Depression
This factsheet might be useful to you if you have depression or if you think
you might have depression. It gives information on the symptoms and
causes of depression, as well as the treatments the NHS may offer you. It
can also help you if you‟re a carer, friend or relative of someone with
depression.

Common signs of depression include feeling low, feeling bad about
yourself and not wanting to do things.

People have different experiences of depression - it affects different
people in different ways.

If you think you might be depressed you should speak to your GP.

It is common for doctors to say depression is 'mild', 'moderate' or
'severe'. Your doctor might offer you different treatments depending
on how bad they think your illness is.

Depression is normally treated with medication, therapy or
counselling.

Nobody knows what causes depression. Family history, upbringing,
stressful events and your lifestyle can all affect your risk.

If you feel low, try to get enough sleep and to eat well if you can. It
is also important to try to keep active, even if you don't feel like it.
This factsheet covers:
1.
2.
3.
4.
5.
6.
7.
8.
9.
What is depression?
What are the symptoms of depression and how is it diagnosed?
What are the different types of depression?
What causes depression?
How is depression treated?
What treatment should I be offered?
What if I am not happy with my treatment?
What risks and complications can depression cause?
Information for family, carers and friends
1
Top
1. What is depression?
Everyone has ups and downs - sometimes you might feel a bit low, or
experience grief when you lose someone you love. It is common for
people to say that they are 'depressed' when they are feeling down, but
this does not mean that they have depression.
Depression is a long lasting low mood that affects your ability to do
everyday things, feel pleasure, or take interest in activities.
Depression is:

a mental illness that is recognised worldwide.

common. It affects about one in ten of us.

something that anyone can get.

treatable.
Depression is not:

something you can 'snap out of.'

a sign of weakness.

something that everyone experiences.

something that lasts forever.
How common is depression?
Depression can affect people of any age, including children, and it is one
of the most common mental illnesses. About one in ten people will be
diagnosed with depression in their life. 1 The number of people who
actually experience depression may be higher than this. More women are
diagnosed than men. This could be because women are more likely to
seek help. 2
Top
2. What are the symptoms of depression and how is it diagnosed?
Doctors make decisions about diagnosis based on guidance. The main
guidance used by NHS doctors is the International Classification of
Diseases (ICD-10).
When you see a doctor, like your GP or a psychiatrist, they will look for the
symptoms that are set out in the ICD-10 guidance. You do not have to
have all of these to be diagnosed with depression - you might have just a
few of them.
The symptoms of depression are: 3

low mood and feeling sad,

less energy and feeling less able to do things,
2

losing interest in activities you used to enjoy,

loss of concentration,

becoming tired easily,

sleeping and eating less,

feeling less good about yourself (loss of confidence),

feeling guilty or worthless,

losing interest in sex, and

thoughts of self-harm or suicide, and making suicide attempts.
Top
3. What are the different types of depression?
You might have heard a number of terms used to describe depression. In
this section, we explain what some of these terms mean.
Clinical depression
Clinical depression is a very common term but it is not a diagnosis. It just
means that a doctor has given you a diagnosis.
Depressive episode
Your doctor might say that you are going through a 'depressive episode'.
This is the formal name that doctors give depression when they make a
diagnosis. They may say that you are going through a 'mild', 'moderate' or
'severe' episode.
Recurrent depressive disorder
If you have had a number of 'depressive episodes', your doctor might say
that you have 'recurrent depressive disorder'. Again, they may say that
your current 'episode' is 'mild', 'moderate' or 'severe'.
Reactive depression
If your doctor thinks that your depression was caused by stressful events
in your life, they may say that it is 'reactive'.
Dysthymia
Your doctor might diagnose you with dysthymia if you have felt low for
several years but have never had symptoms that would be enough to
diagnose depression.
Manic depression
Manic depression is a different illness to depression. It is also known as
„bipolar disorder‟. People with this illness have severe highs (mania) and
lows (depression).
See our 'Bipolar Disorder' factsheet for more information. You can
download it for free at www.rethink.org/resources or phone 0300 5000 927
and ask for a copy.
3
Psychotic depression
If you are severely depressed, you may start to hallucinate or believe
things that aren't true. This is called 'psychosis'. For example, you might
start to hear voices that say that you are worthless and that things will
never improve, or you may start to believe that someone is poisoning your
food.
Post-natal depression
Postnatal depression is a common illness which affects between 10 to 15
in every 100 women who have had a baby. You may get symptoms that
are similar to those in other types of depression.
Seasonal affective disorder (SAD)
This type of depression affects you at the same time of year, usually in the
winter. The symptoms are similar to depression but you may sleep more
rather than less. You might also eat more carbohydrates like chocolate,
cakes and bread. 4
Top
4. What causes depression?
Nobody knows exactly what causes depression. This section looks at
some of the things that might increase your risk.
Your body
Scientists think that if you have depression, some of the chemicals in your
brain are out of balance. In particular, having lower amounts of a chemical
called 'serotonin' in your brain may cause depression.
Changes in your hormones can affect your mood. These changes might
be particularly noticeable for women during pregnancy or menopause.
The family connection
Depression seems to run in families. This could be because:
a) it is passed down in your genes, or
b) you have experienced other people's low moods.
Your background or situation
Problems during your childhood might cause depression. Bad experiences
can lead to you thinking negative thoughts about yourself or about the
world.
Stressful events, including problems at home, a breakup, the death of
someone you know, or losing your home or a job can also affect your
mood. Doctors sometimes call these 'triggers' or 'triggering events' if they
think that these problems have caused your depression.
4
Lifestyle
Good food, exercise and hobbies can make it less likely that you will
become unwell. Having other illnesses or using drugs or alcohol might
make it more likely. There is more information on these things below.
Food
If we eat badly then we may be at risk of physical health problems like
obesity, heart disease and diabetes. In the same way, the things we eat
may affect our moods and our risk of becoming mentally unwell. Some
people deal with their depression by eating high-fat and high-sugar foods.
This is called 'comfort eating', and it can make things worse in the long
term.
Some top tips include: 5

