Can Depression that Started in Sweden be Treated with Exercise?

man running

man runningImprovement to mood is one of the most obvious effects of exercise. But can exercise actually be used as a treatment for depression?

An article recently featured in the Stockholm daily newspaper Dagens Nyheter says it can.  Jill Taube, a Swedish psychiatrist, has written a book about how exercise can help to cure mental illness. She points to studies that show the effects of exercise not only last longer than those of antidepressant medication, but physical activity appears to prevent the recurrence of depression better than antidepressants.

Exercise: A Prescription for Depression

Taube’s exercise ‘prescription’ echoes what the health and fitness experts have been saying for at least 20 years: a combination of cardio and strength activities for 30-45 minutes, at least 3 times a week. Obviously those who have not been exercising need to take it easy to begin with and build up to this. But the idea that there is something people can do themselves about depressed mood is great news for those who want to recover from depression and need more hope in their lives (although it might depress the drug companies!).

Antidepressent Use in Sweden, an Increasing Trend

What makes this research so remarkable is that Sweden has one of the highest rates of antidepressant prescription. According to OECD statistics, Sweden has the 3rd highest consumption rate of antidepressants in Europe (after Iceland and Denmark). And antidepressant prescription is on the rise in Sweden. The National Board of Health and Welfare (Socialstyrelsen) has issued guidelines to try to cut the rise of prescribed depression medication and encourage the use of talk therapy. But these changes will take time because the culture around prescribing antidepressants needs to change. A survey of GP attitudes from 2004 indicated that most doctors considered drug treatment with antidepressants alone was effective and sufficient in most cases of depression. Less than half the doctors thought that psychotherapy was required as a complement. This is despite reliable evidence of the effectiveness of talk therapy against moderate depression and the combination of counselling with medication being considered best practice. There is also evidence that effectiveness of antidepressant use really depends on the therapeutic relationship between doctor and patient.

Relief for Anxiety and Depression through Exercising

As a doctor, Taube is concerned with biochemical explanations of how exercise actually works and the article in Dagens Nyheter explains some of this. For the layperson it’s enough to know that it does work. Therapists are familiar with the way depression often goes hand in hand with anxiety (I often describe them as hanging around together, like schoolyard bullies) so it’s no surprise that exercise appears to help relieve anxiety as well.

Taube, who has herself experienced depression, is a dancing enthusiast but explains that other exercise like taking a walk or spin class can give the mind a break from Anxious Thoughts. We know that mental health difficulties can generally lead to poor physical health not only because problems like anxiety and depression stop us from getting out and enjoying life, but because the drugs that are prescribed for them have a slowing down effect on those who take such drugs. So people who are taking medication because they are affected by anxiety, depression and other mental health problems often gain weight and suffer cardiovascular difficulties or musculoskeletal problems because they don’t move themselves as much. Of course it is important to still seek the help of health professionals, particularly if you are experiencing a severe depression or having thoughts of wanting to end your life. Talking together regularly with a doctor, counsellor, therapist or psychologist is a better alternative to just taking drugs on your own.

In 2012 I will be continuing Walking-Talk Therapy  for those who want to have therapeutic and coaching conversations ‘on the go’. Going for a walk together through Rålambshovsparken, along Norr Mälarstrand or around Riddarfjärden is a great physical alternative to sitting down. Of course, if you prefer to talk inside, we can still meet over a tea or coffee in my private consulting room at Fridhemsplan. And for those who are outside of Stockholm or prefer more privacy, online counselling is always available over the internet.

Send me an email or call me on 08-559 22 636 and leave a message if you would like to make an appointment.

Jill Taube’s book “Själ och Kropp” is widely available from book retailers and online, but unfortunately only in Swedish at this stage.

Therapy for Winter Depression or Seasonal Affective Disorder (SAD) in Stockholm

candles

candlesDepression? Seasonal Affective Disorder? The cold and darkness of Sweden at the end of the year is one of the hardest issues for expats. For those of us from relatively warm countries (take note Aussies and South Africans) and others who have never lived this far north, the Swedish climate can be a real shock.

