Depression

WHAT IS DEPRESSION?

Depression is a low mood that lasts for a long time, and affects your everyday life.
In its mildest form, depression can mean just being in low spirits. It doesn’t stop you leading your normal life but makes everything harder to do and seem less worthwhile. At its most severe, depression can be life-threatening because it can make you feel suicidal or simply give up the will to live.

ARE THERE DIFFERENT TYPES OF DEPRESSION?

If you are given a diagnosis of depression, you might be told that you have mild, moderate or severe depression. This describes what sort of impact your symptoms are having on you currently, and what sort of treatment you’re likely to be offered. You might move between different mild, moderate and severe depression during one episode of depression or across different episodes.

There are also some specific types of depression:
Seasonal affective disorder (SAD) – depression that usually (but not always) occurs in the winter. SAD Association provides information and advice.

Dysthymia – continuous mild depression that lasts for two years or more. Also called persistent depressive disorder or chronic depression.

Prenatal depression – sometimes also called antenatal depression, it occurs during pregnancy.

Postnatal depression (PND) – occurs in the weeks and months after becoming a parent. Postnatal depression is usually diagnosed in women but it can affect men, too.

WHAT ARE THE SYMPTOMS OF DEPRESSION?

There are many signs and symptoms of depression, but everyone’s experience will vary. This page covers:
Common signs and symptoms of depression.

  • Psychotic symptoms.
  • Self-harm and suicide.
  • Anxiety.
  • Depression as a symptom of other mental health problems.

COMMON SIGNS AND SYMPTOMS OF DEPRESSION

HOW YOU MIGHT FEEL

  • Down, upset or tearful.
  • Restless, agitated or irritable.
  • Guilty, worthless and down on yourself.
  • Empty and numb.
  • Isolated and unable to relate to other people.
  • Finding no pleasure in life or things you usually enjoy.
  • A sense of unreality.
  • No self-confidence or self-esteem.
  • Hopeless and despairing.
  • Suicidal.

HOW YOU MIGHT BEHAVE

  • Avoiding social events and activities you usually enjoy.
  • Self-harming or suicidal behaviour.
  • Finding it difficult to speak or think clearly.
  • Losing interest in sex.
  • Difficulty in remembering or concentrating on things.
  • Using more tobacco, alcohol or other drugs than usual.
  • Difficulty sleeping, or sleeping too much.
  • Feeling tired all the time.
  • No appetite and losing weight, or eating too much and gaining weight.
  • Physical aches and pains with no obvious physical cause.
  • Moving very slowly, or being restless and agitated.

 

ABOUT PSYCHOTIC SYMPTOMS

If you experience an episode of severe depression, you might also experience some psychotic symptoms. These can include:

  • Delusions, such as paranoia
  • Hallucinations, such as hearing voices

If you experience psychotic symptoms as part of depression, they’re likely to be linked to your depressed thoughts and feelings. For example, you might become convinced that you’ve committed an unspeakable crime. These kinds of experiences can feel very real to you at the time, which may make it hard to understand that these experiences are also symptoms of your depression. They can also be quite frightening or upsetting, so it’s important to seek help and support.

You might feel worried that experiencing psychotic symptoms could mean you get a new diagnosis, but psychosis can be a symptom of depression. Discussing your symptoms with your doctor can help you get the right support and treatment.

ABOUT SELF-HARM AND SUICIDE

If you are feeling low, you might use self-harming behaviours to cope with difficult feelings. Although this might make you feel better in the short term, self-harm can be very dangerous and can make you feel a lot worse in the long term. See our pages on self-harm for more information.
When you’re feeling really low and hopeless, you might find yourself thinking about suicide. Whether you’re only thinking about the idea, or actually considering a plan to end your life, these thoughts can feel difficult to control and very frightening. If you’re worried about acting on thoughts of suicide, you can call an ambulance, go straight to A&E or call the Samaritans for free on 116 123 to talk.

CAN DEPRESSION BE A SYMPTOM OF OTHER MENTAL HEALTH PROBLEMS?

