depression

by Sally Burningham

We all feel sad or down from time to time. That's simply part of life. Feelings like these can be caused by a loss or disappointment, a worry or a recent illness, or they may occur for no obvious reason. However, as long as they aren't too extreme or long-lasting, we usually take them in our stride and find our own ways to cope.

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Although we may say that we are 'depressed' when we are rather low or upset like this, it is not the same as experiencing depression, or 'clinical depression' as it is sometimes called. This is a distressing illness in which feelings such as hopelessness, worthlessness and tiredness come to dominate a person's life so that they can't function normally.

Clinical depression is very common – in the UK, at least one person in every five will experience it at some time in their lives. The important thing to remember is that it is treatable: more than 80% of people with depression can be helped with the appropriate medication and psychological treatment.

Anyone who suspects they are depressed should talk to their GP as soon as possible. The sooner the illness is identified, the sooner it can be sorted out.

recognising depression

Depression is often classified by doctors as 'mild', 'moderate' or 'severe':

• mild: symptoms are relatively less intense and may come and go
• moderate: symptoms tend to be more distressing and persistent
• severe: symptoms are likely to be intense, constant and debilitating.

While each person will be affected by depression in their own individual way, many depressed people experience some of the same symptoms:

common symptoms

• feeling sad, hopeless or despairing for much of the time
• tiredness, lack of energy and irritability
• a loss of interest or pleasure in activities that were once enjoyed
• a slowing down of mind and body, or increased agitation and restlessness
• increased anxiety
• problems remembering, concentrating or making simple decisions
• feelings of low self-esteem, worthlessness or guilt that is not warranted.
• feeling isolated and cut off from other people, even those who are close
• a loss of loving feelings, which can be very distressing
• a loss of interest in sex
• changes in eating habits such as eating too much or too little
• difficulty in getting to sleep, waking much earlier than usual or sleeping too much.
• feeling much worse in the morning, especially on waking
• thoughts of suicide or death.

If you are experiencing some of these symptoms to such an extent that you feel very distressed or unable to cope, it is important to get help from your GP. The earlier depression is diagnosed, the more quickly it can be treated. If you feel unsafe. like harming yourself or suicidal, seek help immediately.

other signs

Sometimes people are unaware that they have depression, even though they may know that they're not coping well. At the same time, friends and relatives may suspect that something is wrong because of how these individuals’ mood, habits and behaviour have changed. It may take a great deal of tact and persuasion to get a depressed person to see their GP.

Sometimes depression is harder to identify because people do not react in ways usually associated with the illness. It is important to be aware that:

• Some people try to cope by making themselves constantly busy – for example, taking on extra work or involving themselves in a flurry of social activity.
• Some people complain of physical aches and pains such as headaches or stomach aches rather than of feeling sad or distressed. It may only become clear that they are actually depressed when no physical cause for the aches and pains can be found.
• People who have been depressed for a long time may come to believe that their feelings are 'normal.'
• People who are depressed are often very anxious, experiencing breathing difficulties, palpitations, stomach churning or pins and needles in the hands and feet, as well as feeling panicky, frightened or uneasy. These symptoms can sometimes mask the fact that they are depressed. For more information see our feature on anxiety.
• Sometimes people become depressed as a result of an underlying physical problem, such as a certain type of cancer , heart problem or other condition. Here the treatment would be for the underlying problem and not the depression itself.

other forms of depression

psychotic depression In this, people with severe depression are out of touch with reality. They are unable to distinguish between what is really happening and what, in their imagination, they believe is happening.

manic depression (bipolar disorder) Another psychotic condition, this is characterised by severe swings of mood, either to mania – a state of extreme elation and overactivity – or to severe depression, or to both. These mood swings can often be reduced or controlled by mood-stabilising drugs such as lithium. Read more about manic depression

postnatal depression This is very different from 'baby blues', a tearful period that many women go through a few days after giving birth. Postnatal depression generally begins during the first six weeks after the birth and develops slowly. Symptoms can include feelings of inadequacy, problems with sleeping, constant worries about the baby’s health, agitation, panic attacks and fear of dying. If you think you may have postnatal depression – or you suspect that a friend or relative has it – you should talk to the GP or health visitor immediately. Read more about postnatal depression

seasonal affective disorder (SAD) This is a form of depression linked to the changing seasons. People become depressed in the autumn and winter and recover in the spring when daylight time increases. Symptoms include wanting to sleep for long periods and a craving for sweet foods. This kind of depression can be treated with special light boxes.

what causes depression?

