Depression

Symptoms, treatment and support

Depression is more than feeling sad or having a difficult few days. It can affect mood, interest, energy, sleep, appetite, concentration, relationships, work, study and the ability to manage everyday life.

People experience depression differently. Some feel persistently sad or hopeless, while others describe irritability, emotional numbness, loss of motivation, exhaustion or physical complaints. When symptoms persist, become severe or begin interfering with daily functioning, a professional mental health assessment can help identify what is happening and what treatment may be appropriate.

Effective treatments are available. Depending on the person and the severity of symptoms, treatment may involve psychological therapy, medication, support for sleep and daily routines, family involvement and treatment of associated medical, social or substance-use problems.

What is depression?

Depression is a mental health condition characterised by persistent depressed mood and/or a marked loss of interest or pleasure, together with other emotional, cognitive, behavioural or physical symptoms. A depressive episode typically lasts for at least two weeks, with symptoms occurring for much of the day on most days, but diagnosis also depends on severity, functional impact, clinical context and other possible explanations.

Important

Having one or two symptoms does not by itself mean that someone has depression. A diagnosis requires assessment of the overall pattern, duration, severity, impairment and possible psychiatric or medical causes.

At a Glance

What it can feel like

Persistent low mood, irritability, emptiness, loss of pleasure, hopelessness or feeling emotionally disconnected.

What else can change

Sleep, appetite, energy, concentration, motivation, self-confidence, relationships, work and everyday functioning.

Can depression be treated?

Yes. Psychological therapies, medication when appropriate, and social, behavioural and lifestyle interventions can all play a role depending on individual needs.

On this page

On this page

Depression is different from ordinary sadness

Feeling sad, disappointed or distressed after loss, conflict or other difficult life events is part of normal human experience.

Depression is different because the changes tend to be more persistent, pervasive or severe and begin to affect the person’s ability to function.

A person with depression may struggle to:

Get out of bed or begin the day

Concentrate at work or college

Enjoy time with family or friends

Maintain usual routines

Make ordinary decisions

Care for themselves

Feel hopeful about the future

Some people can continue working and appearing outwardly functional while experiencing considerable internal distress. Others experience an obvious decline in day-to-day functioning. Depression should therefore not be judged simply by how a person looks to others.

Signs and Symptoms of Depression

Depression does not look the same in everyone

Symptoms differ between individuals and may change over time. Some people primarily notice emotional symptoms, while others first seek help for sleep problems, fatigue, pain, poor concentration or difficulty functioning.

WHO describes depressed mood or loss of interest/pleasure as core features, accompanied by other cognitive, physical and behavioural symptoms.

Changes in mood and emotional experience

A person may experience:

Persistent sadness or low mood
A sense of emptiness
Irritability or becoming unusually short-tempered
Feeling emotionally numb or disconnected
Frequent crying in some people
Feeling hopeless about the future
Reduced confidence
Feeling helpless or unable to see a way forward

Not everyone with depression describes themselves as sad. Irritability, loss of motivation or emotional numbness may be more prominent in some people

Loss of interest or pleasure

A particularly important symptom is loss of interest or pleasure, sometimes called anhedonia.

Someone may stop enjoying:

Hobbies
Socialising
Food
Intimacy
Music
Sport or exercise
Family activities
Work they previously valued

They may know intellectually that an activity should be enjoyable but no longer experience the emotional reward they once did.

Changes in thinking and concentration

Depression can affect cognitive functioning.

Possible changes include:

Difficulty concentrating
Reduced attention span
Difficulty reading or following conversations
Difficulty remembering information
Indecisiveness
Feeling mentally slowed
Excessive rumination
Repeatedly dwelling on perceived failures
Negative thoughts about oneself
Negative expectations about the future

These changes can significantly affect students, professionals and people managing demanding household responsibilities.

Guilt, worthlessness and self-criticism

Some people develop disproportionate:

Guilt
Self-blame
Feelings of inadequacy
Feelings of worthlessness
Beliefs that they are a burden to others

These beliefs may persist even when family members or objective evidence suggest otherwise.

