Welcome!

Unfortunately this website is not yet completely translated. That is why there is only this one-page summary available in English.

Who wants to volunteer???: I'm in need of a translator who wants to translate the dutch texts of this site in other languages. This website can potentially help lots of people when translated. 

The author: Willem van de Sanden, Ph.D. (Health Psychologist , The Netherlands).

I have been working in the mental healthcare sector for over 35 years. I have completed a course in psychotherapy at the Dutch Client Centered Psychotherapy Association. I was an associate professor at the Amsterdam City University where I developed a time-limited treatment for depression by non-psychotherapists. I was involved in the making of the program ‘Mood Disorders’ and am the author of the self help book: Depressie actief overwinnen, Pearson Publishers 2008

For questions, remarks and more information please send an email to: W.v.d.Sanden@net.HCC.nl.

What is depression?

Most people assume that depression is exclusively an illness. Although you can be very ill when you are suffering from depression, it is in fact a biopsychosocial disorder. That means that depression has biological and psychological and social features, origins and consequences. Although it is possible to cure the biological symptoms sometimes with anti-depressives, that is not enough to change the underlying causes. It will also be necessary to modify the psychological and social factors that play a role in the coming into being of the depression. For instance by changing the way you handle demands of other people or by changing your environment or your perception, you can lessen your vulnerability to depression.

Depression makes you indeed ill and very unhappy but that does not mean that it is always a negative phenomenon. Often depression precedes a better, more competent life. That means when you do the right things and get the right help. Depression is not a state it is a process!

Being depressive

Note: The following text is a translation of a part of the first chapter of a selfhelp-book for people with symptoms of depression. It is published in dutch by Swets & Zeitlinger Publishers in Lisse, The Netherlands. Title: 'DEPRESSIE ACTIEF OVERWINNEN'.

The therapy in the book is a "structural developmental cognitive therapy". It consist of self-help modules + information and advice about better sleeping, bodily exercise, food and relaxation techniques.

Being depressive is an embarrassing and difficult situation in your life. When you endure a depression all kinds of things happen to you and it appears as if you have no control over your situation. The hardest thing of all is that you don't know if it is going to end and if it does, when that will happen.

You feel miserable and you cannot explain to anyone why. You are tired and down-hearted. You see for the most part everything negatively. You cannot deal with people being around you. Responsibilities are difficult to handle. You have little energy for social contacts. You feel isolated or lonely sometimes, yet you would rather be left alone.

You don't have any interest in the things that you used to enjoy, and don't care about them anymore. You brood about everything and have no peace of mind, yet you achieve nothing by all your worrying. The same thoughts return over and over again and in particular when you are lying awake in your bed at nighttime. Sometimes you don't feel like living anymore. You probably have problems concentrating and try, without result, to fight against what is happening to you.

You feel helpless and want to change but it just doesn't happen. You feel ashamed maybe for the fact that you cannot work. It may even be the case that you feel guilty even though you know that is nonsense. Your memories haunt you. You may feel sad, angry, or worthless but mostly you feel empty and apathetic.

Being depressive differs from person to person. The length, the number of complaints and the intensity of it is different with each individual. Therefore depression is sometimes difficult to recognize. If it is of short duration and less intense maybe you are dealing with a depression that everyone has once in a while. If you have a lot of the problems then you probably are suffering from a more severe mood disorder. Perhaps you may need anti depressive medicine. Sometimes you may have complaints that make it seem like you are depressed, however, there is something else the matter like a Chronic Fatigue Syndrome or Parkinson's disease.

Depressive symptoms can also be partly caused by a nervous breakdown or surmenage, or a burn-out syndrome or a post traumatic syndrome. It is often difficult to separate these causes from a depression. People who have a burn-out or surmenage can benefit from (supported) self-help therapy. If you are suffering from a post traumatic syndrome then it is necessary to contact professional help.

How do you recognize a depression?

