UNDER-

STANDING
depression

samh.org.uk
 contents

What is depression? 04
What are the symptoms of depression? 06
What causes depression? 10
How can I look after myself? 14
What treatment is there? 18
How can friends and family help? 22
Useful contacts 24

This booklet
describes the symptoms
of depression and the
different kinds of
treatment available.
It suggests ways that
you can help yourself,
and what family and
friends can do.
Further information
To read or print SAMH’s information booklets visit samh.org.uk.
If you require this information in word document format for compatibility
with screen readers, please email communications@samh.org.uk
For more information visit: samh.org.uk 3
Understanding depression
What is depression?
Depression is a low mood that lasts for a long time, and affects
your everyday life.
In its mildest form, depression can mean just being in low spirits. It doesn’t stop
you leading your normal life but makes everything harder to do and seem less
worthwhile. At its most severe, depression can be life-threatening because it can
make you feel suicidal or simply give up the will to live.
When does low mood Are there different types
become depression? of depression?
We all have times when our mood is If you are given a diagnosis of depression,
low, and we’re feeling sad or miserable you might be told that you have mild,
about life. Usually these feelings pass moderate or severe depression.
in due course. This describes what sort of impact your
symptoms are having on you currently,
But if the feelings are interfering with and what sort of treatment you’re likely
your life and don’t go away after a to be offered.
couple of weeks, or if they come back
over and over again for a few days at You might move between different mild,
a time, it could be a sign that you’re moderate and severe depression
experiencing depression. during one episode of depression or across
different episodes.
‘It feels like I’m
stuck under a
huge grey-black
cloud. It’s dark
and isolating,
smothering me
at every
opportunity.’
4 For more information visit: samh.org.uk
What is depression?
‘Sometimes it feels like a black hole but
sometimes it feels like I need to cry and scream
and kick and shout. Sometimes I go quiet and
lock myself in my room and sometimes I have to
be doing something at all times of the day
to distract myself.’
There are also some specific Is premenstrual dysphoric disorder
types of depression: (PDD) a type of depression?
• Seasonal affective disorder (SAD) –
depression that usually (but not always) PDD is a severe form of premenstrual
occurs in the winter. syndrome (PMS). Many women
• Dysthymia – continuous mild experience PMS, but for some women
depression that lasts for two years their symptoms are severe enough to
or more. Also called persistent seriously affect their daily life. This
depressive disorder or chronic is when you might receive a diagnosis
depression. of PDD.
• Prenatal depression – sometimes also
While PDD is not a type of depression,
called antenatal depression, it occurs
most women who experience PDD find
during pregnancy.
that depression is a major symptom.
• Postnatal depression (PND) – occurs NHS Choices has more information
in the weeks and months after about PMS and PDD (see ‘Useful
becoming a parent. Postnatal depression contacts’ on p.24).
is usually diagnosed in women but it can
affect men too.
PANDAS has information and support
for anyone experiencing pre- or postnatal
depression (see ‘Useful contacts’ on p.24).
5
Understanding depression
What are the symptoms of depression?
There are many signs and symptoms of depression, but everyone’s
experience will vary.
This section covers:
• common signs and symptoms of
depression
• psychotic symptoms
• self-harm and suicide
• anxiety
• depression as a symptom of other
mental health problems.
Common signs and symptoms of depression
Some common signs of depression include:
How you might feel
• down, upset or tearful
• restless, agitated or irritable
• guilty, worthless and down on yourself
• empty and numb
• isolated and unable to relate to
other people
• finding no pleasure in life or
things you usually enjoy
• a sense of unreality
• no self-confidence or self-esteem
• hopeless and despairing
• suicidal
6 For more information visit: samh.org.uk
What are the symptoms of depression?
About psychotic symptoms
‘I had constant If you experience an episode of severe
low mood, depression, you might also experience
hopelessness, some psychotic symptoms.
These can include:
frustration with • delusions, such as paranoia
myself, feeling • hallucinations, such as hearing voices.
like I could cry at If you experience psychotic symptoms
any moment.’ as part of depression, they’re likely to be
linked to your depressed thoughts and
feelings. For example, you might become
