety and depression in separate camps,

32
00:03:17,910 --> 00:03:23,280
but the new genetic evidence is suggesting they're much more dimensional, they're much more mixed.

33
00:03:23,280 --> 00:03:27,780
And also the treatments that work for depression tend to work for anxiety as well.

34
00:03:27,780 --> 00:03:32,640
So there's quite a lot of evidence that actually to make a two biggest separation between anxiety,

35
00:03:32,640 --> 00:03:38,310
stress, depression, exhaustion isn't quite what is going on in the world.

36
00:03:38,310 --> 00:03:47,690
Things like anger, irritability, road rage, you know, typical explosion's that you see we all say everyday.

37
00:03:47,690 --> 00:03:50,880
Are they related to depression at all? They can be.

38
00:03:50,880 --> 00:03:58,020
I mean, that they're more likely to be related to stress because you often get in high chronic stress.

39
00:03:58,020 --> 00:04:03,810
You get people showing a lot of anger. But also and it depends on the age group.

40
00:04:03,810 --> 00:04:09,990
So, for example, in adolescent depression, that can be quite a lot of anger and irritability and hostility,

41
00:04:09,990 --> 00:04:15,240
which is how often within that age group, a lot of sadness is expressed.

42
00:04:15,240 --> 00:04:19,140
But you couldn't get a diagnosis just from being angry all the time.

43
00:04:19,140 --> 00:04:24,420
You'd need some of these other things like weight loss or appetite change, sleep change and that sort of thing.

44
00:04:24,420 --> 00:04:34,290
Depression is increasing worldwide. Is it increasing predominantly in the developed world or is it also increasing in the Third World?

45
00:04:34,290 --> 00:04:41,160
Well, what we now know is that depression is is rapidly becoming one of the biggest reasons

46
00:04:41,160 --> 00:04:49,650
for people to have basically lose years of their affective life through disability.

47
00:04:49,650 --> 00:04:55,320
So the World Health Organisation publishes data a decade by decade over that.

48
00:04:55,320 --> 00:04:59,900
And about two decades ago, they recognised that depression was becoming a big problem.

49
00:04:59,900 --> 00:05:09,650
Well, it's now arrived. So in the end, they have a statistic of the year's life lost to disability and in high and middle income countries,

50
00:05:09,650 --> 00:05:18,530
depression is the top of the list for that. So it's higher than the disability caused by heart disease, for example,

51
00:05:18,530 --> 00:05:23,690
cerebrovascular disease, road traffic accidents and even in low income countries.

52
00:05:23,690 --> 00:05:29,660
And rayland and it's still in the top 10 of years lost to disability.

53
00:05:29,660 --> 00:05:38,900
So depression actually exacts a bigger toll on society than cancer and heart disease and other things like osteoarthritis.

54
00:05:38,900 --> 00:05:44,540
Indeed, in terms of its global impact, of course, there's the suicide impact as well.

55
00:05:44,540 --> 00:05:48,650
Nearly a million people die prematurely by suicide each year.

56
00:05:48,650 --> 00:05:56,110
Across the world. But also, there's the more hidden cost as well as the big cost of things like suicide.

57
00:05:56,110 --> 00:06:03,140
People feeling like they can't function, feeling like stay in bed rather than getting up, which is not just laziness.

58
00:06:03,140 --> 00:06:06,500
This is depression, as it were, that's doing this to them.

59
00:06:06,500 --> 00:06:12,620
It affects the ability to be a breadwinner for your family, the ability to look after your family.

60
00:06:12,620 --> 00:06:18,530
And that's why it's such a burden right across the globe.

61
00:06:18,530 --> 00:06:25,760
Can you give us some figures as to the prevalence of depression, both in the developed world and the developing world?

62
00:06:25,760 --> 00:06:31,790
So in high income countries, for example, depressive disorders, which is what we've been talking about,

63
00:06:31,790 --> 00:06:38,750
account for about 14 percent of the year's life lost to disability and putting that in proportion.

64
00:06:38,750 --> 00:06:44,870
If you look at Alzheimer's and other dementias, that's about five percent of the year's lost disability.

