Depression can cause people to experience low moods and feelings of sadness. The symptoms can range from mild to severe, and anyone can experience depression.

While some people may say they are depressed when they feel a little ‘down’ or unhappy for a few days, this is different to the clinical condition, which can last for weeks or months.

Neuraxpharm provides medication alternatives for depression and once your doctor has determined your specific needs, they can prescribe the product that best adapts to your needs and condition.

Find out more about what can cause depression, the effects it can have, and the treatments available.

What is depression?

Depression is a common mental health condition that can cause ongoing negative feelings and a general lack of interest in daily life and activities that the affected person would usually enjoy. It can also affect people’s appetite and sleep, with knock-on effects causing tiredness and poor concentration. People with depression may also develop low self-esteem.


The condition can last for some time and have a substantial effect on day-to-day wellbeing and enjoyment of life and relationships.

What are the main types of depression?

Depression can usually be described as major depression or persistent depression. Major depression describes the condition when it affects a person every day for at least two weeks; this can happen just once or over a number of episodes. Persistent depression describes the condition when someone has major depressive episodes interspersed with periods of less severe symptoms over a period of at least two years.

In 2008, the World Health Organization ranked major depression as third in a list of leading causes of worldwide ‘burden of disease’ (the impact a health problem has on a population), and projected that the disease would rank first by 2030(1).

Persistent depressive disorder is a common chronic mood disorder that is often more disabling than episodic major depression. The term covers several chronic depressive presentations, including chronic major depression and recurrent major depression without recovery between episodes(2). Some types of depression are particular to certain groups; for example, pregnant women may experience perinatal or postpartum depression around the time of their baby’s birth. This type of depression will most likely require specialist treatment, which might include therapy and medication.

Other depressive disorders include psychotic depression, seasonal affective disorder, the related condition bipolar disorder, disruptive mood dysregulation disorder (in children and young people) and premenstrual dysphoric disorder (PMDD).

Psychotic depression is where mood disturbance is accompanied by delusions, hallucinations, or both. While it was once considered relatively uncommon, it is frequently encountered in clinical practice, particularly in treatment-resistant depressed patients.

Seasonal affective disorder (SAD) is a combination of biological and mood disturbances with a seasonal pattern, typically occurring in the autumn and winter with remission in the spring or summer. Researchers in one study found that, in a given year, about 5% of the US population experiences the disorder, having symptoms for about 40% of the year(3). However, prevalence estimates in other studies have varied from 0% to 9.7%. SAD is more prevalent at higher northern latitudes, but the prevalence varies across ethnic groups(4).

The diagnosis of disruptive mood dysregulation disorder is a relatively new one. It requires frequent, persistent, severe temper outbursts that are out of proportion to the situation and developmental context, combined with persistent angry/irritable mood between the temper outbursts(5).

Premenstrual disorders affect up to 12% of women. They include premenstrual syndrome and premenstrual dysphoric disorder, which encompass the psychological and physical symptoms that cause significant impairment during the luteal phase of the menstrual cycle but resolve shortly after menstruation(6).

How many people experience depression?

Depression is a common condition that is thought to affect more than 264 million people worldwide(7). One study showed that across the 28 countries in the European Union, at least 21 million people were affected by depression. This made depression the costliest brain disorder in Europe, with total direct and indirect costs corresponding to 1% of the total economy (gross domestic product) of the EU(8).

Symptoms

Depression can cause a wide variety of mental and physical symptoms, and one person’s symptoms may differ from another’s.

What are the symptoms of depression?

The symptoms of depression range from mild to severe. Unlike unhappy feelings caused by a difficult situation that resolve themselves over a short period of time, the symptoms of depression are persistent.

The symptoms can affect people’s physical and mental health as well as how they interact socially. Many people with depression also experience anxiety. Symptoms can include:

Mental/emotional:

  • An ongoing feeling of sadness
  • Low self-confidence and self-esteem
  • Constant anxiety
  • Feelings of helplessness, hopelessness, or worthlessness
  • Guilt
  • Thoughts of suicide and death
  • Self-harming

Physical:

  • Tiredness and low energy
  • Difficulty concentrating
  • Problems with sleep
  • Lack of appetite
  • Loss of sex drive and/or sexual problems
  • Physical aches and pains
  • Gastrointestinal problems such as stomach-aches or diarrhoea

Social:

  • Lack of enjoyment of activities that were previously pleasurable
  • Avoidance of other people, including family and friends
  • Difficulties at work or school

What are the stages of depression?

