We'll get started now.
Thank you all very much indeed for joining us this morning for our latest talk in Experimental Psychology's Our Mental Wellness Series.
We're really delighted to be joined by number of our colleagues from the
Department of Psychiatry today to talk about managing depression and low mood.
And before we just get started, I should just introduce myself. My name's Cathy Creswell.
And just to let you know, this is part of a series and you will be up to find previous sessions, on managing
stress and anxiety and also overcoming sleep difficulties, on our YouTube channel.
So please do have a look at those. And we've got another session coming up in January on the twenty eighth of January.
And on overcoming mistrust and paranoia. So please do join us for that, too.
I'm also just want to highlight that we'll be sharing some resources and also be asking your feedback, which will come to you in an email tomorrow
so it would be wonderful to have your responses to that. But without further ado, I'd like to introduce you now to Professor Willem Kuyken.
who is the John Riblat Family Foundation Professor of Mindfulness and Psychological Science.
He's a principal investigator in the University of Oxford Mindfulness Research Centre (and director of the University of Oxford Mindfulness Centre),
as well as being a fellow at Kellogg College. So we're absolutely delighted to have him here today talking to us about managing depression and low mood.
Thanks so much, Willem. Thank you, Cathy,
and it's an absolute privilege to have a chance to speak as part of this fantastic series on mental wellness for university staff and beyond.
And to have a chance to speak to you all about something which is clearly very much on people's
mind of how to manage one's mood and possibly depression in the midst of this pandemic.
So I'm just going to share some slides. I'd like to start by kind of, in a way, just a bit of a thought experiment,
if you imagine that my title today was not managing depression and low mood, but instead was managing heart health.
What would come next would feel, I think, probably quite straightforward. All the things I put up next would be perhaps not surprising at all.
Seven steps to a healthier heart. Diet. Maintaining one's weight.
Managing cholesterol. Moreover, there wouldn't be much stigma associated with this.
So here's my hope, if you like, that for the next five, 10, 50 years,
the work that we do in experimental psychology and psychiatry here at the University of Oxford will move us to the same place with mental health,
that managing mental health will have that same clarity, but also won't have the same stigma that it currently does.
So what I'd like to do in the next 20 minutes or so that I have, is to strike a
realistic balance between optimism and hope and also the reality of what depression is.
And just start by saying what depression is and then go on to talk about the treatments that are available,
but then also what we can all do individually to manage our mental health and wellbeing.
So what is depression? We sent round a illustration recently from from a recent illustrated book by
Matthew Johnston called I Had a Black Dog. First I'll state what depression isn't.
It isn't sadness. And it isn't grief. It also isn't the kind of feelings that we have around being cooped up in the midst of this pandemic.
These are just normal human emotions, normal human reactions.
Yes, sure, Depression might be on the dimension, but it is a qualitatively different phenomenon.
It's captured beautifully, I think, in this slide.
It has this sense of these two cardinal symptoms, sense of unrelenting low mood, usually pretty well every day,
all of the day, for about two weeks or just a sense of loss of pleasure that has other symptoms which the slides speak to - early morning,
waking to thinking, low self-worth, lack of energy, irritability and in extreme forms, suicidal thinking and suicidality.
It tends to have a life course. Typically onset is late adolescence, early adulthood.
People who've had a single episode of depression have a 50 percent chance of having a second.
And the more episodes people have, the more it's likely to have a recurring cause.
I say that not to sort of strike a pessimistic note,
but rather just to strike the note that at that point it becomes more like living with diabetes or a more long term condition.
Women are more likely to suffer from depression than men, and depression is something that is associated with deprivation, low socio economic status.
The pressures of those kind of social conditions affect people and they affect people in the long term.
So what I'd like to do now is just put a poll up for you all to have a look at.
The poll is a very simple yes or no question.
Do you know anyone in your immediate circle of family or friends who have suffered from depression or have you yourself suffered from depression?
