Many of us will suffer from depression at some point in our lives
- recognise depression as a cause of low mood
- understand that insomnia may be due to depression
- get treatment and reassurance
With Dr Morton’s - the medical helpline© you can email or phone a real doctor at any time for more information, reassurance or advice
What's the difference between low mood and real depression?
Depression is a serious illness affecting the physical working of the brain whereas we can all have low mood for one reason or another. Almost anyone can get a depressive illness if enough things go wrong in their lives. It can affect even the most talented and high achieving people. If you are feeling depressed then it is helpful to know that there are very effective treatments available and that many people who have felt as you do now are in the process of recovering, or have recovered.
At some point in our lives, at least one in ten of us (some studies suggest as many as one in three) will develop depression. Unless we've had experience of it most of us don't really understand what it is. We know what it's like to feel sad, stressed and anxious when things are difficult, but within a week or two we’ll be back to normal.
Clinical depression is different. It is a very unpleasant, disabling, and serious illness. Most sufferers experience very strong feelings of sadness and misery most of the time and are not cheered up when good things happen. It is not possible to 'snap out of it' or 'pull yourself together'. Saying things like this to a depressed person will only make them feel worse. They need understanding, support and the right treatment to get better. The good news is that there are very effective treatments.
Psychological symptoms of depression
- feeling sad or tearful most of the time
- low mood and feeling helpless with no hope for the future
- feeling guilty or worthless
- losing interest in things and not getting enjoyment out of life
- poor concentration perhaps leading to difficulty remembering things
- difficulty in making decisions
- feeling anxious or worried
- having suicidal thoughts or wanting to harm yourself
Physical symptoms such as insomnia
- insomnia or disturbed sleep - this may be difficulty in getting to sleep and/or waking up very early and not being able to get back to sleep. Some people find they sleep much more than usual.
- appetite disturbance - you may lose your appetite and as a result lose weight. Sometimes your appetite can increase and you may gain weight.
- life seems to slow down and you might move/speak more slowly than usual
- low sex drive
- feeling much worse in the morning when you wake up with your mood improving a little as the day goes on or mood swings for no obvious reason
- unexplained aches and pains
- changes in menstrual cycle
When you should ring a doctor
If you think you are suffering from depression then you should ring a doctor straight away. It is particularly important to get advice straight away if you have thoughts of suicide or self-harm.
There are very effective treatments: both talking therapies and medication. These should be combined with advice on taking exercise, eating healthily, and structuring your day. More severe depression will require referral to a specialist mental health service.
The first person to see is your GP who will make sure that your symptoms are not due to a physical illness, and who will assess the type and severity of your depression. He or she will check for other psychological symptoms such as excessive anxiety that can go with depression.
There are a lot of different types of talking treatments that are now available. It can be difficult to know what is involved, and which will suit you best.
Counselling - a counsellor will help you think about the problems you are currently experiencing and support you in finding solutions or ways of dealing with difficulties rather than telling you what to do
Cognitive Behavioural Therapy (CBT) - this is a widely used, effective treatment for depression, anxiety and many other conditions. Many therapists and counsellors are trained to use this. Whilst it recognises that early events may have shaped your thinking patterns - particularly negative ones - it concentrates more on how negative thoughts can influence your mood and feelings and behaviour in the present. For example when you have negative thoughts it tends to make you feel unhappy and as a result you may stay in more and isolate yourself from friends and family. This social isolation can add to feelings of depression. CBT encourages you to adjust negative and self-defeating thoughts and beliefs by challenging them and choosing more rational and realistic ones. It also encourages you to increase pleasant and positive activities which can have a positive effect on your mood.
Mindfulness based CBT (MBCBT) - this is particularly effective for treating recurrent depression and is recommended by NICE (National Institute for Clinical Excellence). It emphasises the concept of mindfulness which is paying attention in the present moment on purpose and non-judgementally. It combines mindfulness techniques like meditation and breathing exercises with elements of CBT to help break the negative thought patterns characteristic of recurrent depression.
An additional benefit of CBT is that it halves your risk of future problems (whereas taking antidepressants doesn't reduce your risk of relapse). If your depression is more severe you may not initially be able to cope with the work required in CBT and you may need to wait until your depression has lifted a little (usually with the help of medication), rest and regular reviews by specialist services and other supportive measures.
Interpersonal Psychotherapy (ITP) - this focuses on your relationships with other people and on problems you may be having in your relationships such as difficulties with communication or coping with bereavement. There is some evidence that IPT can be as effective as antidepressants or CBT.
Treatments for depression using medication aim to readjust the balance of neurotransmitters in your brain to bring your mood back to normal. There are newer, effective antidepressants called SSRIs (selective serotonin re-uptake inhibitors) which are safer in over-dosage than the older tricyclic antidepressants.
