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Depression

Everything you need to know about living well with depression

  • Introduction
  • Types
  • Symptoms
  • Daily Living
  • Support
  • Glossary

Introduction

If you, or someone you know, are displaying depression symptoms, this guide may help you to understand more about depression and how it affects a person’s life.

You may be wondering, what is depression? NRS Healthcare are here to help explain this, as well as explore depression symptoms, treatment for depression, what causes depression, and types of depression. We hope you find this guide useful, and that it raises awareness of how to get help for depression.

Introduction

What is depression?

Depression is a mental health condition. Depression causes mood issues, in particular extreme low mood, often accompanied by a range of other mental and physical symptoms that affect a person’s daily life and how much they enjoy it. It is more than just ‘feeling down’. Everyone feels down from time to time, but not everybody has depression.

People of all ages can develop depression but some people are more likely than others to have the condition. Some people recover from their depression, whereas others may experience depression for long periods, or multiple times.

Some people develop depression symptoms as a result of a difficult time in their life, such as experiencing trauma or as a part of grief. However, others do not know why their depression began or understand the causes of depression.

Depression is really common, but it is difficult to say how many people are living with depression symptoms in the UK. Many people do not seek help for depression, so remain unreported. Some people do not realise they have depression. The condition affects males and females, but depression in men is receiving a lot of media coverage currently, due to the high rate of male suicides. Suicide is the leading cause of death amongst young people aged 20-34 and the leading cause of death for men under 50 in the UK. Suicide is often linked to depression, although suicide is a complex issue and not solely an action of someone who is depressed. There are different types of depression and a variety of possible causes of depression which we explore later in more detail.

There are a variety of depression treatment options available which may include medications, psychological therapies, self-help and alternative therapies.

To find out more about depression, visit the Mental Health Foundation website.

What causes depression?

There are a multitude of factors that influence the causes of depression for some people and not others. Depression symptoms may take time to develop and get worse over time, whilst depression triggers are often different for different people, and may include:

• Things that happened to you as a child

• Experiences you’ve had as an adult

• Difficulties or worries in life e.g. money problems/debt, problems at work/being out of work, loneliness, housing problems

Stress

• Having a chronic health condition such as coronary heart disease, chronic kidney disease, or COPD

• Other medical conditions such as anaemia and thyroid problems

• Having a disability

• Loneliness

• Other mental health problems

• Drug abuse

• Drug side effects

• Alcohol abuse

• Upbringing

Genetics

• Hormones

• Personality

• Giving birth

• Unhealthy lifestyle

• Winter / lack of daylight (in Seasonal Affective Disorder – see Types of Depression for more information)

Research suggests that multiple negative experiences may be more likely to lead to depression rather than one big event or trauma.

Scientists are learning more and more about the biological causes of depression and have found that genes may play a part in how likely a person is to develop depression. They know that certain areas of the brain are responsible for mood regulation and that chemicals in the brain and body may be involved in depression. They believe that stress may cause depression. They have also found that many neurotransmitters such as serotonin, dopamine and glutamate may cause depression, but the way these chemicals work is still being researched. There is some evidence that the gut and how effectively it functions is related to depression symptoms, and serotonin is found predominantly in the gut.

Psychological theories suggest various causes of depression, from Freudian explanations involving conflict between the ‘id’ and the ‘ego’, to cognitive approaches that suggest negative thought processes affect the way a person sees themselves and events that happen in their lives. These psychological theories underpin psychological treatments for depression – read more about depression treatment.

For more information on what causes depression, visit the Rethink website.

Did you know... "Depression is a mental health condition that causes long spells of despair, unpleasant physical symptoms and which affects daily life"

Types of Depression

Read on to find out more about the types of depression a person may experience.

Depression comes in various forms and everyone experiences it differently. Generally, ‘clinical depression’ is the term used by doctors when they diagnose you with the condition but, depending on the circumstances or possible causes of depression in each case, and the other symptoms a person is experiencing, a doctor may suggest you have a different type of depression. It may be important to understand the type of depression you have, so that you can ensure you are getting the right help for depression.

Introduction

Types of depression include:

Clinical depression – a general type of depression that isn’t associated with any of the specific types below. It may come on suddenly or gradually and may be caused by a variety of factors or one big life event. It may also occur as part of a grieving process. Some people have depression multiple times, whilst others may just have it once and recover.

