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Depression


Expert reviewer, Dr Rahul Bhattacharya, Psychiatrist
Next review due June 2020

Depression is an illness where you have a continuous low mood and/or a loss of interest and enjoyment in your life.

This information is for you if:

  • you think you might have depression
  • you’re living with depression
  • you’re a family member or friend of someone you think or know is depressed

Man on laptop

About depression

Everyone has ups and downs – sometimes you might feel a bit low or experience grief when you lose someone you love. It’s common for people to say that they are ‘depressed’ when they are feeling down. However, if the sadness becomes persistent and you lose interest in your life, affecting how you think or behave, it’s possible you have depression. It’s important to remember that depression isn’t a sign of weakness and it’s not something people can just ‘snap out’ of. Most people feel better talking to a trained therapist or taking medication or both.

Depression is common; each year, around one in 20 adults in the UK will have an episode of depression. It’s the third most common condition GPs see in their practices.

If you need help now

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

  • Samaritans
    116 123 (UK and ROI)

Alternatively, follow this link to 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.

How do I know if I have depression?

There are lots of symptoms of depression and they affect everyone in different ways. Not everybody will have the same experience. The two core symptoms of depression are having a low mood (feeling down or hopeless) along with losing interest or pleasure from doing things.

Below we’ve outlined the symptoms you may get if you have depression.

Feelings

You might:

  • feel low all the time
  • not enjoy or want to do any of the things you usually enjoy
  • feel guilty
  • feel helpless
  • feel worthless or have a loss of self-esteem or self-confidence
  • feel hopeless, you might feel that it’s too hard or painful to live and have thoughts about death or suicide

Physical symptoms

Depression isn’t just about how you feel mentally; you might change your behaviour and get physical symptoms too. Aches and pains are sometimes what people notice first. You may:

  • cry in situations in which you wouldn’t usually cry
  • feel tired and lack energy
  • have a loss of sex drive (libido)
  • have trouble sleeping – possibly taking one or two hours to go to sleep, and especially waking up earlier than usual
  • get unexplained or worsening aches and pains
  • have constant headaches
  • feel restless or agitated
  • have poor concentration and find it difficult to make decisions

You might be:

  • smoking or drinking more alcohol than usual
  • eating more or not being hungry, often resulting in weight gain or weight loss
  • avoiding your family and friends, or cancelling plans you’ve made

You might have anxiety too – although this is a separate condition, you may have symptoms of depression and anxiety at the same time. You can read more detail about this in our expert blog: Anxiety and depression - the link.

Personal experiences

Below are some quotes from interviews with people who have had or are going through depression. It can sometimes help to understand the condition more by hearing from people who know personally what it’s like.

“With depression even good things you might have experienced seem to become twisted in your mind and appear bad.”

“It’s a very tiring thing to go through and completely destroys any motivation, confidence, and self-esteem you may have had.”

“I’ll go to the shop and it’s like I’m watching myself from above or below, you know. And it swings between that and absolute searing pain to the point where I’m curled on my bed and genuinely believing that anything, including dying, is better than this kind of thing, you know. I can’t think of, get me a thesaurus [laughs], but, utter despair, followed by utter emptiness.”

“I’ve got no emotions on anything. I don’t feel happy, I don’t feel sad, I’ve just got the same face on all the time.”

“I would have loved it if there was a reason and I could have fixed it, if someone, you know in my family was dying and I could’ve been depressed about that, that would’ve been great, because I could’ve just been sad, and know why, and it was right in front of me, but it was this thing behind me on my shoulders that you just couldn’t, there was nothing, absolutely nothing. It was awful.”

“I call it the dark side, you know, the real you, what you’re hiding. But it’s very hard to, for you, you know it’s, people don’t want to be around you if you’re very negative and quite down, you know, if you seem to pull other people down so, you try to be cheery and you know, and not let it affect you. But sometimes it gets where you can’t hide it anymore, and I think I got to that point where I couldn’t pretend, I couldn’t, couldn’t carry on, couldn’t make out that you know, that I was feeling normal, and that, that, you know that something wasn’t going on.”

