It's Good To Talk … About Depression

No letter this week so I thought I would take the opportunity to look at depression. Many people use the term depression quite freely but if you have ever had or been close to some one who is suffering from depression it really can be very debilitating and have a considerable impact when trying to maintain a sense of 'normality" and "stability" .

Depression can be brought on by a life changing episode, it could be a bereavement, an accident, the break down of a relationship, the diagnosis of an illness or an array of other life changing incidents. These can cause a trigger of initial sadness which is then followed by a much deeper sense of sadness, very low mood, lethargy often difficulty sleeping and either comfort or under eating can all be common symptoms. 


Many of us tend to look for a reason for depression so that we can understand why it has happened and what can be done to stop it. The GP is often the first port of call, some are more understanding then others, some are possibly a little quick to prescribe common anti-depressants others will take a more long term view and offer counselling  and other types of support.

Some times depression simply seems to appear from nowhere, clients often say that they have no idea why they feel the way they do and so have no idea how to make themselves feel better. It may seem at first that there is no obvious trigger but often it can be something that at first glance seems quite insignificant or not even related to you that triggers some thoughts and feeling from the past. For example, it might be that a friend has a child who is being bullied at school and they talk to you about it, this could bring up your own childhood bullying that you thought you had locked well away or make you realise that you are in fact being bullied yourself at work. I


t can sometimes take a while to make a link and begin to develop and understanding as to how your depression impacts you and those around you. Once this process of exploration and reflection starts to take place it creates an awareness in you that in time will enable you to see you have choices as to how you want to live with your depression. 


Sometimes medication is needed and necessary, sometimes understanding yourself at a deeper level can provide you with the tools to spot the triggers early enough so that you can manage them more effectively in the future.

Mental health and particularly depression is still very misunderstood, its not as obvious as a broken leg but still requires the same support and care from family and friends. Many people suffer in silence and I hope that if this article does anything it helps someone to find the strength to talk to someone and seek the support that they need, be it from friends & family or a more structured support from professionals.

Take care and keep an awareness of those around you who may be silently suffering.

Warm regards

Kate

It's Good To Talk – About Job Fulfilment

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Dear Kate

I have been reading your column on and off for a few months and don’t know if you can help but decided to ask anyway.

I have been living in Ibiza for just over two years and have fallen in love with the island.  I was nervous about coming alone and setting up a life for myself but everyone has been really friendly and welcoming and now I have a great circle of friends, there are times when I feel a little lonely but I'm OK with that and sure there would be times back in England when I might have felt a bit lonely as well.

The real issue for me is work. I bad about complaining because I know a lot of people find it difficult to get jobs especially in the winter and I am lucky enough to have an all-year round job but I really hate it.

I'm scared to give it up as I know I am lucky to have it; I just find it so tedious and boring. The only good thing about it is that it enables me to stay here and I have made one good friend there.

Thank you very much and I hope you don’t’ think I'm being unreasonable.
TS


Dear TS

Thank you for your e-mail and I wonder why you feel you might be being unreasonable? If something is causing you anxiety or stress then that makes it important and something that you might want to explore.

People often compare how others might respond to a similar situation and feel uncomfortable that what they are experiencing is not "as important" as the problems other people may have, BUT the reality is everyone reacts to different things in their lives in a different way and therefore comparing reactions or trying to attribute a level of importance to your issue is impossible.

The only thing you need to focus on is that if it is important to you then that in itself validates it 100 per cent.

So, focussing on your issue i.e. work is important. We spend a huge amount of time at work and finding it tedious and boring must be difficult.    I suppose you have a few options; one being that you approach your boss/manager and ask if there are any additional projects/tasks or responsibilities that you can take on, explaining that you are finding that your current role is not stimulating you enough and you feel you can offer the business more then it is currently getting from you.

I am sure it is not often that employees ask for more and it could be that your manager is simply unaware of how you are feeling.

Another option would be to explore your fear of looking for an alternative post somewhere else. You have left England and set yourself up in Ibiza very successfully on your own which must have felt quite daunting at times so what is holding you back for taking that risk again and looking for another job?

I understand you may feel that your opportunities here are more limited then in England but if you were able to find, apply and be successful in your last application, is there any reason why that might not happen again?

Ibiza is a wonderful island and you sound as if you have found a place to live that real fits with who you are, it would be a shame to let your feeling about your current job impact your life outside of work, and I hope that you find a way to feel more stimulated and challenged in the near future.

Please do keep in touch and let me know how you get on.

Warm regards
Kate

It's Good To Talk - When Heading Back To Britain

Dear It’s Good to Talk

We have been in Ibiza for 17 years and till about two years ago we enjoyed living here, work in the summer has always been full on and very tiring but then we have been able to chill out and relax in the winter.

The last two years me and my wife have become very restless and have decided that it’s probably time to head back to the UK. The island has begun to feel very small and we are now looking forward to starting again back home.

The thing that worries us is that both the kids were born here, they have only ever been to the UK for holidays and see Ibiza as home, one of them is quite excited about living in the UK but the other, who is 14, really is against the idea and wants to stay here with his friends.

