Depression RET101

Everyone experiences variation in mood: sometimes you just feel a bit low, or
experience normal grief that accompanies the loss of someone you love. But a long
lasting low mood that interferes with the ability to function, feel pleasure, or take an
interest in things is not merely a case of the blues - it is an illness known as
depression. This factsheet looks at the symptoms, causes and possible treatments
for depression.

Key Points

 Symptoms of depression include a long lasting unhappy mood, low self

esteem, and lack of motivation.
 Depression comes in different forms from mild, moderate and severe to
psychotic in some rare cases. Part of the bi-polar disorder may also
involve periods of depression.
 Different factors are thought to contribute to depression such as
genetics, brain chemistry, upbringing and lifestyle.
 Depression can be treated with either medication, therapy or both.

If you think you are suffering from depression speak to your GP who can prescribe
medication or refer you to a counsellor.

Depression affects a person’s physical state, mood and thought processes. People
with depression cannot merely "pull themselves together" and get better. It is not a
sign of personal weakness or a condition that can be willed away but an illness that
needs treatment to reduce symptoms.

Depression affects anyone of any age, including young children. According to the
Mental Health Foundation, 1 in 6 people will have depression at some point in their
life. It is most common in people aged 25 to 44 years. However, these figures are
based on people who actually seek help, and there will be more who remain
undiagnosed. People who do not receive support, especially young men, are at
particular risk of suicide1.

1. Symptoms of depression
Listed below are a number of symptoms associated with depression. Not everyone
who is depressed will experience every symptom. Some people experience a few
symptoms, some experience many. Severity of symptoms varies between individuals
and also varies over time.

 feelings of helplessness and hopelessness

 feeling useless, inadequate, bad

-1-

Rethink is the operating name of the National Schizophrenia Fellowship, 15th Floor, 89 Albert Embankment, London SE1 7TP Phone 0845 456 0 455, Fax 0207 820 1149,
e-mail: info@rethink.org web site: www.rethink.org. For publications: www.mentalhealthshop.org. © 2009, all rights reserved.
No part of this leaflet may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information
storage and retrieval system without the permission, in writing, of the National Schizophrenia Fellowship. Rethink Advice & Information Service: 0207 840 3188 Monday to
Friday 10am – 2pm
  self hatred, constant questioning of thoughts and actions, an overwhelming need
for reassurance
 being vulnerable and "over-sensitive"
 feeling guilty
 a loss of energy and motivation, that makes even the simplest tasks or decision
seem difficult
 self harm
 loss or gain in weight
 difficulty with getting off to sleep, or (less frequently) and excessive desire to
sleep
 agitation and restlessness
 loss of sex drive
 finding it impossible to concentrate for any length of time, forgetfulness and a
sense of unreality
 physical aches and pains, sometimes with the fear that you are seriously ill

In more serious cases of depression these feelings may also include:

 suicidal ideas
 failure to eat or drink
 delusions and/or hallucinations

2. What are the different types of depression?

Depression can come in different forms and in different degrees. For the purpose of
management and treatment the most common types of depression are often referred
to as the following2.

Mild: Depression is described as mild when it has a negative but limited effect on
your daily life, for example, you may have difficulty concentrating at work or
motivating yourself to do the things you normally enjoy.

Moderate: More of the symptoms are present in moderate depression than in mild
depression and they are usually more obvious. There may be a clear reduction in
functioning at home and in the workplace.

Severe (sometimes known as clinical or major depression). Severe depression

significantly interferes with an individual’s ability to cope with their daily life - eating,
sleeping and many other everyday activities seem impossible tasks which can be life
threatening as a person may be unable to look after themselves. There is also a high
risk of suicide. Some people may experience only one episode but several episodes
in a lifetime is more common. In some circumstances a person’s inability to function
can lead to hospitalisation.

-2-

Rethink is the operating name of the National Schizophrenia Fellowship, 15th Floor, 89 Albert Embankment, London SE1 7TP Phone 0845 456 0 455, Fax 0207 820 1149,
e-mail: info@rethink.org web site: www.rethink.org. For publications: www.mentalhealthshop.org. © 2009, all rights reserved.
No part of this leaflet may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information
storage and retrieval system without the permission, in writing, of the National Schizophrenia Fellowship. Rethink Advice & Information Service: 0207 840 3188 Monday to
Friday 10am – 2pm
 Less common types of depression include:

Bipolar Disorder (manic depression): This is also less common form of depression
and characterized by cyclical mood changes of severe highs (mania) and lows
(depression). See our factsheet on Bipolar Disorder for further information.

