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Depression

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Depression



Introduction 

Depression is more than simply feeling unhappy or fed up for a few days.

We all go through spells of feeling down, but when you're depressed you feel persistently sad for weeks or months, rather than just a few days.

Some people still think that depression is trivial and not a genuine health condition. They're wrong. Depression is a real illness with real symptoms, and it's not a sign of weakness or something you can "snap out of" by "pulling yourself together".

The good news is that with the right treatment and support, most people can make a full recovery.

How to tell if you have depression

Depression affects people in different ways and can cause a wide variety of symptoms.

They range from lasting feelings of sadness and hopelessness, to losing interest in the things you used to enjoy and feeling very tearful. Many people with depression also have symptoms of anxiety.

There can be physical symptoms too, such as feeling constantly tired, sleeping badly, having no appetite or sex drive, and complaining of various aches and pains.

The severity of the symptoms can vary. At its mildest, you may simply feel persistently low in spirit, while at its most severe depression can make you feel suicidal and that life is no longer worth living.

Most people experience feelings of stress, sadness or anxiety during difficult times. A low mood may improve after a short time, rather than being a sign of depression.

When to see a doctor

It's important to seek help from your GP if you think you may be depressed.

 

If you've been feeling low for more than a few days, take this short test to find out if you're depressed.

Many people wait a long time before seeking help for depression, but it's best not to delay. The sooner you see a doctor, the sooner you can be on the way to recovery.

Sometimes there is a trigger for depression. Life-changing events, such as bereavement, losing your job or even having a baby, can bring it on. 

People with a family history of depression are also more likely to experience it themselves.

But you can also become depressed for no obvious reason.

Find out more about the causes of depression.

Depression is quite common and affects about one in 10 of us at some point. It affects men and women, young and old.

Depression can also strike children. Studies have shown that about 4% of children aged five to 16 in the UK are anxious or depressed.

Treatment

Treatment for depression involves either medication or talking treatments, or usually a combination of the two. The kind of treatment that your doctor recommends will be based on the type of depression you have.

Living with depression

Many people with depression benefit by making lifestyle changes such as getting more exercise, cutting down on alcohol, stopping smoking and eating more healthily. 

Self-help measures such as reading a self-help book or joining a support group are also worthwhile.

You can read other people's experience of depression in our comments section below.

Symptoms of clinical depression 

The symptoms of depression can be complex and vary widely between people. But as a general rule, if you are depressed, you feel sad, hopeless and lose interest in things you used to enjoy.

The symptoms persist for weeks or months and are bad enough to interfere with your work, social life and family life.

There are many other symptoms of depression and you're unlikely to have every one listed below.

If you experience some of these symptoms for most of the day, every day for more than two weeks, you should seek help from your GP.

Psychological symptoms include:



continuous low mood or sadness



feeling hopeless and helpless



having low self-esteem 



feeling tearful



feeling guilt-ridden



feeling irritable and intolerant of others 



having no motivation or interest in things



finding it difficult to make decisions



not getting any enjoyment out of life



feeling anxious or worried



having suicidal thoughts or thoughts of harming yourself



Physical symptoms include:



moving or speaking more slowly than usual 



change in appetite or weight (usually decreased, but sometimes increased) 



constipation



unexplained aches and pains



lack of energy or lack of interest in sex (loss of libido)



changes to your menstrual cycle



disturbed sleep (for example, finding it hard to fall asleep at night or waking up very early in the morning)



Social symptoms include:



not doing well at work



taking part in fewer social activities and avoiding contact with friends



neglecting your hobbies and interests



having difficulties in your home and family life



Depression can come on gradually, so it can be difficult to notice something is wrong. Many people continue to try to cope with their symptoms without realising they are ill. It can take a friend or family member to suggest something is wrong.

Doctors describe depression by how serious it is:



mild depression has some impact on your daily life



moderate depression has a significant impact on your daily life



severe depression makes it almost impossible to get through daily life – a few people with severe depression may have psychotic symptoms



Grief and depression

It can be hard to distinguish between grief and depression. They share many of the same characteristics, but there are important differences between them.

Grief is an entirely natural response to a loss, while depression is an illness.

People who are grieving find their feelings of loss and sadness come and go, but they're still able to enjoy things and look forward to the future.

