Depression

Quick Facts

• Some signs of depression are feeling low, feeling bad about yourself and not wanting to do things.
• Depression affects different people in different ways.
• If you think you might have depression you can speak to your GP.
• Depression may be treated with medication and talking treatments. Self-help techniques, peer support groups and coping strategies can also help.
• Different things can lead to depression. Your upbringing, stressful events and your lifestyle might all have an effect.
• If you feel low, getting enough sleep and eating healthy foods might help. It might also help to keep active, even if you don’t feel like it.

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What is depression?

Everyone has ups and downs. Sometimes you might feel a bit low, for lots of different reasons. People may say that they are feeling depressed when they are feeling down, but this does not always mean that they have depression.

Depression is a long lasting low mood disorder. It affects your ability to do everyday things, feel pleasure or take interest in activities.

Depression is: 

• a mental illness that is recognised around the world,
• common - it affects about one in ten of us,
• something that anyone can get, and
• treatable.

Depression is not:

• something you can 'snap out of’,
• a sign of weakness,
• something that everyone experiences, or
• something that lasts forever as one episode.

Doctors might describe depression as 'mild', 'moderate' or 'severe'. Your doctor may offer you different treatments depending on how they describe it.

How Common Is Depression?

Depression can affect people of any age, including children. It is one of the most common mental illnesses. The number of people who have depression may be higher than this because not everyone with depression goes to their GP.

Symptoms & Causes

What are the symptoms of depression and how is it diagnosed?

The NHS recommends that you should see your GP if you experience the symptoms of depression for most of the day and every day for over 2 weeks.

Doctors make decisions about diagnosis based on guidelines. One guideline used by NHS doctors is the International Classification of Diseases (ICD-10).

When you see a doctor they will look for the symptoms that are set out in the ICD-10 guidance. You do not have to have all of these to be diagnosed with depression. You might have just a few of them.

The symptoms of depression are:

• low mood, feeling sad, irritable or angry,
• having less energy to do certain things,
• losing interest or enjoyment in activities you used to enjoy,
• loss of concentration,
• becoming tired more easily,
• disturbed sleep and losing your appetite,
• feeling less good about yourself (loss of self-confidence), or
• feeling guilty or worthless.

You may also find that with low mood you:

• feel less pleasure from things,
• feel more agitated,
• lose interest in sex,
• find your thoughts and movements slow down, and
• have thoughts of self-harm or suicide.

Your doctor should also ask about any possible causes of depression. They may also do some tests to check if you have any physical problems which might cause symptoms of depression such as an under-active thyroid.

What causes depression?

There is no single cause of depression. Different things may cause depression for different people.

Genetic factors

Some studies suggest that your genetics can play a part in developing depression. For example, one study found that particular genes may play a key role in developing recurrent depression. However, studies into the genetics of depression are at an early stage.

Your background and current situation

Researchers have also looked at whether having parents or other family members with depression can increase your chances of developing the condition. For example, some studies have looked into the effects having a mother with postpartum depression can have on children as they grow up.

Stressful events, such as problems at home or work, a relationship ending or financial issues may also make it more likely to experience depression.

Hormones and chemicals

Changes in your hormones and chemicals in your body may cause depressive symptoms.

For example, at some point many women might find their mood is affected in the weeks before their period, called pre-menstrual syndrome (PMS). Some women may struggle with premenstrual dysphoric disorder (PMDD) which has a lot of psychological symptoms similar to depression.

Having problems with your thyroid or having low levels of Vitamin B12 may also be linked to experiencing symptoms of depression.

Lifestyle factors

Some studies have shown that not exercising, being under or overweight and having fewer social relationships can increase the risk of experiencing depressive symptoms.

Drugs and alcohol

Both legal and illegal drugs might affect your mental health. If you take prescribed medications, it is important to make sure you take them in the way your doctor suggests.

Some people will drink alcohol as a way to relieve anxiety or depression. However, the evidence suggests that if you drink regularly or misuse alcohol you are at a greater risk of developing depression.

Other illnesses

Depression can come with other mental or physical health conditions such as such as diabetes or cancer. These conditions can make you feel low or may be a trigger for depression.

