spina bifida and sensation skincare and pressure sores fit for anything dietary advice obesity depression and anxiety

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The information on this website does not constitute medical advice for any individual. As specific cases may vary from the general information presented here, SBHI advises readers to consult a qualified medical or other professional on an individual basis.

SPINA BIFIDA AND SENSATION

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Depending on how much nerve damage you have had, you may have difficulties with sensation which can sometimes, unknowingly, put you in danger. For example you may not:

• be able to feel how hot the bath water is
• notice that you are putting your foot by a hot radiator
• realise that your toes have been squashed in your shoes or
• feel your calliper is rubbing
• notice that your skin is cut or broken or even know if you have a broken a bone.

As you grow up, you need to take special care to check for any cuts or bruises especially on those parts of your body which are most at risk.

Circulation

You may have poor circulation (the speed with which blood flows around the body) which can cause a problem, especially if you cannot feel or move the lower part of your body as you should. You may not realise:

• when your blood circulation has slowed down
• if your feet or legs are too cold
• or pressure on your bottom or hips has stopped the blood flowing

Pressure Ulcers / Sores

These are very common among people who have Spina Bifida. It is very important that you check your skin when dressing. The area’s most at risk are the:

• buttocks
• thighs
• feet
• elbows
• back

Things you can do to reduce the risk:

• Push-ups every 15-20 minutes should relieve the pressure on the buttocks.
• If you can’t lift up, leaning forward or to the side should provide adequate relief.
• Use the pressure relieving cushion that came with your chair, and if necessary, you may have a pressure relieving mattress on your bed.
• Remember your feet! Shoes (not too tight) should be worn.
• Cotton socks without elasticated ankles.
• Wearing fashionable clothes may be “cool” but try to avoid clothes with zips, press-studs or hard seams.
• Ensure the skin is kept clean and dry but avoid using talc
• If you have a bladder or bowel accident, clean yourself up as soon as you can.
• Lift yourself away from surfaces when transferring - this avoids dragging the skin and damaging it.
• Try not to knock or drag your feet when transferring if you have limited sensation.
• Eat healthily as it keeps your skin in good condition and keeps your weight down
• Remember your fluids too - they help to keep the skin’s elasticity.

Top Tips

• Never rest hot drinks on your lap.
• Don’t have your bed next to a radiator.
• Always check your bath water with your hands to make sure it’s not too hot.
• Don’t rest your feet on radiators/heaters.
• At the first sign of a sore, get it checked. Pressure ulcers can be hard to heal once developed and can lead to prolonged bouts of total bed rest - definitely not good for the social life

 

SKIN CARE & PRESSURE SORES

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Skin Care Management - Children

Parents of young children should check their skin daily for any signs of redness especially the back and buttocks area, and potential pressure points from shoes or calipers. Change, wash and dry as soon as possible if the child is wet or soiled.

A good balanced diet, with plenty of fruit and vegetables is invaluable for prevention and healing. An adequate intake of fluids to hydrate the skin is necessary and extra Vitamin C and Zinc aids the healing process.

Self skincare management should be introduced as early as possible. Skin should be regularly inspected as part of a regular care routine, using a long-handled mirror to view hard to see parts of the body. In case of incontinence 'accidents', wash and dry skin as soon as possible. Wheelchair users should relieve pressure on the buttocks by lifting the bottom every twenty minutes or at the very least, change position. Change position of feet frequently. Wear suitable clothing - no tight clothes, hard seams, zips or buttons that could cause pressure sores. Wear shoes that fit properly. Make sure that the wheelchair cushion is suitable - seek advice from Occupational Therapist, Physiotherapist or Seating Clinic. Protect skin when transferring and finally, protect skin from burns and frost-bite.

Skin Care Management - Adults

Poor circulation below the waist means that the cells don't get adequate supplies of oxygen and nutrients to keep them healthy. Nor do their get rid of all their waste products.
A system of the body called the lymphatic system works together with the circulation to remove fluid and waste products. This also does not work as efficiently in people with Spina Bifida as it should, so there can be a build-up of fluid in the legs. This is called oedema. All these things together mean that pressure sores can develop very rapidly and then be very slow to heal.