“I genuinely believed that I was utterly, utterly purposeless and that all I did was bring other people down or have negative effects on other people and stuff.”

“What I did get and I still get now, is kind of, is to get quite tired, and I think one of my kind of coping strategies you know on the basis that I have depression is, is to kind of sleep during the day. I don’t want to sleep during the day, but like it’s more of like a, even if you’re not tired if you think, ‘Oh I’d really love to just have a nap’.”

“I think it’s almost like you just turn life off for an hour. You go to sleep, turn life off for an hour and you get back up again, you know start afresh for the day.”

“This like this depression, which I didn’t know what it was, just literally erupted. And, I was in a seriously bad place, it just like, couldn’t do anything, was just house bound, just in floods of tears, couldn’t sleep.”

“I just did not care. I genuinely did not believe that there was any reason for me not to be punished by something every second of the day.”

“I think I remember describing it once, it was like trying to, like say life is like a jigsaw puzzle, I was like trying to put it together but I just didn’t have all the pieces. It was like desperately searching for those pieces without even knowing what those pieces are meant to be.”

Copyright © University of Oxford. All rights reserved. This video was created as a part of a larger research project, see more videos on healthtalk.org

Types of depression

Depression can be classified in different ways depending on:

  • how severe your symptoms are
  • if it’s triggered by a life event
  • the length of time you have depression for
  • if it comes back
  • the season

Mild, moderate and severe depression

  • Mild depression. This is when you have a few symptoms but they don’t have a big impact on your daily life.
  • 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 is when you have most of the symptoms associated with depression and they affect you so much that you’re unable to function and go about your daily life. Some people who have severe depression may lose touch with reality (this is called psychotic depression).

Bipolar and unipolar depression

  • Bipolar affective disorder. This is also called bipolar disorder and it causes mood swings. Your mood may vary from excitement and elation (mania) to despair and feeling lethargic (depression). In the mania phase, you may do things that other people find illogical.
  • Recurrent depression (sometimes called unipolar depression). This is when depression comes back; it might recur multiple times over the years.
  • 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.

Other types of depression

  • 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. Depression can happen when you’re pregnant and/or during the weeks and months after having your baby.

Help and diagnosis

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. Or you might feel too bad to manage the effort of making an appointment and going to your GP. Depression can feel like it’s taken all of your energy and things that once seemed easy to do, now feel very hard.

Talking to someone close to you is often a good starting point. It might be useful to ask them if they’ve noticed a difference in you and have been worried about you.

Remember, depression can happen to anyone – it doesn’t matter how strong or successful you are. Don’t feel as though it shouldn’t be happening to you or beat yourself up – feeling like this can be part of the illness. Don’t let it stop you getting the help you need, because there are treatments that can help you feel better.

Seek help:

  • when your feelings are worse than they usually are and they aren’t improving
  • when you know the depression is having an impact on your relationships at home and at work
  • if you find yourself feeling that life is not worth living, or that other people would be better off without you

Recovery is possible – speak with your GP who can help you access the right treatment for you.

When you go to your GP, they will ask you some questions to find out if you have depression. They may also ask you about your medical history.

In particular they may ask you:

  • during the last month, have you often been bothered by feeling down, depressed, or hopeless?
  • do you have little interest or pleasure in doing things?

They will also ask you:

  • how long you’ve been feeling like this
  • if you feel this way most of the time
  • if the feelings are there every day
  • if you’ve had these feelings for two weeks or more

Your doctor will ask about other symptoms including:

  • your tiredness and energy levels
  • if you have feelings of worthlessness or guilt
  • if you think about death or have suicidal thoughts
  • if you find it hard to concentrate and are indecisive
  • if you’re irritable or agitated for no clear reason
  • if you’re sleeping a lot, or finding it hard to get to sleep or stay asleep (insomnia)
  • if you’re eating more or less than usual (significantly so)

Your answers will help your GP know if you’ve got depression and how severe it is. He or she will diagnose you with depression if you have at least five of these symptoms with at least one of them being your main symptom.

Your GP may then direct you to local therapy services or they may prescribe medicines for you. However, if you have severe depression your GP may refer you to a psychiatrist (a doctor who specialises in mental health).