Psychotic depression. This occurs in rare cases of severe depression when

depressive symptoms are accompanied by some form of psychosis such as
hallucinations or delusions.

Post-natal depression: This is not "the baby blues" which occurs 2-3 days after the
birth and goes away. Postnatal depression can occur from about 2 weeks and up to a
year after the birth. Around 1 in every 10 women has post natal depression after
having a baby 3.

Seasonal affective disorder (SAD): A type of depression linked to exposure to

sunlight which generally coincides with the approach of winter starting usually from
September and lasting until spring brings longer days and more sunshine. Symptoms
of this depression are a desire to sleep more and eat carbohydrate foods. Bright light
therapy can be helpful.

3. What causes depression?

There is no single known cause of depression. Current explanations tend to lie in a
combination of brain chemistry, genetic and environmental factors 4.

Biochemical
It is known that in people experiencing depression there is a change in their brain
messaging chemicals. These chemicals are important in regulating mood and various
other important functions. When an imbalance of brain chemicals occur, it is believed
that depression can result although it is also possible that the chemical change is the
result of depression.5

Genetic
Some types of depression, like major depression, run in families, suggesting that
some element of depression may be inherited, although there is no single depression
gene. What exactly is inherited is not known but may include changes in brain
structures or brain function, including alterations to the physiological responses to
stress. 6

Hormonal
Hormones are also chemical messages that communicate within the body as a whole
and are thought to contribute to mood. Hormonal changes occur mainly in women
due to menstrual cycle changes, pregnancy, miscarriage, post-natal period, pre-
menopause, and menopause.

Environment/ background

-3-

Rethink is the operating name of the National Schizophrenia Fellowship, 15th Floor, 89 Albert Embankment, London SE1 7TP Phone 0845 456 0 455, Fax 0207 820 1149,
e-mail: info@rethink.org web site: www.rethink.org. For publications: www.mentalhealthshop.org. © 2009, all rights reserved.
No part of this leaflet may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information
storage and retrieval system without the permission, in writing, of the National Schizophrenia Fellowship. Rethink Advice & Information Service: 0207 840 3188 Monday to
Friday 10am – 2pm
 Certain environmental causes such as family factors and adverse childhood
experiences are considered to increase a person chance of developing depression
such as poor parent–child relationship, marital discord and divorce, neglect, physical
abuse and sexual abuse. Such experiences can lead to negative thought patterns
and low self esteem which can be trigger depression later in life particularly when
combined with stressful events such as loss of a job or close relationship. 7

Lifestyle
Food: There has been more attention in recent years to the effect that food and drink
can have on our mental wellbeing. Certain foods contain “essential fatty acids” which
help keep the brain healthy and regulate mood. Other foods are known to have a
detrimental effect on mood.8

Exercise: As well as being essential to your physical health, exercise regulates

blood sugar, improves mood stability releases mood enhancing endorphins.9 An
exercise programme is now recommended by NICE as a treatment for mild to
moderate depression. 10

Substance misuse: Excessive substance use can affect the functioning of the brain
and some research suggests this can have long lasting results. Excessive alcohol
consumption is thought to be linked with depression due to depleting essential fatty
acids in the brain.11 For more information see our factsheet on Physical Health and
Nutrition.

Physical illness
Mood change and depression are more common in people suffering from physical
illnesses than in people who are well. The link between physical illness and
depression could be attributed to several factors, perhaps interacting with each other.
People from poorer backgrounds are more prone to physical illness due to
environmental factors, and mental illness due to increased stress. Negative reactions
of others to people with physical illness (stigma) can cause depression. Those with
depression may be more prone then to developing physical illness, and the reverse is
also true that physical illness can directly cause mental illness. It is also more
common amongst people with a number of forms of chronic illnesses, and so should
be an important consideration in treatment plans.12 For more information see our
factsheet on Physical causes of mental illness and depression.

