There's no physical test for depression.
If you experience depression symptoms most of the day, every day, for more than two weeks, you should visit your GP. This is especially important if:
- you have symptoms of depression that aren't getting any better
- you have thoughts of self-harm or suicide
- your work, relationships with friends and family, or interests are affected by your mood
It can be hard for people with depression to imagine that anything can help them – but the sooner you seek help, the sooner the symptoms start to get better.
Your GP may examine you and perform blood or urine tests to make sure there isn't another condition causing your depression symptoms, like an underactive thyroid.
When you see your GP, they'll try to find out if you have depression by asking you questions. These are likely to be about your health, how you're feeling, and how that is affecting you mentally and physically.
Telling your doctor your symptoms and the affect they are having on you will help your GP to tell if you have depression, and how severe the condition is. It's important to be as open as possible.
Your conversation with your GP will be confidential. This rule can only be broken if your GP thinks there is a significant risk of harm to you or others, and that telling a family member or carer would make that risk lower.
The first place to go is your GP – they will refer to you local talking treatments for depression that are available on the NHS.
You may also have the option to self-refer, depending on where you live, so you can go directly to a professional therapist if you'd rather not talk to your GP.
Talking treatments for depression
There are a number of talking therapies for depression.
Cognitive behavioural therapy (CBT)
CBT helps you make sense of your thoughts and behaviour and the affect they have on you. Part of it's recognising that past events may have played a part in making you who you are, but the main focus is changing how you feel, behave and think now.
You can use CBT to learn how to overcome negative thoughts – this can help you to tackle feelings of hopelessness, for example.
Most people have a course of six to eight CBT sessions that goes over 10 to 12 weeks. Sessions are one-to-one, between you and a CBT-trained counsellor. You might also be offered group CBT.
Computerised CBT (CCBT)
This type of CBT is done using a computer instead of face-to-face with the counsellor. It should be supported by a healthcare professional – your GP may prescribe it, and you might have to use the computer in the GP surgery to access it. CCBT involves a series of weekly sessions.
Interpersonal Therapy (IPT)
IPT is focused on your relationships with people around you, and problems that you might be having with them. These can include problems communicating, or dealing with a bereavement.
There's evidence that suggests IPT can be as effective for depression as CBT or medication, but more research needs to be done.
This is also known as psychoanalytic psychotherapy. You'll work with a therapist who encourages you to say whatever you're thinking. This helps you to find hidden patterns and meanings in your words and behaviour that could be contributing to your depression.
Read more about psychotherapy here.
Counselling is a type of therapy that works really well if you have good mental wellbeing overall but need help coping with a crisis that's currently going on in your life. These can include anger, bereavement, infertility, relationship problems, job loss and serious illness.
On the NHS, counselling usually takes place over six to 12 sessions, each an hour long. The sessions are confidential.
A counsellor helps you to think about what's going on in your life and find new ways of dealing with the problems. They'll offer practical advice, support you, and help you find solutions, but they don't tell you what to do.
Antidepressants are medicines that treat depression symptoms. There are almost 30 different types of antidepressant that can be prescribed to you.
Most people who have moderate or severe depression notice improvement when they take antidepressants, but this isn't the case for everyone. One type of antidepressant might not work for you, but another one could. It can take two or more different treatments to find the right one for you.
Side effects vary between different people and different antidepressants, but the different types of antidepressant all work around as well as each other.
If you're prescribed antidepressants, you should see your GP or specialist nurse regularly while you first start taking the medication – every week or two for at least four weeks. This is so your treatment provider can see how the antidepressants are working.
If the medication is working for you, you should continue taking them at the same dose for at least four to six months after the depression symptoms have eased. People who have had depression in the past might have to take antidepressants for up to five years, maybe longer.
Antidepressants aren't addictive. However, you might have withdrawal symptoms if you stop taking them suddenly or miss a dose. You can read more about withdrawal symptoms below.
Selective serotonin reuptake inhibitors (SSRIs)
If your GP thinks you would benefit from taking an antidepressant, you'll usually be prescribed a modern type called a selective serotonin reuptake inhibitor (SSRI). Examples of commonly used SSRI antidepressants are Seroxat (paroxetine), Prozac (fluoxetine) and Cipramil (citalopram).