In contrast, people who are depressed have a constant feeling of sadness. They don't enjoy anything and find it hard to be positive about the future.

Other types of depression

There are different types of depression, and some conditions where depression may be one of the symptoms. These include:



Postnatal depression. Some women develop depression after having a baby. Postnatal depression is treated in similar ways to other forms of depression, with talking therapies and antidepressant medicines.



Bipolar disorder is also known as "manic depression". It's where there are spells of depression and excessively high mood (mania). The depression symptoms are similar to clinical depression, but the bouts of mania can include harmful behaviour such as gambling, going on spending sprees and having unsafe sex. 



Seasonal affective disorder (SAD). Also known as "winter depression", SAD is a type of depression that has a seasonal pattern usually related to winter.





Media last reviewed: 05/06/2014
Next review due: 05/06/2016




When to seek help

If you experience  symptoms of depression for most of the day, every day for more than two weeks, you should seek help from your GP.

Causes  

There is no single cause of depression. You can develop it for different reasons and it has many different triggers.

For some, an upsetting or stressful life event – such as bereavement, divorce, illness, redundancy and job or money worries – can be the cause.

Often, different causes combine to trigger depression. For example, you may feel low after an illness and then experience a traumatic event, such as bereavement, which brings on depression.

People often talk about a "downward spiral" of events that leads to depression. For example, if your relationship with your partner breaks down, you're likely to feel low, so you stop seeing friends and family and you may start drinking more. All of this can make you feel even worse and trigger depression.

Some studies have also suggested you're more likely to get depression as you get older, and that it's more common if you live in difficult social and economic circumstances.

Stressful events

Most people take time to come to terms with stressful events, such as bereavement or a relationship breakdown. When these stressful events happen, you have a higher risk of becoming depressed if you stop seeing your friends and family and you try to deal with your problems on your own.

Illness

You may have a higher risk of depression if you have a longstanding or life-threatening illness, such as coronary heart disease or cancer.

Head injuries are also an often under-recognised cause of depression. A severe head injury can trigger mood swings and emotional problems.

Some people may have an underactive thyroid (hypothyroidism) resulting from problems with their immune system. In rarer cases a minor head injury can damage the pituitary gland, a pea-sized gland at the base of your brain that produces thyroid-stimulating hormones.

This can cause a number of symptoms, such as extreme tiredness and a loss of interest in sex (loss of libido), which can in turn lead to depression. 

Personality

You may be more vulnerable to depression if you have certain personality traits, such as low self-esteem or being overly self-critical. This may be because of the genes you've inherited from your parents, or because of your early life experiences. 

Family history

If someone else in your family has suffered from depression in the past, such as a parent or sister or brother, then it's more likely you will too.

Giving birth

Some women are particularly vulnerable to depression after pregnancy. The hormonal and physical changes, as well as added responsibility of a new life, can lead to postnatal depression.

Loneliness

Becoming cut off from your family and friends can increase your risk of depression.

Alcohol and drugs

Some people try to cope when life is getting them down by drinking too much alcohol or taking drugs. This can result in a spiral of depression. 

Cannabis helps you relax, but there is evidence that it can bring on depression, especially in teenagers.

And don't be tempted to drown your sorrows with a drink. Alcohol is categorised as a "strong depressant" and actually makes depression worse. 

Diagnosing clinical depression 

If you experience symptoms of depression for most of the day, every day for more than two weeks, you should seek help from your GP.

It is especially important to speak to your GP if you experience:



symptoms of depression that are not improving



your mood affects your work, other interests, and relationships with your family and friends



thoughts of suicide or self-harm



Sometimes, when people are depressed they find it hard to imagine that treatment can actually help. But the sooner you seek treatment, the sooner your depression will lift.

There are no physical tests for depression, though your GP may examine you and do some urine or blood tests to rule out other conditions that have similar symptoms, such as an underactive thyroid.

The main way in which your GP will tell if you have depression is by asking you lots of questions about your general health and how the way you are feeling is affecting you mentally and physically.

Try to be as open as you can be with the doctor. Describing your symptoms and how they are affecting you will really help your GP understand if you have depression and how severe it is.