 

In Stockholm in December it is dark by early in the afternoon. I’ve talked to many expats who really struggle at this time of year. Some have even internalised the problem and have started to think they are depressed or have seasonal affective disorder (SAD). Actually, it is really normal and natural to have trouble with the Swedish winter even if you have been here a long time. I’ve gathered the advice of a range of expats and long term visitors to Sweden who I have met in my counselling work as a therapist. Here are their practical suggestions.

1. Get Active

Jawbone Up BandIt’s natural to not be as active at this time of year but it’s also good to still move your body. Too cold outside? Try training indoors. Friskis och Svettis offer lower cost fitness memberships that include classes for around 3000 crowns a year (even less if you are a student). That’s not even the cost of 1 glass of wine each week! And you don’t have to be particularly athletic to get something therapeutic out of a gym. Try a 30 minute brisk treadmill walk while listening to your favourite music on an iphone or mp3 player. Taking in the scenery of everyone else working out while you go at your own pace can make you feel alive again. Get a Jawbone and set a goal of 10,000 steps a day on your Jawbone. There are plenty of sports you can do in winter as well, like indoor volleyball and swimming. This is the time of year that hot saunas are really appreciated.

2. Rug Up

Feeling colder can make a difference to your mood so it is worth making the effort to be as warm and cosy as you can when you are walking around outside. We lose most of our body heat through our extremities so pull on a wooly hat that covers your ears (called a mössa in Swedish), gloves, warm footwear and a scarf. Have you discovered the advantages of long underwear yet? A decent winter coat is also helpful of course.

3. Go easy on the grog (and the glögg)

The end of the year is a time for celebration but keep in mind that alcohol is a depressant. Bottled spirits tend to lift our own spirits for a short time but the after effects can pull us down the next day or for several days after a few too many. Drinking more than usual will lead to swings in mood and, in the absence of other helpful strategies, some people develop a dependency on alcohol that can create real problems for them, their partners and families (and I am not referring to Systembolaget being closed on a Sunday). Other ways of picking yourself up include exercising regularly, spending time with friends, attending expat group events and…

4. Getting yourself into the light

phillips wake up lightFortunately Stockholm is not completely dark in winter (some places in Sweden are). But the daylight doesn’t last for long. Make sure you make the most of the light and walk around in it during the day if you can. There is some evidence that even a few minutes a day direct daylight on exposed skin (i.e. your face) can make a difference to your physiology and mood. It costs nothing but your time (most of which involves putting on and taking off your warm clothes). Some people use wake up lights and special desk lamps that reproduce the tone of daylight to enlighten their winter days. For example, the Philips Wake-Up Light (available here from Amazon) has a number of settings to replicate sunrise and and even a selection of natural sounds.

.

5. Make plans and look forward to them

Fellow expats agree there is nothing like a break for a week or two somewhere warm and sunny to change your perspective. Swedes know the advantages of travelling during the darker months and flock to the Canaries (no pun intended!), Egypt and even farther destinations like India, Thailand and Vietnam during December and January. Book your tickets early to get the cheap deals. If you don’t mind the snow, there are some great ski-fields within Sweden. Or you can jump on a party boat to Helsinki, Tallin or Riga. If you can’t afford the time or cost of getting away, make plans to do some exotic activities at home or treat yourself to some special meals. Apparently the restaurant Koh Phangan on Skånegatan makes you feel you are really in Thailand.

