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Depression

Depression is a serious illness. Health professionals use the terms depression, depressive illness or clinical depression to refer to something very different from the common experience of feeling miserable or fed-up for a short period of time.
Brought to you by NHS Choices

Overview

Introduction

When you’re depressed, you may have feelings of extreme sadness that can last for a long time. These feelings are severe enough to interfere with your daily life, and can last for weeks or months, rather than days.

Depression is quite a common condition, and about 15% of people will have a bout of severe depression at some point in their lives. However, the exact number of people with depression is hard to estimate because many people do not get help, or are not formally diagnosed with the condition.

Women are twice as likely to suffer from depression as men, although men are far more likely to commit suicide. This may be because men are more reluctant to seek help for depression.

Depression can affect people of any age, including children. Studies have shown that 2% of teenagers in the UK are affected by depression.

People with a family history of depression are more likely to experience depression themselves. Depression affects people in many different ways and can cause a wide variety of physical, psychological (mental) and social symptoms.

A few people still think that depression is not a real illness and that it is a form of weakness or admission of failure. This is simply not true. Depression is a real illness with real effects, and it is certainly not a sign of failure. In fact, famous leaders, such as Winston Churchill, Abraham Lincoln and Mahatma Gandhi, all experienced bouts of depression.

Symptoms

Symptoms of depression

If you’re depressed you often lose interest in things that you used to enjoy. Depression commonly interferes with your work, social and family life. In addition, there are many other symptoms, which can be physical, psychological and social.

Psychological symptoms:

  • continuous low mood or sadness,
  • feelings of hopelessness and helplessness,
  • low self-esteem,
  • tearfulness,
  • feelings of guilt,
  • feeling irritable and intolerant of others,
  • lack of motivation and little interest in things,
  • difficulty making decisions,
  • lack of enjoyment,
  • suicidal thoughts or thoughts of harming someone else,
  • feeling anxious or worried, and
  • reduced sex drive.


Physical symptoms:

  • slowed movement or speech,
  • change in appetite or weight (usually decreased, but sometimes increased),
  • constipation,
  • unexplained aches and pains,
  • lack of energy or lack of interest in sex,
  • changes to the menstrual cycle, and
  • disturbed sleep patterns (for example, problems going to sleep or waking in the early hours of the morning).


Social symptoms:

  • not performing well at work,
  • taking part in fewer social activities and avoiding contact with friends,
  • reduced hobbies and interests, and
  • difficulties in home and family life.


Grief and depression

Even though grief and depression share many of the same characteristics, there are important differences between them. Grief is an entirely natural response to a loss, while depression is an illness. However, sometimes, it can be hard to distinguish between feelings of grief and depression.

People who are grieving find that feelings of loss and sadness come in waves, but they are still able to enjoy things and are able to look forward to the future. However, those who are depressed have a constant feeling of sadness; they do not enjoy anything and have little sense of a positive future.

Doctors describe depression by how serious it is

  • Mild depression has some impact on your daily life.
  • Moderate depression has a significant impact on your daily life.
  • Severe depression makes the activities of daily life nearly impossible. A small proportion of people with severe depression may have psychotic symptoms.

Causes

There are many different factors that can trigger depression. For some people, upsetting or stressful life events, such as bereavement, divorce, illness, redundancy, and job or money worries, can be the cause.

This is often known as 'reactive depression', where depression is a reaction to the event. In other cases, depression does not have an obvious cause.

As depression can have many causes, it is sometimes divided into three broad groups - psychological, physical and social.

  • Psychological - this is where a stressful or upsetting life event causes a persistent low mood, low self-esteem and feelings of hopelessness about the future.
  • Physical or chemical - depression is caused by changes in levels of chemicals in the brain. For example, your mood can change as hormone levels go up and down. This is often seen in women as it is associated with the menstrual cycle, pregnancy, miscarriage, childbirth and the menopause.
  • Social - doing fewer activities or having fewer interests can cause depression, or may happen because of depression.