Any discussion you have with your GP will be confidential. Your GP will only ever break this rule if there's a significant risk of harm to either yourself or others, and if informing a family member or carer would reduce that risk.

Treating clinical depression 

Treatment for depression usually involves a combination of medicines, talking therapies and self-help.

Treatment options

The kind of treatment that your doctor recommends will be based on the type of depression you have. Below is a short description of the types of treatment your doctor may recommend.

Mild depression



wait and see – if you're diagnosed with mild depression, your depression may improve by itself. In this case, you'll simply be seen again by your GP after two weeks to monitor your progress. This is known as watchful waiting.



exercise – there is evidence that exercise may help depression and it is one of the main treatments if you have mild depression. Your GP may refer you to a qualified fitness trainer for an exercise scheme, or you can find out more about starting exercise here. 



self-help groups – talking through your feelings can be helpful. You could talk either to a friend or relative, or you can ask your GP to suggest a local self-help group. Find out more about depression support groups. Your GP may also recommend self-help books and online cognitive behavioural therapy (CBT).



Mild to moderate depression



talking therapy – if you have mild depression that isn't improving, or you have moderate depression, your GP may recommend a talking treatment (a type of psychotherapy). There are different types of talking therapy for depression, including cognitive behavioural therapy (CBT) and counselling. Your GP can refer you for talking treatment or in some parts of the country you might be able to refer yourself.



Moderate to severe depression



antidepressants – antidepressants are tablets that treat the symptoms of depression. There are almost 30 different kinds of antidepressant. They have to be prescribed by a doctor, usually for depression that is moderate or severe.



combination therapy – your GP may recommend that you take a course of antidepressants plus talking therapy, particularly if your depression is quite severe. A combination of an antidepressant and CBT usually works better than having just one of these treatments.



mental health teams – if you have severe depression, you may be referred to a mental health team made up of psychologists, psychiatrists, specialist nurses and occupational therapists. These teams often provide intensive specialist talking treatments as well as prescribed medication. 



You can see a summary of the pros and cons of these treatments, which allows you to easily compare your options.




Talking treatments 

 



Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) helps you understand your thoughts and behaviour and how they affect you.

CBT recognises that events in your past may have shaped you, but it concentrates mostly on how you can change the way you think, feel and behave in the present.

It teaches you how to overcome negative thoughts, for example being able to challenge hopeless feelings.

You normally have a short course of sessions, usually six to eight sessions, over 10 to 12 weeks on a one-to-one basis with a counsellor trained in CBT. In some cases, you may be offered group CBT.

Online CBT

Computerised CBT is a form of CBT that works through a computer screen, rather than face-to-face with a therapist.

It's delivered in a series of weekly sessions and should be supported by a healthcare professional. For instance, it's usually prescribed by your GP and you may have to use the surgery computer to access the programme.

 

Interpersonal therapy (IPT)

IPT focuses on your relationships with other people and on problems you may be having in your relationships, such as difficulties with communication or coping with bereavement.

There's some evidence that IPT can be as effective as antidepressants or CBT, but more research is needed.

Psychodynamic psychotherapy

In psychodynamic (psychoanalytic) psychotherapy, a psychoanalytic therapist will encourage you to say whatever is going through your mind.

This will help you to become aware of hidden meanings or patterns in what you do or say that may be contributing to your problems.

Counselling

Counselling is a form of therapy that helps you think about the problems you are experiencing in your life to find new ways of dealing with them. Counsellors support you in finding solutions to problems, but do not tell you what to do.

Counselling is ideal for people who are basically healthy but need help coping with a current crisis, such as anger, relationship issues, bereavement, redundancy, infertility or the onset of a serious illness.

Getting help

In some parts of the country, you also have the option of self-referral. This means that if you prefer not to talk to your GP, you can go directly to a professional therapist.


 



The majority of suicide cases are linked with mental disorders, and most of them are triggered by severe depression.

Warning signs that someone with depression may be considering suicide are:



making final arrangements, such as giving away possessions, making a will or saying goodbye to friends



talking about death or suicide – this may be a direct statement, such as "I wish I was dead", but often depressed people will talk about the subject indirectly, using phrases like "I think dead people must be happier than us" or "Wouldn't it be nice to go to sleep and never wake up"



self-harm, such as cutting their arms or legs, or burning themselves with cigarettes



a sudden lifting of mood, which could mean that a person has decided to commit suicide and feels better because of this decision



If you are feeling suicidal or are in the crisis of depression, contact your GP as soon as possible. They will be able to help you.

