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The Royal College of Psychiatrists Improving the lives of people with mental illness


Depression: key facts



depression leafletDepression is very common - one in five people become depressed at some point in their lives. Anyone can get low, but someone is said to be suffering from depression when these feelings don’t go away quickly or become so bad they interfere with their everyday life.

Depression can last for a few months. You can get better, only for the depression return again. It is usual to recover from depression, but it is also common for the depression to return. Episodes can last several months (or even longer in some instances).

Why do people get depressed?

Sometimes there may be an obvious reason for becoming depressed, sometimes not. The reason may seem obvious – a relationship breakdown or a bereavement or even the birth of a child – sometimes it is not clear. Either way, these feelings can become so bad that you need help.


What does it feel like to be depressed?

The feeling of depression is deeper, longer and more unpleasant than the short episodes of unhappiness that everyone experiences occasionally.


You will notice:

  • persistent sadness or low mood
  • not being able to enjoy things
  • losing interest in life
  • finding it harder to make decisions
  • not coping with things that used to be easy
  • feeling exhausted
  • feeling restless and agitated;
  • loss of appetite and weight
  • difficulties getting to sleep
  • loss of sex drive
  • thoughts of self-harm or suicide.

Doctors grade depression as mild, moderate and severe to help them decide which treatment to choose.

How do I know if I am depressed?

You may not realise how depressed you are because it has come on so gradually. You may try to struggle on and cope by keeping busy. This can make you even more stressed and exhausted. Physical pains, such as constant headaches or sleeplessness, then start. Sometimes these physical symptoms can be the first sign of a depression.


What help and treatment is available?

  • Self-help: there are now a number of self-help books and computer programmes based on Cognitive Behavioural Therapy (CBT) for depression.
  • Talking treatments: there are several different types of talking treatments. Counselling enables you to talk about your feelings to a professional. Your GP may have a counsellor at the surgery who you can talk to.
  • Cognitive Behavioural Therapy helps people overcome the negative thoughts that can sometimes be the cause of depression.
  • If you have become depressed while suffering from a disability or caring for a relative, then a self-help group may give you the support you need.
  • Medication: Antidepressants can help if your depression is severe or goes on for a long time. They can help you to feel less anxious and cope better so that you can start to enjoy life and deal with problems effectively again. It is important to remember that you won't feel the effect of antidepressants straight away. People often don't notice any improvement in their mood for 2 or 3 weeks.
  • As well as tablets, there is an alternative remedy called St John's Wort available from chemists. This can help in mild to moderate depression. It seems to work in much the same way as an antidepressant, but some people find that it has fewer side-effects. If you are taking other medication, it's important to tell your doctor before taking St John’s Wort.

Which is right for me – self-help. talking treatments or tablets?

It depends on how your depression has developed and how severe it is. On the whole, self-help and talking treatments are best for mild depression. They are equally helpful for moderate depression. If you depression is severe, you are more likely to need antidepressants.


What will happen if I don’t get treatment?

Many depressions will go away eventually, but it may take many months. A small number of people with depression will take their own lives.

What can I do to help myself?

  • Tell someone how you feel.
  • Try to keep active. Even just going for a walk regularly can help your mood and sleep pattern. Doing things can help to take you mind off thoughts that make you depressed.
  • Make sure you eat well.
  • Be careful with alcohol as it makes depression worse.
  • Try not to get worried if you can’t sleep, but do something relaxing in bed such as reading, watching TV or listening to the radio.
  • If you think you know what is causing your depression, it can help to write down the problem and then think of the things you could do to tackle it. Pick the best actions and see if they work.

  • Also try to keep hopeful. This is a very common experience and you will come through it, probably stronger and more able to cope than before.

How can I help someone who is depressed?

  • Listen to them, but try not to judge them.
  • Don’t offer advice unless they ask for it, but if you can see the problem that is behind the depression, you could work with the person to find a solution.
  • Spending time with them, listening over and over to their problems, and encouraging them to keep going with activities in their routine, is all helpful.

If they are getting worse, encourage them to visit their doctor and to accept treatment.

For more in-depth information see our main leaflet: Depression.

This leaflet reflects the most up-to-date evidence at the time of writing.

Produced by the RCPsych Public Education Editorial Board.

Series Editor: Dr Philip Timms

Reviewed by Elaine Ellis

© March 2014. Due for review: March 2016.  

Coping after a traumatic event


A sudden illness, an accident or an assault, or a natural disaster - these are all traumatic experieCoping with traumances which can upset and distress us. They arouse powerful and disturbing feelings in us which usually settle in time, without any professional help.

