The Truth about Depression

This programme contains some strong language.

It's like a black cloak.

You feel like your brain is crushed,

all you want is to be on your own, isolated.

It's like a wheelchair in your head, Stephen.

Only someone who has had it knows how paralysing depression can be.

You don't want to go to the toilet, you don't want to make any food.

Never mind look in the mirror to see what your appearance is like.

No-one is immune.

You just get to a point where you just think, you know what,

I'm too much of a burden.

It's so terrifying,

and you are in an absolute inner turmoil of despair.

There's a one in four chance

that depression will affect YOU at some stage in your life.

Don't tell me to pull myself together,

don't hurt me because I've got an illness called depression.

Understand me a bit more,

don't be hard on me. Don't stigmatise me.

It's bad enough to get it, but the stigma can make you feel much worse.

This is the truth about depression.

Cathal is facing a milestone, it's his 40th birthday

and he's putting on a good front.

This club, for me, is familiar to me, so it is.

It is one of my safety nets,

so I'm comfortable

with this actual arena here that we're in tonight.

But it's at its limits, the sooner I get home and out of these silly clothes the better,

get a cup of tea in front of me,

and it'll probably take me a long time to wind down tonight,

I don't know if I'll get to sleep because I'm on a high now,

but I don't know, maybe it'll all come shortly after, I don't know.

For the past 20 years Cathal has battled with chronic depression.

If and when I'm told I've got an incurable condition,

sometime later on in life,

I'll accept it better,

but it will be nothing compared to the death

that I have lived the whole of my life.

Every day I have went through death with this depression.

It is extraordinary that thousands of us

in Northern Ireland will suffer from depression,

and yet so many people will feel the need to hide it.

Why?

Because of the stigma.

People with depression are judged to be weak.

Some people even go so far as to think it does not exist.

I wanted to find out the real truth about depression.

Cathal's depression hit him suddenly

when he was a student coming home from Belfast.

I remember shouting at the bus driver, "Stop!" And I had to get off.

What was happening to you?

There was a fear, a cloud just came all over me, so it did,

sheer panic, rush of emotions, I didn't know, Stephen.

It was like a deathly feeling, so it was, and I had to get out.

So I was standing on the side of the motorway

and rang for my father to come and pick me up

and that was the start of my mental health problems.

Cathal didn't leave the house for a year.

It's not the thing you want to turn around and say to somebody,

I think you're mental.

You know, which, undeniably I am.

Whatever way you want to butter it up, I have a mental health problem.

Are you frightened of saying that out loud?

No, I'm not afraid to say it now.

I have absolutely no fear of that stigma that's attached to it.

Accepting the fact that I have a severe mental illness

was the first thing in curing myself.

But for those not able to see their depression as an illness

it is really important to show

what is actually happening inside the head.

Examining the brain through imaging is a relatively new area of science,

it's only been studied over the past 15 years or so.

I've come to the University of Manchester,

one of the main centres in the UK for brain imaging.

The part of the brain

responsible for memory and emotion is the hippocampus.

It is here that depression shows up.

What's fascinating is that the hippocampus in depressed people

behaves differently than the hippocampus in those without the illness.

This is a cut through the brain

and I've just outlined in black the areas with were...

Professor Ian Anderson is leading the research.

There's been quite a number of studies

which have suggested that people who are depressed

don't just have an alteration in how the brain's working,

but also actually in the structure of the brain.

The hippocampus has been one of the areas

that's been most found to be smaller in people with depression.

-Smaller?

-Smaller.

So you've got the hippocampus

which is this part of the brain which deals with emotion.

Yes, and memory.

And if someone develops depression,

are you telling me part of the hippocampus,

the grey matter, shrinks?

Well, that's what we've found.

So a bit like if you don't exercise your muscles shrink,

it may be that the same happens with the brain.

If a bit of the brain that's important isn't functioning so well,

that area becomes essentially smaller.

Prof Anderson explained to me how his studies show

this change in the brain and how treatment affects it.

Our group of patients were people who had been depressed on average about five months,

people who would be getting treatment from their general practitioner.

And what we found was that if we looked at the hippocampus

we found a striking decrease in the amount of grey matter,

that's the part of the brain that's got nerve cells

and the connections between nerve cells in,

in people who are depressed

and this was about a 25% decrease,

so it's quite a striking and staggering change, in fact.

You're dead right it's staggering.

So people with depression in your study

had 25% less grey matter

than those non-depressed people.

