Health A to Z
Depression is more than simply feeling unhappy or fed up for a few days.
Most people go through periods of feeling down, but when you're depressed you feel persistently sad for weeks or months, rather than just a few days.
Some people think depression is trivial and not a genuine health condition. They're wrong – it is a real illness with real symptoms. Depression isn't a sign of weakness or something you can "snap out of" by "pulling yourself together".
The good news is that with the right treatment and support, most people with depression can make a full recovery.
Depression affects people in different ways and can cause a wide variety of symptoms.
They range from lasting feelings of unhappiness and hopelessness, to losing interest in the things you used to enjoy and feeling very tearful. Many people with depression also have symptoms of anxiety.
There can be physical symptoms too, such as feeling constantly tired, sleeping badly, having no appetite or sex drive, and various aches and pains.
The symptoms of depression range from mild to severe. At its mildest, you may simply feel persistently low in spirit, while severe depression can make you feel suicidal, that life is no longer worth living.
Most people experience feelings of stress, unhappiness or anxiety during difficult times. A low mood may improve after a short period of time, rather than being a sign of depression. Read more about low mood and depression.
If you've been feeling low for more than a few days, take this short test to find out if you're depressed.
It's important to seek help from your GP if you think you may be depressed.
Many people wait a long time before seeking help for depression, but it's best not to delay. The sooner you see a doctor, the sooner you can be on the way to recovery.
Sometimes there's a trigger for depression. Life-changing events, such as bereavement, losing your job or even having a baby, can bring it on.
People with a family history of depression are more likely to experience it themselves. But you can also become depressed for no obvious reason.
Read more about the causes of depression.
Depression is fairly common, affecting about one in 10 people at some point during their life. It affects men and women, young and old.
Studies have shown that about 4% of children aged five to 16 in the UK are anxious or depressed.
Treatment for depression can involve a combination of lifestyle changes, talking therapies and medication. Your recommended treatment will be based on whether you have mild, moderate or severe depression.
If you have mild depression, your doctor may suggest waiting to see whether it improves on its own, while monitoring your progress. This is known as "watchful waiting". They may also suggest lifestyle measures such as exercise and self-help groups.
For moderate to severe depression, a combination of talking therapy and antidepressants is often recommended. If you have severe depression, you may be referred to a specialist mental health team for intensive specialist talking treatments and prescribed medication.
Read more about treating depression. You can also read a summary of the pros and cons of the treatments for depression.
Reading a self-help book or joining a support group are also worthwhile. They can help you gain a better understanding about what causes you to feel depressed. Sharing your experiences with others in a similar situation can also be very supportive.
Read more about the lifestyle changes you can make to help you beat depression.
The symptoms of depression can be complex and vary widely between people. But as a general rule, if you're depressed, you feel sad, hopeless and lose interest in things you used to enjoy.
The symptoms persist for weeks or months and are bad enough to interfere with your work, social life and family life.
There are many other symptoms of depression and you're unlikely to have all of those listed below.
The psychological symptoms of depression include:
The physical symptoms of depression include:
The social symptoms of depression include:
Depression can often come on gradually, so it can be difficult to notice something is wrong. Many people try to cope with their symptoms without realising they're unwell. It can sometimes take a friend or family member to suggest something is wrong.
Doctors describe depression by how serious it is:
It can be difficult to distinguish between grief and depression. They share many of the same characteristics, but there are important differences between them.
Grief is an entirely natural response to a loss, while depression is an illness.
People who are grieving find their feelings of sadness and loss come and go, but they're still able to enjoy things and look forward to the future.
In contrast, people who are depressed constantly feel sad. They don't enjoy anything and find it difficult to be positive about the future.
Read more about coping with grief and bereavement.
There are different types of depression, and some conditions where depression may be one of the symptoms. These include:
Read more about diagnosing depression.
There's no single cause of depression. It can occur for a variety of reasons and it has many different triggers.
For some people, an upsetting or stressful life event, such as bereavement, divorce, illness, redundancy and job or money worries, can be the cause.
Different causes can often combine to trigger depression. For example, you may feel low after being ill and then experience a traumatic event, such as a bereavement, which brings on depression.
