Depression
Answers to frequently asked questions about depression. For service users, families, friends or anyone with concerns.
What is it?
Most of us have times when we feel miserable, dissatisfied with our lives or feel bad about ourselves. Mild depression doesn't stop you leading your normal life, but things feel more of a struggle and less worthwhile.
Depression can be a normal part of grieving when somebody dies, a relationship ends or your life changes in some way. Sometimes there is no obvious reason and depression can come out of the blue. It affects your ability to think, eat and sleep, as well as your mood. Severe depression can stop you living your life the way you want to. You may feel total despair or suicidal.
Doctors may say you have 'clinical depression' is when these negative and thoughts carry on for a long time, or go beyond normal changes of mood.
Depression is common. According to the World Health Organisation 340 million people have depression worldwide. In the UK it is one of the commonest problems people bring to their GP. Studies estimate that from 7% to 12% of men will have diagnosable depression in their lifetime. The figure is from 20% to 25% for women. Depression is more common in older people, but it can also affect young people. About 5% of children are believed to have clinical depression or an anxiety disorder.
The experience of depression and the symptoms vary from person, but may include:
- Feeling sad/despairing/angry/anxious/irritable - for all or most of every day. You may feel worse in the morning and slightly better in the evening
- Feeling worthless and guilty, being preoccupied with negative thoughts and seeing the worst in everything
- No longer enjoying activities that used to give pleasure -such as eating, reading, sport, television, sex, listening to music
- Loss of appetite or over-eating, weight loss or gain
- Sleep problems: - you may have difficulty getting to sleep at bedtime, or waking in the early hours and being unable to sleep again, or difficulty getting up in the morning
- Feeling tired or lacking energy every day or nearly every day
- Feeling agitated, fidgety, restless, unable to relax
- Having problems concentrating, making decisions and/or remembering things
- Regularly having thoughts of death (not just a general fear of dying) or suicide
Depression feeds on itself as you get depressed about being depressed. You may feel that nothing can help you, but depression can be treated, and people usually recover. Depression and anxiety often go together, but anxiety often disappears when the depression is treated.
What causes it?
Social, emotional and physical factors all play their part in depression. Many people know exactly why they are feeling depressed -it could be a physical illness, financial or relationship problems or difficulties at work. A loved one may have died, or there may be life changes to deal with such as a new baby or moving to a new area. Other people have no idea why they feel depressed.
Scientists have found alterations in the brain's structure and the way it works when somebody is clinically depressed. This suggests there may have be a biological basis. Depression runs in families to some extent. If a parent has depression, it is more likely that their children will also be depressed at some point in their lives. It is not clear how much this is due to genetics or to do with their environment or upbringing.
Where do I go for help?
If you have had five or more of the symptoms listed above, for at least two weeks, you should see your family doctor (GP). Depression can be caused by a number of other conditions, or may even be a side-effect of medication you are taking.
It can be hard to seek help when you feel depressed, but deciding to do something about your depression is the most important step you can take. Depression can be treated effectively by medication or talking therapies or a combination of both. People also find self help and support groups useful once they are over the worst.(link?).
Your GP will talk to you about your feelings and symptoms. They may also ask about events in your life. To get another perspective, they may ask if they can speak to your family members or a close friend.
Your GP will usually treat you themselves. Or, you may be referred to a counsellor, a psychologist, psychiatrist or a Community Psychiatric Nurse (CPN). If you are severely depressed you may be admitted to the psychiatric ward of a hospital.
Many people with depression struggle on alone, without any professional help, and although it can get better on its own, depression can cause a lot of disruption in your relationships and home life.
What is the treatment for depression?
When you are severely depressed you may find that drug treatment is the only help available on the NHS. Or you may be offered a combination of drugs and talking therapies, usually if your depression has not responded to treatment. Individuals find different things helpful. Antidepressant drugs are often useful for getting you through the worst - and may help for atypical depression (when people experience weight gain, or are oversleeping as part of their depression), but they don't look at the cause or the root of depression. Talking therapies can help people who want to understand themselves their depression better.
Medication
Antidepressants are the most common drug treatments for depression. They aim to restore chemicals in the brain to a healthy level. This usually involves increasing levels of noradrenaline and serotonin (two chemicals found in the brain that affect mood).
Antidepressants fall into three main categories:
Tricyclic antidepressants (or TCAs), such as imipramine, clomipramine, amitriptyline. These were one of the first drug treatments for depression and are still used widely today. They have a wide-ranging action in the brain; as well as lifting mood, they cause drowsiness. This can be useful for depressed people who also have sleep problems, but is an unwanted effect for others. Other side effects of these older tricyclics include weight gain, dizziness and sexual problems (impotence in men or a reduced desire to have sex in men and women). They also affect the heart and circulatory system, so are unsuitable for people with heart problems.
Monoamine oxidase inhibitors (or MAOIs) such as moclobemide. These drugs act to block the action of a chemical called monoamine oxidase, which normally breaks down noradrenaline in the brain. People on older types of MAOI (e.g. phenelzine, trancypromine) have to watch their diet carefully - foods like cheese can interfere with their medication. Moclobemide, a newer and safer type of MAOI, does not have this particular side-effect - and has fewer side-effects generally - but there are still certain foods and drugs that people taking moclobemide should avoid.
