Introduction

Depression is more than simply feeling unhappy or fed up for a few days.

We all go through spells of feeling down, but when you're depressed you feel persistently sad for weeks or months, rather than just a few days.

Some people still think that depression is trivial and not a genuine health condition. They're wrong. Depression is a real illness with real symptoms, and it's not a sign of weakness or something you can "snap out of" by "pulling yourself together".

The good news is that with the right treatment and support, most people can make a full recovery.

How to tell if you have depression

Depression affects people in different ways and can cause a wide variety of symptoms.

They range from lasting feelings of sadness and hopelessness, to losing interest in the things you used to enjoy and feeling very tearful. Many people with depression also have symptoms of anxiety.

There can be physical symptoms too, such as feeling constantly tired, sleeping badly, having no appetite or sex drive, and complaining of various aches and pains.

The severity of the symptoms can vary. At its mildest, you may simply feel persistently low in spirit (read about low mood), while at its most severe depression can make you feel suicidal and that life is no longer worth living.

For a more detailed list, read more about the symptoms of depression. 

Most people experience feelings of stress, sadness or anxiety during difficult times. A low mood may improve after a short time, rather than being a sign of depression. Read more information about low mood and depression.

When to see a doctor

Sometimes there is a trigger for depression. Life-changing events, such as bereavement, losing your job or even having a baby, can bring it on. 

People with a family history of depression are also more likely to experience it themselves.

But you can also become depressed for no obvious reason.

Find out more about the causes of depression.

Depression is quite common and affects about one in 10 of us at some point. It affects men and women, young and old.

Depression can also strike children. Studies have shown that about 4% of children aged five to 16 in the UK are anxious or depressed.

Treatment

Treatment for depression involves either medication or talking treatments, or usually a combination of the two. The kind of treatment that your doctor recommends will be based on the type of depression you have.

Read more about the treatment of depression.

Living with depression

Many people with depression benefit by making lifestyle changes such as getting more exercise, cutting down on alcohol, stopping smoking and eating more healthily. 

Self-help measures such as reading a self-help book or joining a support group are also worthwhile.

Find out more about how self-help and improving your lifestyle can help you beat depression.

Read how stopping smoking can improve your mood.

You can read other people's experience of depression in our comments section below.

Symptoms

The symptoms of depression can be complex and vary widely between people. But as a general rule, if you are depressed, you feel sad, hopeless and lose interest in things you used to enjoy.

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

There are many other symptoms of depression and you're unlikely to have every one listed below.

Psychological symptoms include:

  • continuous low mood or sadness
  • feeling hopeless and helpless
  • having low self-esteem 
  • feeling tearful
  • feeling guilt-ridden
  • feeling irritable and intolerant of others 
  • having no motivation or interest in things
  • finding it difficult to make decisions
  • not getting any enjoyment out of life
  • feeling anxious or worried 
  • having suicidal thoughts or thoughts of harming yourself

Physical symptoms include:

  • moving or speaking more slowly than usual 
  • change in appetite or weight (usually decreased, but sometimes increased) 
  • constipation 
  • unexplained aches and pains
  • lack of energy or lack of interest in sex (loss of libido)
  • changes to your menstrual cycle
  • disturbed sleep (for example, finding it hard to fall asleep at night or waking up very early in the morning)

Social symptoms include:

  • not doing well at work
  • taking part in fewer social activities and avoiding contact with friends
  • neglecting your hobbies and interests
  • having difficulties in your home and family life

Depression can come on gradually, so it can be difficult to notice something is wrong. Many people continue to try to cope with their symptoms without realising they are ill. It can take a friend or family member to suggest something is wrong.

Doctors describe depression by how serious it is:

  • mild depression has some impact on your daily life
  • moderate depression has a significant impact on your daily life
  • severe depression makes it almost impossible to get through daily life – a few people with severe depression may have psychotic symptoms

Grief and depression

It can be hard to distinguish between grief and depression. They share many of the same characteristics, but there are important differences between them.

Grief is an entirely natural response to a loss, while depression is an illness.

People who are grieving find their feelings of loss and sadness come and go, but they're still able to enjoy things and look forward to the future.

In contrast, people who are depressed have a constant feeling of sadness. They don't enjoy anything and find it hard to be positive about the future.

Read more about grief and how it differs from depression.