So just look at that. Isn't that extraordinary? I don't if you can see the same screen as I can.
96, 97 percent. All of you are in incredibly good company.
It's a common condition. Two hundred and fifty million people around the world right now are suffering from depression.
If you look at the world's population at some point in their lives, one billion people will suffer from depression.
Winston Churchill. Stormzy. Marilyn Monroe. Lady Gaga.
Hugh Laurie. Dolly Parton. Many, many people have suffered from this condition.
It's a common condition. What does the evidence say about what works?
If you want to have a look at the evidence and look at the treatments that are available, in the U.K.,
the National Institute for Health Care Excellence NICE produces a synthesis of the evidence widely available on the Web link is up here.
I had the privilege of serving on the last nice slide guideline group.
And I think, broadly speaking, one could talk about biological, psychological and social treatments.
We have some world leading experts on the panel today who can speak to anti-depressants in the biological category.
So I'm not going to say too much about that just now. But in the psychological area, we have a whole range of treatments that we know work,
cognitive behavioural treatment, behavioural activation, interpersonal therapy.
Actually, one of the things that's interesting about depression is many different treatments seem to work about the same.
But we've also here in Oxford developed treatments that are focussed on helping people in the long term stay well.
In particular, mindfulness-based cognitive therapy. These are all trials and projects that I've been involved with over the last 10 or so years.
All of these are recommended either in the last NICE guideline or the forthcoming NICE guideline.
These are on the optimistic note treatments that we know that work.
There are also treatments that you will can access. And I'll say more about that in just a moment.
How can we all collectively manage our mood, depression and well-being?
I love this image. It's the sort of life course of depression and well-being, if you like.
And one of things I like about this image is that it has this sense of a person travelling through their life and encountering different areas.
So you could call this maybe perhaps a period of low mood, this perhaps a period of more enduring difficulty.
This a period perhaps of depression. This a period of just maybe a bit like the pandemic, just a pretty, I don't know, grotty time.
You can see the weather clouds. And it has an indeterminate cause.
But what I think is lovely about this image is the way the person traverses each of these challenges in their life
is different. And I think that's the challenge for all of us, too, is to figure out the puzzle of what supports our mood,
what helps us when we become depressed or the people that we love become depressed, and what supports our well-being.
And one of things I'd like to say, I guess on the on the kind of optimistic note here, is I actually don't think it's rocket science.
I think actually in the same way as we now know a lot about heart disease, in the next five, 10, 20 years,
we will have the same currency about the sorts of things that support our mood, depression and wellbeing.
Broadly speaking, I think one can separate them out into biological, psychological and social approaches.
And the other thing to say is,
I think the sort of things that we do when we're going through low mood are different to the things that we might do
when we go through a depression are different to the things that we might do in the midst of something like this pandemic.
And just before I get into this, I want to have one major caveat.
And the caveat is this, that sometimes people are encountering things in their lives,
which are just very difficult things, and those things need to be addressed, need to be addressed.
Somebody, for example, who is caught in an abusive relationship, somebody who's at work and is in a toxic work environment and is burnt out.
Somebody who is in the midst of conflict at home.
Somebody who's living with very, very pervasive and difficult health conditions.
Those things in those cases clearly need to be addressed and addressed first.
That being said, I think there are things that one can do to look after ourselves.
What would low mood, low work with depression and that sort of levels that I'm connoting on this slide here are about things to do when we're well,
things to do when perhaps we're encountering low mood and things to do when we're perhaps actually depressed.
When we're well, rest, we know is really important.
Sometimes that kind of business and the franticness of life means that we lose the balance and we forget to rest.
There's a beautiful recent book by Claudia Hammond, which is called Rest and the many different ways in which people choose to rest sleep.
It's absolutely vital to mental health in a way that we're only beginning to really fully understand.
And I highly recommend the talk on YouTube from this series by Colin Espie and others.