What do you think we should do to make the transition as easy as possible for him?

Thank you

Hi

Thank you for your letter. It seems as if you and your wife have taken your decision to move very seriously and considered it for a long period of time before finally deciding that the best thing is to move back to the UK.

Change is difficult for many people and most of us resist it at some time in our lives, especially if it’s a change over which we have no control. Your son is at a very vulnerable time in his life, all sorts of things are going on aged 14 and friends become a top priority often over family, and it can be distressing to think about having to leave them.

I am not sure of the time line you have in place for moving back, is there time to put some things in place for your son? For example would it be possible to have one or maybe two trips back to the UK before the actual move, so he can see the area in which you are going to live, maybe visit the new school and if possible make contact with a few of his classmates so there are some familiar faces for when he arrives on his first day. Does he have any hobbies or sports that he enjoys playing? Maybe you could see if there are any local groups he could join and visit them as well. I imagine it would make him much more comfortable if he knew there were some positives in place for him and he had a mental picture of where he was going.

Have you asked him what worries him about moving? Would it be possible to arrange for a friend from Ibiza to come and stay during the holidays and possibly for him to come back for a stay with them, that way he has something to look forward to.

You do not mention your other child much except to say they seem quite excited about the move. Even though this maybe the case they may also have some apprehensions and anxieties so and open discussion with both the children, letting them see that both of you also have concerns even though you feel it is the best thing for all of you, may really help you to make this move together as a team.

I hope the move goes well and that live in the UK is all that you hope.

Warm regards

Kate

It's Good To Talk – When children need to know about death

Dear Ibiza Counselling

My husband and I were wondering if you could offer us some advice. We have two children seven  and five years old and have been in Ibiza for just over a year. The move is definitely the right decision for us as a family and we are now just about settled in to a routine and are slowly building a circle of friends. Initially it was difficult for the children to get used to a new home, school and way of life but now they almost seem more settled then us!

When we decided to move we also decided to bring our dog who at the time was already 11years old, obviously the children have never known life with out her and she is very much part of the family. However time is taking its toll and in recent weeks she has become very slow, is going blind and is incontinent. We took her to the vet who said she was in kidney failure and does not have long left. He advised that we should give some thought to how we would like to proceed as she will only get worse and the decline could be quick and she may be in pain.

We have talked, and cried about what we should do and have come to the heart wrenching decision that shortly we will have to have her put down. We as adults are devastated, we got her when we first met and spent so many hours having great times with her that it is difficult to imagine walking through the door and not seeing her. So we have our own grief to deal with, some may think it silly as she’s only a dog but to us she has been part of the family.

Aside form ourselves and our beautiful dog we are also concerned about the children, they have never experienced death and we have not really had any discussions around death with them as they have not naturally come up. 

Do you think we should tell them about Molly or would it be kinder to tell them she has gone to stay with some other children? They spent hours with her in the garden and yesterday I walked in to find all three of the snuggled on the sofa watching cartoons and it broke my heart.

Please tell us how to make this as painless as possible for them

Thank you

DP

Dear DP

Thank you for your e-mail and it is good to hear that you and your family have settled in so well and are enjoying your new life on the island. 

It can be difficult for children moving to a new country with a different language, food and way of life but often they are more adaptable then adults and once they are settled in school and have made friends things can often click into place for them more easily then for us.

I am sorry to hear about Molly; dogs really do become part of the family and the decision you have had to make must have been agonising. I feel it is important before you start to tackle the issue of the children that both you and your husband take time to process what Molly’s passing means to both of you, it sounds as if you both care for her a great deal and that she played a big part in the early days of your relationship together. 

It is important not to gloss over your own feelings because you are worried about the children, and it sounds as if even though you have made the decision about her future you still have some time to spend with her, take some photos and say your good byes, maybe this should be something you and your husband do with out the children.

In terms of telling the children I feel there are three key points to bear in mind. 

Firstly choose your moment well, i.e. when you have plenty of time, they are not over excited or too tired, the house is quiet and you know you will not be disturbed. 

Secondly be honest, death is part of life and they will come across it at some point so hiding it or trying to find ways around it will, in my opinion, not serve them well for the future. 

Thirdly keep it simple and clear so they can understand. They do not need to know detail they just need to know that Molly was very old, unwell and died, and they will not see her again. 

They may or may not have questions about death and what happens when a dog or person dies, if this comes up I would also keep your answers as honest and simple as possible. Over the years as they get older then maybe that is the time to go into more details, if they ask and if it seems appropriate.

I hope this has been of some support to you and hope that you and your husband are able to have some time to say your own goodbyes to Molly in the way you would like.

Take care

Warm regards

Kate

NHS maybe wasting millions on nicotine patches

Oh surprise, surprise  … Nicotine Replacement Therapy (NRT) – whether patches, gum, sprays or inhalers – has been shown to be relatively ineffective at helping smokers quit and remain non-smokers.  Raising important questions as to whether millions of pounds of NHS funds are being wasted.