In this area of the hippocampus, that's right.

I find it amazing that the brain shrinks when you're depressed.

And that it is actually possible to see those changes for yourself.

What we found after eight weeks' treatment

is we that had a partial, a significant increase

in the amount of grey matter in these areas.

These yellow dots.

These yellow dots are the increase,

but it was nowhere near back to normal.

This increase is only the order of a few percent,

so you're still way down compared to how you would be normally.

If we then look at a group of people who have been well for years

we find that it goes completely back to normal,

so somewhere between eight weeks and a few years

the brain seems to recover fully in people who recover and stay well.

So, I'm sorry to make this so simplistic,

but the better chance you give yourself of recovery,

in other words treatment, getting the right advice,

whether it is talking therapies, antidepressants,

over a longer period of time,

the better chance you have of growing all that grey matter back.

That's what we think.

For those of you who are doubters,

there is evidence that depression actually exists in the brain.

It wasn't always the case.

In the past, people with the illness

sometimes disappeared for months at a time.

Let me just give you a sense of this stigma that there was,

in terms of the infrastructure.

So the main hospitals were located very close to Belfast city centre.

You've got to go a lot further out

for the hospitals for infectious diseases,

and then outside of Belfast, in the depths of the countryside,

the old lunatic asylums.

This is Holywell Hospital,

it was actually built about 120 years ago

for patients who were mentally ill to find sanctuary.

The Belfast asylum was at bursting point

and they needed somewhere like this.

It would be said that when people came out here,

big sweeping driveways in the middle of nowhere,

that once they turned that corner,

they wouldn't be seen for quite a while.

And actually, that's where the phrase comes from,

going round the bend.

In the past, people with depression were called lunatics.

I've been looking through the records of the old Belfast Mental Hospital

that used to be here in Knockbracken.

Here's John.

11th of May, 1944. The war years.

And look, he came in here with a ration book and an identity card.

John didn't have much else.

He had one pair of socks, one shirt, and a gas mask.

Here's Charles. Came in in 1941.

Not very many possessions marked down here at all.

He had one vest,

two pairs of socks, one shirt,

look what it says up the side.

Deceased, no friends.

All property to be destroyed.

This new ward in Knockbracken doesn't even look like a hospital.

Things are very different these days.

Heather had no history of depression.

Everything was great.

She was newly married, and loved her job as a nurse.

She was a first aider on a summer camp,

and then one day her life changed forever

when a child suddenly became ill.

The child came to me saying that he was feeling short of breath

and things just deteriorated very quickly.

What happened?

I don't really want to go into this too much.

Don't go any further than you want to.

He just had a severe asthma attack on the field,

and we rung for an ambulance,

but by the time the ambulance had got there, we had to start...

before they arrived we had to start CPR,

and...

I can see the pain on your face now.

So obviously that's a really traumatic event in your life.

And essentially, Heather,

a little boy died in your presence

and that's something the majority of us will never experience.

Yes.

You know, when you're having a camp and it's all supposed to be fun,

you never think that anything like this would ever happen.

At the time of the child's death Heather was pregnant.

Her depression began when she became a mother herself.

I was starting to panic over things, I'd never panicked before.

I couldn't catch a breath,

my heart was racing in my chest,

I was having chest pain, and just couldn't breathe.

Were you sleeping much?

No. I couldn't sleep.

My head was filled with thoughts of, just,

thoughts of what happened, thoughts of things that could happen,

is something going to happen to my child?

And I would sit and watch her at night.

Heather felt she had to cover up her illness.

On the outside when I went out through the doors

I gave people the impression that everything was OK,

because I didn't want people looking down on me,

or saying, it's just attention-seeking behaviour.

And what people were going to think about me.

America always seems to be a few steps ahead of us

in medical matters,

and I wanted to find out what they were doing.

So I headed off to Missouri.

'ECT, or electroconvulsive therapy, has got a bad reputation,

'thanks in part to films like One Flew Over The Cuckoo's Nest in the 1970s.'

If not a little bit heavy.

-Hello, Dr Conway.

-Hey.

I'll tell you what, you turn that on and I'll be suing you for millions, Dr Conway.

'I wasn't going to have the treatment, of course,

'but I was curious about it, and how it worked.

'It's hard to understand

'how a bolt of electricity to the brain could help depression.'

The whole point of ECT is to induce a seizure.

What a seizure essentially is

is a massive discharge of neurones in the cortex moving in a wave.

Why would you want to do that, how does that help depression?

