There are many different types of depression. The condition can be classified as mild, moderate or severe, depending on your symptoms.
- Mild depression. This is when you have very few symptoms which don’t have a great impact on your daily life.
- Moderate depression. This has a considerable impact on your daily life and you may have more symptoms than people with mild depression.
- Severe or major depression. This makes you feel uninterested in doing anything and daily activities are almost impossible, including eating and sleeping. You may feel like you’ve lost touch with reality. For example, you may have hallucinations (hearing, seeing or smelling things that aren't there) or delusions (irrational beliefs). This is known as psychosis.
Other types of depression include the following.
- Dysthymia. This is a type of depression in which your mood is regularly low, lasting at least two years. The symptoms are milder than other types of depression.
- Bipolar affective disorder. This is also known as manic depression or just bipolar disorder and causes mood swings. Your mood may vary from excitement and elation (mania) to despair and feeling lethargic. In the mania phase, you may also do things that other people find illogical.
- Seasonal affective disorder (SAD). This is a type of depression that may affect you during the autumn and winter months. This may be because of the lack of sunlight as daylight hours become shorter.
- Postnatal depression. This may develop any time between two weeks and two years after childbirth. One in 10 mothers get postnatal depression and may have problems sleeping, panic attacks or an intense fear of dying.
There are many symptoms of depression and the condition affects everyone differently. Some that you may have include:
- a continuous low mood
- a loss of interest in the things you usually enjoy doing
- crying a lot
- a loss of self-confidence
- feeling tired and lacking in energy
- poor concentration and difficulty making decisions
- feelings of guilt, worthlessness or helplessness
- thoughts about death and suicide
- a loss of sex drive (libido)
- trouble sleeping – possibly taking one or two hours to go to sleep or waking up earlier than usual
- disturbed eating patterns, often with weight gain or weight loss
- unexplained or worsening aches and pains
- smoking or drinking more alcohol than usual
- feeling like you can’t cope with things any more
- feeling restless or agitated
- anxiety – although this is a separate condition, you may have symptoms of depression and anxiety at the same time
Not everybody who has depression will have the same symptoms. Most people with depression will have at least five or six of the symptoms listed above. The severity of your symptoms, their frequency and how long they last will depend on the type of depression you have.
If you're depressed, recognising the problem is the first, but sometimes hardest, step. Often others around you may suggest that you seek help. If you think you have depression, and it’s affecting how you live your life, see your GP or look into what mental health support is available in your area. They can help to support you and may recommend treatment to help stop depression from taking over your life.
There are no tests to diagnose depression. You may be asked about your home life, any previous experience of depression, and whether you have had thoughts about self-harm or suicide. You’ll be asked about your symptoms, their duration and how much they are affecting your everyday life.
Most people with depression are treated by their GP. However, some people with severe depression may be referred to a psychiatrist (a doctor who specialises in mental health).
Treatment for depression usually involves a combination of self-help, talking (psychological) therapies and antidepressant medicines. Your treatment will depend on how severe your condition is.
Doing some exercise may help your symptoms. Try different sports or activities to find something you enjoy, and that you can keep doing in the long term. You may not feel like eating if you’re depressed. But this can make you feel worse, so try to eat a healthy, balanced diet with plenty of fruit, vegetables and fibre.
If you drink alcohol whilst taking antidepressants, you may become very sleepy, so the two are best not combined. If you're depressed, it can be tempting to use alcohol to try to make yourself feel better. However, alcohol can affect your sleep and your mood and lead to a range of long-term health problems including liver damage.
If you do drink alcohol, it's important that you don't drink more than the recommended guidelines. See our sensible drinking topic for more information.
Having difficulty sleeping or sleeping too much are both common symptoms of depression. If you’re having problems sleeping, try not to worry about it. You may find that listening to relaxing music in bed will help you feel less anxious about getting to sleep. For more tips on getting a good night’s sleep, see our insomnia topic.
Talking therapies involve talking through your thoughts and feelings with a qualified healthcare professional.
Counselling is usually a one-to-one session where you have a chance to express your feelings and problems. There are many different types of counselling, but generally you won't be told what to do about your feelings. Instead, a counsellor listens to what you have to say and then helps you to try and see your feelings and problems in a different way.
Psychotherapy aims to help you understand why you feel the way you do. This is usually achieved by talking about your early childhood and significant relationships.
Cognitive behavioural therapy (CBT) may help you change the way you think and the behaviours that are contributing to your depression. Instead of concentrating on the causes of your symptoms from your past, CBT aims to help you feel better by focusing on the here and now. You can have CBT with a therapist in a one-to-one or group session, or by yourself using a self-help book or computer programme.
Examples of free online CBT programmes include:
- Living Life to the Full
- The Mood Gym and e-Couch
The type of talking therapy you have will depend on what's available, your preferences, and how severe your depression is. Your GP may be able to arrange for you to have talking therapy as part of your treatment.
Antidepressant medicines ease the symptoms of depression in about seven in 10 people with the condition. But if you have mild or moderate depression, you may not need to take them. There are several different types of antidepressant medicines available. All of these can have side-effects (unwanted effects), and some of these are more serious than others. Even if you’re getting unpleasant side-effects, don’t stop taking your medicine without speaking to your GP first.
There are many different types of antidepressant. These include:
- selective serotonin reuptake inhibitors (SSRIs), eg fluoxetine, citalopram and sertraline
- tricyclic antidepressants (TCAs), such as amitriptyline, lofepramine and imipramine
- serotonin and noradrenaline reuptake inhibitors (SNRIs), such as venlafaxine and duloxetine
- noradrenergic and specific serotonergic antidepressants, eg mirtazapine
- melatonin agonist and specific serotonin antagonists, eg agomelatine
- monoamine oxidase inhibitors (MAOIs), such as phenelzine
Antidepressants may take up to two weeks to start having an effect. So it’s important to keep taking your medication even if you don’t immediately feel better. When you first start taking antidepressants, your GP will usually review you every couple of weeks. It can take a while to find the right medicine for you. Be sure to tell your GP if your symptoms don’t improve or get worse, or if you’re at all worried about the medicines you’re taking.
