What is depression?

Everyone has spells of feeling down, but depression is more than just spending a few days feeling sad or unhappy. Depression can make you feel persistently sad and down for weeks or months at a time.

While some people believe that depression is trivial or not a genuine health problem, it's actually a real condition that affects around one in 10 people over the course of their lives. It impacts people of all genders and ages – including children. Studies show that around 4% of children in the UK between the ages of five and 16 are depressed or anxious.

With the right support and treatment, most people recover fully from depression.

Do I have depression?

Depression has a range of different symptoms, and it can affect everybody differently. The symptoms include feeling very tearful, feeling hopelessness and sadness, and losing interest in things you enjoyed before. It's also common for people with depression to have symptoms of anxiety.

Physical symptoms happen with depression too – these can include feeling tired all the time, getting poor sleep, losing your sex drive, losing your appetite, and feeling aches and pains.

If the symptoms are mild, you might simply experience a persistent low mood. It's common to feel stressed, sad or anxious during difficult times in your life, and a low mood can get better after a short time, rather than being a symptom of depression.

Learn more about low mood and depression here.

Severe symptoms of depression can make people feel suicidal – as if life is no longer worth living. Read more about depression symptoms here.

Seeing a doctor about depression

Big changes in your life, like bereavement, losing a job, or even having a baby, can cause symptoms of depression. You're also more likely to experience depression if you have a family history of depression. However, it's also possible to become depressed without there being an obvious reason.

You can learn more about depression causes here.

​Symptoms and causes of depression

Symptoms of depression can be very different from person to person. However, as a general rule, if you are depressed you feel hopeless, sad and lacking interest in things that used to make you feel happy.

Depression symptoms are bad enough to interfere with work, social life and family life, and can persist for weeks or months.

Doctors describe depression in one of three ways, depending on how serious it is:

  • mild depression – it has some impact on daily life
  • moderate depression – it has a significant impact on your daily life
  • severe depression – this makes it nearly impossible to get through your life day to day

A few people with severe depression may have symptoms of psychotic depression.

Below is a list of depression symptoms – it's unlikely that one person would have all of them.

Psychological depression symptoms include:

  • continuous sadness or low mood
  • losing interest in things
  • losing motivation
  • not getting any enjoyment in life
  • feeling tearful
  • feeling guilty
  • feeling anxious
  • feeling irritable
  • finding it hard to make decisions
  • feeling intolerant of other people
  • feeling helpless
  • feeling hopeless
  • low self-esteem
  • feeling worried
  • thinking about suicide
  • thinking about harming yourself

Physical symptoms include:

  • speaking or moving slower than usual
  • aches and pains that can't be explained
  • losing, or sometimes gaining, appetite or weight
  • constipation
  • loss of interest in sex
  • disturbed sleep (having trouble falling asleep, for example, or waking up very early)
  • loss of energy
  • changes in your menstrual cycle (the time of the month when you get your period)

Social symptoms are common too. These include:

  • avoiding talking to or spending time with your friends
  • taking part in fewer social activities
  • neglecting interests and hobbies
  • doing poorly at work
  • difficulties with your family or home life

It's not always possible to tell that you're having symptoms of depression right away – it can start and progress gradually. A lot of people don't realise they're ill and try to carry on and cope with their symptoms. Sometimes it takes a friend or family member to notice that there's a problem.

Depression and grief

Depression and grief have a lot of the same features, and it can be hard to tell them apart. However, they're different in many important ways. Depression is an illness – grief is a completely natural response to loss.

If you're grieving, you may find your feelings of sadness and loss come and go, but it's still possible to enjoy things in life and look forward to the future.

People with depression feel sad persistently, find it difficult to be positive about the future, and don't get enjoyment from anything.

Learn more about the differences between grief and depression here.

Different types of depression

There are different types of depression, and there are some conditions where depression is a symptom. These conditions include:

  • Bipolar disorder – people with bipolar disorder, which is also known as "manic depression", experience times of depression, where the symptoms are similar to clinical depression. They also go through phases when they have excessively high moods (known as "mania"). Bouts of mania can include harmful behaviour like unsafe sex, spending sprees and gambling.
  • Seasonal affective disorder (SAD) is also called "winter depression". It's depression that is related to weather, usually winter, so it happens seasonally.
  • Postnatal depression happens to some women after they've had a baby. It's treated similarly to other types of depression, with antidepressant medication and talking therapy.

Learn more about how depression is diagnosed here.

Causes of depression

Depression doesn't have one single cause – it can have a range of triggers, and there are many different reasons a person can develop the condition. Some people are affected after a stressful life event, like a bereavement or divorce. Other people experience depression related to illness, job loss, or money worries.

Different reasons can combine and trigger depression. If you're feeling low after a job loss or health issues, and then experience something traumatic, like a bereavement, you can develop depression.