Depression can be experienced at any time, and both the symptoms and length of time for which people are affected will differ between individuals. The severity of symptoms usually varies, with many people finding that some days are better or worse than others.


People with mild or moderate depression won’t necessarily go on to develop a worsening of their condition, particularly if they receive treatment as early as possible, but for some people depression does get worse over time.

What are the early signs of depression?

The early signs of depression may look like ordinary tiredness or sadness; however, unlike these normal feelings, the signs of depression won’t go away after a few days. Early signs could include:

  • Being tired all the time, possibly wanting to sleep during the day
  • A loss of moderation – possibly eating too much or too little due to lack of appetite, or sleeping too much or too little
  • Losing focus and struggling to pay attention, possibly leading to problems at work and in conversations
  • Loss of interest in activities the person would normally enjoy
  • Feeling anxious
  • Thinking suicidal thoughts

Causes and risk factors

Research suggests that depression is caused by a mix of genetic, biological, environmental, and psychological factors(9).


Life experiences that may trigger depression can be an ongoing situation such as another health condition, or a temporary issue such as problems at work or difficulties in a relationship.

What causes depression?

The causes of depression differ for each person affected, although they may be related to common issues such as financial worries, illness, giving birth, relationship problems, or losing a job. However, while there may be an obvious trigger, sometimes people develop depression for no apparent reason.


It may also be that a chain of life events leads to depression – for example, a relationship break-up leading to difficulties at home and work, followed by losing a job and subsequent money worries; no single event caused the condition, but the build-up of problems culminated in depression.

Causes of depression can include:

  • A family history of depression
  • Stressful events, such as bereavement or losing a job
  • Giving birth – hormonal and physical changes can lead to perinatal or postnatal depression
  • Feelings of loneliness and isolation
  • Drinking too much or using drugs – alcohol affects the chemistry of the brain, which increases the risk of depression
  • A long-term health condition such as heart disease or cancer, or a head injury

Is depression hereditary?

People with a family history of depression are more likely to experience it themselves. This means that if someone has a parent or sibling with the condition, they are more likely to develop it themselves.

Who might experience depression?

Depression can affect children and young people as well as adults. In adulthood (including in older adults) it can co-occur with other serious medical illnesses, such as diabetes, cancer, heart disease, and Parkinson’s disease. Sometimes medications taken for physical illnesses such as these may cause side effects that contribute to depression.


Depressive disorders occur frequently in older people, and can either be a continuation of earlier problems or can be classed as late-onset depression if they first occur after the age of 60(10).

How long can you live with depression?

People affected by depression may find they only experience one or two episodes, or it may recur throughout their lifetime.


The severity of symptoms and how long they last will vary. Treatments and therapies can help reduce the symptoms and prevent the condition worsening.

Diagnosis

There are no physical tests for depression; however, a doctor may carry out blood tests to rule out other possible causes for symptoms, such as a thyroid problem. The diagnosis is usually made following discussions with a doctor about the symptoms being experienced.

How is depression diagnosed?

The main way a GP will diagnose depression is by asking questions about the patient’s general health and how the way they are feeling is affecting them mentally and physically.


This helps the doctor to determine whether an individual is depressed and whether their symptoms are mild, moderate, or severe.

Test to diagnose depression

There is no single test to diagnose or confirm depression. A mental health specialist will ask questions about symptoms, feelings and emotions, and make a clinical assessment using questionnaires such as the Beck Depression Inventory II (BDI-II) tool, which measures levels of depression(11).

Treatment and medication

Treatment for depression can involve a combination of lifestyle changes, talking therapies and medicine. The recommended treatment for an individual will be based on whether they have mild, moderate, or severe symptoms.

How is depression treated?

A doctor may recommend that someone with mild depression waits to see if it improves without active treatment but with some lifestyle changes such as increased exercise, reduced alcohol intake, or attending support groups. If mild depression is ongoing, patients can be referred for talking therapies or may be prescribed anti-depressants.
A combination of therapies and anti-depressants may be offered to people with moderate or severe depression.

