There are many reasons why people fall into debt. If you experience mental ill-health, it can affect your personal finances. Debt is also a factor that can trigger things such as anxiety or depression.
Why And How People Get Into Debt
There is often a common misconception that people find themselves in debt due to living an excessive lifestyle, or going ‘wild in the aisles’ with credit cards and store cards. The truth might surprise you: unemployment and redundancy are actually the most common triggers for debt problems, and can happen to anyone, no matter what their attitude to money may be.
Whether you’ve lost your job, are suffering from ill mental or physical health or you’ve separated from your partner, changes like this can mean that you struggle to pay your household bills and debts. Having to adjust to such a financial change can be difficult, even if it’s only going to be for the short term.
Why Can Mental Health Problems Effect Your Finances?
Although people diagnosed with mental health problems such as bipolar and depression are more susceptible to debt problems, there are many reasons why mental ill-health can affect the management of your finances. A lack of energy can make it harder to keep track of money, and rash or unwise decisions, can result in spending money on things people can’t actually afford. In more serious cases, taking time off of work may cause a sudden reduction in a person’s income and being admitted into hospital can also make it harder to keep up to date with bills.
Mental health problems and conditions such as dementia may also result in people having difficulties making decisions about money. The ability to make decisions is known as mental capacity and in Ireland mental capacity issues are covered by the Assisted Decision Making (Capacity) Bill (pdf). It is unlawful for people to make decisions on another person’s behalf about what they do with their money unless they have the legal authority.
Why Can Debt Effect Your Mental Health?
Much of debt-related anxiety can be due to a lack of support from creditors and from the individual’s surrounding family, friends and employers. Debt can be a considerable burden, made worse by dealing with it alone. Another issue of debt anxiety is the lack of quality sleep it can often cause. Losing out on a good night’s sleep can not only affect your mood and energy levels, it can also have knock-on negative effects in other areas of your life such as family and career. All of these things in turn can contribute to a person’s debt problem.
Questions To Ask Yourself If You Think You Have A Debt Problem
- Do I often feel anxious when thinking about how I will manage my repayments?
- Am I struggling to or do I routinely miss the minimum payments towards utility bills, credit cards or rent?
- Do I avoid telephone calls from unknown numbers and ignore letters from creditors?
- Am I unable to set aside money for a sudden and unexpected reduction in my income such as redundancy, car expenses or emergency repairs?
If you answered ‘yes’ to any of these questions, then you may want to consider getting help.
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Delirium
Delirium is a condition of severe confusion and rapid changes in brain function, including attention disruption, disorganized thinking, disorientation, changes in sensation. Most forms of delirium are temporary and reversible.
Symptoms May Include
- lack of purposeful thinking or behaviour
- disrupted or wandering attention
- poor concentration
- confusion about time or place
- poor short-term memory
- altered level of consciousness or awareness
- delusions or hallucinations
- altered sleep patterns, especially wakefulness and drowsiness
- lethargic or slow moving
- restless, agitated, hyperactive
- incoherent speech
- emotional or personality changes.
What Causes Delerium?
Delirium can be caused by a wide range of physical problems including:
- lack of oxygen to the brain
- poisons, including alcohol
- street drugs, such as cannabis
- medication, including anti-depressants
- fluid/electrolyte disturbances
- acid/base disturbances
- infections
- pneumonia
- heart failure
- thyroid problems
- anaemia
- kidney failure
Delirium can also be caused by, or is associated with, a number of mental health problems including:
- liver failure.
Treatments and Therapies
The treatment and outlook for delirium depends to a large extent on the cause. For example, if the cause is an infection, antibiotics may solve the problem within a few days. If the delirium is caused by dementia, it may not be curable, although it may be possible to alleviate the symptoms.
In some cases, where someone with delirium has become aggressive or violent and is a danger to themselves or others, medication may be required to control the aggressive behaviour.
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Dementia
Dementia is a decline in mental ability which affects memory, thinking, problem-solving, concentration and perception. Dementia occurs as a result of the death of brain cells or damage in parts of the brain that deal with our thought processes.
Some forms of dementia, such as Alzheimer’s disease, are degenerative. That is, they get worse over time. Other forms of dementia, such as vascular dementia, may be non-degenerative and may not get worse over time.
People with dementia can become confused. Some people also become restless or display repetitive behaviour. They may also seem irritable, tearful or agitated. This can be very distressing for both the person with dementia and their family and friends. Some people with dementia also develop other problems such as depression, disturbed sleep, aggression, inappropriate sexual behaviour and incontinence, although the latter issues tend to be associated with more advanced dementia.
Rates of dementia vary between men and women and between age groups. Dementia is almost invariably a disease of ageing. Dementia in people under 65 is known as early onset or pre-senile dementia and is rare.
What Causes Dementia?
Dementia occurs as a result of the death of brain cells or damage in parts of the brain that deal with our thought processes. This may follow other problems like:
- lack of blood/oxygen supply to these brain areas
- head injury e.g. from boxing or whip lash after a car crash
- pressure on the brain e.g. from a tumour
- hydrocephalus (fluid build-up between the brain and the brain lining)
- neurological disease e.g. Parkinson’s disease, Creutzfeld Jakob disease (CJD)
- infection e.g. AIDS
- vitamin deficiency
- a long period of excessive alcohol intake
The most common form of dementia is Alzheimer’s disease. We do not know what causes Alzheimer’s disease but we do know that ageing is the main factor. The second most common type of dementia is vascular or multi-infarct dementia. This is caused by mini strokes that constrict blood flow and oxygen to the brain.