Medication and depression

There is a lot of disagreement in medical literature about the role of prescribed
medications in inducing symptoms of depression. However, review of research has
suggested that the following drugs may be associated with depression: Beta-
blockers. Corticosteroids, Calcium channel blockers, Levodopa.

If depressive symptoms develop after taking a new medicine, then advice should be
sought from a doctor about whether to try an alternative.13

4. How is depression treated?

-4-

Rethink is the operating name of the National Schizophrenia Fellowship, 15th Floor, 89 Albert Embankment, London SE1 7TP Phone 0845 456 0 455, Fax 0207 820 1149,
e-mail: info@rethink.org web site: www.rethink.org. For publications: www.mentalhealthshop.org. © 2009, all rights reserved.
No part of this leaflet may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information
storage and retrieval system without the permission, in writing, of the National Schizophrenia Fellowship. Rethink Advice & Information Service: 0207 840 3188 Monday to
Friday 10am – 2pm
 The first step to getting treatment is to see your doctor. They should rule out any
physical illness which might cause symptoms of depression. According to NICE some
people with milder forms of depression may benefit from a psychological therapy
alone but you may also be offered anti-depressants. People with moderate to severe
depression should be offered both anti-depressants as well as talking therapy. This
treatment may occur in primary care at first (i.e. through your GP surgery). However,
if symptoms of moderate to severe depression persist after treatment then you
should be referred to the local community mental health team for specialist support. If
this does not happen or you are not offered the appropriate course of treatment as
outlines above then you could contact your local PALS service or Rethink Advice &
Information Service for help.

Sometimes when depression is severe or life threatening (or if a person cannot take
antidepressant medication) electroconvulsive therapy (ECT) is useful14.
Complementary therapies can also have a role in decreasing stress and preventing
relapses. See our factsheet on Complementary Therapy for more information.

Most individuals do best with different types of treatment together - medication to

gain relatively quick symptom relief, and psychotherapy to learn more effective ways
to deal with environmental stressors and negative thought processes.

When talking to your doctor it well help to have an idea about the different treatments
available so we have detailed the main ones below.

Medication
Many people with depression can benefit from taking an antidepressant drug.
Antidepressants are used to improve mood in people who are feeling low or
depressed by improving the functioning of brain chemicals that cause depression.
There are several different types, for example, the tricyclic antidepressants (TCAs),
the mono-amine oxidase inhibitors (MAOI's) and the newer 'selective serotonin re-
uptake inhibitors' (SSRI's) and others. It is important to be aware of possible side
effects, interactions with other drugs and problems when the drug is withdrawn
(discontinuation effects). For more information please see our factsheet on Anti-
depressants.

Psychological therapies / talking therapies.

Therapy usually involves meeting with a trained therapist for a fixed number of
sessions where you talk about your depression and find solutions. Sometimes this is
done in a group setting. Therapy can be accessed privately or through the GP. There
are many different types of therapy available depending on the nature of the
depression and the individual’s preference. According to NICE, the most promising
and commonly used treatment for depression at the moment is Cognitive Behavioural
Therapy (CBT) and this should be offered by your GP15. Other common therapies are
psychodynamic therapy, problem-solving therapy (or interpersonal therapy) and
general counselling. Their availability may be limited on the NHS but it worth asking
your GP if you are interested in them. For more information about the different
therapies please see our factsheet on Talking Treatments.

-5-

Rethink is the operating name of the National Schizophrenia Fellowship, 15th Floor, 89 Albert Embankment, London SE1 7TP Phone 0845 456 0 455, Fax 0207 820 1149,
e-mail: info@rethink.org web site: www.rethink.org. For publications: www.mentalhealthshop.org. © 2009, all rights reserved.
No part of this leaflet may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information
storage and retrieval system without the permission, in writing, of the National Schizophrenia Fellowship. Rethink Advice & Information Service: 0207 840 3188 Monday to
Friday 10am – 2pm
 Computer Based Therapy
Computer Cognitive Behavioural Therapy (CCBT) is a relatively recent approach to
treating mild to moderate depression where people access CBT through an
interactive computer programme at home. Users complete weekly sessions to learn
new tools and techniques to modify your thinking and there is often homework
between sessions. The most popular programme currently in use by the NHS is
called “Beating the Blues” and it should be available free of charge through your GP.
Some areas are also using versions of CCBT to provide low intensity therapy. The
computer programme is used in conjunction with weekly telephone sessions with a
mental health worker to assist with progress. Research collected by NICE suggests
that CCBT can be effective as a first option for treating mild to moderate
depression16.

