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Depression


Expert reviewer Dr Liz Russell, Consultant Psychiatrist
Next review due October 2022

Depression is an illness where you have a continuous low mood and/or a loss of interest and enjoyment in your life. Everyone feels down from time to time. But with depression, you have a persistently low mood for a couple of weeks or more, that’s having a significant impact on your life.

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Symptoms of depression

If you have depression, you’ll have felt down or hopeless nearly every day for at least two weeks, and/or have lost interest or pleasure in your usual activities.

Depression affects everyone in different ways, and there are lots of other symptoms that you may experience. You may:

  • feel tired (fatigued) and have no energy
  • feel worthless or have a loss of self-esteem or self-confidence
  • have changes in your sleep pattern – either having trouble sleeping (insomnia), or sleep more than normal
  • feel restless or agitated
  • find it hard to concentrate and difficult to make decisions
  • lose your appetite and/or lose weight
  • keep having thoughts about death or suicide if you’re severely depressed

It’s important to remember that depression isn’t a sign of weakness and it’s not something people can just ‘snap out’ of.

If you need help now

This page is designed to provide health information about depression. If you need help now, the following helpline is free for you to call and talk to someone.


Alternatively, visit Mind's website and click on the yellow ‘I need urgent help’ button at the top left of the page. This is a tool that is designed to help you understand what’s happening to you and how you can help yourself.

If you need immediate help or are worried about someone, call the emergency services.

Causes of depression

People develop depression for lots of different reasons, and sometimes it’s not possible to pinpoint one particular cause. It’s often a combination of several different things. These may include factors such as:

  • a stressful life event, such as a bereavement, relationship breakdown or losing your job
  • genetic factors – you’re at greater risk if you have a family history of depression
  • having a long-term or serious physical health problem, like diabetes, heart disease or a condition that causes you pain
  • if you’ve recently had a baby – this can cause a specific type of depression known as postnatal depression
  • the time of year – people with seasonal affective disorder find they’re only affected at a certain time of year (usually winter)
  • having other mental health conditions such as anxiety, schizophrenia or premenstrual dysphoric disorder
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Seeking help for depression

Sometimes it’s hard to know if you’re depressed; the illness can make it difficult to see things clearly or it may have come on gradually. But it’s always ok to ask for help, even if you’re not sure if you’re definitely experiencing depression.

Talking to someone close to you is often a good starting point. They may have already noticed that something’s wrong, and can offer you support. Or you may prefer to speak to someone on a helpline, such as the Samaritans. You may also be able to access support services for mental health through your work, if this is something they offer. In many areas of England, you can also self-refer yourself for NHS talking therapy (without going through your GP). This is through an NHS service called Improving Access to Psychological Therapies (IAPT).

If you’re finding your feelings are interfering with your ability to cope on a day-to-day basis, it’s worth seeking help from your GP as early as possible. Your GP can diagnose your depression and tell you about the support or treatment options available to you.

Diagnosis of depression

Your GP will usually be able to assess whether you’ve got depression and how severe it is just from talking to you. They’ll ask you some questions about how you’ve been feeling, how long you’ve been feeling that way and how often you have those feelings. They may use a standard questionnaire to do this. They will also ask whether you’ve noticed any other symptoms – such as trouble sleeping, changes in how much you’ve been eating or whether you’ve been feeling tired or irritable.

Your depression may be classed as mild, moderate or severe, depending on how much impact it has on your daily life.

It can be hard starting a conversation about how you feel with your GP. Try to think about what you want to say in advance – write things down if it helps. You might like to take someone with you to support you. Never worry that your problem is too small or unimportant, and don’t forget your GP is likely to have seen plenty of people in your position before.

Treatment for depression

There are several different types of treatment for depression. Your GP will talk through which ones might be appropriate for you.

Self-help programmes

If your depression is relatively mild, your GP may first recommend a self-help programme. These are usually available quite quickly, and you may find you don’t need any other treatment. They include the following.

