Depression

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Depression is a common mental disorder that causes people to experience depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration.

Depression is different from feeling down or sad. Unhappiness is something which everyone feels at one time or another, usually due to a particular cause. A person suffering from depression will experience intense emotions of anxiety, hopelessness, negativity and helplessness, and the feelings stay with them instead of going away.

Depression can happen to anyone. Many successful and famous people who seem to have everything going for them battle with this problem. Depression also affects people of every age.

Half of the people who have depression will only experience it once but for the other half it will happen again. The length of time that it takes to recover ranges from around six months to a year or more.

Living with depression is difficult for those who suffer from it and for their family, friends, and colleagues. It can be difficult to know if you are depressed and what you can do about it.

Signs and symptoms of depression

  • Tiredness and loss of energy.
  • Sadness that doesn’t go away. 
  • Loss of self-confidence and self-esteem. 
  • Difficulty concentrating. 
  • Not being able to enjoy things that are usually pleasurable or interesting. 
  • Feeling anxious all the time. 
  • Avoiding other people, sometimes even your close friends. 
  • Feelings of helplessness and hopelessness. 
  • Sleeping problems - difficulties in getting off to sleep or waking up much earlier than usual.
  • Very strong feelings of guilt or worthlessness. 
  • Finding it hard to function at work/college/school. 
  • Loss of appetite. 
  • Loss of sex drive and/or sexual problems. 
  • Physical aches and pains. 
  • Thinking about suicide and death. 
  • Self-harm

If you experience four or more of these symptoms for most of the day - every day - for more than two weeks, you should seek help from your GP.

What causes depression?

Depression can happen suddenly as a result of physical illness, experiences dating back to childhood, unemployment, bereavement, family problems or other life-changing events.

Examples of chronic illnesses linked to depression include heart disease, back pain and cancer. Pituitary damage, a treatable condition which frequently follows head injuries, may also lead to depression.

Sometimes, there may be no clear reason for your depression but, whatever the original cause, identifying what may affect how you feel and the things that are likely to trigger depression is an important first step.

Types of depression

There are several types of depression, some of which are listed below.

Mild depression

Depression is described as mild when it has a limited negative effect on your daily life. For example, you may have difficulty concentrating at work or motivating yourself to do the things you normally enjoy.

Major depression

Major depression interferes with an individual’s daily life - with eating, sleeping and other everyday activities. Some people may experience only one episode but it is more common to experience several episodes in a lifetime. It can lead to hospital admission, if the person is so unwell they are at risk of harm to themselves.

Bi-polar disorder

The mood swings in bi-polar disorder can be extreme - from highs, where the individual feels extremely elated and indestructible, to lows, where they may experience complete despair, lethargy and suicidal feelings. Sometimes people have very severe symptoms where they cannot make sense of their world and do things that seem odd or illogical.

Post-natal depression

Many new mothers experience what are sometimes called 'baby blues' a few days after the birth. These feelings of anxiety and lack of confidence are very distressing but in most cases last only a couple of weeks. Post-natal depression is more intense and lasts longer. It can leave new mothers feeling completely overwhelmed, inadequate and unable to cope. They may have problems sleeping, panic attacks or an intense fear of dying.

They may also experience negative feelings towards their child. It affects one in ten mothers and usually begins two to three weeks after the birth.

Seasonal Affective Disorder (SAD)

SAD is associated with the start of winter and can last until spring when longer days bring more daylight. When it is mild, it is sometimes called ‘winter blues’. SAD can make the sufferer feel anxious, stressed and depressed. It may interfere with their moods and with their sleeping and eating patterns.

Taking control of your depression

Depression often makes you feel helpless. Taking action to make yourself feel more in control will have a positive effect, whether it’s going to see your GP for treatment, joining a gym, going for daily walks, or doing something that you are interested in or good at. If you don’t feel up to starting something new or joining a local group on your own, ask a friend to come with you.

There are many things you can do to help manage your symptoms and a wide range of treatments, both medical and non-medical, available through your GP.

The sections below should help you to work out what you could be doing yourself and what information or support you may want to ask your GP about.

How you see yourself

The way you think about yourself will affect your frame of mind and feelings of depression. It is common to have feelings of worthlessness or guilt with depression. Try to be aware of any negative thoughts you have about yourself and how they might be affecting how you see yourself and how you feel. If you can, try to think about how realistic these thoughts are and how you might change them into something more positive. You can speak to your GP about getting counselling or cognitive therapy.

Social networks

If you feel depressed it can be difficult to be sociable. Loneliness may make you feel worse, so it’s important to keep in touch with friends and family. Having people around you or groups that you are involved in will help to reduce feelings of isolation.

If you do not have many social networks you could find out about local community groups or befriending schemes from your local library or ask at your GP surgery.

Worries about work, money or a legal situation

Making sure that you do not feel overwhelmed by your work responsibilities is important because it gives you a sense of being in control. It’s important to make time for yourself to do things you want to do or to be with friends and family. 

  • If you're struggling to cope with work pressures and you have access to an occupational health department, you can speak to them about how you are feeling. They may be able to help you to review your work commitments or address specific issues that are affecting your work.
  • If you are having financial difficulties, speak to your local Citizens Advice Bureau about how you might get financial help.
  • National Debtline provides free, confidential and independent advice for people with debt problems. If you are out of work or want to change your job, your local job centre may offer support in finding work.