It is difficult to give a standard description of unipolar depression. The opinions about depression vary with the profession and the theoretical vision of the researchers and the discipline of the therapist. In general it can be said that with a depression you have a change of mood that is different from normal. You suffer from your mood. Usually your mood is dull, that means, you don't feel happy or you don't enjoy the things you always liked. Your mood can be negative and therefore you feel dejected and miserable. With a serious depression that miserable feeling can express itself in a pitch black melancholy, life is almost unbearable.

It can happen that there are periods that you are too excited. If that is the case, than it is likely that you have a bipolar depression, or that you have to stop using anti depressive medication. Professional helpers are usually in agreement that depression has physical and psychological symptoms and that a combination of physiological, psychological, and social factors lead to a depression.

Physical characteristics of depression

The principal physical complaints that can appear are:

Often tired and without energy;
Early awakening, insomnia, or sleep which is too deep and too long;
Sometimes problems with digestion;
Sometimes pain without a clear reason;
Sometimes weight loss or gain;
Tense muscles, poor posture;
A feeling of pressure in your head;
Inertness;
Sometimes stomach aches;
Sometimes sexual impotence or aversion;
Shallow breathing;
Vulnerability for infections.

Psychological characteristics

The principal psychological complaints that can appear are:

A negative mood varying from light somberness to deep despair, dependent on the seriousness of the depression;

With bipolar depression:

Periods of euphoria with a tendency to overestimate yourself;
Mood swings, which means that you feel better later in the day;
Automatic, involuntary thought or worry;
Negative thinking about yourself;
Apathy and passiveness;
Often anhedonia, which means not being able to enjoy the things you used to enjoy;
Often lowered self confidence;
Sometimes a feeling of worthlessness or guilt feelings;
Sometimes fear;
Sometimes almost no feelings or emotions (alexithymia) which make it difficult to understand others or to empathize with them;
Difficulties with concentration and attention;
Slowness in thinking and action;
Aversion to people;
Difficulty with taking initiative and making decisions;
A feeling of hopelessness.

Behavior and communication

There are different ways that someone who is depressive can behave. I will name a few that you may recognize:

Little communication, cannot suggest a topic;
Not being able to achieve normal activities;
Express yourself negatively about everything, complaining;
Exclusive alertness to negative things;
Cry a lot;
React irritable;
Sometimes too much alcohol, drugs or medicine or betting;
Nervousness, always busy, talk a lot;
Frequent conflicts with partner or other people close to you;
React too rational with too little sensitive interest toward others.

It is important to keep in mind that the identified characteristics belong to a depression and that most of the symptoms disappear or decrease as the depression becomes less intense!

The course of a depression

Everyone's depression is different. Therefore we can only speak in general about the course of your depression. It is known from people who have had therapy for a depression, that the length of a depression can last anywhere from three months to longer than three years. For about a third the therapy is shorter than three months, and for about a third longer than three years. That is not to say that the complaints continue to remain at the same level during the duration of the depression.

Usually the somberness gradually or quickly intensifies until it reaches the deepest point and then begins to diminish. In the last stage there are fluctuating ups and downs: It can happen that you feel pretty good one day and then suddenly you are down in the dumps for a few days. That is normal, don't be alarmed, and think that it is beginning all over again. It can be caused by something else, for instance because you do too much in too short a time since you feel better. It can also be that circumstances have caused you to be too busy or as a result of an emotional confrontation. Therefore be careful even if you feel like you used too, you are still vulnerable for some time. Moreover, you have probably learned that you don't want to continue with the old stressful lifestyle that you had.

If you resume your normal activities too quickly or try to catch up arrears, you are in danger of remaining in a sort of fluctuating depression where you sometimes feel good and the next day worse.

Also, many people remain depressed because they try to avoid the deepest part of the gully.
Unfortunately, the quickest way to overcome your depression is by going through the deepest part of the valley.
Remember: the sun is shining behind the (darkest) clouds!

