Depression

Depression is a mental health condition where you have a 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 that lasts for a couple of weeks or more with a significant impact on your life.

If you need help now

This page is designed to provide general health information. If you need help now, please use the following services.

• Samaritans. 116 123 (UK and ROI) - This helpline is free for you to call and talk to someone.
• NHS Services has a list of where to get urgent help for mental health.
• Mind website. Click the ‘Get help now’ button on 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 think you might harm yourself or are worried someone else might come to immediate harm, call the emergency services on 999 or go to your local accident and emergency department.

Causes of depression

You can develop depression for lots of different reasons. Sometimes it’s not possible to pinpoint one particular cause. It’s often a combination of several different things. These may include:

• a stressful life event such as a bereavement, relationship breakdown or job loss
• genetic factors – you’re more at risk if you have a family history of depression
• a long-term or serious physical health problem like diabetes, heart disease or a condition that causes you pain
• problems with alcohol or drug addiction
• physical or mental abuse in the past or post-traumatic stress disorder
• experiencing neglect as a child or an unstable family life
• if you’ve recently had a baby – this can cause a specific type of depression known as postnatal depression (also known as postpartum depression)
• the time of year – people with seasonal affective disorder find they’re affected at a certain time of year (usually winter)
• if you have other mental health conditions such as anxiety, schizophrenia or dementia

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 you can have other depression symptoms. You may:

• feel tired (fatigued) and have no energy
• feel isolated and unable to connect with people such as friends and family
• feel worthless or have a loss of self-esteem or self-confidence
• have trouble sleeping (insomnia) or sleep more than usual
• feel restless or agitated
• find it hard to concentrate and make decisions
• see changes in your appetite and/or weight
• feel hopeless about the future
• find it harder than usual to handle stress
• find it hard to manage your emotions
• have thoughts about death or suicide (if you’re severely depressed)

Depression isn’t a sign of weakness and it’s not something you can ‘snap out of’. Depression can have a major impact on your personal, social, and work life.

Seeking help for depression

Sometimes it’s hard to know if you’re depressed because depression can make it difficult to see things clearly. Also, it may have come on gradually. But it’s always OK to ask for help, even if you’re not sure that you have depression.

The first step in getting help for depression is to reach out to someone. Who you talk to will depend on your preference. Choose what feels right for you. Here are some potential options.

• Talk to someone close to you. They may have already noticed that something’s wrong, and can offer you support.
• A GP can diagnose depression (or refer you to someone who can) and tell you about treatment options. 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 a GP as early as possible.
• Speak to a helpline such as the Samaritans or a self-help group. See our section on other helpful websites for details of some organisations that can help you.
• You may 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 self-refer yourself for NHS talking therapy (without going through a GP). This is through a service called the NHS Talking Therapies, for anxiety and depression programme (formerly called Improving Access to Psychological Therapies (IAPT)).

Diagnosis of depression

A GP will usually be able to assess if you’ve got clinical depression and how severe it is from talking to you. They’ll ask you 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’ll also ask if you’ve noticed any other symptoms such as trouble sleeping, changes in appetite or if you’ve been feeling tired or irritable.

Your depression may be classed as less severe or more severe, depending on how much impact it has on your daily life. Sometimes, your symptoms may suggest you have bipolar depression (bipolar disorder). This is a mental health condition that causes severe mood swings from depression to elation.

You may find it hard to start a conversation about how you feel with a 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.

Treatment for depression

There are several different types of treatment for depression.Your GP will discuss which ones might work and create a plan for you.

Wellbeing

To help improve your overall feeling of wellbeing, you could try the following.

• Try to do some regular physical activity – anything from walking and gardening to running and swimming. If you can do something outdoors, even better.
• Try and keep a healthy lifestyle by eating a healthy diet, not drinking too much alcohol and getting enough sleep.

Start small and make changes gradually. If you make or try to make big changes, you might feel overwhelmed. Tackle things in small actions.

It may help to do group activities such as joining a singing group or a running group. Anything you enjoy doing may help. You could also volunteer to help in your local community or spend some time around people who have overcome depression.