Postnatal depression (PND) – this affects women who have had a baby and the condition may come on immediately after the birth or sometime after, when the child is older. It is extremely common, with 1 in 10 women reported to experience this. There are multiple factors that make a woman more likely to experience postnatal depression, such as a traumatic birth or difficult pregnancy, a baby who is poorly as a newborn, being unable to breastfeed, and so on. Having a baby is often a stressful time. Other factors that may play a role in PND include: lack of sleep, parenting anxiety, issues with feeding, feelings of stress, lack of support network, loss of income, less social life, feelings of being out of control, etc. Men can also experience depression as new fathers. Read more about postnatal depression on the PANDAS website

Antenatal depression – occurring whilst a woman is carrying a child, this type of depression may be due to having ill health during pregnancy, feeling ill and tired, bodily changes, having little support, being in an abusive relationship, experiencing major life events whilst pregnant such as divorce or loss of a loved one, and having had previous miscarriages or baby loss. Read more about antenatal depression on the Tommy’s website.

Bipolar disorder / manic depression – a mental health condition in which a person experiences bouts of severe depression as well as times of feeling extremely high, with manic behaviours that may be risky or reckless. For more information on bipolar, visit the Bipolar UK website

Dysthymia – a continuous state of low mood over several years i.e. a consistent mild depression. Read this therapist’s account of a client with dysthymia.

Seasonal affective disorder (SAD) – many people experience depression symptoms during autumn and winter only, which is due to the lack of daylight during these seasons. This affects our brain activity, enhancing production of melatonin and decreasing the production of serotonin, and our circadian rhythm is also affected. Many people find these seasons difficult to deal with, but then find their depression improves as the spring approaches. For more information on SAD, visit the Age UK website.

If you have clinical depression, rather than one of the other depression types listed above, you may be given a diagnosis of mild, moderate or severe depression. This may help your doctor to decide the depression treatments that may work for you. The severity of your depression does not suggest that your depression is less serious than someone else’s, or not as important. Depression is a major thing for anyone, even if it is defined as ‘mild’. Your GP may use these terms, purely to define how much help they think you need at this time.

Did you know... "Depression may be caused by lots of environmental, biological and genetic factors that occur together, or may be triggered by one or two major life events."

Depression Symptoms

There are many symptoms of depression that people may experience. Read on to find out more about what these are.

Some people think that depression is feeling sad sometimes, or feeling a bit low. Depression does include these feelings, but to a severe extent. Everyone experiences times when they are in a bad mood, or when they are having an emotional time. This does not mean they are depressed. Depression involves mental, emotional, behavioural and physical symptoms that affect a person’s ability to live their life, and to have a sense of wellbeing.

Introduction

Many people may be experiencing depression symptoms and not realise that they are depressed.

Symptoms of depression include:

• Prolonged feelings of sadness

• Low self esteem

• Anxiety

• Negative thoughts

• Persistent tiredness or fatigue

• Being unable to sleep or stay asleep

• Feeling emotional and prone to crying

• Aches and pains

• Avoiding people

• Feeling hopeless

• Feeling like life is not worth living

• Feeling suicidal

• Having no appetite or overeating

• Difficulty concentrating

• Having a reduced sex drive

This list isn’t exhaustive and people may report lots of other symptoms that occur as part of their depression.

If you feel you are experiencing any of these symptoms, see your GP or talk to the mental health charity Mind.

Diagnosis of depression

If you think you, or someone you know, may be experiencing symptoms of depression such as those discussed here, it is best to visit a GP. There are no medical tests for depression, but your doctor may decide to run some blood tests, to rule out other health conditions that can cause mood related symptoms, such as anaemia or thyroid problems.

Your GP is likely to ask lots of questions to ascertain how likely it is that you have depression. If they do give you a depression diagnosis, they may discuss with you the depression treatments available, which we talk about in the next section.

Dealing with a diagnosis of depression can be difficult, even if you think you may have the condition. It’s important to remember that you have made a brave first step in recovery.

Find out what it’s like to be diagnosed with depression.

Did you know... "Depression symptoms may include, feelings of hopelessness and sadness, low self-esteem, crying, mood swings, anxiety, fatigue, physical pain, and low appetite."

Living with Depression

Living with depression can be difficult, but there are many depression treatments available and ways to live well with, and recover from, the condition.