What can you do to improve your situation

When you are depressed, be depressed
Don't deny it, do not try to fight it by willpower. The best way to get a grip on the symptoms is bij accepting their existence. When you are severely depressed you need help, you need medication, and you need rest.

When the acute fase is over there are a lot of things you can do to get better and to prevent falling back in the future.

Links

Test the severity of your symptoms at:
Online Depression Screening Test

or:

Mental Health Net - Goldberg Depression Questionnaire

The following site contains a complete and very good selfhelp-book:
www.mcwilliams.com/books/dep/deptoc.htm

Here you can find a therapist when you believe that self help is not sufficient:
www.1-800-therapist.com

Information about the Chronic Fatigue Syndrome:
chronicfatigue.about.com

Information about Bipolar Disorders:
bipolar.about.com

helping.apa.org/ Website of the American Psychological Association, information and links.

depression.about.com/ Newsgroup about mood disorders and links to newsgroups about other disorders like CVS . Discussion chatbox and questions: depression.about.com/mpboards.htm.

cais3.cais.com/viking/nami Website of the National Alliance for the Mentally Ill.

avocado.pc.helsinki.fi/~janne/mood/mood.html Information about mood disorders and therapy.

stripe.colorado.edu/~judy/depression/asdfaq.html Questions and answers. Selfhelp. Very thorough information.

www.mhnet.org/ Website of the Mental Health Net. Seftest. Selfhelp.

www.odos.uiuc.edu/Counseling_Center/depress.htm Guide for depressed people and their family.

www.mcwilliams.com/books/dep/deptoc.htm Downloadable selfhelpbook.

www.cmch.com/pni/ Magazine about psychological and psychiatrical subjects.

www_1-800-therapist_com.html An international (US en Canada) service by medical doctor L.J.Grold. Index of psychiatrists, psychologists, marriage and family-counselers, social workers and psychiatrical nurses.

www.mhnet.org/guide/dep2quiz.html Depression selftest (unipolar/ bipolar/ adhd ) by the farmacologist Ivan Goldberg MD.

www_1-800-therapist_com.html Self-evaluation test.

Newsgroups about depression:

alt.support.grief

alt.support.depression

alt.support.depression.manic

soc.support.depression.crisis

soc.support.depression.family

soc.support.depression.manic

soc.support.depression.misc

soc.support.depression.seasonal

soc.support.depression.treatment

different subjects:

alt.society.mental-health

sci.psychology.announce

sci.psychology.consciousness

sci.psychology.journals.psyche

sci.psychology.journals.psycholoquy

sci.psychology.misc

sci.psychology.personality

sci.psychology.research

sci.psychology.theory

Useful information and tips

Exercise

Regular exercise is an important remedy for depression. Scientific research has shown that it improves mood as well as vitality. Go walking, cycling, swimming, jogging, dancing, etcetera. as often as possible (at least half an hour a day). Do not do it to perform but try to keep your attention on the ‘now’. Find a nice location and experience the feeling in your body and / or the aspects of the environment.

It has been shown that regular physical exercise is a better anti-depressive agent than an antidepressant and that is has a much longer-lasting effect.

In a recent report TNO gives the following guidelines for exercise:
Adults: Five days a week at least thirty minutes a day of moderately strenuous activities.
Youth: at least sixty minutes per day of at least moderately intense activity
 
In order to remain physically fit it is necessary to do moderate to intense exercise a minimum of three times a week for forty minutes: for example through running, brisk walking, cycling, skating or dancing.
It helps when the type of activity suits you and gives you pleasure and satisfaction. Do not go for maximum performance exercise.
 
People with a medical problem such as heart disease or joint problems should first seek advice from their doctor.
Are you not used to intense physical exercise, then slowly build it up and ask advice from an expert if necessary.

