How to be kind to your brain

Depression, also known as clinical depression, is a common mental health condition that is thought to affect around 5% of adults worldwide. 

If you are struggling with symptoms of depression, you aren't alone. According to the US public health agency Centers for Disease Control and Prevention, about one in six adults will experience depression at some time in their life. Mixed anxiety and depression is the most common mental disorder in the UK. 

People with depression may experience feelings of sadness and loss, long periods of low mood and a lack of interest in once-pleasurable activities. The condition can impact all aspects of your life including your work life, relationships and day-to-day activities such as eating, sleeping, working and socialising. Depression can be mild, moderate or severe. 

There are several types of depression. Depression can also be a symptom of another condition.  Some types of depression include: 

• Clinical depression (major depression/ major depressive disorder) — a severe form of depression that isn’t caused by a loss, stressful life event or chronic health condition 
• Postnatal depression – is a common type of depression that can affect mothers, fathers, or partners after the birth of their baby 
• Seasonal affective disorder (SAD) – is a type of depression that comes and goes according to the seasons. Symptoms commonly occur in the winter months. 
• Premenstrual dysphoric disorder (PMDD) – is a severe form of premenstrual syndrome (PMS)  where you experience feelings of depression and anxiety before your period
• Bipolar disorder –  is a mental health condition where you have periods of depression and periods of excessively high mood (mania)

What causes depression?

It sn’t fully understood what causes depression to develop in some people. It may be triggered by a stressful or traumatic life event or occur for no apparent reason. Depression is likely caused by a combination of several factors including an imbalance of brain chemicals, genetics and environmental factors. 

Some possible causes of depression include: 

• An imbalance of chemicals called neurotransmitters in your brain 
• Genetic factors 
• Stressful or traumatic life events
• Chronic health problems such as chronic pain, diabetes or epilepsy 
• Certain medications including isotretinoin, anti-convulsants, and some heart medications 
• Using recreational drugs or alcohol misuse 

What are the symptoms of depression?

The symptoms of depression vary from person to person and can be mild, moderate or severe. 

Symptoms of depression may include: 

• Feeling sad most or all of the time 
• Loss of pleasure or interest in activities you normally enjoy 
• Irritability 
• Memory problems 
• Difficulty making decisions 
• Worrying excessively 
• Difficulty concentrating 
• Low self-worth
• Hopelessness about the future
• Feelings of guilt 

When to see a consultant for depression

See a consultant if you think you may be depressed or have symptoms of depression. 

Make an appointment with your consultant if: 

• Your symptoms are impacting areas of your life such as your relationships, work, eating and sleeping patterns, hobbies and interests 
• You have thoughts of self-harm or suicide
• Your symptoms are getting worse or aren’t getting better

Many people with depression feel reluctant to seek help and may feel that it isn’t a real condition, or that nothing can be done. It’s common to feel hopeless about the future and be unable to imagine feeling better. 

Depression is a medical condition and effective treatment is available. Untreated depression is likely to get worse and can negatively affect every aspect of your life. In severe cases, depression can lead to self-harm and suicide. The sooner you seek help, the sooner you can start treatment and start feeling better. 

Any conversations you have with your consultant are confidential. In rare cases, if your consultant thinks you may pose a risk to yourself or others, they may need to inform a third party such as another mental health professional, or a member of your family. 

How is depression diagnosed?

Your consultant will make a diagnosis by talking about your symptoms. They may ask about: 

• Whether you experience symptoms most of the time 
• Your general health 
• Your medical history 
• Any medications you are taking 
• Whether you have had mental health problems in the past
• Your family history 
• Your lifestyle 
• Your home environment and family situation 
• Whether you have recently experienced a stressful or traumatic life event 
• Whether you ever think about harming yourself or suicide 

There’s no physical test to diagnose depression, but your consultant may perform a physical examination and order blood or urine tests to rule out any underlying medical conditions that could be causing or worsening your symptoms. 


How is depression treated?