Neurological (nerve) problems associated with Spina Bifida and the resulting loss of feeling means that little or no discomfort is felt and therefore there is no trigger telling you to move and reduce the pressure on a particular part of the body.

Incontinence will cause the skin to become even more prone to damage as both urine and faeces contain substances that break down the skin and cause it to become infected.

Pressure Sores

A pressure sore is a sore on an area of skin where there is continuous heavy pressure, leading to a reduced flow of blood to the area causing tissue to erode and die. People with Spina Bifida, especially wheelchair users are prone to developing pressure sores because of de-sensitive skin, paralysis or scoliosis.

Sores usually occur at the site of a bony prominence or where there is pressure and or tension and a reduced flow of blood. They are mostly in the lower part of the body, especially on the buttocks and limbs. These also appear on the feet as a result of badly fitting shoes and calipers. Wet skin is more likely to break down than dry skin i.e. where urine or sweat is present on the skin.

Causes of Pressure Sores

• Immobility
• Poor diet
• Incontinence
• Poor blood supply and oxygen to body tissue (Arterial Disease)
• Weight gain

 

The four grades of Pressure Sores

• Red patch, warm to the touch which blanches when pressed. This then progresses on to the next stage.
• When the lesion is red, it does not blanch and is cool to the touch.
• Pustular formation with oozing and broken skin
• Surface crusting with deep tissue damage

Prevention – reducing the risk

Change your position

Every 20 minutes lift your bottom off the chair and change the position of your legs. This allows the blood to flow normally for a few seconds (that's all it needs!). If it is too difficult to lift your bottom, then try a change of position; leaning forwards or to one side then the other.

Regular inspection of the skin

Ideally the whole body should be inspected night and morning for signs of any redness or changes in the skin. If you find a red patch and it disappears quickly after you have eased the pressure in that area, there is no cause for alarm. But if the red colour remains, this could be the first sign of a sore developing. A close eye should be kept on this area and no further pressure should be put on it. A long-handled mirror is very useful for inspecting the back and bottom!

Diet

A good balanced diet is essential for both the prevention and healing of pressure sores. An adequate intake of fluids helps to keep the skin supple and hydrated. Complex carbohydrates (bread, rice, pasta) will keep the muscles healthy. Iron-rich food such as spinach, will help the blood carry the oxygen around the body to the cells. Vitamin C and zinc (a mineral) both help wound healing, as does an adequate supply of protein (found in meat, fish and dairy products).

Wear suitable clothing

Avoid clothes that are too tight or have hard seams, zips or buttons that might cause pressure. Good fitting shoes, with the feet put in properly, are essential. Take care when transferring from your wheelchair not to knock or drag the body. Barrier creams such as Sudocrem, Conotrane or Zinc and Castor Oil Cream, can be useful protection for the skin against incontinence but the most important protection is to clean up and change as soon as an 'accident' has happened.

Hospital admissions

If you have to go into hospital and will be spending more time than usual in bed, ring the ward and tell them before you go that you will need a pressure-relieving mattress. Operating theatres also need to be aware of your needs before you have an operation. A visit before admission will be useful to you and to the staff.
If you have to visit the Accident & Emergency Department, do remind them as soon as possible of your high risk of developing sores. The staff should then make sure that you are not left on a hand trolley or in a wheelchair without help to move around every 20 minutes or so.

Treatment

The treatment of pressure sores involves firstly, removing the pressure. Superficial wounds should be covered lightly yet allowed to breathe. Don't rub or massage the area. If it appears that a pressure sore is developing, have it seen to immediately. If neglected, sores can become progressively worse, leading to hospitalisation. In extreme cases, the bone may be affected and surgery, even amputation may be necessary.

The best treatment of all is relief of pressure from the affected area. Special cushions and mattresses are available and the community team (occupational therapist or nurse) is responsible for assessing and arranging provision of these.

If there are recurrent sores, it may be that a further assessment of pressure relief aids, equipment, etc - that is, wheelchair and lifestyle - needs to be made.

