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Depression

At some point in their life, everyone experiences some sort of unhappiness, often triggered by a traumatic event such as the break-up of a relationship or a bereavement. Most people also feel down from time to time. However this unhappiness can develop into a bout of depression, a real illness that often goes unrecognised, partly because sufferers are reluctant to seek help. This fact sheet explains the symptoms and possible causes of depression. A separate fact sheet Treatments for depression outlines the options for dealing with the condition.

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Depression affects up to 40% of people at some point in their lives. It often appears first during a persons teens or twenties. Some people then experience recurrent episodes throughout their lives. It is twice as common in women than men.

The most common symptom of depression is low mood. In addition to feeling sad, some people are irritable and tend to lose their temper more easily than usual. Often, people notice that they feel worse either first thing in the morning or last thing at night.

Depressed people find that they cant get pleasure from events or activities that they normally would. They tend to feel different and separate from the rest of the world. Lack of energy, tiredness and poor concentration are also common symptoms. Additionally, sufferers find they do not sleep well, either waking up unrefreshed from a long sleep, or waking up very early in the morning. Loss of sex-drive (libido) and disturbed eating patterns - either loss of appetite or eating too much - are also common.

Symptoms of anxiety routinely occur with depression. People may experience fearfulness, palpitations and even panic attacks. Very often these feelings subside when the depression is treated.

Among the most serious aspects of depression are the thoughts people have about themselves and their lives. Sufferers start to judge themselves excessively harshly or critically. They may think of harming themselves or feel that life is not worth living. People who are depressed are more likely to attempt suicide.

Many people with depression turn to alcohol or illegal drugs to try and blot out their difficult feelings. Unfortunately, this tends to make things worse because alcohol lowers the mood further and, in excess, is harmful to physical health.

Usually a bout of depression is set off by a stressful event, often involving some form of loss. This may be when somebody dies, or after a relationship breaks up. Financial worries, a stressful job, redundancy or fear of unemployment, even moving house can trigger depression in vulnerable people. New mothers are susceptible to postnatal depression. And long-term or serious illnesses such as diabetes or cancer can also trigger depression.
Relationship problems are common in depressed people. These may be part of the cause of a persons depression or a consequence.

Some forms of the illness seem to run in families but researchers have yet to find a simple genetic explanation. Unhappy childhood experiences have been shown to be important in the development of depression in adult life. For example, a child who loses his or her mother before the age of 14 and lacks adequate care from another person is more likely to have depression. Other difficult childhood events such as sexual abuse are linked to depression in adult life.

Finally, some people tend to always look on the darker side of things - its part of their personality. These people are more likely to develop full-blown depression at some point in their lives.

Depression interferes with the way people want to live their everyday lives. They may feel unable to go to work or do any of the things they used to enjoy: it is truly a miserable condition. Despite this, many people do not seek help for their problems. This may be because they feel embarrassed about their feelings - considering them a sign of weakness - or they blame themselves for their misfortune.

Fortunately, a number of treatments are available for depression and talking to a qualified professional about ones feelings is the first step.

The two main approaches to treating depression are psychological therapies, such as counselling, and medical treatment with antidepressants.

For mild forms of depression, psychological treatments are often sufficient. For more severe depression, a combination of psychological treatment and antidepressant drugs, or antidepressants alone is usually recommended.

Antidepressants

A wide range of antidepressant medication is now available. It is important to recognise that these are different from tranquillisers or anti-psychotic medicines. However, like all medicines, they can have some side-effects, but they are not addictive and do not change a persons personality.

The two main groups of antidepressants are known as SSRIs (which stands for selective selective serotonin re-uptake inhibitors) and tricyclics (the name refers to the molecular structure of the drug). They are both known to be effective in treating depression but SSRIs, a group of drugs which includes fluoxetine (Prozac), are now being more widely used because their side-effects tend to be less troublesome.

Most antidepressants take two weeks or so to start gradually working. They are then usually required for around six months to treat a single episode of depression, even if the symptoms clear up sooner. This is because its been shown that a longer course makes a relapse of depression less likely.

St Johns Wort is now a popular complementary medicine for depression that can be bought in health food stores and pharmacies. Some research studies have shown some promising results. If you take St Johns Wort, its important that you tell your doctor and pharmacist, as it does not mix well with some prescription medicines.

Psychological treatment

GPs can often arrange for sufferers to have counselling as part of their treatment. Counselling usually takes the form of a one-to-one session where you have an opportunity to express your feelings and problems, with the counsellor listening and asking questions. Generally in counselling, you wont be told what to do about these feelings. A typical course of counselling is around 6 sessions. More structured types of psychological treatment also exist. These include cognitive behavioural therapy and are described in greater detail in a separate fact sheet - Depression Treatments.