Diet and eating well is important and the judicious use of alcohol and other drugs as well, which can be depressants,
ut people sometimes use to self medicate.
Low mood response to activity and exercise, anti-depressants are also something that we know works and works to keep people well in the long term.
And when people get more severely depressed, medication review and hospitalisation may be indicated.
Now, of course, the area that I know best as a psychologist is the psychological area.
And here, I think, is where in a sense, as I said before, it really isn't rocket science.
A lifelong question that we can all ask ourselves is what is meaningful? What's rewarding?
What do I value in my life? And asking ourselves that question and answering it by doing more of the things
that make us feel better and fewer of the things that make us feel worse.
It's not rocket science. And to keep that under review, appreciation, gratitude, journals, people describe as being tremendously helpful.
I think it's partly because it helps people signal what actually gives value to their life,
what gives pleasure to their life. Learning new skills, mindfulness.
These are all things that we now can support, mental health and wellbeing.
What about when we hit a period of low mood and depression?
Ask for help. Here in Oxford, in the surrounding areas, through the incredible work of David Clark and Richard Layard, and many others around the country,
evidence-based treatments are readily available.
You can actually self refer here in Oxford to the IAPT service, the Improving Access to Psychological Therapy Service, called Talking Space.
You fill in the form and you can get access to evidence-based treatments.
Tremendous piece of work to make mental health accessible in the UK. If suicidal,
The Samaritans or NHS emergency services are always available. And more and more people are looking at kind of social ways of working - gardens,
parks, getting out to nature, connecting with others, talking and listening.
Being with people that we know. Give us joy. Have our back. Make us feel better about ourselves.
So, as I say, it's a lifelong puzzle. It's a way of actually figuring out for ourselves what supports our mood,
what we can do when we become depressed, and what actually supports our well-being in the long term.
So I have a good friend whom I WhatsApped yesterday and I know she suffers from seasonal affective disorder.
And I asked her what she does. And she sent me this picture on WhatsApp.
My solution to low mood is cinnamon buns, based partly on the following exchange with her teenage daughter.
Mum, you should make these more often made. Yes. They taste nice. But then we'd be as big as houses.
A teenage daughter. Yes, but we'd be happy houses. So is my considered answer.
And you're welcome. So I'm not trying to be trite here,
because what's interesting about this example is the very cruel thing about depression is
it destroys our motivation and it makes us feel like this might actually go on forever,
forever. And we are actually the only one who's suffering from this, that actually keeping a sense of doing the right thing and being patient,
and this, too, shall pass, is really important.
So the making of these cinnamon buns, even when one feels like not doing it, I think is kind of part of what this person was trying to communicate.
So I'll just finish again with Matthew Johnston and I Had a Black Dog. Matthew Johnson is somebody who suffered from recurrent depression,
and you can see in the second slide towards the end of his book, his illustrated book, he's sitting, and he's doing a whole range of things,
so he described the whole range of different things that he does at different times.
What I think is important about this slide is that the black dog is still there in the window.
I think with recurrent depression, this sort of propensity to low mood and maybe some of the negative thinking never quite fully goes away.
But he's found a way of living with it that is tolerable, but actually still has meaning and well-being in his life.
So just by way of conclusion. These are some resources that I would highly recommend the book that has been sent round on email to all the delegates.
Then there is also Matthew Johnson's partner, Ainsley Johnston,
who's, quite a few of the people I know who are interested in this talk, are living with somebody who suffers from depression.
She provides her perspective on how to support somebody with depression in living with a black dog.
And then this NHS Web site, the web link just here, has some fantastic resources.
So I'm going to hand over to the panellists now and just finish my talk. But just before doing that
I just want to thank the people who support my work, which is the Wellcome Trust, the Oxford Mindfulness Centre and the Riblat Family Foundation.
Thank you. Great. Thank you very much indeed, Willem.
And I know that we've got lots of questions that will allow us to discuss some of those themes that you've raised in more detail as well.