Medication

Anti-depressants are the main medication used to treat depression. Because there are many different kinds, doctors will work with individual patients to find the right anti-depressant for them. Medications used include:

  • Selective serotonin reuptake inhibitors (SSRI):These work by increasing the level of a chemical known as serotonin in the brain. Serotonin plays a vital role in the brain, boosting feelings of wellbeing and happiness, and aiding thinking, memory, sleep, digestion, and circulation. SSRIs can be taken on a long-term basis, but it can take a few weeks for them to start working.
  • Serotonin and noradrenaline reuptake inhibitors (SNRI):If SSRIs are not sufficient, an SNRI may be offered. These work by increasing the amounts of serotonin and noradrenaline in the brain. They make specific changes in the brain and the nerve cells to regulate mood.
  • Anti-psychotics: These can be used in the treatment of severe depression. They work by reducing excess levels of the brain chemical dopamine. They may also affect levels of acetylcholine, noradrenaline, and serotonin.
  • Mood stabilisers:These can help prevent the lows of depression and help to keep low moods from interfering with daily life.

Medications may be prescribed alongside a therapy, such as cognitive behavioural therapy, to increase their benefits.
Psychotically depressed patients tend to respond poorly to anti-depressants, but remission is likely with neuroleptic/anti-depressant combinations or electroconvulsive therapy(12).

Therapy and intervention

Certain therapies may be recommended as a treatment for depression – either alone or together with medication. Therapies and interventions for depression may include:

  • Electroconvulsive therapy (ECT): This is a brain stimulation procedure delivered with anaesthesia to treat severe symptoms. It is usually delivered as a series of treatments over several weeks, but can also be effective when a rapid response is needed.
  • Cognitive behavioural therapy (CBT):This helps people to understand and manage their own thoughts and behaviours. CBT can be delivered face to face, over the phone, or online.
  • Counselling:This helps people find new ways of dealing with difficult issues in their lives.
  • Interpersonal therapy (IPT): This can help people better manage relationships and personal difficulties.
  • Mindfulness: This helps people to focus on the present moment and their thoughts and feelings, to help them develop a better understanding of their own self.

Diet

A healthy diet is key for physical and mental health, and a nutritionally balanced diet may help people recover from symptoms of depression.

Research shows there is an important link between our brain, our gut, and the beneficial microorganisms that live inside our digestive system (known as the ‘gut–brain axis’), which may affect the way we manage depression.

Foods thought to support normal mood and psychological function include wholegrains, fruit, and vegetables. Foods that contain high levels of saturated fat, refined sugars, other heavily processed ingredients, or caffeine can have a negative effect on psychological wellbeing.

Exercices

Exercise is beneficial for general physical and mental health, and it’s often recommended as one of the main treatments for mild depression. Regular exercise helps to raise self-esteem and promote a positive mood.

One of the possible symptoms of depression is a feeling of being low in energy, which may make exercise seem less attractive. The type of exercise taken isn’t as important as the time spent being regularly active, so people with depression should try to find something they can do regularly, with few barriers to taking part. This could be going for a regular walk around the neighbourhood (either alone or with friends), attending an exercise class at a local centre or online, or taking part in organised sports with a group of people.

Regular exercise is especially beneficial for people with mild to moderate depression.

Prevention

Many people with depression benefit by making lifestyle changes, such as getting more exercise, cutting down on alcohol, giving up smoking, and eating healthily. Other changes people can make to help reduce symptoms include:
  • Joining a support group or learning more about the condition, to gain a greater understanding of why they feel like they do
  • Avoiding the temptation to smoke or drink alcohol to improve their mood
  • Avoiding substance misuse
  • Considering the impact of work – do they need to take some time off to recover, or will returning to work actually be helpful?
Prevention programmes have been shown to reduce depression across communities. These include school-based programmes to enhance a pattern of positive thinking in children and adolescents, interventions for parents of children with behavioural problems to reduce parental depressive symptoms and improve outcomes for their children, and exercise programmes for older people(13).

Scientific studies

Physical activity is known to help treat and prevent depressive symptoms, but the reasons why are still being studied. This includes looking at the anti-depressant effects of exercise on physical factors such as neuroplasticity (the ability of cells in the brain to ‘rewire’ themselves), inflammation, oxidative stress (which can cause cell damage), and the endocrine system, plus mental and emotional factors including self-esteem and social support(14).