People often talk about a "downward spiral" of events that leads to depression. For example, if your relationship with your partner breaks down, you're likely to feel low, you may stop seeing friends and family and you may start drinking more. All of this can make you feel worse and trigger depression.
Some studies have also suggested that you're more likely to get depression as you get older, and that it's more common in people who live in difficult social and economic circumstances.
Some of the potential triggers of depression are discussed below.
Most people take time to come to terms with stressful events, such as bereavement or a relationship breakdown. When these stressful events occur, your risk of becoming depressed is increased if you stop seeing your friends and family and try to deal with your problems on your own.
You may be more vulnerable to depression if you have certain personality traits, such as low self-esteem or being overly self-critical. This may be because of the genes you've inherited from your parents, your early life experiences, or both.
If someone in your family has had depression in the past, such as a parent or sister or brother, it's more likely that you'll also develop it.
Some women are particularly vulnerable to depression after pregnancy. The hormonal and physical changes, as well as the added responsibility of a new life, can lead to postnatal depression.
Becoming cut off from your family and friends can increase your risk of depression.
Cannabis can help you relax, but there's evidence that it can also bring on depression, particularly in teenagers.
"Drowning your sorrows" with a drink is also not recommended. Alcohol is categorised as a "strong depressant", which actually makes depression worse.
Head injuries are also an often under-recognised cause of depression. A severe head injury can trigger mood swings and emotional problems.
Some people may have an underactive thyroid (hypothyroidism) resulting from problems with their immune system. In rarer cases, a minor head injury can damage the pituitary gland, which is a pea-sized gland at the base of your brain that produces thyroid-stimulating hormones.
This can cause a number of symptoms, such as extreme tiredness and a lack of interest in sex (loss of libido), which can in turn lead to depression.
If you experience symptoms of depression for most of the day, every day for more than two weeks, you should seek help from your GP.
It's particularly important to speak to your GP if you:
Sometimes, when you're depressed it can be difficult to imagine that treatment can actually help. But the sooner you seek treatment, the sooner your depression will improve.
There are no physical tests for depression, but your GP may examine you and carry out some urine or blood tests to rule out other conditions that have similar symptoms, such as an underactive thyroid.
The main way your GP will tell if you have depression is by asking you lots of questions about your general health and how the way you're feeling is affecting you mentally and physically.
Try to be as open and honest as you can be with your answers. Describing your symptoms and how they're affecting you will help your GP determine whether you have depression and how severe it is.
Any discussion you have with your GP will be confidential. This rule will only ever be broken if there's a significant risk of harm to either yourself or others, and if informing a family member or carer would reduce that risk.
Read about treating clinical depression.
Cognitive behavioural therapy (CBT) aims to help you understand your thoughts and behaviour and how they affect you.
CBT recognises that events in your past may have shaped you, but it concentrates mostly on how you can change the way you think, feel and behave in the present.
It teaches you how to overcome negative thoughts – for example, being able to challenge hopeless feelings.
CBT is available on the NHS for people with depression or any other mental health problem that it's been shown to help.
You normally have a short course of sessions, usually six to eight sessions, over 10 to 12 weeks on a one-to-one basis with a counsellor trained in CBT. In some cases, you may be offered group CBT.
Online CBT is a type of CBT that's delivered through a computer, rather than face-to-face with a therapist.
You'll have a series of weekly sessions and you should receive support from a healthcare professional. For example, online CBT is usually prescribed by your GP and you may have to use the surgery computer to access the programme.
Ask your GP for more information or read more about online CBT and the courses available.
Interpersonal therapy (IPT) focuses on your relationships with others and on problems you may be having in your relationships, such as difficulties with communication or coping with bereavement.
There's some evidence that IPT can be as effective as antidepressants or CBT, but more research is needed.
In psychodynamic (psychoanalytic) psychotherapy, a psychoanalytic therapist will encourage you to say whatever is going through your mind.
This will help you become aware of hidden meanings or patterns in what you do or say that may be contributing to your problems.
Read more about psychotherapy.
Counselling is a form of therapy that helps you think about the problems you're experiencing in your life so you can find new ways of dealing with them. Counsellors support you in finding solutions to problems, but don't tell you what to do.
