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About this leaflet
This leaflet is for anyone who is, or has been depressed. We
hope it will also be helpful for friends and relatives.
It describes what depression feels like, some
of the help that is available, how you can help yourself and how to
help someone else who is depressed. It also mentions some of the
things we don't know about depression. At the end of the leaflet
there is a list of other places where you can get further
information.
Introduction
We all feel fed up, miserable or sad at
times. These feelings don't usually last longer than a week or two,
and they don't interfere too much with our lives. Sometimes there's
a reason, sometimes not. We usually cope - we may talk to a friend
but don't otherwise need any help.
However, in depression:
- your feelings don't lift after a few days –
they carry on for weeks or months
- are so bad that they interfere with your
life.
What does it feel like?
Most people with depression will not have all
the symptoms listed below, but most will have at least five or
six.
You:
- Feel unhappy most of the time (but may feel a
little better in the evenings)
- Lose interest in life and can't enjoy
anything
- Find it harder to make decisions
- Can't cope with things that you used to
- Feel utterly tired
- Feel restless and agitated
- Lose appetite and weight (some people find
they do the reverse and put on weight)
- Take 1-2 hours to get off to sleep, and then
wake up earlier than usual
- Lose interest in sex
- Lose your self-confidence
- Feel useless, inadequate and hopeless
- Avoid other people
- Feel irritable
- Feel worse at a particular time each day,
usually in the morning
- Think of suicide.
You may not realise how depressed you are for
a while, especially if it has come on gradually. You try to
struggle on and may even start to blame yourself for being lazy or
lacking willpower. It sometimes takes a friend or a partner to
persuade you that there really is a problem which can be
helped.
You may start to notice pains, constant
headaches or sleeplessness. Physical symptoms like this can be the
first sign of depression.
Why does it happen?
As with our everyday feelings of low mood,
there will sometimes be an obvious reason for becoming depressed,
sometimes not. It can be a disappointment, a frustration, or that
you have lost something - or someone – important to you. There is
often more than one reason, and these will be different for
different people. They include:
Things that happen in our lives
It is normal to feel depressed after a
distressing event - bereavement, a divorce or losing a job. You may
well spend a lot of time over the next few weeks or months
thinking and talking about it. After a while you come to terms with
what's happened. But you may get stuck in a depressed mood, which
doesn't seem to lift.
Circumstances
If you are alone, have no friends around, are
stressed, have other worries or are physically run down, you are
more likely to become depressed.
Physical Illness
This is true for life-threatening illnesses
like cancer and heart disease, and also for illnesses that are long
and uncomfortable or painful, like arthritis or bronchitis. Younger
people can become depressed after viral infections, like flu or
glandular fever.
Personality
Some of us seem to be more vulnerable to
depression than others. This may be because of our genes, because
of experiences early in our life, or both.
Alcohol
Regular heavy drinking makes you more likely
to get depressed – and, indeed, to kill yourself.
Gender
Women seem to get depressed more often than
men. It may be that men are less likely to talk about their
feelings and more likely to deal with them by drinking heavily or
becoming aggressive. Women are more likely to have the double
stress of having to work and look after children.
Genes
Depression can run in families. If you have
one parent who has become severely depressed, you are about eight
times more likely to become depressed yourself.
What about bipolar disorder (manic depression)?
About one in 10 people who suffer from serious
depression will also have periods when they are too happy and
overactive. This used to be called manic depression, but is now
often called Bipolar Disorder. It affects the same number of men
and women and tends to run in families (see leaflet on Bipolar Disorder).
Isn't depression just a form of weakness?
Other people may think that you have just
'given in', as if you have a choice in the matter. The fact is
there comes a point at which depression is much more like an
illness than anything else. It can happen to the most determined of
people – even powerful personalities can experience deep
depression. Winston Churchill called it his ‘black dog'.
When should I seek help?
- When your feelings of depression are worse than usual and don't
seem to get any better.
- When your feelings of depression affect your work, interests
and feelings towards your family and friends.
- If you find yourself feeling that life is not worth living, or
that other people would be better off without you.
It may be enough to talk things over with a
relative or friend. If this doesn't help, you probably need to talk
it over with your family doctor. You may find that your friends and
family have noticed a difference in you and have been worried about
you.