Is There A Cure?
Unfortunately, most types of dementia cannot be cured. The exceptions are those dementias related to vitamin deficiency (which can be treated with supplements) and head injury (which can be treated through surgery).
There are some psychological treatments and drugs that can help people in the early stages of dementia. It is very important to get a proper assessment from a medical practitioner as early as possible.
Some lifestyle changes are thought to help prevent dementia. A healthy diet, regular exercise and keeping your mind active by, for example, doing crosswords, computer games or puzzles may help.
Drugs such as Aricept and Reminyl may delay the progression of symptoms of the disease in people with mild to moderate dementia. Medical researchers are currently looking at other medical treatments including anti-oxidants, brain stem cell therapy and a vaccination to stop the build up of plaques in the brain (a hallmark of Alzheimer’s disease). Another drug option, memantine (Ebixa) – approved by NICE to treat moderate Alzheimer’s disease in patients who cannot tolerate the other classes of drugs (Acetylcholinesterase inhibitors) – is also a licensed and approved drug treatment for the severe form of the disease.
Non-medical interventions such as cognitive stimulation therapy (CST) can help people with mild to moderate dementia maintain mental functioning, and alternative therapies such as music therapy, aromatherapy and reminiscence therapy can be of benefit too. Environmental adaptations can also help people with dementia cope better with daily life. For example, people with dementia may have difficulty distinguishing particular colours, and problems with perception. Adapting care home environments can make a big difference to the person’s independence and support their ability to feed and care for themselves for longer. Designing care homes and gardens so people with dementia can wander safely can also help reduce frustration and difficult behaviours.
Dementia and Depression?
The relationship between dementia and depression is complex. The symptoms of dementia and depression – including withdrawal from social activities and general apathy – are very similar. An elderly person with severe depression may occasionally be misdiagnosed as having dementia. A person with dementia may also become depressed. More about Depression.
Caring For Someone With Dementia
If you are looking after someone with dementia you may be entitled to specialist help. You can find out details of local support services from your local social services or GP or www.yourmentalhealth.ie
If you are out during the day you may want to think about using a day centre. These provide care and activities (such as reminiscence therapy) for people with dementia. They are run by local health authorities, social services, voluntary organisations and some nursing and residential homes. Transport to them is often provided.
You may also need to consider residential or nursing care for the person you are looking after.
Residential homes provide meals and activities and help residents with washing, dressing, baths etc. However, people with dementia who also have physical problems or whose behaviour cannot be managed by non-professional staff will need the care offered in a nursing home. How much you pay for residential care will depend on your situation and varies from area to area.
Self Directed Support.
Social services can provide help, including aids and adaptations to the home, meals on wheels, home care, respite care, day care, and residential and nursing care. Some social services provide more help than others and you may have to pay for some of the services, depending on how much money you have.
Where people have control over the the social care and support they receive, this is known as self-directed support.
Many people with dementia are not entitled to local authority social services because their needs may not be assessed to be severe enough or because they have too much in savings or income. These people have to arrange their own social care, for example help at home, assistance with shopping or daily tasks.
People with dementia who are entitled to local authority social services should be offered the option of having a personal budget. This allows them to have a say in what the money that has been allocated to meet their care needs is spent on. Some people may like to receive this as a direct payment. This means that they control the money and how it is spent themselves.
People with dementia who may have difficulties making decisions are still entitled to receive self-directed support from a local authority. But this may be managed by a person appointed to make money decisions on their behalf, for example a trusted family member.
Looking After Yourself.
You also need to think about your own needs. Looking after someone with dementia can be emotionally and physically exhausting, especially if you are on your own. You will need practical and emotional support for yourself as well as regular breaks and holidays.
You may want to think about respite care, when the person you care for goes to stay in a hospital or care home for a short while, perhaps a few days or weeks. Alternatively you may be able to arrange for an alternative carer to come and stay in your house while you are away.
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Depression
Depression is a common mental disorder that causes people to experience depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration.
Depression is different from feeling down or sad. Unhappiness is something which everyone feels at one time or another, usually due to a particular cause. A person suffering from depression will experience intense emotions of anxiety, hopelessness, negativity and helplessness, and the feelings stay with them instead of going away.
Depression can happen to anyone. Many successful and famous people who seem to have everything going for them battle with this problem. Depression also affects people of every age.
Half of the people who have depression will only experience it once but for the other half it will happen again. The length of time that it takes to recover ranges from around six months to a year or more.
Living with depression is difficult for those who suffer from it and for their family, friends, and colleagues. It can be difficult to know if you are depressed and what you can do about it.
Signs and Symptoms of Depression
- Tiredness and loss of energy.
- Sadness that doesn’t go away.
- Loss of self-confidence and self-esteem.
- Difficulty concentrating.
- Not being able to enjoy things that are usually pleasurable or interesting.
- Feeling anxious all the time.
- Avoiding other people, sometimes even your close friends.
- Feelings of helplessness and hopelessness.
- Sleeping problems – difficulties in getting off to sleep or waking up much earlier than usual.
- Very strong feelings of guilt or worthlessness.
- Finding it hard to function at work/college/school.
