Recognising and treating depression

Recognising and treating depression

Depression is a common and disabling illness that is one of the most important public health problems across the world. It is the leading cause of disability worldwide, in terms of years lost. One in five people become depressed at some point in their lives and over 400,000 people receive a diagnosis of depression each year in England.

What is the difference between sadness and depression?

All of us feel sad at some point in our life, but with depression these feelings persist for a long time or become so severe that they interfere with how we function in everyday life.

What causes depression?

Sometimes there may be an obvious reason for becoming depressed, but other times no reason may be found. Common causes include a relationship breakdown or bereavement or even the birth of a child. Genetics may have a role since people with family members who have a history of depression have a higher chance of becoming depressed at some point in their lives. Other biological causes currently being investigated as possible causes for depression include inflammation in the brain and body, and increased activation of stress hormones.

Symptoms of depression include:

  • Persistent sadness or low mood
  • Inability to enjoy things
  • Losing interest in life
  • Feeling tired all the time
  • Feeling restless and agitated
  • Loss of appetite and weight
  • Poor sleep
  • Loss of interest in sex
  • Loss of self confidence
  • Feeling hopeless
  • Thoughts of self-harm or suicide.

How is depression treated?

Depression is classified as mild, moderate or severe depending on the number of symptoms a person is experiencing. The severity of the depression helps determine the recommended treatment. Such treatment can consist of talking therapies such as Cognitive Behavioural Therapy (CBT), counselling or antidepressant medication. Other treatments such as ECT (Electroconvulsive Therapy) or rTMS (repetitive Transcranial Magnetic Stimulation) can be used for very severe conditions, or for treatment-resistant depression.

What is treatment-resistant depression?

Approximately one in three of people do not respond to the main treatments for depression, namely antidepressants and CBT. Depression becomes “treatment-resistant” when it fails to improve despite adequate treatment with antidepressant medication and CBT. Those with treatment-resistant depression are thought to suffer a more severe form of the illness compared to other people with depression.

What happens to people with treatment-resistant depression?

If you feel your depression has not improved with an antidepressant or psychotherapy, don’t worry – there are other strategies. The most important step is to seek a specialist opinion as soon as possible. It is recommended that individuals suffering with treatment-resistant depression be referred for specialist advice to determine whether the diagnosis is accurate and to provide guidance on further treatment. Part of the specialist assessment involves determining whether the antidepressant was taken for long enough at the recommended dose. If this is the case, it is important to rule out a physical cause for the symptoms by carrying out routine tests to look at underlying causes such as thyroid problems.

If no underlying physical cause is found, the first step would involve changing the antidepressant. If that does not work, next steps include combining antidepressants with atypical antipsychotic medicines, mood stabilising medicines or if appropriate, thyroid hormone. Other non-drug treatments include ECT or rTMS as well as more intensive, specialised talking therapies. Despite this, there remain a proportion of people that do not respond to current available treatment, which is why there is extensive research taking place to discover new ways to treat this highly-disabling condition.


This article is for information only and should not be used for the diagnosis or treatment of medical conditions. myHealthSpecialist makes no representations as to the accuracy or completeness of any of the information in this article, or found by following any link from this article. Please consult a doctor or other healthcare professional for medical advice.

Dr Ishrat Husain, Psychiatrist
Dr Ishrat Husain, Psychiatrist

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