Depression can be a part of several mental health problems:

  • Bipolar disorder.
  • Borderline personality disorder (BPD) and other personality disorders.
  • Schizoaffective disorder.

As feelings of low mood or suicidal thoughts might be the reason you first speak to your doctor about your mental health, your GP might offer you treatment for depression without realising that you are also experiencing other symptoms.

If you think you’re experiencing other symptoms, you can talk to your doctor about this to make sure you’re getting the right treatment to help you.

WHAT CAUSES DEPRESSION?

There are several ideas about what causes depression. It can vary a lot between different people, and for some people a combination of different factors may cause their depression. Some find that they become depressed without any obvious reason.

In this section you can find information on the following possible causes of depression:

CHILDHOOD EXPERIENCES

There is good evidence to show that going through difficult experiences in your childhood can make you vulnerable to experiencing depression later in life. This could be:

  • Physical, sexual or emotional abuse.
  • Neglect.
  • Loss of someone close to you.
  • Traumatic events.
  • Unstable family situation.

Research shows that going through lots of smaller challenging experiences can have a bigger impact on your vulnerability to depression than experiencing one major traumatic event.

Difficult experiences during your childhood can have a big impact on your self-esteem and how you learned to cope with difficult emotions and situations. This can make you feel less able to cope with life’s ups and downs, and lead to depression later in life.

LIFE EVENTS

In many cases, you might find your depression has been triggered by an unwelcome, stressful or traumatic event. This could be:

  • Losing your job or unemployment.
  • The end of a relationship.
  • Bereavement.
  • Major life changes, like changing job, moving house or getting married.
  • Being physically or sexually assaulted.
  • Being bullied or abused.

 

OTHER MENTAL HEALTH PROBLEMS

If you experience another mental health problem, it’s common to also experience depression. This might be because coping with the symptoms of your mental health problem can trigger depression. You may find you experience depression if you also experience:

  • Anxiety.
  • Eating problems.
  • PTSD.

 

PHYSICAL HEALTH PROBLEMS

Poor health can contribute to your risk of developing depression. Many health problems can be quite difficult to manage, and can have a big impact on your mood. These could be:

  • Chronic health problems.
  • Life threatening illnesses.
  • Health problems that significantly change your lifestyle.

As part of your treatment for a physical health problem you might be offered support for your mental health at the same time. There are some physical health problems that can cause depression:

  • Conditions affecting the brain and nervous system.
  • Hormonal problems, especially thyroid and parathyroid problems.
  • Symptoms relating to the menstrual cycle or the menopause.
  • Low blood sugar.
  • Sleep problems.

If you think any of the above conditions apply to you, make sure your doctor knows about them. Some can be diagnosed by simple blood tests – your doctor may suggest these are done to help make the right diagnosis, or you can ask for blood tests if you think they may be relevant.

GENETIC INHERITANCE

Although no specific genes for depression have been identified, research has shown that if you have a close family member with depression, you are more likely to experience depression yourself.

While this might be caused by our biology, this link could also be because we usually learn behaviour and ways of coping from the people around us as we grow up.

MEDICATION, DRUGS AND ALCOHOL

Depression can be a side effect of a lot of different medicines. If you are feeling depressed after starting any kind of medication, check the patient information leaflet to see whether depression is a side effect, or ask your doctor. If you think a drug is causing your depression, you can talk to your doctor about taking an alternative, especially if you are expecting your treatment to last some time.
Alcohol and street drugs can both cause depression. Although you might initially use them to make yourself feel better, or to distract yourself, they can make you feel worse overall.

SLEEP, DIET AND EXERCISE

A poor diet and lack or sleep and exercise can affect your mood, and make it harder for you to cope with difficult things going on in your life.
Although a poor diet, or not getting enough sleep or exercise, cannot directly cause depression, they can make you more vulnerable to developing it.

WHAT CAN I DO TO HELP MYSELF?