Counselling on the NHS usually consists of six to 12 hour-long sessions. You talk in confidence to a counsellor, who supports you and offers practical advice.
See your GP for more information about accessing NHS talking treatments. They can refer you for local talking treatments for depression.
In some parts of the country, you also have the option of self-referral. This means that if you prefer not to talk to your GP, you can go directly to a professional therapist.
Most people with moderate or severe depression benefit from antidepressants, but not everybody does. You may respond to one antidepressant but not to another, and you may need to try two or more treatments before you find one that works for you.
The different types of antidepressant work about as well as each other. However, side effects vary between different treatments and people.
When you start taking antidepressants, you should see your GP or specialist nurse every week or two for at least four weeks to assess how well they're working. If they're working, you'll need to continue taking them at the same dose for at least four to six months after your symptoms have eased.
If you've had episodes of depression in the past, you may need to continue to take antidepressants for up to five years or longer.
Antidepressants aren't addictive, but you may get some withdrawal symptoms if you stop taking them suddenly or you miss a dose (see below).
If your GP thinks you would benefit from taking an antidepressant, you'll usually be prescribed a modern type called a selective serotonin reuptake inhibitor (SSRI). Examples of commonly used SSRI antidepressants are paroxetine (Seroxat), fluoxetine (Prozac) and citalopram (Cipramil).
They help increase the level of a natural chemical in your brain called serotonin, which is thought to be a "good mood" chemical.
SSRIs work just as well as older antidepressants and have fewer side effects, although they can cause nausea, headaches, a dry mouth and problems having sex. However, these side effects usually improve over time.
Some SSRIs aren't suitable for children and young people under 18 years of age. Research shows that the risk of self-harm and suicidal behaviour may increase if they're taken by under-18s. Fluoxetine is the only SSRI that can be prescribed for under-18s, and even then only when a specialist has given the go-ahead.
Vortioxetine (Brintellix or Lundbeck) is an SSRI that's recommended by the National Institute for Health and Care Excellence (NICE) for treating severe depression in adults.
Tricyclic antidepressants (TCAs) are a group of antidepressants that are used to treat moderate to severe depression.
TCAs, including imipramine (Imipramil) and amitriptyline, have been around for longer than SSRIs.
They work by raising the levels of the chemicals serotonin and noradrenaline in your brain. These both help lift your mood.
They're generally quite safe, but it's a bad idea to smoke cannabis if you're taking TCAs because it can cause your heart to beat rapidly.
Side effects of TCAs vary from person to person but may include a dry mouth, blurred vision, constipation, problems passing urine, sweating, light-headedness and excessive drowsiness.
The side effects usually ease after seven to 10 days, as your body gets used to the medication.
New antidepressants, such as venlafaxine (Efexor), duloxetine (Cymbalta or Yentreve) and mirtazapine (Zispin Soltab), work in a slightly different way from SSRIs and TCAs.
Venlafaxine and duloxetine are known as serotonin-noradrenaline reuptake inhibitors (SNRIs). Like TCAs, they change the levels of serotonin and noradrenaline in your brain.
Studies have shown that an SNRI can be more effective than an SSRI, but they're not routinely prescribed because they can lead to a rise in blood pressure.
Antidepressants aren't addictive in the same way that illegal drugs and cigarettes are, but when you stop taking them you may have some withdrawal symptoms, including:
In most cases, these are quite mild and last no longer than a week or two, but occasionally they can be quite severe. They seem to be most likely to occur with paroxetine (Seroxat) and venlafaxine (Efexor).
Withdrawal symptoms occur very soon after stopping the tablets, so are easy to distinguish from symptoms of depression relapse, which tend to occur after a few weeks.
Mindfulness involves paying closer attention to the present moment and focusing on your thoughts, feelings, bodily sensations, and the world around you to improve your mental wellbeing.
The aim is to develop a better understanding of your mind and body, and learn how to live with more appreciation and less anxiety.
Mindfulness is recommended by the National Institute for Health and Care Excellence (NICE) as a way of preventing depression in people who've had three or more bouts of depression in the past.