- Loss of appetite.
- Loss of sex drive and/or sexual problems.
- Physical aches and pains.
- Thinking about suicide and death.
- Self-harm
If you experience four or more of these symptoms for most of the day – every day – for more than two weeks, you should seek help from your GP.
What Causes Depression?
Depression can happen suddenly as a result of physical illness, experiences dating back to childhood, unemployment, bereavement, family problems or other life-changing events.
Examples of chronic illnesses linked to depression include heart disease, back pain and cancer. Pituitary damage, a treatable condition which frequently follows head injuries, may also lead to depression.
Sometimes, there may be no clear reason for your depression but, whatever the original cause, identifying what may affect how you feel and the things that are likely to trigger depression is an important first step.
Types Of Depression?
here are several types of depression, some of which are listed below.
Mild depression
Depression is described as mild when it has a limited negative effect on your daily life. For example, you may have difficulty concentrating at work or motivating yourself to do the things you normally enjoy.
Major depression
Major depression interferes with an individual’s daily life – with eating, sleeping and other everyday activities. Some people may experience only one episode but it is more common to experience several episodes in a lifetime. It can lead to hospital admission, if the person is so unwell they are at risk of harm to themselves.
Bi-polar disorder
The mood swings in bi-polar disorder can be extreme – from highs, where the individual feels extremely elated and indestructible, to lows, where they may experience complete despair, lethargy and suicidal feelings. Sometimes people have very severe symptoms where they cannot make sense of their world and do things that seem odd or illogical.
Post-natal depression
Many new mothers experience what are sometimes called ‘baby blues’ a few days after the birth. These feelings of anxiety and lack of confidence are very distressing but in most cases last only a couple of weeks. Post-natal depression is more intense and lasts longer. It can leave new mothers feeling completely overwhelmed, inadequate and unable to cope. They may have problems sleeping, panic attacks or an intense fear of dying.
They may also experience negative feelings towards their child. It affects one in ten mothers and usually begins two to three weeks after the birth.
Seasonal Affective Disorder (SAD)
SAD is associated with the start of winter and can last until spring when longer days bring more daylight. When it is mild, it is sometimes called ‘winter blues’. SAD can make the sufferer feel anxious, stressed and depressed. It may interfere with their moods and with their sleeping and eating patterns.
Taking Control of Your Depression
Depression often makes you feel helpless. Taking action to make yourself feel more in control will have a positive effect, whether it’s going to see your GP for treatment, joining a gym, going for daily walks, or doing something that you are interested in or good at. If you don’t feel up to starting something new or joining a local group on your own, ask a friend to come with you.
There are many things you can do to help manage your symptoms and a wide range of treatments, both medical and non-medical, available through your GP.
The sections below should help you to work out what you could be doing yourself and what information or support you may want to ask your GP about.
How You See Yourself
The way you think about yourself will affect your frame of mind and feelings of depression. It is common to have feelings of worthlessness or guilt with depression. Try to be aware of any negative thoughts you have about yourself and how they might be affecting how you see yourself and how you feel. If you can, try to think about how realistic these thoughts are and how you might change them into something more positive. You can speak to your GP about getting counseling or cognitive therapy.
Social Networks
If you feel depressed it can be difficult to be sociable. Loneliness may make you feel worse, so it’s important to keep in touch with friends and family. Having people around you or groups that you are involved in will help to reduce feelings of isolation.
If you do not have many social networks you could find out about local community groups or befriending schemes from your local library or ask at your GP surgery.
Worries About Work, Money or a Legal Situation
Making sure that you do not feel overwhelmed by your work responsibilities is important because it gives you a sense of being in control. It’s important to make time for yourself to do things you want to do or to be with friends and family.
- If you’re struggling to cope with work pressures and you have access to an occupational health department, you can speak to them about how you are feeling. They may be able to help you to review your work commitments or address specific issues that are affecting your work.
- If you are having financial difficulties, speak to your local Citizens Information about how you might get financial help.
- Money Advice and Budgeting Service – MABS provides free, confidential and independent advice for people with debt problems. If you are out of work or want to change your job, your local job centre may offer support in finding work.
Both the Citizens Information and your local social services department can also help you with advice about benefits if you are unemployed or unable to work because of depression.
Where possible, you should always try to keep working. This is because people with depression often find that having something meaningful to do and a reason to get up in the morning is very helpful. Being with work colleagues, having a routine to the day, and the sense of achievement in getting a job done are all good for your mental health.
Close Relationships
Problems with close personal relationships can have a devastating effect on how you feel about yourself and the world. If you are struggling to cope with a difficult relationship or your depression is causing problems in your relationship you can contact Relationships Ireland. Relationships Ireland helps all couples, whether or not they are married, including couples in same sex relationships. Or you could speak to your GP or practice nurse about getting other forms of relationship counselling.
Physical Activity
There is good evidence that exercise can lift your mood because it can take your mind off your depression as well as stimulate the release of endorphins in the brain. Endorphins are neurotransmitters produced in the pituitary gland in the brain that produce feelings of happiness.
If you have mild or moderate depression your GP might recommend you to join an exercise referral scheme. Ideally you should be aiming to take 50 minutes of exercise three to five times a week. You can break this time down into shorter periods to fit it into your everyday life.
If you want advice about what exercise you should be doing and how it might help your depression, speak to your GP or practice nurse.