65
00:06:44,870 --> 00:06:54,140
If you look at osteoarthritis, it's four percent. If you look at chronic obstructive pulmonary disease, that's about three percent.

66
00:06:54,140 --> 00:06:57,830
So 14 percent is huge compared compared with that.

67
00:06:57,830 --> 00:07:08,090
Then if you look at low and middle income countries and then depression is about 10 percent of that and the next the next in line for their years,

68
00:07:08,090 --> 00:07:13,820
lifelong disability are eye problems, what's called refractive errors. And that's about half that, about four point seven percent.

69
00:07:13,820 --> 00:07:18,170
So, again, in terms of the years life lost disability, it's huge.

70
00:07:18,170 --> 00:07:25,700
What epidemiologists seem to find wherever they look is about one in 20 of the population are depressed.

71
00:07:25,700 --> 00:07:33,050
Any one time. And about 20 percent of the population at some point will get very depressed.

72
00:07:33,050 --> 00:07:38,450
And that's a major problem. Every time I hear these figures, I'm just completely stunned.

73
00:07:38,450 --> 00:07:43,820
What's the fundamental driving force behind the increase in depression?

74
00:07:43,820 --> 00:07:51,590
I think there's always been a proportion of the population that has felt depressed as far as we can go back in history.

75
00:07:51,590 --> 00:07:56,090
You can look in the Psalms, in Hebrew, the Old Testament is the word.

76
00:07:56,090 --> 00:08:01,160
And you see people expressing sadness and depression and anger and mutability and this sort of thing.

77
00:08:01,160 --> 00:08:07,010
You go back way into the beginning of something like Buddhism, for example, 500 years BCE,

78
00:08:07,010 --> 00:08:20,060
and you have people needing to learn to meditate, to deal with the problems of the mind problem, the entanglements of the mind, as it were.

79
00:08:20,060 --> 00:08:22,160
So I think he's been around a long time.

80
00:08:22,160 --> 00:08:33,050
One of the things, however, that's new is over the last 50 years in the Western world, the age of onset of depression has changed.

81
00:08:33,050 --> 00:08:37,460
It's become earlier and earlier and earlier. And that's one of the major discoveries.

82
00:08:37,460 --> 00:08:44,300
It started to emerge from epidemiology where big surveys started to pick up that people

83
00:08:44,300 --> 00:08:50,300
would begin to report from about people born in the 1950s onwards when they were assessed.

84
00:08:50,300 --> 00:08:58,430
Towards the end of the 20th century, they started to report that their depression had started a bit younger than we had previously thought.

85
00:08:58,430 --> 00:09:04,790
It was previously thought that depression was a bit of a late life problem, late 50s, early 60s,

86
00:09:04,790 --> 00:09:12,170
and indeed the evidence that people born in their first part of the 20th century seemed to verify that.

87
00:09:12,170 --> 00:09:18,860
But decade by decade, from about 1950 or 60 onwards, the age of onset got younger and younger.

88
00:09:18,860 --> 00:09:26,520
And so by the late 1980s, 90s, people were beginning to get depressed in their 20s.

89
00:09:26,520 --> 00:09:30,680
And there's been a striking confirmation of that in the last few years.

90
00:09:30,680 --> 00:09:35,630
One of the biggest clinical studies ever conducted was done in America. It was called the Star D trial.

91
00:09:35,630 --> 00:09:39,200
And it was S t the beginning of starting means sequence treatment.

92
00:09:39,200 --> 00:09:45,200
So it was a big trial to look at what treatment to provide one treatment after the other, after the other.

93
00:09:45,200 --> 00:09:49,150
So they have 4000 people who volunteered to take part.

94
00:09:49,150 --> 00:09:53,630
And as part of that trial were asking them, when did you first get depressed?

95
00:09:53,630 --> 00:09:59,300
And they found that the mean age of onset in this sample was about 26.

96
00:09:59,300 --> 00:10:06,190
But. The most common age in which people's jobs get depressed was between 13 and 15 years old.

97
00:10:06,190 --> 00:10:14,390
And that is an astonishing new development, is the same Truffaut kind of anxiety and stress and irritability.