Read more about mindfulness.
St John's wort is a herbal treatment that some people take for depression. It's available from health food shops and pharmacies.
There's some evidence that it may help mild to moderate depression, but it's not recommended by doctors. This is because the amount of active ingredients varies among individual brands and batches, so you can never be sure what sort of effect it will have on you.
You shouldn't take St John's wort if you're pregnant or breastfeeding, as we don't know for sure that it's safe.
Also, St John's wort can interact with the contraceptive pill, reducing its contraceptive effect.
Electroconvulsive therapy (ECT) is sometimes recommended in cases of severe depression where other treatments, including antidepressants, haven't worked.
For most people, ECT is effective at relieving severe depression, although the beneficial effect tends to wear off after several months.
Some people also experience unpleasant side effects after having ECT, including short-term headaches, memory problems, nausea and muscle aches.
There are two types of ECT recommended by NICE – transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS). These are discussed below.
Transcranial direct current stimulation (tDCS) involves placing electrodes on your head.
The electrodes are attached to a small, portable battery-operated stimulator, which delivers a constant, low-strength current to the brain. The electric current stimulates brain activity to help improve the symptoms of depression.
You'll remain awake and alert throughout the procedure, which is usually carried out by a trained clinician. However, it's sometimes possible for tDCS to be self-administered. The treatment can be used on its own or in addition to other treatments for depression.
Treatment sessions are carried out daily and last for about 20-30 minutes, with a course of treatment typically lasting several weeks.
Treatment with tDCS is safe and has been found to be effective in some cases. There's some uncertainty about the way tDCS is delivered, the number of treatments needed, and how long its effects last, so further research in these areas is needed.
NICE has more information about transcranial direct current stimulation for depression.
Repetitive transcranial magnetic stimulation (rTMS) involves holding an electromagnetic coil against your head, which delivers repetitive pulses of electromagnetic energy are at various frequencies or intensities. This stimulates a part of the brain called the cerebral cortex.
Treatment with rTMS usually involves a two to six week course of daily sessions that last about 30 minutes.
Evidence suggests that rTMS for depression is safe, although the effectiveness of treatment can vary between individuals.
NICE has more information about repetitive transcranial magnetic stimulation for depression.
If you've tried several different antidepressants and there's been no improvement, your doctor may offer you a type of medication called lithium in addition to your current treatment.
If the level of lithium in your blood becomes too high, it can become toxic. You'll therefore need blood tests every three months to check your lithium levels while you're on the medication.
You'll also need to avoid eating a low-salt diet because it can also cause the lithium to become toxic. Ask your GP for advice about your diet.
Sharing a problem with someone else or with a group can give you support and an insight into your own depression. Research shows that talking can help people recover from depression and cope better with stress.
You may not feel comfortable about discussing your mental health and sharing your distress with others. If this is the case, writing about how you feel or expressing your emotions through poetry or art are other ways to help your mood.
Here's a list of depression support groups and information about how to access them.
If you have depression it may be tempting to smoke or drink to make you feel better. Cigarettes and alcohol may seem to help at first, but they make things worse in the long run.
Be extra cautious with cannabis. You might think it's harmless, but research has shown a strong link between cannabis use and mental illness, including depression.
The evidence shows that if you smoke cannabis you:
Your GP can give you advice and support if you drink or smoke too much or use drugs.
You may also find the following pages useful:
If your depression is caused by working too much or if it's affecting your ability to do your job, you may need time off to recover.
However, there's evidence to suggest that taking prolonged time off work can make depression worse. There's also quite a bit of evidence to support that going back to work can help you recover from depression.
Read more about returning to work after having mental health issues.
It's important to avoid too much stress, and this includes work-related stress. If you're employed, you may be able to work shorter hours or work in a more flexible way, particularly if job pressures seem to trigger your symptoms.
Under the Equality Act (2010), all employers must make reasonable adjustments to make the employment of people with disabilities possible. This can include people who've been diagnosed with a mental illness.
Read more about how to beat stress at work.
If you're unable to work as a result of your depression, you may be eligible for a range of benefits, depending on your circumstances. These include:
It's not just the person with depression who's affected by their illness. The people close to them are also affected.