It's common to hear about depression being brought on by a "downward spiral" – one thing causing other problems that combine to cause depression. For example, losing your job could make you feel sad, so you spend less time with family and friends and maybe drink more alcohol. These things all make you feel worse, which triggers depression.

There are studies that suggest people are more likely to become depressed when they get older. There's also evidence that depression is more common for people whose economic and social circumstances are difficult.

Depression and illness

Long-lasting or life-threatening conditions like cancer or coronary heart disease can put you at higher risk of developing depression.

Many people don't know that head injuries can cause depression, and a severe head injury can lead to emotional problems and mood swings.

Underactive thyroid (hypothyroidism) can happen as a result of immune system problems. It's also possible, although rare, for a minor head injury to damage the pituitary gland. This is a gland the size of a pea which sits at the base of the brain and produces hormones that stimulate the thyroid. Damage to the pituitary gland can cause symptoms, including severe tiredness and a lack of interest in sex, which can then cause people to develop depression.

Depression and drugs and alcohol

"Drowning your sorrows" is actually a bad idea when it comes to depression. Alcohol is categorised as a "strong depressant" which can make depression worse, and drinking or taking drugs to cope can lead to a downward spiral by having a negative affect on other parts of your life.

There's evidence that cannabis can cause depression, particularly in teenagers, even if it helps you relax.

Other causes of depression

There are a number of things that can lead to developing depression.

  • Stressful events – big changes in your life, like bereavement, the end of a relationship or the loss of a job, can be difficult to deal with. When these things happen, it's important to keep seeing friends and family instead of trying to deal with problems alone – this increases your risk of developing depression.
  • Giving birth – pregnancy and birth can make some people vulnerable to depression. Postnatal depression can happen as the result of physical changes, hormonal changes, and the responsibility of taking care of a new baby.
  • Loneliness – your risk of depression gets higher if you aren't in contact or spending time with family and friends.
  • Personality – some personality traits can put you at a higher risk of developing depression. These include low-self esteem or a habit of criticising yourself too much. These personality traits can come from your genes, which you get from your parents, or they can be as a result of experiences in your early life.
  • Family history – it's more likely for someone to develop depression if a family member, like a sibling or parent, has experienced it before.

​Diagnosing and treating depression

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.

Treating depression

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.

Psychodynamic psychotherapy

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

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

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.

Other antidepressants

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.

Withdrawal symptoms

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
  • anxiety
  • dizziness
  • 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.

Read more about St John's Wort here.

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.

For more information about ECT, visit the Mind website.

Lithium

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.

​Living with depression

There's a lot of advice available for living with depression and feeling better.

Talking about depression

You can find support and insight by talking about depression with another person or a group. According to research, talking can help you to recover and deal better with stress.

If you don't feel comfortable talking about your symptoms and feelings with other people, you can write about how you feel or use poetry or art to express yourself – doing this can also help you to feel better.

Smoking, drugs, alcohol and depression

It might feel like cigarettes and alcohol are helpful, but in the long run they can make you feel worse.

If you have depression it's especially important to be careful when it comes to cannabis. Research has shown there's a strong connection between mental health problems and cannabis use.

According to the evidence, if you smoke cannabis while dealing with depression:

  • your symptoms get worse
  • you feel less interested in things
  • you're more likely to have earlier and more frequent relapses of depression
  • you're less likely to recover fully from depression
  • you feel more tired
  • you won't respond as well to antidepressants
  • you're more likely to stop taking antidepressants

You can get advice and support from your GP on cutting down or stopping drinking, smoking, and drug use.

Learn more about stopping smoking here

Learn more about help to cut down or stop drinking alcohol here

Work, money, and depression

You might need to take time off work if your depression is caused by working too much, or if the symptoms are making it hard for you to do your job. However, research has shown that taking a long time off work can make depression worse, and that going back to work can help you to get better.

When you're dealing with depression it's important to avoid as much stress, work-related and otherwise, as you can. If you're working you might be able to change to shorter hours, or work more flexibly. This is especially true if pressure at work causes you to experience depression symptoms.

The Equality Act means that employers need to make reasonable adjustments to make it possible to employ people with disabilities – this can include people who have been diagnosed with depression and other mental health conditions.

You can find more information about dealing with stress at work here.

If your depression means you are unable to work, there are benefits you may be eligible to claim. These include:

Bereavement and depression

Your depression can be triggered by losing someone who is close to you. The emotional blow suffered when a person you care about dies is powerful – it might feel like you will never recover from the loss.

Along with time, the right help and support can make it possible to start living your life again. Find out more about coping with a bereavement here.

Looking after someone who has depression

If you're close to someone with depression, their condition can affect you too. Your relationship, and family life in general, can be strained, and you might 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 the condition is causing difficulties in your relationship with your partner, you could contact a relationship counsellor who can talk things through with both of you.

