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1 Depression This factsheet might be useful to you if you have depression or if you think you might have depression. It gives information on the symptoms and causes of depression, as well as the treatments the NHS may offer you. It can also help you if you re a carer, friend or relative of someone with depression. Common signs of depression include feeling low, feeling bad about yourself and not wanting to do things. People have different experiences of depression - it affects different people in different ways. If you think you might be depressed you should speak to your GP. It is common for doctors to say depression is 'mild', 'moderate' or 'severe'. Your doctor might offer you different treatments depending on how bad they think your illness is. Depression is normally treated with medication, therapy or counselling. Nobody knows what causes depression. Family history, upbringing, stressful events and your lifestyle can all affect your risk. If you feel low, try to get enough sleep and to eat well if you can. It is also important to try to keep active, even if you don't feel like it. This factsheet covers: 1. What is depression? 2. What are the symptoms of depression and how is it diagnosed? 3. What are the different types of depression? 4. What causes depression? 5. How is depression treated? 6. What treatment should I be offered? 7. What if I am not happy with my treatment? 8. What risks and complications can depression cause? 9. Information for family, carers and friends 1

2 1. What is depression? Everyone has ups and downs - sometimes you might feel a bit low, or experience grief when you lose someone you love. It is common for people to say that they are 'depressed' when they are feeling down, but this does not mean that they have depression. Depression is a long lasting low mood that affects your ability to do everyday things, feel pleasure, or take interest in activities. Depression is: a mental illness that is recognised worldwide. common. It affects about one in ten of us. something that anyone can get. treatable. Depression is not: something you can 'snap out of.' a sign of weakness. something that everyone experiences. something that lasts forever. How common is depression? Depression can affect people of any age, including children, and it is one of the most common mental illnesses. About one in ten people will be diagnosed with depression in their life. 1 The number of people who actually experience depression may be higher than this. More women are diagnosed than men. This could be because women are more likely to seek help What are the symptoms of depression and how is it diagnosed? Doctors make decisions about diagnosis based on guidance. The main guidance used by NHS doctors is the International Classification of Diseases (ICD-10). When you see a doctor, like your GP or a psychiatrist, they will look for the symptoms that are set out in the ICD-10 guidance. You do not have to have all of these to be diagnosed with depression - you might have just a few of them. The symptoms of depression are: 3 low mood and feeling sad, less energy and feeling less able to do things, 2

3 losing interest in activities you used to enjoy, loss of concentration, becoming tired easily, sleeping and eating less, feeling less good about yourself (loss of confidence), feeling guilty or worthless, losing interest in sex, and thoughts of self-harm or suicide, and making suicide attempts. 3. What are the different types of depression? You might have heard a number of terms used to describe depression. In this section, we explain what some of these terms mean. Clinical depression Clinical depression is a very common term but it is not a diagnosis. It just means that a doctor has given you a diagnosis. Depressive episode Your doctor might say that you are going through a 'depressive episode'. This is the formal name that doctors give depression when they make a diagnosis. They may say that you are going through a 'mild', 'moderate' or 'severe' episode. Recurrent depressive disorder If you have had a number of 'depressive episodes', your doctor might say that you have 'recurrent depressive disorder'. Again, they may say that your current 'episode' is 'mild', 'moderate' or 'severe'. Reactive depression If your doctor thinks that your depression was caused by stressful events in your life, they may say that it is 'reactive'. Dysthymia Your doctor might diagnose you with dysthymia if you have felt low for several years but have never had symptoms that would be enough to diagnose depression. Manic depression Manic depression is a different illness to depression. It is also known as bipolar disorder. People with this illness have severe highs (mania) and lows (depression). See our 'Bipolar Disorder' factsheet for more information. You can download it for free at or phone and ask for a copy. 3

