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Symptoms and treatments of depression - and what you can do to help yourself or someone you know.
If you are depressed, you may feel that nothing can help. But this is untrue. Deciding to do something is the most important step you can take. Most people recover from bouts of depression, and some even look back on it as a useful experience which forced them to take stock of their lives and make changes in their lifestyle.
What is depression?
We often use the expression "I'm feeling depressed" when we're feeling sad or miserable about life. Usually, these feelings pass in due course. But if the feelings are interfering with your life and don't go away after a couple of weeks, or if they come back, over and over again, for a few days at a time, it could be a sign that you're depressed in the medical sense of the term.
I felt detached from the world around me. All emotions – love, affection, anger – were gone. Actually, I can't say I had no emotions, I did, but they all seemed desperately negative. Most involved fear. Fear that I would never escape the condition.
In its mildest form, depression can mean just being in low spirits. It doesn’t stop you leading your normal life, but makes everything harder to do and seem less worthwhile. At its most severe, major depression (clinical depression) can be life-threatening, because it can make people suicidal or simply give up the will to live.
There are also various specific forms of depression:
Seasonal affective disorder (SAD)
If you usually become depressed only during the autumn and winter, it could be due to not getting enough daylight. You may benefit from spending time sitting in front of a special light box.
Postnatal depression
Many mothers have ‘the baby blues’ soon after the birth of their baby, but it usually passes after a few days. Postnatal depression is a more serious problem and can appear any time between two weeks and two years after the birth.
Bipolar disorder (manic depression)
Some people have mood swings, when periods of depression alternate with periods of mania. When manic, they are in a state of high excitement, and may plan and may try to execute grandiose schemes and ideas.
At least one person in every six becomes depressed in the course of their lives. One in 20 is clinically depressed. Figures suggest that it is women more than men who become depressed, but men may find it harder to admit to or talk about their experience. All age groups can be affected, and it’s important to take symptoms seriously and not to dismiss them as an inevitable part of growing up or growing old. By recognising and treating the symptoms and getting help, it’s possible to overcome depression, and prevent it coming back.
What are the symptoms of depression?
Depression shows itself in many different ways. People don't always realise what's going on because their problems seem to be physical, not mental. They tell themselves they're simply under the weather or feeling tired. But if you tick off five or more of the following symptoms, it's likely you're depressed:
Anxiety
People who are depressed are often very anxious. It's not clear whether the anxiety leads into the depression or whether the depression causes the anxiety. A person feeling anxious may have a mind full of busy, repetitive thoughts, which make it hard to concentrate, relax, or sleep. They may have physical symptoms, such as headaches, aching muscles, sweating and dizziness. It may cause physical exhaustion and general ill health.
What causes depression?
There's no one cause of depression; it varies very much from person to person and can occur through a combination of factors. Although depression doesn't seem to be inherited through genes (with the possible exception of manic depression), some of us are more prone to depression than others. This could be because of the way we're made, or because of our experiences or family background.
I was so scared of being alone with my thoughts. At night, everything seemed so bleak. I couldn't concentrate on anything; I couldn't read or watch TV. I couldn't relax or unwind. Sleep seemed impossible – so many thoughts were racing through my mind. I would spend hours fantasising about ways of killing myself.
Past experiences can have a profound effect on how we feel about ourselves in the present, and if those feelings are very negative, they can be the start of a downward spiral. In many cases, the first time someone becomes depressed, it's triggered by an unwelcome or traumatic event, such as being sacked, divorced, physically attacked or raped.
Depression is seen by some experts as a form of unfinished mourning. Often events or experiences that trigger depression can also be seen as a loss of some kind. It could be following the actual death of someone close, a major life change (such as moving house or changing jobs) or simply moving from one phase of life into another, as we reach retirement or our children leave home. It’s not just the negative experience that causes the depression, but how we deal with it. If the feelings provoked are not expressed or explored at the time, they fester and contribute towards depression. It's important to acknowledge and grieve over what we have lost in order to be able to move on successfully.
Everything to do with everyday life seemed like such hard work. I simply didn't have the energy to go to work, to see friends, to shop, cook or clean. It all seemed pointless! What was the point in eating, when I didn't even want to be alive?