98
00:10:14,390 --> 00:10:23,050
And we weren't clear about that until about year 2000, where somebody published a big paper in one of the big journals in America.

99
00:10:23,050 --> 00:10:34,660
They'd traced the anxiety level of children and young people over 30 years from the night early 1950s, all the way through to the mid 1980s.

100
00:10:34,660 --> 00:10:43,750
And they found exactly the same thing, that it looked as if the anxiety pattern in children, young people had become that in a sense,

101
00:10:43,750 --> 00:10:49,930
a whole bell shaped curve had shifted towards greater anxiety by about one standard deviation,

102
00:10:49,930 --> 00:10:58,210
which means that whole swathes of children, young people who hadn't been anxious in the 1950s as a Fairborn in the 1980s,

103
00:10:58,210 --> 00:11:04,360
then they were likely to show anxiety, which had been virtually clinical levels 30 or 40 years ago.

104
00:11:04,360 --> 00:11:12,790
I think earlier you said that what we regard as normal levels of anxiety and stress

105
00:11:12,790 --> 00:11:17,980
would have been regarded as a clinical level anxiety and stress 50 years ago.

106
00:11:17,980 --> 00:11:22,590
Is that true? Did I misunderstand that? Because that's quite an astonishing figure.

107
00:11:22,590 --> 00:11:31,600
That's true in anxiety. And now that we know the same is true of depression, that is that 50 years ago,

108
00:11:31,600 --> 00:11:38,020
people would would live out most of their life without getting these crushing depressions.

109
00:11:38,020 --> 00:11:48,760
But now that, you know, 35, 36 percent get depressed before the age of 18 and then there's a whole life ahead of them,

110
00:11:48,760 --> 00:11:53,650
which is the biggest challenge, a whole life ahead of them, where they might actually get another depression.

111
00:11:53,650 --> 00:11:59,200
Because one of the things we now know is if you've been depressed once, you tend to get depressed again,

112
00:11:59,200 --> 00:12:06,580
at least in half, half the cases and once you've been depressed twice, then the chances go up even further.

113
00:12:06,580 --> 00:12:16,450
So does this suggest that depression is really a problem of how we deal with the world the way we think,

114
00:12:16,450 --> 00:12:21,970
rather than a chemical imbalance in the way our brains are actually working?

115
00:12:21,970 --> 00:12:29,830
Well, one of the inferences we can make from these big changes being so rapid and recent is that it can't be genetic changes,

116
00:12:29,830 --> 00:12:38,500
it can't be driven by our basic biological makeup. So there must be something else happening and it must be environmental changes that are driven

117
00:12:38,500 --> 00:12:43,930
that I clearly it could be that people are just recognising depression that was always there,

118
00:12:43,930 --> 00:12:45,910
but now they're recognising it more.

119
00:12:45,910 --> 00:12:53,920
But the fact that both clinical studies and epidemiological studies show up the same thing argues that it's not just that people recognising

120
00:12:53,920 --> 00:13:03,010
it better because you control for the sorts of questions you can ask and cheque that the questions asked are the same over those decades.

121
00:13:03,010 --> 00:13:12,730
But the other thing is we know that after about 1977, you got increases in changing rates of suicide as well, especially in young men.

122
00:13:12,730 --> 00:13:16,360
Right the way over the Western world, you got increases in the suicide rate,

123
00:13:16,360 --> 00:13:21,490
which to some extent mimicked this younger and younger depression hitting.

124
00:13:21,490 --> 00:13:23,560
Now, that's stabilised over the last few years.

125
00:13:23,560 --> 00:13:32,170
But the fact that you get really confirmation from another area that we know is likely to be affected by this changing pattern of depression,

126
00:13:32,170 --> 00:13:41,350
I think shows that something's going on here. It's very difficult to understand exactly what the causes are, changing patterns of society.

127
00:13:41,350 --> 00:13:44,890
The increase in the gap between rich and poor.

128
00:13:44,890 --> 00:13:54,070
The fact that when economies develop rapidly, often there are seem to be some almost unavoidable changes in that in the gaps between rich and poor.

