Depression: signs and getting help

What is depression?

The NHS describes depression as more than simply feeling unhappy or fed up for a few days. It can involve feeling sad for weeks or months, to the point that it interferes with work, social life and family life.

What are the signs?

Some people also notice physical symptoms, such as tiredness, sleeping badly, changes in appetite or unexplained aches. The NHS advises seeing a GP when symptoms of depression last most of the day, every day, for more than two weeks. Low mood can improve after a short time, but feelings that last most of the day, every day, for more than two weeks may be a sign of depression. Many people with depression also have symptoms of anxiety. Aches and pains can also be part of the picture. Depression can range from mild to severe.

What causes it?

Life-changing events such as bereavement, losing a job or giving birth can bring depression on. People with a family history of depression are more likely to experience it, and depression can also arise for no obvious reason.

How is it treated?

Treatment usually depends on how severe the depression is. It usually involves a combination of self-help, talking therapies and medicine. For mild depression, a GP can refer someone for talking therapies, or the person can refer themselves directly to an NHS talking therapies service. For moderate to severe depression, a combination of talking therapy and antidepressants is often recommended. People with severe depression may be referred to a specialist mental health team. For mild depression, a doctor may suggest watchful waiting, which means monitoring progress to see whether it improves, alongside lifestyle measures and guided self-help. The NHS describes exercise as one of the main treatments for mild depression, and guided self-help is usually based on the principles of cognitive behavioural therapy (CBT).

How do antidepressants fit in?

Antidepressants are one of the treatment options, and SSRIs are usually the type prescribed first. Antidepressants do not work straight away; the NHS says it usually takes around a week before effects start to be noticed. The NHS advises that antidepressants are reduced gradually when they are stopped, to help avoid withdrawal symptoms, and that this should be done with the GP. The NHS says to contact a GP straight away if feelings of hopelessness or suicidal thoughts start, or get worse, after starting an antidepressant.

When should someone get help?

A GP appointment is the usual first step for someone who thinks they may have depression. NHS talking therapies accept self-referral, so a GP is not the only way in.

Where can someone get urgent help?

If thoughts of harming yourself or ending your life are present, the NHS advises asking for an emergency GP appointment, calling NHS 111, or calling Samaritans on 116 123 at any time. If you or someone else is in immediate danger, or has been physically harmed, call 999 or go to A&E. In England, NHS 111 has a mental health option (option 2) for urgent help that is not an emergency, which trusts describe as available 24 hours a day. Samaritans listen at any time of day or night, and the number, 116 123, is free to call.