Changes in sleep

Depression can disturb sleep in several different ways:

Difficulty falling asleep
Waking repeatedly during the night
Waking much earlier than intended
Feeling unrefreshed despite sleeping
Sleeping considerably more than usual

Sleep disturbance can both accompany depression and worsen mood, concentration, irritability and energy.

Appetite and weight changes

Some people experience:

Loss of appetite
Reduced interest in food
Unintended weight loss

Others experience:

Increased appetite
Frequent comfort eating
Weight gain

A significant change in appetite or weight should also be considered in the context of physical health and medications.

Fatigue and loss of energy

Depression can produce profound tiredness that is not simply ordinary fatigue.

Someone may find:

Basic household tasks exhausting
Getting dressed unusually difficult
Previously routine work overwhelming
Social interaction draining
Physical movement more effortful

This can sometimes be misunderstood by others as laziness or lack of effort.

Changes in movement and activity

Depression may affect observable behaviour.

Some people become:

Slower in movement
Quieter
Slower in speech
Less spontaneous

Others may become:

Restless
Agitated
Unable to sit comfortably
Visibly anxious or distressed

Clinicians may refer to marked slowing or agitation as psychomotor changes.

Social withdrawal and reduced functioning

A person may:

Stop answering calls or messages
Avoid friends and family
Miss work or classes
Stop exercising
Spend long periods alone
Neglect household responsibilities
Stop attending appointments
Reduce self-care

Functional decline is clinically important even when the individual does not describe symptoms dramatically.

Physical symptoms

Depression can coexist with or contribute to physical complaints, including:

Headaches
Unexplained aches and pains
Gastrointestinal complaints
Reduced sexual interest
Fatigue
Disturbed sleep

Physical symptoms should not automatically be attributed to depression; appropriate medical assessment may be required.

Thoughts about death, self-harm or suicide

Some people with depression experience:

Thoughts that life is not worth living
Wishing they would not wake up
Thoughts of self-harm
Suicidal thoughts
Suicide planning or intent

These symptoms require careful assessment.

Urgent Mental Health Help

Seek urgent help if there is immediate risk of suicide, serious self-harm, inability to remain safe, severe deterioration, psychotic symptoms or inability to care for basic needs.

Clinical note: NICE recommends that people with depression are assessed directly for suicidal thoughts and suicide risk. Where suicide risk is present, clinicians should consider appropriate levels of support and specialist assessment based on the person’s needs.

How Long Do Depression Symptoms Last?

A depressive episode commonly involves symptoms occurring for most of the day, nearly every day, for at least two weeks.

However, the two-week period should not be interpreted as a reason to wait before seeking help. Earlier assessment may be appropriate when symptoms are severe, worsening quickly or affecting a person’s ability to stay safe or manage everyday life.

Important: You do not need to wait two weeks to seek help

However, the two-week period should not be interpreted as a rule that someone must wait two weeks before seeking help.

When should someone seek help sooner?

Earlier assessment is appropriate when:

Symptoms are severe
Suicidal thinking is present
Functioning is deteriorating rapidly
Psychotic symptoms occur
The person cannot safely care for themselves
There is diagnostic uncertainty

Seeking help early can be appropriate even when symptoms have not lasted for two weeks.

Likewise, symptoms lasting longer than two weeks do not automatically establish a diagnosis of depression.

Why Does Depression Happen?

There is usually no single cause.

Depression can develop through an interaction of biological, psychological and social factors.

Possible Contributing Factors

These can include:

Biological Vulnerability

Family history of depression or other mood disorders
Previous episodes of depression
Individual biological susceptibility

Life Events and Psychological Factors

Bereavement
Relationship difficulties
Trauma
Abuse
Financial stress
Occupational problems
Academic stress
Major life changes

Physical Health

Long-term illness, pain, disability and some medical conditions may increase vulnerability to depressive symptoms.

