Anxiety and Depression

What is Anxiety? Everyone experiences anxiety at some time in their life. In fact, it’s a normal reaction to what we think is a threat or danger to us. This can be a real threat or an imaginary one – the feeling of anxiety is the same. People often become anxious in difficult situations, like taking an exam, moving house, having an interview or going to the dentist. These feelings of anxiety usually go away. Sometimes, they can even be useful, making us more alert and improving our performance. But if these feelings start to take over and become a big part of our lives – that is a problem. What causes anxiety? Lots of different things cause anxiety, and anxiety affects different people in different ways. For some of us, anxiety starts after a long slow build-up of stress. It can also start when we do not feel in control of certain aspects of our lives – our health, for example. This can make us feel anxious about the future in general. A stressful event like a chest infection or a stay in hospital can cause anxiety. You might well be worried that it will happen again, for example. Some medicines can make people feel anxious. And, of course, having a lung condition can give you symptoms that make you feel anxious too. Sometimes, the symptoms of lung disease – like tightness in the chest or getting very tired easily – are similar to feelings of anxiety. It is not always clear what is causing anxiety. Sometimes, you can just be aware of feeling anxious all the time. When you cannot understand why you are feeling anxious, this can create a downward spiral: you can become anxious about feeling anxious. This makes you more anxious and so on. Anxiety and Depression It is not easy to live with a lung condition. As well as experiencing symptoms such as getting out of breath and coughing, having a lung condition may make you less active than usual. It can also mean that you don not sleep as well at night. You can lose interest in food – you may get full more quickly, or you might just get tired when Author – Pulmonary Rehabilitation Service Date of issue 2014 Date of review April 2017 Version 2 ID number RESPIRATORY – 001 – Anxiety and Depression – 2012

you eat. These are some of the reasons why people with lung disease can also be depressed. Depression is not the same as anxiety. The difference is that anxiety is related to fear, while depression is related to feeling hopeless. Many people live with both anxiety and depression. How does anxiety affect people? Anxiety affects people in different ways. Recognising symptoms apply to you will help you deal with them. Some symptoms of anxiety affect people physically, some affect how people fell or think. Have a look at the list below. If some of these apply to you, you might be suffering from anxiety. If you follow some of the suggestions in this booklet then you should start to feel better and be able to get on with your life. What are the symptoms of Anxiety? Anxiety – effects on feelings

Anxiety – effects on the body

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A sense of fear Unable to concentrate Irritable Less patient than you were Constant worrying Feeling on edge all the time Getting very tired easily Bad sleep Feeling preoccupied or obsessed with something

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Tightness in the chest Chest pain Nausea Quick, shallow breathing Loss of appetite Butterflies in the stomach Headaches and dizziness Tight or aching muscles Rapid or pounding heart beat Feeling faint Sweating Passing urine a lot Diarrhoea Loss of interest in sex Panic attacks Wind Pins and needles, especially in the hands or around the mouth Trembling

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Panic attacks Some people have panic attacks. This is when the feelings of anxiety take over. You feel like you might faint, pass out, be sick or even stop breathing. When this happens, people often ‘over-breathe’ or hyperventilate. This can be very uncomfortable and makes the situation worse. Learning to breathe properly can help with panic attacks. Techniques for dealing with anxiety Recognising that there is problem is the first step to dealing with it, even if you do not know what is causing the problem. Here are some ways of dealing with anxiety: Talking Talking to someone about the problem can make it seem more manageable. It may help if you choose to talk to someone close to you – a friend or a family member. Or you prefer to talk to someone with a similar lung condition. Most people with anxiety can be treated by their GP. Sometimes they may suggest that you see a psychiatrist or psychotherapist, or a member of the community mental health team. These are all people who can help you get on your way to recovery. Relaxation You can try this on your own, or you may prefer to join a group. Relaxation involves sitting quietly, relaxing the muscles in your body, breathing slowly and deeply and clearing your mind of all thoughts. There are lots of relaxation tapes and books available – ask at your local library or bookshop. Physiotherapy for your breathing can also help. Speak to your GP or nurse about this. Exercise It helps to be active as possible. This will take your mind off your anxious thoughts. Keeping active will also help to keep you fit and it can help you sleep better. Exercise can use up the extra adrenaline that comes with anxiety. Care for yourself

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How your lung disease makes you feel is unique to you – only you really know how you feel. Learn to recognise when you are feeling over-tired or becoming stressed. Then start one of the above courses of action. It should help.

Diet Eating a well-balanced diet is important (whether you have a lung disease or not). For many people, several small meals a day may be better than two or three big ones, but the content and quality are important. Alcohol Too much alcohol might make you feel better for a bit, but it can actually make anxiety worse – although a small glass of sherry or wine can sometimes help with your appetite or help you to relax or sleep. It is important not to overdo it. Saying ‘No’ Learn not to take too much on. Too many demands on your time can increase you anxiety. When you say ‘no’ you are taking back control of your life. Complementary therapies Some people find complementary therapies like hypnosis, massage and acupuncture useful. But remember not to take any herbal or other remedies without checking with your doctor, nurse or pharmacist. Medication for anxiety Sometimes you can use medication to control your anxiety. Your Gp may prescribe something called an ‘anxiolytic’, which is to reduce anxiety, or an antidepressant. Get some help or support Joining a self-help group can be useful if you want to meet people who share your experiences. You may have a local breathe easy group near you. You can meet people with similar lung conditions and perhaps pick up some useful coping strategies. Do not be afraid to ask for help. Anxiety is more common than you think.