Find out more about Exercise.
Diet
Some studies have suggested a link between what you eat and depression, but there isn’t enough conclusive evidence to say whether or not it can definitely make a difference. There is some evidence that foods that are rich in some essential fatty acids found in oily fish, like mackerel, salmon, herring, sardines, kippers and fresh tuna can help to relieve depression.
Whether there is a direct link or not, eating healthily will help you generally feel better and give you more energy, especially if you are also exercising.
Find out more about Diet and mental health.
Avoiding Alcohol and Drugs
Alcohol acts as a depressant on the brain. If you drink too much or too often, you are more likely to become depressed. If you are already suffering from depression, drinking alcohol can make you feel worse instead of better. With such a vicious circle it is best to drink moderately, if at all. Recreational drugs should also be avoided.
Managing Anxiety
Around half of those people who experience depression will also experience anxiety. Taking steps to manage your anxiety can help give you the mental space to begin to deal with your depression. Talking about what is making you anxious, as well as a healthy diet and exercising, will all help you to control your anxiety.
Some people, especially those with mild depression, find that relaxation techniques such as massage and yoga help them to manage their anxiety.
Find out more about managing Anxiety.
Complementary Medicine
There is some evidence that St John’s Wort can help with mild to moderate depression. However, this drug is known to interact with other substances so you need to get advice from a pharmacist or other health professional before taking it.
Getting Help
The first step in getting treatment will normally be to visit your GP practice. They will ask you a number of questions about how your depression is affecting you mentally and physically.
The first appointment can feel difficult so it might be helpful if you write down what you have been experiencing before you go. Make a note of any questions or worries you might have. Some people find it helpful to take a friend or family member.
It is important that you and your doctor agree how best to treat your problems.
Being as open as you can about your symptoms and how they are affecting you will really help. Your GP may suggest you see a specialist such as a mental health nurse, psychiatrist or psychologist.
For mild depression, medication is not recommended because the risks could outweigh the benefits. Your GP has guidelines for treating depression and these recommend ‘watchful waiting’ initially, to see if the depression goes away. Using some of the self-help techniques listed above can help and your GP surgery can offer you support.
More information from Aware found here.
Talking Therapies
Talking therapies such as cognitive behavioural therapy (CBT) and some forms of counselling and psychotherapy work well for depression, although you may have to wait to see a therapist on the HSE. You can pay to see someone privately and your GP may be able to recommend someone. Always check that any private therapist is registered with a professional body.
There are several different kinds of talking therapy. Your GP can advise you about which you might find most helpful.
- Counselling gives people the chance to talk through everyday issues that may be causing depression and to develop strategies for resolving them.
- Cognitive therapy (sometimes called cognitive behavioural therapy or CBT) addresses the way you think and how this can cause depression. It teaches you skills to identify patterns of behaviour and thinking that are causing you problems and change them.
- Psychotherapy can be more intensive than counselling although people and organisations often use these terms interchangeably. It often looks at how past experience may be affecting your life now, so it may involve delving deeply into early experiences and key relationships. This may take more time, although shorter more focused ways of doing this have also been developed. Interpersonal therapy focuses on how you relate and behave towards others. It helps you to build a better self-image and communicate more effectively with others.
In many cases your GP will recommend anti-depressants, either on their own or in combination with talking therapies. Anti-depressants do work for many people but inevitably they do have side effects. You can discuss these with your GP.
About Medications
Medication will not always be the first choice, especially if your depression is mild. There are a number of different types of antidepressants available. Your GP can explain which they believe is the best for you and why. What your doctor prescribes will depend on the type and severity of depression you have. If you experience problems from your medicine or have any concerns, speak to your GP.
If one medication does not work you may be prescribed something else. However it takes a few weeks before your medicine starts to work so you need to allow enough time to see if it is going to be effective.
It is important that you take the medicine for the length of time recommended by your GP. If you come off your medicine too soon (even if you feel better) this can lead to a relapse where the depression returns. As a rough guide, you will usually have to remain on treatment for at least six to nine months and in many cases it could be longer. You need to follow your GP’s advice when you are coming off your medicine as it can be harmful if this is done too quickly.
Find out more about Medication and mental health.
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Diet
Recent evidence suggests that good nutrition is essential for our mental health and that a number of mental health conditions may be influenced by dietary factors.
One of the most obvious, yet under-recognised factors in the development of major trends in mental health is the role of nutrition. The body of evidence linking diet and mental health is growing at a rapid pace. As well as its impact on short and long-term mental health, the evidence indicates that food plays an important contributing role in the development, management and prevention of specific mental health problems such as depression, schizophrenia, attention deficit hyperactivity disorder, and Alzheimer’s disease.
Nearly two thirds of those who do not report daily mental health problems eat fresh fruit or fruit juice every day, compared with less than half of those who do report daily mental health problems. This pattern is similar for fresh vegetables and salad. Those who report some level of mental health problem also eat fewer healthy foods (fresh fruit and vegetables, organic foods and meals made from scratch) and more unhealthy foods (chips and crisps, chocolate, ready meals and takeaways).
A balanced mood and feelings of wellbeing can be protected by ensuring that our diet provides adequate amounts of complex carbohydrates, essential fats, amino acids, vitamins and minerals and water.
While a healthy diet can help recovery, it should sit alongside other treatments recommended by your doctor.
