Depression
Information

Depression is one of the most common mental health problems and is a serious illness. Depression is different from simply feeling unhappy or down – it brings a lasting feeling of deep sadness and loss of interest in things you usually enjoy. Depression has physical as well as psychological symptoms and affects your ability to function day-to-day.

What is depression?

Sadness, feeling ‘down’ or ‘blue’, from time to time, is normal and usually passes within a few days. In depression, the feeling continues for weeks or months and you usually don’t know why you feel that way. It’s common for people with depression to feel a sense of despair, wondering if the mood will ever change.

The illness can affect all areas of life. It can cause you to struggle with work or school, sometimes to the point where you can’t face going there. Housework can get neglected, you may lose interest in hobbies or activities you normally like doing. You may stop seeing friends or going to social events and might have problems with family and home life.

In mild depression, you may just feel constantly down and struggle to get things done through each day. At its most severe depression can be disabling and lead to self-harm or even suicide.

Most people, however, can recover from depression with suitable treatment – usually a combination of self-help, therapy and medication.

“Have something to get up out of bed for every day. Set goals or try to find just one thing you enjoy doing every day”

HealthUnlocked Depression survey response, 2018

How common is depression?

The World Health Organization (WHO) says 300 million people live with depression, making it the leading cause of illness and disability worldwide – in many countries treatment is patchy or unavailable. In the US and UK, the condition affects around one person in ten at some point in their lives. Depression can affect anyone – from very young to elderly, from poor to wealthy, though women are almost twice as likely as men to be diagnosed with depression.

That more women than men appear to get depression is thought to be the result of a range of social factors. Women are more likely to suffer sexual or domestic violence, have lower incomes and often near-constant responsibility for the care of others. Society’s expectations of women can also add pressure to things like appearance and weight. It’s also known that men are less likely to seek help. In addition, WHO points to a ‘gender bias’ among doctors that means many are more likely to diagnose depression in women than men even when both have the same symptoms or identical scores on tests for depression.

Different types of depression

The two main categories of depression are major depressive disorder and persistent depressive disorder. There is also a range of less common types of depression and several other mood disorders that cause depressive symptoms.

Major depressive disorder (MDD)

MDD, also referred to as clinical depression, is severe depression that lasts at least two weeks and interferes with daily functioning.

Persistent depressive disorder (PDD)

Also known as dysthymia, PDD is a form of depression in which symptoms are generally less severe than in MDD, but last much longer – two years or more.

Recurrent brief depressive disorder (RBD)

Symptoms last from 2-13 days and an episode occurs once every month or two. The episodes are short, but symptoms can be severe.

Premenstrual dysphoric disorder (PMDD)

While many women get pre-menstrual stress (PMS), some women have symptoms that are extremely severe and might be diagnosed as PMDD. PMDD is not strictly a type of depression, but symptoms of depression feature heavily in the condition.

Seasonal affective disorder (SAD)

SAD is usually associated with the winter months, when a lack of daylight affects a person’s mood. SAD shares the same symptoms as general depression. It usually eases in the spring and summer.

Prenatal (antenatal) depression

This is depression that arises during pregnancy.

Postnatal depression (PND)

Though it is relatively common for new mothers to have some anxiety, stress, or a sudden lack of confidence in the days and weeks after giving birth, usually these feelings fade. If they persist or worsen, you might be diagnosed with post-natal depression. People with PND often feel overwhelmed, inadequate, and sometimes have thoughts of harming themselves or the baby. PND generally affects only women, but men can have it too.

“Post-natal depression (PND) isn’t easy to define neatly and can look very like depression experienced at other times of life,” says Julia Bueno, an integrative psychotherapist. “It can develop soon after birth, but may also emerge weeks or even months after, and it can go unrecognised for even longer. Symptoms vary but often involve negative thoughts and a lack of motivation, feelings of loneliness and incapability, tearfulness, sleeplessness and anxiety that can become crippling. Many sufferers also feel guilt over their low state, fearing they are ‘bad mothers’ as a result.”

Psychotic depression

Some people with severe depression also get psychosis – delusions, such as believing things that aren’t true, or hallucinations, where they hear, see, feel or even taste things that aren’t there. Hearing voices is a common hallucination.

Bipolar disorder

Bipolar disorder, once known as manic depression, is characterised by extremes, from mania – being elated, over-excited and energetic – to being extremely depressed.

What are the symptoms of depression?

Depression can produce a wide range of symptoms that differ from person to person. Common symptoms include:

  • constantly feeling unhappy

  • feeling hopeless and guilty

  • having low self-esteem

  • being highly self-critical

  • feeling angry, irritable and frustrated

  • struggling with everyday tasks

  • losing interest in activities you usually enjoy

  • having disrupted sleep

  • having changes in your appetite

  • losing your sex drive

  • getting aches and pains without a clear physical cause

  • withdrawing from social life

  • moving and thinking slowly, or being agitated and restless

  • having thoughts of self-harm or suicide, (usually only in severe depression)

  • having symptoms of anxiety

You are very unlikely to have all the symptoms mentioned here but if you think you might be depressed you should see your doctor. People often delay asking for help with depression but the sooner you are diagnosed and can start treatment, the better.