Exercise Therapy
As outlined earlier, there is a substantial body of evidence to show that physical
exercise is an effective treatment for people with mild to moderate depression and
NICE recommends this as a possible treatment for mild depression17. Some GP
surgeries now operate exercise referral schemes where patients will be helped to
develop their own personal exercise programme, under the supervision of a qualified
trainer. The programme will include free or reduced sessions of a suitable exercise
such as gym sessions, swimming or yoga.

Complementary / Alternative Therapies

These can be used as an alternative in mild forms of depression or in addition to
other treatments in more severe forms. There is a wide range of therapies which
people find useful. Some, such as aromatherapy and massage are aimed at
improving people’s emotional well being whereas others, such as medication and
yoga aim to reduce a persons anxiety by relaxation and “mindfulness”. Some
complementary therapies are now available on the NHS. For more information
please see our factsheet on Complementary Therapies

Electroconvulsive therapy (ECT)

ECT is a procedure sometimes used to treat severe depression. In this treatment, an
electric current is applied briefly to the brain, whilst the patient is under sedation. ECT
is only offered if other kinds of treatments have not helped relieve the depression and
there is a possible life threatening situation. See our factsheet on Electroconvulsive
Therapy for more information.

-6-

Rethink is the operating name of the National Schizophrenia Fellowship, 15th Floor, 89 Albert Embankment, London SE1 7TP Phone 0845 456 0 455, Fax 0207 820 1149,
e-mail: info@rethink.org web site: www.rethink.org. For publications: www.mentalhealthshop.org. © 2009, all rights reserved.
No part of this leaflet may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information
storage and retrieval system without the permission, in writing, of the National Schizophrenia Fellowship. Rethink Advice & Information Service: 0207 840 3188 Monday to
Friday 10am – 2pm
 Further information:

Books and resources available from www.mentalhealthshop.org

Overcoming Depression
Third edition of the bestselling self-help book by Professor Paul Gilbert. This fully
revised edition has been extensively updated to reflect over ten years of new
research on understanding and treating depression, particularly the importance of
developing compassionate ways of thinking, behaving and feeling. Based on
Cognitive Behavioural Therapy (CBT), this practical guide will help you to
understand your depression and lift your mood.

Undoing Depression

Depression, says Richard O’Connor is fuelled by complex and interrelated factors. In

this refreshingly sensible book, O’Connor focuses on an additional factor often
overlooked: our own habits. Unwittingly we get good at depression. We learn how to
hide it, how to work around it. We may even achieve great things, but with constant
struggle rather than satisfaction. Relying on these methods to make it through each
day, we deprive ourselves of true recovery, of deep joy and health emotion.

Undoing depression teaches you how to replace depressive patterns of thought and
behaviour with new, better skills. Anyone who has learnt to do depression can learn how to undo it.

The Rethink Advice & Information Service produces a number of fact sheets on a
range of different issues that affect people with mental illness. They are also able to
give confidential, impartial, practical advice on all aspects of mental illness. They can
be contacted at:

Rethink Advice & Information Service

15th Floor
89 Albert Embankment
London
SE1 7TP

Tel: 0845 456 0455 or 020 7840 3188, Monday to Friday 10am – 2pm

Email: advice@rethink.org www.rethink.org

Depression Alliance provide a range of useful information on depression both for

people experiencing depression and their loved ones. They also have a network of
self help groups.

Web: www.depressionalliance.org

-7-

Rethink is the operating name of the National Schizophrenia Fellowship, 15th Floor, 89 Albert Embankment, London SE1 7TP Phone 0845 456 0 455, Fax 0207 820 1149,
e-mail: info@rethink.org web site: www.rethink.org. For publications: www.mentalhealthshop.org. © 2009, all rights reserved.
No part of this leaflet may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information
storage and retrieval system without the permission, in writing, of the National Schizophrenia Fellowship. Rethink Advice & Information Service: 0207 840 3188 Monday to
Friday 10am – 2pm
 Overcome Depression is an organisation providing information and practical advice
on dealing with depression. Includes information for families.