convinced that you’ve committed an
unspeakable crime. These kinds of
How you might behave experiences can feel very real to you at the
time, which may make it hard to
understand that these experiences are
• avoiding social events and activities
also symptoms of your depression.
you usually enjoy
They can also be quite frightening or
• self-harming or suicidal behaviour upsetting, so it’s important to seek help
• finding it difficult to speak or think clearly and support.
• losing interest in sex You might feel worried that experiencing
• difficulty in remembering or
concentrating on things
psychotic symptoms could mean you get
a new diagnosis, but psychosis can be a
‘It felt like
• using more tobacco, alcohol or other symptom of depression. Discussing your I was really
drugs than usual
• difficulty sleeping, or sleeping too much
symptoms with your doctor can help you
get the right support and treatment.
tired, all the
• feeling tired all the time time. I had no
• no appetite and losing weight, (See SAMH’s online booklet Understanding energy or
or eating too much and gaining weight
• physical aches and pains with
psychosis for more information). emotion about
no obvious physical cause anything.’
• moving very slowly, or being restless
and agitated
7
Understanding depression
About self-harm and suicide
If you are feeling low, you might use
self-harming behaviours to cope with
difficult feelings. Although this might make
you feel better in the short term, self-harm
can be very dangerous and can make you
feel a lot worse in the long term.
(See SAMH’s booklet Understanding
self-harm for more information).
When you’re feeling really low and
hopeless, you might find yourself thinking
about suicide. Whether you’re only thinking
about the idea, or actually considering a
plan to end your life, these thoughts can
feel difficult to control and very frightening.
If you’re worried about acting on thoughts
of suicide, you can call an ambulance,
go straight to A&E or call the Samaritans for
free on 116 123 to talk.
8 For more information visit: samh.org.uk
What are the symptoms of depression?
About anxiety Can depression be a symptom of other
It’s very common to experience mental health problems?
depression and anxiety together. Some Depression can be a part of several mental
symptoms of depression can also be health problems:
symptoms of anxiety, for example: • Bipolar disorder
• feeling restless • Borderline personality disorder
• being agitated (BPD) and other personality disorders
• struggling to sleep and eat. • Schizoaffective disorder.
See SAMH’s booklet Understanding anxiety As feelings of low mood or suicidal
and panic attacks for more information. thoughts might be the reason you first
speak to your doctor about your mental
health, your GP might offer you treatment
for depression without realising that you
are also experiencing other symptoms.
If you think you’re experiencing other
‘I flit symptoms, you can talk to your doctor
about this to make sure you’re getting the
between right treatment to help you.
states of
anxiety and
depression.
At times,
each seems
to fuel the
other.’
9
Understanding depression
What causes depression?
There are several ideas about what causes depression. It can vary a lot
between different people, and for some people a combination of different
factors may cause their depression.
Some find that they become depressed Is depression caused by a
without any obvious reason. chemical imbalance?
In this section you can find information No. As antidepressants work by
on the following possible causes of changing brain chemistry, many
depression: people have assumed that
• childhood experiences depression must be caused by
changes in brain chemistry which
• life events
are then ‘corrected’ by the drugs.
• other mental health problems
Some doctors may tell you that
• physical health problems you have a ‘chemical imbalance’
• genetic inheritance and need medication to correct it.
• medication, drugs and alcohol But the evidence for this is very
weak, and if changes to brain
• sleep, diet and exercise.
chemistry occur, we don’t know
whether these are the result of the
depression or its cause.
‘I first experienced
depression at 15, after
psychological abuse and
domestic violence (both
myself and my mother)
at the hands of my
father, for many years.’
10
‘I started to feel that depression really
took a hold after a torrid time in my job,
where I was bullied – I just crumbled.’
Childhood experiences
There is good evidence to show that
going through difficult experiences in your
childhood can make you vulnerable to
experiencing depression later in life.
This could be:
• physical, sexual or emotional abuse
• neglect
• loss of someone close to you
• traumatic events
• unstable family situation.
