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.
Causes of depression
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 - it's part of their personality. These people are more likely to develop full-blown depression at some point in their lives.
Symptoms of depression
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.
Treatment of depression
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 one's 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.

For the majority of people, depression responds to antidepressants and simple counselling. If depression is severe, or intense thoughts of suicide are experienced, general practitioners 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. 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.

Psychological therapies
Doctors 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 won’t 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, including cognitive behavioural therapy.

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 person’s 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 it’s been shown that a longer course makes a relapse of depression less likely.

St John's 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 John's Wort, it’s important that you tell your doctor and pharmacist, as it does not mix well with some prescription medicines.
Prevention of depression
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. 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, learning to talk more openly with people you are close to and exercise are all important ways to look after yourself.
This information was published by Bupa Group's Health Content Team and has been reviewed by appropriate medical or clinical professionals. To the best of their knowledge the information is current and based on reputable sources of medical evidence, however Bupa (Asia) Limited makes no representation or warranty as to the completeness or accuracy of the Content.

The information on this page, and any information on third party websites referred to on this page, is provided as a guide only. It should not be relied upon as a substitute for professional medical advice, nor is it intended to be used for medical diagnosis or treatment. Bupa (Asia) Limited is not liable for any loss or damage you suffer arising out of the use of, or reliance on, the information.

Third party websites are not owned or controlled by Bupa and any individual may be able to access and post messages on them. Bupa is not responsible for the content or availability of these third party websites. Last updated August 2017.
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