Remember
 

• Lift your bottom from your chair every 20 minutes.
• Change the position of your legs at the same time.
• Check your skin all over at least once a day (twice is better).
• If you are wet or soiled, the quicker you clean up and change, the better.
• Take care when transferring from your wheelchair.
• Eat a good balanced diet including a variety of fruit and vegetables, and drink plenty of clear fluids.

FIT FOR ANYTHING

Exercise is just as important for a person with a disability as for anyone. It’s essential to maintain good heart and lung health through aerobic exercise, as well as reducing the risk of osteoporosis.

A recent study of disabled gym users revealed that when it comes to exercise, disabled people have staying power - they are almost twice as likely to still be using the gym at any given point in time than non-disabled users.

But keeping fit doesn’t necessarily mean sticking to arduous gym regimes; the most important thing is for you to be as active as you can.

It may seem a struggle at first, but find an exercise you enjoy and set yourself achievable goals and you’ll feel fantastic.

Exercise can also help to prevent secondary conditions such as heart disease, obesity, diabetes, pressure sores, hypertension, urinary tract infections, and respiratory disease.

DIETARY ADVICE

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People with Spina Bifida often have damage to the nerve supply to the bladder and bowel. The emptying of both may be erratic and uncoordinated, resulting in continence management problems.

Constipation is very common in people with Spina Bifida. The nerve damage to the bowel means the time taken for food to move through the gut is slowed down. Because of this slowing down, the faeces stay in the large bowel (colon) for longer than is normal and this allows more fluid to be absorbed from the bowel, causing the stool to become harder and harder.

Sometimes the stools become impacted; the colon then expands and pushes against the bladder, adding to problems with bladder continence.

More mucus is produced by the swollen bowel and this mucus is stained by the stool. Bacterial activity also causes it to smell. It then leaks out of the anus and is often mistaken for diarrhoea – this is called ‘overflow’.

If the colon and rectum remain swollen for too long they function less well. The colon may lose all elasticity and form a floppy reservoir which may then be extremely difficult to empty completely. The anal sphincters (the muscles which keep the bottom closed) may suffer damage and the anus will remain open and leak constantly. (In some people with Spina Bifida the anal sphincter already does not work properly because of nerve damage).

A low fluid intake (in the mistaken belief that it will help to keep the person dry) and poor diet both add to the existing problem. It is important to keep drinking plenty and to have a diet rich in soluble fibre.

Diet

Dietary fibre can be found in many fruits, vegetables, grains and pulses. There are two types – insoluble (which stays undigested and helps keep matter moving through the bowel) and soluble (which absorbs and holds on to water, keeping the stool soft).

Children and adults need a varied and balanced diet which contains 20-40gms of fibre daily. A glass of liquid, preferably water or diluted juice, should be taken alongside a fibre - rich meal, for the soluble fibre to absorb, as constipation can be caused by a high fibre diet and not enough fluids. Read the labels on packaging for fibre information.

Some people find certain foods cause them to have diarrhoea or to be constipated. Milk, eggs and refined foods, such as white bread, may contribute to constipation. Grapes, sweetcorn or food and drink containing caffeine (tea, coffee, cola, chocolate) or very fatty foods, can cause diarrhoea. A food diary can help to identify foods which are causing problems, so that they can be eliminated or replaced with a healthier alternative.

Constipation may make a person moody, sluggish or agitated and an impacted colon will push on the bladder causing urinary incontinence to worsen.

Other Factors

Poor mobility also adds to the problem of constipation and regular exercise (in a wheelchair or otherwise) should be encouraged.

Some medication used by children and adults with Spina Bifida, such as Oxybutinin and some anti-epileptic drugs, can cause constipation or can make existing constipation worse.

There are many ways of avoiding constipation, including a variety of medications, high bowel washouts, or surgical procedures such as the ACE (see information sheet on ACE: Antegrade Continence Enema). However, establishing a regular toileting pattern early in a child’s life may mean none of these is necessary.

