Depression

Depression is a mental health condition with a range of symptoms that can affect how you think and feel. You may feel low, for example, or lose your enjoyment of things or your interest in them.

The symptoms can be mild or severe. How much depression disturbs your day-to-day life depends on how severe it is.

You can't always tell right away that you have symptoms. Depression can start and get worse gradually.

Many people don't realise they're ill, so they try to carry on and cope with the symptoms. Sometimes it takes a friend or family member to notice that something is wrong.

Depression has many different symptoms, and it doesn't affect everybody in the same way.

Depression may make you feel:

• continuously sad, or low in your mood
• irritable
• guilty
• hopeless
• tired, or low in energy
• emotional or tearful
• anxious
• angry or frustrated about small things
• negative about yourself (low self-esteem)
• low in confidence in yourself
• intolerant of other people

Depression may mean you:

• find it hard to make decisions
• don't enjoy activities that usually make you happy
• think about self-harm or suicidal thoughts
• speak or move slower than usual
• lose interest in sex
• have difficulty concentrating
• have difficulty remembering things
• use alcohol, tobacco or drugs more than usual
• have problems sleeping, or sleep too much
• lose or gain appetite
• lose or gain weight
• have aches and pains that can't be explained

Depression can affect your day-to-day life in several ways. You may have difficulties at home or with your family, and it can get in the way of completing tasks at work.

You may also find yourself avoiding social activities, dropping your usual hobbies or keeping away from people close to you.

• depression is affecting your daily life
• you're not looking after yourself
• you're finding it hard to manage any responsibilities you have

There are many different types of depression. They can affect people at different stages of their lives and during different life events. Depression can be:

• a single event
• recurring episodes
• continuous, known as chronic depression

Depression is also more likely at certain times, such as before a menstrual period, before or after pregnancy, or at particular times of year, as in seasonal affective disorder (SAD).

It can also be a feature of other mental health conditions, such as bipolar disorder.

Some people with severe depression also have symptoms of psychosis. This is called psychotic depression, and it can cause symptoms like:

• hallucinations, which means seeing or hearing things that aren't there
• delusions, which means believing things that aren't true
• psychomotor agitation, which means you can't sit still and fidget all the time
• psychomotor retardation, which can slow your thoughts and movements

People with psychotic depression are at a higher risk of thinking about suicide.

Get help with suicidal thoughts

People with psychosis often don't know they're acting and thinking strangely. This means someone else may have to get help for them.

If someone is having psychosis and has been diagnosed with a mental health condition before, speak to their:

• community mental health team
• social worker

If someone has never had a mental health condition before and is having psychotic depression, you should:

• contact their doctor, or
• take them to the hospital emergency department

If you think you may be depressed, speak to a doctor. They'll ask you about your health and how you've been feeling.

Try to be as open as you can when you talk to the doctor. It helps them find out whether you have depression and how severe it is.

There are several different treatments for depression, and the right one for you depends on how severe your symptoms are. Sometimes the first treatment doesn't work well, so you may need to try a few before you find the one that suits you.

There are many talking therapies for depression, and these include:

• cognitive behavioural therapy (CBT)
• computerised CBT (CCBT)
• interpersonal therapy (IPT)
• psychodynamic psychotherapy
• counselling

Your doctor may suggest medicine such as an antidepressant to treat your depression. This is more likely if your depression is moderate or severe.

You may have to try more than one antidepressant before you find the one that works for you. Some of the different types are:

• selective serotonin reuptake inhibitors (SSRIs)
• serotonin-noradrenaline reuptake inhibitors (SNRIs)
• noradrenaline and specific serotonergic antidepressants (NASSAs)
• tricyclic antidepressants (TCAs)

In certain circumstances, you may be prescribed lithium to treat depression. For example, this can happen if you've tried different antidepressants and your symptoms haven't improved.

Electroconvulsive therapy (ECT) works by sending an electrical current through your brain. Before the treatment you'll be given an anaesthetic, and medicine to relax your muscles.

ECT is only offered in certain circumstances. One example is when you have severe depression and other treatments haven't worked.

Further information on ECT

St John's Wort is a herbal treatment for depression, and you can buy it from pharmacies and health food shops. There's some evidence that it can help less severe depression, but doctors don't recommend it.

It isn't suitable if you're taking certain medicines, or if you're pregnant or breastfeeding. It can also interact with the contraceptive pill.

Depression doesn't have one single cause. Many different things can trigger it, and people come to it for many reasons. Sometimes depression develops with no obvious cause at all.

Depression can set in after a stressful life event. Some examples are:

• bereavement
• divorce or the end of a relationship
• relationship problems
• illness or a physical health problem
• money worries
• job loss

Some other things can raise your risk of depression too:

• drug use
• alcohol
• family history of depression
• your way of thinking (for example, going over a negative event again and again)
• having a baby (many parents experience postnatal depression after a baby is born)
• negative childhood experiences, like neglect or abuse
• having another mental health problem, like anxiety, eating problems or post-traumatic stress disorder (PTSD)

Living with depression can be hard, but there are things you can do to look after yourself. One of them is to talk to people you trust about how you feel.

You could also try something creative, like art, poetry or keeping a journal. It can help you put your feelings into words.

If you're worried about someone close to you who may have depression, try to:

• get professional help for them
• let them know they're not alone and that you care about them
• offer support in finding solutions to their problems

If you're close to someone with depression, the condition can affect you too. Your relationship and family life in general can come under strain, and you may not know what to do or how to help.

Talking about the situation can help. Finding a support group, or talking to other people in a similar situation, can make it easier to cope.

If depression is affecting your relationship, you could contact a relationship counsellor. They can talk things through with both of you.