Experiencing depression can make it hard to find the energy to look after yourself. But taking an active role in your treatment, and taking steps to help yourself cope with your experiences, can make a big difference to how you feel. Here are some things you can try:

LOOK AFTER YOURSELF

Get good sleep. For lots of people who experience depression, sleeping too little or too much can be a daily problem. Getting good sleep can help to improve your mood and increase your energy levels.

Eat well. Eating a balanced and nutritious diet can help you feel well, think clearly and increase your energy levels.

Keep active. Many people find exercise a challenge but gentle activities like yoga, swimming or walking can be a big boost to your mood.

Look after your hygiene. When you’re experiencing depression, it’s easy for hygiene to not feel like a priority. But small things, like taking a shower and getting fully dressed whether or not you’re going out of the house, can make a big difference to how you feel.

Avoid drugs and alcohol. While you might want to use drugs or alcohol to cope with any difficult feelings, in the long run they can make you feel a lot worse.

PRACTISE SELF-CARE

Work out what makes you happy. Try making a list of activities, people and places that make you happy or feel good. Then make a list of what you do every day. It probably won’t be possible to include all the things that make you happy but try to find ways to bring those things into your daily routine.

Treat yourself. When you’re feeling down, it can be hard to feel good about yourself. Try to do at least one positive thing for yourself every day. This could be taking the time for a long bath, spending time with a pet or reading your favourite book. See our relaxation tips for some ideas of things to do.

Create a resilience toolkit. This could be a list of activities you know improve your mood, or you could fill an actual box with things to do to cheer yourself up. Try including your favourite book or film, a notebook and pen to write down your thoughts or notes of encouragement to yourself. It might feel difficult or a bit silly to put it all together but it can be a really useful tool if you’re feeling too low to come up with ideas later on.

KEEP ACTIVE
Join a group. This could be anything from a community project or a sports team to a hobby group. The important thing is to find an activity you enjoy, or perhaps something you’ve always wanted to try, to help you feel motivated.

Try new things. Trying something new, like starting a new hobby, learning something new or even trying new food, can help boost your mood and break unhelpful patterns of thinking and behaviour.

Try volunteering. Volunteering (or just offering to help someone out) can make you feel better about yourself and less alone

Set realistic goals. Try to set yourself achievable goals, like getting dressed every day or cooking yourself a meal. Achieving your goals can help you feel good and boost your self-confidence, and help you move on to bigger ones.

CHALLENGE YOUR LOW MOOD
Keep a mood diary. This can help you keep track of any changes in your mood, and you might find that you have more good days than you think. It can also help you notice if any activities, places or people make you feel better or worse.

Challenge your thinking. Students Against Depression have lots of information and activity sheets to try to help you challenge negative thinking.

Try self-help. If your depression is mild, you might find free cognitive behavioural therapy (CBT) courses online which can help you tackle some of your negative thinking and avoid your depression growing worse.

Contact a helpline. If you’re struggling with difficult feelings, and you can’t talk to someone you know, there are many helplines you can contact. These are not professional counselling services but the people you speak to are trained to listen and could help you feel more able to cope with your low mood.

CONNECT WITH OTHER PEOPLE
Keep in touch. If you don’t feel up to seeing people in person, or talking, send a text or email to keep in touch with friends and family.

Keep talking. It might feel hard to start talking to your friends and family about what you’re feeling, but many people find that just sharing their experiences can help them feel better.

Join a peer support group. Going to a peer support group is a great way to share tips and meet other people who are going through similar things.

Use online support. Online support can be a useful way to build a support network when you cannot, or don’t feel able to, do things in person.

TALKING TREATMENTS FOR DEPRESSION

There are many different talking treatments that can be effective in treating depression:

  • Cognitive behavioural therapy (CBT).
  • Group-based CBT.
  • Computerised CBT (CCBT) – this is CBT delivered through a computer programme or website.
  • Interpersonal therapy (IPT).
  • Behavioural activation.
  • Psychodynamic psychotherapy.
  • Behavioural couples therapy – if you have a long-term partner, and your doctor agrees that it would be useful to involve them in your treatment.