Eat regularly throughout the day,

Drink plenty of water,

Try to avoid too much caffeine - tea, coffee and chocolate,

Try to keep a healthy weight,

Eat fruit, vegetables and wholegrain cereals,

Don't drink too much alcohol.
If you have depression, eating well will probably not have an instant
impact on your mood. However, it might make you feel better in the long
term.
Exercise
Exercising regularly can help your mood. Finding something that you
enjoy doing is important so that you will want to keep it up. Exercise may
also help you to get to sleep. Getting proper sleep is important for your
mental health.
You can try increasing the amount of exercise you do gradually. The
amount you can do will depend on your age, physical health and your
fitness. We have listed some options below:

Going for a walk

Cycling

Gardening

Jogging

Playing a sport

Going to the gym
In some areas, you may be able to get 'exercise on prescription' from your
GP. For example, you could get some free sessions at a local gym.
5
Drug and alcohol use
Using drugs can affect the way your brain works. Scientists think that this
can have long lasting effects on you. Regularly drinking too much alcohol
may also cause depression. 6
There is more information on drugs and alcohol in our 'Drugs, Alcohol
and Mental Health' factsheet. You can download this factsheet for free at
www.rethink.org/resources or phone 0300 5000 927 and ask for a copy.
Other illnesses
You may feel low if you have a physical illness. This risk might be higher if
you have a long-term or life-threatening illness. Some people with brain
injuries and dementia will also have changes in their moods.
For more information on how to look after your physical health see our
‘Good health guide’. You can download this for free at
www.rethink.org/resources.
Top
5. How is depression treated?
The first step to getting treatment is to see your GP. They should rule out
any physical problems which might cause symptoms of depression.
Common treatments for depression include:
Talking therapies
Talking therapy is available on the NHS, from private healthcare providers
and sometimes from charities. You will meet a trained therapist for a fixed
number of sessions. Sometimes this will be with a group of people with
the same diagnosis as you.
There are many different types of talking therapy. According to the
National Institute of Health and Care Excellence (NICE), cognitive
behavioural therapy (CBT) is one of the most effective therapies for
depression. It should normally be available in your area.7
Other common therapies include:

Psychodynamic therapy,

Problem-solving therapy,

Interpersonal therapy, and

General counselling.
These therapies may not be widely available in your area but it is worth
asking your GP about them if you are interested.
Computerised cognitive behavioural therapy (CCBT)
Computerised cognitive behavioural therapy (CCBT) is a relatively new
way of treating mild to moderate depression. It is a way of learning CBT
6
techniques online through a computer. You will complete regular sessions
to learn new ways to deal with your depression.
In a lot of areas, the NHS uses CCBT programmes such as 'Beating the
Blues', 'COPE' and 'Overcoming Depression'. One of these, or something
similar, may be available free of charge through your GP.
Antidepressants
Your doctor might offer you an antidepressant. You may need to try
different types before you find one that works for you. Antidepressants can
have unpleasant side effects and can affect other medicines you are
taking. It is important to talk to your doctor before you stop taking them,
because stopping suddenly can cause problems.
Exercise Therapy
Having good physical health and exercising can help with depression.
Some GP surgeries will put you in touch with local exercise schemes.
These might sometimes be called 'exercise on prescription'.
Electroconvulsive therapy (ECT)
Electroconvulsive therapy (ECT) is a procedure sometimes used to treat
severe depression. In this treatment, an electrical current is briefly passed
through your brain while you are under general anaesthetic. ECT is only
offered if other kinds of treatments have not helped and your depression is
very severe.
Transcranial Magnetic Stimulation (TMS)
TMS involves using magnetic fields to try to change the way the brain
works. Scientists think that this could help people with depression and
does not cause any major safety concerns. 8
Complementary/ Alternative Therapies
Complementary therapies are treatments which are not part of mainstream
medical care. They can include aromatherapy, massage, mindfulness,
meditation and yoga. These are aimed at improving your emotional well
being.
You can find more information on these treatments in the following
factsheets:

'Antidepressants'

'Talking Therapies'

'Electroconvulsive Therapy (ECT)'

'Complementary Therapies'
These are available to download for free from www.rethink.org or by
contacting us directly on 0300 5000 927.
Top
7
6. What treatment should I be offered?
The National Institute of Health and Care Excellence (NICE) produces
guidance on what treatment doctors should offer you. However, your
doctor does not have to give you these treatments. These options might
not be available locally or your doctor might think that a different treatment
will be better.
Mild to moderate depression
Your doctor may offer you:

'low intensity' cognitive behavioural therapy (CBT) such as
guided self-help or computerised cognitive behavioural therapy
(CCBT). Your doctor may put you in touch with an 'IAPT'
(Improved Access to Psychological Therapies) service.

group CBT.

information about getting better sleep.

medication. However, the guidance is clear that the benefits of
using antidepressants for mild depression are small.
If these options do not work for you, your doctor might consider treating
you using the options for moderate to severe depression.
Moderate to severe depression
Your doctor may suggest:

an antidepressant - normally an 'SSRI' or

'high intensity' therapy such as one-to-one CBT or interpersonal
therapy (IPT).
Your doctor will decide which of these would be best, but they should ask
you which one of these you would prefer.
Severe and complex depression
If you:

are at risk of suicide,

drink too much or use drugs,

have other illnesses,

sometimes lose touch with reality ( called 'psychosis')
then your doctor might think about:

putting you in touch with specialist mental health services. This
could include the 'Crisis Team' and 'Community Mental Health
Team' or 'Recovery Team',

using treatments that haven't worked in the past if these were not
used effectively the first time,
8

using new treatments or a new mix of treatments,

whether you need to be in hospital,

using 'electro-convulsive therapy' (ECT) if your depression is lifethreatening or if most treatment options have not worked.
Top
7. What if I am not happy with my treatment?
If you are not happy with the treatment that your doctor has offered you
then you can:

try to resolve the issue with your doctor. An advocate might be
able to help you with this,

ask for a second opinion about your treatment,

contact your local Patient Advice and Liaison Service (PALS) to
see whether they can help resolve your problem,

make a complaint about the way you have been treated.
There is more detailed information on these options below.
'PALS'
If you ever feel unhappy with how your treatment or care is being handled,
or feel that the relationship between yourself and a professional is not
working well, you could call the Patient Advice and Liaison Service (PALS)
at your NHS trust. They can try to resolve any problems or questions you
have. You can find your local PALS‟ details at http://www.nhs.uk/ServiceSearch/Patient-advice-and-liaison-services-(PALS)/LocationSearch/363.
Advocacy
You might find a general/community advocate helpful if you are unhappy
with your treatment. Advocacy can help you understand the mental health
system and enable you to be fully involved in decisions about your care.
An advocate is someone independent from mental health services who
can help to make your voice heard when you are trying to resolve
problems. They may be able to help with writing letters for you or attending
appointments or meetings. You can find more information about advocacy
in our ‘Advocacy’ factsheet.
There may be a local advocacy service in your area which you can contact
for support. You can search online for a local service or the Rethink
Mental Illness Advice Service could search for you.
Your treatment
If you are not happy with your treatment, you can refer to the NICE
guidance to see if you are being offered the recommended treatments.
You can find all of their guidelines at www.nice.org.uk.
9
You can find out more about getting a second opinion, having a choice in
your medication or making a complaint at www.rethink.org/factsheets. You
can download our factsheets for free or call 0300 5000 927 and ask for a
copy to be sent to you.
Top
8. What risks and complications can depression cause?
Having depression can cause problems such as:

Difficulties sleeping

Problems with having sex

Not feeling able to work

Drinking or taking drugs.
If you have any of these problems, you might be able to get help to
overcome them from the NHS or social services.
Top
9.
Information for family, carers and friends
Support for you
As a carer, friend or family member of someone living with depression,
you might find that you also need support.
You can find information on dealing with the symptoms of depression,
such as withdrawing from other people, in our ‘Dealing with unusual
thoughts and behaviours’ factsheet. Our ‘Supporting someone with a
mental illness’ factsheet may also be useful.
It is important to seek emotional support for yourself if are struggling to
cope. You could check whether there are any local support groups for
carers, friends and relatives in your area.
If you feel you need additional support to care for your loved one you
could ask for a carer‟s assessment. You can find more information in our
„Carers Assessments’ factsheet.
If your loved one is supported by a mental health team and you are their
carer, you should be involved with decisions about care planning. There
are particular rules regarding confidentiality and carers. Unless the person
you care for consents, confidential information about them cannot be
passed on to you or other family, friends and carers. The team should
seek permission from them and ask what they are happy for others to
know. This would also include any care plans that are drawn up. You can
find more information in our ‘Confidentiality and Information Sharing –
For Carers, Friends and Relatives’ factsheet.
10
Supporting the person you care for
If you want to support someone with depression, you might find it helpful
to learn about symptoms, treatments and self help techniques. This way
you may be able to encourage your loved one to take the steps they need
to get well. Below are some initial suggestions for providing practical day
to day support: 9

Offer them emotional support, patience, affection and
encouragement. Remember that depression is an illness and
people cannot “pull themselves together”.

Invite them out on walks, outings, and gentle activities.
Encourage them to take part in activities that once gave them
pleasure. However, try not to put too much pressure on them as
not feeling able to engage in activities they used to enjoy can be
a source of further unhappiness.

Help them feel good about themselves by praising daily
achievements.

Encourage them to help themselves through self-help techniques
and further treatment if appropriate.

Find out about self help or support groups in the area.
If you want to know how you can get help for someone who might have
depression read our „Are You Worried About Someone's Mental
Health?’ factsheet.
If the person is severely depressed and/or suicidal you might want to read
our „Helping Someone With Suicidal Thoughts‟ and „Getting Help In A
Crisis’ factsheets.
You can download these factsheets for free from www.rethink.org or call
0300 5000 927 and ask for a copy to be sent to you.
Top
Depression Alliance provides information on their website and also by
post. They also run self help groups across the country.
Tel: 0845 123 23 20
Address: 20 Great Dover Street, London SE1 4LX
Email: [email protected]
Web: www.depressionalliance.org
Mood Swings Network provides a range of services for people affected
by a mood disorder such as depression, including their family and friends.
Tel: 0161 832 37 36 (10am - 4pm Mon-Fri)
Email: [email protected]
Web: www.moodswings.org.uk
11
Online cognitive behavioural therapy (CBT) resources
Get Self Help: www.getselfhelp.co.uk
Live Life to the Full: www.llttf.com
Mood Gym: www.moodgym.anu.edu.au
Top
1
National Institute for Health and Clinical Excellence (2010) Depression.
The treatment and management of depression in adults. CG90. London.
Full guidance at pg 22
2
Royal College of Psychiatrists. Depression
http://www.rcpsych.ac.uk/mentalhealthinformation/mentalhealthproblems/d
epression/depression.aspx [Accessed 14/11/13]
3
World Health Organisation (2010) 'The ICD-10 Classification of Mental
and Behavioural Disorders: Clinical descriptions and diagnostic
guidelines', F32 Depressive episode. Accessed on 29/11/13 at
http://apps.who.int/classifications/icd10/browse/2010/en#/F30-F39.
4
As note 1 at pg 20
5
Mental Health Foundation (2007) 'Healthy Eating and Depression: How
diet might help protect your mental health'
6
The Mental Health Foundation: Feeding Minds Report: The Impact of
food on mental health; Dr. Deborah Cornah, 2006.
7
As note 1 at pg 296, 300
8
National Institute for Health and Clincal Excellence (Nov 2007)
Transcranial magnetic stimulation for severe depression at pg 1
9
O‟Connor (2012). Undoing Depression: What therapy doesn’t teach you
and medication can’t teach you. Souvenir Press. London.
12
© Rethink Mental Illness 2013
Last updated Dec 2013
Next update Dec 2015
Version 8
This factsheet is available
in large print.
Last updated 01/10/2010
Last updated 01/10/2010