Babies and Children

Small babies can be given drinks of cooled, boiled tap water between milk feeds, once or twice daily, to help prevent constipation (especially in formula fed babies) and to maintain a good level of hydration. When weaning, slowly introduce a wide range of vegetables and fruit into the diet, adding pulses eg peas, beans, lentils etc after one year.

Drinks of water or very diluted juice, suitable for very young children, can be given between meals. It is not recommended to give juice in bottles as this can lead to tooth decay.

Small children should not be given extremely high fibre or extremely low fat diets, unless under medical instruction and supervision, as such diets are unlikely to contain enough calories and fat-soluble vitamins to promote growth and general good health. Rather, aim to promote the habit of eating fresh fruit and vegetables daily and avoid high fat snacks (chocolate, crisps) to prevent obesity. A balanced diet including protein, vegetables and carbohydrates should be encouraged.

Food Pyramid

OBESITY

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Obesity is one of the most common nutritional problems in people with Spina Bifida. Obesity may be a cosmetic concern for affected individuals. More importantly, however, obesity is a major health threat. In adults, obesity has been linked to high blood pressure, diabetes, osteoarthritis, abnormal cholesterol metabolism, heart disease, sleep apnea, and psychological problems. Similar health consequences occur for children and adolescents who are obese. Psychological problems are of special concern for developing children, who may be negatively stigmatized by others if they are obese and thus develop poor self-esteem, greater risk for isolation from peers, and depression.

How Obesity Develops

All energy intake (measured in Kilocalories (Calories)) comes from food that is eaten and then used by the body to meet its needs. Obesity results when a person's intake of calories exceeds his or her energy needs for bodily functions (metabolism, physical activity, the thermal effect of food, and growth). Similarly, weight loss results when the body uses more calories than are taken in through eating. On average, most (about 60%) of our energy is used for basic metabolism (which is controlled in part by inheritance); physical activity uses about 25%, the thermal effect of food about 10%, and growth about 5%. Our bodies do a good job of balancing short-term excesses in both energy intake and use. Continued excessive intake, however, will lead to storage of energy in the form of fat (weight gain), and continued insufficient intake will force the body to use stored energy (fat and other tissue like muscle) for the calories it needs to function (weight loss).

Special Concerns for Individuals who have Spina Bifida

Obesity is an even greater health problem for people who have Spina Bifida. Obesity further limits mobility and self-help skills, leading to a spiraling problem of decreased energy use and weight gain, making it harder for the individual to keep up with peers in social and work situations. It adds to the amount of pressure on skin, thus increasing the already high risk of skin breakdown, particularly in areas that are insensate or become wet. Social rejection, which may already be a problem due to others' lack of sensitivity and understanding of disability, may be worsened. And activities of daily living, particularly independence in dressing, continence management and hygiene, may be negatively affected by difficulties in moving a large, heavy body and decreased ability to reach private areas of the body.

Very young children who have Spina Bifida usually grow at about the same rate as their non-disabled peers and are quite physically active, so they usually do not become obese. As they grow older, however, children who have Spina Bifida, especially those who also have hydrocephalus, are at very high risk for developing obesity. Beyond age six at least 50% of children who have Spina Bifida are overweight, and in adolescence and adulthood over 50% are obese.

There are many reasons for this. Neurological impairments that lead to even slight mobility problems make it harder for individuals who have Spina Bifida to be physically active. Due to the requirements of school and work for sedentary activity, and due to the increasing difficulty of moving a larger body that has a mobility impairment, school age children who have Spina Bifida typically become less active as they grown older. Small children grow rapidly and so they require a large number of calories for growth. Older children and adults have slower growth, however, and on average those who have Spina Bifida will not become as tall as their non-disabled peers. So, those with Spina Bifida have fewer requirements for growth, as well. Also, studies have shown that people with Spina Bifida have less lean body mass than their peers, and even when other factors like physical activity are equal, have a lower basic metabolic rate (fat cells have slower metabolic rates than other cells like muscle cells). In some families, food is used to try to compensate for the child's disabilities. (“At least he or she can enjoy eating.”).