So we look forward to further discussion with you shortly. And I just want to also say before we move on here,
Thank you, Willem, for sharing so many useful resources.
Some of those have already gone out to delegates and others and others will be sent out tomorrow in an email, as I mentioned, so huge
thanks for sharing that. I'm sure they'll be really appreciated. I'd now like to introduce the other two members of our panel.
So we're delighted to be joined by Professor Cath Harmer, who is a Professor of Cognitive Neuroscience in the Department of Psychiatry here in Oxford.
Cath is the director of the Psychopharmacology and Emotional Research Lab, Perl, and is also a research fellow at Corpus Christi College.
And I'd also like to introduce you to Professor Andrea Cipriani, who's a Professor of Psychiatry in the Department of Psychiatry.
He's an NIHR research professor and is also director of the clinical research facility at the Warneford Hospital,
associate director for R&D for Oxford Health and NHS Foundation Foundation Trust,
and also an honorary consultant psychiatrist in Oxford Health NHS Foundation Trust.
So I'm sure you'll agree we've got a really fantastic panel to speak to you today.
And so we'd like to do is just start by asking a question which picks up on some of the things that Willem's already mentioned.
So this really reflects a question that many people raised, particularly in the current time, which,
as Willem said, you know, it is challenging and unusual and presents many difficulties for many people.
And this is really that everyone, of course, feels low from time to time.
And so how do we discriminate low mood from a clinical problem?
And I think people did raise it in relation to, for example, the current situation of the pandemic,
but also following a bereavement or in the context of physical health problems that cause discomfort and pain.
How do we know when we should be concerned, when we should consider this to be a problem?
So, Andrea, if I could get to you first. Sure.
Yes. This is a key point to address.
And it's a very frequently asked question from from patients, but also for carers,
because it's crucial to be able to discriminate something that is called low mood.
And as Willem said, is part of our live normal life from something which is a clinical problem. In clinical settings
we tend to consider two important things, that I will to summarise.
One is the low mood. It is itself is not a problem, is how consistently it is low.
We'll mention the duration of symptoms over a longer period of time, weeks.
And also, it's not reactive to normal things that usually cheer up people or may oh,
we consider pleasurable things and people don't get pleasure from these things.
So the duration of symptoms, not just the intensity, but the duration.
And the second thing we consider to discriminate when is a clinical problem is the impact on personal life,
the working life, and also whether people around the person notice that this has been a change.
So these are usually the key pillars to distinguish what is normal low mood or as a normal
reaction within the normal range, to something which is a clinical problem and deserves more attention.
Right. Thank you very much. Willem, do you want to add anything on that point?
Thanks. Thank you. So there was also a lot of questions about what people can do themselves,
particularly thinking about before we get to a point where we feel we need professional help.
What can we do to offset low mood? So Cath, it would be great to hear your thoughts about that.
Yeah. And I think this is a great question, and I agree with some of the suggestions that Willem gave in his talk.
I think there's lots of things that we can all do to try and offset low mood before seeking outside help.
Perhaps the most important thing, although it sounds a bit trite is just to get to know yourself and try and find out what works for you.
There's a huge amount of good advice out there, and we know that some things are very helpful,
such as increasing levels of exercise, having a good daily and sleep rhythme, eating well, spending time with others.
And all of these things can be very helpful. But they will work better for different people.
And it can sometimes seem overwhelming if you see this long list of things that that you should try,
if you try to do them all at once, especially if you feeling a bit low.
So I think taking small steps and thinking about what's most important to you is a good start.
We did a recent study online during the first lockdown and we found that there were a couple of things that really
stood out across a group as being useful and being related to better mood and lower risk of subsequent depression.
And there were two two main things. One of them was spending time outside each day.
This is very important. And this, I think, is maybe particularly important now when we naturally spend a bit less time outside
during lockdown and also having a high level of what's called behaviour activation.
And Willem touched on some of these in his talk. It refers to a number of interlinked things.