Your doctor or mental health professional can talk through the options available in your area and help you find the right kind of talking treatment for you. Unfortunately, we know that in many places NHS waiting lists for talking treatments can be very long.

MEDICATION FOR DEPRESSION

You might also be offered an antidepressant, either on its own or in combination with a talking treatment. There are different types of antidepressants:

  • Selective serotonin reuptake inhibitors (SSRIs).
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs).
  • tricyclics and tricyclic-related drugs.
  • Monoamine oxidase inhibitors (MAOIs).
  • Other antidepressants.

Different people find different medications most helpful. You can talk to your doctor about your options – you might find you need to try out a few different types of medication before you find the one that works for you.

ALTERNATIVE TREATMENTS

There are also other options you can try instead of, or alongside, medication and talking treatments.

If you aren’t experiencing many symptoms, or they aren’t impacting on your daily life too much, then your doctor might suggest:

Watchful waiting – this means being aware of your mood, and seeing how you feel after a few weeks have passed; many people find that some mild depressive symptoms can go away on their own.

Guided self-help – this is usually using ideas from cognitive behavioural therapy(CBT) one-to-one with a mental health professional to learn problem solving techniques.

Physical activity programmes – these are specifically designed for people with depression and run by qualified professionals.

Arts therapies.

Alternative and complementary therapies.

Mindfulness.

Ecotherapy.

Peer support.

Your doctor may be able to refer you to some of these. You can also contact your local Mind to find out what they have available.

ECT
Electroconvulsive therapy (ECT) should only be considered a treatment option for depression in extreme circumstances. According to NICE guidelines this could be if:
You’re experiencing a long and severe period of depression.
Other treatments have not worked.
The situation is life-threatening.

If you feel like you’re in this situation, your doctor should discuss this option with you in a clear and accessible way before you make any decisions.

STAYING WELL
If you start to feel better, it’s important to discuss with your doctor whether you should continue your treatment. Your doctor can also discuss your options for treatment to stay well after an episode of depression has passed.

MEDICATION
If you’re taking medication for depression, it’s important not to stop suddenly. This can be dangerous, and withdrawal symptoms can be difficult to cope with

NICE recommends that you continue to take your antidepressants for at least six months after your episode of depression ends. If you’ve experienced several episodes of depression before, you might want to keep taking your medication if you feel it could help you prevent another episode.

TALKING TREATMENTS
If you’re currently receiving a talking treatment, you don’t have to stop just because you’re feeling better. You can discuss your mood with your therapist and talk about what options might be right for you.

NICE recommends CBT or mindfulness based cognitive therapy (MBCT) to help you stay well if you’ve had episodes of depression in the past.

HOW CAN FRIENDS AND FAMILY HELP?

The support of friends and family can play a very important role in someone recovering from depression. Here are some suggestions for how you can help.
Support them to get help. You can’t force anyone to get help if they don’t want it, so it’s important to reassure your loved one that it’s OK to ask for help, and that there is help out there.

Be open about depression. Lots of people can find it hard to open up and speak about how they’re feeling. Try to be open about depression and difficult emotions, so your friend or family member knows that it’s OK to talk about what they’re experiencing.

Keep in touch. It might be hard for your loved one to have the energy to keep up contact, so try to keep in touch. Even just a text message or email to let them know that you’re thinking of them can make a big difference to how someone feels.

Don’t be critical. If you’ve not experienced depression yourself, it can be hard to understand why your friend or family member can’t just ‘snap out of it’. Try not to blame them or put too much pressure on them to get better straight away – your loved one is probably being very critical and harsh towards themselves already. Mind’s information about depression can help you learn more about it.

Keep a balance. If someone is struggling, you might feel like you should take care of everything for them. While it might be useful to offer to help them do things, like keep on top of the housework or cook healthy meals, it’s also important to encourage them to do things for themselves. Everyone will need different support, so talk to your friend or family member about what they might find useful to have your help with, and identify things they can try to do themselves.

Take care of yourself. Your mental health is important too, and looking after someone else could put a strain on your wellbeing.