Family history

If you have a family history of depression, you are more likely to get depression yourself.

Studies have shown that different versions of a gene (known as 5-HTT) can be inherited, which can have an effect on a natural mood-changing chemical in your brain called serotonin. About 20% of people have got what geneticists (gene specialists) call the 'short' version of the 5-HTT gene, and it is these people who are more likely to develop depression after a stressful life event.

Research has shown that there is a link between depression and the imbalance of chemicals in the brain called neurotransmitters. People who are depressed have a lower level of certain types of neurotransmitters, such as serotonin, norepinephrine and dopamine, than people who are not. It is still not fully understood whether this imbalance is a result of depression, or a cause of it.

Children inherit the 5-HTT gene from their parents, so having a history of depression in the family can increase your risk of developing it. In other words, you have a 'genetic predisposition' for depression.

On the other hand, many people who have a family history of depression never develop the condition. Also, people with no family history of depression can become depressed.

There is rarely one single cause of depression - usually, different causes combine to trigger the condition. For example, you may feel low after an illness and then experience a stressful life event, such as bereavement, which leads to depression.

People often talk about a 'downward spiral' of events that lead to depression. For example, if a person's relationship with their partner breaks down, they are likely to feel low, they may stop seeing friends and family, and they may start drinking more - all of which can make them feel even worse and trigger depression.

Other causes of depression

Other frequent causes of depression include:

  • drinking excess alcohol - men should not drink more than three to four units of alcohol a day and women no more than two to three units a day. A unit of alcohol is roughly the same as half a pint of normal strength lager.
  • using recreational drugs - such as cannabis and cocaine, and
  • taking some types of prescription medication - for example, propranolol can occasionally cause depression.

My friends say I should just pull myself together, and that we all have problems.

Having problems is not the same as being depressed. Not everyone gets depressed when they have difficulties. When you are depressed it just isn’t possible to 'pull yourself together'. The depression stops you functioning. It impedes your ability to get on with life.

Diagnosis

Diagnosing depression

If you think you have depression, you should visit your GP. Your GP may give you a physical examination and do some blood or urine tests to rule out other conditions that have similar symptoms, such as under-active thyroid.

There are no clinical tests for depression, so detailed interviews and questionnaires are usually used to make a diagnosis.

There are many different questionnaires used to measure depression. However, two classifications of mental illness are most widely used:

  • Diagnostic and Statistical Manual of Mental Disorders. This is a classification system based on all the known recorded symptoms associated with a particular mental condition. Your GP will ask you if you have certain symptoms, and depending on your answers, will be able to use the system to identify what the condition is.
  • International Classification of Diseases. This is a similar system of classifications, again based on the known symptoms associated with particular diseases. Developed by the World Health Organization, it is a much wider system, covering all diseases (not just mental health). Your GP will ask you about your symptoms in order to classify your condition.

Using one of these two guidelines, it is usually possible for your GP to diagnose depression, decide which type of depression you are experiencing, and to rule out other mental conditions.

Any discussion that you have with your GP about your depression will be treated in the strictest of confidence. Your GP will only ever break this rule if there is a significant risk of harm to either yourself or to others, and if informing a family member or carer would reduce that risk.

Is it my fault that I have become depressed?
It is definitely not your fault. It may be difficult to avoid it, but there are certainly things you can learn to do to recognise depression early so you can avoid becoming more severely ill.

If you have had depression before, this would involve learning how to recognise your early warning signs. Everyone has their own particular early warning signs, such as not sleeping properly, starting to brood about things, or spending all your time working and not enjoying yourself.

You learn that when you have these early warning signs, you have to reflect on your lifestyle and make changes where necessary.

Can I continue working?
If your depression is caused by overwork, or is affecting your ability to do your job, you may need a little time off to recover. However, there is evidence that taking prolonged time off work can make depression worse. The Department for Work and Pensions found that if you take more than a year off work for a mental health problem, you stand a greater chance of dying than of ever going back to work. In fact, there is quite a lot of evidence that going back to work can help you recover from depression.

