Living Well with a Long-Term Health Condition: 9. Coping with Low Mood and Depression

Why this leaflet?

This resource is intended for people who are living with, or have recently been diagnosed with, a long-term health condition. There is some detail about why living with a long-term condition can make you more vulnerable to low mood and depression; and some advice on how to manage this if it happens. This resource is appropriate for anyone, especially if you are living with a long-term condition or know someone who is. You may need to adapt things slightly to your own situation and it can take a little time and patience to learn to cope with your mood in the best possible way. If you have concerns about anything or how to adapt things to your own particular needs, please ask your GP or your health care professional.

Low mood and depression

Everyone experiences periods of low mood. Sometimes it can be when there are things happening in our lives that we are finding overwhelming or hard to cope with. It can be as a result of unwelcome changes to our lifestyle or the loss of things which we enjoy. This can cause loss of confidence or self-esteem. Sometimes it can be associated with loss and bereavement. Sometimes periods of low mood can happen for no obvious reason. Periods of low mood can last a few days, months or much longer.

Short periods of low mood are fairly common and often right themselves but if low mood has gone on for a much longer time and seems to be happening for no apparent reason then it might be a sign that it is depression. You could think of depression as a more severe kind of low mood.

Some people are more vulnerable to low mood too. This can be due to a number of different reasons and/or a combination of factors. We do know that people with long-term conditions are more vulnerable to low mood and depression. Often this may be because the condition itself might limit other opportunities and because it can be hard and tiring living with many physical symptoms.

** It is also important to remember that that there are also some kinds of depression that are very different in cause and treatment – you may have heard of ‘Bipolar’ (sometimes called Manic Depression) which is a mental illness and requires different treatment. Please remember that the advice and suggestions in this resource are to help with low mood and depression, not these particular types of depression. If you are worried about your low mood, seek help from your GP or health professional who will be able to give you further advice.

Long-term health conditions and low mood

There is a lot of research that shows that shows that people with long-term health conditions are more vulnerable to low mood and depression. About 40% of people who are living with a long-term condition also show symptoms of depression. It is also known that symptoms of low mood can make the symptoms of long-term conditions worse and vice versa. There are many possible reasons for this.

When you are diagnosed with a long-term condition many aspects of your life may have changed or you may be recommended to change some things. You may have experienced a period of symptoms that you did not understand. It may have been a relief to finally have a diagnosis or a fear and worry about what may happen. If you have lived with a condition for a long time you may have to cope with symptoms on a day-to-day basis, medication and other treatments, and the loss of things you might have enjoyed in the past.

Loss. There may be many things that you have lost. Loss can create several strong emotions.

You may feel angry – ‘why did this happen to me’, ‘it isn’t fair’. You may feel the best way of coping with it is to pretend it isn’t as bad as it is and avoid the treatment or advice you have been given. You may feel numb with shock, unable to take in what is happening or feel unable to do anything about it or get together the courage that you need to cope with this new situation. You may feel very low – tearful and emotional – and unsure how you are going to move forward. All of these emotions can be related and be very very powerful. After a period of experiencing such strong emotions some people seem able to make a plan and get on with what they have to cope with, but it is understandable that many people find this much harder and a longer period of low mood might set in, or come and go.

One of the other things that may happen when you have a long-term condition is that you lose the opportunity to do some of the things you have enjoyed or that have been important to you. You may have had to change your job, change your hours or even give up work altogether. This may have affected your finances for you and / or your family. You may have found that you have had to give up or change other activities that you enjoy. This may have affected your quality of life and the enjoyment you can now get from things. You may find that you have had to change the way you do things, and this affects the enjoyment or fulfilment you can get from things. You may not have had a chance to build or maintain friendship networks, or opportunities, that give you a sense of self, support and purpose.

You may find that your long-term condition takes a lot of time. There might be appointments that you have to attend for your health, or your condition. You might have had to slow down or do things differently. It might be frustrating and depressing if you have to repeatedly explain to other people about your condition and the problems associated with it. Sometimes people even feel that they lose their sense of self and become ‘the person with [your condition]’ rather than the person you used to be.

You may have found that living with your long-term condition takes a lot of energy. You may get tired more easily. Your condition may be painful. There may be side effects from medication. All of these things affect your quality of life.

There are therefore lots of losses and changes that can be associated with living with a long-term condition that can make us more vulnerable to depression or feeling low. Unfortunately, it can be a bit of a vicious cycle. If you feel low, all of the other things in life or day to day routine can sometimes feel like too much effort. Your condition can feel it is getting worse and it can be a difficult hole to climb out of.