Research shows that going through lots
of smaller challenging experiences can
have a bigger impact on your vulnerability
to depression than experiencing one
major traumatic event.
Difficult experiences during your childhood
can have a big impact on your self-esteem
and how you learned to cope with difficult
emotions and situations. This can make
you feel less able to cope with life’s ups and
downs, and lead to depression later in life.
NAPAC supports anyone who experienced
abuse in childhood – including sexual,
physical and emotional abuse, and neglect
(see ‘Useful contacts’ on p.24).
For more information visit: samh.org.uk
What causes depression?
Life events
In many cases, you might find your
depression has been triggered by an
unwelcome, stressful or traumatic event.
This could be:
• losing your job or unemployment
• the end of a relationship
• bereavement
• major life changes, like changing job,
moving house or getting married
• being physically or sexually assaulted
• being bullied or abused.
It’s not just negative experiences that
cause depression, but how we deal with
them. If you don’t have much support to
help you cope with the difficult emotions
that come with these events, or if
you’re already dealing with other difficult
situations, you might find that a low mood
develops into depression.
11
Understanding depression
Physical health problems
When does grief become depression?
Poor health can contribute to your risk
of developing depression. Many health
Grief, and the low mood that comes with it, is a natural response to losing problems can be quite difficult to manage,
someone or something we love. How long your grief lasts will be individual to you. and can have a big impact on your mood.
But if you feel that what you’re experiencing might be something more than just These could be:
grief, you can talk to your doctor about it.
• chronic health problems
You might want to try bereavement counselling first, as this may be more helpful
• life threatening illnesses
for you than general treatment for depression. Cruse Bereavement Care offers
support and counselling for anyone affected by bereavement (see ‘Useful • health problems that significantly
contacts’ on p.24). change your lifestyle.
As part of your treatment for a physical
health problem you might be offered
Other mental health problems support for your mental health at the
same time.
If you experience another mental health There are some physical health problems
problem, it’s common to also experience that can cause depression:
depression. This might be because • conditions affecting the brain and
coping with the symptoms of your mental nervous system
health problem can trigger depression. • hormonal problems, especially thyroid your doctor about taking an alternative,
You may find you experience depression and parathyroid problems
if you also experience:
• symptoms relating to the menstrual treatment to last some time.
• anxiety cycle or the menopause
• eating problems • low blood sugar
• post-traumatic stress disorder (PTSD).
• sleep problems.
If you think any of the above conditions
‘My depression apply to you, make sure your doctor knows
seems to flare about them. Some can be diagnosed by
simple blood tests – your doctor may
up during times suggest these are done to help make the
when I am right diagnosis, or you can ask for blood
stressed and tests if you think they may be relevant.
isolated from
other people.’
12 For more information visit: samh.org.uk
What causes depression?
Genetic inheritance
Although no specific genes for depression
have been identified, research has shown
that if you have a close family member
with depression, you are more likely to
experience depression yourself.
While this might be caused by our biology,
this link could also be because we usually
learn behaviour and ways of coping from
the people around us as we grow up.
Medication, drugs and alcohol
Depression can be a side effect of a lot
of different medicines. If you are
feeling depressed after starting any kind of
medication, check the patient information
leaflet to see whether depression is a side
effect, or ask your doctor. If you think a drug
is causing your depression, you can talk to
especially if you are expecting your
Alcohol and street drugs can both cause
depression. Although you might initially use
them to make yourself feel better,
or to distract yourself, they can make you
feel worse overall.
Sleep, diet and exercise
A poor diet and lack of sleep and exercise
can affect your mood, and make it harder
for you to cope with difficult things going on
in your life.
Although a poor diet, or not getting enough
sleep or exercise, cannot directly cause
depression, they can make you more
vulnerable to developing it.
13
Understanding depression How can I look after myself?