Food Consumption
What we are eating now is very different from that of our recent ancestors. Food production and manufacturing techniques, coupled with changing lifestyles and increasing access to processed foods, mean that our intake of fresh, nutritious, local produce is much lower, at the same time as our intake of fat, sugar, alcohol and additives is much higher. It has been estimated that the average person in Ireland and other industrialised countries will eat more than 4 kilogrammes of additives every year.
Healthy Eating on a Budget?
A healthy diet can be more expensive. Fish, fruit and vegetables can be particularly pricey. However, by cutting down on sugary drinks and snacks, takeaways and alcohol, you can save money so you can buy healthier foods.
Take care to buy only as much as you know you can use within the next few days, to reduce waste. You can also cut your costs by taking advantage of special promotions and by shopping at market stalls, which are often cheaper than supermarkets. If you live alone you could save money by splitting purchases with friends (buying bulk is usually cheaper) or by cooking several portions of a dish and freezing some of them. This also saves energy and saves you the effort of preparing meals every day.
Frozen fruit and vegetables are often cheaper than fresh produce and are usually just as good nutritionally (with no wastage). Fresh fruit and vegetables are usually cheapest when they are in season. Beans, lentils and soy mince are also cheaper than meat and just as nutritious.
Regular Meals
Eat regular meals throughout the day to maintain blood sugar levels.
Make sure you eat at least three meals each day. Missing meals, especially breakfast, leads to low blood sugar and this causes low mood, irritability and fatigue. If you feel hungry between meals you may need to include a healthy snack eg. fruit, nuts and cereals.
Refined Foods
Eat fewer high sugar foods and more wholegrain cereals, nuts, beans, lentils, fruit and vegetables.
Sugary foods are absorbed quickly into the bloodstream. This may cause an initial ‘high’ or surge of energy that soon wears off as the body increases its insulin production, leaving you feeling tired and low.
Wholegrain cereals, pulses, fruit and vegetables are more filling and, because the sugar in these foods is absorbed more slowly, don’t cause mood swings.
These foods are more nutritious as they contain thiamin (B1), a vitamin that has been associated with control of mood, and folate and zinc (supplements of these nutrients have been shown to improve the mood of people with depression in a small number of studies).
Healthy Food
Choose
- bread – wholemeal and granary rather than white. Also try rye breads, pumpernickel, wholemeal pitta bread, wholemeal chapattis, oat cakes, rice cakes and corn cakes
- breakfast cereals – choose high fibre, low sugar types eg. wholegrain or bran cereals or porridge
- rice and pasta – go for Basmati and brown rice (this gives a nutty texture in salads) and wholemeal pasta
- potatoes – serve boiled new potatoes in their skins (with a little bit of butter) or mashed or jacket potatoes. Potato wedges (lightly brushed with olive oil) are a lower fat alternative to chips and roast potatoes if you are watching your weight. Try sweet potatoes or yams for a change – these are delicious baked.
Aim to eat at least five portions of fruit and vegetables a day eg. 1 glass of orange juice or ½ grapefruit for breakfast, a banana or apple for a mid morning snack, salad at lunch time and then two types of vegetable (a portion is roughly two serving spoons) and piece of fresh or baked fruit for your evening meal.
NB: Green vegetables should be steamed or boiled in a little water and should not be overcooked or you will lose much of the vitamin content.
Avoid sugar and sugary drinks, cakes, sweets and puddings. These are loaded with calories but have little nutritional value and may trigger mood swings because of their sugar content.
Protein in your diet
Include protein at every meal to ensure a continuous supply of the amino acid tryptophan to the brain.
We all need to eat enough protein to maintain our skin, organ, muscle and immune function but recent research suggests that one particular component of protein, the amino acid tryptophan, can influence mood.
Supplements of tryptophan were tested in studies and in some were shown to improve the mood of people with depression. The supplements were not considered safe and were removed from the market. However, you can ensure your brain gets a regular supply of tryptophan by including at least one good sized portion of protein at each meal ie. meat, fish, eggs, milk, cheese, nuts, beans, lentils (dhal), or a meat substitute such as textured vegetable protein or mycoprotein.
NB: Peanuts are low in tryptophan so if you eat them at a meal-time include another source of protein (eg. other nuts) at the same time.
Variety of food
Eat a wide variety of foods to keep your diet interesting and to ensure you obtain all the micronutrients you need.
The more varied your diet, the more likely you are to obtain all the nutrients you need. If you have bread at one meal, try cereal or potatoes, rice or sweet potatoes at the others. Make sure you include at least 2 portions of different fruits and/or vegetables and a protein food at each meal.
Include some red meat and fish, as they are good sources of vitamin B12, another nutrient that seems to be associated with mood. If you are vegetarian or have a limited budget, include fortified soy mince and yeast extract to increase your intake of this vitamin.
Fish in your diet
Include fish, especially oily fish, in your diet.
A few studies suggest that omega 3 oil supplements may reduce symptoms in people with depression on antidepressant medications. These studies are small but we know that a proper balance of omega 3 and omega 6 oils in the diet is important.