Depression can be tough for those who are living with the condition and also the people around them. Depression can put a strain on all areas of life and may make it seem as though the difficult times will never end. In this section, we look at ways of coping with and improving depression symptoms, finding the right treatment for depression, exercise and healthy diet for depression, and ways to get depression support.

Introduction

Impact on daily living

Depression causes issues with everyday life such as:

Work – may become challenging because a person feels they need to hide their depression, or may experience outbursts of emotion at work. They may also begin to find their responsibilities too stressful

Family life – may become challenging as symptoms of depression may affect a person’s ability to enjoy being with family

Social life / hobbies – some people with depression may exclude themselves socially or have anxiety about social situations. Other people may be able to ‘put a brave face on’ when they are with friends, but feel very depressed when they are on their own. Some people find they have little interest in being with other people or doing anything socially

Exercise – some people find they have no interest in exercising or being active. Their depression may make them feel as though there is point in exercising. Others may not have the energy to exercise and symptoms of tiredness may cause them to feel less energetic

Eating – some people lose their appetite because physical symptoms of depression make them feel as though they cannot eat. Some people may find they eat too much, or eat unhealthy foods, because they do not have the energy to think about food, or prepare healthy food, or they don’t feel as though they are worth the effort. Depression is linked to obesity, with some obese people experiencing depression because of their weight, or becoming obese because they are depressed

Relationships – family life, friendships and relationships with colleagues can all be affected by depression. Depression symptoms can change the way a person feels about their life and the people around them, which can make relationships difficult. If you are experiencing depression and are finding your relationships difficult, you may wish to contact Relate

Health – if a person is depressed, their depression symptoms may make them feel ill, and some of the symptoms of depression, such as being unable to sleep properly or having little appetite, can lead a person to having poor immunity. This means they may be more likely to catch colds, viruses and other short-term health conditions. Sometimes, a person may have a chronic medical condition and be experiencing depression as a result of the challenges that their condition poses

Young people living with depression

People of all ages experience depression, affecting children and young adults too. Symptoms of depression in children are similar to those for adults. If you are a parent and concerned that your child may be depressed, here are some signs of depression to look out for:

• Tiredness, easily exhausted

• Irritable, sad or angry a lot of the time

• Having few interests – not wanting to do anything

• Physical symptoms – stomach aches, headaches, butterflies in the stomach

• Avoiding school, play, groups

• Bottling things up – not wanting to talk about things

There may be other reasons behind your child’s behaviour and they may not have depression. Anxiety amongst children and young people is also common. The best course of action is to take your child to see their GP.

For more information on depression in young people, visit the NHS website.

Young people and their families can find depression support from the charity Young Minds.

Depression treatment

If you, or someone you know, have been given a depression diagnosis, it can be an emotional time. You may feel relieved to have received a diagnosis and can now seek treatment, or you may feel anxious about the depression treatment you’ll have. All these feelings and emotions are normal. Your GP is likely to have recommended a choice of treatments for depression, which we cover here in detail.

Anti-depressant medication

A GP may recommend the use of antidepressant medication for someone who is depressed, particularly if they are considered to have moderate to severe depression that has gone on for some time. Antidepressants generally work by changing the levels of chemicals in the brain that are related to mood and emotion. Most commonly prescribed are selective serotonin re-uptake inhibitors (SSRIs), such as citalopram or fluoxetine. Very severe depression may require tricyclic antidepressants.

Antidepressants may take a little while to start working and the length of time you need to take them will be up to you and your GP to assess, according to how you are feeling. It’s likely you will need to take them for 6 months at least. It’s important to discuss with your GP before you stop taking your medication, as they will need to monitor and advise you on the best way to reduce your dosage before you stop completely. This is because withdrawal symptoms may occur.

The NHS also provides information about a range of other antidepressant medications.

Cognitive behavioural therapy (CBT)

CBT is a popular therapeutic treatment for depression, usually carried out between a person with depression (or other mental health condition) and a trained practitioner. It is based on the theory that the way we think affects how we feel and how we behave, and that by changing our thought processes, we can change our outlook and daily life. Many therapists use practical methods for breaking down negative thought patterns that may cause depression, such as written activities and workbooks. They are likely to challenge thoughts within a therapy session. Some people find this difficult at first. Not everyone finds CBT works to help them recover from depression, but lots of people find it helps them and they continue to use the techniques for positive thinking through the rest of their lives.