Treatment

Treating depression

Treatment for depression usually involves a combination of drugs, talking therapies and self help. Hardly anyone with depression is admitted to a psychiatric hospital. Most get treatment from their GP and make a good recovery.

Mild depression

  • If you are diagnosed with mild depression but your GP thinks you’ll improve, you can have another assessment in two weeks' time to monitor your progress. This is known as 'watchful waiting'.
  • Antidepressants are not usually recommended as a first treatment.
  • Exercise seems to help some people. While your progress is being monitored, your GP may refer you to an exercise scheme with a qualified fitness trainer.
  • Talking through your feelings may also be helpful. You may wish to talk to a friend or relative, or your GP may suggest a local self-help group.
  • Your GP may recommend self-help books and computerised cognitive behaviour therapy (CBT) (see below for further details).

Chronic mild depression (present for two years or more) is called dysthymia. This is more likely in people over 55 years and can be difficult to treat. If you are diagnosed with dysthymia, your GP may suggest that you start a course of antidepressants.

Moderate depression

  • If you have mild depression that is not improving, or you have moderate depression, your GP may recommend a 'talking treatment' or prescribe an antidepressant (see below for further details).


Severe depression

  • Your GP may recommend that you take an antidepressant, together with talking therapy. A combination of an antidepressant and cognitive behavioural therapy (CBT) usually works better than having just one of these treatments.
  • You may be referred to a mental health team. These teams are usually made up of psychologists, psychiatrists, specialist nurses and occupational therapists. They often provide intensive specialist talking treatments, such as psychotherapy.


Talking treatments

Cognitive behavioural therapy (CBT)
You normally have a fixed number of sessions - usually six to eight sessions over 10-12 weeks. Some GP practices have counsellors specifically to help patients with depression.

CBT is based on the principle that the way we feel is partly dependent on the way we think about things. It teaches you to behave in ways that challenge negative thoughts - for example, being active to challenge feelings of hopelessness.

Interpersonal therapy (IPT)
IPT focuses on your relationships with other people and on problems, such as difficulties with communication or coping with bereavement. There is some evidence that IPT can be as effective as medication or CBT, but more research is needed.

Counselling
Counselling is a form of therapy that helps you to think about the problems you are experiencing in your life, in order to find new ways of dealing with them. Counsellors support you in finding solutions to problems, but do not tell you what to do.

Antidepressants

Antidepressants take two to four weeks to take effect. If the first antidepressant you try is not effective or causes side effects, it may be necessary to change the dose. Sometimes, a different type of antidepressant will be recommended.

Your GP or specialist nurse should see you every one to two weeks when you start taking antidepressants. You should continue taking the antidepressants for at least four weeks (six weeks if you are elderly) to see how well they are working. If your antidepressants are working, treatment should be continued at the same dose for at least four to six months (12 months if you are elderly) after your symptoms have eased. If you have a history of depression, you should continue to receive antidepressants for up to five years, or longer.

Antidepressants are not addictive but withdrawal symptoms are quite common if you stop taking them suddenly, or you miss a dose.

SSRIs
If your GP thinks you would benefit from taking an antidepressant, you will usually be prescribed an SSRI (selective serotonin reuptake inhibitor).These are as effective as the older TCAs (tricyclic antidepressants) and have fewer side effects. Fluoxetine, citalopram and sertraline are all examples of SSRIs.

SSRIs increase the level of a natural chemical in your brain called serotonin, which helps to lift your mood. You may have some side effects when you start taking SSRIs, such as nausea, headache, sleep problems and anxiety. However, these tend to improve over time.

Some SSRIs should not be prescribed for children under the age of 18 years. Research shows that the risk of self-harm and suicidal behaviour may increase if they are used to treat depression in this age range. Fluoxetine is the only SSRI that may be prescribed for under-18s, but only when specialist advice has been given.