To get a good balance of mega 3 and 6 oils:
- include more omega 3-rich oily fish from sustainable fish stocks – try to include 2–4 portions a week (but no more than 2 portions if you are pregnant or breastfeeding). If buying tinned fish, choose varieties in water, brine or tomato sauce rather than in sunflower oil (this is high in omega 6)
- if you fry food (eg. stir fries) use an oil high in monounsaturates eg. olive or rapeseed oil
- choose a monounsaturated margarine or butter for spreading. Avoid margarines or low fat spreads containing omega 6 polyunsaturated or hydrogenated trans fats (trans fats are damaging to your brain and arteries)
- avoid processed foods such as pies, sausage rolls, crisps and cakes – these are high in saturated and trans fats.
If you don’t like fish you could try an omega 3 supplement (choose one that is purified, contains no vitamin A and has a high eicosapenanoic acid (EPA) content – take no more than 1g EPA per day). If you are vegetarian, try a flax seed supplement (although only a very small fraction of the omega 3 contained in plant products can be used by the body).
Maintain a Healthy Weight
Depression affects different people in different ways. Some people lose interest in food or can’t motivate themselves to shop and cook, so lose weight. Others find they want to eat more and gain weight when they are unhappy. Some medications can also increase or decrease your appetite – if you are concerned that the medication you are taking has made your weight problems worse, speak to your doctor.
Both excessive weight loss or weight gain can make your mood worse and should be avoided. Weight loss and lack of good nutrition will deprive the brain of glucose and the other nutrients that control mood – you may need the advice of a dietitian to help you overcome this problem.
Putting on weight unintentionally or feeling out of control of your eating can increase your depression and can lead to yo-yo dieting, which leaves you further out of control. If you are overweight, follow the advice on healthy eating but be extra careful to limit your fat and sugar intake (no fries, pies, cakes, puddings, sweets, chocolate or sweet drinks), use less fat in cooking, reduce your alcohol consumption, avoid sugary drinks, and increase your exercise levels.
Maintain Adequate Fluid Intakes
Not drinking enough fluid has significant implications for mental health. The early effects of even mild dehydration can affect our feelings and behaviour.
An adult loses approximately 2.5 litres of water daily through the lungs as water vapour, through the skin as perspiration and through the kidneys as urine. If you don’t drink enough fluids to replace this loss then you will get symptoms of dehydration, including irritability, loss of concentration and reduced mental functioning.
Coffee, colas, some energy drinks and tea all contain caffeine, which some people use to boost energy levels. However, in large quantities caffeine can increase blood pressure, anxiety, depressive symptoms and sleep problems.
Caffeine also has a diuretic effect in the body – it encourages the production of urine and therefore leads to dehydration. For this reason you should not rely solely on caffeine-based fluids.
If you do take drinks with caffeine in them, try to limit yourself to just 3–4 cups per day and drink other fluids such as water, fruit juice and non-stimulant herbal teas at other times. Chocolate also contains caffeine and should be limited to an occasional treat.
Alcohol Intake
Alcohol has a depressant effect on the brain and can result in a rapid worsening of your mood. It is also a toxin that has to be deactivated by the liver. During this detoxification process the body uses thiamin, zinc and other nutrients and this can deplete your reserves, especially if your diet is poor.
Thiamin and other vitamin deficiencies are common in heavy drinkers and can cause low mood, irritability and/or aggressive behaviour, as well as more serious and long-term mental health problems.
Because the body uses important nutrients to process alcohol, people who experience depression should consider avoiding alcohol until they have recovered. Even then, because of alcohol’s depressant effects, they should consider drinking only small amounts – no more than once a week.
If you do want to drink alcohol, try not to exceed the recommended safe limits – two units a day for women and three units for men.
1 unit = 1 small glass wine (8 % ABV)
½ pint beer or lager (3.5 % ABV)
1 single measure spirits (40 % ABV)
1 small glass sherry or port (20 % ABV)
NB. % ABV is the strength of the alcoholic content. If the % ABV is higher than the examples listed above, then the drink contains more units of alcohol.
Find out more about alcohol and mental health.
Exercise Regularly
Exercise leads to the release of endorphins – feel-good chemicals in the brain that help us to relax and to feel happy. Exercise is particularly important for people with depression as it also gives structure and purpose to the day. Outdoor exercise that exposes us to sunlight is especially valuable as it affects the pineal gland and directly boosts mood.
Exercise has some other advantages if you are trying to control your weight. For example, the more you exercise, the less you need to cut down on your calorie intake to control your weight. It is also beneficial for heart health and it ensures that you replace fat with muscle, resulting in a more toned body. Exercise also prevents bone mass loss and the increased risk of osteoporosis that can occur if you diet but don’t exercise.
There is no need to join a gym – walking is the easiest, cheapest and best form of exercise and it can be built up as your fitness level increases. Swimming is good for people with joint problems who find weight-bearing exercise difficult. Cycling is also good. Whatever kind of exercise you choose, start with 20 minutes at least three times a week and increase this as your fitness improves.
Find out more about exercise and mental health.
Nutrition Supplements
At the moment evidence for the benefits of nutritional supplements is weak, but if you decide to try them:
- choose a complete one-a-day multivitamin / mineral preparation containing the full recommended daily intake of each vitamin and mineral. These products are relatively safe as they do not contain excessive amounts of any single nutrient (but you should avoid other supplements containing these nutrients, in particular vitamin A as it is toxic in high doses)
- if your doctor prescribes vitamins or minerals for you, tell him/her about any products you are already taking
- if you do take a multivitamin supplement, avoid eating liver and other offal products such as pate, as these are also high in vitamin A.