Over time, when you repetitively do this,

when you repetitively induce these seizures,

it's signalling to the different parts of the brain

that are responsible for maintenance of mood

to produce the normal amount of receptors on the neurones

so that they go back to normal.

Sort of compare it to defibrillating a heart.

'In other words, it's like a computer reboot to the brain.'

Usually about after five treatments or so

the person starts to feel not depressed.

Why the controversy if it's all proven?

I think the whole idea of introducing electricity into someone's brain

is a frightening thing,

and the type of ECT that's sometimes pictured in movies,

like One Flew Over The Cuckoo's Nest,

we've come such a long way since then, so it's very safe now,

and some people would even argue it's safer than medicine,

cos very few people have any problems with it.

Dr Chris Kelly is one of Northern Ireland's leading experts in depression,

he's been working as a psychiatrist for 30 years.

ECT doesn't seem to have the same scary reputation nowadays.

In the City Hospital in Belfast

Chris carries it out on around five patients a week.

We don't use ECT a lot,

it's only for the most severe or refractory forms of depression,

or perhaps in an individual who's had a particularly good response, we would use it.

So it is a very rarely used treatment,

but still the strongest treatment that we have,

and it's really used more as a life-saving treatment

to relieve extreme suffering when no other treatment has really worked.

Anne has had ECT in the past.

When you come out, Stephen, you feel in a daze

and you feel your head is not thinking,

and then through time you feel that this depression is lifting

and you feel elated, you feel, God, I'm not in this black hole,

I feel like I'm alive again.

But it only lasts for a certain time, Stephen.

Because depression is so severe an illness it doesn't cure it.

Anne has had a serious mental illness for the past 40 years.

On top of that she has depression.

How does the depression make you feel?

It feels as if you're just totally alone,

your totally alone within your head.

And then maybe

you get up, dress, you wash, and you look the part,

say, "God, you look well today."

But inside your head you're so depressed,

you feel tired, you feel lethargic,

you feel, you put the kettle on to make a cup of tea

and you haven't got the energy to even make a cup of tea,

you feel so depressed,

you just...

Life is just going on around you

and you don't know what's happening to you.

My sister suffers from MS and I'll say,

"But her head's all right."

She has a physical disability, everybody can see that and help her.

But they think, "Oh, my Aunty Anne's all right, our Anne's all right,"

but our Anne's not all right.

Our Anne has this black hole in her head.

Like a wheelchair in your head, Stephen.

Anne knows only too well the stigma that comes with depression.

People that will say to you the silliest thing in the world,

"What have you to be depressed about?

"You've everything, you've got a good home, you can go here.

"You can take a beer, you can go and visit your friends."

"You're the life and soul of the party."

"You were always good craic when you were young.

"What happened to you?"

It's a state of mind.

Which you can't explain.

People say, "Pull yourself together." "Get yourself on."

-That's the worst thing to say, Stephen.

-Why?

Cos if you could, you would.

You're so depressed you can't do that.

'You have already seen how Cathal struggles with depression,

'what you don't know is that he is a wealthy businessman

'running this engineering plant outside Coalisland.'

You're financially secure?

I'm financially secure. At the minute, yes.

And could probably take retirement.

He's so successful he's been shortlisted

at the Mid-Ulster Business Awards,

but his struggle against his illness is a lifelong battle.

Cathal thought he had his depression under control,

but then, a few years ago, he had another breakdown.

Just as he was trying to expand his business.

Resources were all looked at carefully, and location,

and market,

and the only thing that wasn't factored in

was my mental health resource.

That stress was making his depression worse.

He went from never touching alcohol, to drinking heavily.

The culmination of going on and off medication,

stronger, less,

sleeping tablets,

uppers, downers, alcohol,

coming in the evenings, more alcohol,

to get to sleep, more alcohol,

and then it got to the stage, getting up, more alcohol.

Again, it's hard for me to imagine,

because I see you as this healthy, robust, strong businessman.

We're in a two-storey house, Stephen, as you know,

and I jumped out of the top-storey window.

So how does depression get you to jump out a window?

The thoughts in your head are that nonsensical

that I don't even know what, I was trying to get away from something,

I don't know, I was trying to get away from Cathal, so I was.

Like many people with serious depression,

Heather reached a stage where she didn't think she could take any more.

It was her thoughts of her family that kept her going.

