Everyone occasionally feels sad or down, but often these feelings pass within a couple of days. When a person is experiencing depression, however, the condition interferes with daily life and functioning. Depression is a serious disorder, and most people who have it need treatment to get better.
The most common types of depression include:
Major depression, also known as clinical depression, is characterised by a combination of symptoms that interfere with the ability to work, sleep, eat, and enjoy life during the same two-week period. An episode of major depression may occur only once or twice, but more often, a person has several episodes (recurrent depression). If the pattern is seasonal, it will be what is commonly known as seasonal affective disorder.
Persistent depressive disorder (dysthymia) involves chronic symptoms that last for two years or more. Since depressive symptoms may be consistent in the person’s daily life, they may think this is just who they are. They may keep a person from functioning at “full steam” or from feeling good when being social or working, for example. Sometimes people with persistent depressive disorder also experience major depressive episodes.
Premenstrual dysphoric disorder is a significant change in mood, with depression and anger that begins a week before a woman’s period and which starts to improve after the beginning of the period, or becomes minimal in the week post period.
Post-natal depression is diagnosed when a new mother has a major depressive episode within one month to a year after giving birth.
Symptoms of depression
People who are depressed may not display all symptoms of the condition. Some people experience a few symptoms, and some have many. The frequency and severity of symptoms may vary from one person to the next.
Symptoms of depression include the following:
Causes of depression
Depression has no single cause. It may result from a combination of genetic, biochemical, environmental, and psychological factors. For example, some types of depression tend to run in families, but depression can also occur with no family history at all. A difficult experience, such as the death of a loved one, could trigger a depressive episode as well.
Treatment options
Most people with depression—even those with severe symptoms—can be helped with treatment. Effective treatment begins with visiting your GP to rule out medical causes of the problem. If they find no disease or other medical condition that may be causing the depression, the next step is a psychological evaluation. The doctor may refer you to a mental health professional, who will talk further with you about your symptoms.
Once you have a diagnosis, treatment can proceed in several ways. The most common types of treatments use medicines and psychotherapy, or both.
Medicines. A doctor may prescribe antidepressants or other medicines that may be helpful. Many people have concerns about taking medicines. Having a low level of neurotransmitters is one of several biological factors related to depression, and medicines can help with it. Taking medicines for depression is no different from someone with diabetes needing insulin or someone with high blood pressure taking medicine to lower blood pressure. Yet there is often a stigma around taking medicines for depression. It is important to work with your doctor to determine the best medicine for you and your specific needs. You may need to try a few different ones in the beginning, all while working with your doctor until you find the one that works best for you.
Antidepressant medicine
Antidepressants work with natural brain chemicals known as neurotransmitters, such as serotonin, norepinephrine, or dopamine.
Antidepressants include:
A doctor may need to try a variety of antidepressants and adjust the dosage to find one that works for you.
If antidepressants are prescribed for you
Take these steps if an antidepressant is prescribed for you:
Ask about the side effects. Also find out about any testing that may need to be done to monitor the effects of the medication on your body.
Be patient. Finding the right medicine can take time. Work closely with your doctor and report any side effects and benefits that you experience.
Always talk to your doctor before you stop taking a medicine, even if you feel better. Some medicines must be stopped gradually to give your body time to adjust. If you have chronic major depression, you may need to take a medicine daily to avoid disabling symptoms.
If you are taking MAOIs, know the restrictions. Remember that you will have to avoid fermented foods, including cheeses, wines, and pickles. Get a complete list of foods to avoid and always carry the list with you.
Never mix medicines—prescribed, over-the-counter, or borrowed—without talking to your doctor. If your dentist or any other medical professional prescribes a drug, tell them that you are taking antidepressants. Some drugs that are safe when taken alone can be dangerous if taken with other medications.
Avoid alcohol. Alcohol can make antidepressants less effective. Talk to your doctor about how to plan for situations in which alcohol may be served.
Call your GP if you have a question. Reach out to your doctor anytime about any drug, or if you are having a problem you believe is drug related. Your questions and concerns are important.