129
00:13:54,070 --> 00:13:58,780
We know that in the countries that have the least gap between rich and poor,

130
00:13:58,780 --> 00:14:03,700
then the levels of stress, the levels of trust, even within the communities are higher.

131
00:14:03,700 --> 00:14:08,620
The levels were hope are higher and people tend to live longer their societies.

132
00:14:08,620 --> 00:14:15,610
So there are little bits of evidence that people are beginning to put together to suggest what the changes might have been.

133
00:14:15,610 --> 00:14:24,760
But what we're working on are treatments that approaches which can now deal with depression epidemic.

134
00:14:24,760 --> 00:14:32,800
If you had to choose a fundamental driving forces behind depression, what what would what would they be?

135
00:14:32,800 --> 00:14:36,850
Well, at the individual level, that the way we think about life.

136
00:14:36,850 --> 00:14:47,740
So where we feel we are, as it were, in relation to other people, in relation to our own standards, understand that other people set for us.

137
00:14:47,740 --> 00:14:55,990
So one of the ways in which society is changing is the way in which it expects us to to do things, the targets it sets for us.

138
00:14:55,990 --> 00:14:59,910
And so on. And when society sets us target.

139
00:14:59,910 --> 00:15:07,770
And says, meet those or else. Then the best you can hope for from your work is relief when you've met your targets.

140
00:15:07,770 --> 00:15:13,970
In other words, if you could do a good job and feel pleased, you've done a good job because of your work.

141
00:15:13,970 --> 00:15:19,500
I know you're a heart surgeon and you've saved, you know, several lives this week.

142
00:15:19,500 --> 00:15:25,500
Then that must be a really good sense of worth about what you've done.

143
00:15:25,500 --> 00:15:30,880
But what happens if you've got a target to save six lives this week? All you do is when you've saved six lives.

144
00:15:30,880 --> 00:15:33,600
Thing off often couldn't staff met my targets.

145
00:15:33,600 --> 00:15:45,570
So suddenly it turns the possibility of of satisfaction with a job well done into relief that you haven't made a mistake.

146
00:15:45,570 --> 00:15:57,120
So you've turned potentially something really enjoyable about life into a thing that isn't going to, as it were, give you the motivation.

147
00:15:57,120 --> 00:16:02,640
So gradually that that can work for a while, you know. But gradually it can eat away.

148
00:16:02,640 --> 00:16:13,380
I think to you in ways that are a bit pernicious. So how could you for example, you know, if you're omnipotent dictator, how could you change society?

149
00:16:13,380 --> 00:16:16,200
Or, you know, perhaps if you were running a company,

150
00:16:16,200 --> 00:16:24,990
how could you change the culture of that company or of that society to actually promote mental health and wellbeing?

151
00:16:24,990 --> 00:16:31,200
I think it's what people talk about work life balance, don't they? And that's really important.

152
00:16:31,200 --> 00:16:43,800
It also to recognise that productivity needs engagement and engagement needs a sense of control, a sense of choices.

153
00:16:43,800 --> 00:16:50,460
So as you go down companies, traditionally you get people having less and less choice about what they do.

154
00:16:50,460 --> 00:16:55,470
And if you can find a way to increase the choice, then you naturally increase the creativity.

155
00:16:55,470 --> 00:17:00,630
We know that when a company is run on just target lines and so on in this stress stressful way,

156
00:17:00,630 --> 00:17:03,940
that actually people in order to meet their targets, they feel very stressed.

157
00:17:03,940 --> 00:17:08,700
They put in more hours, but they artlessly more productive because they're not seeing the whole picture.

158
00:17:08,700 --> 00:17:12,810
And if you want employers to see the whole picture and if we want us in our family life to the whole

159
00:17:12,810 --> 00:17:18,240
picture that you have to learn to attend and you have to learn to see the whole picture by reducing stress.

160
00:17:18,240 --> 00:17:19,800
And there are things we can do about that.

161
00:17:19,800 --> 00:17:27,150
And mindfulness, which is what I've spent much of my life researching over the last 20 years, is one of the answers to that.