It's having a good structure in your day, seeking out, doing things that you find enjoyable.
Trying not to put off things that you find unpleasant, but you have to do and they can hang over you.
These are getting things out of the way. I also think it's really important to be kind to yourself.
And sometimes we can be our own worst critic.
Certainly, I would never speak to other people, think about other people the way I would berate myself sometimes.
And I think it's important to kind of try to tune in to that, to recognise that you're doing it and then try and overcome that
that tendency by giving yourself some praise and reward. And the more you do it, the more habitual it becomes, the easier, easier it becomes.
And so I think it's very important just to start with small steps of the things that seem most valuable or meaningful to you and go from there.
Remembering that we're all individuals and some of us will be relevant to different people in different ways
and we have to find our own path to things which can help us offset these difficult times
and they happen in our own life. Right. Thank you very much.
And you mentioned sleep there, so just to take the opportunity again, just to mention that, sir,
in on our YouTube channel, you'll find the last session that we did, which was on overcoming difficulties with sleep.
So please do take a look at that. And Willem, would you like to add anything further on that point?
Really, just to echo Cath's invitation to to make this a sort of kind self exploration I want instead of like hunting out all of this expert advice,
actually just really treating ourselves as the expert.
What do we know in a given moment, in a given day, in a given a week, what makes us feel a sense of aliveness,
a sense of vitality and a sense of engagement with others and trusting ourselves in that.
I think it's a kind of self exploration, which I think is really powerful and really interesting.
So I just to echo I think what what Cath said.
And I think some of these things like sleep something people say, yeah, I get that about sleep, but I don't know how to work with that.
There are evidence based programmes. I mean, Colin's work with Sleepio is a fantastic result,
but it takes the effort to go through the programme of the sort of diagnosis, if you like, of what,
why am I having sleep problems? And then to kind of work through that kind of approach to that.
So some of these things can feel as as as as as Catherine said, like a sort of insurmountable mountain.
But we sort of break them down into small steps. What does it mean to exercise?
I just mean just taking a 15 minute walk each day. What does it mean to sleep differently?
Well, I'm just leaving our phone outside our bedroom. These are small but important steps.
All right. Thanks very much.
We had a lot of questions about antidepressant medication, and some people asked how long they might expect to be on them.
What sort of side effects to expect. And also how likely they are to work for any any individual.
Cath, can I go to you first with that? Yeah, sure. Again, I would say this relies very much on the individual.
And there are lots of things which need to be taken into account when making a decision about whether to take an antidepressant drug treatment.
As a general rule of thumb, if it's your first experience of depression, most people would take antidepressants for around six months or so,
although it may vary a little bit between people. The side effects can also vary quite a bit.
So in our research studies, when we look at different antidepressants,
actually most people can't tell if they're taking the antidepressant or the placebo,
but others will experience side effects. There are initial side effects, often like nausea or headaches.
And this is usually just the first few days of treatment and it gets better.
And I think it's important to recognise that anxiety can also get a little bit worse in the first few days or week.
But again, this gets better over time and in general is also usually helped by anti-depressants.
Perhaps the side effect, which is the most problematic, are the sexual side effects.
Again, not affecting everyone, but, of course, can be very distressing. So things like decreased libido, interest in sex.
But again, there are differences between different people and also probably between different antidepressants as well.
The third part is how likely they are to work.
So in our research studies, where we look at antidepressants, often in GP clinics on primary care, actually the response is pretty good.
Around 60 to 70 percent of people feel quite a bit better.
If you look at larger data sets across more diverse populations. One of the largest studies of this kind suggests that around 50 percent of people
who go into treatment with an SSRI type of antidepressant will do quite well.
And of those who don't respond to that, if they try second one, half of those again will respond.
So anti-depressants are effective. They are a good treatment option, but they certainly don't work for everybody.
And unfortunately, we don't have a good way of predicting who is most likely to get benefit from this in advance.
