Depression

Overview

Depression is a low mood that lasts for weeks or months and affects daily life. Symptoms vary a lot between people and range from mild to severe. They can be psychological, such as continuous low mood and hopelessness, or physical, such as feeling constantly tired and sleeping badly. Self-help, talking therapies and antidepressant medicines are among the treatments the NHS describes, and the choice depends on how severe the depression is.

Symptoms

What a clinician may find

• Continuous low mood, hopelessness and low self-esteem.
• Avoiding contact with friends and taking part in fewer social activities.
• Poor sleep, changes in appetite and constant tiredness.

Complications

• Severe depression can make a person feel suicidal or feel that life is no longer worth living.
• Some people have psychotic depression, and NHS inform says they might be at higher risk of thinking about suicide.
• Depression can affect daily life.

Diagnosis

There is no physical test that diagnoses depression. The NHS says a GP may examine the person and arrange some urine or blood tests to rule out other conditions with similar symptoms, such as an underactive thyroid. The GP also asks about medical history, previous mental health problems, home environment and lifestyle, recent triggers such as stressful events, and any thoughts of suicide or self-harm.

Treatment

Treatment is based on how severe the depression is. For mild depression, a GP may suggest watchful waiting, in which progress is monitored, along with exercise or guided self-help. Talking therapies such as cognitive behavioural therapy (CBT) can also be used. For moderate to severe depression, a combination of talking therapy and antidepressants is often recommended. NICE advises against routinely offering antidepressants first for less severe depression unless the person prefers them. A GP will usually prescribe a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI) if one is thought likely to help, and the NHS names sertraline and citalopram among them. The NHS says people can refer themselves directly to an NHS talking therapies service without a GP referral.

Prevention

The NHS and Mind describe regular exercise, not drinking too much alcohol, eating and drinking regularly and sharing experiences with other people as ways of looking after mood.

Key facts

What is depression, and how is it different from low mood?

Depression is a low mood that lasts for weeks or months and affects daily life. The NHS says a low mood may improve after a short period of time, and that this is not necessarily a sign of depression. It advises seeing a GP when symptoms of depression last for most of the day, every day, for more than two weeks. Symptoms vary a lot between people and range from mild to severe. The NHS notes that severe depression can make a person feel suicidal, or feel that life is no longer worth living.

Mind describes several forms of depression. Persistent depressive disorder is continuous depression that lasts for two years or more. Seasonal affective disorder is depression that occurs at a particular time of year or during a particular season. Antenatal depression occurs during pregnancy, and postnatal depression occurs in the first year after having a baby.

What are the symptoms of depression?

Symptoms vary a lot from person to person, and the NHS groups them as psychological, physical and social. Psychological symptoms include continuous low mood, hopelessness, low self-esteem and feeling tearful. Suicidal thoughts are also listed among the psychological symptoms.

Physical symptoms include feeling constantly tired, sleeping badly, changes in appetite or weight, usually a decrease, and unexplained aches and pains. Social effects include avoiding contact with friends and taking part in fewer social activities.

Some people have psychotic depression. NHS inform says that a person with psychotic depression might be at higher risk of thinking about suicide. Anyone who has these thoughts, or who is worried about someone else, can use the crisis routes described at the end of this article.

What causes depression, and how is it diagnosed?

The NHS says there is often a trigger for depression, and that a family history raises the likelihood of experiencing it. Other factors it lists include stressful events, personality and giving birth. It notes that grief after bereavement can bring on symptoms of depression, although these usually ease over time. MedlinePlus lists genetic, biological, environmental and psychological factors as possible causes. NIMH and MedlinePlus add that certain medicines and medical conditions, such as viruses or thyroid disorders, can cause symptoms like those of depression. The NHS lists low mood as a common symptom of an underactive thyroid.

There is no physical test that diagnoses depression. The GP asks about medical history, previous mental health problems, home environment and lifestyle, recent triggers such as stressful events, and any thoughts of suicide or self-harm. The NHS says a GP may examine the person and arrange some urine or blood tests to rule out other conditions with similar symptoms, such as an underactive thyroid. MedlinePlus says blood tests may look for conditions such as anaemia or thyroid disease.

How is depression treated?

Treatment is based on how severe the depression is. For mild depression, the NHS says a GP may suggest watchful waiting, which means monitoring progress to see whether it improves on its own. Exercise and guided self-help may also be suggested. The NHS says guided self-help usually involves six to eight sessions of working through a workbook or online course with support from a therapist. Talking therapies such as CBT can also be used for mild depression, particularly if it is not improving.

For moderate to severe depression, a combination of talking therapy and antidepressants is often recommended. Severe cases may go to a specialist team that provides intensive talking treatments as well as prescribed medicine.

NICE says guided self-help is the suggested first step for most people with less severe depression, and that the evidence for group CBT and group behavioural activation was good. NICE advises against routinely offering antidepressants first for less severe depression unless that is the person's preference. The NHS also describes interpersonal therapy, counselling and behavioural couples therapy. The NHS says people can refer themselves directly to an NHS talking therapies service without a GP referral, although services vary by area and cannot provide urgent mental health help.

What do antidepressants involve?

The NHS says a GP will usually prescribe a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI) if one is thought likely to help. It names sertraline, paroxetine, fluoxetine and citalopram as commonly used examples. NICE considers SSRIs the preferred antidepressant if one is chosen, because of their safety and tolerability.

The NHS says SSRIs work about as well as older antidepressants with fewer side effects, although they can still cause nausea, headaches, a dry mouth, tiredness, sleeping problems and problems with sex. Tricyclic antidepressants are older options used for moderate to severe depression. The NHS says symptoms start to improve within four weeks of starting an antidepressant, and that if it is working, it is continued for at least four to six months after symptoms have eased.

The NHS pages for sertraline and citalopram advise against stopping suddenly, because withdrawal symptoms can occur. They also say these medicines are not addictive in the way that illegal drugs and cigarettes are.

Living with depression and self-help

The NHS lists exercise as one of the main treatments for mild depression, and includes not drinking too much alcohol among its tips for coping with depression. Self-help is described as one part of care, alongside talking therapies and medicines where these are needed.

Mind suggests aiming to wake up and go to bed at the same time each day, and eating and drinking regularly. Mind also notes that sharing experiences with other people can help someone feel better, and that having someone listen and show they care can help in itself.

The NHS says people can refer themselves to an NHS talking therapies service for CBT or counselling, and that after contact someone from the service usually gets in touch within a few weeks. Waiting times for talking therapies can be several weeks or months, so a GP can discuss other options in the meantime.

Thoughts of suicide and where to get help

Severe depression can make a person feel suicidal, and the NHS says help is available. If someone is in immediate danger, the NHS says to call 999 or go to A&E.

Samaritans can be called free on 116 123, and the line is open 24 hours a day, every day. NHS 111 is also available 24 hours a day, and the NHS lists it for urgent mental health help. The number to press for the mental health option varies by area, so the option is described here by name rather than number.

A GP appointment is the routine route when symptoms of depression last for most of the day, every day, for more than two weeks. A GP can discuss treatment options, including talking therapies and antidepressants, and can refer a person to talking therapies, although people can also refer themselves. Talking therapy services are not able to provide urgent help, so anyone in a crisis is directed to the routes above.

Frequently asked questions