6. It’s okay to hibernate a little

Winter is a time of closing down in contrast to the expansiveness of summer. In many ways we have lost touch with the natural rhythms that we see in the animal world. So what if you want to sleep 10 hours instead of 8? That’s how it goes with the cold and darkness. You aren’t depressed and you don’t need medication just because you don’t feel like going out and want to stay in bed more than usual. Lower your Expectations and stop giving yourself a hard time. You can make up for it in the Spring. That brings me to…

7. Embracing the experience

Canon CameraIf you can’t beat it, make the most of it. Not all the Swedes take off to sun and sand in wintertime yet they still manage to stay sane and get on with their lives. It might take some time to get the knack of it but those who emigrated to Sweden a number of years ago tell me that there is something to be said for embracing the climate at this time of year. They have taken up photography or cross-country skiing (even with the skis that use little wheels when there is no snow), planned Melodifestival parties, visited the Christmas markets, lit up their apartments with small candles, played and recorded music, painted, drawn, read and written books. The Swedes are a nation of creatives. Even if you just document what you are seeing or hearing around you and how you are feeling in a journal or blog you will be in the company of many who have gone before you in the great musical, literary and artistic traditions of Scandinavia.

8. Remember: It will pass!

From 22 December the nights are shorter and the days start to get longer. When the snow arrives, it can make a difference as well, reflecting daylight or streetlights and generally making everything a bit brighter. Many people do find January is the worst month for them simply because they have endured the darkness and low temperatures for so long. So even getting a sense of the length of winter can help and this often happens for expats once they have been in Sweden for a couple of cold seasons.

If being in Sweden has lost its purpose for you at this dark time of the year, maybe it is time for a meaning-recovering conversation over a hot cup of tea or coffee. Narrative therapy and other collaborative counselling practices can provide you with the opportunity to reconnect with your motivation and find a new lease of life to last through winter. If you want some practical help, together we can construct a plan or strategy to get you through to lighter times. Contact me through the website or call and leave a message on 08-559 22 636 if you would like to make an appointment.

Thanks to Elin, Steve, Evelyn, Barbara, Marie, Matthew, Janet, Paul and Rob for their contributions as well as to all my clients who have found or are finding their own ways of dealing with the darkness and cold.

Mental Health in Sweden: Normal Behaviour Becoming Harder to Achieve

bar graph image

bar graph imageIs psychological disability in Sweden really stopping so many from working?

(Update from June 2013: This post is actually about the pathologising of human experience: how more and more people are being labelled as ‘disordered’ or ‘deficient’ by the psychiatric profession in Sweden and the expectation that individuals fit with certain norms of behaviour. Some bloggers have attempted to use my words as evidence that Sweden is suffering from collective mental breakdown due to a breakdown of gender expectations and norms. I am certainly NOT suggesting that. If anything, taking a more gender neutral approach in education and other social functions has contributed to greater personal freedom for Swedes. However there is an increasing requirement for individuals to be diagnosed with an illness or disability in order to access support. Read on for more…)

The Swedish newspaper Dagens Nyheter has run a story about the sharp increase in numbers of young people leaving work and put onto disability pensions (known as ‘activity support’ for those under 30 and ‘sickness benefits’ for those 30-64).

Fewer young people are returning to employment after being pensioned off work, a phenomenon that has been referred to as a ‘ticking time bomb’ in view of the fact that many may be destitute by the time they are 30.

Sweden is not alone here. There were increases in young people starting on disability support in other Scandinavian OECD countries between 1995 and 2007. In Finland the increase was 5 percent, in Denmark 10 percent but Sweden had a massive 80 percent increase! That’s almost 30,000 people under 30 in Sweden who are on a disability pension.

Psychiatric Disorders Becoming More Common in Sweden

So why the huge increase? Well 73% of those young people have been given medical psychiatric diagnoses such as autism, ADHD and Aspergers. Could it really be that Sweden had such a rise in psychiatric disorders and mental disabilities compared to our Nordic neighbours? Is it something in the water?

As a counsellor, therapist and coach, I am often asked about such diagnoses and the increases. I think people expect me to say something about teenage computer gaming culture or genetics or to applaud the ‘science’ responsible for discovering such a vast previously undiagnosed population.

But what I see happening in Sweden is that so-called ‘normal’ behaviour is becoming more defined. The goal posts for what is considered normal are being brought closer together. The tolerance for non-conformity and extremes of mood and behaviour is reducing. It is becoming harder to be ‘lagom’!