Types of treatment

Talking therapies

Talking therapies and taking antidepressants are the two main treatments for depression. Your GP might suggest one or both options after talking to you about how much your symptoms are affecting you and what your preferences are.

Talking therapies involve talking through your thoughts and feelings with a qualified healthcare professional. There are several types of talking therapy, as described below.

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.

If you have mild-to-moderate depression your GP may suggest you try CBT using a computer programme or by using a self-help book. They may also offer you one-to-one therapy or group-therapy, depending on what’s available in your area.
Examples of free online CBT programmes include:


Other talking therapies

There are some other talking therapies that your GP may be able to offer you if you have mild-to-moderate depression and you don’t want to have the other treatments. You’ll usually have a number of sessions spread over several weeks or months. These therapies are described below.

Counselling

In counselling, 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 so you can arrive at answers yourself.

Psychodynamic therapy

Psychodynamic therapy aims to help you understand why you feel the way you do. This is usually achieved by talking about what’s happening in your life now as well as looking back at the past.

If you have moderate-to-severe depression, your local service may be able to offer you the following. This may also be an option for you if initial treatment for mild-to-moderate depression hasn’t worked.

Interpersonal therapy

This therapy focuses on your relationships and how they may be affecting or linked to your depression. This might be to do with key relationships in your life or adapting to new roles in your life or events. The goal is to help you find ways of coping and strengthening your relationships.

Behavioural activation

Behavioural activation focuses on goal setting, particularly reintroducing activities that you used to enjoy but are no longer doing. The therapy helps you to think about your behaviour – what you may have been avoiding and why. The activities you’re asked to work towards are things that are known to be good for us.

Couples therapy

This therapy involves both you and your partner so you can work through problems that are affecting you both.

Group exercises

A group-based exercise programme can be helpful if you have mild-to-moderate depression. It’s an activity programme where you go to three sessions a week over about three months. The sessions last for about 45-minutes to an hour.

For more information about how exercise may help depression, use the picture icons and scroll across to see our FAQ: Exercise and depression.

Medicines

Antidepressants

Antidepressants ease the symptoms of depression in about seven out of 10 people. If you have moderate-to-severe depression, you might take antidepressants and have a talking treatment. If your depression is mild, you might not need to take antidepressants at all. But if you’ve had mild depression for at least two years or you’ve previously had more severe depression, then antidepressants may be an option for you.

What type of antidepressant will my doctor prescribe?

There are different types of antidepressant; your doctor will usually offer you an SSRI (selective serotonin reuptake inhibitor). This is because most people are able to tolerate the side-effects of this type better than others. SSRIs include fluoxetine, citalopram and sertraline.

Other types of antidepressant include serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs). There is also an antidepressant called vortioxetine, which can be prescribed for severe depression. Your doctor can explain more about which antidepressant might be best for you.

How long do antidepressants take to work?

For some people, symptoms start to improve in a few days but it generally takes about two to four weeks. This is why it’s important to keep taking the medicine for four to six weeks even if you don’t immediately feel better. When you first start taking antidepressants, your GP will usually review you every couple of weeks.

What if I don’t think they are working?

Tell your GP if your symptoms don’t improve or get worse. If your medicine isn’t working, your GP may suggest increasing your dose or may offer you a different medicine or a combination of medicines.

Will I need to take other medicines too?

You may need to take other medicines if your medicine hasn’t worked or you have particular symptoms (such as psychotic symptoms). In this case, your doctor (this will likely be a psychiatrist) may change your antidepressant or prescribe another one to take with it. Or they may suggest taking a different medicine alongside an antidepressant. For example, he or she may suggest a medicine called lithium or an antipsychotic medicine such as quetiapine.

A psychiatrist is a doctor who specialises in mental health.

What about side-effects?

All antidepressants 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.

In the first few weeks, there’s a risk of feeling slightly worse until the medicine takes effect. And depending on which antidepressant you’re taking, other common side-effects include an upset tummy, feeling sick, constipation, feeling agitated, having an increased or decreased appetite.

