Depression is a common mental disorder that causes people to experience depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration.

Depression is different from feeling down or sad.  Unhappiness is something which everyone feels at one time or another, usually due to a particular cause.  A person experiencing depression will experience intense emotions of anxiety, hopelessness, negativity and helplessness, and the feelings stay with them instead of going away.

Depression can happen to anyone.  Many successful and famous people who seem to have everything going for them battle with this problem.  Depression also affects people of every age.

Half of the people who have depression will only experience it once but for the other half it will happen again.  The length of time that it takes to recover ranges from around six months to a year or more.

Living with depression is difficult for those who suffer from it and for their family, friends, and colleagues.  It can be difficult to know if you are depressed and what you can do about it.

Signs and symptoms

• Tiredness and loss of energy.

• Sadness that doesn’t go away. 

• Loss of self-confidence and self-esteem. 

• Difficulty concentrating. 

• Not being able to enjoy things that are usually pleasurable or interesting. 

• Feeling anxious all the time. 

• Avoiding other people, sometimes even your close friends. 

• Feelings of helplessness and hopelessness. 

• Sleeping problems - difficulties in getting off to sleep or waking up much earlier than usual.

• Very strong feelings of guilt or worthlessness. 

• Finding it hard to function at work/college/school. 

• Loss of appetite. 

• Loss of sex drive and/or sexual problems. 

• Physical aches and pains. 

• Thinking about suicide and death. 

• Self-harm

If you experience four or more of these symptoms for most of the day - every day - for more than two weeks, you should seek help from your GP.

What leads to depression?

Depression can happen suddenly as a result of physical illness, experiences dating back to childhood, unemployment, bereavement, family problems or other life-changing events.

Examples of chronic illnesses linked to depression include heart disease, back pain and cancer.  Pituitary damage, a treatable condition which frequently follows head injuries, may also lead to depression.

Sometimes, there may be no clear reason for your depression but, whatever the original cause, identifying what may affect how you feel and the things that are likely to trigger depression is an important first step.

Types of depression:

• Mild depression

Depression is described as mild when it has a limited negative effect on your daily life.  For example, you may have difficulty concentrating at work or motivating yourself to do the things you normally enjoy.

• Major depression

Major depression interferes with an individual’s daily life - with eating, sleeping and other everyday activities.  Some people may experience only one episode but it is more common to experience several episodes in a lifetime.  It can lead to hospital admission, if the person is so unwell they are at risk of harm to themselves.

• Bi-polar disorder

The mood swings in bi-polar disorder can be extreme - from highs, where the individual feels extremely elated and indestructible, to lows, where they may experience complete despair, lethargy and suicidal feelings.  Sometimes people have very severe symptoms where they cannot make sense of their world and do things that seem odd or illogical. 

• Post-natal depression

Many new mothers experience what are sometimes called 'baby blues' a few days after the birth.  These feelings of anxiety and lack of confidence are very distressing but in most cases last only a couple of weeks.  Post-natal depression is more intense and lasts longer.  It can leave new mothers feeling completely overwhelmed, inadequate and unable to cope.  They may have problems sleeping, panic attacks or an intense fear of dying.  They may also experience negative feelings towards their child.  It affects one in ten mothers and usually begins two to three weeks after the birth.

• Seasonal Affective Disorder (SAD)

SAD is associated with the start of winter and can last until spring when longer days bring more daylight.  When it is mild, it is sometimes called ‘winter blues’.  SAD can make the sufferer feel anxious, stressed and depressed.  It may interfere with their moods and with their sleeping and eating patterns.

How do I get help?

Talking therapies such as cognitive behavioural therapy (CBT) and some forms of counselling and psychotherapy work well for depression, although you may have to wait to see a therapist on the NHS.  You can pay to see someone privately and your GP may be able to recommend someone.  Always check that any private therapist is registered with a professional body.

There are several different kinds of talking therapy.  Your GP can advise you about which you might find most helpful.

Counselling

Counselling gives people the chance to talk through everyday issues that may be causing depression and to develop strategies for resolving them.

• Cognitive therapy

Cognitive therapy (sometimes called cognitive behavioural therapy or CBT) addresses the way you think and how this can cause depression.  It teaches you skills to identify patterns of behaviour and thinking that are causing you problems and change them. 

• Psychotherapy

Psychotherapy can be more intensive than counselling although people and organisations often use these terms interchangeably.  It often looks at how past experience may be affecting your life now, so it may involve delving deeply into early experiences and key relationships.

 

This may take more time, although shorter, more focused ways of doing this have also been developed.  Interpersonal therapy focuses on how you relate and behave towards others.  It helps you to build a better self-image and communicate more effectively with others.

• Anti-depressants

In many cases your GP will recommend anti-depressants, either on their own or in combination with talking therapies.

 

Anti-depressants do work for many people but inevitably they do have side effects.  You can discuss these with your GP.

About medication

Medication will not always be the first choice, especially if your depression is mild.  There are a number of different types of antidepressants available.  Your GP can explain which they believe is the best for you and why.  What your doctor prescribes will depend on the type and severity of depression you have.  If you experience problems from your medicine or have any concerns, speak to your GP.

If one medication does not work you may be prescribed something else.  However it takes a few weeks before your medicine starts to work so you need to allow enough time to see if it is going to be effective.

It is important that you take the medicine for the length of time recommended by your GP.  If you come off your medicine too soon (even if you feel better) this can lead to a relapse where the depression returns.  As a rough guide, you will usually have to remain on treatment for at least six to nine months and in many cases it could be longer.

You need to follow your GP’s advice when you are coming off your medicine as it can be harmful if this is done too quickly.

BMJ Group: Depression – Adults

BMJ Group: Depression – Children

BMJ Group: Depression – Postnatal

BMJ Group: Bipolar Disorder

The British Dietetic Association: Diet and Depression

NHS Choices: Seasonal Affective Disorder

Seasonal Affective Disorder: Ways To Beat The Winter Blues