This leaflet may be useful if:
  • you have been through a traumatic experience and want to understand more about how you are feeling
  • you know someone who has been through a traumatic experience, and want to get a better idea of how they might be feeling.
  • It describes the kind of feelings that people have after a trauma, what to expect as time goes on, and mentions some ways of coping and coming to terms with what has happened.

A traumatic event occurs when a person is in a situation where there is a risk of harm or danger to themselves or other people. Situations like this are usually frightening or cause a lot of stress. In such situations, people feel helpless.

What is a traumatic event?

Examples of traumatic events include:

  • serious accidents
  • being told you have a life-threatening illness
  • bereavement
  • violent personal assault, such as a physical attack, sexual assault, robbery, or mugging
  • military combat
  • natural or man-made disasters
  • terrorist attack
  • being taken hostage
  • being a prisoner of war.

What happens immediately after a trauma?

Immediately after a traumatic event, it is common for people to feel shocked, or numb, or unable to accept what has happened.

Shock  - when in shock you feel:

  • stunned or dazed or numb
  • cut off from your feelings, or from what is going on around you.

Denial -  when in denial, you can't accept that it has happened, so you behave as though it hasn't. Other people may think that you are being strong or that you don't care about what has happened.

Over several hours or days, the feelings of shock and denial gradually fade, and other thoughts and feelings take their place.

What happens next?

People react differently and take different amounts of time to come to terms with what has happened. Even so, you may be surprised by the strength of your feelings. It is normal to experience a mix of feelings. You may feel:

  • Frightened … that the same thing will happen again, or that you might lose control of your feelings and break down.
  • Helpless … that something really bad happened and you could do nothing about it. You feel helpless, vulnerable and overwhelmed.
  • Angry … about what has happened and with whoever was responsible.
  • Guilty … that you have survived when others have suffered or died. You may feel that you could have done something to prevent it.
  • Sad … particularly if people were injured or killed, especially someone you knew.
  • Ashamed or embarrassed … that you have these strong feelings you can't control, especially if you need others to support you.
  • Relieved … that the danger is over and that the danger has gone.
  • Hopeful … that your life will return to normal. People can start to feel more positive about things quite soon after a trauma.

What else might I notice?

Strong feelings affect your physical health. In the weeks after a trauma, you may find that you:

  • cannot sleep
  • feel very tired 
  • dream a lot and have nightmares
  • have poor concentration
  • have memory problems
  • have difficulty thinking clearly
  • suffer from headaches
  • experience changes in appetite
  • experience changes in sex-drive or libido
  • have aches and pains
  • feel that your heart is beating faster.

What should I do?

  • Give yourself time
    It takes time - weeks or months - to accept what has happened and to learn to live with it. You may need to grieve for what (or who) you have lost.
  • Find out what happened
    It is better to face the reality of what happened rather than wondering about what might have happened.
  • Be involved with other survivors
    If you go to funerals or memorial services, this may help you to come to terms with what has happened. It can help to spend time with others who have been through the same experience as you.
  • Ask for support
    It can be a relief to talk about what happened. You may need to ask your friends and family for the time to do this - at first they will probably not know what to say or do.
  • Take some time for yourself
    At times you may want to be alone or just with those close to you.
  • Talk it over
    Bit by bit, let yourself think about the trauma and talk about it with others. Don't worry if you cry when you talk, it's natural and usually helpful. Take things at a pace that you feel comfortable with.
  • Get into a routine
    Even if you don't feel much like eating, try to have regular meals and to eat a balanced diet. Taking some exercise can help - but start gently.
  • Do some 'normal' things with other people
    Sometimes you will want to be with other people, but not to talk about what has happened. This can also be part of the healing process.
  • Take care
    After a trauma, people are more likely to have accidents. Be careful around the home and when you are driving.

What should I NOT do?

  • Don't bottle up your feelings
    Strong feelings are natural. Don't feel embarrassed about them. Bottling them up can make you feel worse and can damage your health. Let yourself talk about what has happened and how you feel, and don't worry if you cry.
  • Don't take on too much
    Being active can take your mind off what has happened, but you need time to think to go over what happened so you can come to terms with it. Take some time to get back to your old routine.
  • Don't drink or use drugs
    Alcohol or drugs can blot out painful memories for a while, but they will stop you from coming to terms with what has happened. They can also cause depression and other health problems.
  • Don't make any major life changes
    Try to put off any big decisions. Your judgement may not be at its best and you may make choices you later regret. Take advice from people you trust.

When should I get professional help?