4 Psychotic depression If you are severely depressed, you may start to hallucinate or believe things that aren't true. This is called 'psychosis'. For example, you might start to hear voices that say that you are worthless and that things will never improve, or you may start to believe that someone is poisoning your food. Post-natal depression Postnatal depression is a common illness which affects between 10 to 15 in every 100 women who have had a baby. You may get symptoms that are similar to those in other types of depression. Seasonal affective disorder (SAD) This type of depression affects you at the same time of year, usually in the winter. The symptoms are similar to depression but you may sleep more rather than less. You might also eat more carbohydrates like chocolate, cakes and bread What causes depression? Nobody knows exactly what causes depression. This section looks at some of the things that might increase your risk. Your body Scientists think that if you have depression, some of the chemicals in your brain are out of balance. In particular, having lower amounts of a chemical called 'serotonin' in your brain may cause depression. Changes in your hormones can affect your mood. These changes might be particularly noticeable for women during pregnancy or menopause. The family connection Depression seems to run in families. This could be because: a) it is passed down in your genes, or b) you have experienced other people's low moods. Your background or situation Problems during your childhood might cause depression. Bad experiences can lead to you thinking negative thoughts about yourself or about the world. Stressful events, including problems at home, a breakup, the death of someone you know, or losing your home or a job can also affect your mood. Doctors sometimes call these 'triggers' or 'triggering events' if they think that these problems have caused your depression. 4

5 Lifestyle Good food, exercise and hobbies can make it less likely that you will become unwell. Having other illnesses or using drugs or alcohol might make it more likely. There is more information on these things below. Food If we eat badly then we may be at risk of physical health problems like obesity, heart disease and diabetes. In the same way, the things we eat may affect our moods and our risk of becoming mentally unwell. Some people deal with their depression by eating high-fat and high-sugar foods. This is called 'comfort eating', and it can make things worse in the long term. Some top tips include: 5 Eat regularly throughout the day, Drink plenty of water, Try to avoid too much caffeine - tea, coffee and chocolate, Try to keep a healthy weight, Eat fruit, vegetables and wholegrain cereals, Don't drink too much alcohol. If you have depression, eating well will probably not have an instant impact on your mood. However, it might make you feel better in the long term. Exercise Exercising regularly can help your mood. Finding something that you enjoy doing is important so that you will want to keep it up. Exercise may also help you to get to sleep. Getting proper sleep is important for your mental health. You can try increasing the amount of exercise you do gradually. The amount you can do will depend on your age, physical health and your fitness. We have listed some options below: Going for a walk Cycling Gardening Jogging Playing a sport Going to the gym In some areas, you may be able to get 'exercise on prescription' from your GP. For example, you could get some free sessions at a local gym. 5

6 Drug and alcohol use Using drugs can affect the way your brain works. Scientists think that this can have long lasting effects on you. Regularly drinking too much alcohol may also cause depression. 6 There is more information on drugs and alcohol in our 'Drugs, Alcohol and Mental Health' factsheet. You can download this factsheet for free at or phone and ask for a copy. Other illnesses You may feel low if you have a physical illness. This risk might be higher if you have a long-term or life-threatening illness. Some people with brain injuries and dementia will also have changes in their moods. For more information on how to look after your physical health see our Good health guide. You can download this for free at 5. How is depression treated? The first step to getting treatment is to see your GP. They should rule out any physical problems which might cause symptoms of depression. Common treatments for depression include: Talking therapies Talking therapy is available on the NHS, from private healthcare providers and sometimes from charities. You will meet a trained therapist for a fixed number of sessions. Sometimes this will be with a group of people with the same diagnosis as you. There are many different types of talking therapy. According to the National Institute of Health and Care Excellence (NICE), cognitive behavioural therapy (CBT) is one of the most effective therapies for depression. It should normally be available in your area. 7 Other common therapies include: Psychodynamic therapy, Problem-solving therapy, Interpersonal therapy, and General counselling. These therapies may not be widely available in your area but it is worth asking your GP about them if you are interested. Computerised cognitive behavioural therapy (CCBT) Computerised cognitive behavioural therapy (CCBT) is a relatively new way of treating mild to moderate depression. It is a way of learning CBT 6

