1. Feeling sad does not necessarily mean you have depression
Sadness is such a normal emotion – and so very appropriate to many of the experiences that we all have. What would it be to never feel sad? We may not enjoy feeling low, but it would be a very strange thing not to have experienced it at all. So we are all sad at times and feeling low in mood is a very common experience which we all have to deal with. As we all know what it is to feel sad, we can all have some understanding of why to suffer from clinical depression is so horrible; just think of feeling like that all the time – and an episode of clinical depression may last for months.
To be defined as clinically depressed and for it to be seen as a mental health disorder, those well known feelings actually have to stay over a long period of time (over a couple of weeks at least) and really interfere with your life. Even with this restrictive definition, it is the second most common mental health problem that people need help with, after anxiety.
2. There does not have to be an obvious reason for your depression
Though an episode of depression may be associated with a difficult life event such as loss of job, what is not so commonly understood is that clinical depression can also be triggered by experiences that are not necessarily associated with recognisably saddening events. For example stress – even though the source of stress is not directly making one feel sad, may cause the same emotions that one would experience from a more obviously saddening experience. For many sufferers one of the most worrying problems is that their depression sometimes seems to improve but then returns again without an obvious cause. This can leave sufferers anxiously dreading a relapse, even when they are not depressed. Fortunately appropriate treatment can greatly reduce the chance of depression recurring.
3. Depression is not always revealed by feelings of sadness
Like many mental health conditions, some people have a lot of difficulty in admitting that they have a problem, even to themselves. Depression can be revealed in many different ways: some people may become irritable, or drink excessively. However, there are a number of features that very often occur together, which are often associated with depressed mood, for example:
- Not being able to enjoy things that you used to enjoy
- Always feeling tired
- Having sleep difficulties
- Losing your appetite
- Losing your sex drive
- Just losing interest in doing anything
- Getting irritable, or just feeling agitated all the time
- Feeling that life isn’t worth living
4. Cause and effect – there can be other underlying conditions causing your depression
Psychiatrists are always very aware that other mental health disorders, such as anxiety, or a neurodevelopmental condition like ADHD, can occur along with depression, or actually cause that depression. Occasionally physical health conditions such as hormone abnormalities can also cause depression. It is their breadth of understanding of mental illness that makes the involvement of a psychiatrist in diagnosing a mental health condition so important.
It is also important to think about mental health in terms of physical health and physical illness. There isn’t really any separation between the mind and the body, and recognising what is called co-morbidity is central to our role. Psychiatrists are medical doctors. We make medical diagnoses, taking all physical and mental factors as a whole. Picking up the physical symptoms and having the breadth of medical knowledge that comes with being trained in medicine, is sometimes about recognising what doesn’t fit in with a familiar pattern and exploring it.
Depression can sometimes affect people who also have periods of abnormally elevated mood as part of bipolar affective disorder. It is important to let your psychiatrist or GP know if you have experienced mood elevation as well as depression because it may mean some treatments are more likely to be helpful for you than others.
As psychiatrists, we will make a diagnosis based on the intensity of the feelings you describe, the impact they have on your life, and their pattern over time. Occasionally people who are depressed consider killing themselves, so one of the questions that a psychiatrist will always ask is whether their patient has had any thoughts of self harm or suicide.
5. Having depression doesn’t always mean you will need to take antidepressants
People are often anxious about taking antidepressants. Modern Selective Serotonin Reuptake Inhibitors (SSRIs) can be useful for many people to help manage their depression. They can be very effective, especially when they are used to treat a moderate to severe episode. Unfortunately, people may fear that their family and society in general (and especially their workplace) will see taking antidepressants as a sign of weakness. Anxieties like this can deter people from seeking help. About two thirds of people who try antidepressants find them beneficial, though some people have to try a number of different medications to find the one that suits them the best. The best person to advise you on this is a psychiatrist. Antidepressants are generally safe to use and well tolerated, although they can cause side effects that he or she will be able to tell you about. For a good overview of antidepressants I suggest you look at the NHS Choices page on the subject.
It is also important to tell your doctor if you are already taking so called complementary medications of any sort. For instance, though St John’s Wort has been used for centuries as a folk remedy for depression, there is limited scientific evidence of any benefit in even mild to moderate depression – but it definitely can cause side effects if you are using it while taking prescription antidepressants.
6. Psychiatrists don’t prescribe antidepressants to everyone they see with depression
Antidepressants are just one of the ways of helping with depression and they are not right for everyone. In a consultation, a psychiatrist will discuss which treatments have the best evidence, and may be best suited to you as an individual. He or she will discuss with you how this treatment can be accessed, both in the NHS and privately. Additionally, other organisations, such as charities (MIND, for example) can be a useful source of help. Increasingly, we are also recommending apps and online support services and there is recent clinical evidence that TMS – Transcranial Magnetic Stimulation, can be effective.
Depression is usually managed through a combination of three types of treatment: medication, talking treatments (including self help techniques) and lifestyle changes to help you to firstly reduce and control your depression and then to learn how to recognise the triggers, and perhaps control and even eliminate the potential for future downward spirals.
There are many different types of talking treatments, and there is growing evidence for certain types of therapy. The most commonly used for depression is Cognitive Behavioural Therapy which helps to identify the negative thoughts that can occur, and teaches you both the effects that these have and methods to manage them. There are a number of books and internet resources that use the same principles, and can help to give people a framework to help recover from depression.
Maintaining physical activity, and having structure in your life is good for all of us and it definitely can help people with depression. Just doing some regular activities, even simple things like walking can help. Ten minutes a day is enough to make a difference if it is regular.
7. You can’t just cope with it – you do need to get help
Some people try to develop their own ways of coping with depression rather than seeking help. These can seem helpful in lessening the immediate distress, but they can lead to depression going on for longer. A good example of this is isolating oneself to avoid stressful situations. Though it helps reduce stress, in the long run it may create its own problems. A psychiatrist or therapist will often try to help people to identify ways of recovering from depression by changing such unhelpful coping mechanisms.
Using alcohol or recreational drugs to cope is a particular danger with depression, potentially adding a bigger problem to your life and making it harder to recover. Sleep problems are also common in depression and many other mental health problems. It is easy to get into bad habits, for instance, watching TV in bed for hours, so it is worth discussing sleep problems in more detail with your psychiatrist.
8. There are many resources available to you
Even if you are unable or unwilling to take the big step yet by seeing a psychiatrist, you should at least do some more research. There are a number of internet resources on depression which range from providing information, personal accounts, ways of promoting recovery. Here is a list of some useful sites:
General information about depression:
Online CBT resources:
Information about therapies
Peer support networks
Andy Montgomery is a Psychiatrist and Medical Lead and with Psychiatry UK – you can view his profile here.