You just get to a point where you just think,

"I'm too much of a burden,"

and I think you get to the point where

you nearly do think that it'd be easier for them,

and you know, looking back now,

I know that it definitely would not have been easier,

and it was definitely the wrong thing for me to think.

Stephen, I'm 61,

I'll have had this ongoing all my life from when I was 19.

I've attempted suicide, I've been so low, I just can't see a way out.

But with the backup that I've got, there's people out there to help.

Why, Anne, why does it get so low

that you decide to try to take your life?

You just feel you're in the way, Stephen,

you just feel everybody's going to be better off without you.

Depression is so severe.

And you attempted it recently?

I attempted it about six to eight weeks ago.

What happened recently?

The police caught me, Stephen.

And got me to hospital.

Because I'd mentioned to a stranger I felt so depressed,

and they must have picked up the sign

and rang to get them to the house.

Did they have to break the door down, or what happened?

They came and they got the key off my neighbour,

my neighbour keeps the spare key,

and they found me in bed with the tablets in me.

And got to hospital and got sorted out, thank God.

In the United States it's estimated that 10% of people

with treatment-resistant depression take their own lives.

Vagus nerve stimulation therapy,

VNS therapy,

has unique mechanism of action.

But now there's an experimental treatment available,

even for the very severe cases.

The vagal nerve stimulator is like a pacemaker

planted under the skin that sends a signal to the brain.

Susan is a teacher who decided to get one fitted

after suffering severe depression for most of her life.

The pulse comes from the battery pack,

it travels along the wiring to the vagus nerve,

and that impulse travels into the brain.

It's no big deal, I can show you the scar.

So that's literally where the little battery pack is.

That's right, it's right in there.

And then they had to make an incision in your neck, did they?

Yeah, I looked like the bride of Frankenstein for a few days!

They typically make the incision in the neck

in the fold, in the natural crease, so as it heals it's less noticeable.

I don't know that you can even notice it now.

I can't notice it, actually, no.

My psychiatrist told me

about this experimental study down at St Louis University,

and I'm so grateful, it's helped me enormously.

I'm still on a lot of medications,

but this has kind of put a floor under me,

below which I can't go,

and if it weren't for VNS and modern psycho-pharmaceuticals,

I would just be curled up in a corner somewhere,

I would just be unable to function.

MACHINE BEEPS

So it's going to run through

and it's going to send a signal to test that the communication

within that whole system is operating correctly.

Oh, it's working.

What do you feel, Susan?

Just feels like a pain in the neck.

It's a stimulation.

You sometimes get an area where it makes you cough.

Are you all right?

Yes, I'm OK.

Can you tell me what you feel, Susan?

Yes, it's just a sharp pain, but it's very brief

and when that happens I know that it's working, so I don't mind.

That's for really severe cases, most people will never be that bad.

I wanted to find out about other treatments available.

The starting point for most doctors are those

modern psycho-pharmaceuticals Susan talked about.

The main ones, antidepressants,

which balance the chemicals in the brain.

They're of moderate effectiveness.

I would say that if you treat somebody with a good course

you'll probably get 6 to 7 people out of 10 better

with an antidepressant trial, in the first trial.

Antidepressants are now one of the most prescribed drugs in the world.

And we take a lot here in Northern Ireland.

In 2011, over two million prescriptions were written here.

Do you never think depression for you will go away?

Never. I know for a fact

that the tablets that my doctor has prescribed,

I have to take them

equally as much as a person with asthma has to take an inhaler.

I have to take my tablets for the rest of my life,

because if I didn't, then my life would be shortened.

Doctors rate depression on a scale from mild, moderate to severe.

When you're on medication they want you to stick to it.

It is important to adjust your lifestyle,

adjust your view to cope with that depression.

And what I mean by that, what I basically mean, is

if you are a diabetic

you would be careful about what you eat,

you would be careful

that you took your medication and your insulin,

and you would moderate your lifestyle.

For severe forms of depression

I do think there is an importance about compliance with the treatment,

whatever that treatment is, that keeps you well,

and an awareness that that may need to go on

for a longer period of time

than perhaps other illnesses, other treatment.

MUSIC: "Coronation Street theme"

Denise Welch, star of Coronation Street and Loose Women,

has decided she is not going to hide the illness

she has suffered from for most of her life.

-Hello.

-Hello, Denise, how are you?

-I hope you like dogs.

-Good to see you. I'm terrified of them!

-She's as soft as anything. Come on in.

-Thank you very much.

-Come on, I'll get the kettle on.

-Thank you very much.