Depression may also be caused by an underactive thyroid. The thyroid gland controls metabolic rate and, if it is not working properly, can cause you to experience various symptoms. If it is underactive, you will feel sluggish and lethargic, may put on weight, and feel depressed. If it is overactive, you may feel very speeded up, lose weight and have symptoms similar to mania. It is important to have a thyroid function test (a simple blood test) to make sure that this is not the cause of your depression, especially if you cannot account for it in other ways, such as recent life events. If an underactive thyroid is diagnosed, it can be treated successfully with appropriate medication (see Useful websites).
Anecdotal evidence suggests that occasionally people become very depressed in response to certain foods. Such a reaction is very individual, and people are often not aware of the particular food substance or drink that is causing the problem. But if you suddenly feel depressed for no apparent reason, it may be worth considering whether you have eaten or drunk something new, and whether this might have caused your sudden change of mood. If this is the cause, your mood should lift very quickly, so long as you don’t consume any more of the particular item.
Poor diet, lack of physical fitness, and illnesses, such as flu, can all leave us feeling depressed. Frequent use of some recreational drugs can also play a part.
It's clear that people who are depressed show changes to the chemical messengers (called neurotransmitters) in the brain. It's less clear whether this is a cause or a result of the depression.
o to help myself? Depression has one major characteristic that you need to be aware of when thinking about what you can do to defeat it. It can feed on itself. In other words, you get depressed and then you get more depressed about being depressed. Negative thoughts become automatic and are difficult for you to challenge. Being in a state of depression can then, itself, become a bigger problem than the difficulties that caused it in the first place. You need to break the hold that the depression has on you.
An important thing to remember is that there are no instant solutions to problems in life. Solving problems involves time, energy and work. When you are feeling depressed, you may well not be feeling energetic or motivated to work. But if you are able to take an active part in your treatment, it should help your situation.
Fighting negative attitudes
Try to recognise the pattern of negative thinking when you are doing it, and replace it with a more constructive activity. Look for things to do that occupy your mind.
Activity is good for the mind
Although you may not feel like it, it’s very therapeutic to take part in physical activities, for 20 minutes a day. Playing sports, running, dancing, cycling, and even brisk walking can stimulate chemicals in the brain called endorphins, which can help you to feel better.
Caring for yourself
You need to do things that will improve the way you feel about yourself. Allow yourself positive experiences and treats that reinforce the idea that you deserve good things. Pay attention to your personal appearance. Set yourself goals that you can achieve and that will give you a sense of satisfaction.
Look after yourself by eating healthily. Oily fish, in particular, may help alleviate depression. Don’t abuse your body with tobacco, alcohol or other drugs, which make it worse.
Alternative and complementary therapies
Practitioners of complementary and alternative medicine concern themselves with the person as a whole, and don't just treat their symptoms. They can take more time with you than a GP can.
Practitioners may offer treatments such as acupuncture, massage, homeopathy and herbal medicine that many people with depression have found helpful. St John's Wort is one of the herbal remedies that have become very popular, and may help to lift your mood. But if you are already taking other medication, it may not be safe to combine them. Consult your pharmacist or GP for more information.
Self-help groups
It can be a great relief to meet and share experiences with other people who are going through the same thing you are. It can break down feelings of isolation and, at the same time, show you how other people have coped. Finding that you can support others can help you, too.
These groups are often led by people who have overcome depression themselves. For help in locating local self-help groups, talk to your GP and consult the 'Useful organisations' below.
What treatments are available?
At a time when you may well find making decisions difficult, it can also seem like an added burden to try and choose between a range of treatment options.
What is actually available to you may depend very much on where you live. For example, talking treatments, such as counselling and psychotherapy, are more readily available in London and the South-East than they are in rural areas of northern England. You should be able to choose freely among a range of treatment options, but, in practice, most people attending GP surgeries are offered antidepressants as the first treatment choice. Don't be afraid to ask your GP about the treatments offered and what the alternatives are.
