Professor Ed Watkins is a clinical psychologist at the University of Exeter, who specialises in the treatment of depression. Here he looks at ways to better tackle depression.
In the dark clutches of January, many of us feel low after the overindulgence of the festive season. We may have eaten and drunk too much. Credit card bills loom large. We review 2015 and what we want to improve in 2016. For those vulnerable to depression, this is a risky time as realities can take on the hard edge of winter frost – referrals to GPs and NHS treatment services for depression peak in January and February.
I encourage those who experience depression to see this New Year as an opportunity to get our expert support, whilst helping us to improve treatment. How will we do this? Through two activities that most people do every day: eating and using the internet.
We want to find out how internet therapy for depression works, so we can make it better. We are also testing whether you can eat your way to better mental health. We need volunteers to help us. Maybe you, or someone you know, can help?
By depression, I don’t mean feeling a bit low, as is sometimes used in everyday speech. Instead, clinical depression involves symptoms that persist every day for weeks on end and that cause significant distress and impairment, including not enjoying normally pleasurable activities, poor sleep, disturbed appetite, negative self-worth, tiredness, poor concentration, and sometimes suicidal thoughts.
Depression is common. Approximately one in five people will experience these debilitating symptoms during their lifetime. Because it is so common, occurs repeatedly, and disrupts work and family life, the World Health Organisation estimates that depression will cause greater individual disability than stroke, cancer, and heart disease.
The good news is that we have effective treatments, including antidepressant medication and talking therapies such as cognitive-behavioural therapy (CBT). CBT uses problem solving, positive activities, and challenging negative thinking to break people out of depression. However, only 15 per cent of adults with depression and anxiety disorders are offered such therapy, despite it being recommended by the National Institute for Health and Care Excellence (NICE). Moreover, even these treatments only achieve sustained recovery in one third of patients.
This indicates that we need more powerful and widely available treatments. A recent editorial in the leading scientific journal Nature noted, “despite progress, we do not yet fully understand how psychological treatments work – or when they don’t.” This understanding is necessary to improve treatment. If we can identify therapy’s active ingredients, we can discard the inactive parts and concentrate the active ones to make therapy stronger, briefer, and more widely available.
Building a better therapy
My team is pursuing an exciting line of enquiry that rises to this challenge. In an innovative approach, we allocate all patients by chance to different combinations of components within CBT. This reveals which components best reduce depression so that we can build a better therapy.
We study internet CBT because it makes therapy more widely available and accessible nearly anywhere and at any time. It overcomes stigma, limited mobility, difficulty scheduling therapy sessions, long distances and inconvenience.
Funded by the Cornwall Partnership NHS Foundation Trust and the South West Academic Health Services Research Network, we are now recruiting across all of South West England. Anyone with depression can volunteer for a version of free internet CBT, with support from a therapist. To find out more or sign up, please visit Improve Research Trial on Facebook or visit the Mood Disorders Centre’s Depression Mood Screener for Internet Treatment site.
We also want to prevent mild January blues from spiralling into full-blown depression: Prevention is an essential part of reducing depression. Our European-funded MooDFOOD project tests whether improving diet and nutrition can prevent depression in overweight people.
Whilst most people know that obesity is a major public health challenge, many don’t know that obesity, depression, and poor diet are linked. Studies involving more than 55,000 people show that being overweight increases the chances of becoming depressed, and vice versa.
Unhealthy diet is one mechanism linking obesity and depression. Eating processed foods, fried foods, and refined sugars is associated with depression, whereas a Mediterranean diet rich in fruits, vegetables, fish, and whole‐grains is associated with less depression.
However, the role of diet in preventing depression has not been directly tested. We also don’t know whether it is a healthy diet reducing fat and sugar or just increasing particular vitamins and nutrients that protects against depression.
To answer these questions, we are recruiting individuals near Exeter who are mildly depressed and overweight or obese (Body Mass Index 25-40). Participants receive by chance either free multi-nutrient supplements, containing Vitamin D, calcium, folic acid, selenium and Omega 3 fatty acids, or inactive placebo pills, each daily for a year. Half of the participants also receive lifestyle coaching to manage mood, improve diet and reduce unhealthy eating, such as habitual snacking on sugary and fatty foods.
If successful, this could provide a public health strategy to achieve widespread positive effects on mental health and physical wellbeing, helping more people to avoid depression through January and beyond. For more information, please visit our website.