Other types of depression

There are different types of depression, and some conditions where depression may be one of the symptoms. These include:

  • Postnatal depression. Some women develop depression after having a baby. Postnatal depression is treated in similar ways to other forms of depression, with talking therapies and antidepressant medicines.
  • Bipolar disorder is also known as "manic depression". It's where there are spells of depression and excessively high mood (mania). The depression symptoms are similar to clinical depression, but the bouts of mania can include harmful behaviour such as gambling, going on spending sprees and having unsafe sex. 
  • Seasonal affective disorder (SAD). Also known as "winter depression", SAD is a type of depression that has a seasonal pattern usually related to winter.

Read more about diagnosing depression.

Causes

There is no single cause of depression. You can develop it for different reasons and it has many different triggers.

For some, an upsetting or stressful life event – such as bereavement, divorce, illness, redundancy and job or money worries – can be the cause.

Often, different causes combine to trigger depression. For example, you may feel low after an illness and then experience a traumatic event, such as bereavement, which brings on depression.

People often talk about a "downward spiral" of events that leads to depression. For example, if your relationship with your partner breaks down, you're likely to feel low, so you stop seeing friends and family and you may start drinking more. All of this can make you feel even worse and trigger depression.

Some studies have also suggested you're more likely to get depression as you get older, and that it's more common if you live in difficult social and economic circumstances.

Stressful events

Most people take time to come to terms with stressful events, such as bereavement or a relationship breakdown. When these stressful events happen, you have a higher risk of becoming depressed if you stop seeing your friends and family and you try to deal with your problems on your own.

Illness

You may have a higher risk of depression if you have a longstanding or life-threatening illness, such as coronary heart disease or cancer.

Head injuries are also an often under-recognised cause of depression. A severe head injury can trigger mood swings and emotional problems.

Some people may have an underactive thyroid (hypothyroidism) resulting from problems with their immune system. In rarer cases a minor head injury can damage the pituitary gland, a pea-sized gland at the base of your brain that produces thyroid-stimulating hormones.

This can cause a number of symptoms, such as extreme tiredness and a loss of interest in sex (loss of libido), which can in turn lead to depression. 

Personality

You may be more vulnerable to depression if you have certain personality traits, such as low self-esteem or being overly self-critical. This may be because of the genes you've inherited from your parents, or because of your early life experiences. 

Family history

If someone else in your family has suffered from depression in the past, such as a parent or sister or brother, then it's more likely you will too.

Giving birth

Some women are particularly vulnerable to depression after pregnancy. The hormonal and physical changes, as well as added responsibility of a new life, can lead to postnatal depression.

Loneliness

Becoming cut off from your family and friends can increase your risk of depression.

Alcohol and drugs

Some people try to cope when life is getting them down by drinking too much alcohol or taking drugs. This can result in a spiral of depression. 

Cannabis helps you relax, but there is evidence that it can bring on depression, especially in teenagers.

And don't be tempted to drown your sorrows with a drink. Alcohol is categorised as a "strong depressant" and actually makes depression worse. 

Diagnosis

If you experience symptoms of depression for most of the day, every day for more than two weeks, you should seek help from your GP.

It is especially important to speak to your GP if you experience:

  • symptoms of depression that are not improving
  • your mood affects your work, other interests, and relationships with your family and friends
  • thoughts of suicide or self-harm

Sometimes, when people are depressed they find it hard to imagine that treatment can actually help. But the sooner you seek treatment, the sooner your depression will lift.

There are no physical tests for depression, though your GP may examine you and do some urine or blood tests to rule out other conditions that have similar symptoms, such as an underactive thyroid.

The main way in which your GP will tell if you have depression is by asking you lots of questions about your general health and how the way you are feeling is affecting you mentally and physically.

Try to be as open as you can be with the doctor. Describing your symptoms and how they are affecting you will really help your GP understand if you have depression and how severe it is.

Read more about the symptoms of depression.

Any discussion you have with your GP will be confidential. Your GP will only ever break this rule if there's a significant risk of harm to either yourself or others, and if informing a family member or carer would reduce that risk.

Find out about the treatments you may be offered for depression.

Treatment

Talking treatments

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) helps you understand your thoughts and behaviour and how they affect you.

CBT recognises that events in your past may have shaped you, but it concentrates mostly on how you can change the way you think, feel and behave in the present.

It teaches you how to overcome negative thoughts, for example being able to challenge hopeless feelings.

CBT is available on the NHS for people with depression or any other mental health problem that it has been shown to help.

You normally have a short course of sessions, usually six to eight sessions, over 10 to 12 weeks on a one-to-one basis with a counsellor trained in CBT. In some cases, you may be offered group CBT.

Online CBT

Computerised CBT is a form of CBT that works through a computer screen, rather than face-to-face with a therapist.

It's delivered in a series of weekly sessions and should be supported by a healthcare professional. For instance, it's usually prescribed by your GP and you may have to use the surgery computer to access the programme.

