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Depression

Depression is more than simply feeling unhappy or fed up for a few days. We all go through spells of feeling down, but when you're depressed, you feel persistently sad for weeks or months rather than just a few days. Some people still think that depression is trivial and not a genuine health condition. They're wrong. Depression is a real illness with real symptoms, and it's not 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 can make a full recovery from depression. How to tell if you have depression.

Depression affects people in many different ways and can cause a wide variety of symptoms. They range from lasting feelings of sadness and hopelessness to losing interest in the things you used to enjoy and feeling very tearful or anxious. There can be physical symptoms too such as feeling constantly tired, sleeping badly, having no appetite or sex drive and complaining of various aches and pains. The severity of the symptoms can vary. At its mildest, you may simply feel persistently low in spirit, while at its most severe, depression can make you feel suicidal and that life is no longer worth living. For a more detailed list, read more about the symptoms of depression. When to see a doctor

It's important to seek help from your GP if you think you may be depressed. If you've been feeling low for more than a few days, take this short test to find out if you're 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 is a trigger for depression. Life-changing events, such as bereavement, or losing your job or even having a baby, can bring it on. People with a family history of depression are also more likely to experience depression themselves. But you can also become depressed for no obvious reason. Find out more about the causes of depression. Depression is quite common and affects about one in ten of us at some point. It affects men and women, young and old. Depression can also strike children. Studies have shown that about 4% of children aged 5-16 in the UK are affected by depression. Treatment

Treatment for depression involves either medication or talking treatments, or usually a combination of the two. The kind of treatment that your doctor recommends, will be based on the type of depression you have. Read more about the treatment of depression. Living with depression

Many people with depression benefit by making lifestyle changes such as getting more exercise, cutting down on alcohol and eating more healthily. Self-help measures such as reading a self-help book or joining a support group are also worthwhile. Find out more about how self help and improving your lifestyle can help you beat depression.

Symptoms of depression

The symptoms of depression can be complex and vary widely between people. But as a general rule, if you are 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 every one listed below. If you experience some of these symptoms for most of the day, every day for more than two weeks, you should seek help from your GP. Psychological symptoms include: continuous low mood or sadness feeling hopeless and helpless having low self-esteem feeling tearful feeling guilt-ridden feeling irritable and intolerant of others having no motivation or interest in things finding it difficult to make decisions not getting any enjoyment out of life having suicidal thoughts or thoughts of harming yourself feeling anxious or worried Physical symptoms include: Moving or speeking more slowly than usual change in appetite or weight (usually decreased, but sometimes increased) constipation unexplained aches and pains lack of energy or lack of interest in sex changes to your menstrual cycle disturbed sleep (for example, finding it hard to fall asleep at night or waking up very early in the morning) Social symptoms include: not doing well at work taking part in fewer social activities and avoiding contact with friends neglecting your hobbies and interests having difficulties in your home and family life Depression can come on gradually and so it can be difficult to notice that something is wrong. Many people continue to try to cope with their symptoms without realising they are ill. It can take a friend or family member to suggest that something is wrong. Doctors describe depression by how serious it is 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. A few people with severe depression may have psychotic symptoms. Grief and depression

It can be hard 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 loss and sadness come and go, but they're still able to enjoy things and look forward to the future. In contrast, people who are depressed have a constant feeling of sadness. They don't enjoy anything and find it hard to be positive about the future. Read more about grief and how it differs from depression. Other types of depression

There are different types of depression, and some conditions where depression may be one of the symptoms. These include: Postnatal depression. Some women develop depression after having a baby. Postnatal depression is treated in similar ways to other forms of depression, with talking therapies and antidepressant medicines. Bipolar disorder is also known as 'manic depression'. It's where there are spells of depression and also of excessively high mood (mania). The depression symptoms are similar to clinical depression, but the bouts of mania can include harmful behaviour such as gambling, going on spending sprees and having unsafe sex. Seasonal affective disorder (SAD). Also known as 'winter depression', SAD is a type of depression that has a seasonal pattern usually related to winter.