Other antidepressants
These include:

  • TCAs (tricyclic antidepressants), such as dothiepin, imipramine and amitryptyline. These are used to treat moderate to severe depression. They work by raising the levels of the chemicals serotonin and noradrenaline in your brain, which both help to lift your mood. You should not smoke cannabis if you are taking TCAs because it can cause your heart to beat rapidly.
  • MAOIs (monoamine oxidase inhibitors), such as phenelzine sulphate, is sometimes used to treat 'atypical depression'. This is when you tend to eat and sleep more than usual. You should not smoke cannabis if you are taking MAOIs because it may affect the way these medicines work, and it is not clear what effect this may have on you.
  • New antidepressants, such as venlafaxine, nefazodone, and mirtazapine, work in a slightly different way from SSRIs and tricyclics. These drugs are known as SSNIs (Serotonin-norepinephrine reuptake inhibitors). Like TCAs, these antidepressants work by changing the levels of serotonin and noradrenaline in your brain. Studies have shown that a SSNI like venlafaxine can be more effective than a SSRI, though it is not routinely prescribed as it can lead to a rise in blood pressure.


St John's wort

St John's wort is a herbal treatment that some people take for depression. Though there is some evidence that it may be of benefit in treating mild or moderate depression, its use is not recommended. This is because the quantity of its active ingredients vary among individual brands and batches, so it is uncertain what sort of effect it could have on you.

Taking St John's wort with other medications, such as anticonvulsants, anticoagulants, antidepressants and the contraceptive pill, can also cause serious problems.

You should not use St John's wort if you are pregnant or breastfeeding as there is not enough evidence that its use is safe in these situations.

Electroconvulsive therapy (ECT)

Sometimes, other treatments, such as specialist medicines or electroconvulsive therapy (ECT), may be advised if you have severe depression. Electroconvulsive therapy (ECT) works for severe depression, but it is only used when antidepressants and other treatments have not worked.

If ECT is recommended for you, you will first be given an anaesthetic and medication to relax your muscles. You will then receive an electrical 'shock' to your brain through electrodes placed on your head. You may be given a series of ECT sessions. For most people, the treatment works well in relieving severe depression, but the effect may not be permanent. Some people may experience unpleasant side effects, including memory problems.

Lithium

If you have tried several different antidepressants and have experienced no improvement, your doctor may offer you a type of medication called lithium, in addition to your current treatment.

There are two types of lithium - lithium carbonate and lithium citrate. Both are usually effective, but if you are taking one that is effective, it is best not to change. In order to work, you have to have a certain level of lithium in your blood. If this level becomes too high, the lithium can become toxic. Therefore you will need blood tests every three months to check your lithium levels. You should also avoid going on a low-salt diet because this can also cause the lithium to become toxic - consult your GP for advice about your diet.

Before you start taking lithium, you should have an electrocardiograph (ECG) to check your heart

Will my depression return?

You can make a full recovery with treatment, but there is a risk that your depression will return. About half of the people who have a first episode of depression will have another episode within 10 years. The risk of further bouts of depression for these people is higher than in someone who has never been depressed, and more likely if treatment is not continued for the prescribed period of time.

Withdrawal symptoms

Antidepressants are not addictive in the way illegal drugs are, but when you stop taking them you will probably have some withdrawal symptoms, including:

  • stomach upsets,
  • flu-like symptoms,
  • anxiety,
  • dizziness,
  • vivid dreams at night, and
  • sensations in the body that feel like electric shocks.

In most cases, these effects are mild. But, for a small number of people, they can be quite severe. They seem to be most likely to occur with paroxetine (Seroxat) and venlafaxine (Efexor).

Side effects

Side effects of treatments

SSRIs

You may experience some side effects when you start taking SSRIs, including:

  • nausea,
  • headache,
  • sleep problems and
  • anxiety.

However, the above side effects tend to improve over time.

TCAs

Common side effects of TCAs (tricyclic antidepressants) include:

  • dry mouth,
  • constipation,
  • sweating,
  • problems passing urine,
  • slight blurring of vision and
  • drowsiness.