Depression is probably due to a combination of different causes, although it is not always clear what these are and they can vary from person to person.

who is most at risk?

Anyone can be affected by depression, but some people are more at risk than others. Being 'at risk' doesn't mean that you will necessarily develop depression. It just means you are more vulnerable.

You are more likely to suffer from depression if:

• There is a history of depression in your family. Some people may inherit a genetic predisposition to the illness.
• You have had distressing experiences in childhood such as the loss of your mother before the age of 11 or some form of physical or sexual abuse.
• You have a long-term illness.

what are the triggers?

A number of things can contribute to depression. These include:

• Stressful and upsetting events that often involve some form of loss, such as bereavement, divorce or redundancy.
• Changes in lifestyle due to, for example, illness, unemployment or retirement.
• Insecurity over issues such as work, money or relationships.
• Feeling trapped in a situation over which you have no control.
• Feeling lonely and having no one to turn to.
• The after-effects of certain illnesses or side-effects of certain drugs.
• The effects of heavy drinking – alcohol acts as a depressant and makes miserable feelings worse.

Sometimes it is obvious that one or more of these factors has helped to trigger a person's depression. At other times, it is less clear – in fact, the depression may appear to have come 'out of the blue.'

treating depression

Most people will 'come out' of a depression eventually, but without treatment, they may have many months or even years of unnecessary misery. If you are suffering from depression, it is important to get treatment as soon as possible, both for your own sake and for those close to you.

Different treatments work for different people. Often a combination of treatments and self-help approaches works best. Talk over the options with your GP.

antidepressant medication

The symptoms of depression are believed to occur because certain chemicals in the brain become less active. Antidepressant drugs increase the amounts of these brain chemicals and this helps to alleviate the symptoms. For more information see our feature on antidepressants and tranquillisers.

If you have moderate or severe depression, your doctor is likely to prescribe an antidepressant to lift your mood and help you feel well enough to resume normal life. (If you only have mild depression, some form of psychological therapy is likely to be more effective.)

At least 70% of those with moderate or severe depression find antidepressants effective. There are many different types, so if one variety doesn't suit you or has unpleasant side-effects, your doctor can try you on another.

Important things to remember when taking antidepressants:

• Most take at least two to three weeks to work so you won't notice any immediate improvement. You need to be patient.
• People who take antidepressants for six months or more are much less likely to have a recurrence of their depression. So you may need to take them for some months after you feel better.
• When you do stop taking them, you should do so gradually to prevent withdrawal symptoms.
• Some people have to remain on antidepressants indefinitely. This is because they have a permanent chemical imbalance in their brains – not because they are failures!
• Antidepressants are not addictive. They are often confused with tranquillisers such as Valium, which are addictive.

Although antidepressants will lift your mood, they will not help you tackle any underlying problems that may have contributed to your depression. Once you feel well enough, you may want to look at these problems through other approaches such as psychological therapies or self-help.

psychological therapies

These treatments may help you look more clearly at the problems underlying your depression, enabling you to find new ways of coping. Discuss with your GP or consultant what might be the most appropriate for you.

None of these therapies will make you feel better immediately or provide you with instant solutions. What you will be offered is a safe space and a great deal of support to look at your life and see what changes you want to make. Over time, you will probably find that you become more confident, see situations in a different way or realise that different choices are open to you. But you do need to make a commitment to attend regularly, even though sometimes you might feel that you're not getting anywhere. There is no quick fix.

There are wide range of psychological therapies, including:

individual counselling and psychotherapy Both offer you the opportunity to work through your feelings and difficulties with the help of a therapist on a one-to-one basis. In counselling, the focus is more likely to be on problems in the here and now. In psychotherapy, you will spend more time looking at the past to gain a better understanding of the present.

group therapy With the guidance of a professional, you can explore your problems with other people who have similar ones. You may find it easier to confront your own difficulties in the company of others trying to do the same.

cognitive therapy This helps you understand, challenge and balance your negative attitudes and behaviour. You may be asked to test out your assumptions in real life or your therapist may use role play or relaxation methods to help you find more positive ways to cope. For more information on cognitive therapy see our feature on cognitive behaviour therapy.

Some of these therapies are available through the NHS. For others, you may have to go through a voluntary organisation or privately. If you go privately. make sure to check the therapist's credentials very carefully. (Check out the feature am I losing my mind? for more information about finding a therapist.)

ECT (electroconvulsive therapy)

ECT is used to treat people with very severe depression. It works more quickly than antidepressants – people who have it usually start to improve after one week. It is given to individuals who are actively suicidal or not eating or drinking – that is, in life-threatening situations. In such cases, it can be life-saving.