The National Institute for Health and Clinical Excellence (NICE) guidelines on the treatment of depression (updated 2009) suggest that, for mild depression, antidepressants are not appropriate because the risk of side effects outweighs the benefits. Suggested treatments include watchful waiting – a recognition of the fact that depression often goes away without
treatment – guided self-help, short-term talking treatments such as cognitive behaviour therapy (CBT), interpersonal psychotherapy (IPT), behavioural activation, and exercise programmes. For more severe depression antidepressants are appropriate, and selective serotonin reuptake inhibitors (SSRIs) are suggested because their side effects are usually better tolerated than those of the alternative types of antidepressants. However, combining a psychological treatment with medication maybe the most effective course for severe depression.
Antidepressants
Antidepressant drugs are the most common medical treatment for depression. They work on chemical messengers in the brain to lift your mood. They can’t cure depression, but they can alleviate the symptoms so that you may feel able to take action to deal with the depression yourself. It often takes between two to four weeks before the drugs take effect. The usual recommendation is that you stay on them for six months in order to prevent a recurrence. They don’t work for everyone.
Antidepressants frequently cause unpleasant side effects, which are worse to begin with. Some can be dangerous when used with other drugs. Of the various different types available, SSRIs are usually the preferred first choice because, although they have as many listed side effects as older drugs, they are usually better tolerated. Others include tricyclic antidepressants and MAOIs (monoamine oxidase inhibitors). Whichever type of antidepressant you take, you may experience withdrawal symptoms when you stop taking them, especially if you have been taking them for some time. Because of this you should withdraw slowly, reducing the dose in stages over a period of weeks.
If you are depressed, you may feel that nothing can help. But this is untrue. Deciding to do something is the most important step you can take. Most people recover from bouts of depression, and some even look back on it as a useful experience which forced them to take stock of their lives and make changes in their lifestyle.
What is depression?
We often use the expression "I'm feeling depressed" when we're feeling sad or miserable about life. Usually, these feelings pass in due course. But if the feelings are interfering with your life and don't go away after a couple of weeks, or if they come back, over and over again, for a few days at a time, it could be a sign that you're depressed in the medical sense of the term.
I felt detached from the world around me. All emotions – love, affection, anger – were gone. Actually, I can't say I had no emotions, I did, but they all seemed desperately negative. Most involved fear. Fear that I would never escape the condition.
In its mildest form, depression can mean just being in low spirits. It doesn’t stop you leading your normal life, but makes everything harder to do and seem less worthwhile. At its most severe, major depression (clinical depression) can be life-threatening, because it can make people suicidal or simply give up the will to live.
There are also various specific forms of depression:
Seasonal affective disorder (SAD)
If you usually become depressed only during the autumn and winter, it could be due to not getting enough daylight. You may benefit from spending time sitting in front of a special light box.
- Find out more about seasonal affective disorder
Postnatal depression
Many mothers have ‘the baby blues’ soon after the birth of their baby, but it usually passes after a few days. Postnatal depression is a more serious problem and can appear any time between two weeks and two years after the birth.
- Find out more about postnatal depression
Bipolar disorder (manic depression)
Some people have mood swings, when periods of depression alternate with periods of mania. When manic, they are in a state of high excitement, and may plan and may try to execute grandiose schemes and ideas.
- Find out more about bipolar disorder (manic depression)
At least one person in every six becomes depressed in the course of their lives. One in 20 is clinically depressed. Figures suggest that it is women more than men who become depressed, but men may find it harder to admit to or talk about their experience. All age groups can be affected, and it’s important to take symptoms seriously and not to dismiss them as an inevitable part of growing up or growing old. By recognising and treating the symptoms and getting help, it’s possible to overcome depression, and prevent it coming back.
What are the symptoms of depression?
