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Depression

Depression is a condition in which you have a continuous low mood, feel irritable or lose interest and enjoyment in everyday activities. This lasts longer than a few days or comes back repeatedly.

About depression

It's normal to have days or weeks when things aren't going right and you feel unhappy. Depression is when these feelings don't go away quickly and start to interfere with your everyday life. To diagnose depression, your symptoms should usually be present for at least two weeks, and affect you almost every day.

Around one in 10 adults in the UK will have depression at some point in their lives. People can be affected by depression at any age, and women are more likely to get depression than men.

On average, a bout of depression can last for up to eight months.

Types of depression

There are different types of depression. Some of these are listed below.

Mild depression. This doesn't usually stop you living your daily life, but you may find it difficult to concentrate at work or do things that you normally enjoy.
Moderate depression. This has a significant 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.
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. It’s also known as subthreshold depression.
Bipolar affective disorder. This is also known as manic depression or just bipolar disorder. This condition causes mood swings. Your mood may vary from excitement and elation (mania) to despair and lethargy. In the mania phase, you may also do things that seem illogical to others.
Seasonal affective disorder (SAD). This is a type of depression that may affect you during the autumn and winter months. This may be due to a lack of sunlight as daylight hours become shorter.
Postnatal depression. This may develop two to three weeks after childbirth and can last for months or even years. One in 10 mothers experience postnatal depression and may have problems sleeping, panic attacks or an intense fear of dying.

Symptoms of depression

If you have depression, you may have a number of different symptoms including:

a continuous low or irritable 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
using more tobacco or alcohol than usual
anxiety – however, it’s not clear if anxiety causes depression or depression causes anxiety

Not everybody that has depression will have the same symptoms. The severity of your symptoms, their frequency and how long they last will depend on the type of depression you have.

Complications of depression

Depression is a chronic condition. A chronic illness is one that lasts a long time, sometimes for the rest of the affected person’s life. When describing an illness, the term ‘chronic’ refers to how long a person has it, not to how serious a condition is. At least half of people who have a period of depression will have at least one or more period 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 general health and your relationships with friends and family.

Depression can also be associated with suicide – nearly two-thirds of people who commit suicide have depression.

Causes of depression

The exact cause of depression isn't fully understood at present. The causes can vary from person to person, but it’s likely to be a combination of your family background, experiences and personality that make you more likely to become depressed.

Factors that may make you more likely to develop depression can include:

a poor parent-child relationship in early life, including abuse and neglect
divorce, including parental divorce in childhood
bereavement
relationship breakdown
having a long-term or serious illness like diabetes or heart disease
a family history of depression
poverty
unemployment
gender (women are more prone to depression than men)
isolation from friends and family
alcohol and drugs

Diagnosis of depression

If you're depressed, recognising the problem is the first, yet hardest, step. Often others around you may suggest that you seek help. By visiting your GP, you will find the support and treatment you need to stop depression from taking over your life.

There are no tests to diagnose depression. Your GP will ask you about your home life, relationships, any previous experience of depression, and whether you have had suicidal thoughts or thoughts about self-harming. He or she will ask you about your symptoms, their duration and how much they are affecting your everyday life. Your GP may also ask you to fill in a questionnaire about your symptoms. The number of symptoms you have will help your GP find out which type of depression you have.

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 of depression

There are a number of treatments for depression. Treatment usually involves a combination of self-help, talking (psychological) therapies and antidepressant medicines. Your treatment will depend on how severe your depression is.

Self-help

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. Relaxation techniques, such as massage and meditation may also help ease your symptoms. Depression may make you feel like not eating. This can make you feel worse, so eating a healthy, balanced diet with plenty of fruit, vegetables and fibre, can be helpful.

If you're depressed, it can be tempting to use alcohol to enhance your mood. If you drink alcohol, it's important that you don't drink more than the recommended guidelines (no more than three or four units a day if you’re a man, and no more than two or three units a day if you’re a woman). Alcohol can affect your sleep and your mood and lead to a range of long-term health problems including liver damage.

Talking therapies

Your GP can often arrange for you to have talking therapy as part of your treatment.

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 by yourself, in a group, using a self-help book or computer programme.

The type of talking therapy you have will depend on what's available, your preferences, and how severe your depression is.

Medicines

Antidepressant medicines aren't always needed in mild or moderate depression.

There are several different types of antidepressant medicines available. All can have side-effects, so it's important to find the medicine that suits you best. Side-effects are the unwanted effects of taking a medicine. If you have side-effects, it’s important to talk to your GP before you stop taking it. Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine and citalopram, increase the level of serotonin in your brain, lifting your depression. SSRIs tend to cause fewer side-effects than other antidepressants, so many people find them easy to take. They are often the first type of antidepressant offered.

There are many other types of antidepressant, which work in different ways. These include sertraline, venlafaxine and mirtazapine. They can be useful for people who get side-effects with other medicines, or people who have specific symptoms.

Tricyclic antidepressants (TCAs) delay the absorption of the natural brain chemicals noradrenaline and serotonin, so that there are more of these chemicals in your brain for longer. This is thought to help with depression. Some TCAs have a sedating effect, so they may be helpful if you’re feeling anxious and agitated. Amitriptyline and imipramine are examples of TCAs.

Monoamine oxidase inhibitors (MAOIs) such as phenelzine are used less frequently than other antidepressants because they can cause serious side-effects if you eat certain foods such as cheese. If you have to take MAOIs, your GP will explain these side-effects and give you a card with a list of foods not to eat.

Taking your medication for at least six months after you start to feel better can help prevent your depression coming back. When stopping antidepressant medicine, your GP will usually reduce your dose gradually over at least four weeks. Don't stop taking your medicine suddenly because you may get withdrawal symptoms and your depression may return.

See our antidepressants factsheet for more information.

Complementary therapies

St John's wort (Hypericum perforatum) is a herbal medicine that can be used to treat mild or moderate depression. You can buy this as tablets in health food stores and pharmacies. You should always ask for advice from 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, similar to those found in MAOIs, which may interact with some foods and other commonly used medicines, such as cheese and the contraceptive pill. The National Institute for Health and Clinical Excellence (NICE) doesn’t advise taking St John’s wort for depression for this reason and because there is also uncertainty about how much you should take for it to be effective.

You may find herbal remedies helpful but it’s important to remember that natural doesn’t mean harmless. Herbal remedies contain active ingredients and may interact with other medicines or cause side-effects. Don’t start taking any herbal remedies without speaking to your GP or pharmacist first.

Hospital treatment

Most people who have depression can be successfully treated without being admitted to hospital. However, if you have severe depression and have suicidal thoughts or if you’re struggling to cope, you, your family, or psychiatrist may feel you need the shelter and protection of a hospital.

Before going into hospital, you may have a mental health assessment. This involves talking with your GP and answering questions about how you’re feeling.

Electroconvulsive therapy (ECT)

ECT will only be considered if you're severely depressed or if treatment with medicines hasn't worked. ECT is always given in hospital under general anaesthesia, which means you will be asleep during the procedure and feel no pain. It involves having an electrical current passed through your brain to produce an epileptic fit.

ECT is a controversial treatment because it's not absolutely clear how it works. A side-effect of ECT is memory loss. It's usually considered as a last resort.

ECT often works very quickly, greatly lifting your depression. However, it doesn't appear to stop depression coming back in the future.