Depression and Anxiety

Anxiety and depression are terms that many of us are familiar with, although it can be more difficult to describe them or to recognise how or whether they might be affecting us.

Many people will experience some type of mental distress at some point in their lives, and sometimes this can be more severe than at others. 

People with disabilities such as spina bifida and hydrocephalus are perhaps more likely to be affected by depression or anxiety than people in the wider population.

Why might people with spina bifida and hydrocephalus be more likely to be affected by anxiety and depression?

There could be a variety of reasons:

  • physical problems causing distress, such as pain, illness; limited opportunities to be outdoors or take exercise if mobility is affected; frequent hospital stays or for long periods
  • cognitive effects of spina bifida and hydrocephalus: this can affect how individuals may process information, deal with their emotions, or use coping strategies to handle challenges
  • psychosocial factors: Shine members have repeatedly mentioned examples including societal attitudes and stigma, the built environment, lack of autonomy in one’s own life (who make decisions about what happens to you, and when) benefits, money, work, relationships, social support, and effects of illness and hospitalisation on many of these things.

Mental distress is often said to be a result of an imbalance between the demands placed on someone, and resources available to that person to cope. So many people with hydrocephalus, spina bifida, or a range of similar conditions, can often face many demands whilst resources to cope may not be enough.


Features of anxiety can be very physical, commonly:

  • feeling your heart pounding or racing
  • feeling hot, flushed, sweaty and unsteady
  • breathing may become rapid and more shallow
  • feeling agitated, unable to relax, and having difficulty sleeping
  • gastro-intestinal disturbances: stomach-churning
  • dizziness, possibly nausea

Severe anxiety can show itself as a preoccupying worry or fear, very often with a focus on future events and possibilities – which may not always be likely or unavoidable – and our emotional responses can override the more rational and measured part of our mind.

Anxiety results from an automatic stress response when something frightens or upsets us, sometimes known as ‘fight, flight or freeze response’.

This involves the sympathetic branch of our nervous system being activated and chemicals like adrenaline and cortisol entering our bloodstream. For our ancestors, this response would keep them safe from very real, physical dangers, preparing them to fight or to run away (or perhaps stay really still to avoid being found – as happens to ‘rabbits in the headlights’).

We need a certain level of stress to make ourselves do anything – we would otherwise be resting all the time. Some people actively seek an ‘adrenaline rush’, and words like ‘arousal’ and ‘excitement’ carry much more positive connotations although very similar bodily reactions.

These strong reactions, however, can nowadays also occur in response to threats that are not physical – we cannot run away from bills, bad news, etc. If we are very distressed, or excited, for a very long time without relief, this can cause alterations in our brain and body (muscle tension is very common; high blood pressure is not unusual; the way our body uses sugar can also be affected. Depression can also follow periods of chronic stress.

Anxiety, thinking and stress management

Because anxiety can be such a powerful reaction, our focus is often entirely on how afraid or upset we are. If our mind is preoccupied by something that has happened, or worrying about what might happen, we will often lack the ‘presence of mind’ to concentrate on doing something at the present time. This can prevent us from thinking more positively and perhaps looking for solutions to problems that we might face.

Managing stress can help us to keep anxiety’s effects under some kind of control.

Mindfulness is a technique that requires a lot of practice to work really well, but aims to help us live in the present moment, rather than being carried away with all sorts of other thoughts.  

There are a number of different types of relaxation techniques, including Progressive Muscle Relaxation, that aim to reduce the unpleasant physical symptoms of anxiety. Either written guidance or videos can easily be found through internet searches, ideally through respected sources like the NHS.

Click here, for an example.

By reducing the stress levels and focussing on ‘now’, we stand a better chance of dealing with things in a practical way.


Typical features of depression are persistently feeling low and sad. One difference from anxiety is the tendency to ruminate (go over and over the same thoughts) on past regrets and failings, and feelings of guilt – people who are depressed may use the term “I should have” a lot – although there are often feelings of hopelessness for the future.