There’s some evidence that SSRI antidepressants can increase suicidal thoughts in young people, so there are limits on their use in this age group. In the UK, fluoxetine is the only SSRI antidepressant licensed for use with young people. This is monitored closely by a psychiatrist.

How long should I take them for?

Taking antidepressants for at least six months after you start to feel better can help to 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. These are often mild and will go away but sometimes they can be quite severe. That’s why it’s important to reduce your dose gradually over a number of weeks as agreed with your doctor. To find out more about continuing treatment, for example, if your symptoms come back, see our FAQ: Relapse.

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.

Complementary therapies

St John’s wart (Hypericum perforatum), has been found to help ease mild or moderate depression. However, the National Institute for Health and Care Excellence (NICE) doesn’t advise taking St John’s wort for depression because it may interact with other medicines. 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.

Electroconvulsive therapy (ECT)

Most people who have depression can have successful treatment without being admitted to hospital. If you have severe depression with suicidal thoughts or you’re struggling to cope, then you, your family or psychiatrist may feel you need treatment in hospital.

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 to trigger a fit. Your muscles will twitch slightly but you won’t be convulsing. This treatment can ease some of the symptoms of depression, though it’s not certain exactly how it works. ECT is always given in hospital under general anaesthesia and with muscle relaxants. This means you will be asleep during the procedure and feel no pain.

Side-effects of the treatment 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.

Self-help

There are some things you can do alongside medical treatment that can boost your mood. They can also help to distract you and look after your general health.

Gentle exercise

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. If the idea of exercise feels daunting, first try something gentle like swimming or yoga.

Eat and drink well

Eating a healthy, balanced diet with plenty of fruit, vegetables and fibre can help you maintain a steady level of energy and think clearly. Keeping hydrated is also important in maintaining energy and keeping your thoughts clear.

Avoid alcohol and drugs

Doctors advise not drinking alcohol while taking antidepressants. Even if you’re not taking antidepressants, it’s a good idea to avoid alcohol because it can make depression worse. It may make you feel better for a short while, but the effect doesn't last. Drinking can stop you dealing with important problems and from getting the right help. It's also bad for your physical health.

Don’t take recreational drugs such as cannabis. There’s evidence that regular use, particularly in young people, can bring on depression.

Sleep well

Try to get into a healthy sleep pattern so you are well rested. If you find getting to sleep difficult, listening to soothing music in bed, meditating or practising relaxation techniques may help.

Self soothe

Using your senses to self soothe is a helpful way to take care of yourself when you’re having to use a lot of energy dealing with depression. Choose things that you enjoy. Some ideas might be:

  • listening to music that makes you feel good
  • following a recipe for a nutritious meal
  • lighting a scented candle
  • wearing something very comforting, such as a soft jumper

Write things down

The act of putting pen to paper can help by getting the thoughts in your head out and down on to paper. Or you can type on your phone or laptop. Sometimes, writing it down can help pinpoint exactly what you’re feeling and give you some control and understanding of your feelings.

Use distraction techniques

A key characteristic of depression is the negative thought pattern in which you go over and over something in your mind. To help break this pattern in a moment, distraction techniques can be helpful. A distraction technique is an action that gives you a new focus and some respite. It can be something really simple such as changing a light bulb or hanging up the washing.

Make a toolkit

Put together a box of ‘tools’ for the times when you’re feeling too low to come up with a plan or are struggling with ideas. It could contain anything you know will occupy your mind and give you a break from your thoughts. For example, your favourite book or magazine, some treats, a crossword. Or you could put in encouraging notes or a letter you’ve written to yourself to encourage you, photos of good times and memories.

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.

Causes of depression

People develop depression for lots of different reasons, and sometimes it’s not possible to pinpoint a cause. Some of us seem to be more vulnerable to depression than others. This may be because of our genes or experiences early in our life or both.

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
  • bereavement
  • relationship breakdown
  • unemployment
  • taking alcohol and drugs
  • bullying and abuse
  • big changes in your life such as moving house or even getting married
  • a family history of depression
  • having a long-term or serious illness like dementia, diabetes, heart disease or a condition that causes you pain
  • other mental health conditions such as anxiety or schizophrenia

Frequently asked questions

  • An episode of depression lasts about six to eight months on average. The risk of it coming back is 50 per cent if it’s the first bout of depression you’ve had; 70 percent if it’s the second; and 90 percent if it’s your third.