Sleep

Persistent sleep disturbance may both contribute to and result from depression.

Alcohol and Substance Use

Alcohol or other substances may worsen mood symptoms, complicate diagnosis and interfere with treatment.

Social Circumstances

Loneliness, unemployment, caregiving burden, family conflict or lack of social support may contribute.

WHO notes that depression reflects complex interactions between social, psychological and biological factors rather than a single cause.

How Is Depression Assessed?

Depression should not be diagnosed simply from an online questionnaire or a symptom checklist.

A comprehensive mental health assessment may consider:

Current symptoms
Duration
Severity
Effect on work, study, relationships and self-care
Previous episodes
Previous treatment and response
Medication history
Physical health
Sleep
Alcohol or substance use
Family psychiatric history
Recent stressors
Support system
Suicidal thoughts or self-harm risk

NICE specifically emphasises assessing both symptoms and functional impairment, alongside clinical history and contextual factors.

Could Something Else Be Causing the Symptoms?

Yes. This is one reason professional assessment is important.

Clinicians may consider whether symptoms could be related to or complicated by:

Bipolar disorder
Anxiety disorders
Trauma-related disorders
Substance or alcohol use
Grief
Medication effects
Relevant physical illnesses

Important Bipolar Screening Point

A person presenting with depression should be asked about previous periods of:

Unusually increased energy
Reduced need for sleep
Overactivity
Unusually high confidence
Impulsive or disinhibited behaviour

This helps avoid overlooking bipolar disorder, where treatment planning can differ substantially.

How Is Depression Treated?

There is no single depression treatment that is best for everyone.

Treatment should reflect:

Severity
Duration
Previous episodes
Previous treatment response
Associated conditions
Suicide risk
Physical health
Patient preference
Social circumstances

Shared decision-making is central to current NICE recommendations.

Psychological Treatments

Evidence-based psychological treatments can be effective for depression.

Depending on clinical circumstances, these may include:

Cognitive Behavioural Therapy – CBT

CBT examines patterns of thoughts and behaviour associated with depression and helps the person develop more adaptive ways of responding.

Behavioural Activation

Behavioural activation focuses on gradually rebuilding meaningful and rewarding activities that may have reduced as depression developed.

Interpersonal Psychotherapy

This focuses on relationships, interpersonal difficulties, role transitions, grief and other relational factors associated with depressive symptoms.

Problem-Solving Approaches

These aim to develop systematic ways of addressing practical difficulties that contribute to distress.

WHO recommends structured psychological interventions for adults with moderate-to-severe depression, including CBT, behavioural activation, interpersonal therapy, problem-solving therapy and other structured approaches.

Does Everyone With Depression Need Medication?

No.

The need for medication depends on clinical severity, preference, history and individual circumstances.

For less severe depression, NICE advises that antidepressants should not routinely be offered as first-line treatment unless medication is the person’s informed preference.

For more severe depression, appropriate first-line options may include:

Psychological treatment
Antidepressant medication
A combination of medication and psychological treatment

NICE lists combined individual CBT and antidepressant treatment among first-line options for more severe depression, while WHO recommends considering psychological treatment or combined treatment according to preferences and benefits/harms.

Medication should be prescribed and monitored by an appropriately qualified clinician.

What Happens After Starting an Antidepressant?

Treatment should not consist simply of giving a prescription and asking the person to return months later.

Follow-up may include monitoring:

Whether symptoms are improving
Adverse effects
Adherence
Suicidal thoughts
Sleep
Functioning
Physical health where relevant

If there is inadequate improvement, clinicians may reassess:

Diagnosis
Adherence
Dose and duration
Associated psychiatric conditions
Physical illness
Alcohol/substance use
Psychosocial stressors

NICE advises reviewing possible explanations for non-response before simply escalating treatment.

Severe or Complex Depression

Some people require specialist or more intensive treatment.