Depression shows itself in many different ways. People don't always realise what's going on because their problems seem to be physical, not mental. They tell themselves they're simply under the weather or feeling tired. But if you tick off five or more of the following symptoms, it's likely you're depressed:
- being restless and agitated
- waking up early, having difficulty sleeping, or sleeping more
- feeling tired and lacking energy; doing less and less
- using more tobacco, alcohol or other drugs than usual
- not eating properly and losing or putting on weight
- crying a lot
- difficulty remembering things
- physical aches and pains with no physical cause
- feeling low-spirited for much of the time, every day
- being unusually irritable or impatient
- getting no pleasure out of life or what you usually enjoy
- losing interest in your sex life
- finding it hard to concentrate or make decisions
- blaming yourself and feeling unnecessarily guilty about things
- lacking self-confidence and self-esteem
- being preoccupied with negative thoughts
- feeling numb, empty and despairing
- feeling helpless
- distancing yourself from others; not asking for support
- taking a bleak, pessimistic view of the future
- experiencing a sense of unreality
- self-harming (by cutting yourself, for example)
- thinking about suicide.
Anxiety
People who are depressed are often very anxious. It's not clear whether the anxiety leads into the depression or whether the depression causes the anxiety. A person feeling anxious may have a mind full of busy, repetitive thoughts, which make it hard to concentrate, relax, or sleep. They may have physical symptoms, such as headaches, aching muscles, sweating and dizziness. It may cause physical exhaustion and general ill health.
What causes depression?
There's no one cause of depression; it varies very much from person to person and can occur through a combination of factors. Although depression doesn't seem to be inherited through genes (with the possible exception of manic depression), some of us are more prone to depression than others. This could be because of the way we're made, or because of our experiences or family background.
I was so scared of being alone with my thoughts. At night, everything seemed so bleak. I couldn't concentrate on anything; I couldn't read or watch TV. I couldn't relax or unwind. Sleep seemed impossible – so many thoughts were racing through my mind. I would spend hours fantasising about ways of killing myself.
Past experiences can have a profound effect on how we feel about ourselves in the present, and if those feelings are very negative, they can be the start of a downward spiral. In many cases, the first time someone becomes depressed, it's triggered by an unwelcome or traumatic event, such as being sacked, divorced, physically attacked or raped.
Depression is seen by some experts as a form of unfinished mourning. Often events or experiences that trigger depression can also be seen as a loss of some kind. It could be following the actual death of someone close, a major life change (such as moving house or changing jobs) or simply moving from one phase of life into another, as we reach retirement or our children leave home. It’s not just the negative experience that causes the depression, but how we deal with it. If the feelings provoked are not expressed or explored at the time, they fester and contribute towards depression. It's important to acknowledge and grieve over what we have lost in order to be able to move on successfully.
Everything to do with everyday life seemed like such hard work. I simply didn't have the energy to go to work, to see friends, to shop, cook or clean. It all seemed pointless! What was the point in eating, when I didn't even want to be alive?
Depression may also be caused by an underactive thyroid. The thyroid gland controls metabolic rate and, if it is not working properly, can cause you to experience various symptoms. If it is underactive, you will feel sluggish and lethargic, may put on weight, and feel depressed. If it is overactive, you may feel very speeded up, lose weight and have symptoms similar to mania. It is important to have a thyroid function test (a simple blood test) to make sure that this is not the cause of your depression, especially if you cannot account for it in other ways, such as recent life events. If an underactive thyroid is diagnosed, it can be treated successfully with appropriate medication (see Useful websites).
Anecdotal evidence suggests that occasionally people become very depressed in response to certain foods. Such a reaction is very individual, and people are often not aware of the particular food substance or drink that is causing the problem. But if you suddenly feel depressed for no apparent reason, it may be worth considering whether you have eaten or drunk something new, and whether this might have caused your sudden change of mood. If this is the cause, your mood should lift very quickly, so long as you don’t consume any more of the particular item.
- Find out more about food and mood
Poor diet, lack of physical fitness, and illnesses, such as flu, can all leave us feeling depressed. Frequent use of some recreational drugs can also play a part.
- Find out more about psychological effects of street drugs
It's clear that people who are depressed show changes to the chemical messengers (called neurotransmitters) in the brain. It's less clear whether this is a cause or a result of the depression.
o to help myself? Depression has one major characteristic that you need to be aware of when thinking about what you can do to defeat it. It can feed on itself. In other words, you get depressed and then you get more depressed about being depressed. Negative thoughts become automatic and are difficult for you to challenge. Being in a state of depression can then, itself, become a bigger problem than the difficulties that caused it in the first place. You need to break the hold that the depression has on you.
