Depression presents differently throughout the population, and for some people it might be affected by pregnancy, monthly hormonal cycles or even by a change in seasons.
Persistent depressive disorder is used as a diagnosis for people who experience chronic depression – that is, depression for two years or longer.
Psychologists often report an uptick in consultations and referrals for mental health problems every autumn, and for some people winter leaves them feeling down, anxious, and low on energy, sleep or concentration.
Depression might be described or diagnosed as ‘atypical’ if the person reports that positive events (current or future) improve their mood. People with atypical depression still experience persistent low mood, and contrary to its name this type of depression is common and normal.
‘Major depressive disorder’ is a clinical classification from the Diagnostic and Statistical Manual (DSM), known more simply as ‘depression’ or clinical depression’.
The risk of developing mental health problems increases during pregnancy and for a year after birth, and is particularly high for people with a history of severe mental health problems. But PND can occur even where there is no history of mental health problems. Many people experience a few days of depression after they give birth that clears up on its own. But persistent low mood is difficult to shift alone and can be severe.
During pregnancy, women run a higher risk of mental health problems – particularly depression. Prenatal depression, sometimes called antenatal, can manifest in anxiety, loss of interest in life or the pregnancy, and poor sleep or concentration.
Hormonal changes in the menstrual cycle can affect mood, and for some people these changes are so severe and debilitating that their premenstrual symptoms are recognised as PMDD.
Because PMDD is a hormone-related disorder, it is defined as an ‘endocrine’ disorder. But given its mental health symptoms, it has recently been added to a key mental health classification, the Diagnostic and Statistical Manual of Mental Disorders (DSM).
Depression is generally measured as a few weeks of persistent low mood. Most GPs use a depression ‘score’, measured through a questionnaire, to decide what advice to give a person.
Depression might not present as ‘sadness’. It can also appear as loss of interest, energy, concentration, pleasure or perspective.
In depressive episodes, people might find they want to eat or sleep a lot more or less than usual. Some people with depression experience slurred speech, or fidgety restless energy. Others report other physical symptoms, such as headaches.
Depression might also present in irritability or even anger. Feelings of hopelessness or failure can make people lash out during depressive episodes.
Depression is only one of the reasons that people seek therapy, and people don’t have to be depressed to benefit from therapy. Low mood is a normal part of life, and can be a feature of other experiences and mental health diagnoses.
For example, grief is not depression, although some people who are grieving might also be depressed, or might benefit from treatment for depression. We would recommend anyone struggling with bereavement to explore counselling and therapy to help support them in the period after losing a loved one. Low mood is normal after other types of loss too, including endings (the end of a relationship, job or period of life).
Depression can be diagnosed after a few weeks of daily symptoms, but some people may live with depression for longer than that before seeking treatment.
Depression is a chronic condition which can return throughout life. Some people with a diagnosis report that their depression comes and goes. Others report that depression appears ‘out of nowhere’ or without a trigger.
The Office of National Statistics reported that last summer, around one in ten adults reported symptoms of depression. During the Covid-19 pandemic, this figure jumped.
Adults and children get depression. In adults, statistics suggest that slightly more women than men experience depression, although some men report a stronger sense of stigma around seeking help.
Depression can develop when people go through hormonal changes (such as pregnancy or the menstrual cycle) and after big life events such as bereavement, divorce and redundancy. But it can also arise without a clear trigger, and some people experience depression ‘out of the blue’ or ‘out of nowhere’.
It’s hard to know why we become depressed sometimes, and that can prevent people seeking treatment, but therapists and doctors are well aware that even without a clear cause, people experiencing depression need help just as much as any other patient.
Depression, even when a person feels suicidal, is treatable. Evidence for treating depression with talk therapy is good. NICE recommends CBT, MBCT and interpersonal therapy for people experiencing depression, depending on symptoms and history of depression.
Some people with depression respond well to taking antidepressants. They can take medication by itself, or combine it with therapy.
There is growing evidence that there are some behavioural interventions that support the treatment of mild depression. Exercise, sleep, stress management and social interaction are all recommended during treatment or to manage symptoms.
The UK’s first charity for people with suicidal thoughts opened in 1953. Suicide was decriminalised in 1961 as public awareness of mental health crises improved.
The US Food and Drug Administration (FDA) approved fluoxetine for the treatment of depression in 1987. This was the first ‘selective serotonin reuptake inhibitor’ available, one of a new wave of drugs for treating severe depression.
In 2008 the Improving Access to Psychological Therapies (IAPT) programme launched, which helped more people get therapy on the NHS.
Walks and outdoor sports events run by a new charity boost awareness for the evidence that staying fit can help manage depression.
Marverine Cole’s BBC radio feature asks why Afro-Caribbean women in the UK are at greater risk of depression.
Matthew Johnson’s graphic memoir about depression – his own, and the common experience many people share.
After a massive bereavement, Poorna Bell starts asking questions about what fulfillment means to her.
Andrew Solomon’s account of depression tells the story of his breakdown, treatment and recovery.
Young people can contact Childline through online chat or by phone (0800 1111) to get specialist support with low mood, depression and suicidal thoughts or feelings, 24 hours a day.
NHS Choices provides information about the signs, symptoms and treatment for depression.
For people in distress or despair, especially for people experiencing suicidal thoughts, Samaritans is open 24 hours a day by phone (116 123) and email (jo@samaritans.org).