    The risk increases if you’ve had severe symptoms, if anxiety has been a key feature, if you’ve got a personality disorder, or if your symptoms included psychosis.

    One in 10 people get persistent depression.

    Because depression can come back in some people, treatment takes the risk of relapse in to account. Talk to your doctor about what they recommend for you.

    For example, it’s known that taking antidepressants for six months after you feel better can help prevent depression coming back. Antidepressants haven’t been shown to be addictive so it’s important not to worry about that.

    After six months, you and your doctor may decide to continue with your antidepressants. This will depend on how you’re feeling at the time, how many previous episodes of depression you’ve had, and any other health problems you have.

    If you’re at risk of having a relapse, your GP may suggest you continue taking antidepressants for up to two years.

    If you haven’t had antidepressant treatment, your doctor will discuss your other options with you. These include more talking treatments like CBT or a type of treatment called Mindfulness-based cognitive therapy. There’s more information about this in our expert blog: Mindfulness – can it help with depression.

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

    Offer emotional support. Your reassurance and a listening ear can be a source of support, especially when times are particularly challenging. Kind words 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. Keep up social contact. You might not think you do much or enough to help but you do more than you know.

    Give practical help. When someone is depressed, day-to-day tasks can feel too overwhelming. Helping with shopping, the laundry or making a phone call might be things you can do when they are feeling like this. You can also help them seek support by going with them to their GP.

    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.

    Encourage them to seek help. If your loved one is talking about death, take it seriously. Make sure they tell their doctor or other family members who can support them to accept help. Encourage them to get the help they need, to take their medicines, and see their therapist if this is part of their treatment.

    Recognise an emergency. If you’re worried that someone may harm themselves or is talking of suicide, this is an emergency. Stay with them and call their GP or their therapist; or call 111 or 999; or take them to A and E.

  • It can be difficult to spend a lot of time with someone who is very depressed – you may start to feel down too. Take some time out for yourself, and talk to others if you feel frustrated. Support from specialist groups may also be helpful.

    Our Mental Health Nurses suggest the following ways to look after yourself.

    • Have time out where you do something you enjoy or just have a bit of time to relax.
    • Even though you may want to fix everything for someone, remember there is only so much you can do. Set boundaries and remember that you can support them but they will need to get help for themselves.
    • Don’t forget about your own mental wellbeing. Carry on your usual daily routine as much as you can. Do things you enjoy and see your friends. Look after your health – your diet, sleep and exercise needs.
    • Talk to someone for support if you’re feeling the strain. Whether it’s a friend, a counsellor or support group, don’t feel as though you’re betraying anyone by getting help too.

    For more information read about Being there for someone with depression.

  • It’s well known that doing exercise releases ‘feel good’ hormones called endorphins. But can exercise help ease the symptoms of depression? A review of the research (this means a lot of studies were looked at together) looked into this question and found the following.

    • Exercise is more effective than having no type of therapy at all. However, when the researchers looked only at the studies that were of the highest quality, this finding wasn’t as definite.
    • Exercise may be as effective as antidepressants and psychological (talking) therapies for reducing symptoms of depression. This finding is based on a small number of studies so it isn’t completely certain.

    So, the findings seem positive and may well work for some people. If you think it will work for you and you’d rather try this than take medicines, you should consider talking to your doctor. It’s important to talk through your preferences with your doctor so that you can get the best help for you.

    Group-based structured exercise programmes are a recommended treatment option if you have mild-to-moderate depression. Talk to your GP about whether this is available in your area.


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Related information

  • Fatmata Kamara, Specialist Nurse Adviser at Bupa UK, recommends the following places for further support for depression. You can read more and also get help from these sites.

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  • Reviewed by Natalie Heaton, Specialist Health Editor, Bupa Health Content Team, June 2017
    Expert reviewer, Dr Rahul Bhattacharya, Psychiatrist
    Next review due June 2020



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