Depression
What depression is, how it is recognised, and an honest overview of what helps, from practical steps through to therapy and medication.
Depression is one of the most common reasons people see a doctor, and one of the most treatable. It is not a weakness, a character flaw, or something you can simply snap out of. If you recognise yourself in this guide, please know that most people with depression get better, and that asking for help is the right thing to do.
If you need help right now
If you are having thoughts of ending your life, or feel unable to keep yourself safe, please do not wait for a routine appointment.
- Call 999 or go to A&E if your life is in immediate danger
- Call NHS 111 and choose the mental health option, available 24 hours a day
- Call Samaritans free on 116 123, any time, day or night
- Text SHOUT to 85258 for free, confidential text support
What is depression?
Everyone has spells of feeling low. Depression is different in its persistence, its depth, and its impact. It involves low mood or a loss of interest and pleasure, present most of the day on most days for at least two weeks, alongside other symptoms that affect how you think, how your body feels, and how you function.
How common is it?
Around one in six adults in England reports symptoms of a common mental health problem such as depression or anxiety in any given week. Depression can affect anyone, at any age, including people whose lives look fine from the outside.
Source: Adult Psychiatric Morbidity Survey, NHS England.
Symptoms
Depression looks different from person to person. Not everyone feels sad. Some people mainly notice exhaustion, irritability, or a sense that nothing is enjoyable any more.
How you feel
- Persistent low mood or sadness
- Loss of interest or pleasure in things you usually enjoy
- Feeling hopeless, worthless, or guilty
- Irritability or feeling tearful
- Feeling numb or empty
How you think
- Poor concentration and indecision
- Harsh self criticism
- Expecting the worst
- Feeling like a burden to others
- Thoughts of self harm or suicide
Your body
- Tiredness and low energy
- Sleeping too little or too much
- Changes in appetite or weight
- Moving or speaking more slowly, or feeling restless
- Reduced sex drive
- Unexplained aches and pains
What you do
- Withdrawing from friends and family
- Struggling at work or with everyday tasks
- Neglecting hobbies and self care
- Drinking more alcohol than usual
Why it happens
There is rarely a single cause. Depression is best understood as the result of several factors combining, and sometimes it arrives with no obvious trigger at all. The idea of a simple chemical imbalance is an oversimplification.
Life events and stress
Bereavement, relationship breakdown, money worries, job loss, loneliness, and prolonged stress at work or at home.
Biology and family history
Depression runs in families to some degree. Having a close relative with depression raises your risk, but does not make it inevitable.
Physical health
Long term pain or illness, thyroid problems, low vitamin B12, anaemia, the menopause, and the period after childbirth can all contribute.
Medication, alcohol and drugs
Some prescribed medicines can lower mood. Alcohol and recreational drugs commonly cause or worsen depression.
Early experiences
Difficult or traumatic experiences in childhood increase vulnerability to depression later in life.
Other conditions
Depression is more common in people with ADHD, autism, anxiety disorders, and OCD, and can be the first thing that brings these to light.
How it is assessed
There is no blood test or scan for depression. Diagnosis is based on a conversation about how you have been feeling, how long for, and how it is affecting your life. We will also ask, sensitively and directly, about thoughts of self harm or suicide. Asking does not put the idea in your head, and being honest helps us support you properly.
Questionnaires
We often use the PHQ-9, a nine question tool that scores how often you have had key symptoms over the past two weeks. It helps gauge severity and track progress over time. It supports a diagnosis but does not make one by itself.
Checking for physical causes
Depending on your symptoms, we may suggest blood tests to rule out contributors such as thyroid problems, anaemia, vitamin deficiencies, or diabetes, and review any medication you take.
Depression is often described as less severe or more severe. This matters because the recommended starting treatments differ between the two.
What you can do
None of the suggestions below is a cure, and when you are depressed even small things can feel enormous. They are worth trying because each one has evidence behind it, and they work alongside any other treatment.
Keep doing things, even in small amounts
Depression drains motivation, and doing less tends to deepen low mood. Planning small, achievable activities and doing them whether or not you feel like it is the basis of behavioural activation, a well evidenced treatment in its own right.
