Depression

Written by Dr Hamish McAllister-Williams, MRC clinical scientist, senior lecturer and honorary consultant psychiatrist

What is depression?

The word 'depression' causes much confusion. It is often used to describe when someone is feeling 'low', 'miserable', 'in a mood', or having 'got out of bed on the wrong side'. However, doctors use the word in two different ways. They can use it to describe the symptom of a 'low mood', or to refer to a specific illness, ie a 'depressive illness'. This factsheet, relates to depression - the illness.

This confusion is made all the worse because it is often difficult to tell the difference between feeling gloomy and having a depressive illness. Doctors make a diagnosis of depression after assessing the severity of the low mood, other associated symptoms and the duration of the problem.

Depression is very common. Almost anybody can develop the illness; it is certainly NOT a sign of weakness. Depression is also treatable. You may need to see a doctor, but there are things you can do yourself or things you can do to help somebody suffering from the illness. What you cannot do is 'PULL YOURSELF TOGETHER' - no matter whether this is what you think you should be able to do, or what other people tell you to do.

People who have experienced an episode of depression are at risk of developing another in the future. A small proportion may experience an episode of depression as part of a bipolar affective disorder (manic depression) that is characterised by episodes of both low and high moods.

Who gets depressed?

Depression is very common.

Between 5 and 10 per cent of the population are suffering from the illness to some extent at any one time.

Over a lifetime you have a 20 per cent, or one in five, chance of having an episode of depression.

Women are twice as likely to get depression as men.

Bipolar affective disorder is less common than depressive illness with a life-time risk of around 1-2 per cent. Men and women are equally affected.

Getting depression is not a sign of weakness. There are no particular 'personality types' that are more at risk than others. However, some risk factors have been identified, these include inherited (genetic) factors, such as having parents or grandparents who have suffered from depression and non-genetic factors such as the death of a parent when you were young.

What causes depression?

We do not fully understand the causes of depression.

Genes or early life experiences may make some people vulnerable.

Stressful life events, such as losing a job or a relationship ending, may trigger an episode of depression.

Depression can be triggered by some physical illnesses, drug treatments and recreational drugs.

It is often impossible to identify a 'cause' in many people and this can be distressing for people who want to understand the reasons why they are ill. However depression, like any illness, can strike for no apparent reason.

It is clear that there are definite changes in the way the brain works when a person is depressed:

Modern brain scans that can look at how 'hard' the brain is working have shown that some areas of the brain (such as at the front) are not working as well as normal.

Depressed patients have higher than normal levels of stress hormones.

Various chemical systems in the brain may not be working correctly including one known as the serotonin or 5-HT system.

Antidepressants may help to reverse these changes.

Symptoms of depression

Stress can lead to you to feeling 'down' and 'miserable'. What is different about a depressive illness is that these feelings last for weeks or months, rather than days. In addition to feeling low most or all of the time, many other symptoms can occur in depressive illness (though not everybody has every one).

Being unable to gain pleasure from activities that normally would be pleasurable.

Losing interest in normal activities, hobbies and everyday life.

Feeling tired all of the time and having no energy.

Difficulty sleeping or waking early in the morning (though some feel that they can't get out of bed and 'face the world').

Having a poor appetite, no interest in food and losing weight (though some people overeat and put on weight - 'comfort eating').

Losing interest in sex.

Finding it difficult to concentrate and think straight.

Feeling restless, tense and anxious.

Being irritable.

Losing self-confidence.

Avoiding other people.

Finding it harder than usual to make decisions.

Feeling useless and inadequate - 'a waste of space'.

Feeling guilty about who you are and what you have done.

Feeling hopeless - that nothing will make things better.

Thinking about suicide - this is very common. If you feel this way, talk to somebody about it. If you think somebody else might be thinking this way, ask them about it - IT WILL NOT MAKE THEM MORE LIKELY TO COMMIT SUICIDE.

How is depression diagnosed?

Unfortunately there is no brain scan or blood test that can be used to diagnose when a person has a depressive illness. The diagnosis can only be made from the symptoms. Generally speaking a diagnosis of depression will be made if a person has a persistently low mood that significantly influences their everyday life and has been present for two weeks or more, and there are also three or four or more other symptoms of depression.

Who treats people with depression?

General practitioners (GPs), most commonly help treat people with depression.

Patients may also be seen by counsellors, who are often attached to GP surgeries.

If the diagnosis is unclear, or the person is particularly ill, the GP may refer the patient to a psychiatrist.

Patients may be referred to community psychiatric nurses (CPNs) by their GP or psychiatrist.

People suffering from depression may also be seen by psychotherapists.

Treatments for depression

Sometimes when we are going through a 'bad patch' in our life, it is enough to talk through our problems with a friend or relative. However, this may not be enough and we may need to seek professional help. The important thing to remember about depression is that it is treatable. There are many different types of treatment. These include medication and talking therapies (psychotherapy).

Psychotherapy

There are many different forms of psychotherapy.

Simply talking to somebody or your doctor about your problems is a form of psychotherapy and can help greatly.

It is far better to talk about your problems than 'bottling-up' your emotions.

More formal psychotherapy includes counselling, cognitive behavioural therapy (CBT), interpersonal psychotherapy (IPT) and dynamic psychotherapy or psychoanalysis. To read more about treatments click here.

As a general rule psychotherapies are as effective as medication for the treatment of mild depression. However, for more severe illnesses, medication is likely to be needed but this may be supplemented with psychotherapy.

Exactly which type of therapy a doctor recommends depends on the particular problems a patient is suffering from, the views of the patient and local availability of psychotherapy. There is little evidence to suggest that one form of therapy is better than another.

Go To Next Page>>



The documents contained in this web site are presented for information purposes only. The material is in no way intended to replace professional medical care or attention by a qualified practitioner. The materials in this web site cannot and should not be used as a basis for diagnosis or choice of treatment. Conditions for use



© Copyright 1998 - 2004 NetDoctor.co.uk - All rights reserved