ECT is quite straightforward. First, the person is given a short-acting anaesthetic and a muscle relaxant. Then, an electric current is passed through their brain, causing a very small convulsion.

A course of treatment usually consists of six to eight such sessions over a period of three or four weeks. Although no one quite understands why, most people start to feel better after two or three sessions. They may experience some brief memory loss relating to the time when treatment took place, but this is usually temporary.

helping someone with depression

If you have a friend or relative who is depressed, you may feel quite at a loss as to how best to offer support.

• It is important to persuade the person to visit their GP as soon as possible. However, sometimes people who are depressed are very resistant to suggestions from close friends or relatives. It may help if someone they are less close to makes the suggestion. However, if the depressed person is talking of suicide, you should get help immediately.
• Encourage them to talk about how they feel and to have a good cry if it helps. This can be particularly important for men who are more likely to bottle up their feelings.
• Show you understand that they are going through a very unpleasant and distressing time. Let them know you don't blame them or expect them to 'snap out of it.'
• People with depression often feel they are worthless and unloveable. Praise them whenever you can and reassure them constantly that you care.

The depressed person may seem to be giving you a double message – both 'I need your help' and 'Keep your distance.' On the one hand, they may be quite dependent and demanding, while on the other, they may be unfairly angry or critical. Although it is hard not to feel hurt, it is important to remember that this is part of the depression and not meant personally. The person still needs your affection and approval even if they are unable to respond in a positive way.

help and info

You will find lots of useful advice and information in two other articles in the mind section: self-help strategies and family and friends.

You may want to try out one or more forms of complementary medicine to see if they help with your depression. Always check with your GP first. For information on complementary medicine and depression see the ailments section of the Channel 4 complementary medicine site.

organisations

Association for Post Natal Illness
145 Dawes Road
London SW6 7EB
Helpline: 020 7386 0868 (Mon-Fri 10am-2pm)
E-mail: info@apni.org
Website: www.apni.org
Offers a service for women with postnatal illness, their families, friends and professionals. The key areas are support, education and information. Women experiencing PND can find help through a countrywide network of volunteers who all have experience of the illness. Mothers can also call the helpline or receive postal or e-mail support.

C.A.L.M.
Helpline: 0800 58 58 58 (Sat -Tues, 5pm-midnight every week)
Website: www.thecalmzone.net
Free and confidential helpline aimed at young men aged 15-35 living in Manchester, Merseyside, Cumbria and Bedfordshire who may be feeling low or depressed. Offers telephone counselling and information about other sources of help locally.

Depression Alliance
212 Spitfire Studios
63-71 Collier Street
London N1 9BE
Tel: 0845 123 23 20 (Info pack request line)
E-mail: information@depressionalliance.org
Website: www.depressionalliance.org
National network of self-help groups for people experiencing depression. Offers a quarterly newsletter, national pen friend scheme and correspondence service with advice, guidance, support and fellowship to people experiencing depression, and their carers. Produces booklets and leaflets on various aspects of depression.

Manic Depression Fellowship (MDF)
21 St George's Road
London SE1 6ES
Advice and Information: 08456 340 540 (Mon-Fri 9am-5pm)
E-mail: mdf@mdf.org.uk
Website: www.mdf.org.uk
Provides advice and information for people with manic depression, and their families, carers and mental health professionals. Offers a quarterly journal Pendulum, a network of self-help groups for people with the condition, as well as their relatives and friends, self management training courses, employment advice, travel insurance, and members also have access to a legal advice line. MDF will send out an information pack upon request, which will include a publications list.

Samaritans
c/o Chris
PO Box 90 90
Stirling FK8 2SA
Helpline: 08457 90 90 90 (24 hours)
E-mail: jo@samaritans.org
Website: www.samaritans.org
The Samaritans exists to provide confidential emotional support to any person, irrespective of race, creed, age or status who is in emotional distress or at risk of suicide; 24 hours a day. Can be contacted by e-mail, telephone, writing, or by visiting one of over 200 local branches (details are on the website).

SANE
1st Floor
Cityside House
40 Adler Street
London E1 1EE
SANELINE: 0845 767 8000 (every day 6pm-11pm)
E-mail: sanemail@sane.org.uk (admin queries only)
Website: www.sane.org.uk
SANELINE is a National mental health helpline providing information and support for people with mental health problems, and those who support them. They can provide information on the illness and symptoms, local and national mental health services, medication, treatments and therapies.