Antidepressants may increase the risk of suicidal thoughts in children, adolescents, and young adults. People in all three groups need to be monitored closely by health professionals if they take antidepressants, especially in the first weeks of treatment.
Psychotherapy, or “talk therapy.” Psychotherapy is a form of treatment that can help a person enhance problem solving skills, manage feelings of anxiety and depression, build relationships and social skills, and even improve job performance. Research shows that psychotherapy can be effective in treating most common mental health problems.
Therapists often draw on different forms of psychotherapy, tailoring treatment to the needs of a client. No one form of psychotherapy is best for everybody. Therapies like cognitive behavioural therapy (CBT), interpersonal, psychodynamic, and “third wave” therapies such as dialectical behaviour therapy (DBT), have all been shown to be effective with managing depressive symptoms. However, the level of comfort and trust between the client and the therapist is often more important than the type of psychotherapy used.
Depression that is severe or keeps coming back will generally require both medication and psychotherapy, but a combination of holistic treatments may help overall wellbeing.
Skills and actions to manage symptoms of depression
If there is a possibility you are experiencing depression, try to see a medical professional as soon as possible. Some research suggests that the longer you wait, the more problems you may have later. You can also help yourself by taking these steps:
Try behavioural activation. Do things you’ve enjoyed in the past, like going to the cinema or a sports event or walking in your favourite park. Take part in social, religious, and other activities that have had meaning for you.
Set goals you can achieve. Focus on what’s realistic for you to accomplish, not on what you or others think you “should” accomplish.
Break large tasks into small ones and set priorities. Do what you can, as you can. Tell yourself you will work at the task for 10 or 15 minutes. Then if you want to work longer, that’s great.
Keep your expectations realistic. Expecting too much too soon may increase feelings of failure if you fall short. Give yourself credit for what you have accomplished, even if that seems small.
Put off making major life decisions, such as whether to change jobs or get married or divorced, until you feel better. If you need to make a big decision, talk about it with people who you trust and know you well.
Expect to improve gradually, not overnight. Don’t assume you can “snap out of” depression or see progress straight away. Improvement often occurs in small, meaningful steps and with support.
Remember that you can reframe your negative thinking with more realistic thoughts. Negative thinking is part of depression. It can ease as your depression responds to treatment.
Steps to take in finding help and support
If you aren’t sure where to turn for help with depression, start by talking to your GP. The quickest and easiest way to access NHS Talking Therapies is to use the online self-referral system. You can find your local NHS psychological therapies service by visiting the NHS website: NHS talking therapies for anxiety and depression.
Others who can provide help and support, or referrals, include:
Mental health professionals. Psychiatrists, psychologists, social workers, and clergy members who have special training in counselling can provide different kinds of support. You can also contact your organisation’s assistance programme (or EAP) for support and resources.
Community resources. You can find community mental health support through local NHS mental health services, charities like Mind and Rethink Mental Illness, and helplines such as Samaritans (116 123), or by contacting your GP for referrals to appropriate resources.
Support groups. You can find community mental health support groups through organisations like Mind, Rethink Mental Illness, and local NHS services, or by visiting your GP, who can refer you to nearby support networks and peer groups.
Your personal support network. Talk with trusted friends or relatives, and try to avoid becoming isolated.
Find further resources here:
If you feel suicidal
Seek help straight away if your depression is causing you to think of hurting yourself or someone else. For immediate help:
Call 999 or go to a hospital. Ask a friend or relative to help you do these things if you can’t do them yourself. Hospitals and emergency rooms have psychiatrists on staff. If you need an immediate evaluation, this is the quickest way to be seen by professional.
Call your GP. Be honest and upfront. Your doctor can only help you based on the information you share. You should tell them how you have been feeling and what you have been thinking.
Chat online with the Samaritans or call their free number 116 123 immediately.
This information is provided to supplement the care provided by your GP or mental health professional and is not to be used as a substitute for professional medical advice. Always seek the advice of your GP or another qualified health or mental health professional if you have questions about a medical condition or plan of treatment.