To find out more about if this depression treatment is suitable for you, visit the NHS website.

Mindfulness

Mindfulness is a meditative practice that encourage a person to live in the present moment and not get too wrapped up in their thoughts. It is proven to help change the way a person’s brain works, and some people with depression may find it useful. Mindfulness teaches us to be aware of the present moment and avoid pushing away thoughts and feelings. People who practice mindfulness often report that they feel less stressed, less anxious and happier. Mindfulness can be challenging, especially for people with low mood or depression, so it isn’t for everyone. For more information on mindfulness, visit the NHS website.

Counselling, talking therapy and other therapies

There are a range of options if you would like to use therapy as a depression treatment. Talking therapies and counselling services can help you to open up about problems, thoughts, fears, and feelings that you have kept internally for some time. A good therapist can help you explore your feelings in a safe environment, but talking therapies are often challenging and can bring up lots of emotions, memories and feelings.

There are many other therapy types according to what you want to achieve, what feelings and experiences you have had. Different people respond better to different treatments. To find out more about therapy depression treatments, visit the Mental Health Foundation website.

Depression diet

Depression can affect how a person feels about food and eating. Depression symptoms can include a loss of appetite, whilst some people overeat when they are depressed. A healthy, balanced diet can actually be a great depression help. Eating well gives our body the energy it needs to function. Many people with depression do not eat a healthy, balanced diet and this affects their energy levels, which may then cause them to feel more tired and, consequently, their moods may be negatively affected further. Similarly, dehydration can have an effect on mood, so drinking lots of water is important for someone experiencing depression.

For advice on eating a healthy diet for depression, visit the Mind website.

Many people take herbal, vitamin and mineral supplements for depression. St. John’s Wort is a well-known and effective solution for people with depression, but it must not be taken with other medications. Other supplements include vitamin D, 5-HTP, vitamin B and omega 3. Always speak to your GP before taking depression supplements of any sort.

Exercise for depression

Exercise can boost feel-good hormones called endorphins so it can be helpful for a person with depression to do some physical activity. Depression exercise doesn’t have to be anything fancy, it can simply be taking a walk every day, but it can help, especially if you have mild to moderate depression. However, for some people living with depression that is severe, even getting out of bed can be difficult, so taking up exercise can seem an impossible task.

For more information on exercise for depression download this Mental Health Foundation leaflet.

Depression and employment

People with depression are able to work but may find working difficult. Your employer has a duty to make reasonable adjustments if you need support for depression, for example, changes to your workload or working environment. It is up to you if you tell your employer about your depression. Mind offers advice about telling your employer you have depression.

If you are an employer and are concerned that one of your employees may have depression, read this information leaflet about providing depression support to staff.

Did you know... "There are many treatments for depression including psychological therapies and antidepressant medication."

Support for Depression

Remember, you are not alone!

We hope this guide has helped explain what depression is, what causes depression, the symptoms of depression, treatments for depression, and types of depression.

If you feel you need support for depression, there is a wealth of advice and information available online, through various charitable organisations and the NHS. If you have depression, you may find it useful to talk to other people who have depression. Here, we point you towards depression help and support groups and other online resources that offer further information and advice.

Introduction

Communities

Anxiety, Depression & Mental Health Support Group – a Facebook community for people across the world to share their experiences if they have anxiety or related mental health difficulties

Sane – a charity-run forum for people experiencing depression directly or who are affected by someone else’s depression, to share information, experiences, get informal advice and receive depression support

Resources

Get Self Help – a website full of practical, self-help resources such as worksheets, and vast amounts of information for people experiencing a wide range of issues such as anxiety, phobias, health anxiety, social anxiety and OCD

House of Light – support for antenatal and postnatal depression, including a helpline and information about these conditions

Mental Health Foundation – a charity supporting people with mental health and their families, as well as helping to understand mental health through research

Mind – the leading mental health charity, offering a wealth of advice and information online as well as an information helpline, online emergency help advice, workplace wellbeing advice, and details about lots of mental health conditions and treatment options

NHS – information on depression including treatments for depression, depression symptoms and tips for healthy living

Rethink – a charity supporting people with mental health problems and their families, including online information about depression, advice for carers and families, and lots of support options such as local groups and helplines