Helping yourself
Don't keep it to yourself
If you've had some bad news, or a major upset,
tell someone close to you - tell them how you feel. You may
need to talk (and maybe cry) about it more than once. This is part
of the mind's natural way of healing.
Do something
Get out of doors for some exercise, even if
only for a walk. This will help you to keep physically fit, and
will help you sleep. Even if you can't work, it's good to keep
active. This could be housework, do-it-yourself (even as little as
changing a light bulb) or any activity that is part of your normal
routine.
Eat well
You may not feel like eating - but try to eat
regularly. Depression can make you lose weight and run short of
vitamins which will only make you feel worse. Fresh fruit and
vegetables are particularly helpful.
Beware alcohol!
Try not to drown your sorrows with a drink.
Alcohol actually makes depression worse. It may make you feel
better for a short while, but it doesn't last. Drinking can stop
you dealing with important problems and from getting the right
help. It's also bad for your physical health.
…. and cannabis
While cannabis can help you to relax, there is
now evidence that regular use, particularly in teenagers, can bring
on depression.
Sleep
If you can't sleep, try not to worry about it.
Try listening to the radio or watch some TV while you're lying in
bed. Your body will get a chance to rest and, with your mind
occupied, you may feel less anxious and find it easier to get some
sleep.
Tackle the cause
If you think you know what is behind 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 things to do
and try them.
Keep hopeful
Remind yourself that:
- Many other people have had
depression.
- It may be hard to believe, but you will
eventually come out of it.
- Depression can sometimes be helpful – you may
come out of it stronger and better able to cope. It can help you to
see situations and relationships more clearly.
- You may be able to make important decisions
and changes in your life, which you have avoided in the past.
What kind of help is available?
Most people with depression are treated by
their family doctor. Depending on your symptoms, the severity of
the depression and the circumstances, the doctor may suggest:
- self-help
- talking treatments
- antidepressant tablets
Guided self-help
This can include:
- Self-help leaflets or books, using CBT
principles (see below)
- Self help computer programmes or the
internet
- Exercise - 3 sessions per week for 45 minutes
to 1 hour, for between 10 and 12 weeks
Whichever of these is right for you depends on
your personality and lifestyle.
Talking treatments
There are many different sorts of
psychotherapy available, some of which are very effective for
people with mild to moderate depression. They include:
Counselling
Simply talking about your feelings can be
helpful however depressed you are. Sometimes it is hard to express
your real feelings even to close friends. Talking things through
with a trained counsellor or therapist can be easier. It can be a
relief to get things off your chest and it can help you to be
clearer about how you feel about your life and other people.
There may be a counsellor at your GP surgery with whom
you can talk, or your GP can refer you to a local counselling
service.
Cognitive behavioural therapy (CBT)
Many of us have habits of thinking which,
quite apart from what is happening in life, are likely to make us
depressed and keep us depressed. CBT helps you to:
- identify any unrealistic and unhelpful ways of thinking
- then develop new, more helpful ways of thinking and
behaving.
See our leaflet on
CBT for further information.
Problem-solving therapy
This helps you to be clear about your key
problems, how to break them down into manageable bits and how to
develop problem-solving skills.
Couple therapy
If your depression seems connected with your
relationship with your partner, then RELATE can be helpful in
enabling you to sort out your feelings – it is an organisation that
specialises in working with couples. (see 'other organisations' for
contact details).
Support groups
If you have become depressed while suffering
from a disability or caring for a relative, then sharing
experiences with others in a self-help group may give you the
support you need.
Bereavement Counselling
If you are not able to get over the death of
someone close to you, you need to talk about it with a specialist
bereavement counsellor.
Interpersonal and psychodynamic
psychotherapy
This may be more suitable if you have had
long-standing difficulties with your life or relationships. This
tends to be a longer-term treatment and helps you to see how your
past experiences may be affecting your life here and now.
Group therapy
Talking in groups can be helpful in changing
how you behave with other people. You get the chance, in a safe and
supportive environment, to hear how people see you and the
opportunity to try out different ways of behaving and talking.
Talking treatments do take time to work.
Sessions usually last about an hour and you might need anywhere
from five to 30 sessions. Some therapists will see you weekly,
others every two to three weeks.
