What is depression?

Depression is a mental health condition that causes persistent feelings of low mood or sadness. People with depression often find that they lack motivation, have difficulty sleeping, and, in some cases, have suicidal thoughts.

It is completely normal to feel low or sad occasionally, and most people will struggle from time to time with life’s challenges, but when these feelings become more intense and long-lasting it could be a sign of depression. 

What are the signs and symptoms of depression?

Depression is a common illness affecting millions of people worldwide, and many people put off seeking help because they feel that their symptoms aren’t important enough to talk to someone about. However, depression is a condition that can cause serious psychological and physical symptoms, so it is important to recognise the signs so you can seek help.

Physical symptoms of depression include:

• body aches and pains
• loss of appetite
• tiredness
• weight loss or gain
• low energy
• low libido
• erectile dysfunction
• constipation
• speaking and moving slower

Psychological symptoms of depression include:

• changes in personality
• memory loss
• intolerant of other people
• difficulty with thinking
• concentrating and making decisions
• thinking of harming yourself or others
• suicidal thoughts and attempts

What does depression feel like?

Depression can feel different for different people and it can affect people mentally, physically and even disrupt their routine and day to day life.

People with depression often experience:

• Feelings of sadness and low mood most of the day and almost everyday for weeks or months
• Loss of motivation and interest in most of your normal activities like work, hobbies, sports, etc.
• Feeling helpless, hopeless and empty
• An inability to concentrate or focus
• Feeling angry and irritable easily over even small matters
• Sleeping issues - not sleeping very much or sleeping too much
• Feelings of guilt or worthlessness
• Feelings of low self esteem
• Feelings anxious and worried a lot

Depression can also affect your social life. It can cause a loss of interest in hobbies, lower your libido (interest in sex), make it harder to socialise or try new things, and make you want to avoid spending time with friends and family.

If you are experiencing symptoms of depression which are getting worse and you are struggling to cope, you should visit your GP or local emergency service immediately. 

What causes depression?

Depression is a complex mental illness, so there is no single cause. However, there are a number of factors that can play a role in depression, such as traumatic life experiences, hormonal and chemical changes in the body, social or economic pressures, and genetics (family history). You are also more likely to experience depression as you get older.

Depression is a common illness and can be triggered by different things. People experience depression in different ways, and sometimes without a clear trigger. You are not causing your depression. 

Medication

Some common medications used to treat chronic conditions have been linked with depression according to recent research. Although no single medication has been shown to directly cause depression, some prescribed medications (steroids, anticonvulsants, antipsychotics, hormonal drugs, stimulants, statins and PPIs) have listed depression as a possible side effect.

Medical conditions

Long term illnesses or life threatening conditions can trigger depressive episodes, or increase your risk of depression. This can be because of the condition itself altering the chemistry of your brain or body, such as head injuries, thyroid conditions, or certain cancers. For others, living with a long-term illness can be stressful and exhausting, and can lead to low mood and a loss of interest in everyday activities. 

Pregnancy

Pregnancy and childbirth are major life events that are often stressful, and can put women at a higher risk of depression. Hormonal changes, being responsible for a newborn baby, and the lifestyle changes that come along with pregnancy and childcare are common causes of postnatal depression.  

Family history (genetics)

Genetics may be the cause of depression in some cases, as it is more common in people who have blood relatives with the condition. While most people with a mental illness do not have a family member with the same illness, some studies suggest that having a family member with certain depressive disorders could increase your risk. Currently, very little is known about the genes that may be involved in depression. 

Personality

People with certain personality traits, like low self esteem, introversion, or other insecurities, may be more vulnerable to depressive symptoms. These personality traits or dispositions could run in the family genetically, or they could be learnt behaviour through life experiences. 

Stress

Stress from different life events like financial issues, loss of a loved one, work-related pressures or relationship issues, can be a factor that causes depression. Usually, stress will be a short-term feeling that disappears when you’ve resolved what’s causing it.

Alcohol and Drugs

Some people turn to substances, such as alcohol and other recreational drugs, to help them cope with pressures in their lives. Others may find that these substances can trigger depressive episodes, even when they do not feel depressed sober. 
Alcohol changes how you think and react toward situations, which is why some people turn to drinking to help them deal with stressful or traumatic events. However, alcohol affects the chemistry of your brain, which can make you more prone to depressive thoughts or low mood.