Self-help programmes

Self-help programmes include the following.

• A self-help manual or booklet. These may be based on the principles of cognitive behavioural therapy (CBT), which aims to change how you think and behave. You’ll have support from a trained health professional who will check your progress through the programme.
• Computerised CBT. These are computer-based or web-based programmes which you complete yourself 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 more than one session a week for about 10 weeks.

Talking therapies

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. A GP may refer you to a therapist or, in some areas, you may be able to access these services yourself (self-refer). You can have the therapy on your own or with a group.

There are different types of talking therapy for depression. These include the following.

• Cognitive behavioural therapy (CBT) aims to help change the way you think and behave.
• Behavioural activation focuses on increasing activities that give you positive experiences.
• Interpersonal psychotherapy focuses on identifying how your relationships relate to your feelings, and explores emotions and changing your responses.
• Counselling focuses on the way you process emotions in order to help you find your own solutions and ways to cope.
• Short-term psychodynamic psychotherapy (STPP) helps you to recognise difficult feelings in your relationships and stressful situations and identify how patterns can be repeated.
• Eye movement desensitisation and reprocessing (EMDR) helps you process and recover from past experiences using bilateral stimulation – this often takes the form of eye movements, combined with talk therapy.
• Psychodynamic psychotherapy explores how past experiences and thoughts you're unaware of (your subconscious mind) affect your thinking, feelings, relationships and behaviour today.

Alternatively, you can have therapy that focuses on problem solving or mindfulness-based therapy if this is more appropriate for you.

Medicines

Your doctor may offer you an antidepressant medicine instead of or as well as a talking therapy. Antidepressants include the following types.

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

When you first start taking antidepressants, a GP will usually review you within a couple of weeks and regularly (as often as needed) after that. Your symptoms may start to improve in a few days but it generally takes up to four or five weeks.

Antidepressants may make you feel more agitated or anxious at first. Contact a GP for advice if this happens. If your medicine doesn’t seem to be working after four weeks, the GP may suggest they increase your dose or switch you to a different medicine.

If regular antidepressants don’t seem to help, 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 need to continue to take your antidepressants for at least six months after you start to feel better. This will help prevent your depression coming back. When you’re ready to stop antidepressants, the GP will usually reduce your dose gradually over weeks to months, to prevent withdrawal symptoms.

Complementary therapies

St John’s wort (Hypericum perforatum) is a herbal remedy that some people take for milder depression. There’s some evidence that it might help ease less severe depression. But doctors don’t recommend it because there’s a lot of uncertainty about how much you need to take for it to work well. There’s also potential for serious interactions with a number of other medicines.

Don’t take any herbal remedies without speaking to a GP or pharmacist first.

Hospital treatments

Hospital treatment for depression includes the following therapies.

• Electroconvulsive therapy (ECT) 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. This means you’ll be asleep during the procedure and feel no pain. You’ll only be offered ECT if you're severely depressed and need urgent treatment or if other treatments haven’t helped.
• Transcranial magnetic stimulation 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.
• Implanted vagus nerve stimulation is when a surgeon implants an electrical stimulator under the skin of your chest and connects it to your vagus nerve. Stimulating this nerve is thought to reduce symptoms of depression and improve your mood. There isn’t enough evidence yet to say it works so you’ll only have this under certain circumstances – for example, if you’re part of a research trial.

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. It’s easier sometimes for others to notice that we’re struggling before we see it.
• Physical activity. Physical activity can really boost your mood. If you don’t know where to start with exercise, try something gentle like swimming, walking or yoga.
• Eat and drink well. Eat a healthy, balanced diet with regular meals because this can help you maintain a steady level of energy.
• Don’t drink too much alcohol or take drugs. It can be tempting to use alcohol or recreational drugs to cope with difficult feelings, but they can make depression worse in the long term. Regular use of recreational drugs such as cannabis can bring on depression.
• Sleep well. Try to get into a healthy sleep pattern so you get enough rest. Good sleep 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.
• Know what things trigger your depression and have a plan to manage them, wherever possible. Not all triggers are within your control so seek appropriate support to manage them if you need to.