In Sweden, psychiatric health has been constructed as a medical problem. Both anxiety and depression are treated primarily with medication. But drugs are also heavily prescribed for those whose attention, communication techniques or social skills fall outside what is measured to be the norm. And unfortunately, those norms are progressively less accommodating.

There’s no doubt that the pathologising of human experience is increasing in many countries. More people are being diagnosed as depressed, anxious, having a mental disability or disordered in some way. And this corresponds to increasing expectations that we fit prescribed ways of being and relating to each other. In workplaces and schools across Australia, the United Kingdom and America, more standards of performance are being established and procedures for selection are becoming more sophisticated.

Fortunately, not all mental health, psychotherapy or counselling practitioners favour responding to diversity with drugs or exclusion and many take a more norm-critical approach. Narrative therapy, Open Dialogue and other collaborative therapeutic practices are approaches which honour what people have to say about their own experience, rather than categorise us using medical terminology.

My hope is that eventually the doctors, psychiatrists, psychologists, therapists and others responsible for measuring, diagnosing and categorising people will see the limitation of these practices. I look forward to a new era when Swedish society ceases to be obsessed with locating its deficits and deficiencies but instead acknowledges the unique skills, competencies and abilities of all individuals. A time when the expertise we bring to life’s challenges is respected and valued by the health professionals we consult and diversity is appreciated rather than shunned. Perhaps then we will see more young people participating in the workforce in Sweden.

Adjustment to Life in Sweden and Therapy in English

Image of a man with stress associated with cultural adjustment

Image of a man with stress associated with cultural adjustmentFor most expats, relocating to Sweden means adjusting to a different culture. Reactions associated with the stress, uncertainty and the upheaval of relocation to another culture are very common for those from English speaking countries. These reactions can include experiences of anxiety, withdrawal, low mood, depression and other mental health difficulties.

In my therapeutic work with people who have moved to Sweden, we often talk about how unexpected these reactions were. After all, Sweden appears to be an orderly place and most people, particularly younger people and those Swedes living in the large cities, speak English. At first it was easy to imagine that life here could be easy and that it would not take long to settle in.

But the expats I talk with tell me they were unprepared for the differences in culture and climate they encountered. They describe low mood, difficulty sleeping, anxious thoughts or constant worries as well as the impact of such feelings on their relationship with partners.

Some people confess a lack of energy or enthusiasm or say they are finding it hard to enjoy life. Some people increase their use of alcohol to help them manage these feelings then find drinking causes further problems or takes them away from what they want from life. Occasionally people tell me they have an unexplained sense of panic they want help to overcome.

So what can you do if you are experiencing difficulty adjusting to life in Sweden?

5 Ways to Take Action and Get Help to Adjust to Living in Sweden

If you are struggling with feelings associated with depression or anxiety after moving to Sweden, here are a few things to keep in mind.

1. Share your feelings

Talk about your feelings instead of bottling them up. Trying to contain or hide emotions can be useful at times but, when they aren’t released, emotions can become explosive or leak out in inappropriate situations.

2. Connect with others

Talking to your girlfriend or boyfriend or sambo might not be enough. The emotions around cultural adjustment can also be a pressure on relationships so it is important to share your experiences with people other than your partner. The language barrier can be difficult but there are also a number expat groups, particularly in Stockholm. Remember that there are plenty of others who have been through similar hard times after moving to Sweden and if you can connect with them it can be helpful to hear other perspectives on how to make it through.

3. Exercise regularly

Particularly as it gets colder, the freezing temperatures and darkness can have us slowing down, staying inside and not being as active. But thoughts and emotions and even sleeping patterns can be positively affected by physical activity. Whether it is bodypump or working out at the gym, football, a regular yoga class, swimming or just a long, brisk walk everyday, keeping up exercise can help.

