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Depression

Depression is a condition in which you may have low mood, a loss of interest in everyday activities, feelings of low self-worth, a lack of energy and poor concentration, all of which are prolonged.

About depression

Around one in four women and one in 10 men have depression serious enough to need treatment at some point in their lives. People of all ages can be affected.

You are said to have depression when your feelings:

  • don't go away quickly
  • are so bad that they interfere with everyday life

There are different types of depression, which are as follows.

Mild depression

Mild depression doesn't usually stop you leading your daily life but makes everything harder to do and seem less worthwhile.

Moderate depression

Moderate depression has a significant impact on your daily life.

Severe depression

If you feel depressed or uninterested in doing anything and daily activities are almost impossible, you may have severe depression. You may also have physical symptoms, including tiredness or a loss of appetite.

There are also various specific forms depression, which include the following.

Dysthymia

This is chronic mild depression (lasting at least 2 years).

Bipolar affective disorder

This is a type of depression in which your mood swings between high and low. This is also sometimes called manic depression.

Seasonal affective disorder (SAD)

This is a condition where you get big mood swings in different seasons of the year. For more information, see Related topics.

Postnatal depression

Some women become depressed soon after childbirth. For more information, please see Related topics.

Symptoms

The number of symptoms that you may have differs depending on the type of depression. The main emotional symptoms include:

  • a continuous low mood, which may be worse in the mornings
  • feeling irritable
  • crying a lot
  • a loss of interest or pleasure in activities that you would normally enjoy
  • a loss of self-confidence
  • a lack of energy, tiredness and poor concentration
  • difficulty in making decisions
  • feeling helpless or hopeless
  • feeling guilty
  • a restless or agitated feeling
  • thoughts about suicide

The main physical symptoms include:

  • a loss of sex drive (libido)
  • trouble sleeping - possibly taking one or two hours to go to sleep or waking up earlier than usual
  • disturbed eating patterns - either loss of appetite or eating too much
  • unexplained aches and pains

People who are depressed may also be very anxious.

Complications

About half the people who have an episode of depression will have at least one more episode.

Depression can also be associated with suicide. Carers should look out for changes in mood, negativity and hopelessness, and talk about suicide or self-harm.

Causes

The exact cause of depression isn't fully understood at present. It may develop due to a combination of triggers. The precise reasons for developing it are probably different for each person.

The likelihood of you becoming depressed may increase if you:

  • experience stressful events, such as bereavement, divorce or losing a job
  • have a long-term or serious illnesses, such as diabetes, cancer and arthritis
  • have a pessimistic personality
  • drink too much alcohol (this may be part of the cause of depression or a consequence)
  • have depression in your family (if one of your parents has severe depression, you are eight times more likely to get depression yourself)

Depression is also linked to changes in how your brain works. The brain sends signals from nerve to nerve using chemicals called neurotransmitters. The neurotransmitters called noradrenaline and serotonin are out of balance and don't work properly in people with depression.

Diagnosis

If you are depressed, recognising the problem is the first, yet hardest, step. If you take that step, you can find the support and treatment you need to stop depression taking over your life.

Your GP is a good first point of contact. He or she will ask about your life and symptoms. Your GP may also suggest some blood or urine tests to see if any other medical condition is causing the symptoms.

Most people with depression are treated by their GP. However, some people with severe depression are referred to a psychiatrist - a doctor specialising in mental health.

Treatment

A number of treatments are available for depression. The two main approaches are talking (psychological) therapies, such as counselling, and treatment with antidepressant medicines. Your treatment will depend on how severe your depression is.

Self-help

Mild depression can be helped by regular exercise. Regularly playing sports or even taking a brisk walk can make you feel better. Your GP may advise you to follow an exercise programme. Look after yourself by eating healthily and don't smoke or drink alcohol, which can make you feel worse. Take care of yourself by allowing yourself treats and doing things that make you feel good about yourself.