Preventing Obesity – a Family Affair

Prevention of obesity is the only sure method of promoting optimum nutritional health. Preventing obesity for individuals who have Spina Bifida is a family affair that must begin early in a child's life and continue indefinitely. Fortunately, if healthy eating and exercise habits are begun early, they can become part of a very enjoyable lifestyle, rather than one that is perceived as a life of deprivation.

Most eating behaviours and food likes and dislikes are learned in the context of home and family. Thus, by modeling and teaching healthful eating habits, family members have a chance to improve the child's health. This may be difficult, especially for families where eating patterns and genetic factors have led to obesity being commonplace. When a child has Spina Bifida and family members are somewhat frustrated by their inability to correct their child's underlying disabilities; making this contribution to health and well-being can be very rewarding.

Strategies for Success

The most helpful strategy for preventing obesity is to help the child view food as a necessity for growth and activity rather than as a reward for managing the difficulties of daily living. The goal is to condition the child to perceive food not as an emotional, but rather a physical, necessity.

Children can learn about good nutrition as they help plan family meals and shop for ingredients. Remember, children cannot consume food that is not available!! Caregivers need to purchase nutritionally sound, healthy foods using the "Food Pyramid" [see “dietary advice” information sheet) as a guide. Most food servings should come from fruits, vegetables, bread and cereals, fewer from dairy products and meats, and only a small amount from foods high in fats, processed sugars and other carbohydrates. Remember that fat has 9 Calories per gram while carbohydrates and protein have only 4 Calories per gram. Therefore, decreasing fats can have the greatest impact on weight loss.

Food should be eaten at regular times during meals that are pleasant and that take enough time for individuals to eat slowly and realize when their hunger has been satisfied. Treats and snacks should be limited to times when a little extra energy is really needed and should be both nutritionally sound and enjoyable. Food and visual reminders of food should be removed from the environment and other cues for increasing enjoyment of life, such as posters about exercise or hobbies, should be substituted. Entertainment should rarely centre on food or meals. Children should receive only non-food rewards for positive behaviours. Children need to learn to distinguish between boredom and hunger, and also to enjoy foods other than those with high fat or high sugar content. Studies reveal that if such foods are strictly limited from our diets, we lose our taste for them and crave them less and less.

The second important strategy is to help children who have Spina Bifida enjoy exercise. Physical activity has two benefits; it burns calories and can decrease hunger by resetting the body's "thermostat." Most physical activities that other children enjoy can be adapted for children who have mobility impairments. Horseback riding, tennis, swimming, and wheelchair sports like basketball and track are life-long activities that most children love and families can enjoy together. Community organisations such should be encouraged to create such opportunities for individuals who have physical disabilities. Small children can be even more active as they learn to complete some helpful tasks around the house. Such activities not only burn calories, but also help children feel good about themselves as capable people who can help others. Watching television or sitting in front of a computer are activities that demand few calories, and should be limited.

Weight Reduction

Once people become obese, losing weight is hard to do. Most can only lose about 10% to 15% of their body weight, and even these individuals usually regain this weight after their strict program of diet, exercise and behaviour modifications is withdrawn.

Once people with Spina Bifida have become obese, it is even harder for them to lose weight than it is for others. It is not impossible, however! If an individual is motivated to lose weight and limits caloric intake while also increasing exercise, weight can be reduced. The assistance of a nutrition consultant may help in such cases, since a very low calorie diet -1,000 calories per day or even less--may be needed. It can be difficult to create an interesting, enjoyable and nutritionally sound diet using so few calories. Weight reduction strategies should be started one by one, so the individual and family can become used to new patterns of living. Trying to do too much at once is often overwhelming and self-defeating. Most importantly, the individual should recognize that any weight reduction contributes to good health, and that losing weight should be don e in small measures and will take a long time. Small weight losses should be celebrated, (but not with food!) because they really are important!

In summary, individuals who have Spina Bifida are very likely to become obese unless they, with the help of their families and friends, prevent gaining too much weight during their childhood and adolescence. Obesity has many negative consequences, so it needs to be prevented or managed to achieve optimum health and quality of life. The benefits of healthy eating and sufficient exercise for individuals who have Spina Bifida are numerous and important, and last throughout life. Perhaps no other single intervention will make such a positive contribution to long-term good health and quality of life.