Symptoms of low mood and depression

The symptoms of low mood and depression can often look similar. The main difference is that depression might go on for longer and begin to interfere with your day-to-day life and be harder to shift. The items marked with an * are symptoms that can be more common in depression.

A general feeling of lack of energy and motivation. It can be really hard to find the energy to do things, even little everyday jobs, like shopping or jobs around the house.
A loss of interest in seeing people or wanting to keep in touch with people. Even if you do see people sometimes it just doesn’t seem enjoyable or feels like ‘too much effort’. Sometimes people say it is like feeling numb or ‘going through the motions’.
A loss of pleasure from doing the things you might normally enjoy.
Tiredness and fatigue.
Tearfulness – people who are depressed will often say that they are more tearful than usual.
* Being tearful about things that you are not directly concerned with, like hearing sad stories on the news. You might find yourself thinking a lot about sad stories you might hear and being really preoccupied with these.
Loss of confidence. It might seem really hard to try new things or worry that something you are doing will go wrong.
* Loss of interest in looking after yourself or others – taking less interest than usual in your appearance, for example.
Sleep problems.
Loss of appetite or a change in appetite.
Anxiety – worrying that things might go wrong.
Loss of concentration or a change in your normal level of concentration.
Irritability – perhaps having a short fuse, getting angry or irritated more than usual or having a low tolerance to other people’s mistakes or behaviour you don’t like.
Withdrawn – not wanting to talk to people.
* Moving or speaking slowly and without any energy or interest in your voice, so much so that other people might notice.
* Thoughts that won’t go away that you might want to end your life.

Lack of energy and motivation

This is one of the most common symptoms of low mood. Sometimes it just seems as though everything is just too much of an effort and the enjoyment or benefit you will get from doing something just outweighs the effort of having to do it. This can often be associated with feeling even more tired than usual. Your mood might seem ‘flat’, as though there isn’t any enjoyment from things.

This pattern can become a vicious cycle. It can seem like it is a huge effort to do things, and it can seem overwhelmingly tiring. The more tired you get the harder it is to find the energy to do things. This is even harder if you are also coping with the symptoms of a long-term health condition, like pain or fatigue. Sometimes tiredness can also be a side effect of medication.

Coping with lack of energy and motivation

Many people find that the most successful way of coping with lack of energy and motivation is to try to start doing things again in very small steps. Your aim is to very gradually increase what you are able to do. Sometimes the steps need to be very small.

Set yourself a goal: Try to set yourself a goal of what you want to achieve. This often works best if it is a SMART goal. Each of the letters of the word SMART is a reminder of how to maximise the chances of achieving your goal.

Take the example ‘I want to go walking more often’. Have a look at the table below and see how you can make sure this is a SMART goal.

		The vague way!	The SMART way!
Specific	Make your goal as clear as you can. Make sure your goal is about just one thing you want to do.	‘I want to go walking more often’.	‘I want to walk once around the circuit of the park every day’. If this is too hard just at the moment you might need to start with a smaller step like ‘I am going to walk to the bottom of the garden each day’.
Measurable	Make sure you can measure your goal – so that you know when you have achieved it.	If you just say I want to go walking more often, how will you know if the distance or time you are walking is changing or improving?	You will know when you have achieved this.
Achievable	Make sure the goal is something you can work on right now in your life as it is at the moment.	Maybe walking around the park is too hard for you just at the moment – try and find another goal that you CAN do.	You used to get enjoyment out of doing this and would like to be able to do it again.
Relevant / Realistic	Make sure your goal is relevant to your life at the moment, and fits in to your current lifestyle.	Maybe there isn’t a park near you, or you don’t want to do this. Try and find something you DO want to do.	There is a park near you, and you would like to be able to take your children to a playground there.
Timely	Make sure you put a date or a time when you want to achieve this goal by.	When do you want to have achieved this? If you don’t put a time down, it is hard to stick to your goal and easier to say to yourself ‘I’ll do it tomorrow’.	If you put a time down, you have something to work towards and you start to see yourself achieving something.

Try to stay connected to people

It is easy to feel isolated and not want to socialise with people when our mood is low. Sometimes it is just too much effort. You may feel embarrassed about how you feel. You may worry that you will be bad company and make other people feel low too. If you are not doing very much you may think you have nothing to talk about.

You may worry that other people will ask you too many questions about how you feel, or about your long-term condition. If you don’t want lots of questions, try to tell people in advance. Then when you do meet up with people the time you have together might be more relaxed and you will feel less pressured. That way there will be less room for misunderstanding.

Even if you don’t feel like meeting a lot of people it can really help to talk about how you feel. Try sharing your feelings with a friend or a family member that you trust. Sometimes just sharing how you feel can make you feel better. The friend or family member doesn’t have to provide the answers, just listening can help.

