Depression is characterised by low mood, and a loss of interest in most activities. Someone is considered as being depressed when they have these symptoms for at least two weeks.

  1. Third most common complaint in UK general practice
  2. Can be induced by a traumatic event
  3. Treated with CBT and antidepressants

A diagnosis of clinical depression is not always straightforward, as feeling depressed for short periods of time is very common. However, if you feel you may be experiencing depression, our online video consultation service can put you in touch with a doctor.

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What is depression?

Depression is a feeling of persistent low mood, with a loss of interest in activities, changes in appetite and low self-esteem. It is a very common condition and can have a profound effect on a person’s life if it's not effectively treated, particularly if it's severe and leads to suicidal tendencies.

Depression is the third most common reason for GP visits in the UK. Every year, one in twenty adults will experience an episode of depression. Depression which is severe enough to require treatment occurs in a quarter of women and 10% of men at some point in their lifetime. 

Statistics from 1996-2006 suggest that doctors were documenting symptoms but not diagnosing depression. The incidence rate fell in the UK for diagnosed depression from 22.5 to 14 cases per 1000 of people who were at risk. The incidence rate for symptoms related to depression however rose from 5.1-15.5 per 1,000 people at risk.

What causes depression?

What specifically causes depression is unknown, but it's thought to be a combination of genetic, social and psychological factors. The likelihood of these factors leading to depression may depend on:

  • The nature of someone’s personality
  • How a person’s mechanisms react to potential stressors
  • Difficult situations, such as being made unemployed, losing money, breaking up with a partner or losing a loved one
  • The effect of other serious conditions such as cardiovascular diseases
  • or a head injury.

Who gets depression?

There are certain groups of people who are more likely to develop depression than others. If you have a history of depression in the family, have developed another mental health problem such as dementia, or frequently visit your GP, there is thought to be a greater susceptibility to depression.

Once an initial assessment has been made, a doctor might decide to prescribe an antidepressant, such as an SSRI (selective serotonin reuptake inhibitor). There are many different theories about the best choice, but a recent analysis suggests that escitalopram has the longest period of remission. For younger people, it is thought that fluoxetine is more effective. Other SSRIs include citalopram, paroxetine and sertraline

However, other antidepressants outside the SSRI classification can be prescribed. This includes what are known as tricyclic antidepressants, such as Elavil and Nortriptylinel, and another family of medicines known as serotonin-norepinephrine reuptake inhibitors (SNRI) Examples of these include Efexor, Vensir and Venlalic.

Additionally, it's important for doctors to consider what the risk of coming to harm is for each individual, and monitor the situation accordingly. For young persons, a doctor will likely arrange an appointment a week after starting treatment to see how they are getting on.

If you are concerned about depression and want to speak to a doctor online, you can do so through our secure video consultation service. Book an appointment at a time that suits you, and our practitioner may be able to help you get the advice and treatment you need.

Page last reviewed:  12/06/2020
Diagnosis and treatment

How does someone know they have depression?

It's natural for someone to feel low at certain points in their lives, and to feel sad in general a times. In most cases these feelings pass, but in cases of depression it starts to interfere with daily life, and there is an awareness of low mood which persists beyond a couple of weeks. If there are repeated episodes, this could be an indication of depression.

Someone with depression might have physical symptoms, such as feeling tired, and as if there is something weighing them down, which leads to difficulty concentrating. It may also manifest in a loss of appetite, loss of sex drive and being unable to sleep properly.

The mental aspects of the condition may include not being able to enjoy things that you would normally, having a strong sense of worthlessness, avoiding social contact with family and friends, and a sadness that does not pass.

How is depression diagnosed?

Doctors may use the statistical manual fourth edition (DSM-IV) classification from NICE guidelines, which can diagnose the extent of someone's depression.

For an initial assessment of whether someone has depression, a doctor will ask about the presence of two ‘core’ symptoms: 

  • Feeling continually low and hopeless for a period of more than two weeks 
  • Taking little interest or pleasure in activities.

Following this, a doctor will look to identify other typical symptoms of depression, including: 

  • Fatigue
  • A sense of worthlessness
  • Thoughts about suicide and death
  • Difficulties concentrating
  • Insomnia
  • Weight loss or a loss of appetite
  • Restlessness

If a person has five or more of these symptoms, in addition to one of the ‘core’ symptoms, a diagnosis of depression can be made. 

There are three categories of depression: mild, moderate and severe. Mild depression can be categorised as having five of the symptoms, but with these symptoms only having a minor impact. Moderate depression occurs when symptoms are more distinct but not severe. Severe depression denotes symptoms that obviously interfere with a person’s daily life.

Does depression require treatment?

Not everyone with depression requires medication. Treatment options may depend on individual preferences, and should be tailored to suit personal needs. Mild depression often improves with regular exercise, or through simply sharing feelings with friends. Sometimes medication or psychological help (known as ‘talking therapy’) is required.

Initially, a doctor will want to monitor someone’s symptoms, particularly if they have only developed recently. After a short period of time, it may be useful to start a low-intensity form of cognitive behavioural therapy (CBT). 

If the person’s depression is clearly moderate to severe from the outset, then CBT can be started immediately in combination with selective serotonin reuptake inhibitors (SSRIs), such as Cipralex or Brintellix, or other types of antidepressants.

What treatments are there for depression?

Depending on the severity of symptoms, there are a variety of treatment options available. Initial assessment is crucial in identifying certain factors that could be exacerbating the condition, such as alcohol or substance abuse.

Mild depression is not usually treated with antidepressants unless it persists after CBT or another type of psychotherapy. CBT in mild depression is usually used to formulate a self-help programme that the person can continue, without the need to see a specialist every week.

Antidepressants are effective for moderate to severe depression, but may have both advantages and disadvantages. For example, some antidepressants can make people extremely drowsy, and this can lower concentration levels. They can also lower sex drive and affect someone’s appetite.

Page last reviewed:  12/06/2020
Questions and Answers

What should I do if I think I might have depression?

If you think you may have symptoms of depression (particularly if your symptoms have lasted for more than two weeks) you should contact a doctor for advice. 

Depression is a very common condition, and although it can be difficult to talk about, there is no need to feel any embarrassment about speaking to a doctor.

Are there side effects of depression treatment?

Antidepressant medicine can cause side effects. Due to the fact that there are many different types of antidepressants, side effects can vary greatly. 

Common side effects of SSRIs include decreased alertness and a reduced sex drive. Tricyclic antidepressants can cause tooth decay as well as other side effects similar to SSRIs.

Cognitive behavioural therapy and similar psychotherapies have no physical side effects. However, the nature of therapy can be challenging for some people, who might find opening up about their difficulties stressful.

Can I consult a doctor about depression online?

If you would like to speak to one of our doctors about depression online, you can do so by using our video consultation service. One of of our UK doctors can discuss what treatment options are available to you, and refer you to a specialist to talk through self-help practices and CBT techniques.

Page last reviewed:  12/06/2020

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