Depression is when you feel persistently sad and unhappy for a long period of time and affects your everyday life. Depression can sometimes be viewed as trivial and not a real health condition - this is not true. Depression is a real illness with real symptoms and is a very common mental health condition. The severity of depression is usually categorised into the following:
• Mild depression – has some impact on your daily life
• Moderate depression – has a significant impact on your daily life
• Severe depression – makes it almost impossible to get through daily life
There are several types of depression and the condition itself can be a resulting symptom of a mental illness such as bipolar disorder.
• Postnatal depression – women can develop depression a short time after giving birth; this is known as postnatal depression and it is treated in a similar way to other types of depression - with talking therapies and antidepressant medicines
• Seasonal affective disorder – a type of depression with a seasonal pattern, usually related to winter. Coincidentally, this condition is also known as “winter depression”
• Bipolar disorder – with bipolar disorder there are spells of both depression and excessively high mood (mania); the depressive symptoms are similar to that of clinical depression.
SIGNS AND SYMPTOMS OF DEPRESSION:
• Avoiding contact with family and friends
• Avoiding social events and neglecting hobbies
• Not doing as well at work
• Continuous low mood, feeling upset and tearful
• Feeling hopeless and low self-esteem
• Lack of motivation or interest in things
• Feeling irritable and intolerant of other people
• Thoughts of self-harm or suicide
• Changes in appetite or weight loss/gain
• Lack of energy, muscle aches and pains
• Disturbed sleep patterns and low sex drive
SOME CAUSES OF DEPRESSION: Stressful events 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. Personality 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. Family history 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. Giving birth 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. Loneliness Becoming cut off from your family and friends can increase your risk of depression. Alcohol and drugs When life is getting them down, some people try to cope by drinking too much alcohol or taking drugs. This can result in a spiral 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. Illness You may have a higher risk of depression if you have a longstanding or lifethreatening illness, such as coronary heart disease or cancer. 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 numerous symptoms including extreme tiredness, and a lack of interest in sex (loss of libido), which can in turn lead to depression.
TREATMENT Treatment for depression usually involves a combination of self-help, talking therapies and medicines. The treatment that will be recommended will be based on the type of depression you have.
Mild depression If you have mild depression, the following treatments may be recommended. Wait and see If your GP diagnoses you with mild depression, they may suggest waiting a short time to see if it gets better by itself. In this case, you’ll be seen again by your GP after 2 weeks to monitor your progress. This is known as watchful waiting. Exercise There’s evidence that exercise can help depression, and it’s one of the main treatments for mild depression. You may be referred to a group exercise class. Self-help Talking through your feelings can be helpful. You could talk to a friend or relative, or you could ask your GP or local psychological therapies service if there are any self-help groups for people with depression in your area. You could try self-help books or online cognitive behavioural therapy (CBT). Mental health apps You can also find mental health apps and tools in the NHS apps library.
Mild to moderate depression If you have mild to moderate depression that isn’t improving, or moderate depression, you may find a talking therapy helpful. There are different types of talking therapies for depression, including cognitive behavioural therapy (CBT) and counselling. Your GP can refer you for talking treatment, or you can refer yourself directly to a psychological therapies service.
Moderate to severe depression If you have moderate to severe depression, the following treatments may be recommended. Antidepressants Antidepressants are tablets that treat the symptoms of depression. There are almost 30 different types of antidepressant. They have to be prescribed by a doctor, usually for depression that’s moderate or severe. Combination therapy Your GP may recommend that you take a course of antidepressants plus talking therapy, particularly if your depression is quite severe. A combination of an antidepressant and CBT usually works better than having just one of these treatments. Mental health teams If you have severe depression, you may be referred to a mental health team made up of psychologists, psychiatrists, specialist nurses and occupational therapists. These teams often provide intensive specialist talking treatments as well as prescribed medication.
TALKING TREATMENTS Cognitive behavioural therapy (CBT) 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 it’s been shown to help. You normally have a short course of sessions, usually 6 to 8 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.
CBT Online CBT is a type of CBT delivered through a computer, rather than face-to-face with a therapist. You’ll have a series of weekly sessions and should receive support from a healthcare professional. Interpersonal therapy (IPT) Interpersonal therapy (IPT) focuses on your relationships with others and 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. Psychodynamic psychotherapy 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.
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 6 to 12 sessions that last an hour. You talk in confidence to a counsellor, who supports you and offers practical advice. It’s ideal for people who are generally healthy but need help coping with a current crisis, such as anger, relationship issues, bereavement, redundancy, infertility or a serious illness.
See your GP for more information about accessing NHS talking treatments. They can refer you for local talking treatments for depression. 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 psychological therapies service.
SIGNPOSTING FOR DEPRESSION
www.breathingspace.scot A free, confidential phone and web based service for people in Scotland experiencing low mood, depression or anxiety.
depressionuk.org A self-help organisation made up of individuals and local groups.
Mental Health Foundation
mentalhealth.org.uk Provides information and support for anyone with mental health problems or learning disabilities.
mind.org.uk Promotes the views and needs of people with mental health problems.
nhs.uk Provides a wealth of information on treatments for depression available through the NHS.
samaritans.org A 24-hour telephone helpline for people struggling to cope.
SAMH - Scottish Association for Mental Health
www.samh.org.uk Provides a range of mental health support and services.