Some people don't want to take tablets, but for many people they are a life saver. Keep an open mind and give them a proper chance to work, because they are very effective for many people. Your doctor may have to try two or even three different types to find the one that suits you best and is most effective.
Psychotherapy combined with medication is more effective, with less chance of relapse, than medication alone - so make sure that you get both if your doctor advises.
Most people find their GP helpful and knowledgeable about this condition, but occasionally this isn't the case. If you don't find your GP easy to talk to then you can ask to see another one. Most practices are happy to arrange this. If you don't think he/she understood how unwell you feel then make another appointment and take a friend and explain again. Alternatively you could ring to speak to a GP at Dr Morton’s and they may help point you in the right direction.
Sometimes there can be a wait for the talking therapies and you could potentially arrange to see someone privately. Ask for a recommendation or look on The British Association for Counselling and Psychotherapy website where you'll find a list of accredited counsellors in your area.
Most people with mild/moderate depression will not need referral to specialist mental health services and your GP will have access to psychological treatments in primary care.
Over the past 15 years there has been a huge increase in availability of psychological treatments in primary care including IAPT (Improving Access To Psychological Therapies) and some of these are self-referral so you don't need to go to your doctor first. You may be able to choose which talking therapy you would like - Counselling, CBT or Interpersonal Psychotherapy (ITP)
More information about depression
Everyone is different and depression can affect different people in different ways. You are not likely to be experiencing all the same symptoms as others do, and the impacts they have on your life may be different. If you have most or many of the above symptoms and your work and/or home life have been affected for more than two weeks then you may well have depression. It can develop slowly, and may start with a feeling that things are getting out of control. By the time you realise what's happening you may be too unwell to get help on your own. Tell your family or friends and they will help you. This is the first step on the road to getting better.
There are a few physical illnesses: for instance thyroid disease, Addison's disease, chronic fatigue syndrome (ME) and even glandular fever (infectious mononucleosis) which share some of the same symptoms as depression, including tiredness and lack of energy. For this reason your doctor may want to check your general health as well.
There is no one thing that causes depression. Lots of different things can play a part
- stressful life events: bereavement and divorce, losing your job, serious money worries and moving house are all at the top of the list, but there are many more
- physical illness: having a serious or life threatening physical illness such as cancer, heart disease, head injury and a bad dose of flu
- early life experiences: traumatic or unhappy experiences or losses in childhood - for example losing a parent or experiencing abuse - can make depression more likely some years later
- gender: women are more likely than men to get depression, although the gap is closing especially in people over 35 years old
- alcohol: some people self-medicate with alcohol when they feel down. It can help us feel more relaxed and forget our worries for a while, but it’s not an antidepressant. It actually is a central nervous system depressant and can make us more depressed. Some people develop a serious alcohol or other drug problem in this way
- personality: depression can be associated with a variety of personality traits, including: intelligence, creativity, sensitivity, reliability, courage. Having low self-esteem and being self-critical are associated with increased risk of depression
Any of these factors can combine to cause depression, leading to changes in the physical functioning of the brain. Amounts of chemicals (called neurotransmitters) in the brain can change, altering our mood. A recent finding is that when people are depressed there are changes in the way that their memory works too. Positive memories are recalled more slowly than usual whereas negative ones are not slowed, so a depressed person will tend to remember more negative things.
These days many people - famous and otherwise - are helping break the taboo on talking about mental health.
Postnatal depression (PND) is a type of depression that is associated with pregnancy. It frequently happens within one to two months after giving birth, but in some cases it can also start during the pregnancy. It is a common problem, affecting 10 - 15% of new mothers. As well as experiencing typical symptoms of depression, women may feel overly anxious about their baby, or have the very distressing sensation of not bonding with or not loving their baby.
Most women do get better without treatment, but it is far better to address postnatal depression when it first starts, to avoid going through months of unhappiness and suffering. Speaking to a GP is a good place to start.
Some people tend to get depressed in the winter months. At its extreme, this is called ‘seasonal affective disorder’ (SAD for short). This condition is at its worst when sunlight is most scarce, which coincides with that stressful time of year, Christmas. It happens most commonly to those living in the Northern hemisphere, having been born and brought up nearer the equator.
The treatment of SAD involves getting a full spectrum light source (mimicking sunlight without the harmful UV rays) and taking regular aerobic exercise, preferably out of doors. SAD lamps are available from various vendors.
If a parent or sibling has had depression, it is not inevitable that you will too, but you have more of a chance of developing it. There is definitely an hereditary predisposition but there is no identified gene.
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