We all feel down or fed-up at times but these feelings don’t usually last and are a normal response to problems or difficulties in our lives. However, when they don’t go away, are more than we can cope with and our ability to carry out our work and have satisfying personal relationships is affected, it may be depression, the illness.

Depression is very common and may affect as many as 1 in 4 people at some stage in their lives. Women are more likely to experience it, but people of all ages and backgrounds are susceptible. Recent studies have shown that between 8-12% of the population (more than 150,000 people in Northern Ireland) experience depression in any year.

What Causes Depression

There is usually more than one cause or risk factor. Most of these fall into one of the following categories:

• Heredity: being born to a parent or close relative who has had depression may increase our risk
• Environment: current factors like poor housing, money worries, stress, relationship problems, physical illness, loneliness
• Life events and experiences: past issues like bereavement, abuse, bullying, job loss, relationship break-up
• Personality: people with a more sensitive personality or who have perfectionist tendencies are more vulnerable to depression. It’s not what happens to us but how we deal with it that matters.

Most people with depression probably fall into two or more of these categories, and the more factors that apply the greater the risk. Sometimes there doesn’t seem to be any reason.

Symptoms of Depression

At least two of the following core symptoms for at least two weeks:

• An unusually sad mood that does not go away;
• Loss of enjoyment and interest in activities that used to be enjoyable;
• Tiredness and lack of energy

In addition, people who are depressed can have a range of other symptoms such as:

• Loss of confidence in themselves or poor self-esteem;
• Feeling guilty when they are not really at fault;
• Wishing they were dead;
• Difficulty making decisions and concentrating;
• Moving more slowly or becoming agitated and unable to settle;
• Having difficulty sleeping or sleeping too much;
• Loss of interest in food or eating more than usual, leading to weight loss or weight gain.

The number and severity of symptoms experienced will determine whether the depression is diagnosed as mild, moderate or severe.

What Helps for Depression

If you think you might be depressed you should see your GP as soon as possible. Earlier treatment leads to a quicker and better recovery. The GP can also rule out any other medical cause for your symptoms. He will decide on suitable treatment depending on the severity of symptoms. Simple lifestyle changes or self-help strategies may be all that is needed for mild depression, but the GP will want to keep an eye this. The three main types of help for depression are:

Talking therapies (psychotherapies)

Cognitive behavioural therapy (CBT) has been proven very effective for mild/moderate depression and in preventing relapse. It works on the basis that if we change our unhelpful thinking patterns and behaviour it will improve how we feel. Self-help books based on CBT and computerised CBT are also available and there are other types of therapy and counselling. Ask your GP to tell you about them. Any of these may be used with/without medication as well.

Medication

Anti-depressants are the most commonly prescribed and effective treatments for moderate/severe depression. It is important, however, to take them exactly as prescribed and only to stop taking them as and when advised by your GP. They are not addictive, but stopping them suddenly or too soon may cause a relapse. They work by boosting certain brain chemicals that affect mood. Any side effects usually disappear or are tolerable, although you should tell your GP about them.

Self-help strategies

When we’re feeling depressed, we tend to do less and less because of the tiredness, difficulty sleeping/eating, and negative thinking. We stop doing things we used to enjoy. It can get so bad that we can't go to work or do things at home. We stay in bed or stay at home doing very little and we isolate ourselves from friends and family. Just increasing our activity levels can make a big impact on our mood, but it's important to get a balance of activities which give you a sense of:

• Closeness - doing things with other people e.g. walking with or visiting friends/family, talking on the ‘phone
• Achievement - things that make us feel that we have done something useful e.g. doing the ironing, tidying the garden, helping someone else
• Pleasure - doing something you enjoy e.g. reading, going to the cinema, dancing, visiting the local park

Other key factors for recovery include:

• Keeping physically active on a regular basis
• Maintaining a regular sleep routine
• Eating a healthy, balanced diet
• Avoiding alcohol, or keeping it to safe limits