The side effects should ease after seven to 10 days, as your body gets used to the medication. However, if they continue or become troublesome, you should tell your GP, as a switch to a different antidepressant may suit you better.

MAOIs

If you are taking MAOIs (monoamine oxidase inhibitors), you will have to avoid food that contains the chemical tyramine. This is normally found in foods that have been fermented or cured to increase their flavour, like cheese, pickled meat or fish. Your GP should give you a list of food and drink to avoid.

You should not drink any alcohol or fermented liquids, even if they are alcohol free.

As MAOIs have the potential to interact with a wide range of medication, you should not take any other drug or medicine - even over-the-counter medication - without checking with your GP first.

Common side effects of MAOIs include:

  • blurred vision,
  • dizziness,
  • drowsiness,
  • increased appetite,
  • nausea,
  • restlessness,
  • shaking or trembling, and
  • difficulty sleeping.

In rare cases, MAOIs have the potential to cause a wide range of other side effects. You should check with your GP if you are concerned about any unusual symptoms that you have.


There have been a number of cases where MAOIs have caused a dangerous rise in blood pressure. If you experience a stiff neck, severe headache, chest pains, vomiting or nausea, or a fast heartbeat, you should seek emergency help immediately by dialling 999 and asking for an ambulance.

The restrictions involved in terms of diet and the potential for side effects means that MAOIs are normally only prescribed when other treatments have not been effective.

Other treatments

  • ECT can cause short-term headaches, memory problems, nausea and muscle aches.
  • St John's wort may cause you to feel sick and lead to dizziness and a dry mouth.

Complications

Sucide and depression

Mental disorders, particularly depression and substance abuse, are associated with more than 90% of all cases of suicide.

The warning signs of suicide

Some of the warning signs that people with depression are considering suicide are:

  • Making final arrangements - such as giving away possessions, making a will or saying goodbye to friends.
  • Talking about death or suicide - this may be a direct statement, such as 'I wish I was dead', but often depressed people will talk about the subject indirectly, using phrases like, 'I think dead people must be happier than us', or 'wouldn't it be nice to go to sleep and never wake up'.
  • Self-harm - such as cutting their arms or legs, or burning themselves with cigarettes.
  • A sudden lifting of mood - this could mean that a person has decided to commit suicide and feels better because of this decision.


Helping a suicidal friend or relative

If you see any of the above warning signs, you should:

  • get professional help for the person,
  • let them know they are not alone and you care about them, and
  • offer your support in finding other solutions to their problems.

If you feel that there is an immediate danger, stay with the person or have someone stay with them, and remove all available means to suicide. The most obvious means is medication. Over-the-counter drugs such as painkillers can be just as dangerous as prescription medication. Also, remove sharp objects and poisonous household chemicals like bleach.

Helping yourself
If you feel you may be suffering from mild to moderate mental illness, there are lots of organisations to give you the support and advice you need. The NHS, voluntary organisations and private organisations can all help.

Visit your family doctor to find out if general counselling is available in your area. Your GP can advise whether a referral would help you. If you’re having relationship or marriage difficulties, contact Relate (0845 130 4010). Its counsellors can talk things through with you and your partner. You will normally be expected to pay a fee to cover the costs of the sessions, although some Relate centres offer subsidies.

The mental heath charity SANE has a dedicated helpline on 0845 767 8000. The service offers practical information, crisis care and emotional support. It is open from 1pm to 11pm, every day.

Prevention

Preventing depression

To deal with depression, and help prevent repeated bouts of depression, you should:

  • take your medicines regularly as directed, without skipping any days,
  • discuss reducing or stopping medication with your GP before you make any changes,
  • gradually try to increase the activities that you enjoy,
  • avoid smoking, illegal drugs and alcohol - these may seem to make you feel better in the short term, but can make you feel worse in the long term,
  • use a problem-solving approach to deal with stress and worry,
  • try to identify negative thoughts and change them to positive thoughts,
  • assess your symptoms regularly and consult your GP or counsellor if problems arise,
  • increase the amount of exercise that you do - this can trigger the release of the brain chemical serotonin, which boosts your mood,
  • learn how to relax using relaxation exercises and tapes,
  • practice yoga, meditation or have a massage to help relieve tension and anxiety, and
  • join a self-help group and discuss your feelings and concerns - it can help you to feel less isolated.


