Depression is a commonly used word, often used by or about people to describe a particular feeling; feeling low or unhappy. It’s often used to describe a temporary feeling, feelings on a particular day, or feelings about a particular situation or circumstances. In most cases, these feelings lift of their own accord after a short time, or following a change in the contributing circumstances. The use of the word in this way may make it difficult for some people to understand the concept or experience of depression when used in its clinical sense. While depression may be mild, moderate or severe, it is very different from just feeling low. It is something that is likely to interfere with daily life, with relationships, with one’s ability to work, to enjoy life and to experience oneself or others in an enjoyable or fulfilling way. It can last for long periods of time, with some fluctuation in the level and intensity of depression felt.
The changes brought about by depression are likely to be apparent to those close to you, particularly in moderate to severe cases. This is because of the extent of the impairment to your ability to relate to others, and to participate in everyday activities. To others you may appear quiet and withdrawn, possibly rejecting of friends and family. Some people, particularly if they have had depression over a long period of time may learn to put on a ‘mask’, to present a lighter, brighter face to others than they actually feel inside. This may be because they feel they ‘can’t’ or ‘shouldn’t’ show their real selves to others; that they may be rejected if they do so. This can make it very hard for individuals to ask for help, and make it difficult for others to recognise that you need help and support.
Experiences of depression can vary from individual to individual, but it is often felt and described as a blackness, a heavy weight, an emptiness, as if the life source or spirit has been extinguished. You may feel removed from other people, aware that your experience of life is different, and uncertain about how or whether you can relate to others, or indeed if you want to relate to or engage with them, or with the world outside yourself.
When depressed, you may feel hopeless and unable to see any positives in life; this is a very difficult reality to live with, but for that time, it is your reality, indeed the only reality. It can also be difficult to realise that previously enjoyable or fulfilling activities may no longer provide any sense of pleasure or satisfaction. This may serve to isolate you from others with whom you may previously enjoyed sharing leisure activities or hobbies. In severe cases, feelings of emptiness, bleakness, helplessness and worthlessness may be such you may lose any sense of a meaning in life, or begin to consider suicide.
Depression can affect people in many different ways. Some people experience primarily psychological and emotional symptoms, whilst others may experience a range of physical effects. The following is a list of possible symptoms of depression:
There is no one cause of depression. Broadly speaking there are three main triggers for developing depression:
Most people diagnosed with depression are treated by their family doctor, although a small minority of people may be referred to a psychiatrist or a member of the local Community Mental Health Team for more specialised help. Depending on your symptoms, the severity of the depression, and your circumstances, the doctor may suggest anti-depressant medication, a talking treatment or a combination of both.
Antidepressant medication acts on chemicals in the brain that lift your mood. They treat the symptoms, but cannot treat the root cause of depression. This is why talking treatments are often prescribed in conjunction with antidepressants, so that you can be helped to address the reasons why you became depressed in the first place.
It may take a few weeks before medication starts to have a noticeable effect; your doctor will normally talk through the process with you and will generally arrange to see you regularly during the initial stages of medication to monitor effectiveness. As with any medication, you may experience unwanted side-effects, which you need to discuss with your doctor. There is a range of anti-depressant medication available and a different one may be more effective. It can take a bit of time to find the right one.
Talking treatments such as counselling and therapy alone can be effective in combating depression for some people. For others a combination of talking treatments and anti-depressant medication may be most effective. Talking treatments aim to help people recognise contributing factors in their lives, and work out coping strategies to deal with these.
Referrals for talking treatments can be arranged by your doctor. However, there may be long waiting lists on the NHS. Free or low-cost counselling is provided by a number of charities and voluntary organisations; you can find out about options in your area by contacting SANE Services. There are also many private practitioners – you can find out more about how to find a counsellor or therapist privately from the list of organisations at the bottom of this page.
Admission to hospital
In severe cases of depression, in-patient hospital treatment may be appropriate, for example when the condition has proved to be resistant to treatment, where the person is so severely depressed they cannot cope at home, or where the person is assessed as being at a high risk of suicide.
Hospital admission can give medical staff the opportunity to accurately assess a person’s condition over a period of time, and to provide levels of care and attention that could not be provided at home.
When you are depressed, it can be very difficult finding the energy and motivation to try to help yourself. However, if you are able to take an active part in your treatment it should help your situation improve, and helps you to feel as though you have some control over your life.