162
00:17:27,150 --> 00:17:35,340
Does depression inevitably return or, you know, is it possible to just have one episode of depression and,

163
00:17:35,340 --> 00:17:40,980
you know, that's it for the rest of your life. You go over it, you dust yourself down and carry on with the rest of your life.

164
00:17:40,980 --> 00:17:48,900
Is that possible? Or does it tend to return? Okay. Depression can be a one off.

165
00:17:48,900 --> 00:17:53,310
And so it doesn't it's not inevitable return. So it's a bit of a message of hope.

166
00:17:53,310 --> 00:17:59,460
If we said, oh, it's always going to return, then it's a counsel of despair for many people.

167
00:17:59,460 --> 00:18:06,480
On the other hand, if you've been depressed once, you do have a slightly increased threshold and it rather depends why you got depressed.

168
00:18:06,480 --> 00:18:11,940
If you got depressed because of a big life event, for example, bereavement,

169
00:18:11,940 --> 00:18:20,760
unemployment, separation and the sorts of reasons that would make any of us low then.

170
00:18:20,760 --> 00:18:26,400
So long as you don't have a repeat of those sort of events, then you don't necessarily not really going to get depressed again.

171
00:18:26,400 --> 00:18:34,290
But the problem is that if you get depressed, the threshold for you getting depressed again is slightly altered.

172
00:18:34,290 --> 00:18:42,690
And if then you get depressed for a second time, what we know is the triggers of a third depression are less.

173
00:18:42,690 --> 00:18:46,830
So, for example, you might need bereavement or unemployment the first time you get depressed,

174
00:18:46,830 --> 00:18:56,190
the second time it might be something slightly less of a stress or but then the third, fourth time, then you may not need a stressor at all.

175
00:18:56,190 --> 00:19:02,550
By the time actually you've had three, four, five depression, it may be that you just wake up one morning feeling a bit low.

176
00:19:02,550 --> 00:19:05,160
By the end of the day, you're feeling very depressed.

177
00:19:05,160 --> 00:19:11,730
So the statistics suggest that about 50 percent of people might have a one off episode and then it doesn't bother them again.

178
00:19:11,730 --> 00:19:17,760
But if they'd been depressed twice, the chances to get depressed again are much higher.

179
00:19:17,760 --> 00:19:22,920
Three times the rates at about 70 to 80 percent.

180
00:19:22,920 --> 00:19:30,510
And yet our studies, we find, for example, that if we follow people up for about 12 months without offering any treatment to them,

181
00:19:30,510 --> 00:19:35,100
then if they've had three depressions in the past before they've come to see us,

182
00:19:35,100 --> 00:19:41,670
then between 60 and 80 percent of them will get depressed again in those next 12 months.

183
00:19:41,670 --> 00:19:46,320
People who become repeatedly depressed year after year.

184
00:19:46,320 --> 00:19:50,700
What proportion of their lives do they actually spend in that depressed state?

185
00:19:50,700 --> 00:19:54,150
Well, we didn't know the answer to this question until fairly recently.

186
00:19:54,150 --> 00:19:59,720
And there's some researchers in the states who've done a long term follow up of a study called.

187
00:19:59,720 --> 00:20:06,060
And IMH, that's the National Institute for Mental Health. They started a study in 1975.

188
00:20:06,060 --> 00:20:13,210
And because they were able to keep in touch with this large number of people that started, then they went to look at,

189
00:20:13,210 --> 00:20:17,670
you know, how much time do people actually spend depressed if they've been repeatedly depressed?

190
00:20:17,670 --> 00:20:25,290
And the figures are staggering. What they found was, and it's just been published in the last couple of years,

191
00:20:25,290 --> 00:20:32,430
is that people on average spend 32 percent of their time in episode over a 20 year period.

192
00:20:32,430 --> 00:20:41,070
So on average, four months a year are spent in episodes of depression, which I mean, considering the burden that we talked about earlier.

193
00:20:41,070 --> 00:20:52,170
It's an incredible statistic and some pretty disturbing statistic. What proportion of people then go on to begin self-harm or even commit suicide?

194
00:20:52,170 --> 00:20:56,820
There are changing rates of self-harm and suicidal behaviour. And the definitions vary.