Author – Pulmonary Rehabilitation Service Date of issue 2014 Date of review April 2017 Version 2 ID number RESPIRATORY – 001 – Anxiety and Depression – 2012

What is Depression? Depression is a persistent low mood, characterised by feeling bad about yourself and felling hopeless about the future. It is often associated with chemical changes in the brain. Many different factors can trigger depression. For some people, upsetting or stressful life events such as illness, bereavement, redundancy and worries about your job or money can be the cause. For some people, learning they have a lung disease, and trying to learn to live with it, can be a trigger for depression. Depression can make you less enthusiastic about being involved in your normal activities and interests – and this in turn adds to your depression. Quite often, depression is triggered by more than one of these factors, which can influence and affect each other in complicated ways. Depression and lung disease Living with lung disease can make you feel tired all the time, partly because it may be difficult to sleep. It can be exhausting to eat, and the medications can make food seem tasteless. You may become so self-conscious about your oxygen or a chronic cough that you become more reluctant to go out in public. You may have been active for all of your life and now cannot do the things you once enjoyed. Dealing with these changes and difficulties can put you at risk of developing depression. Depression is unpleasant. It can leave you feeling disconnected from your life. You not only feel bad, but you also have less energy to do the things you want to do, including taking care of yourself and managing your lung condition. Depression can also make you feel as if things will never get any better. If you feel this way, you might feel reluctant to follow the treatment plan for your lung condition, which can lead to your health getting worse.

Depression is a common problem but it can be treated.

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What are the symptoms of depression? Do you have any of the following symptoms?               

You feel sad more often than not, for several weeks at a time. Your sleep is disrupted; you wake up early, or your sleep is restless, or you have difficulty falling asleep. You are sleeping either much more or much less than usual. You are less interested in favourite people or activities. You have less energy and you do not feel like doing anything. You find it hard to concentrate and solve problems. You are eating much more or less than usual. You feel bad about yourself or you feel worthless. You feel hopeless – that you will never feel better no matter what happens. You cry much more easily and more often than usual. You feel irritable with everyone and everything in your life. You are much more sensitive to criticism than usual. You feel guilty. You cannot laugh or enjoy yourself. You think about suicide, or you wish your life would end.

If you answer yes to five or more items on this list, you may have depression – please contact your doctor, nurse or health team and talk to them about your symptoms. Dealing with depression One of the symptoms of depression is hopelessness – feeling that nothing can help, so why bother? In fact, lots of things can help you help fight depression. We will look at some of the methods to combat depression in more detail later in the booklet, but the main strategies are:    

Learning techniques such as breathing control to reduce anxiety, which is a barrier to activity. Trying to exercise more and stay active. Exercise can trigger the release of a chemical in the brain called serotonin, which boosts your mood. Learning to relax. Eating a well-balanced diet. Author – Pulmonary Rehabilitation Service Date of issue 2014 Date of review April 2017 Version 2 ID number RESPIRATORY – 001 – Anxiety and Depression – 2012

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Joining a support group such as breathe easy and discussing your feelings and concerns. You are not alone. Taking any antidepressant medicines, as prescribed by your doctor without skipping any doses or days. Trying to identify negative thoughts and change them to positive thoughts. Using a problem-solving approach to deal with stresses and worries.

Ways of coping with depression Do not keep it to yourself Talk with someone close to you. Tell them how you feel. It may help to talk to someone who also has a lung condition. Breathing techniques People with lung disease often find their breathing gets difficult when they are upset, angry or anxious. Worries about breathing can stop people from doing things they would like to, and this can add to feelings of isolation and hopelessness. Breathing techniques can help overcome feelings of breathlessness and control anxiety. Do something Try walking around the house and garden. Get outside, even if only for a short, slow walk. This will help you to keep physically fit, and you may sleep better. Try to keep active. This could be housework, walking to the local shop, or any part of your normal routine. It can help take your mind off painful thoughts which make you more depressed. Just doing one thing each day (e.g. going out for the paper, doing the washing up) can make you feel a lot better about yourself. Think about hen in the day you feel best (e.g. lunchtime, first thing in the morning), and try to do something then. Do things you enjoy Arrange to meet friends, or ask a friend to visit you, even just for a coffee. Phone someone you have not seen for a while. Cook a simple meal. Starting a new hobby can also be a good way to meet people, focus your mind and have some fun. Author – Pulmonary Rehabilitation Service Date of issue 2014 Date of review April 2017 Version 2 ID number RESPIRATORY – 001 – Anxiety and Depression – 2012

Eat well Try to eat a good, balanced diet, even though you may not always feel like eating. Eat small meals more often rather than just three big meals. This can be much more comfortable for people with a lung condition. Beware of alcohol Resist the temptation to drown your sorrows with a drink. Alcohol actually makes depression worse. It may make you feel better for a few hours, but you will feel worse again afterwards and it does not mix with antidepressant tablets. Sleep Try not to worry about finding it difficult to sleep. It can be helpful to listen to the radio or watch TV while you are lying down and resting your body, even if you cannot sleep. If you can occupy your mind in this way, you may find it easier to get off to sleep. Keep hopeful Remind yourself that depression is an illness which many other people have gone through, and recovered from. Relaxation You can help yourself relax using simple techniques like having a bath or making a warm milky drink. Take time out. It is good to spend some time on yourself. Or try this quick relaxation technique:

Author – Pulmonary Rehabilitation Service Date of issue 2014 Date of review April 2017 Version 2 ID number RESPIRATORY – 001 – Anxiety and Depression – 2012