DEPRESSION AND ANXIETY

Feelings and Disability
 

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Many people with long-term physical difficulties don’t like using the word ‘disabled’ about themselves but it is the word that the government uses to talk about people who have a long-term health problem. If you need to claim social welfare payments then it may be a ‘Disability’ Allowance or if an employer or a college treat you unfairly then it will ‘Disability’ law that is being broken. So we will carry on using this word here.

Everybody, disabled or not, goes through times when they feel ‘down’ or low in mood, sometimes for days or weeks at a time. Sometimes we know why we feel this way - losing somebody close, or having other things go on in our lives which we don’t want, for instance.

Because we can’t control everything that happens in our lives, bad things are bound to happen from time to time. What this means is that feeling down is ‘normal’. If someone close to you dies it can take many months to get over it but during this time your mind is working hard at getting used to the loss. At first, you may be sad all the time; gradually you are sad for less time and eventually you may be able to remember the person with fondness and even smile at good memories. We call this feeling ‘grief’ and the process ‘grieving’. But other changes in our lives can make us feel the same way. Breaking up with a close friend, losing a job we like, and so on. While we are getting used to the changes, we will feel low.

Sometimes we don’t know why we are feeling this way but there is always a reason. Sometimes we are so used to trying to deal with what is making us feel low that we stop noticing it. When the feelings go on for a long time this can be puzzling for us, and for those around us who can see that there is something wrong.

Living with any type of disability is difficult. It can often seem that other people around you get what they want more easily. It may seem to you that there are things you would like to do that you will never be able to. Other people are not always kind if they know you are disabled. But because disabled people have to cope with these things every day, they sometimes stop realising how hard it is, begin to feel very down and sometimes don’t know why. If you get down sometimes, try to think how someone who is not disabled would feel if they suddenly became disabled and had to cope with all the problems you have to cope with all the time. You are probably doing very well to cope with all your problems.

Actually, a lot of people who become disabled, as a result of accidents for instance, do find it very hard to cope and get very down before they learn how to cope.
Even when we know why we are feeling low it is often helpful to talk about it to somebody else. Sharing problems with somebody you trust is usually a good idea, especially if they have experienced the same difficulties themselves. If that isn’t possible then you can sometimes find people who are trained to help.

 

So, if you feel down for a week or so, try:

To talk to someone else you trust about how you feel

To remember that what you are having to cope with is difficult

Not to get angry with yourself –remember that you are coping with something that some people couldn’t cope with at all

To treat yourself as sympathetically as you would want to treat somebody else who was going through the same thing.

To keep on meeting friends and doing the things you know you enjoy- even if you don’t really feel like it you will probably feel better afterwards.

Depression

If you feel low for more than a few weeks and you don’t know why; if you can’t tell yourself to ‘snap out of it’ or if the things that usually interest you don’t cheer you up then you may be experiencing what is often called ‘depression’ and you may need special help to start feeling better.

Most disabled people are not depressed and disabled people who become depressed do not stay depressed. This is another way of saying that it may not be the disability itself which causes depression but how people cope with it. If you become depressed it may be that you have to cope with change or something new.

The difference between feeling ‘down’ and feeling depressed is that when you are depressed, the feelings are deeper and last for longer. If you are down, you can often tell yourself to do things to make you feel better; that doesn’t work when people are depressed because they lose interest totally.

What might happen if you or someone you know gets depressed?

• Feeling sad nearly all the time
• Feeling hopeless about your future
• Feeling like a failure or feeling worthless
• Not enjoying things you used to enjoy, losing interest in things you used to be interested in, losing interest in sex
• Feeling that you are to blame for a lot of what goes wrong
• Losing confidence in yourself
• Wanting to harm or kill yourself
• Crying or feeling like crying although you didn’t cry easily before
• Being restless a lot of the time
• Lack of energy and feeling tired a lot of the time
• Sleeping much more than usual or having trouble getting off to sleep
• Feeling bad tempered a lot of the time
• Wanting to eat a lot more or a lot less than usual
• Not being able to concentrate as well as before, finding it very difficult to make decisions
• Smoking or drinking too much. Relying on social drugs.