It is important to remember that supplements are not an alternative to a healthy diet and you should still maintain a varied and balanced diet.
Depression And Diet
A number of cross-country and population-based studies have linked the intake of certain nutrients with the reported prevalence of different types of depression. For example, correlations between low intakes of fish by country and high levels of depression among its citizens – and the reverse – have been shown for many types of depression. Complex carbohydrates as well as certain food components such as folic acid, omega-3 fatty acids, selenium and tryptophan are thought to decrease the symptoms of depression.
Those with low intakes of folate, or folic acid, have been found to be significantly more likely to be diagnosed with depression than those with higher intakes. Similar conclusions have been drawn from studies looking at the association of depression with low levels of zinc and vitamins B1, B2 and C. In other studies standard treatments have been supplemented with these micronutrients resulting in greater relief of symptoms in people with depression and bi-polar affective disorder, in some cases by as much as 50%.
Sample Meal Plan
Breakfast
1/2 grapefruit / fruit juice
Cereal e.g. wholegrain or bran cereal / porridge, with semi-skimmed milk
or
1–2 slices wholemeal bread / toast with scraping of monounsaturated spread / butter, and kippers / egg / grilled bacon / baked beans
Tea / coffee / herbal tea / water
Mid morning
Tea / coffee / herbal tea / water
Fruit / nuts
Lunch
1–2 slices wholemeal or pitta bread sandwich with scraping of monounsaturated spread / butter and filling of fish / meat / egg / cheese / humus / meat substitute / nut butter, with salad
or
Jacket potato with baked beans / tuna and corn / chilli con carne / prawn filling, and salad
or
Soup e.g. pea and ham / farmhouse broth, and bread
or
Salad with meat / fish / egg / cheese, and bread
or
Cooked meal – see below
Fruit / yoghurt
Tea / coffee / herbal tea / water
Mid afternoon
Tea / coffee / herbal tea / water
Fruit / fruit and nuts / mixed seeds
Dinner
2tblsp Basmati or brown rice / wholemeal chapattis / wholemeal pasta / new potatoes / sweet potato / yam / couscous and 100–120g meat / fish / eggs or bean / lentil dish e.g. chilli con carne / rice and peas / dhal / stir-fried prawns and vegetables and 2 portions of green and root vegetables / large mixed salad
Fresh / tinned fruit / baked fruit and low fat crème fraiche / yoghurt
Tea / coffee / herbal tea / water
Supper
Small bowl of cereal, as breakfast, or toast and yeast extract / nut butter / cheese
This advice was written Dr Lynn Harbottle, consultant in nutrition and dietetics at the Health and Social Services Department, Guernsey, sponsored by an educational grant from Nutricia Clinical Care.
Mentally healthy recipes
Download recipes from Mental Health Foundations Feeding Minds guide, including dishes by Anthony Worrall Thompson and other celebrities.
Mentally Healthy Recipes (PDF file, 1.63MB)
Food and mood diary
Mental Health Foundations printable food and mood diary will help you understand how the way you feel is affected by what you drink and eat.
Food and Mood diary (PDF file, 130KB)
Podcasts
New Year’s Resolutions – A Healthy Diet
This podcast looks at how diet affects our mental health, and teaches you some techniques to help make small changes to your eating habits and improve your overall mental and physical wellbeing.
Wellbeing and Nutrition
This podcast looks at how exercise benefits both your mental health as well as physical health and teaches you some techniques to help you create and stick to a programme of regular exercise.
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Drugs
Substance abuse covers misuse of a range of mind altering substances. It can have a severe impact on your functioning as well as your physical health.
Substance abuse or misuse is formally defined as the continued misuse of any mind-altering substance that severely affects person’s physical and mental health, social situation and responsibilities.
Alcohol dependence is the most common form of substance misuse, but any drug, including heroin, cocaine, crack and cannabis, comes into this category, as does the misuse of glue and aerosols.
Substance abuse may also include smoking cigarettes or drinking excessive amounts of coffee. Although not strictly a form of substance abuse, the eating disorder bulimia nervosa does involve the misuse of food.
Most forms of substance abuse may give you a temporary feeling of well-being or of being in control, but all of them can ultimately damage your health.
The most severe forms of substance misuse are normally treated by specialist drug and alcohol rehabilitation services. For people with mental health problems who are also substance misusers, the mental health team normally encourages contact with a specialist substance misuse service for help. There is also a lot you can do to help yourself.
What leads to substance abuse?
There are many reasons why you may start to use any of these substances. You may begin because of curiosity, rebellion, or influence from peers. You may find the experience enjoyable and want to repeat it. It may start when you are unhappy or stressed or trying to cope with problems in your life. Drugs, alcohol, nicotine, solvents and even food can start as ‘props’ to help you get through difficult times. But the feelings of relief are only temporary and, as the problems don’t disappear, you may use more and more of these substances and risk becoming dependent on them – which in itself creates new problems.