195
00:20:56,820 --> 00:21:02,370
So self-harm sometimes, I mean people who harm themselves, physically, cutting themselves and so on.

196
00:21:02,370 --> 00:21:07,200
Deliberate self-harm is sometimes broader than that, people that take overdoses and so on.

197
00:21:07,200 --> 00:21:17,400
And we know that the rates of of suicide in people who been severely depressed are elevated compared with the general population.

198
00:21:17,400 --> 00:21:23,790
Now, about one percent of the population die by suicide anyway.

199
00:21:23,790 --> 00:21:28,860
If you've been depressed in the past, that's likely to be higher about four or five percent.

200
00:21:28,860 --> 00:21:36,900
If you've been depressed and been an inpatient at some point in your life and been hospitalised for depression, it can be as high as 10 to 15 percent.

201
00:21:36,900 --> 00:21:45,000
So one in six, one in seven people die by suicide if they've been in inpatient, hospitalised for depression.

202
00:21:45,000 --> 00:21:50,910
But, of course, it's not inevitable. Most people don't die in this way.

203
00:21:50,910 --> 00:21:57,030
But it's always a tragedy when it when it happens for the further family left behind.

204
00:21:57,030 --> 00:22:03,410
For the for the friends and colleagues of the person. Is suicide always linked with depression?

205
00:22:03,410 --> 00:22:07,400
It's the most closely linked problem so that even.

206
00:22:07,400 --> 00:22:15,200
I mean, you get elevated risk of suicide in other mental health problems like schizophrenia, for example, or bipolar disorder.

207
00:22:15,200 --> 00:22:19,790
But it's the depressive aspect of schizophrenia.

208
00:22:19,790 --> 00:22:28,880
So many people can can survive, as it were, having serious mental health problems in an amazingly courageous way.

209
00:22:28,880 --> 00:22:31,430
But depression takes away that hope.

210
00:22:31,430 --> 00:22:38,660
And it's when hopelessness comes, which tends to come with depression, that as people become at greater risk of suicide,

211
00:22:38,660 --> 00:22:44,840
whatever the condition it is, it's the it's the occurrence of depression that accounts for for that.

212
00:22:44,840 --> 00:22:52,160
Do you people tend to kill themselves as they come out of a depression rather than when they actually

213
00:22:52,160 --> 00:22:58,160
have the kind of hopelessness and the lack of energy when they are in the teeth of a depression?

214
00:22:58,160 --> 00:23:03,740
This is a quite of clinical evidence for that. It's never been proven by research.

215
00:23:03,740 --> 00:23:13,970
It's a very difficult thing to to to prove. But many people have said that they thought that the person was actually feeling happier now.

216
00:23:13,970 --> 00:23:20,000
And the natural inference is exactly as you suggest, that people, when they're very, very depressed,

217
00:23:20,000 --> 00:23:25,610
actually have very little energy and that it's when the energy starts to come back.

218
00:23:25,610 --> 00:23:29,870
But the mood has not yet improved. That is a very dangerous time.

219
00:23:29,870 --> 00:23:34,940
It's also true to say that some of the big studies that Lewis Appleby and others have done in the

220
00:23:34,940 --> 00:23:42,020
United Kingdom have found that the most vulnerable time is a time just after discharge from hospital,

221
00:23:42,020 --> 00:23:51,320
for example, after a change in medication which reflected very often reflected the fact that their physician thought they were feeling better.

222
00:23:51,320 --> 00:24:00,950
So that's also indications that when people are on the mend and people around them think they can stand on their own two feet,

223
00:24:00,950 --> 00:24:06,430
that that almost that transition is a very difficult time for people.

224
00:24:06,430 --> 00:24:10,760
You were mentioning about the close links between depression and suicide and asking about that.

225
00:24:10,760 --> 00:24:18,860
And somebody is calculated actually how much of the suicide risk in the world could be eliminated if we could eliminate depression.

226
00:24:18,860 --> 00:24:23,420
And it turns out to be about 80 percent because of the very close association.

227
00:24:23,420 --> 00:24:28,070
People don't tend to be suicidal outside an episode of depression.

228
00:24:28,070 --> 00:24:33,680
Depression is the thing that is the, as it were, the final common pathway, depression and hopelessness.