If you can't or don't want to contact your GP, call the Samaritans on 08457 90 90 90, 24 hours a day, seven days a week. Alternatively, visit the Samaritans website or emailjo@samaritans.org.

Helping a suicidal friend or relative

If you see any of the above warning signs:



get professional help for the person



let them know they are not alone and that you care about them



offer your support in finding other solutions to their problems



If you feel there is an immediate danger, stay with the person or have someone else stay with them, and remove all available means of committing suicide, such as medication. Over-the-counter drugs such as painkillers can be just as dangerous as prescription medication. Also, remove sharp objects and poisonous household chemicals such as bleach.


 

Psychotic depression 

Some people who have severe clinical depression will also experience hallucinations and delusional thinking, the symptoms of psychosis.

Depression with psychosis is known as psychotic depression.

What are the symptoms of severe depression?

Having severe clinical depression means feeling sad and hopeless for most of the day, practically every day, and having no interest in anything. Getting through the day feels almost impossible.

Other typical symptoms of severe depression are:



fatigue (exhaustion)



loss of pleasure in things



disturbed sleep



changes in appetite



feeling worthless and guilty



being unable to concentrate or being indecisive



thoughts of death or suicide



 

What are the symptoms of psychosis?

Having moments of psychosis (psychotic episodes) means experiencing:



delusions – thoughts or beliefs that are unlikely to be true 



hallucinations – when a person hears (and in some cases feels, smells, sees or tastes) things that aren't there; a common hallucination is hearing voices.



The delusions and hallucinations almost always reflect the person's deeply depressed mood – for example, they may become convinced they're to blame for something, or that they've committed a crime.

"Psychomotor agitation" is also common – this means not being able to relax or sit still, and constantly fidgeting. 

Or, at the other extreme, a person with psychotic depression may have "psychomotor retardation", where both their thoughts and physical movements slow down.

People with psychotic depression are at greater risk than normal of thinking about suicide.

What's the cause?

The cause of psychotic depression is not fully understood. What we do know is that there's no single cause of depression and it has many different triggers.

For some, stressful life events such as bereavement, divorce, serious illness or financial worries can be the cause.

Genes probably play a part, as severe depression can run in families, although it's not known why some people also develop psychosis.

Many people with psychotic depression will have experienced adversity in childhood, such as a traumatic event.

How is it treated?

Treatment for psychotic depression involves:



medication – a combination of antipsychotics and antidepressantscan help relieve the symptoms of psychosis



psychological therapies – the one-to-one talking therapycognitive behavioural therapy (CBT) has proved successful in helping some people with psychosis



social support – support with social needs, such as education, employment or accommodation



The patient may need to stay in hospital for a short period while they're receiving this treatment.

Sometimes electroconvulsive therapy (ECT) may be recommended if the patient has severe depression and other treatments, including antidepressants, haven't worked.

Treatment is usually very effective, although patients may need to be continuously monitored in follow-up appointments.

Getting help for others

People with psychosis are often unaware that they're thinking and acting strangely.

Because of this lack of insight, it's often down to the friends, relatives or carers of a person affected by psychosis to seek help for them.

If you're concerned about someone you know and think they may have psychosis, you could contact their social worker or community mental health nurse if they've previously been diagnosed with a mental health condition.

If this is the first time they've shown symptoms, contact their GP or take them to A&E.

If you think the person’s symptoms are placing them at possible risk of harm you can:



take them to the nearest accident and emergency (A&E)department, if they agree



call their GP or local out-of-hours GP



call 999 and ask for an ambulance



Support and advice

More information on psychosis

SANE

Supporting someone who has experienced psychosis

Mind


Driving

Having psychosis could affect your ability to drive.

If you have been diagnosed with psychotic depression, it's your legal obligation to tell the Driver and Vehicle Licensing Agency (DVLA) as it could affect your driving ability.

GOV.UK provides details about telling the DVLA about a medical condition.








Depression