Interpersonal therapy (IPT)

IPT focuses on your relationships with other people and on problems you may be having in your relationships, such as difficulties with communication or coping with bereavement.

There's some evidence that IPT can be as effective as antidepressants or CBT, but more research is needed.

Psychodynamic psychotherapy

In psychodynamic (psychoanalytic) psychotherapy, a psychoanalytic therapist will encourage you to say whatever is going through your mind.

This will help you to become aware of hidden meanings or patterns in what you do or say that may be contributing to your problems. Read more about psychotherapy.

Counselling

Counselling is a form of therapy that helps you think about the problems you are experiencing in your life to find new ways of dealing with them. Counsellors support you in finding solutions to problems, but do not tell you what to do.

Counselling on the NHS usually consists of six to 12 hour-long sessions. You talk in confidence to a counsellor, who supports you and offers practical advice.

Counselling is ideal for people who are basically healthy but need help coping with a current crisis, such as anger, relationship issues, bereavement, redundancy, infertility or the onset of a serious illness.

Getting help

Your first port of call should be your GP, who can refer you for NHS talking treatments for depression available locally.

In some parts of the country, you also have the option of self-referral. This means that if you prefer not to talk to your GP, you can go directly to a professional therapist.

Antidepressants

Antidepressants are medicines that treat the symptoms of depression. There are almost 30 different kinds available.

Most people with moderate or severe depression benefit from antidepressants, but not everybody does. You may respond to one antidepressant but not to another, and you may need to try two or more treatments before you find one that works for you.

The different types of antidepressant work about as well as each other. However, side effects vary between different treatments and people.

When you start taking antidepressants, you should see your GP or specialist nurse every week or two for at least four weeks to see how well they are working. If they are working, you'll need to continue taking them at the same dose for at least four to six months after your symptoms have eased.

If you've had bouts of depression in the past, you may need to continue to take antidepressants for up to five years or longer.

Antidepressants aren't addictive, but you may get some withdrawal symptoms if you stop taking them suddenly or you miss a dose (see 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

St John's wort

St John's wort is a herbal treatment that some people take for depression. It's available from health food shops and pharmacies.

There's some evidence that it may help mild to moderate depression, but it's not recommended by doctors. This is because the amount of active ingredients varies among individual brands and batches, so you can never be sure what sort of effect it will have on you.

Taking St John's wort with other medications, such as anticonvulsants, anticoagulants, antidepressants and the contraceptive pill, can also cause serious problems.

You shouldn't take St John's wort if you are pregnant or breastfeeding, as we don't know for sure that it's safe.

Also, St John's wort can interact with the contraceptive pill, reducing its contraceptive effect. Read more about St John's wort.

Electric shock treatment

Sometimes electroconvulsive therapy (ECT) may be recommended if you have severe depression and other treatments, including antidepressants, haven't worked.

During ECT, you'll first be given an anaesthetic and medication to relax your muscles. Then you'll receive an electrical "shock" to your brain through electrodes placed on your head.

You may be given a series of ECT sessions. It is usually given twice a week for three to six weeks.

For most people, ECT is good for relieving severe depression, but the beneficial effect tends to wear off after several months.

Some people get unpleasant side effects, including short-term headaches, memory problems, nausea and muscle aches.

Read more information about electroconvulsive therapy (ECT) on 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 are 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 will 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 clinical depression

Talking about it

Sharing a problem with someone else or with a group can give you support and an insight into your own depression. Research shows that talking can help people recover from depression and cope better with stress.

You may not feel comfortable about discussing your mental health and sharing your distress with others. If so, writing about how you feel or expressing your emotions through poetry or art are other ways to help your mood.

Smoking, drugs and alcohol

It may be tempting to smoke or drink to make you feel better. Cigarettes and booze may seem to help at first, but they make things worse in the long run.

Be extra cautious with cannabis. You might see it as harmless, but research has revealed a strong link between cannabis use and mental illness, including depression.

The evidence shows that if you smoke cannabis you:

  • make your depression symptoms worse
  • feel more tired and uninterested in things
  • are more likely to have depression that relapses earlier and more frequently
  • will not have as good a response to antidepressant medicines
  • are more likely to stop using antidepressant medicines
  • are less likely to recover fully

If you drink or smoke too much or use drugs, get advice and support from your GP, or read these articles about getting help if you want to stop smoking, or drinking too much alcohol.

Work and finances

If your depression is caused by working too much or is affecting your ability to do your job, you may need time off to recover. However, there is evidence that taking prolonged time off work can make depression worse. There's also quite a lot of evidence that going back to work can help you recover from depression.