If you're caring for someone with depression, your relationship with them and family life in general can become strained. You may feel at a loss as to what to do. Finding a support group and talking to others in a similar situation might help.
If you're having relationship or marriage difficulties, it might help to contact a relationship counsellor who can talk things through with you and your partner.
In this video called 'Help with your relationship: couples therapy', a relationship counsellor explains what couples therapy involves and who it can help.
Men are less likely to ask for help than women and are also more likely to turn to alcohol or drugs when depressed.
Read more about care and support.
Losing someone close to you can be a trigger for depression.
When someone you love dies, the sense of loss can be so powerful that you feel it's impossible to recover. However, with time and the right help and support, it's possible to start living your life again.
Find out more with these videos and articles all about coping with bereavement.
The majority of suicide cases are linked with mental disorders, and most of them are triggered by severe depression.
Warning signs that someone with depression may be considering suicide include:
Contact your GP as soon as possible if you're feeling suicidal or are in the crisis of depression. They'll be able to help you.
If you see any of the above warning signs in a friend or relative:
If you feel there's an immediate danger, stay with the person or have someone else stay with them, and remove all available means of committing suicide, such as medication.
Over-the-counter medication, such as painkillers, can be just as dangerous as prescription medication. Also, remove sharp objects and poisonous household chemicals such as bleach.
Read more about how supporting someone who's suicidal.
Some people who have severe clinical depression will also experience hallucinations and delusional thinking, the symptoms of psychosis.
Depression with psychosis is known as psychotic depression.
Someone with severe clinical depression feels sad and hopeless for most of the day, practically every day, and has no interest in anything. Getting through the day feels almost impossible.
Other typical symptoms of severe depression are:
Read more about the psychological, physical and social symptoms of clinical depression.
Having moments of psychosis (psychotic episodes) means experiencing:
The delusions and hallucinations almost always reflect the person's deeply depressed mood – for example, they may become convinced they're to blame for something, or that they've committed a crime.
"Psychomotor agitation" is also common. This means not being able to relax or sit still, and constantly fidgeting.
At the other extreme, a person with psychotic depression may have "psychomotor retardation", where both their thoughts and physical movements slow down.
People with psychotic depression have an increased risk of thinking about suicide.
The cause of psychotic depression isn't fully understood. It's known that there's no single cause of depression and it has many different triggers.
For some, stressful life events such as bereavement, divorce, serious illness or financial worries can be the cause.
Genes probably play a part, as severe depression can run in families, although it's not known why some people also develop psychosis.
Many people with psychotic depression will have experienced adversity in childhood, such as a traumatic event.
Read more about the causes of clinical depression.
Treatment for psychotic depression involves:
The person may need to stay in hospital for a short period of time while they're receiving treatment.
Electroconvulsive therapy (ECT) may sometimes be recommended if the person has severe depression and other treatments, including antidepressants, haven't worked.
Treatment is usually effective, but follow-up appointments so that the person can be closely monitored are usually required.
People with psychosis are often unaware that they're thinking and acting strangely.
As a result of this lack of insight, it's often down to the person's friends, relatives or carers to seek help for them.
If you're concerned about someone and think they may have psychosis, you could contact their social worker or community mental health nurse if they've previously been diagnosed with a mental health condition.
Contact the person's GP if this is the first time they've shown symptoms of psychosis.
If you think the person's symptoms are placing them or others at possible risk of harm you can:
The following websites provide further information and support:
Vanessa Phillips from Hertfordshire was known as a strong person, always willing to help others. When she had a breakdown, her friends didn't know she was the one who needed help.
"My breakdown was triggered by my mother's death. I was a 41-year-old divorced single parent of two children and I had no support. The council was trying to evict me from my home.
"I was eating hardly anything and I wasn't sleeping. I was shaking and suffering huge anxiety, but I didn't know I was ill. I thought I just had too much on my plate. I now feel that if people had been there for me, if people had listened to me, I might not have become so ill.
"Everyone knew me as a very strong person who helped others with their problems, so when I was saying, 'I'm not coping, I need help', people didn't pay any attention. I began spending a lot of time in bed under my duvet. I went to my doctor, who gave me antidepressant pills. I knew nothing about depression and he didn't tell me anything.