Depression and diet

There is increasing evidence that changes in your diet can help prevent depression occurring, or if you are depressed, can help in the treatment of your depression.

Omega-3 fatty acid
Research has shown a link between the amount of a fish people in different countries eat and the level of depression. In Japan, where people eat on average 70kg (150lbs) of fish a year, the rate of depression is 0.12%. Whereas in New Zealand, where people eat only 18kg (40lbs) of fish a year, the rate of depression is almost 50 times higher.

It is though that a chemical found in fish - omega-3 fatty acid - may help your brain work more efficiently, so serotonin (which can boost your mood) has more of an effect on you.

Fish that contains a lot of omega-3 fatty acid includes salmon, sardines and mackerel. Vegetarian alternatives include walnuts and tofu, and omega-3 food supplements are also available over the counter (OTC) from health shops.

Protein and serotonin
Serotonin is made up of an amino acid called 5-HTP, which is made from another amino acid called tryptophan. Both of these are found in protein-rich foods, such as meat, fish, beans and eggs. Foods also high in vitamin B, such as bananas and avocados, can be beneficial to your mood as they convert tryptophan into serotonin. By eating these types of food, you are helping your body to produce more serotonin and it can therefore boost your mood.

Bad-mood food
Alcohol, caffeine, sugar, chocolate, cakes, biscuits, cheese and bread are the most common types of foods that cause low moods. Sugar is a major cause of altering mood because when you eat something sugary, your blood sugar level rises sharply, which is followed about an hour or so later by a 'sugar low', as the amount of sugar in your blood decreases. This has a negative effect on your mood and energy level, leading to poor concentration, anxiety, irritability, aggression, tiredness and depression.

Expert view

Depression expert Cosmo Hallstrom on the questions to ask

We asked Dr Cosmo Hallstrom, a psychiatrist and specialist in depression, what he would want to know if he was diagnosed with depression.

How should I tackle my depression?
If you went to the doctor because you were feeling low, a diagnosis of depression will probably come as no surprise. Remember, you are not alone. Depression is a common condition with wide implications, so concentrate on the options put forward by your GP to help you deal with it.

If you went to the doctor complaining of physical symptoms, such as back pain, chronic tiredness or headaches and your GP spots that you're depressed, it may take some time to accept this. Try to understand your problem and work out why you're depressed. When you’re feeling low, the world looks bad. Maybe you’re blaming it on your lifestyle when it is, in fact, your internal chemistry. All these things are interlinked.

Do I need to take medication?
If your depression is sufficiently severe to cause problems in your daily life, you should consider taking medication under the advice and guidance of your GP. If your depression is linked to problems in your lifestyle, you should seek counselling.

I'm feeling better. Can I stop taking my tablets?
It's very important to take the full course of tablets. They won't have an instant effect and may not be the only remedy you’re prescribed. You may also want to consider cognitive behaviour therapy.

Will I suffer from depression for the rest of my life?
Most people with depression make a full recovery, with or without treatment and go on to live full and productive lives.

I don't feel like doing anything. Can't I just stay in bed?
It's important to keep going at whatever level you can, and not to give up work and social activities. It's best not to stay in bed all day, or to punish yourself or give up on life. Take your recovery in stages and work out where the problem lies.

Lifestyle

Living with depression

No one’s life runs smoothly all the time, so it helps to know how to combat depression and anxiety.

Hard times at work, relationship difficulties, bereavement or money worries can leave you feeling anxious or depressed. As many as one in four people experience depression at some time in their lives, but if you are affected there are positive steps you can take.