It's important to avoid too much stress, and this includes work-related stress. If you're employed, you may be able to work shorter hours or work in a more flexible way, particularly if job pressures seem to trigger your symptoms. Under the Equality Act (2010) all employers must make reasonable adjustments to make the employment of people with disabilities possible. This can include people with a diagnosis of mental illness.

Read more about how to beat stress at work.

If you can't work as a result of your depression, you may be eligible for a range of benefits, depending on your circumstances. These include:

Looking after someone with depression

It's not just the person with depression who is affected by their illness. The people close to them are too.

If you're caring for someone with depression, your relationship with them and family life in general can become strained. You may feel at a loss as to what to do. Finding a support group and talking to others in a similar situation might help.

If you're having relationship or marriage difficulties, it might help to contact a relationship counsellor who can talk things through with you and your partner.

Men are less likely to ask for help than women and are also more likely to turn to alcohol or drugs when depressed.

Coping with bereavement

Losing someone close to you can be a trigger for your depression.

When someone you love dies, the emotional blow can be so powerful that you feel it's impossible to ever recover. However, with time and the right help and support, it is possible to start living your life again.

Find out more with these videos and articles all about how to cope with bereavement.

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, such as giving away possessions, making a will or saying goodbye to friends
  • talking about death or suicide – this may be a direct statement, such as "I wish I was dead", but often depressed people will talk about the subject indirectly, using phrases 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, such as 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 are feeling suicidal or are in the 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 are 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 clinical depression will also experience hallucinations and delusional thinking, the symptoms of psychosis.

Depression with psychosis is known as psychotic depression.

What are the symptoms of severe depression?

Having severe clinical depression means feeling sad and hopeless for most of the day, practically every day, and having no interest in anything. Getting through the day feels almost impossible.

Other typical symptoms of severe depression are:

  • fatigue (exhaustion)
  • loss of pleasure in things
  • disturbed sleep
  • changes in appetite
  • feeling worthless and guilty
  • being unable to concentrate or being indecisive
  • thoughts of death or suicide

Read more about the psychological, physical and social symptoms of clinical depression.

What are the symptoms of psychosis?

Having moments of psychosis (psychotic episodes) means experiencing:

  • delusions – thoughts or beliefs that are unlikely to be true 
  • hallucinations – when a person hears (and in some cases feels, smells, sees or tastes) things that aren't there; a common hallucination is hearing voices 

The delusions and hallucinations almost always reflect the person's deeply depressed mood – for example, they may become convinced they're to blame for something, or that they've committed a crime.

"Psychomotor agitation" is also common – this means not being able to relax or sit still, and constantly fidgeting. 

Or, at the other extreme, a person with psychotic depression may have "psychomotor retardation", where both their thoughts and physical movements slow down.

People with psychotic depression are at greater risk than normal of thinking about suicide.

What's the cause?

The cause of psychotic depression is not fully understood. What we do know is that there's no single cause of depression and it has many different triggers.

For some, stressful life events such as bereavement, divorce, serious illness or financial worries can be the cause.

Genes probably play a part, as severe depression can run in families, although it's not known why some people also develop psychosis.

Many people with psychotic depression will have experienced adversity in childhood, such as a traumatic event.

Learn more about the causes of clinical depression.

How is it treated?

Treatment for psychotic depression involves:

  • medication – a combination of antipsychotics and antidepressants can help relieve the symptoms of psychosis
  • psychological therapies – the one-to-one talking therapy cognitive behavioural therapy (CBT) has proved successful in helping some people with psychosis
  • social support – support with social needs, such as education, employment or accommodation

The patient may need to stay in hospital for a short period while they're receiving this treatment.

Sometimes electroconvulsive therapy (ECT) may be recommended if the patient has severe depression and other treatments, including antidepressants, haven't worked. 

Treatment is usually very effective, although patients may need to be continuously monitored in follow-up appointments.

Getting help for others

People with psychosis are often unaware that they're thinking and acting strangely.

Because of this lack of insight, it's often down to the friends, relatives or carers of a person affected by psychosis to seek help for them.

If you're concerned about someone you know and think they may have psychosis, you could contact their social worker or community mental health nurse if they've previously been diagnosed with a mental health condition.

If this is the first time they've shown symptoms, contact their GP or take them to A&E.

If you think the person’s symptoms are placing them at possible risk of harm you can:

  • take them to the nearest accident and emergency (A&E) department, if they agree
  • call their GP or local out-of-hours GP
  • call 999 and ask for an ambulance

Support and advice

More information on psychosis

SANE

Mind