If you find it hard to talk to someone directly, emailing or texting can be helpful too.

Some people feel more comfortable talking to people they don’t know so well or prefer to keep their worries private. There are organisations that can offer specialist advice and support for many different long term health conditions. You might want to try and find an organisation or a helpline for the health condition that affects you. It can be helpful to hear that other people are experiencing much the same and this helps to feel less isolated.

Try to find the best ways of staying connected to people that work for you. Experience and research shows that if you are able to stay connected to people it can really help low mood and depression.

Notice what helps your mood

Make a list of the activities, people and places that normally help to lift your mood. It can help to think back to things you have done in the past that have helped you feel better.

Some of these things can help:

Arrange to meet a friend.
Watch your favourite TV programme or listen to some music.
Cook a simple meal.
Phone someone you haven’t seen for a while.
Try and get some fresh air in a garden or a park.
Try writing things down.
Try a crossword or a puzzle.
There are many adult colouring books available – this can be a very absorbing, satisfying and soothing way of helping mood. It can be very rewarding to see a coloured picture emerge.
Try to have some nice things around. If you are spending a lot of time in one room or one space, try to make that space as nice as possible. A small bunch of flowers, a houseplant, a scent or something you enjoy looking at can make a big difference.
Try to get outside if you can. It is not always possible to get outside, and you may not have access to a garden or a green space. We do know that spending time in natural light is very helpful for lifting low mood.

Sometimes when you start something different or new it doesn’t feel like it is helping. Persevere and try doing something more than once and you may find that slowly it becomes more enjoyable or rewarding.

Try something little and often and don’t expect too much from yourself to start with. You may find that if your mood is low your concentration is not as good as usual.

Look after yourself

When you are feeling down it can be really hard to feel good about yourself. Your health condition may have affected the way you look or how you feel about your body.

Do what you can to look after yourself:

Eat as healthily as possible. If you have been given any advice about diet for your condition, try to stick to that advice. Try to stick to a routine for eating. Even if you do not feel like eating try just to have something small.
Try to get good sleep and find as good a sleep routine as you can. If you would like more advice about sleep, try the leaflet in this series: Your Sleep
Look after your hygiene. This might not seem important when you are feeling low, but small things like having a bath or a shower, getting properly dressed or washing your hair can make a big difference to how you feel.

Your thoughts

We all have thoughts all of the time. They are a little bit like the commentary that is always running in our heads. Many of these thoughts affect how your run your day and how you feel.

Have a look at the following resource in this series which explains thoughts and how they affect how you feel in a bit more detail:

Making Your Thoughts Work for You

When you are low you can be particularly vulnerable to negative thoughts that can make your mood even lower and can affect your physical symptoms too. It can be easy to get into a bit of a vicious cycle with thoughts.

These might be the kinds of thoughts that people with a long-term condition can have:

‘There’s nothing I can do that is fun anymore’

‘Everything is so much hard work’

‘I spend all my time at hospital appointments’

‘People must think I am so boring, I have nothing else to talk about’

‘I am hopeless’

‘I am always so tired’

‘Everything is so painful’

Have a look at the words above that are in bold. These kinds of words can creep into our thinking and can have quite a negative effect. We can all fall into these kinds of traps from time to time. Have a look at the table below and see whether there is an alternative way of thinking about something.

Thought	Problem	Another way
There’s nothing I can do that will be fun anymore.	This is an example of predicting the future and overgeneralising. Try and focus on what you can do now, today, rather than think about the future.	There are quite a lot of things that are hard at the moment. I am finding small things to do that I enjoy.
Everything is so much hard work; everything is terrible.	This is an example of catastrophising. Try and focus on small things that you can do and be realistic.	I will set myself a small goal every day, so it seems like I am achieving something.
I spend all my time at hospital appointments.	This is an example of overgeneralising.	I do spend a lot of time at hospital appointments but when I can I am doing other things too.
People must think I am so boring. I have nothing else to talk about.	This is an example of mind reading and jumping to conclusions – it is tempting to double guess what other people are thinking, but it isn’t necessarily true.	I am the same person I was before this happened. If I don’t have much of interest to talk about at the moment doesn’t mean I am a boring person.
I am hopeless.	This is an example of labelling. Just because I have a long-term condition doesn’t mean I am hopeless.	Just because I am not well doesn’t mean I am hopeless.
I am always so tired.	This is an example of thinking the worst. Beware of words like ‘never’ or ‘always’.	I am doing what I can and realistic about the goals I set myself.
Everything is always so painful.	This is an example of thinking the worst. Beware of words like ‘everything’ or ‘nothing’.	I do notice that there are sometimes of day when things are less painful.