Problems with talking treatments
These treatments are usually very safe but
they can have unwanted effects. Talking about things can bring up
bad memories from the past and this can make you feel worse for a
while. Others have reported that therapy can change their outlook
and the way they relate to friends and family. Therapy can put a
strain on a close relationship. Make sure that you can trust your
therapist and that they have the necessary training. If you are
concerned about having therapy, talk it over with your doctor or
therapist. Unfortunately, talking treatments are still in short
supply. In some areas, you may have to wait for several months.
Antidepressants
If your depression is severe or goes on for a
long time, your doctor may suggest a course of antidepressants.
These are not tranquillisers, although they may help you to feel
less anxious and agitated. They can help people with depression to
feel and cope better, so that they can start to enjoy life and deal
with their problems effectively again. Although there is a
continuing debate about how much more effective they are than
placebo (‘dummy drug’), they seem to be most helpful with more
severe depressions.
If you do start taking antidepressants,
you probably won't feel any effect on your mood for two or three
weeks. You may notice that you start to sleep better and feel less
anxious after a few days.
How do antidepressants work?
The brain is made up of millions of cells
which transmit messages from one to another using tiny amounts of
chemical substances called neurotransmitters. Upwards of 100
different chemicals are active in different areas of the brain. It
is thought that in depression two of these neurotransmitters are
particularly affected – Serotonin, sometimes referred to as 5HT,
and Noradrenaline. Antidepressants increase concentrations of these
two chemicals at nerve endings and so seem to boost the function of
those parts of the brain that use Serotonin and Noradrenaline. Even
so, it is not certain that this is the actual mechanism that
improves your mood.
Problems with antidepressants
Like all medicines, antidepressants have
side-effects, though these are usually mild and tend to wear off
after a couple of weeks. The newer antidepressants (called SSRIs)
may make you feel a bit sick at first and you may feel more anxious
for a short while. The older type of antidepressants can cause a
dry mouth and constipation. Your doctor can advise you on what to
expect, and will want to know about anything that worries you. You
will also get written information on the medication from your
pharmacist.
If an antidepressant makes you sleepy, you
should take it at night, so it can help you to sleep.
However, if you feel sleepy during the day, you should not drive or
work with machinery till the effect wears off. Alcohol can make you
very sleepy if you drink while taking the tablets, so it is best
avoided.
You can eat a normal diet while taking most of
these tablets and they don't cause problems with pain-killers,
antibiotics or the contraceptive pill.
Your GP, not a psychiatrist, will usually be
the one who prescribes an antidepressant. At first, he or she will
need to see you regularly to make sure the tablets agree with you.
If they do help, it is advisable to stay on them for at least four
months after you feel better. If you have had more than one episode
of depression, you may have to stay on them for longer than this.
When it is time to stop, you should come off them slowly with the
advice of your doctor.
People often worry that antidepressants are
addictive. Certainly, you may get withdrawal symptoms if you stop
an antidepressant suddenly. These can include anxiety, diarrhoea
and vivid dreams or even nightmares. This can nearly always be
avoided by slowly reducing the dose before stopping. Unlike drugs
such as Valium (or nicotine or alcohol), you don't have to keep
taking an increasing amount to get the same effect, and you will
not find yourself craving an antidepressant.
Antidepressants and young people
There are some limits to the use of
antidepressants for younger people, in their teens. There is
some evidence that SSRI antidepressants can increase suicidal
thoughts in young people, so there are limits on their use in this
age group. In the UK:
- Fluoxetine is the only SSRI antidepressant licensed for use
with young people.
- It should usually be used only in addition to a psychological
therapy.
- It should be given under the direction of a psychiatrist
- The young person should be seen every week at least for the
first 4 weeks.
You can find more detailed information in the
our leaflet on antidepressants.
Alternative remedies
St John's
Wort is a herbal remedy available from chemists. It is
widely used in Germany and there is evidence that it is effective
in mild to moderate depression. There are now one-tablet per day
preparations available. It seems to work in much the same way as
some antidepressants, but some people find that it has fewer
side-effects. One problem is that it can interfere with the way
other medications work. If you are taking other medication, you
should discuss it with your doctor.
Which is right for me - talking or
tablets?
It depends on how your depression has
developed and how bad it is. On the whole, talking treatments have
been found to help in mild and moderate depression. Medication is
not thought to be helpful in mild depression. If your depression is
severe, you are more likely to need antidepressant medication,
usually for a period of 7-9 months.
People often find that it is useful to have
some form of psychotherapy after their mood has improved with
antidepressants. It can help you to work on some of the things in
your life that might otherwise make you become depressed again.