There are many ways in which you can help yourself. For instance, the more you understand your illness, the more likely you are to be able to see it as an illness that is treatable, rather than being a reflection on you as a person.
Giving and receiving support
Having depression can make life feel very difficult for long periods at a time. Family and friends can provide support, if you feel able to ask for it and can be receptive to it. However, many people also find it helpful to seek support outside their circle of family or friends. In particular, making contact with others who have a similar diagnosis and experience can be helpful. This can be especially useful so that you don’t feel alone in your experience (the feeling of being the ‘only one’ is, ironically, one of the most common feelings to accompany depression, and it can be a huge relief to know this is not the case).
Making contact with others in a similar situation provides an opportunity to get help, understanding and support – it also provides an opportunity for you to give that understanding and support to others when you feel ready and able to do so. This can be an invaluable aspect of this kind of contact, particularly if you have been feeling that you are a ‘burden’ on your family and friends. It serves as a reminder that you have something to offer, and helps to identify the ebb and flow of your feelings, enabling you to make contact with aspects of yourself you may have feared lost.
One way of making this kind of contact is through a local support or self-help group. You can get details of such groups by contacting SANE Services (see below); we can search our SANE Information Database (SID) for support options in your area.
If you don’t have such a group close by, or if you feel you’re not quite ready for that kind of contact, you might like to consider making contact through a medium such as an internet forum, such as the SANE Support Forum. You can find out more about support options in your area from SANE Services (including the SANE Support Forum).
Recognising and dealing with negative thoughts
Depression can cause you to sink into a cycle of negative thinking. This may feel like it’s you, but it’s important to remember that this is a symptom of depression, and that there are things you can do to help yourself deal with this symptom, even though it can also be difficult to find the motivation to do so.
It’s also important to remember to try not to give yourself a hard time if your motivation is low and you feel inadequate or unable to help yourself at a particular time. With support, and treatment that is right for you, you may eventually feel your mood lift to the extent where you will feel more able to help yourself.
Talking to friends and family, to people in a self-help group or on an internet support forum, or to a counsellor or therapist (see below) can help you recognise patterns of negative thinking, find ways of challenging them, and try to replace them with more constructive thoughts.
Although it may be difficult to find the motivation, being active can be very therapeutic. This may be easier if physical activity has been a normal part of your routine, as you can consider how you can continue it as part of your self-help routine.
However, even if you are not normally physically active, simply walking in the open air can be very beneficial. Physical activity helps to stimulate production of chemicals in the brain called endorphins. These can help lift your mood, give you more energy and make you feel better. If your chosen activity involves some social contact, this may also be helpful, as you may feel able to join in an activity without feeling some of the pressures that may accompany a solely ‘social’ interaction.
Again, try not to give yourself a hard time if this feels too hard for you at times, but it’s useful to keep it in mind as a helpful and nurturing thing to do when you feel more able.
Depression may make it feel very difficult just to get out of bed in the morning, or to wash or put on fresh clothes. However, you will feel better if you try to adopt a simple routine of getting up at a certain time, having a basic wash or quick shower and putting on fresh clothes. While it can be difficult to communicate with other people when you’re depressed, you may like to get the support of a friend or family member to encourage you in this aspect of caring for yourself. Your appetite may be affected by depression. Some people eat more than usual and may feel even more depressed if this is associated with weight gain, or just eating food that you wouldn’t normally eat. Others may eat less than normal, and this can be distressing simply because it’s an indication that things are not ‘right’, and that maybe you don’t feel in control of this aspect of your life.
Either way, it’s a good idea to try to establish a simple routine that helps you to eat healthy, nurturing food at regular times. Friends and family may be able to help with this but, again, if this routine is difficult at times, it can be helpful to try to be accepting of this, and to know that when you feel a bit better, you have a routine that is supportive and nurturing for you.
Some people find treatments such as herbal remedies or homeopathy helpful. It is important that you discuss such treatments with your doctor in case of interaction with any medication they may have prescribed.
Treatments like massage can help to make you feel better, and sometimes the care and attention given by complementary therapists can feel very supportive and healing in itself. Practices such as meditation and yoga may also be helpful for some people. You may find
creative therapies such as art and poetry can help channel energies.
SANE provides emotional support to anyone affected by mental health problems, including families, friends and carers.