People who feel depressed can often label themselves as pathetic, useless, maybe unattractive, or may feel everyone else is better than them, or has an easier life.

People might cry more than usual, but sometimes depression makes people feel unemotional and less able to cry.

It can be very difficult to feel satisfaction or pleasure (or sometimes for good feelings to last after a pleasurable event), and there is often reduced, or no, interest in otherwise enjoyable activities – such as talking to other people, food, sex or hobbies, etc.

Sleep may often be disturbed – either sleeping more (although not feeling refreshed), or being unable to sleep enough. Some people may feel permanently tired and lack the motivation to do anything at all, nor to see the point of trying to do anything.

Persistent thoughts about dying or even suicide are potentially serious effects of depression, and people should seek medical help – urgently if necessary – if they or someone they know is having suicidal thoughts.

When should I look for help?

Anxiety and, especially, depression, can become serious problems, so if things are getting unmanageable, seek help.

Signs that it is time to seek help might include:
  • not being able to do things you have to (self-care, going to work, family responsibilities); housework
  • frequent bouts of crying (more than usual); increased agitation and irritability – unable to ‘be’ where you are, in your own skin
  • persistent negative thoughts, which also interfere with sleep; perhaps complete preoccupation with one troublesome issue, or weaving lots of problems together in your mind
  • continuously feeling weak / tired / sick / no appetite
  • if you are thinking of killing or harming yourself, get urgent medical help!

Essentially, big differences from what is normal for you, and aren’t because of an obviously physical problem (physical problems should not be dismissed as possible reasons).

Some ways of coping might not be so ideal. If you notice the following things are happening and you feel unable to get them under control on your own, maybe they are signs that you could do with some help:

Avoiding the problematic issue completely, or doing nothing 

Some problems will not go away just by avoiding them – like unpaid bills or benefit applications. If you need help, ask for it. Avoiding activity and people altogether, over a prolonged period, is likely to make things feel much worse.

Ignoring your distress

Unpleasant feelings are unlikely to go away on their own, especially if they have persisted for a few days. Don’t let stigma or what others think stop you from taking that initial step in looking for help – the first step can be tough, and needs a bit of bravery.

Drugs, alcohol and smoking

These can make you feel better in the short-term, but the need for them gradually increases, and it can be very hard to stop using them. Illegal drugs can seem so tempting for people at their most vulnerable times. The people that sell them also know this.

Taking your frustration out on others

Targeting innocent people around us with our own anger is unlikely to be helpful, or encourage them to want to help us. Some psychotherapists use terms to describe how this might show itself: projection – a tendency to put the blame for our own distress, guilt and shame onto other people around us; transference – transferring our feelings about someone else to an innocent person (e.g. responding to a new partner based on our experiences with a previous partner).

If you feel that the descriptions of anxiety and depression above apply to you (or to someone you know), then the first step is to try to speak to someone that you trust.

Distressing feelings and thoughts can be very hard to manage if they just stay in your own head; sometimes, just putting them into words can be helpful. To a point, friends and family are fine, but very deep distress can also cause people who are emotionally involved and care about you to become upset themselves, so seeking further help might also be important.

Getting help

The main ways of accessing help will include:

Speaking with the GP

The GP may prescribe anti-depressants, and / or refer you to psychological therapy. In some areas, you can self-refer to psychological therapy services.

You can find out more here.

Not all mental health services seem to take into account that some people have cognitive issues as well as mental health issues. Some people find neuropsychology referrals helpful. This would usually start with a referral from the GP.

Private counselling

Counsellors are trained to listen, and can help you look at things differently. In many cases, you would need to pay for this. It is wise to check whether the counsellor is registered with a renowned association, such as the British Association for Counselling & Psychotherapy. Contact practitioners to ask what experience and knowledge they have of your particular conditions.

Voluntary sector support

Organisations like Shine may be able to help with some of your problems and be someone you can speak to, but others focus particularly on mental health, such as SANE and MIND.