So, it may not be a case of one treatment or
the other, but what is most helpful for you at a particular time.
Both talking treatments and antidepressants are about equally
effective in helping people get better from moderate depression.
(see references). Many psychiatrists believe that antidepressants
are more effective in treating severe depression.
Some people just don't like the idea of
medication, some don't like the idea of psychotherapy. So, there is
obviously a degree of personal choice. This is limited by the fact
that proper counselling and psychotherapy are not readily available
in some areas of the country.
When you are low it can be difficult to work
out what you should do. Talk it over with friends or family or
people you trust. They might be able to help you decide.
Will I need to see a
psychiatrist?
Probably not. Most people with depression get
the help they need from their GP. If you don't improve and
need more specialist help, you will be referred to a psychiatrist
or a member of the Community Mental Health Team. A psychiatrist is
a medical doctor who specialises in the treatment of emotional and
mental disorders. Community team members may be a nurse,
psychologist, social worker or occupational therapist. Whichever
profession they belong to, they will have specialist training and
experience in mental health problems.
The first interview with a psychiatrist will
probably last about an hour. You may be invited to bring a relative
or friend with you if you wish. The psychiatrist will want to find
out about your general background and about any serious illnesses
or emotional problems you may have had in the past. He or she will
ask about what has been happening in your life recently, how the
depression has developed and whether you have had any treatment for
it already. It can sometimes be difficult to answer all these
questions, but they help the doctor to get to know you as a person
and to get an idea of what would be good options for you.
This might be practical advice, or suggesting
different treatments, perhaps involving members of your family. If
your depression is severe or needs specialist treatment, you might
need to come into hospital – but this is only needed for one in
every 100 people with depression.
What will happen if I don’t get any
treatment?
The good news is that 4 out of 5 people with
depression will get completely better without any help in about 4-6
months - sometimes more. So, why bother to treat depression?
Although 4 out of 5 people get better in time,
this still leaves 1 in 5 who are still depressed two years later.
As yet, we can't accurately predict who will get better and who
will not. Even if you get better eventually, the experience can be
so unpleasant that you may feel that you want to shorten the time
you are depressed. Moreover, if you have a first episode of
depression, you have a roughly 50:50 chance of having another one.
A small number of people with depression will eventually commit
suicide.
Taking up some of the suggestions in this
leaflet may shorten a period of depression. If you can overcome it
by yourself, then that will give you a feeling of achievement and
confidence to tackle such feelings again if you feel low in the
future. However, if the depression is severe or goes on for a long
time, it may stop you from being able to work and enjoy life.
How can I help someone who is
depressed?
- Listen. This can be harder than it sounds.
You may have to hear the same thing over and over again. It's
usually best not to offer advice unless it's asked for, even if the
answer seems perfectly clear to you. If depression has been brought
on by a particular problem, you may be able to
help find a solution or at least a way of tackling the
difficulty.
- It's helpful just to spend time with someone
who is depressed. You can encourage them, help them to talk, and
help them to keep going with some of the things they normally
do.
- Someone who is depressed will find it hard to
believe that they can ever get better. You can reassure them that
they will get better, but you may have to repeat this over and over
again.
- Make sure that they are buying enough food
and eating enough.
- Help them to stay away from alcohol.
- If they are getting worse and start to talk
of not wanting to live or even hinting at harming themselves, take
them seriously. Make sure that they tell their doctor.
- Encourage them to accept help. Don't
discourage them from taking medication, or seeing a counsellor or
psychotherapist. If you have worries about the treatment, then you
may be able to discuss them first with the doctor.
References
Randomised controlled trial of problem solving
treatment, antidepressant medication, and combined treatment for
major depression in primary care.
British Medical Journal (2000); 320:26-30
bmj.com/cgi/content/full/320/7226/26
Natural history and preventative treatment of
recurrent mood disorders.