4. Try to find balance

If you are indoors a lot, make sure you get outside regularly. If you are only spending time with your partner or on your own, make an effort to engage with others. If you are working or studying, give yourself some downtime doing things that are fun or relaxing. If you aren’t working or studying, look into some volunteer work to give yourself a regular meaningful activity.

Trying to adjust to a new culture sometimes has us putting most of our energy into the familiar aspects of our lives but this can result in imbalance. Generally, the Swedes understand balance through the concept of ‘lagom’ and will be more understanding if you tell them you are trying to find balance in your life.

5. Do something today and stop delaying

The most important thing, in my professional experience, is to start to take action right now and not just hope the feelings will go away. They might go away, in time, but they are more likely to disappear when you are expressing how you feel, involved in activities with others and looking after your body and mind.

If you are stuck, meeting with a counsellor, coach or therapist is one way to get on track with the changes you are making. Make a start today on doing something to improve your life in Sweden. Call me now on 08- 559 22 636 or send an email through the contact page. Usually we can meet within a week.

3 Advantages of Counselling in English in Stockholm

rushing for the train

rushing for the trainAnyone trying to find an English speaking therapist in Stockholm has a story why he or she moved to Sweden. When people email or call me about my therapy services they often want help with couples counselling, family difficulties or work issues and career direction.

 

Counsellors working with expats in Stockholm know living in a foreign culture is stressful and are aware of the difference it can make to access counselling in English.

 

1. It’s important your therapist understands you

Often when people start talking and opening up with me about the difficulties they experience, their problems start to ease and even to ‘dissolve’ in the conversation. Sometimes these conversations are about recovering tools and skills used in the past. This is why it is so useful to meet with someone else who is a native English speaker. The experience of therapy is better when your therapist understands the expressions, subtleties and nuances of your language as well.

Professional counselling is more than just listening and a good therapist should be able to ask you questions that will open up new perspectives and encourage you to think in different ways. But just ‘getting it off your chest’ is a start and can lead you to feel better, more motivated and more capable of using skills and tools for dealing with anxiety, depression and changes in mood.

 

2. Nothing beats experience

The problems people experience after moving to Sweden are not always attributable to just one cause, but can be a result of the interaction between several factors including the climate, Swedish cultural differences, family expectations, relationship issues or adjusting to life as an expat. Having myself relocated to Stockholm from an English speaking country I relate personally to the challenges of living in Sweden.

Resolving psychological matters is not always straightforward but my professional experience is that talk therapy and other appropriate treatment usually results in finding new ways forward. This is the power of therapeutic conversations: the possibility to make new meaning out of situations where you have felt stuck or lost or hopeless.

 

3. More options than the Swedish healthcare system

Sweden has one of the best public healthcare systems in the world. However it isn’t perfect and can be slow, bureaucratic and offers little choice of psychological treatment other than a limited course of CBT (cognitive behaviour therapy) or perhaps a psychoanalyst who is selected for you. Deciding to meet a private English-speaking therapist means you can choose the approach that suits you and, most importantly, shop around to find a practitioner you like and can relate to.

If you are making the transition to living in Stockholm, or even if you have been here for some time, the freedom to attend counselling when and how often you want might be important to you. Having flexibility around your appointments and not having to queue for treatment can help you to cope and be a factor in your recovery. I always offer to work in with other health providers where appropriate and this is another benefit of using a private therapist who works primarily in English.

 

Available for all English speakers

Whether you are Australian or from New Zealand, British, Irish, South African, Canadian or an American from the US, commencing therapy, counselling or coaching with a qualified professional who speaks the same language can avoid the limitations of the public health services.

  • If you think you might be suffering from SAD (seasonal affective disorder), anxiety, depression, cultural adjustment, drinking problems or stress…
  • If you want one-to-one therapy, counselling for a relationship as a couple or as an individual…
  • Or if you are just looking for a qualified person to be a sounding board’,

I welcome you to contact me and discuss the possibilities of working together in Stockholm.