Food and beverages

A healthy diet can improve your mood. Try for example to:

Drink less or no beverages that contain caffeïne;
Quit smoking;
Abstain from refined sugar and white flour;
Eat as little as possible fat and meat, preferably white meat;
Eat vitamine-rich food.

A little chocolate can help. Furthermore try and eat food that contains tyrosine and tripofane: fish, nuts, seeds, sauerkraut, dairy products, cereals, lentils, bananas, dates, cottage cheese, eggs, brown rice, sesame seed and sunflower seeds.

One of the ways to improve your strength and vitality and thereby increase the likelihood of recovery is healthy food. I would not claim that a healthy diet alone is sufficient, unless a lack of certain vitamins or minerals are the cause of the depression. In any case, healthy eating and drinking can have very beneficial effects. Reducing the intake of certain foods (such as fatty or sugary foods) or drinks (caffeine, sweet drinks, too much alcohol) can already rapidly have a positive impact.

Lack of appetite: Lack of food weakens the body and makes you feel more tired and vulnerable. Try to at least eat fruits and vegetables + whole meal bread or whole wheat crackers or biscuits + protein rich foods such as fish, chicken, egg, cheese, tofu, beans, mushrooms, milk, yogurt or cottage cheese. There are now breakfast drinks or fruit breakfasts that are quick and easy to eat.

Drink and eat small amounts several times per day.

Take a good quality complete vitamin and mineral supplement. If you feel you aren’t able to eat enough, please consult your doctor!

Caffeine: Drink little to no caffeine containing drinks, so no coffee and regular tea or coke when you're restless, irritable, anxious or when you sleep poorly. Decaffeinated coffee is ok. Too much coffee can make you agitated, raises blood pressure and increases the chance of miscarriage. If you start to reduce or cut out your caffeine intake you may temporary (for about one week) experience some withdrawal symptoms such as headaches, fatigue and concentration problems. Drink herbal teas instead of regular tea.

Alpha

Alcohol: Use little or no alcohol. Preferably drink an alcohol free beer. Just make sure you have enough fluid intake: about one and a half to two liters per day.
Guideline: men two standard glasses and women one standard glass of wine, beer or spirits. Red wine is good for the heart. Alcohol disrupts quality of sleep. So after your evening meal, do not consume anymore alcoholic beverages.

Stop smoking: nicotine increases the production of cortisol in your body - this is a stress hormone - and inhibits the uptake of tryptophan, a raw material for serotonin. Serotonin is a hormone that among other things is necessary for sleep. A deficit of serotonin in the brain can cause depression.

Don’t eat refined sugar and white flour products - which upset the balance in your body and make you feel even more tired after a short energy boost. You quickly get used to using no sugar and it is better for your overall health.

In small amounts Alpha

chocolate can have a positive effect. This seems to apply especially to women. Eat no more than a few pieces a day. Chocolate contains: caffeine, theobromine, phenylethylamine (works as a stimulant) and anandamide. Together they help to improve mood. This appears to be effective especially for PMS (premenstrual syndrome).
Eat low fat and little meat. Eat white meat rather than red meat, and preferably from an organic source.

Do not eat ready meals from the microwave. They lack in vitamins. If you do, combine it with a fresh salad.

Eat foods rich in tyrosine. This substance is converted into noradrenaline. Noradrenaline in the blood gives a relaxed yet active feeling. Tyrosine is found in: fish, nuts, seeds, sauerkraut, dairy and grains. Tyrosine is available in capsules, but use only under the supervision of a physician.

Food which contains tryptophan can also help you feel more relaxed. Tryptophan is found in lentils, bananas, dates, cottage cheese, yogurts, eggs, grains, brown rice, sesame seeds, sunflower seeds and nuts. Tryptophan is more easily absorbed in combination with something sweet, such as honey - hot milk with honey can help you to fall asleep more easily.

For more information about nourishment:

P. Slagle (MD): 'The way up from down'.
Rid yourself from stress, low moods, depression with this easy to follow , drug free program of B-vitamines and amino acids.
New York: St Martins Paperbacks.

