Depression

Published by Bupa's Health Information Team, June 2010.

This factsheet is for people who have depression, or who would like information about it.

Depression is a condition in which people may have low mood, a loss of interest in everyday activities, feelings of low self-worth, a lack of energy and poor concentration, all of which last a long time.

About depression

Around one in five people in the UK have depression at some point in their lives. People are affected by depression at any age.

Depression is characterised by a number of symptoms including a loss of interest and enjoyment in the ordinary things in life.

It's normal to have days or weeks when things aren't going right and you feel unhappy. You're said to have depression when your feelings don't go away quickly and the symptoms start to interfere with your everyday life.

Types of depression

There are a number of ways to categorise depression. You may hear it referred to in terms of severity.

• Mild depression. This doesn't usually stop you leading your daily life but makes everything harder to do and seem less worthwhile.
• Moderate depression. This has a significant impact on your daily life, and you may have more symptoms than people with mild depression.
• Severe depression. This makes you feel uninterested in doing anything - daily activities are almost impossible.

There are also specific forms of depression, which include the following.

• Dysthymia. This is mild depression, lasting at least two years.
• Bipolar affective disorder - also known as manic depression or just bipolar disorder. This is a condition which causes mood swings. Your mood varies from excitement to depression and despair. You may also have hallucinations.
• Seasonal affective disorder (SAD). This is a type of depression with a seasonal pattern, occurring most commonly in the winter months.
• Postnatal depression. This develops two to three weeks after childbirth and lasts for months or even years

Symptoms of depression

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

• a continuous low mood, which may be worse in the mornings
• feeling irritable
• crying a lot
• a loss of interest in your social life
• a loss of self-confidence
• a lack of energy
• tiredness and poor concentration
• difficulty in making decisions
• feeling helpless, worthless or hopeless
• feeling guilty
• thoughts about death and suicide
• anxiety
• 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 - either loss of appetite or eating too much
• unexplained or worsening aches and pains
• physical slowness

Complications of depression

At least half of the people who have an episode of severe depression will have at least one more episode. You're more likely to have several episodes of depression if you're under 20 or of an older age.

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

Causes of depression

Depression varies from person to person and everyone's experience is different. The exact cause of depression isn't fully understood at present, but there seem to be certain factors that make a person more likely to develop depression.

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

• a poor parent-child relationship in early life
• parental divorce in childhood
• bereavement
• relationship breakdown
• physical and/or sexual abuse in childhood
• having a neurotic personality
• having a long-term or serious illness like diabetes or heart disease
• a family history of depression
• poverty
• homelessness
• unemployment
• gender (women are more prone to depression than men)

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. If you take that step and visit your GP, you will find the support and treatment you need to stop depression from taking over your life.

Your GP will ask you about your home life, your relationships, any previous experience of depression, and whether you have had suicidal or self-harming thoughts. 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.

Most people with depression are treated by their GP. However, some people with severe or problematic depression are referred to a psychiatrist - a doctor who specialises in mental health.

Treatment of depression

There are a number of treatments for depression. The two main treatments are talking (psychological) therapies such as counselling, and antidepressant medicines. Your treatment will depend on how severe your depression is.

Self-help

Doing some exercise in addition to your medication and/or counselling may help your symptoms. Try a few sports or activities to find something you enjoy, and that you can keep doing in the long-term. Relaxation and meditation may also help your symptoms.

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 because it can affect your sleep and your mood, and can lead to a range of long-term health problems including liver damage.

Medicines

Antidepressant medicines aren't always needed in mild or moderate depression. A large number of people with depression get better within six months without medication.

There are several different types of antidepressant medicine available. All can have side-effects, so it's important to find the medicine that suits you best. Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Tricyclic antidepressants (TCAs) alter your brain chemistry (delaying the absorption of the natural brain chemicals noradrenaline and serotonin, so that there is more of these chemicals in your brain for longer). This is thought to help with depression. TCAs can have troublesome side-effects, including increased appetite, weight gain, dizziness, sweating, drowsiness and shaking. Dosulepin and clomipramine 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. Your GP will explain these side-effects and give you a card with a list of foods to avoid.

Selective serotonin re-uptake inhibitors (SSRIs) such as fluoxetine and paroxetine increase the level of serotonin in the brain. This in turn appears to lift your depression. SSRIs tend to cause fewer side-effects than other antidepressants, so many people find them easier to take. They are often the first type of antidepressant used.

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

Taking your medication for at least six months after you start to feel better can help prevent the depression coming back. Ask your GP for more information on each medicine. When stopping antidepressant medication, your GP will usually reduce your dose gradually over at least four weeks. Don't stop taking your medication suddenly because you may experience withdrawal reactions.

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, with the counsellor listening and asking questions. 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. Counsellors may be based at your GP surgery. If not, your GP will be able to refer you to an appropriate organisation. You will normally have a fixed number of sessions - often six to 12.

There are also more structured types of talking therapy. These include cognitive behavioural therapy (CBT) and psychodynamic psychotherapy (a type of talking treatment that goes more deeply into childhood experience and significant relationships).

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

Complementary therapies

St John's wort (Hypericum perforatum) is a complementary medicine that can help 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 are also taking prescription or over-the-counter medicines (including antidepressants). This is because St John's wort can interact with some other commonly used medicines, such as the contraceptive pill.

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, you, your family, or your 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 doctor and answering some questions about how you are feeling.

Electroconvulsive therapy (ECT)

ECT is a controversial treatment because it's not absolutely clear how it works. A side effect of ECT is memory loss.

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

This treatment is only considered if you're severely depressed or if treatment with medicines hasn't worked for you. ECT is always given in hospital under general anaesthesia, which means you will be asleep during the procedure and feel no pain. It works by passing an electric current through the brain and causing a seizure. People tend to have ECT sessions twice a week for six to 12 sessions.

Video

See our video about depression in old age:

• Depression in old age

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.