Can you describe what depression does to you,

what words would you put to it?

It's so terribly frightening.

I can't eat anything when I have it, I have absolutely no appetite,

it's like putting sandpaper in my mouth,

I lost two stone in three weeks once

when I had to pull out of a pantomime

and I collapsed in my dressing room with it.

It had a physical manifestation at some points,

my face would twist,

and my hands would... it was almost like

I had Bell's palsy or some kind of arthritic condition,

the depression was so bad.

If someone came to the door

and said, "You've won 23 million on the National Lottery,

or they said, "Your family have been wiped out in an aircraft disaster,"

it would be like that. Nothing.

You are void of feeling and emotion.

And that is the most horrible thing,

for someone who loves their family as much as I do.

And if you lose that and think you won't get better

you will probably end up killing yourself.

And I used to use thought of suicide as a comfort blanket.

What do you mean?

If I don't get better I can always kill myself.

And everyone will be better off without me

because I'm not ever going to be able to live like this.

I can't live like this.

23 years ago, when her son Matthew was born,

depression struck out of the blue.

I remember looking at the sterilising bottles, and my mum,

she'd say, "Go and get the bottles ready, it's four hours, he's ready for his feed,"

and it was like someone had said to me,

"There's Everest, go and climb it now."

That's how it felt, to get off the settee and go and do the bottles.

'It was getting harder and harder for Denise to cover up her illness.

'She was a big star...'

I don't like Duggie asking you to do things that he's too scared to do himself.

'..but was hiding a big secret.

'She was leading a dangerous double life

'when she was filming Coronation Street.

'People just didn't have a clue what was really going on

'behind-the-scenes.'

The police don't look too kindly on people who demand money with menaces.

'I was self medicating, I was using drugs.'

I got myself into some terrible situations.

I was working on drugs.

I was a mess, physically, emotional wreck.

I was driving to get drugs at three o'clock in the morning.

And you crashed, big time, didn't you?

You had the profile, the drink, the drugs,

was it self-destruct

because of depression?

Well, all I thought about was,

I need respite from this feeling,

if alcohol numbs it for a bit,

if cocaine numbs it for a bit,

that's what I'm doing.

CHEERING AND APPLAUSE

So, which mystery star will be the first to stare into fame's unforgiving abyss?

Denise was just about holding it together,

but the depression was taking over.

I remember when I was doing Celebrity Stars in Their Eyes

and there was a wardrobe in my dressing room at Granada television,

and I was in the wardrobe, with the door closed,

thinking that they might think that I'd gone away or left...

I was lucid and I can remember doing it,

but I was so terrified of how I felt.

Denise Welch is Petula Clark!

Metaphorically there's so much in that,

because you're going to walk out a few minutes later...

Being Petula Clark.

But what you're hiding is what you're really like.

Your cowering in a wardrobe.

-And of course...

-..because of an illness.

-Yeah.

# When you're alone and life is making you lonely

# You can always go

# Downtown... #

Denise talks openly,

because she's sick and tired

of those people who say depression isn't a serious illness.

I went to see a GP in London,

and I'd never seen this GP before.

So I'm so depressed, my mum takes me down there, to get some help,

and she said to me,

"Well, you see, dear, I had five children,

"now I just didn't have time to get depressed,"

that's what she said to me.

That's a common reaction to depression,

some commentators have described it

as a designer illness.

How does it make you feel when you hear them say that?

It makes me feel very angry, they've never had it.

"I'm all right. "Pull your socks up and get on with it."

Because the two standard phrases are, "Snap out of it." "Pull yourself together."

HEATHER: When people do say that to you

it puts an awful pressure on you,

because you can't actually do it,

and when you can't, it's like a failure as well,

so I think it makes you worse.

Well, it made me worse.

For Anne, coping with that stigma

is one of the worst aspects of her mental illness.

How do you feel when someone says to you, "Pull yourself together"?

You feel like saying, "You take my head and you be depressed."

Cos people are totally ignorant, Stephen.

Ignorant in both senses of the word,

they're ignorant of ill manners

and ignorant of the knowledge of depression.

Nobody wants to feel depressed.

Do you think I want to feel...

If I could pull myself together, of course I would.

But it's so deep in your head, Stephen, you can't.

I can't pull myself together like a pair of curtains.

The depression is that severe.

Don't shout at me, don't tell me to pull myself together,

don't hurt me any more.

Don't hurt me because I've got an illness called depression.

Understand me a bit more, don't be hard on me.