'Prescription for Healing' - a list of the vitamins and amounts recommended by Dr. Harold Bloomfield, MD, author of "Hypericum and Depression", that are needed to help combat depression.

'Chronic Depression - Treating and Managing' contains a regimen of vitamins and herbs that may be useful in treating depression.

Vitamins and minerals

Omega-3 capsules

There is a lot of evidence that omega-3 can help with improving your mood and cognitive functioning (and blood pressure etcetera ).  See: Andrew L. Stoll, MD. (2001): The Omega-3 connection. Fireside. New York. 

Fish oil capsules are highly recommended. Lots of research - also published in mainstream psychiatric journals - shows that fish oil is beneficial in depression, especially in bipolar depression where mood fluctuates between highs and lows. Use fish oil in the form of omega-3 capsules. These contain DHA and EPA. DOSAGE: between 600 and 1000 mg of EPA per day (see label or package insert). Omega 3 also improves blood pressure and has many positive effects on brain function. If you have low blood pressure first consult your doctor!! Buy purified fish oil. Vegetarians can buy omega-3 capsules from a vegetarian source.

See also: Dr. David Servan-Schreiber. Your brain as medicine. Kosmos-Z & K Publishers Utrecht / Antwerp.

St Johns Worth

St Johns worth -or hypericum perforatum- is a very effective antidepressive medicine for mild and medium depression as is proven by scientific research.

See: Archives of General Psychiatry, vol. 55, nov. 1998.

Dosis: 3 x 300 mg of an extract of St Johns Worth containing 0,3 % hypericine.

Combination with 'Kawa Kawa' increases the effectivity in case of stress-related symptoms (nervousness, sleepproblems). Do not use Kawa Kawa in combination with benzodiazepines.

!!! Health risks of st Johns Worth:

St Johns Worth makes your skin hypersensitive for sunlight;
It activates a liver-enzym that can disturb the effectivity of anticonceptive medication;
Do not use St Johns Worth simultaniously with synthetic antidepressives like Prozac, etc. Consult your GP or Psychiatrist;
Theofylline, Digoxine and Ciclosporine interact with St Johns Worth.

5-HTP

5-HTP is synthesized in the body ​​from L-tryptophan, a food component. 5-HTP increases the production of serotonin. Serotonin is a neurotransmitter and aids the transmission of stimuli between neurons. In depression, serotonin levels appear to be too low.

5-HTP is available as a dietary supplement and may help with mild depression.

!! RISKS: Do not use in combination with the following medications: Carbidopa (prescribed for Parkinson's disease), SSRI = a type of antidepressant, Imitrex, Maxalt, Zomig, Amerge, Tramadol, do not use in Down syndrome and pregnancy, lactation and renal and liver disorders.

Always consult your GP.

L-Tryptophan

L-Tryptophan is sometimes recommended for depression. This food component however, has no effect on the serotonin levels in the brain. It may promote relaxation and sleep.

Turyl

Extract of plants. The producer is DNH Zimmermann. According to the producer this increases mental resilience. See: www.dnhresearch.nl

Melatonin

Can aid in falling asleep and helps to strengthen the immune system. Use only after consulting your doctor. It needs to be taken long before going to bed and dosage and timing must be accurately determined. Take approximately 5 hours before bedtime.

REGULAR MEDICATION

For depression, several types of antidepressants are prescribed. Especially in severe depression this is necessary. Typically, they are effective only above a certain dose and their effect only becomes noticeable after 2 to 5 weeks of usage. The side effects usually disappear within a few weeks. If not, consult your doctor or psychiatrist.

Try to overcome your depression with counseling and physical activity before you start using antidepressants, unless you are severely depressed.

PROZAC: Can sometimes cause a state of confusion or agitation.

For information about the side effect of specific medication see: www.lareb.nl

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