  • A self-help manual or booklet. These are based on the principles of cognitive behavioural therapy (CBT), which aims to change how you think and behave. You will have support from a trained health professional, who should check your progress through the programme.
  • Computerised CBT. These are computer or web-based programmes which you complete yourself, again with support from a trained professional.
  • A group-based exercise programme. This is an activity programme specifically designed for people with depression. You go to three sessions a week over about three months. The sessions last for about 45-minutes to an hour.

Talking therapies

If initial self-help treatments haven’t helped, or your depression is more severe, your GP may suggest a talking therapy. Talking therapies involve talking through your thoughts and feelings with a qualified therapist. You’ll usually have a number of sessions spread over several weeks or months. Your GP may refer you, or in some areas, you may be able to self-refer (access these services yourself).

There are several types of talking therapy for depression. These include Cognitive Behavioural Therapy (CBT), which aims to help change the way you think and behave, and behavioural activation, which increases your activities and positive experiences. Alternatively, you may be offered therapy that focuses on your relationships, or mindfulness-based therapy if this is more appropriate.

Medicines

Your doctor may offer you an antidepressant medicine instead of, or as well as a talking therapy, depending on how long you’ve had symptoms and how severe they are. Antidepressants include the following.

  • Selective serotonin reuptake inhibitors (SSRIs). These are usually the first type your GP will suggest. This is because the side-effects of this type are generally easier to cope with than others. SSRIs include fluoxetine, citalopram and sertraline.
  • Tricyclic antidepressants (TCAs). These are associated with more side-effects than other antidepressants. Examples include imipramine and lofepramine.
  • Monoamine oxidase inhibitors (MAOIs). These can have dangerous interactions with certain foods and other medicines, and so are only prescribed by specialists. An example of an MAOI is moclobemide.

When you first start taking antidepressants, your GP will usually review you every couple of weeks. For some people, symptoms start to improve in a few days but it generally takes about two to four weeks. Some people find their treatment makes them feel more agitated or anxious at first. Contact your GP for advice if this happens. If your medicine doesn’t seem to be working after a few weeks, your GP may suggest increasing your dose or switching you to a different medicine.

Sometimes, if regular antidepressants don’t seem to be helping, your doctor may suggest other types of medicine to take alongside your usual antidepressant. These may include a medicine called lithium or an antipsychotic medicine such as quetiapine. Sometimes a psychiatrist (a doctor who specialises in mental health) may need to prescribe these.

You’ll usually be advised to continue taking your antidepressants for at least six months after you start to feel better, to help prevent your depression coming back. When you’re ready to stop the antidepressants, your GP will usually reduce your dose gradually over at least four weeks, to prevent withdrawal symptoms.

Complementary therapies

St John’s wart (Hypericum perforatum) is a herbal remedy that many people take for mild depression. There’s some evidence that it might help ease mild or moderate depression. However, it’s use isn’t recommended. There’s lots of uncertainty about how much you need to take for it to work well, and there’s also potential for serious interactions with a number of other medicines.

Don’t start taking any herbal remedies without speaking to your GP or pharmacist first.

Hospital treatments

In rare cases, for instance if you need urgent help, your doctor may suggest one of the following therapies.

  • Electroconvulsive therapy (ECT). This involves briefly passing an electrical current through your brain to trigger a seizure (fit). ECT is always given in hospital under general anaesthesia and with muscle relaxants, which means you’ll be asleep during the procedure and feel no pain. You’ll only be offered it if you're severely depressed, need urgent treatment or if other treatments haven't helped.
  • Transcranial magnetic stimulation. This involves placing an electromagnetic coil against your scalp. You won’t need anaesthesia for this procedure. You might be offered this if medicines don’t seem to have worked for your depression, or they’re not suitable for you. It’s only available in certain areas.

Living with depression

There are things you can try alongside medical treatment that might help you to feel better.