How can I look after myself?

Experiencing depression can make it hard to find the energy to look ‘Be kind to yourself. If you
after yourself. But taking an active role in your treatment, and taking steps need ‘me time’, give it to
to help yourself cope with your experiences, can make a big difference to yourself. You are worth it.’
how you feel. Here are some things you can try:

Look after yourself ‘I’ve made a list of Practise self-care

• Get good sleep. For lots of people who things I usually • Work out what makes you happy. • Be kind to yourself. None of us achieve
experience depression, sleeping too little Try making a list of activities, people and all our goals. Don’t beat yourself up if
enjoy, like you don’t do something you planned to,
or too much can be a daily problem. places that make you happy or feel good.
Getting good sleep can help to improve
knitting or Then make a list of what you do every or find yourself feeling worse again.
your mood and increase your playing the day. It probably won’t be possible to Try to treat yourself as you would treat a
energy levels. guitar, and I try include all the things that make you friend, and be kind to yourself.
• Eat well. Eating a balanced and to do little bits happy but try to find ways to bring those
nutritious diet can help you feel well, of these things into your daily routine.
think clearly and increase your activities when • Treat yourself. When you’re
energy levels. I’m feeling low.’ feeling down, it can be hard to feel
• Keep active. Many people find exercise good about yourself. Try to do at least
a challenge but gentle activities like yoga, one positive thing for yourself every day. ‘I’ve written a
swimming or walking can be a big boost This could be taking the time for a letter to myself
to your mood. long bath, spending time with a pet which I keep
or reading your favourite book. along with a
• Look after your hygiene. When you’re
experiencing depression, it’s easy for • Create a resilience toolkit. This could few other ‘feel
hygiene to not feel like a priority. be a list of activities you know improve good’ items in a
But small things, like taking a shower and your mood, or you could fill an actual
box with things to do to cheer yourself
tin box. The
getting fully dressed whether or not
you’re going out of the house, can make up. Try including your favourite book letter reminds
a big difference to how you feel. or film, a notebook and pen to write down me that
• Avoid drugs and alcohol. While you
your thoughts or notes of although the
might want to use drugs or alcohol to
encouragement to yourself. It might storm has to
feel difficult or a bit silly to put it all take its course,
cope with any difficult feelings, in the
together but it can be a really useful tool
long run they can make you feel a
if you’re feeling too low to come up with
it will
lot worse.
ideas later on. eventually pass
and things will
get better.’

14 For more information visit: samh.org.uk 15

Understanding depression How can I look after myself?

‘I find reading other people’s

experiences makes me feel
less like I’m alone in this. It’s
actually made me feel more
comfortable.’

Keep active Challenge your low mood Connect with other people ‘What helps is
• Join a group. This could be anything • Keep a mood diary. This can help you • Keep in touch. If you don’t feel up to
from a community project or a sports keep track of any changes in your mood, seeing people in person, or talking, send
surrounding
team to a hobby group. The important and you might find that you have more a text or email to keep in touch with myself with
thing is to find an activity you enjoy, good days than you think. It can also friends and family. friends and
or perhaps something you’ve always help you notice if any activities, places or
wanted to try, to help you feel motivated. people make you feel better or worse.
• Keep talking. It might feel hard to start family who
talking to your friends and family about
• Try new things. Trying something new, • Challenge your thinking. Students what you’re feeling, but many people
understand
like starting a new hobby, learning Against Depression has lots of find that just sharing their experiences without pointing
something new or even trying new food, information and activity sheets to try can help them feel better. it out, who treat
can help boost your mood and break to help you challenge negative thinking • Join a peer support group. Going to a
unhelpful patterns of thinking and (see ‘Useful contacts’ on p.24). peer support group is a great way to
me normally but
behaviour. • Try self-help. If your depression is share tips and meet other people who recognise that
• Try volunteering. Volunteering (or just mild, you might find free online cognitive are going through similar things. everyday life can
offering to help someone out) can behavioural therapy (CBT) courses • Use online support. Online support be a struggle
make you feel better about yourself and like MoodGYM can be a useful way to build a support sometimes.’
less alone. Volunteer Scotland can (web: moodgym.anu.edu.au) can help network when you cannot, or don’t
help match you with a volunteering you tackle some of your negative thinking feel able to, do things in person.
opportunity in your area (see ‘Useful and avoid your depression growing Online forums like Elefriends are
contacts’ on p.24). worse. specifically for anyone struggling with
• Set realistic goals. Try to set yourself • Contact a helpline. If you’re struggling their mental health.
achievable goals, like getting dressed with difficult feelings, and you can’t talk
every day or cooking yourself a meal. to someone you know, there are many
Achieving your goals can help you helplines you can contact. These are not
feel good and boost your self- professional counselling services but the
confidence, and help you move on people you speak to are trained to listen
to bigger ones. and could help you feel more able to
cope with your low mood.

16 For more information visit: samh.org.uk 17

Understanding depression What treatment is there?

What treatment is there?