Don't stigmatise me.

It's nothing to be ashamed of,

it is an illness, depression is an illness.

Those tears aren't running down your cheek

because of your depression,

they're running down your cheek

because you feel that people don't understand.

Exactly, Stephen.

They're judging you.

They judging me, putting a label on me, Stephen.

That is an attitude

that psychiatrists are all too familiar with.

I've worked as

a psychiatrist for 30 years,

and I sadly have looked after people

where depression has been the fundamental cause of them taking their own life.

I have also seen people who come into hospital severely malnourished,

who have been lying in their bed neglecting themselves,

it exists.

I've seen it for 30 years.

Trust me, it exists, it's severe, it's life-threatening.

When Heather got the help she needed

she was found to have had post-traumatic stress disorder,

because of the trauma of a child dying in front of her.

She had to wait for sessions of cognitive behavioural therapy,

so-called talking therapy.

Luckily for her

her church paid for her to go to England for intensive treatment.

And, it worked.

They reprogramme your thinking,

and try to get you to look at things differently.

Are you able to tell me in layman's terms what they actually do,

they sit down and they talk to you, think positive, or what?

One of the issues I had was I found it difficult

to go into crowded areas,

because I was so afraid of somebody taking unwell,

and what they made me do

was put me into those situations

and I had to keep going back

until the fears and anxieties lesson.

Some of them were just very simple things

like I had to go for a walk, had to sit down,

and I had to do stuff that I've enjoyed.

As he said, it's like resetting the balance in your brain.

It's about a person being challenged by the therapist

with regard to the negative views,

their negativity, their assumptions,

and doing homework on the basis of that

to try and restructure their view about things,

and look at a different way of perceiving themselves

and perceiving what is happening outside.

Science has been investigating just that type of negative thinking.

I went to the Oxford Centre for Brain Research

where they have been examining activity in the brains of depressed people.

Their work centres on the amygdala,

a tiny area that's like

the computer hub of the brain.

Just like we saw with the hippocampus,

the amygdala behaves differently in depressed people.

This area here is the amygdala that we're interested in looking at.

Just right in the centre there.

Research scientist Catherine Harmer

took a sample of depressed people

and showed them negative images as she was scanning their brain.

Her results are fascinating.

They show that depressed people's brains exaggerate negative images.

So these are all slices in the brain

taken at different angles showing the response,

the difference in response,

in the amygdala in people who are depressed

and people who aren't depressed.

So what the activity level that you can see in red here

is the difference between those two groups,

the statistical difference.

In other words, the science clearly shows

that people with depression lose perspective,

and part of their brain is much more sensitive to negativity.

So, in someone who has never suffered from depression,

we wouldn't see that orange blob at all.

That's right.

So when people are depressed,

they showed an exaggerated, much bigger response of the amygdala

to these kinds of negative cues from these facial expressions.

So, what an amygdala, with someone who's depressed does,

it makes a mountain out of a mole hill.

It looks at a sad face or a sad incident and it exaggerates it.

That's right, it's more tuned into picking up

even mildly negative or ambiguous cues,

and reacting as if it was a much more negative or much more important stimulus.

But, there is hope.

They also found the amygdala

does respond positively to treatment,

like antidepressants or talking therapies.

Do you know what's crazy about this, Chris?

Here we are, you and other experts

clearly showing me how science

can actually detect literal changes in the brain

and yet we have very educated people

questioning whether depression actually exists.

Yes, and if you actually do a CT, or computerised tomographic image

of the size of people's adrenal glands,

this is not in the brain, this is in the body,

the stress hormone,

they are significantly larger in people with depression,

so you have a toxic environment in severe depression of people

pumping out stress chemicals that are much higher.

Those chemicals are also in the brain as well.

This is a place where history and memory meet.

I'm in the Ulster Museum in Belfast,

at the Troubles exhibition.

It's a quiet, serene sort of place.

You can feel the sadness of the 3,700 deaths we had here.

It's all recent history for many of us.

Researchers have found that 40% of people here

have suffered some sort of traumatic event.

According to a study carried out at the University of Ulster,

Northern Ireland has the highest recorded rate

of post-traumatic stress disorder,

in the world.

And here's something that might surprise you.

It is still going on, years after the Troubles have ended.

Here, at the Everton Centre in North Belfast,

they know all about it.

This unique centre is on the interface

between Protestant and Catholic areas.

What we found is that when you're traumatised you live in the past,

you live with a past events,

it's nearly like you're stuck in the past.