And this is something which is very important for research to focus on. And it's actually a good link to our next panellist, Andrea,
whose work focuses very much on this question. Absolutely.
Yes. Can I go to you now? I totally agree with what Cath just said.
It's crucial that the big challenge for for us now is to catch up with what medicine is doing in other fields.
So ideally, to be able to personalise treatment, based on the clinical presentation and on people's need, but also people's preferences.
And this is something I'd like to spend a few words on, because the big problem we have in psychiatry and if you want in medicine in general,
is that everything tends to be clinician led while it should be person centred.
And if we move to this paternalistic paradigm to something which is more shared decision making process,
I think this will help tackling one of the most important things that Willem mentioned at the beginning,
which is stigma towards mental health and
especially towards anti-depressants, because sometimes people think, well,
I should be able to do it myself without any help, but actually especially for people with severe symptoms,
Antidepressants can really help in the majority of cases.
And they should also be considered in combination with other treatments, including psychological treatments.
In terms of what side effects to expect, if we have this shared decision making process and paradigm.
I think it's crucial also to incorporate what people think about these specific adverse events,
because what is upsetting for me may be less relevant for somebody else.
The good thing is that when we present this information to patients and carers,
we know that, for instance, some adverse events, like the gastrointestinal adverse events,
nausea, diarrhoea, constipation for the most commonly prescribed antidepressant called SSRI,
the certain emerged ones, they tend to disappear over a few days, a few weeks.
Others, the ones that Cath mentioned, the sexual side effects, they tend to stay for longer.
So this is also something to be factored in when we inform people about the side effect profile.
And also, we should be aware, as Cath said, that not all antidepressants are the same
so the side effect profile may may differ. The last thing about how long people may expect to be on antidepressants.
Yes, we we have pretty strong data that if you continue taking the antidepressants,
once the symptoms are over, you reduce more or less by 50 percent the chance to get a relapse.
And as Cath said, it is an individual decision because we have people who may benefit for prolonged treatment
and people who actually don't have any added value from this continuation treatment.
So it's very important to have an open discussion.
And what I'm trying to push is to have a discussion based on some numbers so people can quantify the expected benefit and have an informed decision.
Thank you so much. And if Willem would got a follow up question for you both.
So just a follow up to Cath and Andrea, which is OK.
I think something's around for a lot of people who are on long term anti-depressants as sort of the questions and the issues they have
about coming off their anti-depressants are to do with things like tapering and discontinuation and maybe discontinuation syndromes as well.
Yeah, it did the how to taper off the medication is another thing very important to consider to avoid withdrawal symptoms.
And this varies a lot because we have in the general population, people that we call fast metabolisers.
They usually need higher doses of drugs because they eliminate the drug very fast.
And there's also when you taper off and stop the medication, it has to be very gradual
otherwise, you have a big jump in terms of levels of drugs in the body or on the other hand,
we have this low metabolisers and then the tapering off is much, much easier.
Thank you. Cath, do you want to add anything? No, I mean, I agree.
I think there's been increasing focus on the withdrawal effects of coming off anti-depressants.
And I agree it's a very important area, both for kind of clinical questions that have to come off it, but also what what's happening under the hood?
What what kinds of things contribute to those kinds of people experiences?
And if we knew that, then it might be possible to to support or target those same processes as well.
So I think we are all aware of the growing importance of focussing on that stage.
We need to know more about what's underlying it. And also how we can predict who's going to find it most difficult to come off anti-depressants.
And also, does that place them at high risk of a relapse as well?
So I think that there are research questions around that are very much ongoing.
Thank you very much. So we had a lot of questions about how best to support other people who are struggling with low mood or depression.
So we'd be really keen to hear what advice you would give. Andrea,
can I go to you first of all? Sure. I'd like to go back to two
two things that Willem said in his presentation. So how best to support people who are struggling with low mood and depression or depression?
We all have low mood and we all can suffer from depression.
