Using anti-depressants

Anti-depressants can be very useful in managing depression. These medicines can help change negative thinking and lift your mood. They take around two to four weeks to have any effect. You can reduce and then stop them at any time without serious lasting dependence symptoms. Talk to your doctor about ways to manage depression using medications and any concerns that you have about using them.

The most important thing is to take them every day for at least four to six months to help improve depressed moods. Depression can return if you stop and start anti-depressants, or if you do not take them for at least four months.

You can discuss the use of anti-depressants and length of drug treatment with your doctor, pain specialist or pharmacist (and see Useful Information at the back of this book for a list of self-help books on managing or overcoming depression, including the use of medication).

PART I SUMMARY

•   Mood changes are very common in chronic pain. Understanding which moods can affect you is a helpful important step towards change.

•   Depression is a very common experience in chronic pain. The person-centred model shows its effects and helps focus on what can be changed for the better.

•   Understanding unhelpful thinking and challenging it, using thought challenge questions, can help lessen depressed moods. It may improve enjoyment, despite the pain.

•   Using the chapters on rewards, getting fitter and being more active and acceptance will also help lessen depression.

•   Your healthcare practitioner can help and anti-depressants can be useful to lessen depression and reduce relapse.

Part 2: managing anxiety

This section aims to help you understand:

•   What anxiety is

•   What the effects of anxiety are

•   How to manage anxiety by dealing with unhelpful thinking

•   How to overcome avoidance

•   How to change unhelpful behaviors

What is anxiety?

Anxiety can range from feeling a bit uneasy or nervous to having a continuing sense of dread. Sometimes anxiety can become so bad that the person feels panicky and frightened. We all feel anxious at certain times and this is normal. A certain level of anxiety can help us to perform at our best, whether in sport or giving a speech at a wedding or at a job interview. Anxiety is a problem when it is more severe than you would expect in the situation and when it affects your life. For example:

If you are often anxious

•   When there seems to be no good reason for it

•   If there is a lot of anxiety

What are the effects of anxiety?

Anxiety affects you in three main ways:

1   Body symptoms and many different sensations Sweating, feeling shaky, pounding heart, choking feeling, dry mouth and dizziness are some of the many body sensations you may experience when you become anxious or worried.

2   Unhelpful thinking and beliefs These lead to worrying, negative thoughts like ‘What if . . .’ or making negative predictions. Sometimes frightening images or pictures can occur, which in turn can make you feel anxious or frightened.

3   Behaviors or actions Anxiety can either lead you to avoid doing certain activities or lead you to do things to keep yourself feeling safe in order to lessen anxiety.

The person-centred model of Jim (opposite) shows how anxiety can affect a person and their pain. It shows examples of the different stresses in a life situation that can cause anxiety or worry. It also shows the links between pain and feeling anxious or worried.

Jim still has shingles pain and no longer works as a teacher. He is anxious about his pain as, when he reaches into cupboards, he has bad shooting pains. He finds he is worrying about:

•   Ann’s new swollen leg symptoms.

•   If he can manage the garden on bad pain days.

•   His memory, as he seems very forgetful some days. Even his daughter has noticed this problem in the last month.

•   Going out into busy crowded places in case someone bumps into the left side of his chest and makes his pain worse.