You live in terror of the future,

because you're always waiting for the next bad thing to happen to you,

and you miss the present,

and what we hope to offer here

is an opportunity to give people a chance

to live back in the present in their daily lives.

This is the only place of its type for people

with Troubles-related depression,

and provides a safe place for them to tell their story.

And get help.

We would have

many, many of our clients with the past addiction issues, for example.

Alcohol and trauma, drugs and trauma,

any kind of addiction and trauma is very related,

because how else do you cope?

How else do you get by, how else do you survive?

I was really surprised that most of the people using this centre

are men between the age of 25 and 40.

Many of them are under threat from their own side.

Many of our young people would see the people who either shot them,

took them away, tortured them,

on a regular basis,

and so can you imagine how that heightens their fear

and their terror and many suffer from anxiety and depression,

particularly many of them suffer from a lot of isolation,

and do present with the symptoms of the complex post-traumatic stress.

The ripple effect of the Troubles on families

has never been measured,

but if your parents were directly affected,

the chances are your life will be too.

Back in North Belfast I'm in St Patrick's College,

a stone's throw from the Everton Centre.

Depression, talking about depression.

The charity Aware Defeat Depression

is trying to teach young people what to look out for in this talk

for 12 and 13-year-olds.

I'm going to give you situations in a day,

and if I puts you in better form, say higher,

if it puts you in worse form, say lower.

You wake up in the morning, boys, and it's Monday morning.

Lower.

Straightaway yous are a wee bit below par, aye?

You get to school, you spent all weekend doing a bit of homework

and you forgot it.

Lower.

Then your friend bounces over and tells you teachers off today,

we're going to have free period for two periods and do nothing.

Higher.

You go into the canteen at lunchtime,

your friends are all over there and they're completely ignorant you,

you don't know why.

Lower.

One of them comes over and says, "I didn't see you,"

-tells you the craic, and you play football and you have a laugh.

-Higher.

-You're on your way home from school, you fine 20 quid lying in the street.

-Higher.

Somebody accuses you of stealing the money and takes it off you.

Lower.

Then your friend phones or texts to tell you

the wee girl that you've liked for a long time likes you too.

-Higher.

-Tell the truth!

Somebody fancying you.

See with your mood, boys, that's healthy,

it goes up and it goes down.

Now, if you were suffering with depression it would look more like this,

thinking your friends aren't speaking to you does that to your mood.

Realising they are does that your mood.

Finding 20 quid lying in the street, does that to your mood,

accused of stealing it does that to you mood.

Being told that the wee girl fancies you, you probably just wouldn't believe it.

Does that to your move.

You see what I mean.

Depression is a very sad mood that doesn't change.

The things that normally would have lifted you, given you a wee lift,

aren't lifting you any more.

That's depression, does that make sense?

Michaela knows too well the pain of depression.

I lost my sister to suicide when I was 16. She was 18.

And as I always say in the presentations,

I genuinely believe that if somebody had have come into our school

and told us what I now tell the young people,

she may not have become so unwell that suicide was an option.

I believe very strongly that it is the stigma

that stops people from getting help.

Ideally a healthy mood,

you will be happy and you will be sad,

but it won't go to the extremes.

The talk was changing the boys' thinking.

Do you think you would judge someone?

Not now, like, I wouldn't judge them.

-Why?

-Because I fully understand why.

And it's not fun to make fun of people with depression,

because it could happen to me or anybody else,

so I wouldn't do it now.

There's people you can just ring up and talk to them about it

and let it out,

and you don't have to wreck stuff and stuff like that,

just to get it out, just talk to someone.

When more and more people say the same thing about something,

there's a power behind it, a momentum behind it.

Depression will probably go down in numbers instead of up.

Depression is a disease, like cancer,

and you shouldn't slag anyone about.

Why do so many people do it?

Just cos they think they're different,

but they're not, they're just like everybody else.

You would think we, here in Northern Ireland,

would be a special case,

when you hear about the ripple effect of the Troubles.

But it doesn't sound like it.

In 2011, Professor John Appleby,

a top economist,

reported that Stormont

spends up to 30% less on mental health than England,

despite having over 30% more cases.

We are running considerably

off the pace compared to our cousins across the way.

Is this government, this local administration,

taking mental health seriously?

Well, that's a good question.

What do you think?

I think we could do more.

What type of things do people get

in England that they don't get here in Northern Ireland,

in terms of depression?