Move your body
Regular physical activity has good evidence for improving mild to moderate depression. It does not need to be intense. A daily walk outdoors counts.
Protect your sleep
Keep regular bed and wake times, get daylight in the morning, and avoid long daytime naps. Poor sleep and low mood feed each other.
Go easy on alcohol
Alcohol is a depressant. It can feel like it helps in the moment but reliably worsens mood, sleep, and anxiety over the following days.
Stay connected
Isolation makes depression worse. You do not need to explain everything. Simply spending time with someone you trust helps.
Put off big decisions
Depression distorts how you see yourself and your future. Where you can, delay major life decisions until you are feeling more like yourself.
Talking therapies
Talking therapies are a first line treatment for depression of any severity. For less severe depression, NICE recommends them ahead of medication unless you would prefer otherwise.
Options with good evidence include:
- Guided self help, working through structured materials with support from a practitioner
- Cognitive behavioural therapy (CBT), individually or in a group
- Behavioural activation
- Interpersonal therapy (IPT)
- Counselling for depression
- Mindfulness based cognitive therapy, particularly for preventing relapse
In England you can refer yourself to NHS Talking Therapies without seeing a GP first. Waiting times vary by area. Private therapy is also an option, and we can help you find a suitably accredited therapist.
Antidepressants
Antidepressants are most clearly helpful in more severe depression, where NICE recommends a combination of an antidepressant and CBT as one of the most effective options. They can also be a reasonable choice in less severe depression if that is your preference or other approaches have not helped. The most commonly used are SSRIs such as sertraline, citalopram, and fluoxetine.
What to expect
- They take time. Some benefit is usually noticeable within two to four weeks, with further improvement after that
- Early side effects such as nausea, headache, disturbed sleep, and feeling jittery are common and usually settle within a couple of weeks
- Some side effects, including reduced sex drive and emotional flatness, can persist. Tell us, because there are alternatives
- They are not addictive in the way that sedatives or alcohol are, but they should not be stopped suddenly
- Once you are well, it is usual to continue for at least six months to reduce the risk of relapse
- When the time comes to stop, the dose is reduced gradually to minimise withdrawal symptoms
Important: In the first few weeks of starting or changing the dose of an antidepressant, some people, particularly those under 25, feel more anxious or agitated, or notice new or stronger thoughts of self harm. If this happens, contact us or NHS 111 urgently. This is why we arrange an early review after starting treatment.
Common questions
Short answers to the questions we are asked most often.
What are the symptoms of depression?
The core symptoms are persistent low mood or a loss of interest and pleasure, present most of the day on most days for at least two weeks. Others include tiredness, poor sleep, changes in appetite, poor concentration, feelings of guilt or worthlessness, and thoughts of self harm.
How is depression diagnosed?
There is no blood test or scan. Diagnosis is based on a conversation with a doctor about how you have been feeling, for how long, and how it is affecting your life. A questionnaire called the PHQ-9 is often used to gauge severity, and blood tests may be suggested to rule out physical causes.
How long do antidepressants take to work?
Some benefit is usually noticeable within two to four weeks, with further improvement after that. Early side effects such as nausea, headache, and disturbed sleep are common and usually settle within a couple of weeks. Once you are well, treatment is usually continued for at least six months.
Is therapy or medication better for depression?
Both work. For less severe depression, NICE recommends talking therapies such as guided self help or CBT ahead of medication unless you would prefer otherwise. For more severe depression, a combination of an antidepressant and CBT is one of the most effective options.
Where can I get urgent help for depression in the UK?
If your life is in immediate danger call 999 or go to A&E. You can call NHS 111 and choose the mental health option at any time, call Samaritans free on 116 123, or text SHOUT to 85258 for free, confidential text support.
Next steps
If low mood has lasted more than two weeks, or is affecting your work, relationships, or ability to cope, please talk to a doctor. An appointment with us is unhurried and confidential, and there is no pressure to choose any particular treatment.