Eat healthily and stay active
Exercise combats stress, so even taking a walk at lunchtime will help. It is also important to relax. Do something that gives you a break from routine, such as joining an evening class. Spend time with friends and family and talk about your feelings. Don’t use cigarettes or alcohol to make you feel better. They may seem to help at first, but smoking or drinking too much will make things worse.

Some doctors prescribe exercise therapy – research shows it may be as effective as antidepressants. Being physically active lifts your mood, reduces stress and anxiety, boosts the release of endorphins (your body’s feel-good chemicals) and improves self-esteem. In fact, some research has shown that exercise can be as successful in treating depression as psychotherapy and medication. Exercise is thought to help with depression in several ways.

  • It leads to an increase in endorphins (chemicals that make us feel better) in the body.
  • It makes us more socially active, we meet more people and are more supported and less isolated.
  • It gives us new goals and a sense of purpose.
  • It improves our self-esteem and makes us look better.

The National Institute for Clinical Excellence recommends that exercise is used to treat depression in people of all ages. GPs can prescribe exercise for their patients.

Deal with stress
A little stress can be good, giving you the drive to cope with life’s challenges. Too much can make you feel overwhelmed and ill. Tell-tale signs are irritability and anxiety, as well as physical symptoms such as headaches, digestive problems and palpitations. If you notice these symptoms, visit your GP or tackle the reasons for your stress yourself. Sharing a problem with someone else can often give you new insight into the reasons for your depression.

Ten steps to relaxation

  • Choose a quiet place.
  • Make yourself comfortable.
  • Close your eyes.
  • Breathe slowly and deeply in a calm, effortless way.
  • Do a few gentle stretching exercises.
  • Gently tense and then relax each part of your body.
  • As you focus on each area, think of warmth and relaxation.
  • Push any distracting thoughts to the back of your mind – imagine them floating away.
  • Don’t try to relax – simply let go of the tension in your muscles.
  • Do this for about 20 minutes whenever you feel stressed.

Drinking and depression

Alcohol helps us to forget our problems for a while. It can help us to relax and overcome any shyness. It can make talking easier and more fun, whether in the pub, a club or at a party.

If you are depressed and lacking in energy, it can be tempting to use alcohol to help you keep going and cope with life. The problem is that it is easy to slip into drinking regularly, using it like a medication. The benefits soon wear off, the drinking becomes part of a routine, and you have to keep drinking more to get the same effect.

We know there is a connection between depression and alcohol. Evidence shows that:

  • If you drink too much, too regularly, you are more likely to become depressed. There is evidence that alcohol changes the chemistry of the brain and that this increases the risk of depression.
  • Hangovers create a cycle of waking up feeling ill, anxious, jittery and guilty.
  • Regular drinking can lead to family arguments, poor performance at work, an unreliable memory and sexual problems.
  • If we drink alcohol to relieve anxiety or depression we will become more depressed.

Real stories

Vanessa's story

'It took me a long time, but I did get back on my feet'

Vanessa Phillips from Hertfordshire was known as a strong person, always willing to help others. When she had a breakdown, her friends didn’t know she was the one who needed help

“My breakdown was triggered by my mother’s death. I was a 41-year-old, divorced, single parent of two children and I had no support. The council were trying to evict me.

“I was eating hardly anything and I wasn’t sleeping. I was shaking and suffering huge anxiety, but I didn’t know I was ill. I thought I just had too much on my plate. I now feel that if people had been there for me, if people had listened to me, I might not have become so ill.

“Everyone knew me as a very strong person who helped others with their problems, so when I was saying ‘I'm not coping, I need help’ people didn’t pay any attention. I began spending a lot of time in bed under my duvet. I went to my doctor who gave antidepressant pills. I knew nothing about depression and he didn’t tell me anything.

“A friend came round to see if I was all right one Friday morning. She didn’t know I'd already decided to kill myself. She found me sitting in bed ranting and raving. She saw an empty pill bottle and a half empty bottle of Scotch and she phoned my doctor who phoned an ambulance.