Recreational drug use (like cannabis) can also lead to feeling depressed. Cannabis is often used recreationally to relax, but some people find that it can trigger anxiety or depressive thoughts.

Alcohol or drug-induced depression can happen even with casual use: you do not need to be addicted to a substance for it to cause depressive episodes. However, dependencies or addictions to substances can increase your risk of depression. If you are struggling with alcohol induced depression or drug abuse, you should speak to your local GP for support. 

What types of depression are there?

Depression is a more general term used to describe the condition, but there are different types of depression depending on the cause and symptoms, and different ways to treat them.

• Clinical depression - Clinical depression is depression without a clear trigger. People with clinical depression show symptoms like consistent low mood, feelings of hopelessness, helplessness and thoughts of suicide. They can be treated with antidepressants and therapy.

• Reactive depression - This type of depression is stress-related and is usually caused by stressful life events like the loss of a loved one or job, divorce or major life changes. Its symptoms are usually behavioural (withdrawal from friends and family, not performing well at work or home) and emotional (feeling sad, hopeless, anxious, not enjoying daily life). If reactive depression persists for a long time without improvement, it can be treated with antidepressants and therapy.

• Postnatal depression - Postnatal depression is commonly experienced by parents in the first year after the birth of their baby. In addition to the common symptoms of depression, parents may also show symptoms of lack of bonding with the baby, fatigue, trouble sleeping and scary thoughts about hurting their baby. This type of depression can be managed by a combination of self help (eating healthy, sleeping well and exercising regularly), antidepressants, support groups and therapy.

• Psychotic depression - This is a type of severe depression that includes psychotic symptoms like hallucinations (for example, hearing voices that say you’re worthless) and delusions (self blame and feeling you are responsible for a problem or situation which is unlikely to be true). Psychotic depression can be managed with antidepressants, psychological therapy, social support or Electroconvulsive therapy (ECT), if nothing else works.

• Manic depression - This type of depression is also known as bipolar disorder and mainly affects your mood. The symptoms are normally extreme and people can move from feeling very low and depressed one moment, to feeling high and overactive the next moment. It is usually managed with a combination of medicines and therapy.

• Seasonal (Winter) depression  -  Seasonal depression is also called Seasonal affective disorder (SAD) and is a type of depression that has a seasonal pattern of symptoms. The common symptoms are over sleeping and being less active during the autumn/winter months. Symptoms tend to improve as spring/summer approaches, but therapy and antidepressants can be used as treatment options if it becomes worse.

How is depression diagnosed?

If you are experiencing long-lasting  symptoms of depression, such as feeling low every day for two or more weeks, then you should speak to your GP for support. Your GP can help determine if you have depression by:

• asking you some general questions about your health, how long you have had symptoms, and if your symptoms are affecting your work and home life
• asking you questions to find out if your symptoms are affecting your physical and mental health
• carrying out some urine and blood tests to rule out other causes of your symptoms (e.g thyroid problems, pregnancy or a chronic disease)

Should I see a doctor if I am depressed?

You should always consult your GP first if you feel you have symptoms of depression. If you are experiencing severe symptoms or suicidal thoughts, you should immediately contact your nearest emergency service provider. 

What is a depression test?

Depression can only be diagnosed by your doctor, but there are different tools online that can be used to check if you have symptoms of depression. Depression tests, also known as depression questionnaires or mood self-assessments, are tools used by health services such as the NHS to allow you to self assess your depression. This can help you know if you potentially have depression, and whether you should speak to your GP about it.

Some common questionnaires used to assess depression include:

• PHQ9 (Patient Health Questionnaire)
• HADS (Hospital Anxiety and Depression Scale) 
• NHS Mood Self Assessment
• NHS Depression Self Assessment

Some depression tests you can find online may not always be clinically accurate. If you are taking an online depression test, make sure it’s on a reputable medical website to make sure you're getting reliable results. 

How is depression treated?

Depression can be treated and managed with a combination of lifestyle changes, therapy, and medication. There is no “one size fits all” treatment for depression. Depression affects everybody differently, so you may need to try several different approaches to find the best way for you to overcome your depression.

Can you treat depression with therapy?

There are several types of therapy that can be used to treat depression. 

