Depression

Your health expert: Miss Rose Stephen, Psychotherapist
Content editor review by Rachael Mayfield-Blake, April 2023
Next review due April 2026

Depression is a mental health condition 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 has 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, and 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
having 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 (postpartum depression)
the time of year – people with seasonal affective disorder find they’re affected at a certain time of year (usually winter)
having 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 there are other depression symptoms. You may:

feel tired (fatigued) and have no energy
feel isolated and unable to connect with friends and family
feel worthless or have a loss of self-esteem or self-confidence
have trouble sleeping (insomnia) or sleep more than normal
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 normal to handle stress
find it hard to manage your emotions
keep having thoughts about death or suicide (if you’re severely depressed)

Depression isn’t a sign of weakness and it’s not something you can just ‘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 if you definitely 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 just some of your 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 the treatment options available to you. 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 someone on a helpline such as the Samaritans or a self-help group. See our section on other helpful websites for details of some organisations who 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 an NHS service called Improving Access to Psychological Therapies (IAPT).

Diagnosis of depression

A GP will usually be able to assess if 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’ll 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 less severe or more severe, depending on how much impact it has on your daily life.

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. And don’t forget the 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. The GP will talk through which ones might work for you and create a plan with you.

Wellbeing

To help improve your overall feeling of wellbeing:

regularly do some physical activity – anything from walking and gardening to running and swimming –and if you 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. Break things into small chunks.

It may help to do group activities such as joining a singing group. Or a group for anything you enjoy doing. 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), for example, 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 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 more than one session a week over 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, 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:

cognitive behavioural therapy (CBT), which aims to help change the way you think and behave
behavioural activation, which increases your activities and positive experiences
interpersonal psychotherapy, which focuses on identifying how your relationships relate to your feelings, and explores emotions and changing your responses
counselling, which will focus on the way you process emotions to help you find your own solutions and how to cope
short-term psychodynamic psychotherapy (STPP), which will help you to recognise difficult feelings in your relationships and stressful situations, and identify how patterns can be repeated
eye movement desensitisation and reprocessing (EMDR), which helps you process and recover from past experiences using side-to-side eye movements combined with talk therapy
psychodynamic psychotherapy, which explores how childhood 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.

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 antidepressants. SSRIs include fluoxetine, citalopram and sertraline.
Tricyclic antidepressants (TCAs). These can have 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 are only prescribed by specialists. An example of an MAOI is moclobemide.

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 weeks.

Your treatment 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.

Sometimes, if regular antidepressants don’t seem to help, your doctor may suggest other types of medicines 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 at least four weeks, 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 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 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). 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 ECT 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.
Implanted vagus nerve stimulation. In this procedure, a surgeon will implant an electrical stimulator under the skin of your chest and connect 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.
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. Eat a healthy, balanced diet with regular meals as it can help you maintain a steady level of energy.
Don’t drink too much alcohol or take drugs. It can be tempting to turn to alcohol and recreational drugs to cope with difficult feelings but they can make depression worse in the long-run. 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.

Looking for support with depression?

We’re committed to helping people improve their mental health, which is why we’ve created lots of useful information about mental health and wellbeing. Anyone can use it, even if you don't have health insurance with us.

To enquire about health insurance for future conditions, call us on 0808 115 6779^∧

Find out more about how we support mental health

There are things you can do to help support someone with depression. Your reassurance and a listening ear can mean the world to them. Stay calm, be patient and try not to make assumptions about how the person is feeling. You may be able to help with practical support such as daily tasks or getting professional help when they’re ready. Learn more about depression so you understand it better too.

It’s hard to know but it’s possible that your depression may come back after treatment. You’re more at risk of a relapse the more episodes of depression you’ve had. There are several things you can do to help prevent this. For example, you may need to continue treatment with antidepressants or take another medicine. Or you could try a psychological treatment such as CBT or mindfulness-based therapy.

See our section: treatment of depression for more information.

Symptoms of depression include feeling down or hopeless and losing interest or pleasure in activities you would normally enjoy. While depression affects everyone in different ways, other symptoms can include feeling tired and worthless – you may lose your confidence in things. Depression can also affect your sleep and concentration.

See our section: symptoms of depression for more information.

The causes of depression can vary and often it’s a combination of different things. For example, you may get depressed after you lose your job or because of pain from having a long-term or serious physical health problem. Depression can also run in families.

See our section: causes of depression for more information.

Depression

If you need help now

Causes of depression

Symptoms of depression

Seeking help for depression

Diagnosis of depression

Treatment for depression

Wellbeing

Self-help programmes

Talking therapies

Medicines

Complementary therapies

Hospital treatments

Living with depression

Looking for support with depression?

More on this topic

Did our Depression information help you?

Depression

If you need help now

Causes of depression

Symptoms of depression

Seeking help for depression

Diagnosis of depression

Treatment for depression

Wellbeing

Self-help programmes

Talking therapies

Medicines

Complementary therapies

Hospital treatments

Living with depression

Looking for support with depression?

More on this topic

Antidepressants

Cognitive behavioural therapy (CBT)

Anxiety

Talking therapies for mental health

Postnatal depression

Did our Depression information help you?