What we do know from research is that we can change our thoughts to lessen the impact they can have on our physical feelings or the symptoms of a long-term condition.

Changing your thoughts

Can you change your thoughts? Yes, you can! With a bit of practice, you can learn to change your thoughts!

An important first step in changing thoughts is to understand how your thoughts can be unhelpful. It can be quite useful to keep a diary.

When you are feeling particularly overwhelmed try and note down what you are thinking. Try to identify the words you are actually saying to yourself. What commentary is going through your head? Try to think about the words that you are saying to yourself rather than the feeling or the emotion that goes along with it? Sometimes it can be quite hard to separate this, but it helps if you can!

What if I don’t believe it?

To start with it can be hard to say some of these things to yourself. Perhaps you don’t really believe what you are thinking or saying. It might almost seem as though you are ‘kidding’ yourself. The important thing to remember is that by learning to change our thoughts it helps us to start believing things too. Thoughts really are that powerful.

Try to identify the ‘thought traps’ that you are most vulnerable to. You might not really believe it at first but stick with your new thought and it will begin to sit more comfortably with you. This does take patience and may take a little time. Always work on one thing at a time.

Next steps

If you think you are vulnerable to falling into ‘thought traps’ try and keep a diary to find out a bit more clearly about when and how you might get overwhelmed.

Try to notice the times when you are most vulnerable to any of these thought traps.
Have a look at the ideas in this leaflet and see if you can put any of them into practice.
‘One step at a time’. It always helps to take things slowly and patiently and will help you to notice any changes.
Share the ideas in this resource with someone who can support you.
The ideas in this resource form the basis of Cognitive Behavioural Therapy (CBT). If you feel that you need some more guidance to help you change your thought patterns you can get CBT. This is available on the NHS. You might ask your GP to refer you to a local Talking Therapies Service – previously called IAPT (Improving Access to Psychological Therapies), or you can refer yourself.

Low mood and anxiety

Low mood and depression can sometimes be linked to anxiety. There might be lots of reasons for this. If it is an effort to do things, or you feel you are not achieving very much, you may lose your confidence in your ability to do things, and this can lead to anxiety. It can be hard to restart something you have not done for a long time. Worrying about how things may go wrong or focussing on the bad things in life, or even the world, can be a common symptom of low mood and depression, and this can lead to anxiety – worrying about things that may go wrong.

Have a look at the following resource in this series which explains this in a bit more detail:

Managing Anxiety and Worry

When to seek help for depression and low mood

Low mood and depression can be very common when you are living with a long-term health condition. Try some of the suggestions in this resource, and the other resources in this series. They may help to lift your mood. Sometimes it can feel like a long and hard journey and your mood might feel very dependent on things that are happening around you rather than anything you have done.

It is always important to tell someone how you feel especially if you begin to experience some of the symptoms marked with a * in the earlier section ‘What are the Symptoms of Low Mood and Depression’. These can be signs that you may need more specific treatment for depression. Depression can also last for a long time (sometimes months or years), and if you begin to feel completely overwhelmed by your mood ask for help.

It is very important to seek help if you begin to experience persistent thoughts that you want to take your own life or that there is no point in living. The Samaritans are available 24 hours a day. There is always someone available to talk to who might be able to help in an immediate crisis. If you think you might be vulnerable, find the number of your local Samaritans and type it into your phone so that it is there if you need it. There might be other people or services that you can be sure you have in your phone too, in case you need them.

Summary

It can be very hard to live with low mood and it can take a lot of energy to keep things going or even feel better. Try to understand how your mood might be linked to your long-term condition and how you feel physically and mentally. Understanding your body and the way you feel is often the best start. Try setting small achievable goals and following some of the other suggestions in this resource and it may help.

The following leaflets from our ‘Living Well with a Long-Term Health Condition’ series might help you:

Making the Most of Your Life
Living an Active Lifestyle
Managing Anxiety and Worry
You Sleep
Problem Solving
Making Your Thoughts work for You
Finding More Help – psychological help explained
What is the Mind Body Link
Coping with Low Mood and Depression (current leaflet)

King’s Patient Advice and Liaison Service (PALS)

This is a service that offers support, information and assistance to patients, relatives and visitors. They can also provide help and advice if you have a concern or complaint that staff have not been able to resolve for you. The PALS office is located on the ground floor of the Hambleden Wing, near the main entrance on Bessemer – staff will be happy to direct you.

You can find their website here.

Tel: 020 3299 3601 Fax: 020 3299 3626 Email: kch-tr.pals@nhs.net

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Written by Dr Clare Cooper, Clinical Psychologist for the IMPARTS programme, February 2023.