7 techniques online through a computer. You will complete regular sessions to learn new ways to deal with your depression. In a lot of areas, the NHS uses CCBT programmes such as 'Beating the Blues', 'COPE' and 'Overcoming Depression'. One of these, or something similar, may be available free of charge through your GP. Antidepressants Your doctor might offer you an antidepressant. You may need to try different types before you find one that works for you. Antidepressants can have unpleasant side effects and can affect other medicines you are taking. It is important to talk to your doctor before you stop taking them, because stopping suddenly can cause problems. Exercise Therapy Having good physical health and exercising can help with depression. Some GP surgeries will put you in touch with local exercise schemes. These might sometimes be called 'exercise on prescription'. Electroconvulsive therapy (ECT) Electroconvulsive therapy (ECT) is a procedure sometimes used to treat severe depression. In this treatment, an electrical current is briefly passed through your brain while you are under general anaesthetic. ECT is only offered if other kinds of treatments have not helped and your depression is very severe. Transcranial Magnetic Stimulation (TMS) TMS involves using magnetic fields to try to change the way the brain works. Scientists think that this could help people with depression and does not cause any major safety concerns. 8 Complementary/ Alternative Therapies Complementary therapies are treatments which are not part of mainstream medical care. They can include aromatherapy, massage, mindfulness, meditation and yoga. These are aimed at improving your emotional well being. You can find more information on these treatments in the following factsheets: 'Antidepressants' 'Talking Therapies' 'Electroconvulsive Therapy (ECT)' 'Complementary Therapies' These are available to download for free from or by contacting us directly on

8 6. What treatment should I be offered? The National Institute of Health and Care Excellence (NICE) produces guidance on what treatment doctors should offer you. However, your doctor does not have to give you these treatments. These options might not be available locally or your doctor might think that a different treatment will be better. Mild to moderate depression Your doctor may offer you: 'low intensity' cognitive behavioural therapy (CBT) such as guided self-help or computerised cognitive behavioural therapy (CCBT). Your doctor may put you in touch with an 'IAPT' (Improved Access to Psychological Therapies) service. group CBT. information about getting better sleep. medication. However, the guidance is clear that the benefits of using antidepressants for mild depression are small. If these options do not work for you, your doctor might consider treating you using the options for moderate to severe depression. Moderate to severe depression Your doctor may suggest: an antidepressant - normally an 'SSRI' or 'high intensity' therapy such as one-to-one CBT or interpersonal therapy (IPT). Your doctor will decide which of these would be best, but they should ask you which one of these you would prefer. Severe and complex depression If you: are at risk of suicide, drink too much or use drugs, have other illnesses, sometimes lose touch with reality ( called 'psychosis') then your doctor might think about: putting you in touch with specialist mental health services. This could include the 'Crisis Team' and 'Community Mental Health Team' or 'Recovery Team', using treatments that haven't worked in the past if these were not used effectively the first time, 8

9 using new treatments or a new mix of treatments, whether you need to be in hospital, using 'electro-convulsive therapy' (ECT) if your depression is lifethreatening or if most treatment options have not worked. 7. What if I am not happy with my treatment? If you are not happy with the treatment that your doctor has offered you then you can: try to resolve the issue with your doctor. An advocate might be able to help you with this, ask for a second opinion about your treatment, contact your local Patient Advice and Liaison Service (PALS) to see whether they can help resolve your problem, make a complaint about the way you have been treated. There is more detailed information on these options below. 'PALS' If you ever feel unhappy with how your treatment or care is being handled, or feel that the relationship between yourself and a professional is not working well, you could call the Patient Advice and Liaison Service (PALS) at your NHS trust. They can try to resolve any problems or questions you have. You can find your local PALS details at Search/Patient-advice-and-liaison-services-(PALS)/LocationSearch/363. Advocacy You might find a general/community advocate helpful if you are unhappy with your treatment. Advocacy can help you understand the mental health system and enable you to be fully involved in decisions about your care. An advocate is someone independent from mental health services who can help to make your voice heard when you are trying to resolve problems. They may be able to help with writing letters for you or attending appointments or meetings. You can find more information about advocacy in our Advocacy factsheet. There may be a local advocacy service in your area which you can contact for support. You can search online for a local service or the Rethink Mental Illness Advice Service could search for you. Your treatment If you are not happy with your treatment, you can refer to the NICE guidance to see if you are being offered the recommended treatments. You can find all of their guidelines at 9