Family and friends will probably be able to see you through this difficult time. Many people find that the feelings that they experience after a traumatic event gradually reduce after about a month. However, you may need to see a professional if your feelings are too much for you, or go on for too long.

You should probably ask your GP for help if:

  • you have no one to share your feelings with
  • you can't handle your feelings and feel overwhelmed by sadness, anxiety, or
  • nervousness
  • you feel that you are not returning to normal after six weeks
  • you have nightmares and cannot sleep
  • you are getting on badly with those close to you
  • you stay away from other people more and more
  • your work is suffering
  • those around you suggest you seek help
  • you have accidents
  • you are drinking or smoking too much, or using drugs to cope with your feelings.

What is post-traumatic stress disorder?

Following a traumatic event, some people experience a particular condition called post-traumatic stress disorder (PTSD). Symptoms that are most commonly experienced by people with PTSD include:

  • re-experiencing the trauma through vivid and distressing memories or dreams
  • avoiding situations that remind them of the traumatic event
  • feeling numb, as though they don't have the same range of feelings as normal
  • being in a state of 'alertness' - watching out for danger.

If you are experiencing problems that might be PTSD, you should seek professional help.

What professional help is available?

Your GP might suggest that you talk with someone who specialises in helping people cope with traumas. They will usually use a talking treatment, such as counselling or psychotherapy. For example, a talking treatment called cognitive behavioural therapy has been shown to be helpful.

You may find that there is a support group for people who have been through a similar trauma to yourself. It can be helpful to hear that others have had similar feelings and experiences.

Can my doctor prescribe any medication to help me cope?

Medication can sometimes be helpful following a trauma, but it is still important to see your doctor regularly to check how you are doing.


There are drugs that can help to reduce the anxiety that can follow a trauma. They can also help you to get off to sleep. They are often called 'tranquillisers'. Common ones include diazepam (Valium), lorazepam (Ativan) and temazepam.

In the short term, tranquillisers can help you to feel less anxious and to sleep. However, if they are used for longer than a couple of weeks:
  • your body gets used to their effect and they stop working
  • you have to take more and more to get the same effect
  • you may get addicted to them.


You can become ill with depression following a trauma. Depression is different form normal sadness - it is worse as it affects your physical health and it goes on for longer. Depression can be treated with either antidepressant medication, or with talking treatments such as counselling or psychotherapy.

Useful web links

Further reading

Overcoming Traumatic Stress by Claudia Herbert and Ann Westmore is a self-help book. It is based on cognitive behavioural therapy and demonstrates, with practical advice and exercises, how to find new and effective ways of coping with and overcoming traumatic stress. Published by Constable & Robinson.


  • Bisson J.I., Roberts N. & Macho G. (2003). The Cardiff traumatic stress initiative: an evidence-based approach to early psychological intervention following traumatic events. Psychiatric Bulletin, 27, 145-147.
  • Bisson J.I., Bolton J., Mackway-Jones K. and Guthrie E. (2007) Major disaster planning, in Handbook of Liaison Psychiatry, Eds. Lloyd G.G. and Guthrie E. Cambridge University Press.
  • Bonanno, G.A. (2004). Loss, trauma, and human resilience. Have we underestimated the human capacity to thirve after extremely aversive events? American Psychologist, 59, 20-28.
  • Galea, S., Ahern, J., Resnick, H., Kilpatrick, D., Bucuvalas, M., Gold, J., & Vlahov, D. (2002). Psychological sequelae of the September 11 terrorist attacks in New York City. New England Journal of Medicine, 346, 982-987.
  • Mellman T.A., Bustamante V., David D., et al. (2002). Hypnotic medication in the aftermath of trauma. Journal of Clinical Psychiatry, 63, 1183-1184.
  • National Collaborating Centre for Mental Health (2005). Post-traumatic stress disorder: the management of PTSD in adults and children in primary and secondary care. London?Leicester: Gaskell and the British Psychological Society.
This factsheet was produced by the Royal College of Psychiatrists' Public Education Editorial Board and the Faculty of Liaison Psychiatry.
This leaflet reflects the best available evidence at the time of writing.
Series Editor: Dr Philip Timms
Lead authors: Dr Jim Bolton, Professor Jonathan Bisson, Professor Elspeth Guthrie, Mr Steve Wood.
Expert reviewer: Dr Jim Bolton.
© June 2015. Due for review: March 2018. Royal College of Psychiatrists.
This leaflet may be downloaded, printed out, photocopied and distributed free of charge as long as the Royal College of Psychiatrists is properly credited and no profit gained from its use. Permission to reproduce it in any other way must be obtained from The College does not allow reposting of its leaflets on other sites, but allows them to be linked directly.

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