Young Minds

Young Minds can give important support to parents and young people.


The Samaritans are a voluntary ‘listening’ service. At the time of writing, contacting them is free, and can be done at any time of the day or night. Sometimes just saying your worries out loud can change the way you feel, and you don’t need to feel suicidal to contact them.

Cruse Bereavement Care

Bereavement can have a big impact on mental wellbeing. Cruse Bereavement Care are a national organisation who specialise in supporting people affected by bereavement.


Anti-depressants do not simply make very real problems go away. Indeed, neither do alcohol or illicit drugs, nor many interventions. What they may be able to do is affect how you feel and think. Not all of these medicines help everyone, but for some people, anti-depressant medication is really important in their wellbeing or recovery from mental health problems, and may help them to address – or seek help to address – practical problems they are facing.

As with any medication, they are most effective if taken as prescribed and other instructions are followed.

With any intervention, it is really important that you want it and agree to it. This applies to treatment for mental health. If you are reluctant to ask for or accept help, it may be worth asking yourself why this might be. Becoming depressed or anxious, and seeking help or accepting treatment, are not signs of weakness. It is vital that stigma should not prevent people from getting help.

If you have any other, serious diagnosed mental health conditions, these may require more specialist input, so don’t delay speaking with a doctor if you are experiencing difficulties.

Helping yourself 

More positive ways of trying to challenge or manage symptoms of anxiety and depression might include:


Almost anything is better than spending long periods of doing nothing. If you have made yourself do something despite feeling demotivated, take time to reflect on this and praise yourself for making the effort.

Getting out 

Being in the same place all day for days on end can have a negative effect on mood. Of course, this can be enforced by physical issues, but often depression is ‘telling’ us not to bother. Being around people, physical activity and daylight are all possible benefits of getting out regularly, and can reinforce that we are not victims of depression’s effects.

Breathing or relaxation exercises, or Mindfulness

see Anxiety, thinking and stress management, section, above.

Keep learning

Learning new things can give a sense of achievement and capability.

Helping others

This is subtly but significantly different from ‘putting others first’ or making yourself feel less important than other people. Choosing to give of yourself – perhaps through voluntary work – can really feel good and increase self-esteem.


Music exists to reflect and influence feelings. Gentler tunes may help you relax, more upbeat music might motivate you. Heavy metal, rap or punk music might help you vent frustrations, but do bear neighbours in mind if you like it loud.

Things you enjoy

Whilst depression can reduce our ability to feel pleasure, it can also make us not bother trying anything.

So try to do things you enjoy, such as:

  • visiting a nice place
  • watching a DVD you like (especially something that makes you laugh)
  • a phone call to someone who usually makes you feel better (beware of continually using the same person too much – people have their own limits of what they can handle)
  • read something absorbing (but not too controversial or emotional)
  • looking through old photos – good memories need looking after and to be refreshed!

Exercise is not something that everyone can do, every day, but it can be valuable in various ways:

  • helps body to use sugar, fat and other chemicals differently
  • requires effort – giving you a reason to feel proud
  • improves circulation of blood and lymph, which is good for health
  • can help to relieve muscle tension
  • can be enjoyable
SMART goals

By setting ourselves goals (or having others help us do this) that are Specific, Measurable, Achievable, Realistic, and Time-related, we might be able to give ourselves evidence that we can do things that we want and have a degree of control in our lives. These, again, can be very personal.

There are a number of resources online, but it is advisable to go through respected websites such as those mentioned previously.

What works for different people and the choices people have available to them are very variable, but understanding how mental distress may be affecting you can be an important stage in doing something about it.

You are not alone in feeling depressed or anxious. You do not have to face everything all on your own. Seek help if you need it. These are not signs of weakness; taking steps to address these things is a brave move.

Support team

Shine’s support team are also here to talk through anything with you:
Call us on 01733 555988 or click here to email us. 

Our office hours are Monday to Friday, 9am to 5pm.
We aim to respond to all enquiries as quickly as possible!

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