If you have had a number of these problems for more than a couple of weeks, or if you know someone who seems to have these problems, then getting help from someone else is important.

Remember, becoming depressed is not being “silly” or a sign of weakness. There are always real reasons for becoming depressed and help is available.

You may be a part of a support group or be part of an organisation (such as SBHI) which can help, so try this first.

Most people who become depressed go to their own doctor, who can make a further referral if specialist treatment is required.

Dealing with Depression

There are two main ways of dealing with depression:

• Talking about problems to a trained person
• Taking drugs called ‘anti-depressants’ which are prescribed by a doctor.

Your doctor should be able to refer you to a counsellor or another suitable therapist who will be able to find out why you are depressed and help you to deal with it. When this is available, this is first thing to try.

You will probably need to see your counsellor every one or two weeks to begin with and you should expect to be seeing them for at least 6 months – feelings of depression tend to get better quite slowly but you can expect to get back to normal eventually.

Anti-Depressants

If counselling is not available or if you are really depressed, your doctor might suggest you take anti-depressants.

It is true that taking pills will not solve problems but sometimes people are so depressed that they lack the mental energy to sort things out. Anti-depressants will sometimes help by making you feel more like tackling problems. Sometimes you can take anti-depressants and have counselling at the same time but the type of anti-depressant needs to be carefully chosen by your doctor for this to happen.

Most anti-depressants are not addictive and you can come off them quite easily when the time comes. You need to be taking them for 3 to 4 weeks before they start to work and you need to take them for at least 3 months before you can tell whether they are working for you. Doctors prefer depressed patients to keep taking them for 6 months.

Anti-depressants can make you feel peculiar or a bit poorly when you first start taking them but most people manage to cope. If you get severe problems you should tell your doctor. Do not increase or reduce the amount you take without discussing it with your doctor. Drinking alcohol or taking other drugs while you are taking anti-depressants can be dangerous – again, discuss this with your doctor.

When you feel the time has come to stop taking anti-depressants, discuss this with your doctor. You will usually need to reduce the amount you take gradually.

How to help other people who become depressed

People who become badly depressed can lose interest in helping themselves and they may have started to shut themselves away from other people. It may seem to you that they are not interested in being with you.

Underneath the depression though, there is usually a strong need to be close to others.
If they don’t seem interested in seeing you, try to show that you still want to see them. Listen to them if they want to talk about problems.

Being with a depressed person is often no fun – be prepared for their gloomy thoughts and lack of interest.

Don’t tell them to “pull themselves together”.  Being badly depressed means that they can’t do this.

Most important, accept that you may not be able bring them out of depression yourself and try not to feel responsible if you seem to be failing.

If you are worried, suggest that they go to see their doctor if they haven’t already been. If they won’t, don’t be afraid to tell someone else who can help, even if the depressed person seems not to want you to. It is important that they get to see someone who can help without becoming too emotionally involved. The person’s doctor, a teacher or a parent are people you could tell.

A depressed person may not want you to do this at the time, but may well thank you later when they can understand that you needed to help.

Supports

There are a many supports available to help you if you are feeling depressed or to help someone you know who may be feeling depressed.

SBHI Family Support Worker (FSW)

The role of the FSW is very diverse and is guided by the needs of our members, their families and carers. Our aim is to work with our members, their families and carers by providing guidance, advocacy, emotional and practical support.  Visit the Family Support page on this web site.

Aware Helpline PHONE: 1890 303302

Aware supports those who are directly affected by depression. Aware operates a helpline from 10am to 10pm Monday to Wednesday and 10am to 1am Thursday to Sunday.  The Aware Helpline is a non directive listening service for people affected by depression, either as sufferers or as family and friends. The Helpline offers a non judgemental listening ear to people who may be distressed or worried, or just need someone to talk to. You can also call the helpline if you are worried about someone who may be depressed or for information about depression or Aware services.