When suffering from depression, men are less likely to ask for help than women. They're also more likely to turn to drugs and alcohol to cope with the symptoms.

Depression and suicide

The majority of suicide cases are linked with mental disorders, and most of them are triggered by severe depression.

Warning signs that someone with depression may be considering suicide are:

  • making final arrangements, like giving away their things, making a will or saying goodbye to friends
  • talking about death or suicide – this may be with direct statements, like "I wish I was dead", but often depressed people talk about the subject indirectly, saying things like: "I think dead people must be happier than us" or "wouldn't it be nice to go to sleep and never wake up"
  • self-harm, like cutting their arms or legs, or burning themselves with cigarettes
  • a sudden lifting of mood, which could mean that a person has decided to commit suicide and feels better because of this decision

If you're feeling suicidal or are in a crisis of depression, contact your GP as soon as possible. They will be able to help you.

If you can't or don't want to contact your GP, call the Samaritans on 116 123, 24 hours a day, seven days a week. Alternatively, visit the Samaritans website or email jo@samaritans.org.

Helping a suicidal friend or relative

If you see any of the above warning signs:

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

If you feel there is an immediate danger, stay with the person or have someone else stay with them, and remove all available means of committing suicide, such as medication.

Over-the-counter drugs such as painkillers can be just as dangerous as prescription medication.

Also, remove sharp objects and poisonous household chemicals such as bleach.

​Psychotic depression

Some people who have severe depression will also experience symptoms of psychosis – these are hallucinations and delusional thinking.

Depression with psychosis is known as psychotic depression.

Symptoms of severe depression

People who have severe clinical depression feel sad and hopeless for most of the day, and feel no interest in anything. They feel this way practically every day, and getting through the day feels nearly impossible for them.

Other symptoms include:

  • fatigue (exhaustion)
  • losing pleasure in things
  • inability to concentrate
  • difficulty making decisions
  • sleep disturbance
  • appetite changes
  • feeling guilty
  • feeling that they're worthless
  • having thoughts about suicide, or death

Read more about the different types of depression symptoms here.

Symptoms of psychosis

Moments of psychosis are known as psychotic episodes. The person experiencing a psychotic episode will have:

  • Delusions – beliefs or thoughts that are likely to be false.
  • Hallucinations – hearing, seeing or sometimes smelling, feeling or tasting things that aren't there. Hearing voices is a common type of hallucination.

Hallucinations and delusions almost always reflect the deeply depressed mood of the person experiencing them. They may believe they have committed a crime or that they are to blame for something.

People with psychosis also commonly experience something called psychomotor agitation. People experiencing this cannot sit still or relax, and fidget all the time.

The opposite symptom can also happen – psychomotor retardation can cause a person's thoughts and the movement of their body to slow down.

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

Causes and treatments of psychotic depression

We don't fully understand what causes psychotic depression yet. However, we know that depression doesn't have one single cause, and that the condition has a lot of different triggers.

Causes of psychotic depression

Big, stressful events like divorce, serious illness, financial worries, or bereavement can trigger depression for some people.

Severe depression can run in families, which suggests genes might play a role in depression, but the reason some people develop psychosis as part of severe depression is not known.

Many people who have psychotic depression have experienced a difficult time in childhood, like a traumatic event.

Learn more about causes of clinical depression

Treating psychotic depression

Treatment for psychotic depression has three main parts:

  • medication – taking a combination of antipsychotics and antidepressants can help to relieve psychosis symptoms
  • psychological therapies – cognitive behavioural therapy (CBT) is a talking therapy done one-to-one with a trained counsellor, and it has succeeded in helping some people with psychosis
  • social support – support with social needs like employment, education and accommodation

People with psychotic depression may have to spend some time in hospital to receive treatment.

Electroconvulsive therapy (ECT, or electric shock treatment) is sometimes recommended if other treatments, including antidepressants, haven't worked for severe depression.

Although treatment for psychotic depression is usually very effective, people with the condition still need follow-up appointments with their treatment team so they can be continuously monitored.

Getting help for someone with psychotic depression

Often friends, relatives, or carers have to seek help for a person with psychotic depression. This is because people with psychosis often don't know they're acting and thinking strangely.

If you're worried about someone you know and think they may be experiencing psychosis, and they've been diagnosed with a mental health condition before, contact their community mental health team or social worker.

If they've never shown signs of a mental health condition and you think they may be experiencing psychotic depression, contact their GP or take them to Accident and Emergency (A&E).

If you think the person's symptoms are putting them at risk, you can:

  • take them to the nearest A&E, if they agree
  • phone their GP
  • phone the local out-of-hours GP
  • phone 999 and ask for an ambulance

Advice and support

Visit the SANE website or the Mind website for more information, support and advice about psychotic depression.

Learn more about psychosis here