So the first thing is not to be afraid of having a discussion and mention this because it can happen.
So it's important for people who are suffering with those symptoms and low mood to be aware and have some feedback about these.
And also go and have a word with a GP or a specialist.
Because I think one of our roles as medics in the field is also to give feedback
to patients and see that actually you're not suffering from depression.
It's just low mood. So it's not automatic. Every time we see a patient to a person to assume it's a patient and prescribe medication. On the contrary,
I spend a lot of time advising people and stopping the medication or not prescribe anything, of course.
The other thing is about stigma.
So sometimes having or actually often having a diagnosis helps, because diagnosis is not a label to have on the person.
On the contrary, is a way for us to define a group of symptoms and have a treatment which is likely to be effective for this person.
So it actually helps the process and be able to see whether we are above the threshold of something clinically significant or below is crucial
also for treatment purposes. Thank you very much. Willem,
can I go to you on that question too. One thing I would add is that two things.
One is it takes a lot of patience because we've heard about the course of depression and that's been weeks and months.
So it's not something that you can hurry or cajole someone through.
So as a carer, it requires a lot of patience.
And I think the thing I'd say then for people who are living with someone with depression is it's really important to take care of yourself.
Because actually, to be able to support someone with depression, you yourself need to be in good shape.
So if you have a teenager or a partner or a parent who is suffering from depression,
maybe one of the best things you can do to support that person is to look after
yourself so that you yourself are actually in good shape to be there for them.
And can show that sense of patience and support through that depression.
But again, I'd just point you to the book, Living with Black Dog.
It's just, I think, a very vibrant example of her experience of living with someone with depression.
If I could just ask a follow up question relating to this. I mean, as you well know, I work with children and young people.
And one of the things that often comes up as a major symptom for low mood and depression in adolescents is high levels of irritability.
And I know that's not unique to adolescents, but it does present some challenges in identifying depression, distinguishing it from normal experiences.
And, you know, sometimes parents do reflect that sometimes they thought this was just adolescence.
And, you know, later maybe it becomes clearer that the young person is struggling with depression.
And irritability is potentially a particularly challenging thing for those living with people to be able to address.
Because whilst we might like to have a nice conversation about the issues,
maybe that's not going to go down quite so well if people are really struggling with irritability.
So I was really keen to hear your thoughts on that. And any advice you would give?
I don't know if anyone has a particular view. Cath, I'd like to I'd like to hear your view.
But I guess what I'd say is I think this is where that example of looking after yourself is really important.
And I think that for me personally, mindfulness is actually very helpful,
because actually to be able to stay grounded and to be able to have some perspective,
when someone or a child or an adolescent is irritable, helps us to realise that this is not about me.
So that the eligibility might be directed at me. But this is not about me. This is about them.
And how can I stay steady and support them? But, Cahty, I know you're being very even handed as the chair.
But actually, I think probably the best person to answer this question would be you.
Well, yeah. I mean, I think I'd very much reiterate what you've just said. I think I think the thing that we see happening is that when, you know,
young people are struggling with irritability, it's very easy for that then to lead to conflicts.
And because it's frustrating for parents. It feels disrespectful.
It feels like they're being challenged and say parents may respond by fighting back.
And then obviously then the young person feels they're being attacked, being targeted,
and you get caught in a vicious cycle that sort of escalates the conflict and leaves everybody feeling pretty rubbish.
So I think exactly what you have said is that sort of trying to maintain that patient ability to step back from it a bit and not take it personally,
but instead just to be more curious and empathic and gentle in in response, but recognise it's very difficult to do.
Thank you. So, Willem, you've already touched on the last question that we were going to get to.
I don't know if you've got anything else you want to say about it.
And that was really about exactly this, that where people are looking after a loved one or someone who is close to them who has depression,
how can people also best after themselves?
Andrea, you've commented on that as well, but we'll go to Cath first and then I'll come back and see if you've got anything else that you want to add.