Causes

There is no single cause of depression, you can develop it for different reasons. Depression has many different triggers. For some, an upsetting or stressful life event, such as bereavement, divorce, illness, redundancy and job or money worries, can be the cause. Often, different causes combine to trigger depression. For example, you may feel low after an illness and then experience a traumatic event, such as 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, so you stop seeing friends and family, and you may start drinking more. All of this can make you feel even worse and trigger depression. Some studies have also suggested you're more likely to get depression as you get older and that it's more common if you live in difficult social and economic circumstances. Stressful events

Most people take time to come to terms with stressful events, such as bereavement or a relationship breakdown. When these stressful events happen, you have a higher risk of becoming depressed if you stop seeing your friends and family and you try to deal with your problems on your own. Illness

You may have a higher risk of depression if you have a long standing or life-threatening 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. Even 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 loss of interest in sex, which can in turn lead to depression. 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 due to the genes you've inherited from your parents, or because of your personality or early life experiences. Family history

If someone else in your family, such as a parent or sister or brother, has suffered from depression in the past, then it's more likely that you will too. 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

Some people try to cope when life is getting them down by drinking too much alcohol or taking drugs. This can result in a spiral of depression. Cannabis helps you relax, but there is evidence that, especially in teenagers, it can bring on depression. And don't be tempted to drown your sorrows with a drink. Alcohol actually makes depression worse.

Diagnosing depression

t's really important to see your GP if you think you have depression. Sometimes when people are depressed, they find it hard to imagine that treatment can actually help. But, the sooner you seek treatment, the sooner your depression will lift. There are no physical tests for depression, though your GP may examine you and do some blood or urine tests to rule out other conditions that have similar symptoms, such as underactive thyroid. The main way in which your GP will tell if you have depression is by asking you lots of questions about your general health and how the way you are feeling is affecting you mentally and physically. Try to be as open as you can be with the doctor. Describing your symptoms and how they are affecting you will really help your GP understand if you have depression and how severe it is. Read more about the symptoms of depression. Any discussion you have with your GP about your depression will be confidential. Your GP will only ever break this rule if there's a significant risk of harm to either yourself or to others, and if informing a family member or carer would reduce that risk.

Treating depression

Treatment for depression usually involves a combination of medicines, talking therapies and self help. The kind of treatment that your doctor recommends, will be based on the type of depression you have.

Treatment Overview

Wait and see If you're diagnosed with mild depression, your depression may improve by itself. In this case, you'll simply be seen again by your GP after two weeks to monitor your progress. This is known as watchful waiting. Exercise Exercise has been proven to help depression, and is one of the main treatments if you have mild depression. Your GP may refer you to a qualified fitness trainer for an exercise scheme or you can find out more about starting exercise here. Read more about exercise for depression. Self help groups Talking through your feelings can be helpful. It can be either to a friend or relative, or you can ask your GP to suggest a local self-help group. Find out more about depression support groups. Your GP may also recommend self-help books and online cognitive behavioural therapy (CBT). Talking therapy If you have mild depression that isn't improving, or you have moderate depression, your GP may recommend a talking treatment. There are different types of talking therapy for depression including cognitive behavioural therapy (CBT) and counselling. Your GP can refer you for talking treatment or, in some parts of the country, you might be able to refer yourself. Read more below in Talking treatments. Antidepressants Antidepressants are tablets that treat the symptoms of depression. There are almost 30 different kinds of antidepressant They have to be prescribed by a doctor, usually for depression that is moderate or severe. Read more below in Antidepressants. 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. Read more below in Antidepressants. 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.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) helps 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 active to challenge feelings hopeless. CBT is available on the NHS for people with depression or any other mental health problem that it has been shown to help. You normally have a short course of sessions, usually six to eight sessions, over 10-12 weeks on a one-to-one basis with a counsellor trained in CBT. In some cases, you may be offered group CBT. Read more about CBT. Online CBT Computerised CBT is a form of CBT that works through a computer screen, rather than face to face with a therapist. It's delivered in a series of weekly sessions and should be supported by a healthcare professional. For instance, it's 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 here. Interpersonal therapy (IPT) IPT focuses on your relationships with other people 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. Counselling Counselling is a form of therapy that helps you think about the problems you are experiencing in your life to find new ways of dealing with them. Counsellors support you in finding solutions to problems, but do not 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. The counsellor supports you and offers practical advice. Counselling is ideal for people who are basically healthy but need help coping with a current crisis, such as anger, relationship issues, bereavement, redundancy, infertility or the onset of a serious illness. Getting help Your first port of call should be your GP, who can refer you for NHS talking treatments for depression available locally. 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.