They help increase the level of a natural chemical in your brain called serotonin, which is thought to be a "good mood" chemical.
SSRIs work just as well as older antidepressants and have fewer side effects.
They can, however, cause nausea and headaches, as well as a dry mouth and problems having sex. However, all these negative effects usually improve over time.
Some SSRIs aren't suitable for children under the age of 18. Research shows that the risk of self-harm and suicidal behaviour may increase if they're taken by under-18s. Fluoxetine is the only SSRI that can be prescribed for under-18s, and even then only when a specialist has given the go-ahead.
Tricyclic antidepressants (TCAs)
This group of antidepressants is used to treat moderate to severe depression.
TCAs, which includes Imipramil (imipramine) and amitriptyline, have been around for longer than SSRIs.
They work by raising the levels of the chemicals serotonin and noradrenaline in your brain. These both help lift your mood.
They're generally quite safe, but it's a bad idea to smoke cannabis if you are taking TCAs because it can cause your heart to beat rapidly.
Side effects of TCAs may include a dry mouth, blurred vision, constipation, problems passing urine, sweating, light-headedness and excessive drowsiness, but vary from person to person.
The side effects usually ease after seven to 10 days, as your body gets used to the medication.
New antidepressants, such as Efexor (venlafaxine), Cymbalta or Yentreve (duloxetine) and Zispin Soltab (mirtazapine), work in a slightly different way from SSRIs and TCAs.
Venlafaxine and duloxetine are known as SNRIs (serotonin-noradrenaline reuptake inhibitors). Like TCAs, they change the levels of serotonin and noradrenaline in your brain.
Studies have shown that an SNRI can be more effective than an SSRI, though they're not routinely prescribed as they can lead to a rise in blood pressure.
Antidepressants are not addictive in the same way that illegal drugs and cigarettes are, but when you stop taking them you may have some withdrawal symptoms, including:
- upset stomach
- flu-like symptoms
- vivid dreams at night
- sensations in the body that feel like electric shocks
In most cases these are quite mild and last no longer than a week or two, but occasionally they can be quite severe. They seem to be most likely to occur with paroxetine (Seroxat) and venlafaxine (Efexor).
Withdrawal symptoms occur very soon after stopping the tablets, so can easily be told apart from symptoms of depression relapse, which tend to occur after a few weeks.
Other treatments for depression
There is a range of other treatments that people are given for depression.
St John's Wort
St John's Wort is a herbal treatment that you can buy from pharmacies and health food shops. Some people take it for depression. There's some evidence that it can help the symptoms of mild-to-moderate depression, but doctors don't recommend St John's Wort because the amount of active ingredients change depending on the brand and batch. This means that you can never be sure what kind of effect it will have.
If you take St John's Wort with other medications, like anticonvulsants, anticoagulants, antidepressants and the contraceptive pill, it can cause serious problems. St John's Wort can interact with the contraceptive pill and reduce its effectiveness at preventing pregnancy.
You shouldn't take St John's Wort while pregnant or breastfeeding, as we can't be certain that it's safe.
Electroconvulsive therapy (ECT) – electric shock treatment
If you have severe depression and other treatments, like medication, haven't worked, ECT might be recommended for you.
When receiving ECT, you will be given an anaesthetic and medication that relaxes your muscles to begin with. Electrodes will be placed on your head that give an electrical "shock" to your brain.
ECT is given over a series of sessions, normally twice a week for three to six weeks.
ECT can cause side effects including nausea, headaches, aches in the muscles and memory problems.
Most people find that ECT is good for relieving severe depression, but the beneficial effects tend to wear off when several months have passed.
If you've tried several different antidepressants and had no improvement, your doctor may offer you a type of medication called lithium in addition to your current treatment.
There are two types of lithium: lithium carbonate and lithium citrate. Both are usually effective, but if you're taking one that works for you, it's best not to change.
If the level of lithium in your blood becomes too high, it can become toxic. You'll therefore need blood tests every three months to check your lithium levels while you're on the medication.
You'll also need to avoid eating a low-salt diet because this can also cause the lithium to become toxic. Ask your GP for advice about your diet.