Taking your medication for at least six months after you start to feel better can help prevent your depression coming back. When stopping antidepressants, your GP will usually reduce your dose gradually over at least four weeks. Stopping your medicine suddenly could lead to withdrawal symptoms.
As well your antidepressant treatment, your GP may suggest you take a medicine called lithium or an antipsychotic medicine such as quetiapine.
If you have any questions, ask your GP for advice and always read the patient information leaflet that comes with your medicine. For more information about antidepressants and more detail about different side-effects, see our antidepressants topic.
You may decide to try herbal medicines, such as St John's wort (Hypericum perforatum), to help ease mild or moderate depression. You can buy this as tablets in health food stores and pharmacies. However, remember that natural doesn’t mean harmless. Talk to your GP or pharmacist before taking St John's wort, especially if you're taking prescription or over-the-counter medicines (including antidepressants). This is because St John's wort contains active ingredients which may interact with some foods and other commonly used medicines, such as cheese and the contraceptive pill.
Because of these possible interactions, the National Institute for Health and Care Excellence (NICE) doesn’t advise taking St John’s wort for depression. It’s also not clear how much you need to take for it to work well.
Don’t start taking any herbal remedies without speaking to your GP or pharmacist first.
Most people who have depression can be successfully treated without being admitted to hospital. If you have severe depression with suicidal thoughts or you’re struggling to cope, you, your family, or psychiatrist may feel you need treatment in hospital.
Electroconvulsive therapy (ECT)
You’ll only be offered ECT if you're severely depressed, need urgent treatment or if medicines haven't helped. It involves having an electrical current passed through your brain. ECT is always given in hospital under general anaesthetic, which means you will be asleep during the procedure and feel no pain.
It's not clear how ECT works.
Side-effects of the treatments include headaches, confusion and memory loss. ECT often works very quickly, greatly lifting your depression. However, it doesn't appear to stop depression coming back in the future.
- Living Life to the Full
People develop depression for lots of different reasons, although sometimes it’s not possible to pinpoint a cause. It’s likely to result from a combination of your family background, experiences and personality.
Factors that may make you more likely to develop depression can include:
- unsettled or difficult relationships with your parents in childhood
- divorce, including your parents getting divorced when you were younger
- relationship breakdown
- having a long-term or serious illness like diabetes or heart disease
- a family history of depression
- gender (women are more prone to depression than men)
- isolation from friends and family
- alcohol and drugs
Although most people who have major depression get better with treatment, it’s a chronic (long-term) condition – symptoms can last for up to two years. More than half of all people who have a period of depression will have at least one more during their lifetime. You’re more likely to have several periods of depression if you’re under 20 or in old age when you have your first episode.
Depression can reduce your quality of life and may affect your ability to work, your relationships with friends and family and your general health. For example, it’s linked to doing less physical activity, and drinking too much alcohol. Sometimes, depression can also be associated with suicide.
What can I do to help someone with depression?
If you know someone who has depression, it's important for you to be reassuring, to listen but not judge, and to be there to talk to. You can also help him or her make an appointment to get help – their GP or local mental health services are good places to start.
When people are depressed, they often feel helpless, hopeless and alone. Being affectionate and helping them feel good about themselves by praising daily achievements will help him or her feel better about themselves. Remember, things that may seem small to you may be big steps for them, such as cooking a meal, leaving the house or talking to a friend. People with depression often isolate themselves from others. They may stop seeing friends and relatives. Try to stay in contact, by talking on the phone and visiting if you can.
Encourage the person to seek help and advice. Reassure them that they are important to you, and that they can get better with treatment. If he or she makes any comments about suicide, don’t ignore them. Tell their GP or therapist if you can.
It can be difficult to spend a lot of time with someone who is very depressed – you may start to feel down too. Have some time out as well, and talk to others if you feel frustrated. Support from specialist groups may also be helpful.
Depression in people who have a chronic (long-term) physical illness, such as diabetes or heart disease, is common and often goes undetected. If you're worried about someone, encourage them to talk to their GP about how they are feeling.
Can yoga help depression?
There is very little proof to suggest that yoga is helpful as a treatment for depression. However, some research studies suggest that certain types of yoga may be beneficial and help reduce common symptoms of depression, such as anxiety and stress.
There are different types of yoga and some may be more helpful than others. Ashtanga yoga, for example, can be quite dynamic and fast-paced, while other types, such as Hatha yoga, with mindfulness meditation, are more focused on meditation and breathing. Hatha yoga poses are done slowly and are meant to help with relaxation and awareness. These may help to de-stress your mind – something that can be helpful if you’re depressed.
Doing some exercise in addition to taking medicine or having counselling may help your symptoms.
Does acupuncture work for depression?
At the moment, there isn't enough medical proof suggesting that acupuncture is helpful in treating depression.
Acupuncture has been part of traditional Chinese medicine for thousands of years but only in the past 30 years has it become integrated into general medicine. It's used mostly as a complementary treatment (one given alongside conventional treatments).
Evidence suggests that acupuncture needles stimulate nerve endings and may alter the way your brain works to correct the imbalance of energy in your body. However, there isn't enough proof to support the use of acupuncture as a treatment for depression.
Taking time out to do things that make you feel good may help lift your mood. Eating a healthy diet, getting enough sleep, and making the time to rest, relax and exercise are all important ways to look after yourself.
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