“I was kept in hospital for two weeks and sent home with more pills, but still no more information about depression. I started going to the library and reading books on mental health and saw how diet, lifestyle, healthy eating and vitamins were involved.

“Slowly, I did begin to recover. I had a lot of help from a lovely mental health nurse who took a real interest in me. She used my love of plants to deal with my social exclusion by driving me in her car to the garden centre for a walk and a cup of coffee. It was somebody else caring. She was the catalyst who helped me sort out things I couldn’t cope with.

“It took me a long time, but I did get back on my feet. It would have been faster if I'd had more support and more information. I now run an awareness group for depression so that others don’t have to go through what I happened to me.”

Trisha's story

'I've learnt to live with my depression'

Having suffered bullying, abuse and depression, talk show host Trisha Goddard knows what it’s like to hit rock bottom. She tells how she fought the odds – and won

Barely an episode of Trisha goes by without a bitter, explosive argument. There are always tears, usually a confession or two and almost always confrontation.

Some people think Trisha Goddard’s daytime show is pure voyeurism, but Trisha is definitely not in it for cheap thrills. She’s in the business of helping people, rather than judging them, and she takes her role of counsellor very seriously indeed. She understands that if you strip away all the anger, you are left with a person who feels sad, vulnerable and lost. She understands because she’s been there. “It all started when I was about 14,” she says. “I didn’t realise it at the time, but looking back, I went through many depressed states during my teens.”

Ironically, both of her parents were psychiatric nurses. Her mother was a black Dominican and her father was English and white. “I was bullied at school because of my colour, I wasn’t very close to my three sisters and my parents used to hit me. The thing is, I used to think that every family behaved like that so, although I was miserable, I didn’t really understand my feelings.”

For many years Trisha didn’t dare to listen to those feelings. Her first marriage, in 1985, ended after nine months. “It was a weird relationship,” she admits. “He’d go to work and lock me in the house.”

She left her husband and got a job as a TV reporter in Sydney, but career success couldn’t cure her depression. Within a year, she was hospitalised. “My depression wasn’t recognised and I was given no treatment. That was to cause me tremendous problems later.”

Nearly 10 years later, Trisha suffered a severe breakdown.

Looking back, she can trace the path to her sense of utter despair. First, she discovered her ex-husband was gay and, in 1989, had died of Aids (luckily she tested negative). Then she found out her second husband was having an affair. They split up, leaving Trisha to bring up their two daughters, Billie and Madi. During that time she was, by her own admission, “a career-driven monster”.

“I carried on working, but it was all too much for me,” she admits. “I was absolutely shattered. I was incapable of making even the simplest decisions. I just thought I was like everyone else who was going through a stressful time. In the end I was so exhausted I ended up taking a massive alcohol and medication overdose.”

Trisha was hospitalised and referred to a psychiatric unit where she received intense psychotherapy. “Being in that hospital was the lowest point of my life,” she says. “I was on suicide watch and the authorities were threatening to take my children away. Fortunately they didn’t.”

Her traumatic experience proved a turning point. She quit her job to concentrate on bringing up her daughters and having therapy. She also started working for the mental health services in Australia, which is how she met and fell in love with Peter Gianfrancesco, who was head of Australian Mind. They married in 1998 and moved to England when Trisha was offered the chance to replace Vanessa Feltz on a morning chat show.

It was the start of the good life for Trisha. She now lives with her family in Norwich, but she takes nothing for granted. “My depression hasn’t gone away, but I’ve learned to live with it,” she says. “I’m no longer a victim of the illness, instead I’m a survivor.

“Exercise and relaxation help a lot,” she says. “I have a personal trainer and I also go running with my two dogs. I don’t believe much in diets, but I eat natural foods like wholemeal bread, fruit and salads. Every little helps.”

There is one person who has helped Trisha more than anyone. “I have great family and friends,” she says. “But I’ve got to credit most of my recovery to my wonderful husband, Peter. We’ve been together now for nearly six years and I still can’t believe how much in love with him I am.”

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This article was originally published by NHS Choices

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