An important thing to remember is that there are no instant solutions to problems in life. Solving problems involves time, energy and work. When you are feeling depressed, you may well not be feeling energetic or motivated to work. But if you are able to take an active part in your treatment, it should help your situation.
Fighting negative attitudes
Try to recognise the pattern of negative thinking when you are doing it, and replace it with a more constructive activity. Look for things to do that occupy your mind.
Activity is good for the mind
Although you may not feel like it, it’s very therapeutic to take part in physical activities, for 20 minutes a day. Playing sports, running, dancing, cycling, and even brisk walking can stimulate chemicals in the brain called endorphins, which can help you to feel better.
Caring for yourself
You need to do things that will improve the way you feel about yourself. Allow yourself positive experiences and treats that reinforce the idea that you deserve good things. Pay attention to your personal appearance. Set yourself goals that you can achieve and that will give you a sense of satisfaction.
Look after yourself by eating healthily. Oily fish, in particular, may help alleviate depression. Don’t abuse your body with tobacco, alcohol or other drugs, which make it worse.
Alternative and complementary therapies
Practitioners of complementary and alternative medicine concern themselves with the person as a whole, and don't just treat their symptoms. They can take more time with you than a GP can.
Practitioners may offer treatments such as acupuncture, massage, homeopathy and herbal medicine that many people with depression have found helpful. St John's Wort is one of the herbal remedies that have become very popular, and may help to lift your mood. But if you are already taking other medication, it may not be safe to combine them. Consult your pharmacist or GP for more information.
Self-help groups
It can be a great relief to meet and share experiences with other people who are going through the same thing you are. It can break down feelings of isolation and, at the same time, show you how other people have coped. Finding that you can support others can help you, too.
These groups are often led by people who have overcome depression themselves. For help in locating local self-help groups, talk to your GP and consult the 'Useful organisations' below.
What treatments are available?
At a time when you may well find making decisions difficult, it can also seem like an added burden to try and choose between a range of treatment options.
What is actually available to you may depend very much on where you live. For example, talking treatments, such as counselling and psychotherapy, are more readily available in London and the South-East than they are in rural areas of northern England. You should be able to choose freely among a range of treatment options, but, in practice, most people attending GP surgeries are offered antidepressants as the first treatment choice. Don't be afraid to ask your GP about the treatments offered and what the alternatives are.
The National Institute for Health and Clinical Excellence (NICE) guidelines on the treatment of depression (updated 2009) suggest that, for mild depression, antidepressants are not appropriate because the risk of side effects outweighs the benefits. Suggested treatments include watchful waiting – a recognition of the fact that depression often goes away without
treatment – guided self-help, short-term talking treatments such as cognitive behaviour therapy (CBT), interpersonal psychotherapy (IPT), behavioural activation, and exercise programmes. For more severe depression antidepressants are appropriate, and selective serotonin reuptake inhibitors (SSRIs) are suggested because their side effects are usually better tolerated than those of the alternative types of antidepressants. However, combining a psychological treatment with medication maybe the most effective course for severe depression.
Antidepressants
Antidepressant drugs are the most common medical treatment for depression. They work on chemical messengers in the brain to lift your mood. They can’t cure depression, but they can alleviate the symptoms so that you may feel able to take action to deal with the depression yourself. It often takes between two to four weeks before the drugs take effect. The usual recommendation is that you stay on them for six months in order to prevent a recurrence. They don’t work for everyone.
Antidepressants frequently cause unpleasant side effects, which are worse to begin with. Some can be dangerous when used with other drugs. Of the various different types available, SSRIs are usually the preferred first choice because, although they have as many listed side effects as older drugs, they are usually better tolerated. Others include tricyclic antidepressants and MAOIs (monoamine oxidase inhibitors). Whichever type of antidepressant you take, you may experience withdrawal symptoms when you stop taking them, especially if you have been taking them for some time. Because of this you should withdraw slowly, reducing the dose in stages over a period of weeks.
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