The NHS website has a self-assessment tool that could help you decide whether you need to see your doctor.

How is depression diagnosed?

Diagnosis of depression is done mainly by the doctor asking you questions about how you feel, your general health and how your symptoms affect you mentally, physically and socially. You should talk openly about your feelings and the effects – conversations with your doctor are confidential so you should feel free to be completely honest.

You might also be asked to complete a standard questionnaire from which a ‘score’ can be derived that helps the doctor decide if you are depressed and how severe the depression might be.

There are likely to be some physical tests, such as blood tests. These are not tests for depression but are to rule out other conditions, such as underactive thyroid, that can produce depressive symptoms.

“I was always crying over everything and always thought that I had something medically wrong with me”

HealthUnlocked Depression survey response, 2018

What causes depression?

As with most mental illnesses, there is no single cause of depression and there’s often no obvious cause at all. There are however, various factors or circumstances that may lead to depression or make you more at risk of being depressed. These can include:

Life events

Depression can be triggered by a stressful life event, such as bereavement, losing a job, living with a chronic illness, or having a baby. Chronic conditions, such as heart disease, back pain and cancer, are linked to depression. Hormonal problems caused by an underactive thyroid also make a person more vulnerable to depression.

“There is a cause and effect relationship between chronic illness and depression,” says Kate Hardenberg, a person-centred psychotherapist. “Serious illness can cause huge life changes and limit mobility and independence. A chronic illness can make it harder to do the things you enjoy, and it can erode self-confidence and hope for the future. In some cases, the physical effects of the condition itself or the side effects of medication lead to depression, too. Depression is connected to low motivation, low self-esteem and low self-worth, which leads to poor self-care, which doesn’t help if you have a long-term illness that requires you to take good care of your physical health.”

Family history

A family history of depression increases your chances of having the illness. But it is unclear whether this is genetic – an inherited tendency – or is related to the impact of growing up with a parent with depression.

Childhood experiences

There is a lot of evidence that suggests things that happen in childhood can have a lasting impact and lead to depression in adulthood. Such things as physical, sexual or emotional abuse, bullying, neglect, parents divorcing, or frequently moving home and schools can make someone more vulnerable to depression.

Lifestyle

Using ‘recreational’ drugs, drinking heavily or having addictions to things such as gambling or pornography, can all contribute to the development of depression. Often substance abuse or addictions exist alongside depression. Evidence suggests people with gambling addiction, for example, are twice as likely to be depressed as those without the addiction. It is, however, difficult to know whether depression develops from substance abuse or addiction, or if it happens the other way around.

Other mental health problems

Having other psychological disorders may make someone more likely to develop depression alongside their original illness. Anxiety, post-traumatic stress disorder, and eating disorders, for example, are all often accompanied by depression.

How is depression treated?

How your depression is treated will depend on your symptoms and their severity – whether the depression is classed as mild, moderate or severe. Typically, it will include lifestyle changes you can do yourself, talking therapies and medication.

With mild depression – where you have few or only low-level symptoms – your doctor might suggest a period of ‘watchful waiting’ in which you’ll be monitored to see if your symptoms improve by themselves. This is more likely with mild depression than with moderate or severe depression. You might be advised to join a self-help group or to take up some exercise.

“Try to find something you can do that helps. Exercise helps me”

HealthUnlocked Depression survey response, 2018

Exercise is a recognised treatment for mild to moderate depression – chemicals released in the brain when you exercise naturally improve your mood and sense of wellbeing. NICE, the UK National Institute for Health and Care Excellence, recommends it to treat depression. Doctors can prescribe a physical activity programme for you which is usually a group exercise class three times a week for 10-14 weeks.

You might also be given a self-help programme in which you work through a book or self-help manual with some support from a health professional who’ll monitor your progress. A course of computerised cognitive behavioural therapy (CCBT) may also be offered – it’s based on the talking therapy, CBT. In CCBT, you work through a computer programme that helps you understand depression and develop skills to deal with problems and negative thoughts.

If you have mild depression that isn't improving, or moderate depression, talking therapies, such as cognitive behavioural therapy (CBT), will be used. CBT can be done in groups of up to 10 people or individually, one-to-one with a therapist. Some people with mild to moderate depression may be given antidepressant medicines, though this is usually avoided if possible.

A combination of talking therapy and antidepressants is commonly used for moderate to severe depression. Talking therapies you might be offered include:

  • CBT

  • Interpersonal therapy, to resolve problems in relationships with family, partners and friends

  • Behavioural activation, to develop more positive behaviours

  • Behavioural couples therapy, to help partners build a more supportive relationship

  • Counselling, which helps you understand your symptoms and problems

  • Psychodynamic therapy, which can be useful for examining problems rooted in the past or in childhood

Your doctor should explain that, while counselling and psychodynamic therapy do help some people, there is uncertainty over their usefulness in treating depression.