Further help

For the majority of people, depression responds to antidepressants and simple counselling. If depression is severe, or intense thoughts of suicide are experienced, GPs often refer sufferers to a psychiatrist. Psychiatrists are qualified doctors who have specialist training in treating mental health and can suggest a wider range of therapy, medical and psychological.

Sometimes, people need to be admitted to hospital for severe depression. They (or their family) may feel they are unsafe to be looked after at home, due to suicidal thoughts. Depressed people are not typically a danger to others.

An important factor in the prevention of depression is learning to manage stress. Stress is a highly individual experience; we all have different things in our lives that cause frustration or unhappiness. We all need to be aware of how we are feeling and of how to develop positive ways of coping. This may simply mean making more time to relax, exercise, or learning to talk more openly with people you are close to.

1. What can I do to help someone with depression?

If you know someone who has depression, it's important for you to be reassuring, to listen but not judge, and to be there to talk to. This will be an invaluable help and support for him or her through depression.

When people are depressed, they often feel helpless, hopeless and alone. Being affectionate and spending time with your friend or relative will help him or her feel better about themselves.

People with depression often isolate themselves from others. They may stop seeing friends and relatives. Try to keep in touch regularly, and visit if you can.

Encourage the person to seek help and advice. Treatment from his or her GP can improve symptoms and help them overcome depression.

Reassure the person that he or she is important to you, and that they can get better with treatment.

It can be difficult to spend a lot of time with someone who is very depressed, you may start to feel down too. Have some time out as well, and talk to others if you feel frustrated. Support from specialist groups or your GP may also be helpful.

2. Can yoga help depression?

There is little evidence to specifically recommend yoga for depression but some research does indicate that it may have some benefits.

There are different types of yoga and some may be more helpful than others. Ashtanga yoga, for example, can be quite dynamic and fast-paced, while other forms such as Hatha yoga, with mindfulness meditation, are more focused on meditation and breathing.  Doing some exercise in addition to your medication or counselling may help your symptoms.

3. Does acupuncture work for depression?

There isn't enough medical evidence to recommend acupuncture as a treatment for depression.

Acupuncture has been part of traditional Chinese medicine (TCM) for thousands of years but only in the past 30 years has it become integrated into general medicine. It's used mostly as a complementary treatment (one given alongside conventional treatments).

It's thought that acupuncture needles stimulate nerve endings and alter the way your brain functions. However, there isn't enough evidence to recommend acupuncture as a treatment for depression.

Taking time out to do things that make you feel good may help lift your mood. Eating a healthy diet, getting enough sleep, and making the time to rest, relax and exercise are all important ways to look after yourself.

Further Information

Sources

  • One in five. The Depression Alliance.www.depressionalliance.org, published 2003
  • Depression: the treatment and management of depression in adults. National Institute for Health and Clinical Excellence (NICE), October 2009.www.nice.org.uk
  • Silva de Lima M, Moncrieff J, Soares B. Drugs versus placebo for dysthymia. Cochrane Database of Systematic Reviews 2000, Issue 4. doi: 10.1002/14651858.CD001130
  • Depression terms you might hear. The Depression Alliance.www.depressionalliance.org, accessed 19 February 2010
  • Postnatal depression. The Royal College of Psychiatrists.www.rcpsych.ac.uk, published August 2007
  • Alcohol and depression. The Royal College of Psychiatrists.www.rcpsych.ac.uk, published June 2008
  • Anafranil. The electronic Medicines Compendium (eMC).www.emc.medicines.org.uk, accessed 4 March 2010
  • Making sense of antidepressants. Mind.www.mind.org.uk, published 2008
  • Treatments for depression. The Depression Alliance.www.depressionalliance.org, accessed 4 March 2010
  • Making sense of counselling. Mind.www.mind.org.uk, published 2008
  • Linde K, Berner MM, Kriston L. St John's wort for major depression. Cochrane Database of Systematic Reviews 2008, Issue 4. doi: 10.1002/14651858.CD000448.pub3
  • Making sense of electroconvulsive therapy (ECT). Mind.www.mind.org.uk, published 2008
  • Friends and Family. The Depression Alliance.www.depressionalliance.org, accessed 5 March 2010
  • Pilkington K, Kirkwood G, Rampes H, et al. Yoga for depression: the research evidence. Database of Abstracts of Reviews of Effects (DARE).www.crd.york.ac.uk, accessed 5 March 2010
  •  Smith CA, Hay PPJ, MacPherson H. Acupuncture for depression. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD004046. doi: 10.1002/14651858.CD004046.pub3

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