Depression

Depression is a common mental health condition. Unlike the ups and downs of ordinary life, low mood or loss of interest and pleasure lasts most of the day, nearly every day, for at least two weeks, and gets in the way of work, study and relationships.

It may happen once or return in episodes. It affects people of every age and background, and it can be treated.

• Feeling low, empty or irritable most of the day
• Losing interest or pleasure in things that used to matter
• Poor sleep, or sleeping far more than usual
• Tiredness and low energy, even after rest
• Eating much less or much more, with weight change
• Difficulty concentrating, remembering or deciding
• Feeling worthless, or heavily guilty
• Body aches or stomach trouble with no clear cause
• Thoughts of death, of self-harm or of suicide

Many people notice the physical symptoms first, such as tiredness or body pain, and only later recognise the low mood behind them.

See a doctor within a few days if low mood or loss of interest has lasted more than two weeks, if sleep, appetite or energy are badly disturbed, if daily life has become difficult, if low mood follows childbirth, or if treatment is not helping.

Depression comes from a mix of social, psychological and biological factors. Difficult life events matter: bereavement, loss of work, money worries, violence, abuse, loneliness and long-term illness or pain.

Physical and mental health affect each other, so thyroid disease, anaemia, long-term pain, some medicines, alcohol and drug use can bring on or worsen depression.

• A previous episode of depression, or a family history of it
• Bereavement, separation, job loss or financial stress
• Abuse, violence or neglect, in childhood or later
• Long-term illness, disability or persistent pain
• Pregnancy and the months after childbirth
• Loneliness, alcohol or drug use

Untreated depression affects work, study, income and relationships, and makes other illnesses such as diabetes and heart disease harder to manage because self-care slips. Alcohol and drug use often increase.

The most serious risk is suicide, which is why thoughts of suicide or self-harm are treated as an emergency.

• Keeping in touch with family and friends rather than withdrawing
• Keeping a regular routine for sleeping, eating and activity
• Being physically active, even a daily walk
• Limiting alcohol, and not using drugs
• Speaking to someone trusted early, before things build up
• Treating long-term physical illness and pain properly

There is no blood test for depression. The diagnosis comes from a conversation about mood, sleep, appetite, energy and how long the symptoms have lasted, sometimes helped by a short questionnaire.

The doctor asks directly about thoughts of self-harm, because that changes how urgently help is arranged. Blood tests may check for thyroid disease or anaemia, which can look similar, and the doctor asks about periods of unusually high mood or energy, which point to a different condition.

Talking treatments are the first choice and they work: cognitive behavioural therapy, which examines the link between thoughts, feelings and behaviour, behavioural activation, which rebuilds daily activity step by step, and interpersonal and problem-solving therapy.

Antidepressant medicines are used for moderate and severe depression, often together with therapy. They are not needed for mild depression and are not the first choice for children. They take a few weeks to work, and are reduced slowly rather than stopped suddenly.

Alongside treatment, contact with people, a steady routine, daily activity and avoiding alcohol all help. Severe depression that does not respond is managed by a specialist mental health team.