The most commonly used antidepressants are SSRIs – selective serotonin reuptake inhibitors. There are other types of antidepressant, but SSRIs generally produce fewer side effects and work just as well. Many people find anti-depressants very effective, but they aren’t right for everyone. You should discuss the risks and benefits of antidepressants with your doctor and make sure you take the medication as directed. There are risks if you skip doses or stop the medicine suddenly.

“Take your meds. Give them a chance to work. Be patient. Depression doesn't go away overnight”

HealthUnlocked Depression survey response, 2018

If your depression is particularly severe, you may be offered intensive talking therapies, and other medicines, in the care of a specialist mental health team.

If you have psychotic depression, treatment is broadly similar, but you’ll usually also be given anti-psychotic medicine and may need a short stay in a hospital.

Living with depression

It’s not possible to say exactly how long it will take for you to recover from depression – everyone is different. Some may feel better after a few weeks; others take six months to a year. For 20%-30%, the symptoms may diminish but never entirely go away.

Whether you are living with depression for weeks, months or years, there’s plenty you can do to make yourself feel better and help with your recovery.

First, stick with your treatment plan – depression medicines, therapy and self-help activities all take time to work and you must keep them going to get the benefits. Don’t skip therapy sessions or exercise classes and do take any medication in line with your doctor’s advice. It’s tempting to stop taking antidepressants once you start to feel better. But stopping too soon will likely make your depression return. You shouldn’t stop any treatment without first talking to your doctor.

“Maintain a support group of people you trust and love. Make sure they understand that you sometimes need to be alone, that you will have bad days, and most of the time they can’t do anything to help but be present”

HealthUnlocked Depression survey response, 2018

Talk to trusted friends and family members about your illness – this can help you and will help them understand what you are dealing with and how they might be able to support you. A strong support network is one of the best things you can have, for both physical and mental health. Though socialising might seem difficult, or even impossible, seeing people you care about, accepting help, and spending time with friends is hugely valuable.

Make sure you eat a healthy balanced diet – eating properly is essential for your general health and helps you deal with stress and tension.

Even if exercise is not included in your treatment plan, make sure you do some regular activity. What exercise you can do depends on your circumstances. Guidelines in the UK and the US suggest healthy adults should do 150 minutes of moderate exercise each week. But any exercise is better than none. Even taking a daily brisk walk can make you feel better.

Try to be kind to yourself and not get stressed about things. Stress can be a trigger for depression. If you find work stressful, consider talking to your employer about adjusting your job or hours to ease the stress. Some people find they can’t work when they are depressed but being off for a long time can make your depression worse. There’s good evidence that going back to work can relieve depression, possibly because it brings a sense of purpose or usefulness.

Limit or avoid alcohol, and don’t take ‘recreational’ drugs or medicines that haven’t been prescribed. Cannabis, for example, has been shown to make symptoms worse and to reduce your chance of a full recovery.

Mindfulness is an evidence-based method of dealing with symptoms of depression. In mindfulness, you learn to pay attention to the present and be aware of your feelings and thoughts and the world around you moment-to-moment. Anyone, ill or not, can practise mindfulness – many people find it helps them enjoy life more. The technique is also recommended by NICE to help prevent depression returning. You can find out more about mindfulness on the NHS website.

There are many things you can do to support yourself. Some people find a ‘gratitude journal’ to be an excellent tool in combating depression. Try writing down three things every day that you are thankful for – they can be as small as, say, having enjoyed an apple at lunchtime or being pleased that your train wasn’t delayed in the morning.

If you feel overwhelmed with things you worry about, writing a list of things that bother you might be helpful. Identify what things are and aren’t in your control and try to let go of those you can do little about. Instead, look at what you can control and plan steps towards your goals.

“Make use of the good days, there will be some! For those very bad days, try taking everything slowly in microsteps, you can do it!”

HealthUnlocked Depression survey response, 2018

Support

You can find online communities and local support groups for people with depression where you can talk to others who are also dealing with the illness. There’s plenty of evidence that taking part in support groups can help you cope and improve your recovery.

For online support, you could try the Anxiety and Depression Support community at HealthUnlocked.

In the UK, the NHS website has advice on ways to find depression support groups. You can also find groups through:

Talking therapies are available on the NHS and through private therapists and counsellors, who you can find on sites such as welldoing.org.

In the US, you can find support through:

You can find out more about mindfulness at:

If you have postnatal depression, try PANDAS

If you are in a crisis or having suicidal thoughts you can call the Samaritans anytime, day or night.

Smartphone apps

There’s a range of free and low-cost smartphone apps that some people find helpful in managing their depression. You can find them by searching for ‘depression’ in your device’s app store.