Bodywhys (The Eating Disorders Association of Ireland) Helpline: 1890 200 444

Bodywhys’ core services centre on providing confidential, non judgemental support for people affected by eating disorders.  The helpline is open for two hours each week day offering a non-judgemental and confidential support and information service.  Callers can access names of local health professionals, details of all Bodywhys support services and other voluntary organisations where appropriate.  Bodywhys also offers support groups, an online support group and email support.

Childline Helpline PHONE: 1800 66 66 66

Childline is 24-hour service for children and young people up to 18 years of age. Childline is open 365 days a year (even Christmas Day!). It offers support to young people through the Childline listening service over the phone. You can call Childline for a chat or to talk about any problems you might have.  Calls to Childline are confidential and we don’t have caller ID or trace any calls. It won’t cost you anything to call Childline and our number won’t show up on the phone bill. http://www.childline.ie/

 

Teen-Line Ireland TEEPHONE: 1800-833-634

Teenline Ireland is a national helpline for teenagers. Teen-Line provides a listening and support service

Samaritans Phone: 1850 609090

Samaritans is a confidential emotional support service for anyone in the UK and Ireland. The service is available 24 hours a day for people who are experiencing feelings of distress or despair, including those which may lead to suicide. You can talk to Samaritans at any time of the day or night.

Samaritans is a confidential emotional support service for anyone in Ireland. The service is available 24 hours a day for people who are experiencing feelings of distress or despair, including those which may lead to suicide. You can talk to Samaritans at any time of the day or night.

 

Text Someone NOW

You can also access support and information on where to go for help in a crisis through your mobile by texting the word HeadsUp to 50424.

The Samaritans also offer a 24:7 text support service, 365 days a year, for anyone in emotional distress.  This service is available nationwide.  To receive the service, simply send an SMS text message to 087 2 60 90 90

 

Spunout

Spunout provides information, support and advocacy opportunities to young people throughout Ireland. Their website provides hundreds of fact sheets on all aspects of youth health and culture including mental health, suicide and sexual health as well as a searchable database of help contacts, moderated discussion forums and an advocacy platform for young people to get heard. www.spunout.ie

 

Bebo

www.bebo.com/yourmentalhealth 

          
Black Dog

Ireland's interactive comprehensive self-help site for men and women coping with mental distress. It is a place to visit, take your time, exchange views and advice, get angry, relax or get information which might be useful. www.theblackdog.net

 

HSE Infoline PHONE: 1850 24 1850 (Callsave)

The HSE provides thousands of different services in hospitals, health facilities and communities throughout Ireland. To find out more about what services are available in your area you can access information through their website and or email queries. You can also contact the HSE infoline if you have a question about your health services, your entitlements, or how to access HSE health or social services in your area? Contact the HSE infoline from 8am to 8pm, Monday to Saturday on Callsave 1850 24 1850
http://www.hse.ie/en/HealthServices/

 

GROW Infoline PHONE: 1890 474474

GROW is a Mental Health Organisation which helps people who have suffered, or are suffering, from mental health problems. Members are helped to recover from all forms of mental breakdown, or indeed, to prevent such happening. GROW mental health groups and support services are anonymous, confidential and open to all. If you would like information on GROW or the location of your nearest GROW group, email (info@grow.ie) or contact our National Information Line (1890 474 474).

 

Teen Counselling

Teen Counselling provides a counselling service for adolescents and their families who are experiencing a wide range of problems and has a special interest in the area of substance abuse in the 12-18 year age group. Mater Dei Counselling Centre, Clonliffe Road, Dublin 3. Tel: 837 1892 http://www.iol.ie/~croscare/MDeiTeen.htm

 
The National Counselling Institute of Ireland

As a professional body committed to furthering the promotion of counselling as a professional service throughout the community, the National Counselling Institute provides a Find a Counsellor service that allows you to search our database for a suitably qualified Counsellor in your area. www.ncii.ie 061 216288

 

The Psychological Society of Ireland

PSI is the learned and professional body for psychologists in Ireland.  Their website offers a service that allows you to search for a registered psychologist that meets your needs, from amongst their database of Psychological Society of Ireland Registered Members.
http://www.psihq.ie/

 

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