There are also many studies looking at the effects of diet on depression; for example, the effects of probiotics on communication between the gut and the brain(15), and the benefits of certain nutrients(16).


Research has shown that the gut microbiota (the beneficial microorganisms that live inside our digestive system) is associated not only with gastrointestinal diseases, metabolic disorders such as obesity and diabetes mellitus, but also with neuropsychiatric disorders, including major depressive disorders. The microbiota is important in the development of brain systems, and recent studies have shown that gut microorganisms are capable of producing and delivering neuroactive substances, such as serotonin and gamma-aminobutyric acid, that act on the gut–brain axis(17).

Referenced sources

  1. Mathers C, Boerma T, Ma Fat D. The global burden of disease: 2004 update. World Health Organization; 2008. Accessed February 2021. https://apps.who.int/iris/bitstream/handle/10665/43942/9789241563710_eng.pdf
  2. Schramm E, Klein DN, Elsaesser M, Furukawa TA, Domschke K. Review of dysthymia and persistent depressive disorder: history, correlates, and clinical implications. Lancet Psychiatry. 2020;7(9):801-812. doi:10.1016/S2215-0366(20)30099-7
  3. Kurlansik SL, Ibay AD. Seasonal affective disorder. Am Fam Physician. 2012;86(11):1037-1041. PMID: 23198671
  4. Magnusson A. An overview of epidemiological studies on seasonal affective disorder. Acta Psychiatr Scand. 2000;101(3):176-184. PMID: 10721866
  5. Rao U. DSM-5: disruptive mood dysregulation disorder. Asian J Psychiatr. 2014;11:119-123. doi:10.1016/j.ajp.2014.03.002
  6. Hofmeister S, Bodden S. Premenstrual syndrome and premenstrual dysphoric disorder. Am Fam Physician. 2016;94(3):236-240. PMID: 27479626 
  7. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1789-1858. doi:10.1016/S0140-6736(18)32279-7
  8. Sobocki P, Jönsson B, Angst J, Rehnberg C. Cost of depression in Europe. J Ment Health Policy Econ. 2006;9(2):87-98. PMID: 17007486
  9. National Institute of Mental Health. Depression. Updated February 2018. Accessed February 2021. https://www.nimh.nih.gov/health/topics/depression/index.shtml 
  10. Eschweiler GW. Diagnostik und multimodale Therapie der Altersdepression: Neue Entwicklungen [Diagnostics and multimodal treatment of depression in old age: new developments]. Z Gerontol Geriatr. 2017;50(2):99-105. doi:10.1007/s00391-016-1174-2
  11. Wang YP, Gorenstein C. Psychometric properties of the Beck Depression Inventory-II: a comprehensive review. Braz J Psychiatry. 2013;35(4):416-431. doi:10.1590/1516-4446-2012-1048
  12. Dubovsky SL, Thomas M. Psychotic depression: advances in conceptualization and treatment. Hosp Community Psychiatry. 1992;43(12):1189-1198. doi:10.1176/ps.43.12.1189
  13. World Health Organization. Depression. Accessed February 2021. https://www.who.int/health-topics/depression#tab=tab_1
  14. Kandola A, Ashdown-Franks G, Hendrikse J, Sabiston CM, Stubbs B. Physical activity and depression: towards understanding the antidepressant mechanisms of physical activity. Neurosci Biobehav Rev. 2019;107:525-539. doi:10.1016/j.neubiorev.2019.09.040
  15. Huang R, Wang K, Hu J. Effect of probiotics on depression: a systematic review and meta-analysis of randomized controlled trials. Nutrients. 2016;8(8):483. doi:10.3390/nu8080483
  16. Osher Y, Belmaker RH. Omega-3 fatty acids in depression: a review of three studies. CNS Neurosci Ther. 2009;15(2):128-33. doi:10.1111/j.1755-5949.2008.00061.x
  17. Evrensel A, Ceylan ME. The gut–brain axis: the missing link in depression. Clin Psychopharmacol Neurosci. 2015;13(3):239-244. doi:10.9758/cpn.2015.13.3.239
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