  • Speak to people. It might seem hard at first, but lots of people find that opening up to friends and families can help them feel better and more understood.
  • Exercise. Doing exercise can really boost your mood. If you don’t know where to get started with exercise, try something gentle like swimming, walking or yoga.
  • Eat and drink well. Eating a healthy, balanced diet with regular meals can help you maintain a steady level of energy.
  • Avoid alcohol and drugs. It can be tempting to turn to alcohol and recreational drugs to cope with difficult feelings; but actually, they can make your depression worse in the long-run. Regular use of recreational drugs, such as cannabis, can bring on depression, particularly in young people.
  • Sleep well. Try to get into a healthy sleep pattern so you are well rested. Getting good sleep – aiming for seven to nine hours per night -- can help to improve your mood.
  • Look after yourself. Even small goals like getting dressed every day or cooking a healthy meal can help to give yourself a boost. Try to make time for things that you enjoy and make you feel good.

Frequently asked questions

  • To help support someone with depression, these are some of the things you can do.

    • Recognise an emergency. If you’re worried that someone may harm themselves or is talking of suicide, stay with them and call for an ambulance, or help them get to A&E.
    • Offer emotional support. Your reassurance and a listening ear can mean the world to someone who is depressed and struggling. Stay calm, be patient and try not to make assumptions about how the person is feeling.
    • Give practical help. When someone is depressed, day-to-day tasks can feel too overwhelming. Offering help with shopping, housework or making healthy meals can be useful; but try to encourage them to do things for themselves too. You can also offer them practical support with getting professional help when they’re ready.
    • Be informed. Learn more about depression so you understand it better. It’s hard if you feel you don’t know what someone is going through because you haven’t experienced it yourself. There are some useful organisations listed in our section Other helpful websites.
    • Look after yourself. Don’t forget your own mental wellbeing. It can be challenging supporting someone who is very depressed. Take some time out for yourself, and talk to others if you feel frustrated. Support from specialist groups may also be helpful.
  • Some people do find that their depression returns after treatments. This happens in about a third of people within a year of finishing their treatment. You’re at greater risk of a relapse the more episodes of depression you’ve had.

    There are several things your doctor may suggest to reduce your chance of a relapse, if they think you may be at risk.

    • Continuing treatment with antidepressants for at least six months after you feel better, but sometimes for longer if it might be helpful.
    • Taking additional medication.
    • Trying a psychological treatment, such as CBT or mindfulness-based therapy.

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Related information

    • Depression. NICE CKS. cks.nice.org.uk, last revised October 2015
    • Depression. PatientPlus. patient.info, last reviewed 15 March 2019
    • Depression in adults: recognition and management. National Institute of Health and Care Excellence (NICE), last updated April 2018. www.nice.org.uk
    • Depression. Mind. www.mind.org.uk, published March 2019
    • Bipolar disorder. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised September 2017
    • Depression. Royal College of Psychiatrists, June 2015. www.rcpsych.ac.uk
    • Seeking help for a mental health problem. Mind. www.mind.org.uk, published December 2017
    • The improving access to psychological therapies manual. National Collaborating Centre for Mental Health, 2019. www.england.nhs.uk
    • Psychotherapies. Royal College of Psychiatrists. www.rcpsych.ac.uk, published April 2015
    • Shinohara K, Honyashiki M, Imai H, et al. Behavioural therapies versus other psychological therapies for depression. Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD008696. DOI: 10.1002/14651858.CD008696.pub2
    • Antidepressant drugs. BNF. National Institute for Health and Care Excellence (NICE). bnf.nice.org.uk, last updated 30 August 2019
    • Guidance on the use of electroconvulsive therapy. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, last updated 1 October 2009
    • Repetitive transcranial magnetic stimulation for depression. National Institute for Health and Care Excellence (NICE), December 2015. www.nice.org.uk
    • Sleeping well. Royal College of Psychiatrists, September 2015. www.rcpsych.ac.uk
    • Depression in adults. BMJ Best Practice. bestpractice.bmj.com, last reviewed August 2019
  • Reviewed by Pippa Coulter, Freelance Health Editor, October 2019
    Expert reviewer Dr Liz Russell, Consultant Psychiatrist
    Next review due October 2022



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