The sort of treatment you’re offered for depression will depend on:

• how much your symptoms are Talking therapies for depression Medication for depression Treatment for severe and
affecting you There are many different talking You might also be offered an complex depression
• your personal preference for what sort therapies that can be effective in treating antidepressant, either on its own or in
of treatment you find helps you. depression: combination with a talking treatment. If your depression is severe and
• cognitive behavioural therapy (CBT) There are different types of complex, your doctor should refer you
The main treatments for depression are:
antidepressants: to specialist mental health services.
• talking therapies • group-based CBT They can discuss with you the following
• computerised CBT (CCBT) – this is CBT • selective serotonin reuptake
• medication. options:
delivered through a computer inhibitors (SSRIs)
This section also covers: • trying talking therapies and
programme or website • serotonin and norepinephrine medication again
• alternative treatments reuptake inhibitors (SNRIs)
• interpersonal therapy (IPT) • hospital admission
• ECT • tricyclics and tricyclic-related drugs • medication for psychotic symptoms
• behavioural activation
• treatment to stay well. • monoamine oxidase inhibitors (MAOIs) • planning for and managing a crisis
• psychodynamic psychotherapy
• behavioural couples therapy – if you • other antidepressants.
Remember: you have a right to be Different people find different medications
have a long-term partner, and your
involved in your treatment. most helpful. You can talk to your doctor
doctor agrees that it would be useful to
involve them in your treatment. about your options – you might find you
Your doctor or mental health professional need to try out a few different types of
can talk through the options available in medication before you find the one that
your area and help you find the right kind of works for you.
‘I really struggled
with the SSRIs, even talking treatment for you. Unfortunately, we
though my GP told know that in many places NHS waiting lists
me that was the for talking therapies can be very long.
only course of
action. They made
me feel worse than
‘Taking care of my
I did to start with, diet and body, talking
then incredibly and alternative
tired. I fought for methods work far
a referral for CBT
and in the end it better for me.’
saved me.’

18 For more information visit: samh.org.uk 19

Understanding depression What treatment is there?

Alternative treatments ECT Staying well

There are also other options you can try Electroconvulsive therapy (ECT) should If you start to feel better, it’s important ‘Fluoxetine
instead of, or alongside, medication and only be considered a treatment option for to discuss with your doctor whether you
talking therapies. depression in extreme circumstances. should continue your treatment. Your
has helped me
If you aren’t experiencing many symptoms, According to NICE guidelines this doctor can also discuss your options for to manage my
or they aren’t impacting on your daily life could be if: treatment to stay well after an episode of lows so they
too much, then your doctor might suggest: • you’re experiencing a long and severe depression has passed. See the chapter on do not become
period of depression ‘Self-care’ for more ideas on staying well. as crippling as
• watchful waiting – this means being
aware of your mood, and seeing how you • other treatments have not worked
Talking treatments
they used to.’
feel after a few weeks have passed; many • the situation is life-threatening.
people find that some mild depressive If you’re currently receiving a talking
If you feel like you’re in this situation, your
symptoms can go away on their own therapy, you don’t have to stop just
doctor should discuss this option with you
• guided self-help – this is usually using because you’re feeling better. You can
in a clear and accessible way before you
ideas from cognitive behavioural therapy discuss your mood with your therapist and
make any decisions.
(CBT) one-to-one with a mental health talk about what options might be right for
professional to learn problem solving you. NICE recommends CBT or
techniques mindfulness based cognitive therapy
Is neurosurgery ever used to treat (MBCT) to help you stay well if you’ve had
• physical activity programmes – these
depression? episodes of depression in the past.
are specifically designed for people with
depression and run by qualified
Neurosurgery for mental disorder Medication ‘An understanding
professionals.
(NMD) is only performed very rarely,
You might also find these other treatments in extreme circumstances. NMD is only
If you’re taking medication for depression, counsellor who
helpful, however many symptoms you’re offered if all other treatments have
it’s important not to stop suddenly. gave me tech-
experiencing: failed and cannot ever be performed
This can be dangerous, and withdrawal niques to use as
symptoms can be difficult to cope with. I moved forward
• arts therapies without your consent.
• alternative and complementary
NICE recommends that you continue to helped me get on
therapies
take your antidepressants for at least six the right track.’
months after your episode of
• mindfulness depression ends. If you’ve experienced
• ecotherapy several episodes of depression before, you
• peer support. might want to keep taking your medication
Your doctor may be able to refer you to if you feel it could help you prevent
some of these. another episode.