Medicines

Antidepressants

There are several different types of antidepressant medicines available. All have side-effects, so it's important to find the medicine that suits you best. Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

  • SSRIs (selective serotonin re-uptake inhibitors) such as fluoxetine (Prozac) and paroxetine (Seroxat) are the most commonly prescribed type of antidepressant. SSRIs work by raising the levels of the natural chemical serotonin in the brain, which in turn tends to lift the mood.
  • Tricyclics (the name refers to the molecular structure of the drug) are as effective as SSRIs, but they can have different side-effects, which may be slightly more troublesome for some people. Dosulepin (Prothiaden) and clomipramine (Anafranil) are examples of tricyclics. These work by raising the levels of the chemicals serotonin and noradrenaline in the brain, which both tend to lift the mood.
  • There are several other types of antidepressant, which work in a different way from SSRIs and tricyclics. These include venlafaxine (Efexor), and mirtazapine (Zispin). They can be useful for people who experience side-effects with other medicines.
  • MAOIs (monoamine oxidase inhibitors) such as phenelzine (Nardil), are used less than other antidepressants because they can cause serious side-effects if you eat certain foods when taking an MAOI. Ask your GP to explain these to you.

Antidepressants usually take four to six weeks to make you feel better and you will need to take them for at least six months. Taking medication even after you feel better can help prevent the depression coming back. Ask your GP for more information on each medicine. When stopping antidepressant medication, your GP will usually reduce the dose gradually over a four-week period.

Complementary therapies

St John's wort (Hypericum perforatum) is an unlicensed complementary medicine for the treatment of mild depression. You can buy this as tablets in health food stores and pharmacies. You should ask for advice from your GP or pharmacist before taking St John's wort if you are also taking prescription (including antidepressants) or over-the-counter medicines. This is because St John's wort can be harmful if it's taken with some other medicines.

Talking therapies

Your GP can often arrange for you to have talking therapy as part of your treatment, and counsellors may be based at your surgery.

Counselling usually takes the form of a one-to-one session where you have an opportunity to express your feelings and problems, with the counsellor listening and asking questions. In these sessions you won't be told what to do about your feelings but the counsellor encourages you to solve your problems. You normally have a fixed number of sessions - usually six to eight over 10 to 12 weeks.

More structured types of talking therapy also exist. These include cognitive behavioural therapy (CBT) and psychodynamic psychotherapy (a type of talking treatment that goes more deeply into childhood experience and significant relationships). For more information about CBT, please see Related topics.

The type of talking therapy you have will depend on what's available, your preferences and how severe your depression is.

Hospital treatment

Most people who have depression can be successfully treated without being admitted to hospital. However, if you have severe depression and have suicidal thoughts, you (or your family) or your psychiatrist may feel you need the shelter and protection of a hospital.

Before admission you may have a mental health assessment. This involves talking with your doctor and answering some questions about how you are feeling.

Electroconvulsive therapy (ECT)

This treatment is only offered to people who are severely depressed and haven't responded to treatment with medicines. ECT is only used if absolutely necessary. ECT is always given in hospital under general anaesthetic, which means you will be asleep during the procedure and feel no pain. It works by passing a small electric current through the brain. The resulting convulsion may ease the depression, but can also have side-effects such as memory loss. Ask your GP to explain these to you.

Further information

Mind

Mental Health Foundation

Sources

  • Depression. World Health Organization (WHO). www.who.int, accessed 18 December 2007
  • Depression. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 18 December 2007
  • Understanding depression. Mind. www.mind.org.uk, accessed 6 December 2007
  • The Royal College of Psychiatrists website. www.rcpsych.ac.uk, accessed 6 December 2007
  • World Health Organisation (WHO). The ICD-10 Classification of Mental and Behavioural Disorders - Diagnostic criteria for research. Switzerland: WHO, 1993
  • The treatment of depression in adults. National Institute for Clinical Excellence (NICE). December 2004, with amendments 2007. Clinical Guideline 23 Information for the public. www.nice.org.uk
  • British National Formulary 54.Section 4.3 Antidepressant drugs. September 2007. www.bnf.org

Related topics

Cognitive behavioural therapy

Postnatal depression

Seasonal affective disorder (SAD)