Treatment for depression depends on the type and severity of your depression and includes lifestyle changes, medication, talking therapies and brain stimulation therapy. Depression is usually treated with a combination of one or more treatments. 

Lifestyle changes

If you have mild depression, your consultant may recommend making some changes to your lifestyle to see if your symptoms improve before moving to other treatments. 

Some lifestyle changes that can help with depression include: 

• Eating a nutritious, healthy diet and cutting back on junk food 
• Regular exercise
• Cutting down or abstaining from alcohol 
• Not taking recreational drugs 
• Quitting smoking
• Joining a support group 
• Practicing good sleep hygiene to promote restful sleep 
• Reducing stress with activities such as mindfulness, meditation, yoga, massage and breathing techniques 
• Writing your thoughts and feelings in a journal 

Talking therapies

Talking therapies are a type of treatment for depression that involves talking to a trained mental health professional about your thoughts, feelings and behaviours. They can help you express your feelings in a safe, non-judgmental environment, identify unhelpful patterns in your thoughts and behaviour and learn coping skills or new ways of thinking and behaving. 

Some types of talking therapy used to treat depression include: 

• Counselling — involves talking to a trained counsellor to explore coping strategies and help you deal with issues in your life 
• Cognitive behavioural therapy (CBT) — works by examining and changing unhelpful thought patterns and behaviour
• Guided self-help — involves working through a CBT-based workbook with the guidance of a therapist
• Behavioural activation — offers practical steps and problem-solving skills to make small changes in your life 
• Interpersonal therapy — aims to help people with depression identify and work on problems in their relationships with family, friends and partners 
• Mindfulness-based cognitive therapy — uses mindfulness techniques combined with cognitive therapy to focus on your thoughts and feelings as they happen. It is often used to help prevent depression from coming back. 
  

The main medication for depression is antidepressants. These are prescription medications that work by altering your brain chemistry and correcting the imbalance of neurotransmitters like dopamine and serotonin. Antidepressants are often used in combination with talking therapies to treat moderate to severe depression. 

There are several different types of antidepressants that work in slightly different ways. You may need to try more than one type of antidepressant to find the one that works best for you. Antidepressants can cause side effects. Your consultant will explain all the possible side effects of your medication before you start taking it. Tell your consultant if you experience unpleasant side effects while taking antidepressants. They may decide to try a different antidepressant that may cause fewer side effects. 

Your consultant will start you on the lowest dose of antidepressant and may increase your dose if needed. Antidepressants take a few weeks to work, and you will need to take them regularly for at least one to two weeks before you notice any effect. Most people continue to take antidepressants for six months after they start to feel better. If you have recurrent episodes of depression, your consultant may prescribe antidepressants long-term. 

Brain stimulation therapy

If you have major depression that doesn’t respond to other treatments, or your depression keeps coming back, you may be a candidate for brain stimulation therapy. 

Brain stimulation therapy uses electricity to activate or inhibit nerve cells in your brain using electrical impulses, implants, or magnets. 

There are three types of brain stimulation therapy: 

• Repetitive transcranial magnetic stimulation (rTMS) — uses repeated magnetic pulses to stimulate your brain
• Electroconvulsive therapy (ECT) — controlled electrical impulses are delivered to your brain to trigger a seizure which affects the chemicals and neurons in your brain. ECT is performed under general anaesthetic
• Vagus nerve stimulation (VNS) —a device like a pacemaker is inserted under the skin of your chest. The device remains in place until it runs out of battery (normally three to eight years) and uses electrical pulses to stimulate your vagus nerve which sends signals to your brain

Further help and support for depression

Depression is a common, but serious mental health condition that is characterised by feelings of sadness, hopelessness and low mood. People with depression may experience depression once or you may have multiple depressive episodes during your lifetime. The good news is that depression is treatable, and most people with depression are able to manage their condition and lead healthy, fulfilling lives. 

For help, you can book an appointment with one of our pyschiatric specialist consultants. They can diagnose and treat a vast range of mental health conditions.