Caffiene
Coffee, tea and chocolate all contain caffeine. It is also added to some soft drinks and energy drinks as well an ingredient in some painkillers and cold remedies. The average cup of coffee contains around 40mg of caffeine per cup, a can of cola around 23mg, and some energy drinks have four times that amount. Plain chocolate has 40mg caffeine per 100g – nearly three times as much as milk chocolate
Coffee, tea and chocolate all contain caffeine. It is also added to some soft drinks and energy drinks as well an ingredient in some painkillers and cold remedies. The average cup of coffee contains around 40mg of caffeine per cup, a can of cola around 23mg, and some energy drinks have four times that amount. Plain chocolate has 40mg caffeine per 100g – nearly three times as much as milk chocolate
Caffeine stimulates the brain and nervous system. It can make you feel more alert and better able to concentrate, and it also increases acid production in the stomach, which helps digestion. If you regularly drink large quantities of caffeine – say, five or more cups of coffee a day – you may find your tolerance has increased and you need to drink even more to get the same stimulant effect.
The disadvantages of caffeine are that it increases your heart rate and blood pressure and makes you pass more urine – so you may end up losing calcium if you have too much. Sensitivity to caffeine varies from person to person, but too much can make you anxious, restless, irritable, jittery and sleepless. It can also give you headaches, stomach pain, nausea, muscle twitching or palpitations.
Cutting out caffeine in one go can be difficult because you may experience withdrawal symptoms, including severe headaches as well as nausea, anxiety, fatigue and depression. One way to avoid this is to gradually decrease the amount of caffeine you consume, either by drinking fewer cups of coffee each day or by gradually switching to decaffeinated coffee. It’s important not to switch to other substances that also have high levels of caffeine, such as cola or chocolate.
Drugs
Medicinal drugs, such as tranquillisers and sleeping tablets, may have been prescribed for very good reasons, but they can also cause health problems if used for long periods. Tranquillisers are thought only to really help anxiety for about a month and sleeping tablets are only effective for a couple of weeks. After that time you may find you need a higher dose to get the same effect and even then your anxiety may increase or your sleeplessness return.
Street drugs, such as cannabis or ecstasy, are usually taken for recreational purposes. How they affect you will depend on the type of drug, your own physiology, the amount you use, your mood and your environment. For some people, the first hit can cause problems, especially if the drug contains impurities. For other people, the problems may start as their bodies get used to the repeated use of the drug, and they need higher and higher doses to maintain the same effect.
Types of Drugs
Stimulants
Stimulants include caffeine and tobacco as well as amphetamines, anabolic steroids, ‘poppers’, hallucinogenic amphetamines (ecstasy), cocaine and crack. They act on the central nervous system and increase brain activity. Users generally feel more confident and alert, are able to stay awake for longer and can perform physical tasks for a longer period of time. High doses can cause nervousness and anxiety 9except for tobacco). Stimulants can also cause temporary feelings of paranoia (except for tobacco and caffeine).
Depressants
These include minor tranquillisers such as Valium, Librium, Mogadon and temazepam, solvents, glues, aerosols and gases. Depressants act on the central nervous system and slow down brain activity. They relax you, making you feel less tense and anxious, but at the same time impair mental and physical activity and decrease self-control.
Analgesics
Analgesics are painkillers and include heroin, opium, pethidine and codeine. They make users less sensitive to emotion and physical pain and produce feelings of warmth and contentment.
Hallucinogens
These include cannabis, LSD and magic mushrooms. Hallucinogens act on the mind, heightening sensations and distorting the way users see and hear things.
Signs You May Be Developing a Dependancy On Drugs
If you rely on drugs to help you feel less anxious or depressed or to improve your mood, you may be becoming psychologically dependent. If you rely on drugs to achieve certain physical effects or you can’t face the unpleasant physical effects of not taking the drugs, you may be becoming physically addicted. In fact, most drug-related problems generally involve physical and psychological symptoms and sometimes it is difficult to separate the two.
Other signs that you could be becoming dependent on drugs are:
- if obtaining and taking drugs are more important than anything else in your life
- if you use drugs to block out both physical and emotional pain
- if you use drugs to distance yourself from problems such as loneliness, family or relationship problems, low self esteem, poverty or housing difficulties, unemployment or lack of opportunities.
Food – Bulimia Nervosa
People with bulimia nervosa can’t stick to a healthy eating pattern. They tend to binge, that is, eat a lot at once. This makes them feel guilty and out of control so they then panic and punish themselves by starving, making themselves sick, taking laxatives or over-exercising. This can lead to a number of physical problems including tooth decay, constipation and intestinal damage, as well as heart and kidney disease. Tell-tale signs of bulimia nervosa include making excuses to avoid eating in company or rushing to the lavatory after a meal.
Nicotine
You may smoke tobacco to help you relax or you may feel that smoking helps you cope with stress, but the health effects of smoking are very serious. Long-term smoking causes cancer and heart and lung disease and also damages the health of other people who are exposed to cigarette smoke.
Solvents
Solvent abuse (or volatile substance abuse) is the inhalation of fumes from ordinary household products in order to get high. Products that may be sniffed include cigarette lighter refills (butane gas); aerosols (it is the propellant, often butane, that is inhaled); solvent based adhesives (glue sniffing), and petrol.
Most volatile chemicals act as depressants, slowing down brain activity and making users feel more relaxed and less tense and anxious. They also impair mental and physical activity and decrease self-control. Prolonged misuse of solvents and volatile substances can result in brain, liver and kidney damage.
Signs You May Becoming Dependent On Solvents
Users may start out experimenting with solvents out of boredom and then move on to using them casually or recreationally. A very small number of users come to rely on them as a way of coping with life – not just to have some fun.
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