New evidence raising these doubts over NRT and of course the  pharmaceutical industry's massive campaign to promote sales,  follows research which found smokers who quit through NRT were just as likely to start again as those who stopped through will power alone.

The ten year study, conducted by Harvard School of Public Health and the University of Massachusetts,  discovered that smokers who quit through NRT were just as likely to start again as those who stopped through will power alone.

The new paper – “A prospective cohort study challenging the effectiveness of population-based medical intervention for smoking cessation”   by Hillel R Alpert, Gregory N Connolly, Lois Biener  –  examined  the  “effectiveness of nicotine replacement therapies   either with or without professional counselling, and provide evidence needed to better inform healthcare coverage decisions.

Starting in the 2000, the US researchers followed a representative sample of 1,916 adults which included 787 who had recently quit smoking.

Each participant was interviewed three times, about once every two years during the 2000s, asked about their use of gum, patches and other such products, their periods of not smoking and their relapses.

At each stage, about one-third of those trying to quit had relapsed and the use of replacement products made no difference, whether they were taken for the recommended two-month period or with the guidance of a counsellor.

Significantly the study showed the relapse rate was just as high among those using NRT as though who went “cold turkey.”

Who would have thought it eh?  Well this writer for a start. And probably also every hypnotherapist who has successfully helped people to stop smoking with   clients/patients who had previously tried patches, gums etc.

Time and again smokers who want to quit the habit have come to my practice room reporting how they had tried NRT but had failed to quit.

Fairly recently one such client was a general practitioner who said he regularly prescribed nicotine replacement for his patients but knew that for most patients it did not work.

The US findings – published in the online edition of Tobacco Control   – showed much the same outcomes for both heavy and light smokers irrespective of Is whether or not NRT was accompanied by professional cessation counselling. 

It is worth noting that in the United Kingdom the Department of Health generally claims counselling doubles the success rate.

However close examination of the UK figures shows that the failure rate for NRT is over 90 per cent

The study’s lead author, Hillel Alpert from Harvard School of Public Health’s Center for Global Tobacco Control, commented: “This study shows that using NRT is no more effective in helping people stop smoking cigarettes in the long-term than trying to quit on one's own."

"Even though other well-controlled studies have shown that nicotine replacement therapy can be effective, our study looked at real-world use over the long-term. And in the real world, cigarettes are simply a very powerful addiction. And NRT is apparently not an effective replacement for that addiction."

About ten years ago researchers at the University of California, San Diego conducted a large scale survey of NRT  – “Impact of Over-the-Counter Sales on Effectiveness of Pharmaceutical Aids for Smoking Cessation”   by John P Pierce, PhD; Elizabeth A Gilbin   – which also concluded that “since becoming available over the counter, NRT appears no longer effective in increasing long-term successful cessation in California smokers.”

It's Good to Talk

Dear Kate,

My wife has told me that she has been having an affaire; we have been together ten years and married for three. 

We met on our first day at university in the UK and have been together ever since, moving to Ibiza five years ago. I knew we were in trouble but never in my wildest dreams thought that this would happen. 

I have asked her to go to counselling but she refuses saying her mind is made up that we are over. I am totally gutted, I thought we would be together forever and we had been talking about having children. 

The additional pressure is that neither of us have  found anywhere to stay and it is so expensive here that it may take a while and in the mean time we are stuck living in the same house which is making me feel even worse especially when she “goes out”.

Any pointers you have would be really appreciated 

Thank you

Bob (not my real name)

Dear Bob

Thank you for your e-mail and sorry to hear that Christmas and New Year have been so difficult for you. 

It sounds as if you have no hope of reconciliation with your wife and are going through the motions of having to accept the situation that you now find yourself in. This can be very difficult and often brings up uncomfortable emotions, disbelieve, acceptance and anger to name a few. 

These are all completely to be expected and it is important to acknowledge them and spend a little time on reflecting how they are influencing your every day life and behaviours towards yourself and others. They will pass in time so be particularly kind to yourself during these early stages of the break up.

On a more practical note, is there no way your wife can move out even for a short period of time to give you some space to process what has gone on. I wonder why you haven’t insisted on this given it is her who has created this situation; does she not have some responsibility to create a physical situation that is easiest for you both? 

I wonder whether there is something more that is stopping you from asking her to leave? Do you have some hope still that things are redeemable?  Or maybe one of you moving out signifies a much more real and physical end to the marriage. 

Whatever it is, it might be beneficial to ask yourself some questions about how to move forward in a way that is best for you.

It does seem like you were / are fully committed to this marriage having been together for 10 years and to have started talking about children must have been a big step for both of you.

There are lots of changes that happen in the first ten years after leaving university in your 20’s and the both of you have grown up together and maybe part of that growing up has brought changes in your views on the future which could never have been foreseen.

In time you will come to terms with the new future that is now in front of you and one day it will feel exciting and challenging to be able to make those choices but for now take care and focus on you and how best you can manage both the emotional and physical implications of your situation.

All the best

Kate