Both the Citizens Advice Bureau and your local social services department can also help you with advice about benefits if you are unemployed or unable to work because of depression. 

Where possible, you should always try to keep working. This is because people with depression often find that having something meaningful to do and a reason to get up in the morning is very helpful. Being with work colleagues, having a routine to the day, and the sense of achievement in getting a job done are all good for your mental health.

Close relationships

Problems with close personal relationships can have a devastating effect on how you feel about yourself and the world. If you are struggling to cope with a difficult relationship or your depression is causing problems in your relationship you can contact Relate on 0845 456 1310. Relate helps all couple, whether or not they are married, including couples in same sex relationships. Or you could speak to your GP or practice nurse about getting other forms of relationship counselling.

Find out more about counselling.

Physical activity

There is good evidence that exercise can lift your mood because it can take your mind off your depression as well as stimulate the release of endorphins in the brain. Endorphins are neurotransmitters produced in the pituitary gland in the brain that produce feelings of happiness.

If you have mild or moderate depression your GP might recommend you to join an exercise referral scheme. Ideally you should be aiming to take 50 minutes of exercise three to five times a week. You can break this time down into shorter periods to fit it into your everyday life.

If you want advice about what exercise you should be doing and how it might help your depression, speak to your GP or practice nurse.

Find out more about exercise and mental health.

Diet

Some studies have suggested a link between what you eat and depression, but there isn’t enough conclusive evidence to say whether or not it can definitely make a difference. There is some evidence that foods that are rich in some essential fatty acids found in oily fish, like mackerel, salmon, herring, sardines, kippers and fresh tuna can help to relieve depression.

Whether there is a direct link or not, eating healthily will help you generally feel better and give you more energy, especially if you are also exercising.

Find out more about diet and mental health.

Avoiding alcohol and drugs

Alcohol acts as a depressant on the brain. If you drink too much or too often, you are more likely to become depressed. If you are already suffering from depression, drinking alcohol can make you feel worse instead of better. With such a vicious circle it is best to drink moderately, if at all. Recreational drugs should also be avoided.

Find out more about alcohol problems.

Managing anxiety

Around half of those people who experience depression will also experience anxiety. Taking steps to manage your anxiety can help give you the mental space to begin to deal with your depression. Talking about what is making you anxious, as well as a healthy diet and exercising, will all help you to control your anxiety.

Some people, especially those with mild depression, find that relaxation techniques such as massage and yoga help them to manage their anxiety.

Find out more about managing anxiety.

Complementary medicine

There is some evidence that St John’s Wort can help with mild to moderate depression. However, this drug is known to interact with other substances so you need to get advice from a pharmacist or other health professional before taking it.

Find out more about complementary medicine.

Getting help

The first step in getting treatment will normally be to visit your GP practice. They will ask you a number of questions about how your depression is affecting you mentally and physically.

The first appointment can feel difficult so it might be helpful if you write down what you have been experiencing before you go. Make a note of any questions or worries you might have. Some people find it helpful to take a friend or family member.

It is important that you and your doctor agree how best to treat your problems.

Being as open as you can about your symptoms and how they are affecting you will really help. Your GP may suggest you see a specialist such as a mental health nurse, psychiatrist or psychologist.

For mild depression, medication is not recommended because the risks could outweigh the benefits. Your GP has guidelines for treating depression and these recommend 'watchful waiting' initially, to see if the depression goes away. Using some of the self-help techniques listed above can help and your GP surgery can offer you support.

Talking Therapies

Talking therapies such as cognitive behavioural therapy (CBT) and some forms of counselling and psychotherapy work well for depression, although you may have to wait to see a therapist on the NHS. You can pay to see someone privately and your GP may be able to recommend someone. Always check that any private therapist is registered with a professional body.

There are several different kinds of talking therapy. Your GP can advise you about which you might find most helpful.

  • Counselling gives people the chance to talk through everyday issues that may be causing depression and to develop strategies for resolving them.
  • Cognitive therapy (sometimes called cognitive behavioural therapy or CBT) addresses the way you think and how this can cause depression. It teaches you skills to identify patterns of behaviour and thinking that are causing you problems and change them. 
  • Psychotherapy can be more intensive than counselling although people and organisations often use these terms interchangeably. It often looks at how past experience may be affecting your life now, so it may involve delving deeply into early experiences and key relationships. This may take more time, although shorter more focused ways of doing this have also been developed.Interpersonal therapy focuses on how you relate and behave towards others. It helps you to build a better self-image and communicate more effectively with others.

    In many cases your GP will recommend anti-depressants, either on their own or in combination with talking therapies. Anti-depressants do work for many people but inevitably they do have side effects. You can discuss these with your GP.

    About medication

    Medication will not always be the first choice, especially if your depression is mild. There are a number of different types of antidepressants available. Your GP can explain which they believe is the best for you and why. What your doctor prescribes will depend on the type and severity of depression you have. If you experience problems from your medicine or have any concerns, speak to your GP.

    If one medication does not work you may be prescribed something else. However it takes a few weeks before your medicine starts to work so you need to allow enough time to see if it is going to be effective.

    It is important that you take the medicine for the length of time recommended by your GP. If you come off your medicine too soon (even if you feel better) this can lead to a relapse where the depression returns. As a rough guide, you will usually have to remain on treatment for at least six to nine months and in many cases it could be longer. You need to follow your GP’s advice when you are coming off your medicine as it can be harmful if this is done too quickly.

    Find out more about medication for mental health problems.


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