Antidepressants

Antidepressants are medicines that treat the symptoms of depression. There are almost 30 different kinds of antidepressant available. 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 see how well they are working. If they are 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 bouts 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 be prepared to get some withdrawal symptoms if you stop taking them suddenly or you miss a dose. Selective serotonin reuptake inhibitors (SSRIs) 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 Seroxat (paroxetine), Prozac (fluoxetine) and Cipramil (citalopram). 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. They can, however, cause nausea and headaches, as well as dry mouth and problems having sex. However, all these negative effects usually improve over time. Some SSRIs aren't suitable for children under the age of 18. 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. Tricyclic antidepressants (TCAs) This group of antidepressants is used to treat moderate to severe depression. TCAs, which includes Dosulepin (dothiepin), Imipramil (imipramine) 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 are taking TCAs because it can cause your heart to beat rapidly. Side effects of TCAs, which vary from person to person, may include dry mouth, blurred vision, constipation, problems passing urine, sweating, light-headedness and excessive drowsiness. The side effects usually ease after 7 to 10 days, as your body gets used to the medication. Monoamine oxidase inhibitors (MAOIs) MAOIs, such as Nardine (phenelzine sulphate) are sometimes used to treat depression. If you are taking MAOIs, you need to avoid food that contains the chemical tyramine, such as cheese, pickled meat or fish. Your GP will give you a more detailed list of food and drink to avoid. You should also avoid drinking any alcohol or fermented liquids (even if they are alcohol free). Steer clear of smoking cannabis if you are taking MAOIs because it may affect the way these medicines work, and it's not clear what effect it may have on you. Common side effects of MAOIs include blurred vision, dizziness, drowsiness, increased appetite, nausea, restlessness, shaking or trembling, and difficulty sleeping. The dietary restrictions and potential for side effects mean that MAOIs are used very rarely, and are normally only prescribed when other treatments have not been effective. Other antidepressants New antidepressants, such as Effexor (venlafaxine) and Zispin Soltab (mirtazapine), work in a slightly different way from SSRIs and TCAs. These drugs are known as SNRIs (serotonin-norepinephrine reuptake inhibitors). 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, though they're not routinely prescribed as they can lead to a rise in blood pressure. Withdrawal symptoms Antidepressants are not addictive in the same way that illegal drugs and cigarettes are, but when you stop taking them you may have some withdrawal symptoms, including: upset stomach flu-like symptoms anxiety dizziness vivid dreams at night sensations in the body that feel like electric shocks In most cases these are quite mild, but occasionally they can be quite severe. They seem to be most likely to occur with paroxetine (Seroxat) and venlafaxine (Effexor). Common questions about antidepressants answered: How long does it take for antidepressants to work? Can I drink alcohol if I'm taking antidepressants? How should antidepressants be stopped?

St John's wort

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. Taking St John's wort with other medications, such as anticonvulsants, anticoagulants, antidepressants and the contraceptive pill, can also cause serious problems. You shouldn't take St John's wort if you are pregnant or breastfeeding, as we don't know for sure that it's safe. Electric shock treatment Sometimes electroconvulsive therapy (ECT) may be recommended if you have severe depression and other treatments including antidepressants haven't worked. During ECT, you'll first be given an anaesthetic and medication to relax your muscles. Then you'll receive an electrical 'shock' to your brain through electrodes placed on your head. You may be given a series of ECT sessions. It is usually given twice a week for 3-6 weeks. For most people, ECT is good for relieving severe depression, but the beneficial effect tends to wear off after several months. Some people get unpleasant side effects, including short-term headaches, memory problems, nausea and muscle aches. Lithium If you've tried several different antidepressants and had no improvement, your doctor may offer you a type of medication called lithium, in addition to your current treatment. There are two types of lithium: lithium carbonate and lithium citrate. Both are usually effective, but if you are taking one that works for you, it's best not to change. If this level of lithium in your blood becomes too high, it can become toxic. So, you'll need blood tests every three months to check your lithium levels while you're on it. You'll also need to avoid eating a low-salt diet because this can also cause the lithium to become toxic. Ask your GP for advice about your diet.

Living with depression

There are some key steps you can take to lift your mood and help your recovery from depression. Take your medication

It is important to take your medication as prescribed, even if you start to feel better. If you stop your medication too soon, you could have a relapse of your depression. If you have any questions or concerns about the medication you're taking, talk to your doctor or pharmacist. It may help to read the information leaflet that comes with your medication to find out about possible interactions with other drugs or supplements. Check with your doctor first if you plan to take any over-the-counter remedies, such as painkillers, or any nutritional supplements. These can sometimes interfere with antidepressants. Exercise and diet

Exercise and a healthy diet can make a tremendous difference to how quickly you recover from depression. And they will both improve your general health, too. Research suggests that exercise can be as effective as antidepressants at reducing depression symptoms. Being physically active lifts your mood, reduces stress and anxiety, boosts the release of endorphins (your body’s feel-good chemicals) and improves your self-esteem. Read more about exercise for depression. It also helps your mood to have a healthy diet. In fact, eating healthily seems to be just as important for maintaining your mental health as it is for preventing physical health problems.

Reference: NHS UK

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