Probably better access to psychological services,

specialised doctors with experience in that area.

So you can get talking therapy

far easier on the NHS in England than you can in Northern Ireland?

That would be my understanding.

You can get counsellors, counselling,

easier than you can get here in Northern Ireland?

And yet we pay the same level of tax,

we're not at a discount here in Northern Ireland,

the tax rate isn't cut from 40% to 30% for us here in Northern Ireland.

Yet we are getting a worse deal.

Be better if we had a better deal.

So, how much are things really improving in mental health?

It seems to me like we have a way to go.

If you go back to the '60s,

I think cancer has now made the jump

from a stigmatised disorder to one that is not,

so we live in hope and I hope that that will change,

but we do need to have champions, politicians,

willing to move further in order to improve the treatments,

the access to treatments, for the population of Northern Ireland.

Do you know what strikes me, Chris?

We're educated in modern living now,

how to look after our bodies,

I'm know I'm no shining example of having listened.

Do you not think we should be educated in how to look after our brain?

We're told, go to the gym three or four times a week,

eat vegetables, eat fruit.

So what do you do to protect your brain?

What do you do to protect yourself against depression?

Sleeping well, trying to keep a sensible sleep pattern,

eating regularly, trying to keep a sensible balanced diet,

and having time, some time,

away to have your own, to relax,

as well as avoiding too much alcohol,

and other substances,

these are good things in terms of

trying to avoid depression and mental difficulties generally.

Cathal still manages to be at the top of his game,

but at the Business Awards

he can only get through the night with careful planning.

It's quite an ordeal, I've already planned my day out,

as in number one, I'm beside an exit.

In case you think that happened by chance, no, it wasn't,

I asked for our table to be put beside an exit, so I did.

It's a safety net that I've learnt to put up throughout my life,

and I've also had a few tablets before I came here tonight.

Sport is a big part of Cathal's life.

He's decided to take things into his own hands.

He had Derrytresk GAA ground on the shores of Lough Neagh,

he's using his business skills to plan a £1.5 million centre

to ensure faster treatment for depressed people in his area.

What's your dream here?

On this car park here that were standing on,

hopefully within a year

will be the start of the first ever centre of excellence

for emotional health and well-being in Northern Ireland.

And so because you've suffered from it

you've realised there's not enough help,

so you're going to build a whole facility,

or at least make it happen?

If they build it, they will come, Stephen.

The need for it is overwhelming.

If you're coming here straightaway, you're getting immediate expert help.

Cathal has successfully negotiated a grant of £860,000

to make that dream a reality.

Anne keeps herself well with her medication

and help from Mind Wise,

a charity for people with mental health problems.

That's it, keep going.

I go to Mind Wise in Lurgan, I do boxercise.

-Boxercise?

-Yes.

-You box?

-I could knock you out, Stephen.

I think one of my nightmares would be if I was sent down to the BBC, for you lot to practice on me.

I'd be a woman and you could sort me out too, boy.

Does the boxercise help you in terms of your depression?

Yes, it relieves all the stress in your head, Stephen.

They do have a lot of things

that is around depression to get your mood lifted.

Psychiatrists say that most depression

can be cured within three to six months.

Heather is proof that depression doesn't have to be a life sentence

and it's possible to be cured.

She's made great strides in her recovery.

I feel that I'm getting my life back,

more than I have ever felt.

And every day I still have to make an effort,

I still have to say, right, this depression could be here,

but I just have to stop it, I have to push it away.

You're back to having a life again.

I am back to having a life,

my husband's getting his dinner cooked for him again!

You should be proud of yourself.

I am, I am proud of myself,

but I think one of the important things,

and one of the things that the doctor over in England,

the specialist, he said to me, one day you can use your experience to help somebody else.

And he says you can't just put it in a box

and put it away and forget that difficult period in your life,

you have to one day use that experience and help somebody else.

After around 20 years of suffering, Denise had a breakthrough

when she heard about a doctor who specialised in hormone treatment.

It was a gel treatment and I started to get better.

I always believed the origin was hormonal,

you're not depressed, you have a baby,

and you become seriously depressed, post-natal depression.

You've given birth to another human being in your body,

chemical chaos is so great and greater in some people,

it doesn't balance itself out.

Denise knows how tough depression is,

but she also knows that you don't have to let it beat you.

There is a philosophy that some people have

that it's a form of weakness, you're weak if you get it,

if you get through it

you're fucking strong, let me tell you.

You are strong to get through it.

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