Cath, any thoughts on that? No, I mean, I agree with Willem. I think it's pretty important to look after yourself as well.
I think it's it's like they say on the safety briefing on the aeroplane. Put your own oxygen mask on first.
And this is really hard to do.
But it's really important to do it, if you don't look after yourself and it becomes very difficult to talk to anyone else as well.
So it's very important to invest in yourself.
I mean, when I have this question, I was thinking of a time of my own life when perhaps I didn't follow this advice very well.
When I had young twins to look after and a busy job and my sister was just diagnosed with cancer and I took the opposite advice to all of this.
And I didn't invest any time myself in all these things had piled up and became very difficult.
So I think I think my my advice with the benefit of hindsight is to set aside some time to look after yourself, doing some nice things,
if you can, some essential things, some trivial things,
but things that would otherwise mount up and come back. And also to try and seek the support and advice of people around you,
even if it means telling them what they can do to help you.
And I think we've all been in that situation on the other side of this barrier where we can see that somebody is having a very difficult time.
But we don't really know what to do to help. And often then we don't really do anything.
And I think most people are very happy to step in and help and to do some practical things if you need it.
If you can tell them what you need and what would be helpful.
And I think that this is it is really useful to try and gather some more social supports around you at those very difficult times,
because it can be quite easy to become quite isolated,
just focussing on looking after somebody else without the support networks that you normally rely on.
And with things sort of mounting up, and you become in a sort of smaller and smaller space to actually deal with anything yourself.
So I think it is hard to do in a situation where you're busy looking after somebody else.
But I think if you can just set aside a little bit of time yourself every day to do those kinds of things, I think is is really important.
All right. Thank you very much. Willem, Andrea, are there any final things here tonight.
Come out on that point before we finish. I would like to come in if I may, and I think I'm just reflect on the poll that we did at the beginning.
Ninety five percent of the people on this call have either suffered from depression themselves or know somebody who has in their immediate circle.
So this is a very live issue. And I'm minded of the Wordsworth's, his words, "a deep distress have humanised my soul."
And what he was describing was an experience of depression that actually had been somehow transformative.
And many of the people I've described, I don't want to in any sense romanticise depression.
It's not a romantic disorder. But actually standing alongside someone through depression,
the beginning of the depression, and the aftermath of it, can be actually something.
I've experienced this myself in my own life, as Cath's described, can actually deepen a friendship that can deepen a relationship.
It can deepen a marriage. Yes, it feels difficult.
But that teenager, Cathy, that you described, if you can be there for them through the irritability.
And stand steady. You might find later that day when you're in a long car ride with them, they're disclosing something very personal to you.
And I think that actually it's more than just can we survive living with someone?
Depression with depression can actually be part of that relationship.
Can it be something that actually enhances that relationship over the long, long haul?
Because it's a part of life. And I just want to go back to where I started. If we talk about heart disease,
we wouldn't have this kind of worry about it. I would say this is just part of life.
This is part of the human condition. My hope is the same will be will be true here.
This is what happens sometimes to people.
And if we can find a way of navigating our way through it, then actually deepens and strengthens relationships sometimes.
Thank you. And I think that's a really nice place to finish, so I'd just like to thank again our three panellists today.
Wille, Cath and Andrea for a really fantastic session, which I hope will be useful for many people who are listening.
It's really wonderful of them to give up their time to take part. And we really do appreciate it very much.
I also would say huge thanks to Nicola Kaja and
Halley, who've done enormous amounts work behind the scenes to make this series run as smoothly as possible.
And also just to do a final plug for our YouTube channel where you can find the previous talks.
You'll also be able to find this one here. And our next session, which is on overcoming mistrust and paranoia on the twenty eighth of January.
And please do look out for the e-mail from us tomorrow where we'll be asking for some feedback, but also sharing some more resources.
So thank you ever so much for joining us. And we hope you'll be able to join us again soon.
Thank you.