As you may have read in our earlier blog, feeling unusually low in mood or depressed is common following critical illness or injury.We often meet patients who are feeling uncharacteristically low or depressed, particularly following a hospital admission.

Given the difficulty patients often encounter in accessing high quality psychological treatments, they may consider trialling anti-depressant medication as an alternative.

For mild-moderate depression psychological treatments are advised (NICE, 2009).

National Guidelines (which provide treatment recommendations in the UK) recommend that anti-depressant medication is only prescribed for patients experiencing moderate-severe depression, alongside a psychological treatment.Furthermore, evidence suggests that anti-depressant medication may not be as effective as first thought.

A recent article in the British Medical Journal (BMJ) has been published by Jakobsen et al.

A placebo effect occurs when an improvement is produced by a placebo treatment, which cannot be attributed to the placebo itself and therefore must be due to the patient’s belief in that treatment.In this review paper, Professor Kirsch and colleagues found that anti-depressant medication had a statistically significant benefit when compared with placebo, but not a clinically meaningful benefit.

Feeling low or anxious is not uncommon following admission to an intensive care unit.

This brief blog aims to raise awareness of some of the difficulties patients and their families can encounter following an admission to intensive care.

You may also be interested to read this article from the national press:More than 170,000 patients are admitted to intensive care each year in the UK – and the number of admissions in 2020-21 is likely to be substantially higher.

Patients often experience pain, thirst, sleep deprivation, distressing hallucinations, delusions and disorientation, undergo multiple invasive medical procedures and experience side effects from potent drugs.A state of short-term confusion called ‘delirium’ is thought to be common in intensive care patients, affecting about 40% of patients.

Delirious patients can also sometimes appear depressed, lethargic or withdrawn – this can be easily confused with depression or low mood.As a result of the stressors associated with an intensive care admission, about 40% of patients discharged from critical care experience problems with anxiety or depression and about 23% patients report post-traumatic stress.

Many patients also experience changes to their thinking skills, such as memory, attention or the ability to find the right word.For many patients, these common psychological responses improve independently in the 2-4 weeks following discharge from hospital.

Feeling unusually low in mood or depressed is not uncommon following critical illness or injury.

For instance, up to 30% patients experience low mood in the months that follow a heart attack (Baumeister et al., 2011) or an intensive care admission (Wade et al., 2012).

Patients often describe a sense of irony – that in the weeks that follow discharge from hospital, once they are safely home and surrounded by relieved family and friends, that distressing psychological reactions such as low mood should then start to occur.There are several treatment options for people feeling low in mood after a hospital admission.

We hope this article provides some clear suggestions, to help patients make more informed decisions.The first thing to emphasise is that feeling low after a hospital admission is common and people often recover independently within a month of being home.

Ensuring good sleep hygiene, taking regular exercise, following a healthy diet and (if relevant) smoking cessation are all well-established first-line strategies for improving mood.For some people, low mood can persist, despite implementation of these basic self-care strategies.

In these circumstances, we recommend patients meet with a clinical psychologist or discuss with their GP.The main symptoms of depression are a loss of pleasure in activities that were once enjoyable.

The title ‘Clinical Psychologist’ is a protected term in the UK, which means it can only be used by psychologists who have successfully completed an accredited NHS doctoral training program.

Training as a Clinical Psychologist involves completion of an undergraduate psychology degree followed by a period of years spent developing relevant clinical and research experience.

Post graduate applicants can then apply for a three-year NHS doctoral training programme.

Training as a Clinical Psychologist therefore usually takes eight years or more and leads to the attainment of a Doctorate in Clinical Psychology.Clinical Psychologists apply psychological theory to help people understand and make sense of what they are experiencing, to support the person to help reduce psychological distress and to achieve their goals.

Clinical Psychologists are trained to assess and treat a wide range of psychological health difficulties and draw on multiple evidence-based theoretical models and psychological approaches in their work.

By making sense of these factors, understanding one's thoughts, emotions, physiology and behavior and through the engagement with evidence-based psychological interventions with an experienced Clinical Psychologist, improved mental health and wellbeing can be achieved.Clinical Psychologists are also equipped with the skills to apply psychological theory to working effectively with teams and organisations to support the development and maintenance of a healthy and productive workforce where experiences of high stress and other health problems can create difficulties for the individual and the organisation.