10 You can find out more about getting a second opinion, having a choice in your medication or making a complaint at You can download our factsheets for free or call and ask for a copy to be sent to you. 8. What risks and complications can depression cause? Having depression can cause problems such as: Difficulties sleeping Problems with having sex Not feeling able to work Drinking or taking drugs. If you have any of these problems, you might be able to get help to overcome them from the NHS or social services. 9. Information for family, carers and friends Support for you As a carer, friend or family member of someone living with depression, you might find that you also need support. You can find information on dealing with the symptoms of depression, such as withdrawing from other people, in our Dealing with unusual thoughts and behaviours factsheet. Our Supporting someone with a mental illness factsheet may also be useful. It is important to seek emotional support for yourself if are struggling to cope. You could check whether there are any local support groups for carers, friends and relatives in your area. If you feel you need additional support to care for your loved one you could ask for a carer s assessment. You can find more information in our Carers Assessments factsheet. If your loved one is supported by a mental health team and you are their carer, you should be involved with decisions about care planning. There are particular rules regarding confidentiality and carers. Unless the person you care for consents, confidential information about them cannot be passed on to you or other family, friends and carers. The team should seek permission from them and ask what they are happy for others to know. This would also include any care plans that are drawn up. You can find more information in our Confidentiality and Information Sharing For Carers, Friends and Relatives factsheet. 10

11 Supporting the person you care for If you want to support someone with depression, you might find it helpful to learn about symptoms, treatments and self help techniques. This way you may be able to encourage your loved one to take the steps they need to get well. Below are some initial suggestions for providing practical day to day support: 9 Offer them emotional support, patience, affection and encouragement. Remember that depression is an illness and people cannot pull themselves together. Invite them out on walks, outings, and gentle activities. Encourage them to take part in activities that once gave them pleasure. However, try not to put too much pressure on them as not feeling able to engage in activities they used to enjoy can be a source of further unhappiness. Help them feel good about themselves by praising daily achievements. Encourage them to help themselves through self-help techniques and further treatment if appropriate. Find out about self help or support groups in the area. If you want to know how you can get help for someone who might have depression read our Are You Worried About Someone's Mental Health? factsheet. If the person is severely depressed and/or suicidal you might want to read our Helping Someone With Suicidal Thoughts and Getting Help In A Crisis factsheets. You can download these factsheets for free from or call and ask for a copy to be sent to you. Depression Alliance provides information on their website and also by post. They also run self help groups across the country. Tel: Address: 20 Great Dover Street, London SE1 4LX information@depressionalliance.org Web: Mood Swings Network provides a range of services for people affected by a mood disorder such as depression, including their family and friends. Tel: (10am - 4pm Mon-Fri) info@moodswings.org.uk Web: 11

12 Online cognitive behavioural therapy (CBT) resources Get Self Help: Live Life to the Full: Mood Gym: 1 National Institute for Health and Clinical Excellence (2010) Depression. The treatment and management of depression in adults. CG90. London. Full guidance at pg 22 2 Royal College of Psychiatrists. Depression epression/depression.aspx [Accessed 14/11/13] 3 World Health Organisation (2010) 'The ICD-10 Classification of Mental and Behavioural Disorders: Clinical descriptions and diagnostic guidelines', F32 Depressive episode. Accessed on 29/11/13 at 4 As note 1 at pg 20 5 Mental Health Foundation (2007) 'Healthy Eating and Depression: How diet might help protect your mental health' 6 The Mental Health Foundation: Feeding Minds Report: The Impact of food on mental health; Dr. Deborah Cornah, As note 1 at pg 296, National Institute for Health and Clincal Excellence (Nov 2007) Transcranial magnetic stimulation for severe depression at pg 1 9 O Connor (2012). Undoing Depression: What therapy doesn t teach you and medication can t teach you. Souvenir Press. London. 12

13 Rethink Mental Illness 2013 Last updated Dec 2013 Next update Dec 2015 Version 8 This factsheet is available in large print. Last updated 01/10/2010 Last updated 01/10/2010