What is Depression?

Why Do Some People get Depressed?

The short answer is that nobody knows.

Depression may occur in some people but not others in the same circumstances. Genetic pre-disposition and personality type may play a part.

Depression is definitely sometimes a response to prolonged periods of stress (see our page on What is Stress?) or the loss of a person or job, especially when this causes anger (see our page on What is Anger?).

Sometimes there is no obvious cause for depression and sometimes there are many.

Depression can also take slightly different forms: see our page on Types of Depression for further information.

Who is Most at Risk?

The following factors are particularly, but not exclusively, associated with depression:-

Major life changes, even those that are expected or positive
Suffering abuse or experiencing conflict with loved ones (see our pages on Bullying for more)
Having substance abuse issues
Being socially isolated for whatever reason
Having other chronic illnesses, especially chronic pain
A history of depression amongst relatives.

This is not to say that typical sufferers are 'inadequate' in any way. Lots of high-fliers are vulnerable to depression, especially if they set very high standards for themselves and others and are very busy and thus prone to stress.

The “Keep Calm and Carry On” attitude is appropriate is some circumstances but in others such an attitude just leads to further suffering later on if the demands that are placed on somebody are simply too great.

Depression and Diet: the Effect of Ultra-Processed Foods

Depression—and indeed mental health more generally—are complicated conditions. However, there is growing evidence that diet plays a part in our mental health, just as it does in our physical health.

In particular, eating ultra-processed food seems to be harmful for both mental and physical health.

Ultra-processed food is food that has been made using several industrial processes, often involving breaking foods right down into their constituent molecules, and then rebuilding them into something that resembles food again. Ultra-processed foods include fizzy drinks, most packaged snacks, cakes, biscuits and pastries, and many ready meals.

A recent study among female nurses found that those who ate the highest proportion of ultra-processed food (more than nine portions per day) had a 50% greater chance of developing depression than those who ate the lowest quantities (four or fewer portions per day).

The precise nature of the link is not clear. However, it seems to be connected to our gut microbiome—the microbes that live in our digestive systems and help us to digest food.

There is more about this in our page on Ultra-Processed Food.

It is worth trying to avoid eating ultra-processed foods as much as possible for other health reasons. However, it seems particularly worthwhile if you fall into any of the other risk categories for depression.

Symptoms of Depression

There is no test for depression.

Physically depression is associated with a decrease in serotonin levels in the brain, and in the long term an area of the brain called the hippocampus may be smaller, either as a cause or as a result of depression.

However, these changes cannot easily be seen in a living person.

The diagnosis of depression hence depends on behavioural symptoms. These are well documented (MIND provide a particularly good list).

You should consider seeing your doctor or other health care provider if you suffer from any of the following symptoms for a prolonged period:

Low mood, especially if this leads to suicidal thoughts;
Anxiety, particularly if this is over things that don't usually bother you (see our page What is Anxiety? for more);
Waking up early or difficulty sleeping, even if you're very tired (see our page The importance of Sleep for more);
Lack of interest in sex;
No pleasure in your usual favourite activities, or cutting yourself off from your friends and family;
Persistent sobbing or tearfulness;
Failure to look after yourself physically or even self-harm;
Markedly increased or decreased appetite.

These common symptoms of depression can come on so gradually that it is very hard to recognise that you have a problem. Sometimes these feelings have been 'under the surface' for a long time before they become worrying enough to need treatment.

Your family and friends may have spotted that you aren't yourself and it may be worth asking them if they think that there is anything wrong.

If these things are happening to you but aren't overwhelming you, it may be that you simply need to reduce your stress levels. Our pages Dealing with Stress and Avoiding Stress have lots of useful suggestions.

Crazy?

Some people are very judgemental about depression but this is mostly down to fear and ignorance.

Depression really can happen to anyone and often seems to happen to those who are sensitive and giving, so deriding sufferers as 'crazy' or 'nutters' is unfair, unjustified and certainly unhelpful.

What Treatments for Depression are Available?

These are explained in full on our page, Treatments for Depression but briefly they take the form of either talking treatments or drugs.

Talking treatments

Such treatments may include counselling, psychotherapy, or CBT (Cognitive Behavioural Therapy). These come in many forms and for different lengths of time and include group and online therapy. Treatment may also introduce some mindfulness practice, which is learning to be aware of yourself and your body.

Your doctor may only be able to prescribe a certain number of sessions due to financial constraints so do make sure you know what your referral does and does not cover.

Drug treatment

Such treatments usually involve prescribing antidepressants, and these will take a few days or weeks to start working.

Prescribed antidepressants include Prozac and many others drugs and, if one does not work, another may be prescribed since their effect is different in different people.

Sometimes, if depression is severe and a referral to a psychiatrist takes place, anti-psychotic drugs may also be used to treat anxiety.

Tranquillisers such as Valium treat anxiety for only a few hours at a time and are highly addictive, hence they are less often prescribed, or only a limited number of them will be given.

What Can You Do to Help Yourself?

Firstly, make sure you can forgive yourself for being depressed.

Beliefs such as 'Only mad people get depressed!' and 'I shouldn't be depressed when much worse things happen to other people' are inaccurate and unhelpful. It is up to you whether you want to tell everyone what is happening to you, but don't feel ashamed.

Depression is exhausting and you may need time off work to recover, but your colleagues will cope and you won't be of use to anyone until you feel better.

Depression often feels like a horrible black hole from which you will never escape and where time passes very slowly. It is tempting to think that this is reality and your previous happiness was just a delusion. Try to remind yourself that these terrible feelings are not 'real' but the result of a chemical imbalance and that they will pass.

It is very hard to motivate yourself to do anything when you are depressed and everything feels very difficult, rather like trying to wade through treacle.

If you can, try to stay in touch with your favourite people, even if it is just via a few short messages, as that will make you feel less alone.

Exercise is extremely helpful, even if it is just a short walk. Walking will also get you out of the house, which can also be cheering. Ignore people who say “You just need to find a nice hobby” as this is probably not the best time to try something new!

Rest, relaxation and some fairly mindless activities – computer games, TV, gardening, whatever works for you – is more likely to be what you need.

If you do have suicidal feelings, tell somebody. If you are in imminent danger of acting on your feelings, then call the emergency services or an organisation such as The Samaritans immediately.

Whatever you may currently believe, you don't know what is in your future.

If you really don't feel that you want to tell anyone else then try writing a journal or diary, or, if you are already receiving treatment just hang in there until your next appointment with your counsellor or therapist.

Sometimes you may want company but feel too exhausted to entertain anyone: try to explain to a friend that you would find it comforting to just walk or watch television together.

Can You Recover from Depression?

The answer is an emphatic yes, so don't give up hope.

Gradually the clouds lift, you get a few good days, and then the good days outnumber the bad days until your life becomes normal again. People do relapse, some many times, but awareness is everything.

Once you learn what depression feels like, you can start to sense it coming on again and take avoiding action accordingly.

It may be that depression is a trigger to make lasting improvements in your life – to give up particular beliefs, a need to impress, a job that makes you miserable – and thus you may be grateful for its lessons in the long term.

You may also find that you become less judgemental and more accepting of others who struggle.

Our pages on Keeping your Mind Healthy, Relaxation Techniques and Positive Thinking can all help you to develop the skills you need to build some good habits for the future.

The Skills You Need Guide to Stress and Stress Management