Samaritans – a charity providing 24 hours a day, 7 days a week telephone helpline support for people having emotional difficulties, mental health problems, suicidal thoughts, or any related problems

Sane – a charity providing lots of information on mental health conditions, a depression support helpline and an online community

See Me – a Scottish programme aiming to reduce the stigma of mental health problems, with lots of information relating to mental health, including depression, as well as sound advice

The Mix – a charity supporting young people under 25 years old with a variety of services including mental health, offering a confidential helpline, apps and expert advice on many topics including coping with depression and dealing with mental health issues

Time to Change – a charity providing information about mental health conditions such as depression, as well as an online quiz, myths and facts about mental health, advice on how to support someone you know with a mental health condition, and a list of organisations that can help provide advice and support

Young Minds – the leading charity aiming to support young people with mental health difficulties, with advice about looking after yourself, how to get support and advice for parents

Did you know... "Depression affects many areas of daily life, including relationships, family life, work and hobbies."

Glossary

Unsure what something means? Checkout our Glossary section below.

Although we always try to explain things as simply and as clearly as possible, sometimes it’s necessary to use the correct medical terminology. Medical terms are often known for being tricky to pronounce and if you’re not an expert in the subject, they can also be a little difficult to understand. Below, we’ve put together a list of terms used on this page along with a brief explanation of what they mean to help make your understanding of depression as straightforward as possible.

Introduction

5-HTP

– short for 5-Hydroxytryptophan, this occurs naturally in the body but is commercially produced from a plant, thought to help sleep problems, depression, pre-menstrual syndrome, fibromyalgia and many other mood or pain related issues

Anaemia

– an iron deficiency that causes low haemoglobin and symptoms that may be confused with depression e.g. tiredness, dizziness, etc

Antidepressant

– a type of drug medication to treat mood disorders, which may work by changing the chemicals in the brain

Citalopram

– selective serotonin reuptake inhibitor (SSRI) antidepressant medication that may also help people with anxiety or panic attacks, by increasing serotonin (one of the hormones responsible for mood) in the brain

Circadian rhythm

– a 24 hour internal ‘body clock’, controlled by your brain and affected by the amount of light and dark during the day and night. It makes you sleepy and wide awake at certain times of the day (usually the same each day), and when disrupted can cause concentration issues and feeling ‘not quite right’

Dopamine

– released in nerve cells, this neurotransmitter chemical is responsible for the feeling of pleasure, moods and motivation

Endorphins

– hormones produced in the brain that are released to relieve pain or discomfort in the body, and which give feelings of pleasure

Fluoxetine

– more commonly known by the brand name ‘Prozac’, this antidepressant medication works by regulating serotonin in the brain to help create a more stable mood

Genetics

– a person’s genes/DNA inherited from their parents, which determines how their body functions

Glutamate

– a neurotransmitter that helps the gut and brain function, too much or too little of which may cause depression symptoms

Neurotransmitters

– chemicals in the body that enable nerve impulses (messages) to be passed between neurons (in a cell)

Omega 3

– a fatty acid required by the body which, when taken as a supplement, has been shown to reduce depression symptoms

Selective serotonin re-uptake inhibitors (SSRIs)

– a type of antidepressant medication that tend to have few side effects for the majority of people, and which are often used to treat anxiety and depression

Serotonin

– a neurotransmitter (chemical) in the body which has a role to play in mood and feeling ‘happy’

St. John’s Wort

– a popular herbal remedy used to treat mental health problems such as anxiety

Suicide

– the act of taking one’s own life, which may occur due to a multitude of factors, of which depression and related mood or mental health conditions may play a role for some people

Thyroid

– the thyroid is a gland in the neck which delivers hormones to the body and can cause problems if it is not functioning correctly (i.e. delivering too many or not enough hormones)

Tricyclic antidepressants

– older types of medication which are still used to treat depression, but rarely used as an initial treatment due to having potentially more side effects than newer types, and often prescribed for mental health conditions such as bipolar disorder

Vitamin B

– levels of B vitamins in the body affect brain chemicals and mood, so taking supplements may have a positive effect on depression and related conditions

Vitamin D

– an essential nutrient required by the body to enable the absorption of calcium and phosphate, which has also been linked to serotonin levels and mood

Withdrawal symptoms

– unpleasant physical and mental reactions that occur when a person stops taking, or reduces their dose of, a particular drug or medication


Last updated on 05/02/2019

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