Web: www.overcomedepression.co.uk

SAD Association is the longest established support organisation for seasonal

affective disorder. It provides information and advice on seasonal affective disorder.

SAD Association
PO Box 989
Steyning
West Sussex
BN44 3HG

Web: www.sada.org.uk

The Association of Post-natal Illness has information on postnatal depression, and

will put mothers affected by postnatal depression in touch with others who have had
similar experiences.

The Association of Post-natal Illness

145 Dawes Road
Fulham
London
SW6 7EB
Tel: 020 7386 0868

Email: info@apni.org Web: www.apni.org

CALM is a helpline for young men who are depressed or suicidal.

Tel: 0800 585858 (open daily 5pm-3am) Web: www.thecalmzone.net

The Rethink Advice & Information Service welcomes your feedback on whether
this information was helpful to you.

You can provide feedback in the following ways:

By email: Please email your feedback to us at feedback@rethink.org.

By post: You can write to us at the following address:

Rethink Advice & Information Service

15th Floor
89 Albert Embankment
London
SE1 7TP.

By telephone: You can call us on 0845 456 0455 or 020 7840 3188
-8-

Rethink is the operating name of the National Schizophrenia Fellowship, 15th Floor, 89 Albert Embankment, London SE1 7TP Phone 0845 456 0 455, Fax 0207 820 1149,
e-mail: info@rethink.org web site: www.rethink.org. For publications: www.mentalhealthshop.org. © 2009, all rights reserved.
No part of this leaflet may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information
storage and retrieval system without the permission, in writing, of the National Schizophrenia Fellowship. Rethink Advice & Information Service: 0207 840 3188 Monday to
Friday 10am – 2pm
 Last updated 01/10

1 Appleby L. Cooper J. Amos T. Faragher B. Psychological autopsy study of suicides by people aged under 35.British Journal of
Psychiatry. 175:168-74, 1999 Aug.
2 Mental Health Foundation: http://www.mentalhealth.org.uk/information/mental-health-a-z/depression/
3Royal College of Psychiatrists:www.rcpsych.ac.uk/mentalhealthforall/problems/postnatalmentalhealth
4 The National Institute of Mental Heath: http://www.nimh.nih.gov/health/publications/depression/complete-index.shtml#pub5
5 http://www.overcomedepression.co.uk/MajorDepression.html
6 Tsuang MT, Faraone SV. The genetics of mood disorders. Baltimore, MD: Johns Hopkins University Press, 1990.
7 The National Institute For Clinical Excellence: http://www.nice.org.uk/nicemedia/pdf/CG23fullguideline.pdf
8 The Mental Health Foundation: Dr. Deborah Cornah, Feeding Minds Report.
9 The Mental Health Foundation: Exercise and Depression,.
10 The National Institute For Clinical Excellence: http://www.nice.org.uk/nicemedia/pdf/CG23fullguideline.pdf
11 Mathews-Larson, Joan: Alcohol – The bio-chemical connection.
12 Machale, Siobhan, Managing depression in physical illness , Advances in Psychiatric Treatment (2002) 8: 297-305
13 Machale, Siobhan, Managing depression in physical illness , Advances in Psychiatric Treatment (2002) 8: 297-305
14 The National Institute For Clinical Excellence: http://www.nice.org.uk/nicemedia/pdf/CG23fullguideline.pdf
15 The National Institute For Clinical Excellence: http://www.nice.org.uk/nicemedia/pdf/CG23fullguideline.pdf
16
IBID
17 IBID

-9-

Rethink is the operating name of the National Schizophrenia Fellowship, 15th Floor, 89 Albert Embankment, London SE1 7TP Phone 0845 456 0 455, Fax 0207 820 1149,
e-mail: info@rethink.org web site: www.rethink.org. For publications: www.mentalhealthshop.org. © 2009, all rights reserved.
No part of this leaflet may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information
storage and retrieval system without the permission, in writing, of the National Schizophrenia Fellowship. Rethink Advice & Information Service: 0207 840 3188 Monday to
Friday 10am – 2pm