Depression

What is depression?

Depression is a constant feeling of sadness or low mood, with a loss of interest in activities, including those you would normally enjoy.

It’s normal to go through periods where you feel sad or low. But with depression, you might find it hard to identify the cause and feel persistently low for weeks or months. 

Remember that depression isn’t a sign of weakness, and you deserve help.

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What are the symptoms of depression?

Depression not only affects your mental state — symptoms are often both psychological and physical. 

Common psychological symptoms of depression include:

• being unable to enjoy activities that usually make you happy
• hopelessness
• low self-esteem
• poor concentration
• feeling inappropriately guilty and worthless
• feeling irritable and intolerant of others
• feeling suicidal

You might find that your symptoms differ in severity over time, so it might be helpful to keep a diary to track your mood. Many people find depression symptoms are worse at the start of the day. 

Common physical symptoms of depression include:

• low energy
• loss of sex-drive
• aches and pains
• disturbed sleep pattern — like difficulty falling asleep, waking up in the night and struggling to go back to sleep, or oversleeping
• lack of appetite

Some people with depression can experience psychotic symptoms — like hallucinations and delusions. 

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What causes depression?

The exact causes of depression are unknown. But a depressive episode might be triggered by significant life events, like losing a loved one. Or it could be a series of seemingly unconnected events that cause a depressive episode. 

Factors that can play a part in depression are:

• stressful events — like the end of a relationship or losing your job
• family history — like having a sibling or parent who has suffered from depression
• childbirth — 1 in 10 women develop postnatal depression
• loneliness — being cut off from friends and family increases your risk
• illnesses — like heart disease, cancer, or head injuries might affect your mental health
• alcohol and drugs — these can worsen your mental state and make it harder to cope in the long term
• environmental issues — like air, water, noise, or chemical pollution

What does a depression diagnosis involve?

If you feel depressed for most of the day for more than 2 weeks, you should see your GP. 

Your GP will ask you some questions about your symptoms. They might also carry out urine or blood tests to rule out other conditions that can affect your mood — like an underactive thyroid (hypothyroidism).   

If you think you might have depression, you can take the NHS depression self-assessment questionnaire.

Once you have a depression diagnosis, your GP will monitor your symptoms over time. 

Typically, your GP will ask you to complete the patient health questionnaire and general anxiety disorder (PHQ-9 and GAD-7). It covers your mental health, quality of life, and disability information. 

When completing the self-report questionnaire, you might:

• score highly for anxiety but low for depression
• score highly for depression but low for anxiety 
• score highly for both anxiety and depression

If your patient health questionnaire indicates depression, your GP will recommend various treatment options — like medication, therapy, and exercise. Your preferences will always be taken into account.

Supporting someone with depression

If you’ve noticed that someone is experiencing the symptoms of depression, there are many things you can do to support them, like:

• letting them know you’re there to listen without judgement
• offering to cook them a meal or getting their groceries — this can be helpful if they’re feeling low on energy
• avoid giving advice — many people with depression simply want to be listened to
• giving them information about local psychological therapy services or depression support groups 
• contacting them regularly by message, a phone call, or by meeting up for a walk
• being patient — try not to take it personally if someone with depression doesn’t want to meet up or they cancel plans

Supporting someone who lives with depression can be difficult. That’s why looking after your mental health is essential by giving yourself time to relax, eat well, exercise, and get enough sleep. You could also find a support group and talk to others in a similar situation.

If you're having a relationship or marriage problems, seeking professional help from a relationship counsellor is one of the best things you can do. They can help you and your partner talk through things in a safe and nonjudgemental environment. 

How to treat depression

The good news is that there are many different ways to treat depression. Your treatment will depend on how severe your symptoms are, and your personal preference will be considered when discussing your treatment options with your doctor. 

Some treatment options for mild depression are:

• exercise — boosts your mood, which can help with feeling low. Your GP might refer you to a group class 
• self-help — daily journaling and talking about your feelings with someone you trust can be helpful
• mindfulness — to improve your mood. You could try things like meditation and yoga or tai chi
• online or group-based cognitive behavioural therapy (CBT) — a talking therapy where you work with a trained therapist to reframe negative thoughts into more positive ones. You’ll also learn tools to help you cope with triggering situations and improve your self-esteem. These programmes typically take place over 9-12 weeks and require a degree of self-motivation and commitment.  

Sometimes exercise and self-help aren’t enough to treat depression. If you have moderate to severe depression or persistent mild depression, your GP will usually recommend a combination of treatments.

These might include:

• antidepressant medication — like selective reuptake inhibitors (SSRIs). You typically take these daily for up to 6 months or longer. You’ll have regular check-ins with your GP to discuss how well the medication works. While an antidepressant can’t change your circumstances, it might allow you to function more normally and increase your coping ability. Your GP will be able to advise the right antidepressant medicine for you
• psychological treatments — like cognitive behavioural therapy (CBT) and interpersonal therapy (IPT). IPT focuses on improving your interactions and relationships with others based on the idea that your relationships can affect your mental state
• magnesium supplements are believed to play a role in improving symptoms of depression. You should check with your GP first before starting a new supplement

Your doctor might recommend electroconvulsive therapy (ECT) as a last resort if severe depression hasn’t responded to other treatments. 

If you’re worried you might be depressed, try not to:

• lose hope — most people with depression recover, and there are many treatment options available 
• skip meals — you might forget to eat or lose your appetite if you’re feeling low. Maintaining a healthy diet and eating regularly can greatly affect your mood
• drink too much alcohol — it might seem like a good temporary distraction from how you’re feeling, but alcohol can make you feel much worse in the long run
• bottle up your feelings — share how you’re feeling with someone you trust, or seek help from your doctor. It’s always better to share your feelings than to struggle alone