229
00:24:33,680 --> 00:24:42,200
And one of the interesting things that's emerged in the last few years is that when you get repeated depressions,

230
00:24:42,200 --> 00:24:47,360
you can get depressed again and again, but different symptoms can be there each time.

231
00:24:47,360 --> 00:24:51,800
So that always there's cause symptoms seem to be there, like low mood and lack of interest.

232
00:24:51,800 --> 00:24:57,590
But the other things like weight loss, sleep, loss, guilt, they may or may not be there.

233
00:24:57,590 --> 00:25:09,710
But our research in Oxford has found that of all the symptoms that recur when depression recurs, suicidal feelings are the most recurrent.

234
00:25:09,710 --> 00:25:10,100
And of course,

235
00:25:10,100 --> 00:25:17,690
that's important clinically to realise because it means that often doctors will ask somebody who's depressed whether they feel suicidal.

236
00:25:17,690 --> 00:25:23,510
Well, that's an important question to ask, but it's more important to ask, did you feel suicidal when you were last depressed?

237
00:25:23,510 --> 00:25:26,840
Because if people felt suicidal at their worst ever time,

238
00:25:26,840 --> 00:25:32,180
then there's some chances that during this episode, at some point they're going to feel suicidal.

239
00:25:32,180 --> 00:25:33,650
So clinically, it's important.

240
00:25:33,650 --> 00:25:41,540
And research wise, it's important to get to the bottom of what are the characteristics of recurrence so we can begin to begin to help.

241
00:25:41,540 --> 00:25:48,140
So why exactly does a full blown depression feel like?

242
00:25:48,140 --> 00:25:57,890
It's a combination of experiences, of distortions, you might say, in the way you think, the way you feel, the body and your impulses.

243
00:25:57,890 --> 00:26:04,070
So if you take each in turn, your thoughts are dominated by ideas of helplessness,

244
00:26:04,070 --> 00:26:11,450
rejection, being a failure, not being good enough, not being worth your space in the world.

245
00:26:11,450 --> 00:26:16,250
You feel like the lowest of the low and that nobody wants you.

246
00:26:16,250 --> 00:26:23,630
Nobody likes you. And that even if they do like you, that's because they haven't found out the truth about you.

247
00:26:23,630 --> 00:26:28,040
You're just a fraud. And as soon as they find out what you're really like, they'll reject you.

248
00:26:28,040 --> 00:26:32,870
So your your thoughts are dominated by that. That becomes a habit.

249
00:26:32,870 --> 00:26:36,800
So that although many of us might think like that for, you know what,

250
00:26:36,800 --> 00:26:44,000
at once or twice a day or a week or a month in depression, it just like comes all the time.

251
00:26:44,000 --> 00:26:49,000
I mean, many of us know what it's like to wake up in the middle of the night, for example, and not be able to get back to sleep.

252
00:26:49,000 --> 00:26:56,740
Our thoughts go round and round and round. We just ruminate and brood. Well, depression is like that sort of middle of the night thinking.

253
00:26:56,740 --> 00:27:03,080
But it happens during the day as well. Secondly, your feelings get bombarded.

254
00:27:03,080 --> 00:27:08,060
There's feelings of sadness, of hopelessness, of worthlessness.

255
00:27:08,060 --> 00:27:16,610
And they're very closely tied in with your thoughts. If you can imagine somebody standing behind you all day saying how useless you were then.

256
00:27:16,610 --> 00:27:23,840
Sooner or later, you would feel sad, irritable, rundown, exhausted and a miserable failure.

257
00:27:23,840 --> 00:27:28,670
And that's the way in which the feelings reflect those thoughts.

258
00:27:28,670 --> 00:27:35,840
It's not just a mental thing. Your body slows down. You lack energy.

259
00:27:35,840 --> 00:27:40,760
You your body fails to work in an efficient way.

260
00:27:40,760 --> 00:27:49,040
So you don't sleep well. You don't eat well. And this itself feeds back into your sense of fatigue and slowness, lack of energy,

261
00:27:49,040 --> 00:27:55,030
either being in some cases very agitated, in some Caples cases being very, very slow down.