• Cognitive Behaviour Therapy (CBT) - CBT can help you understand how you’re feeling and why, so you can learn to challenge negative thoughts or behaviours caused by depression.
• Interpersonal Therapy (IPT) - IPT helps you focus on your relationships with others and how you can better manage your communication when dealing with symptoms of depression.
• Psychodynamic psychotherapy - In this type of therapy, a therapist will encourage you to say what’s going on in your mind, to uncover any hidden meanings behind your thoughts and behaviours that may be causing your depression or making it worse.

Can I get counselling for depression?

Counselling is a kind of therapy that helps you to look at how you think and feel about your condition or problems, and explore new ways of dealing with them. A counsellor will provide a safe space for you to talk about your mental health, and will listen to you, and support you, without judgement.

You can get a number of counselling sessions free on the NHS, and your GP will be able to refer you to a specialist counsellor to help you talk about your depression. You can also choose to get private counselling services at a cost.

Can you treat depression with medication?

Antidepressants are medicines used to treat moderate and severe depression. Doctors usually prescribe a course of treatment for a few weeks at a time to see how you react to the medication, but patients are encouraged to continue taking antidepressants until they are symptom-free for 6 months.

Antidepressants work by increasing the amount of certain chemicals in the brain such as serotonin and noradrenaline, which are linked with mood and emotion. 
Some common examples of antidepressants used are:

• selective serotonin reuptake inhibitors (SSRIs)
• tricyclic antidepressants (TCAs).
• selective serotonin reuptake inhibitors (SSRIs)
• serotonin-noradrenaline reuptake inhibitors (SNRIs)
• monoamine oxidase inhibitors (MAOIs)

When taking antidepressants, you will need to take them for at least 2 weeks without missing a dose to start feeling their effects, but it may take up to 8 weeks to feel the full benefit. It’s important that you don’t suddenly stop taking antidepressants as this can put you at risk of experiencing withdrawal symptoms.

You should speak to your doctor about coming off antidepressants safely before making any changes to how you take your medication.

If you don’t see any improvement in your symptoms after 4 weeks of taking your antidepressants as prescribed, you should speak to your GP who may discuss with you about increasing your dose or changing your medication. 

How can I deal with depression?

What self-help is available for depression?

Certain people use self-help methods to cope with depression. Your local GP or mental health services can provide more information about this. Some self help methods for managing depression are:

• NHS self-help guided therapy - your therapist can provide workbooks or an online course you can do at home 
• Self help books, blogs, or videos, recommended by your GP or professional groups
• Apps and online tools - the NHS apps library has a number of online resources to help you manage your mental health

Does exercise help with depression?

Mental health and physical health are closely linked, and studies have shown that physical exercise can help to improve the symptoms of depression, and can even help prevent it. Exercise can benefit the mind by releasing endorphins into the brain which make you feel happier, improving self-esteem, and relieving stress. 
Your GP may recommend exercise to help support other treatment options for your depression. 

If you have not exercised for a long time and are concerned about how it will affect your body and health, you can discuss this with your GP, who will support you with the right activity to start with.

How can I support someone else who has depression?

If someone you know is struggling with depression, there a few ways you can offer your support to them:

• Be willing to listen to their concerns and accept them without judgement
• Be patient with them
• Keep communicating with them
• Get information about services that may be helpful for them
• Encourage and support them to stick with their treatment and therapy

If they start showing signs that their depression is getting worse (for example if they are having suicidal thoughts), you should encourage them to seek professional help.

Further support for depression

Are there depression support groups?

Support groups can help people struggling with depression by helping you meet other people going through similar challenges. There are various forms of support groups available across the UK, both face-to-face and online:

• The Mind website has information about local support groups
• Your local GP or mental health services can help you locate depression support groups in your area
• There are online forums like Sane or Togetherall where you can meet other people dealing with depression or other mental health problems

What charities help people with depression?

There are a number of mental health charities across the UK that can provide support and help to people with depression (or similar mental health problems) and their families.

• Bipolar UK helps people living with manic depression or bipolar disorder
• CALM (Campaign against living miserably) provides support for men aged 15 to 35 at risk of committing suicide
• Men’s health forum provide support for men going through stress
• Mind provides support for people with mental health problems like depression
• Depression UK is a charity that supports people with depression

Depression helplines

There are helplines available that provide advice and support for depression over the phone. Many are open 24 hours a day 7 days a week. They are:

• Mind Infoline 0330 123 3393
• YoungMinds 0808 802 5544
• CALM 0800 58 58 58
• Rethink Mental Illness 0300 5000 927
• Samaritans 116 123 (free 24-hour helpline)

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