Some people with brain injuries and dementia may also have changes in their moods.

Types

You might have heard a number of terms used to describe depression. Here are the most common forms of depression.

Clinical depression

Clinical depression is a common term, but it is not a formal diagnosis. People sometimes say ‘clinical diagnosis’ to just mean they have been diagnosed by a doctor.

Depressive episode

Your doctor might say that you are going through a 'depressive episode'. This is the formal name that doctors give depression when they make a diagnosis. They may say that you are going through a 'mild', 'moderate' or 'severe' episode.

Recurrent depressive disorder

If you have had repeated episodes of depression, your doctor might say that you have recurrent depressive disorder. They may say that your current episode is 'mild', 'moderate' or 'severe'.

Reactive depression

If your doctor thinks that your episode of depression was caused by particular stressful events in your life, they may say that it is reactive. For example, divorce, job or money worries. This is sometimes separated from an adjustment disorder, where you may struggle with some symptoms of depression because of adapting to a major change in your life, such as separation from people, retirement or migrating to a new area.

Severe depressive episode with psychotic symptoms

If you are going through a severe episode of depression, you may get hallucinations or delusions. A hallucination means you might hear, see, smell, taste or feel things that aren’t real. A delusion means that you might believe things that don’t match reality. These symptoms are called psychosis.

Dysthymia

Your doctor might diagnose you with dysthymia if you have felt low for several years, but the symptoms are not severe enough, or the episodes are not long enough for a doctor to diagnose recurrent depressive disorder.

Cyclothymia

Your doctor might diagnose cyclothymia if you struggle with persistently unstable moods. You might have several periods of depression and periods of mild elation. These periods of depression or elation are not severe enough or long enough to diagnose recurrent depression or bipolar disorder. Cyclothymia is more commonly associated with bipolar disorder than depression.

Post-natal depression

Post-natal depression refers to episodes of depression after childbirth. It is a common illness which affects more than 1 in 10 women within 1 year of having a baby. You may get symptoms that are similar to those in other types of depression.

Our “Mum’s Wellness Project” is an early intervention programme which works with mums who are at risk of postnatal depression.

Seasonal affective disorder (SAD)

This type of depression affects you at the same time of year, usually in the winter.^, The symptoms are similar to depression, but some people find they sleep more rather than less, and crave carbohydrates like chocolate, cakes and bread.

Manic depression

Manic depression is the old name for bipolar disorder. It is a different illness to depression. People with this illness have highs (mania) and lows (depression).

Treatment

The first step to getting treatment is to see your GP. If your GP thinks you have depression, they will talk to you about the treatments they can offer. 

Talking therapies

Talking therapy is available on the NHS, from private healthcare providers and sometimes from charities. You will meet a trained therapist for a fixed number of sessions. Sometimes this will be with a group of people with depression.

There are different types of talking therapy that you might be offered. These include:^,

• cognitive-behavioural therapy,
• psychodynamic therapy,
• problem-solving therapy,
• interpersonal therapy,
• behaviour activation,
• group therapy,
• relationship counselling,
• bereavement counselling,
• mindfulness based therapy, and

The type of therapy you are offered will depend on the cause of your symptoms and their severity. Therapies may also have different levels based on how long or intense the treatment is.

Computerised cognitive behavioural therapy (cCBT)

Computerised cognitive behavioural therapy (cCBT) is one way of treating mild to moderate depression. You learn CBT techniques online using a computer. You will go through the same type of session as you would if you were with a therapist. It can be helpful after you have finished talking therapies to stop your symptoms coming back.

'Beating the Blues' is one of the cCBT programmes you can get. They are free but you need to talk to your GP about it.

Antidepressants

Your doctor might offer you an antidepressant. You may need to try different types before you find one that works for you. If you do not want to take antidepressants, tell your doctor and you can discuss other options.

Antidepressants can have side effects and can affect other medicines you are taking. Your doctor will check if you have physical health conditions or if you take other medication.

It is important to talk to your doctor before you stop taking medication, because stopping suddenly can cause problems.