"A friend came round to see if I was all right one Friday morning. She didn't know I'd already decided to kill myself. She found me sitting in bed ranting and raving. She saw an empty pill bottle and a half-empty bottle of whisky and she phoned my doctor, who called an ambulance.
"I was kept in hospital for two weeks and sent home with more pills, but still no more information about depression. I started going to the library and reading books on mental health, and saw how diet, lifestyle, healthy eating and vitamins were involved.
"Slowly, I began to recover. I had a lot of help from a lovely mental health nurse who took a real interest in me. She used my love of plants to deal with my social exclusion by driving me in her car to the garden centre for a walk and a cup of coffee. Having someone else caring about me was the catalyst that helped me sort out things I couldn't cope with.
"It took me a long time, but I got back on my feet. It would have been faster if I'd had more support and more information. I now run a depression awareness group so that other people don't have to go through what happened to me."
Having experienced bullying, abuse and depression, talk show host Trisha Goddard knows what it's like to hit rock bottom. She tells how she fought against the odds, and won.
Barely an episode of Trisha goes by without a bitter, explosive argument. There are always tears, usually a confession or two and almost always confrontation.
Some people think Trisha Goddard's daytime show is pure voyeurism, but Trisha isn't trying to exploit other people's problems for entertainment. She wants to help people rather than judge them, and she takes her role of counsellor very seriously. She understands that if you strip away all the anger, you're left with a person who feels sad, vulnerable and lost.
She understands because she's been there. "It all started when I was about 14," she says. "I didn't realise it at the time, but looking back, I went through many depressed states during my teens."
Ironically, both her parents were psychiatric nurses. Her mother was Dominican and her father was English. "I was bullied at school because of my colour. I wasn't very close to my three sisters and my parents used to hit me. But I used to think that every family behaved like that so, although I was miserable, I didn't really understand my feelings."
For many years, Trisha didn't dare listen to those feelings. Her first marriage, in 1985, ended after nine months. "It was a weird relationship," she admits. "He'd go to work and lock me in the house."
She left her husband and got a job as a TV reporter in Sydney, but career success couldn't cure her depression. Within a year, she was hospitalised. "My depression wasn't recognised and I was given no treatment. That was to cause me tremendous problems later."
Nearly 10 years later, Trisha had a severe breakdown. Looking back, she can trace the path to her sense of utter despair. First, she discovered her ex-husband was gay and, in 1989, had died of AIDS (luckily she tested negative). She then found out her second husband was having an affair. They split up, leaving Trisha to bring up their two daughters, Billie and Madi. During that time she was, by her own admission, "a career-driven monster".
"I carried on working, but it was all too much for me," she admits. "I was absolutely shattered. I was incapable of making even the simplest decisions. I just thought I was like everyone else who was going through a stressful time. In the end I was so exhausted I took a massive alcohol and medication overdose."
Trisha was hospitalised and referred to a psychiatric unit, where she received intense psychotherapy. "Being in that hospital was the lowest point of my life," she says. "I was on suicide watch and the authorities were threatening to take my children away. Fortunately, they didn't."
Her traumatic experience proved a turning point. She quit her job to concentrate on bringing up her daughters and having therapy. She also started working for the mental health services in Australia, which is how she met and fell in love with Peter Gianfrancesco, who was head of Australian Mind. They married in 1998 and moved to England when Trisha was offered the chance to replace Vanessa Feltz on a morning chat show.
It was the start of the good life for Trisha. She now lives with her family in Norwich, but she takes nothing for granted. "My depression hasn't gone away, but I've learned to live with it," she says. "I'm no longer a victim of the illness. Instead, I'm a survivor.
"Exercise and relaxation help a lot," she says. "I have a personal trainer and I also go running with my two dogs. I don't believe much in diets, but I eat natural foods like wholemeal bread, fruit and salads. Every little helps."
There's one person who has helped Trisha more than anyone. "I have great family and friends," she says. "But I've got to credit most of my recovery to my wonderful husband, Peter. I still can't believe how much in love with him I am."