Seasonal Affective Disorder Association (SADA)
PO Box 989
Steyning BN44 3HG
Website: www.sada.org.uk
Well-established support organisation for Seasonal Affective Disorder with useful information on treatment and an information pack.

websites

Depression and Bi-Polar Support Alliance
www.dbsalliance.org
The DBSA fosters an understanding about the impact and management of these illnesses by providing up-to-date, scientifically-based tools and information written in language the general public can understand.

DIPEx.org
www.dipex.org
This site offers a unique support service for patients affected by a range of conditions and is designed to provide a true insight into the impact of illness, offering personal experiences on many issues and the answers to those questions patients are sometimes too afraid to ask.

Get Connected
Free Helpline: 0808 808 4994 (every day 1pm-11pm)
E-mail: help@getconnected.org.uk
Website: www.getconnected.org.uk
Phone and e-mail service helping young people find the best support whatever their problem. The above helpline is offered free by most mobile phone operators.

HealthyGenius.com
www.healthygenius.com
An extensive new website about mental illness.

Mental Help Net
www.mhnet.org
Website offering information on a wide range of mental health topics.

PsychCentral
http://psychcentral.com
The Internet's largest and oldest independent mental health social network created and run by mental health professionals. The site has lots of useful resources, recommended books and even quizzes.

Royal College of Psychiatrists
www.rcpsych.ac.uk
Website contains informative factsheets on manic depression, and other mental illnesses.

Royal College of Psychiatrists
www.rcpsych.ac.uk/info/help/pndep/index.asp
Very helpful factsheet on Postnatal Depression and how it can be treated.

reading

Beat Depression and Reclaim Your Life by Alexandra Massey (Virgin Books, 2005)
Contains practical, realistic advice including suggestions for what you can do when you are too depressed to move, and how to progress when your head is just above the water. There are chapters on shame and learning to confront this condition head-on. It gets good reviews on Amazon.
Get this book

Dealing with Depression by Kathy Nairn and Gerrilyn Smith (Women's Press, 2001)
This is a practical guide for sufferers of depression and those who know someone who is depressed. It identifies the causes of depression and the many forms it may take, explores ways of coping and recovering, and evaluates the help available.
Get this book

Dealing with Depression Naturally: Alternative and complementary therapies for restoring emotional health by Syd Baumel (McGraw-Hill, 2000)
Explores natural ways to restore emotional health, including mood-enhancing fats, herbal antidepressants and their proven remedies.
Get this book

Depression: Why it happens and how to overcome it by Paul Hauck (Sheldon Press, 1979)
A useful book for everyone who gets depressed and for those who have to live or work with people who suffer from depression. The author uses case histories from his own practice.
Get this book

Depression by Constance Hammen (Psychology Press, 1997)
Particularly for students and professionals, this book covers clinical and diagnostic facts, and demographics such as why depression is more common in women and the young. Also considers genetic and biological factors, current treatment and developments.
Get this book

Depression: The way out of your prison by Dorothy Rowe (Brunner-Routledge, 2003)
The author offers a way of understanding depression that allows sufferers to take charge of their lives. She argues that it is not an illness requiring drugs but a defence we use to hold ourselves together when we feel our lives falling apart. This book contains stories of people who have changed their lives by conquering depression for good.
Get this book

Depression: Social and economic timebomb by Anne Dawson and Andre Tylee (Wiley Blackwell, 2000)
Depression is one of the commonest disorders worldwide yet it continues to be under-diagnosed, especially in men, who tend not to present classic symptoms. This book sets out to offer practical solutions to a wide range of problems.
Get this book

Depression: The commonsense approach by Tony Bates (New Leaf, 1999)
This guide describes depression, outlines the common and not so common signs and briefly looks at some of the theories that have been put forward to explain it, offering sufferers the tools with which to deal with negative thinking.
Get this book

Natural Prozac: Learning to release your body's own anti-depressants by Joel Robertson and Tom Monte (HarperSanFrancisco, 1998)
Offers an approach to dealing with depression without the use of drugs. The book advocates using the body's own natural chemistry to restore the brain's chemical balance and end the dangerous cycle of negative thought patterns and behaviour that cause depression to recur.
Get this book

The Natural Prozac: How to use St John's Wort, the anti-depressant herb by Jonathan Zuess (Three Rivers Press, 1998)
Explains the properties of hypericum, commonly known as St John's Wort, a herb known for alleviating mild to moderate depression with few side effects.
Get this book

(July 2001, resources updated April 2008)