Selective reuptake inhibitors Serotonin-specific reuptake inhibitors (SSRIs) (will include a definition in glossary of these) such as Citalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline are a newer type of anti-depressants with a slightly different action to tricyclics and different side effects. These can include feeling or being sick, headache, upset stomach, diarrhoea, constipation, restlessness, anxiety, weight loss and sexual problems (impotence in men or a reduced desire to have sex in both men and women). Other reuptake inhibitors include the noradrenaline reuptake inhibitors (e.g.Reboxetine) and the serotonin/ noradrenaline reuptake inhibitors (e.g.Venlafaxine).
Want to know more?
see Treatment of depression
Antidepressants usually take between two and eight weeks to work - so instant relief is not possible with these drugs. If, after two months, your treatment still doesn't seem to be helping or you are getting side-effects, talk to your doctor before deciding to stop taking it. There are many different treatment options available - he or she may suggest an alternative drug, talking therapies, or for severe depression ECT may be suggested (see below).
Other physical treatments given for depression include:
- Mood stabilisers such as Lithium, Carbamazapine. Although they are not antidepressants, these drugs are sometimes used to treat depression when other drugs have failed to work.
- Electroconvulsive therapy (ECT) - is sometimes given to severely depressed people when anti-depressant drugs have failed to work. It is not known why or how it sometimes works for depression.
- People with anxiety and depression may also be prescribed tranquillisers such as Lorazepam for a short course, usually only about two weeks.
Talking therapies
Talking therapies like counselling, psychotherapy or Cognitive Behaviour Therapy (CBT) can help mild to moderate depression. By exploring and understanding yourself and your depression, you can sometimes find ways of coping. Spending time with somebody who listens attentively to what you have to say can be therapeutic in itself.
You may find talking therapies most useful when a severe depression has passed; it can also help you notice and take action if you are getting depressed again.
Counselling looks at what you are facing now, and can help people adjust to life events, illnesess or losses. CBT aims to help you change negative thought patterns and psychotherapy helps you to find and explore the root cause of your depression.
A range of talking therapies may be available on the NHS in your area, but they are in short supply, and what is available varies across the country. If you are interested ask your GP (they may have a counsellor working in their surgery), psychiatrist or nurse. Many voluntary organisations and self help groups offer counselling and support for people with depression, free of charge or low cost.
What can I do to help myself?
What you can do depends very much on how depressed you are feeling. If you are very low you may be unable to act, and may need professional help to get you to a point where you can help yourself. Try anything which makes you feel better about yourself. This might include:
Talking about how you feel: Telling your family and friends how you feel is important -pretending you are alright can be the hardest part of their illness. Meeting other depressed people and releasing pent up feelings can help you feel less isolated.
Looking after yourself physically: this may involve regular exercise such as running or dancing, cutting down on alcohol and tobacco, eating well and noticing if you are exhausted and need a break . Exercise is especially good as it releases mood improving chemicals - endorphins - into the brain.
Reducing stress and learning how to relax and take time for yourself: Try to reduce the stress in your life, and learn to recognise when you are becoming stressed. Learning and practising relaxation techniques or yoga can be helpful. Some people find alternative therapies like massage, aromatherapy or meditation relaxing and pleasurable.
Once your depression has lifted it is important to continue looking after your mental health. Keeping a diary can be helpful; it's a useful way of focusing on how you feel and can help you recognize if an episode of depression is on its way. Be aware of what might trigger your depression. Bear in mind that It is often people who know you very well who can spot warning signs of depression first. If you get help and support at early, you may avoid a crisis.
Other steps you may be able to take when your depression has lifted include:
Inform yourself as best you can: use the Internet, local libraries and your doctor to find out about your condition and your medication. Give your family and friends may information on depression to read - it may make it easier for them to appreciate what you are going through. Also, find out what activities are available to you in your local area. Even if you don't feel like taking part in them now, you may do in the future.
Find out what benefits you're entitled to: especially if your depression means you need time off work. The Citizen's Advice Bureau, Social Services and Legal Advice Centres may be useful places for you to find out what you're entitled to. Depression is an illness like any other - your employers may be legally obliged to provide sick pay for long term illnesses.
Want to know more?
Self Help and Support Groups
Depression Alliance - UK charity offering help to people with depression, run by sufferers themselves.
National Foundation For Depressive Illness - a US-based support network for people with depression.
The Samaritans - providing confidential emotional support to any person who is suicidal or despairing
Other pieces on emental-health.com
History - insight into history of approaches to depression.
Biology - referenced guide to diagnosis, biological techniques and findings
Treatment - referenced guide to approaches to treatment and the way they work.
Fastfacts - a quick guide to who gets it, how it's treated, and hot topics.
Links - to other resources
Personal accounts
Read others' experiences of depression
Masked depression - one sufferer's account of masked depression
Please email us with other questions you would like to see featured.
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