Exercise Therapy

Regular exercise can help with your mood if you struggle with depression. Some GP surgeries will put you in touch with local exercise schemes. This is sometimes called ‘exercise on prescription’ and can give you access to free or reduced cost programmes.

Brain stimulation

Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) is a procedure sometimes used to treat severe depression. In this treatment, an electrical current is briefly passed through your brain while you are under general anaesthetic. This means you are not awake during the procedure. You should only have ECT if you have severe depression, it is life-threatening and treatment is needed as soon as possible. Or you may be given ECT if no other treatments have worked.    

Transcranial direct current stimulation (tDCS)

This treatment involves using a small battery-operated machine to pass a low current through your brain to stimulate activity. You are awake during the procedure, with daily sessions for several weeks. NICE state that there is not a lot of good evidence for how tDCS works for depression, but there are no major safety concerns.

Repetitive transcranial magnetic stimulation (rTMS)

TMS uses electromagnetic coils to deliver pulses of magnetic energy to specific parts of your brain. This stimulates the brain and may help to reduce depression and anxiety. You are awake during the procedure and can leave hospital the same day. If this is offered, you may have daily sessions for several weeks. NICE have examined rTMS and found that it is safe and effective enough to be offered on the NHS.

Complementary or Alternative Therapies

Complementary therapies are treatments which are not part of mainstream medical care. They can include aromatherapy, herbal remedies, acupuncture, massage, meditation and yoga. These treatments may help improve your emotional wellbeing and may help with side effects.

I’m unhappy with my treatment

If you are not happy with your treatment you can:

• talk to your doctor about your treatment options,
• ask for a second opinion,
• get an advocate link to Advocacy to help you speak to your doctor,
• contact the Patient and Client Council and see whether they can help, or
• make a complaint.

There is more information about these options below.

Treatment options

You should first speak to your doctor about your treatment. Explain why you are not happy with it. You could ask what other treatments you could try.

Tell your doctor if there is a type of treatment that you would like to try. Doctors should listen to your preference. If you are not given this treatment ask your doctor to explain why it is not suitable for you.

Second opinion

A second opinion means that you would like a different doctor to give their opinion about what treatment you should have. You can also ask for a second opinion if you disagree with your diagnosis.

You don’t have a right to a second opinion. But your doctor should listen to your reason for wanting a second opinion.

Advocacy

An advocate is independent from the mental health service. They are free to use. They can be useful if you find it difficult to get your views heard. There are different types of advocates available. Community advocates can support you to get a health professional to listen to your concerns. And help you to get the treatment that you would like. MindWise offer advocacy services – find out more. 

Support

You can get support if you are a carer, friend or family member of someone living with depression.

You could get in touch with carer support groups or sibling support groups. You can search for local groups in your area online or ask your GP.

You can ask your local authority for a carer’s assessment if you need more practical support to help care for someone.

As a carer you should be involved in decisions about care planning. There are rules about information sharing and confidentiality which may make it difficult for you to get all the information you need in some circumstances.

Supporting the person you care for

You might find it easier to support someone with depression if you understand their symptoms, treatment and self management skills. You can use this to support them to get help and stay well.

Below are some initial suggestions for providing practical day to day support to someone with depression.

• Offer them emotional support by being a good listener, reminding them that treatment is available and reassuring them. Remember that depression is an illness and people cannot “snap out of it”.
• Encourage them to get some exercise and eat healthily. You could invite them out on walks, or help them do things they used to enjoy.
• Keep a note of changes in their medication, or their condition. This can help the person you care for in appointments.
• Help them to stay away from alcohol and other unhealthy things.
• Take them seriously if they are feeling very unwell and are thinking about hurting themselves.
• Encourage them to get professional help.

You could also try and find out about self-help or support groups in their area. Your local IAPT service may be a good place to start.

Think about what you can do if you are worried about someone’s mental state or risk of self harm. It will help to keep details of their mental health team and discuss a crisis plan with them. Read more about supporting someone.

Further support

Aware NI

Local charity which offers support groups across Northern Ireland for those who are experiencing depression.

www.aware-ni.org

Action Mental Health

Offers a range of support for people experiencing mental health issues, including support groups, mentoring and employment support.

https://www.amh.org.uk/