Thase FE. Annual Review of Medicine (1999);
50:453-468.
med.annualreviews.org/cgi/content/full/50/1/453
NICE Clinical guideline 23 Depression -
Management of depression in primary and
secondary care. December 2004 National
Institute for Clinical Excellence, London
www.nice.org.uk/page.aspx?o=235213
NICE Clinical guideline 23 The treatment of
depression in children and young people. September 2005,
National Institute for Clinical Excellence, London
www.nice.org.uk/guidance/index.jsp?action=byID&o=10970
Effectiveness of antidepressants: evidence
based guidelines for treating depressive disorders with
antidepressants
Anderson IM et al. (2000); Journal of
Psychopharmacology 14 (1): 3-20.
jop.sagepub.com/cgi/content/abstract/14/1/3
Problems stopping: antidepressant
discontinuation reactions
British Medical Journal; (1998)
316:1105-1106.
bmj.com/cgi/content/full/316/7138/1105
Cannabis and mental health (2002) Rey and
Tennant, BMJ 325 (7374): 1183.
Other organisations
Association for Postnatal
Depression: Helpline: 020 7386 0868
(10am- 2pm Mon, Weds and Fri and 10am- 5pm, Tues and Thurs).
http://apni.org/
Provides support to mothers suffering from
post-natal illness. It exists to increase public awareness of the
illness and to encourage research into its cause and nature.
Aware- Helping to
defeat depression: Helpline: 00 353 1 90
303 302; Tel: 00 353 1 661 7211. http://www.aware.ie/ Provides
information and support to people affected by depression in Ireland
and Northern Ireland.
Depression
Alliance: Tel: 0845 123 23 20;
http://www.depressionalliance.org/;
email:
information@depressionalliance.org
Information, support and understanding for
people who suffer with depression, and for relatives who want to
help. Self-help groups, information, and raising awareness for
depression.
Depression UK:
(Previously the Fellowship of Depressives Anonymous) http://www.depressionuk.org/;
Email: info@depressionuk.org
A national mutual support group for people
suffering from depression.
MDF
The Bipolar Organisation: Tel: 08456 340 540; http://www.mdf.org.uk/; email;
mdf@mdf.org.uk.
A user-led charity working to enable people
affected by bipolar disorder (manic depression) to take control of
their lives.
MDF The Bipolar Organisation
Cymru: Helpline: 08456 340 080; Tel: 01633 244244;
Fax: 01633 244111; http://www.mdfwales.org.uk/;
Email: info@mdfwales.org.uk
Works to enable people affected by manic
depression to take control of their lives through self-help groups
and information on all aspects of the condition.
National Association for Premenstrual
Syndrome: Phone/Fax: 0870 777 2178; http://www.pms.org.uk/
Medical charity providing information,
advice and support to women affected by PMS, their partners and
families.
Relate: Tel:0845 456 1310;
http://www.relate.org.uk/;
email: enquiries@relate.org.uk
UK's largest and most experienced
relationship counselling organisation.
Samaritans: Helpline:
08457 90 90 90; (Ireland): 1850 60 90 90; http://www.samaritans.org/;
e-mail: jo@samaritans.org
National organisation offering support to
those in distress who feel suicidal or despairing and need someone
to talk to. The telephone number of your local branch can be found
in the telephone directory.
SaneLine: Tel.
0845 767 8000; http://www.sane.org.uk/SANEline
A national out-of-hours telephone helpline
offering emotional support and information for people affected by
mental health problems. Open from 6pm to 11pm every day of the
year.
Young Minds: Tel:
020 7336 8445; http://www.youngminds.org.uk/
A national charity committed to improving the
mental health of all children and young people under 25. Special
web pages for young people at http://www.youngminds.org.uk/young-people/
This leaflet was produced by the Public
Education Editorial Board of the Royal College of Psychiatrists
with support from Depression Alliance.
Series Editor: Dr Philip Timms
Expert Review: Dr David Baldwin
Editorial Board: Dr Ros Ramsay, Dr Martin
Briscoe, Deborah Hart, Ashok Kumar
User and Carer input: Royal College of
Psychiatrists Special Committee of Patients and Carers
Illustration by Lo Cole/Inshed.co.uk
This leaflet was produced by the Royal College of Psychiatrists'
Public Education Editorial Board.
Series Editor: Dr Philip Timms.
Updated: May 2008 (links updated)
Information about treatments can change rapidly and the College
updates its mental health information leaflets regularly.
© May 2008
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 is gained from its use. Permission to reproduce it in
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For a catalogue of public education materials or copies of our
leaflets contact: Leaflets Department, The
Royal College of Psychiatrists, 17 Belgrave
Square, London SW1X 8PG. Telephone: 020 7235 2351
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in Scotland SC038369.
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