262
00:27:55,030 --> 00:28:02,450
And so that's the way the blame. If you look at the way people walk when they're depressed, for example, the gate is very different.

263
00:28:02,450 --> 00:28:10,340
Not as if we're walking upright, walking slouched, go from side to side instead of actually more steady on their feet.

264
00:28:10,340 --> 00:28:16,050
And lastly, your behaviour is affected. You don't either.

265
00:28:16,050 --> 00:28:24,410
You feel like you feel suicidal, but also you feel like withdrawing from the world and that sense of withdrawal,

266
00:28:24,410 --> 00:28:29,240
of not wanting to see things that once again, most of us have had times in our life when the phone rang with.

267
00:28:29,240 --> 00:28:39,140
Oh, do I have to answer that? Or when we didn't want to get up in the morning and anybody could have seen, we were quite so withdrawn.

268
00:28:39,140 --> 00:28:43,940
But that goes on relentlessly. It a fear. It feels like it goes on relentlessly in depression.

269
00:28:43,940 --> 00:28:46,370
And when you put these together, the thoughts, the feelings,

270
00:28:46,370 --> 00:28:54,830
these body changes and your impulse to act or your behaviour or tendencies to withdraw, then that is what drags you down.

271
00:28:54,830 --> 00:29:04,950
It's not surprising then that people feel the burden and can't function when they've got all of this going on in their life.

272
00:29:04,950 --> 00:29:12,890
So is there any one thing that drives people or tip people over the edge from a normal run of the

273
00:29:12,890 --> 00:29:21,320
mill sadnesses or periods of rumination or reflection into a period of full blooded depression?

274
00:29:21,320 --> 00:29:26,120
There are. And actually, I'd like to tackle that in great detail in later episodes,

275
00:29:26,120 --> 00:29:34,640
because it's exactly what tips people into other episodes that the research is most exciting over the last 20 or 30 years.

276
00:29:34,640 --> 00:29:42,350
And out of that comes the interest in mindfulness research. So that's something that I think we'd be able to go into detail in future episodes.

277
00:29:42,350 --> 00:29:54,350
So that implies it is possible to stop a depression from or other normal feelings of unhappiness that we all experience from day to day.

278
00:29:54,350 --> 00:30:01,160
It's possible to stop that and prevent it from tipping over the edge into into clinical depression.

279
00:30:01,160 --> 00:30:11,300
That's the most exciting development in the last 20 years. And the way in which mindfulness is able to help people to notice when the tipping point is

280
00:30:11,300 --> 00:30:18,260
coming and allow you to deal with what you've got then without going down into the depths is,

281
00:30:18,260 --> 00:30:22,670
I think, one of the major things. And that's must have huge clinical relevance.

282
00:30:22,670 --> 00:30:28,250
It's got huge political relevance, because if we could find and I'll describe that in the later episode,

283
00:30:28,250 --> 00:30:33,860
if we can find that this is actually as useful as antidepressants or as other treatments.

284
00:30:33,860 --> 00:30:44,630
It's it's it's a global significance because it doesn't depend on medications, which in some context are just too expensive for people to purchase.

285
00:30:44,630 --> 00:30:54,080
Thanks very much for that, Mark. In this episode, we're talking about the new psychology of depression and what exactly depression is.

286
00:30:54,080 --> 00:31:01,760
And in the next episode, we'll be talking about the major treatments for depression and how they've changed over the last century or so.

287
00:31:01,760 --> 00:31:05,180
For further information about the issues raised in this programme,

288
00:31:05,180 --> 00:31:11,330
you can read The Mind four Way Through Depression by Professor Mark Williams and his co-workers.

289
00:31:11,330 --> 00:31:21,470
Or you could read our book, Mindfulness. Finding Peace in a Frantic World by Mark Williams and me, Danny Penman, where you could visit our Web site.

290
00:31:21,470 --> 00:31:30,770
Frantic World Dot.com. If you'd like to support further research in this area, you could visit Oxford mindfulness dot org.

291
00:31:30,770 --> 00:31:35,568
That's all one word. And follow the links to the development campaign.