20 For more information visit: samh.org.uk 21

How can friends and family help?
The support of friends and family can play a very important role in
someone recovering from depression. Here are some suggestions for
how you can help. ‘Listen carefully,
don’t judge and
most of all, don’t
• Support them to get help. You can’t force • Keep a balance. If someone is say, ‘Cheer up.’ It’s
‘Just a simple anyone to get help if they don’t want it, struggling, you might feel like you should just not that
call or text so it’s important to reassure your loved
one that it’s OK to ask for help, and that
take care of everything for them.
While it might be useful to offer to help
simple. Sometimes
asking me how there is help out there. them do things, like keep on top of the
solutions are
unnecessary, so
I am helps. I • Be open about depression. Lots of housework or cook healthy meals,
it’s also important to encourage them
don’t feel you have
people can find it hard to open up and
don’t want speak about how they’re feeling. Try to to do things for themselves. Everyone to provide one.’
sympathy, just be open about depression and will need different support, so talk to
your friend or family member about what
to know they difficult emotions, so your friend or
family member knows that it’s OK to talk they might find useful to have your help
are there if I about what they’re experiencing. with, and identify things they can try
to do themselves.
need them.’ • Keep in touch. It might be hard for your
• Take care of yourself. Your mental health
loved one to have the energy to keep
up contact, so try to keep in touch. is important too, and looking after
Even just a text message or email to let someone else could put a strain on your
them know that you’re thinking of them wellbeing.
can make a big difference to how (See SAMH’s booklet How to cope when
someone feels. supporting someone else).
• Don’t be critical. If you’ve not
experienced depression yourself, it can
be hard to understand why your friend
or family member can’t just ‘snap
out of it’. Try not to blame them or put
too much pressure on them to get better
straight away – your loved one is
probably being very critical and harsh
towards themselves already. The rest of
this Understanding depression booklet
can help you learn more about it.

22 For more information visit: samh.org.uk 23

Understanding depression Useful contacts for work?

Useful contacts

Breathing Space Elefriends National Institute for Health and See Me

Clinical Excellence (NICE)
T: 0800 83 8587 W: elefriends.org.uk W: seemescotland.org
W: breathingspace.scot A friendly online community for people W: nice.org.uk National programme to tackle mental
Confidential out of office hours telephone experiencing a mental health problem. Guidelines on treatments for depression. health stigma and discrimination.
line for people experiencing low mood,
anxiety or depression. Give Us A Shout PANDAS (SIGN) Scottish Intercollegiate
Guidelines Network
T: 85258 ((text only) W: pandasfoundation.org.uk
British Association for Counselling Pre- and post-natal depression advice T: 0131 632 4720
W: giveusashout.org
and Psychotherapy (BACP)
W:giveusashout.org and support. W: sign.ac.uk
T: 014455 88 33 00 Evidence based clinical practice guidelines
W: bacp.co.uk The National Association for People SAD Association for the NHS in Scotland
Information about counselling Abused in Childhood (NAPAC)
W: sada.org.uk
and details of local therapists Students Against Depression
T: 0808 801 0331 Info and advice on seasonal affective
W: napac.org.uk disorder (SAD). W: studentsagainstdepression.org
COSCA (Counselling & Psychotherapy
A charity supporting adult survivors of Information and support for students
in Scotland) Samaritans
any form of childhood abuse. Provides a experiencing depression.
T: 01786 475140 support line and local support services. T: 116 123
W: cosca.org.uk E: jo@samaritans.org
To find a counsellor or psychotherapist NCT
W:samaritans.org
T: 0300 330 0700 Freepost:
Cruse Bereavement Care Scotland
W: nct.org.uk RSRB-KKBY-CYJK, Chris,
T: 0845 600 2227 National charity for parents, providing PO Box 90 90
W: crusescotland.org.uk information and support for all parents. Stirling
Support for anyone affected by the FK8 2SA
death of someone close. NHS Inform
A 24-hour free telephone helpline for
W:nhsinform.scot peoplestruggling to cope.
Information on medical conditions

24 For more information visit: samh.org.uk 25

Understanding depression Useful contacts for work?

Notes

26 For more information visit: samh.org.uk 27

Since 1923, SAMH has represented
the voice of people affected by
mental health problems in Scotland.
We are here to provide help,
information and support.

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SAMH is the Scottish Association for Mental Health

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