Examples include:

Severe depression
psychotic depression
Recurrent episodes
Significant suicide risk
Substantial functional impairment
Treatment that has not produced adequate improvement

In selected severe circumstances, electroconvulsive therapy (ECT) may be considered, including situations where a rapid response is clinically required or where other treatments have not been sufficiently effective.

Hospital-based treatment may be appropriate when the person cannot be adequately supported safely in a less intensive setting.

How Ahana Can Help

Psychiatric Assessment

A psychiatrist can assess symptoms, severity, risk, previous episodes, physical and psychological factors and appropriate treatment options.

Psychological Therapies

Evidence-based psychological treatment may form part of depression care alone or alongside medication.

Outpatient Care

Suitable for many individuals who can remain safely at home while receiving consultation, treatment and follow-up.

Inpatient Care

May be considered when symptoms are severe or more intensive assessment, support or monitoring is required.

Urgent Mental Health Care

For acute deterioration, significant safety concerns or circumstances requiring urgent assessment.

Recovery From Depression

Recovery means more than obtaining a lower symptom score.

It may involve:

Enjoying activities again
Returning to work or study
Improving sleep
Reconnecting with relationships
Rebuilding confidence
Managing stress
Resuming meaningful responsibilities
Rxecognising early warning signs

Recovery can be gradual. Different areas of functioning may improve at different rates.

Preventing Relapse

For some people, depression can recur.

Relapse-prevention planning may include:

Understanding personal triggers
Recognising early warning signs
Maintaining sleep and routines
Continuing appropriate treatment
Practising skills learned in psychological therapy
Planning how to respond if symptoms return

NICE recommends discussing continuation of antidepressants and/or psychological treatment after remission when relapse risk remains significant.

WHO also recommends considering continuation of effective antidepressant treatment for at least six months after remission in adults with moderate-to-severe depression who have benefited from it, with ongoing monitoring.

Do not turn that into a statement that everyone must take medication for six months; duration is individualised.

What Can Someone Do Alongside Professional Treatment?

Self-care does not replace treatment when treatment is required, but supportive measures can help recovery.

Useful measures may include:

Maintaining regular sleep and waking times
Gradually returning to meaningful activities
Remaining connected with trusted family or friends
Regular physical activity as tolerated
Regular meals
Reducing or avoiding alcohol
Avoiding illicit drugs
Attending follow-up appointments

WHO includes maintaining activities, social connection, exercise, regular eating/sleeping and reducing alcohol/drug use among useful self-care measures

Family and Caregiver Support

Depression affects families as well as individuals.

Family members can help by:

Listening without dismissing the person’s experience
Encouraging professional assessment
Supporting treatment attendance
Helping with routines when functioning is impaired
Observing significant deterioration
Taking suicidal statements seriously

Avoid telling someone simply to:

Cheer up.
Be positive.
You have nothing to be depressed about.

Depression is not a failure of willpower.

Frequently Asked Questions

What are the most common symptoms of depression?

Common symptoms include persistent low mood, loss of interest or pleasure, low energy, sleep or appetite changes, difficulty concentrating, feelings of guilt or worthlessness, hopelessness and withdrawal. Some people also experience suicidal thoughts. The pattern and effect on daily functioning matter more than any single symptom.

How do I know whether I am depressed or just sad?

Ordinary sadness often changes with circumstances and does not necessarily cause sustained impairment. Depression tends to be more persistent or severe and may affect motivation, sleep, concentration, relationships and everyday functioning. A professional assessment can help when the distinction is unclear.

Can depression cause physical symptoms?

Yes. Depression may be associated with tiredness, disturbed sleep, appetite changes, aches, gastrointestinal complaints or reduced sexual interest. However, physical symptoms can have many causes and should not automatically be attributed to depression.

Does everyone with depression need antidepressants?

No. Treatment is individualised. Psychological treatment may be appropriate without medication for many people, particularly in less severe depression. Medication may be considered depending on severity, previous history, clinical need and patient preference.

How long does treatment take to work?

The timeline varies according to the condition, treatment and individual. Psychological and medication treatments generally require ongoing engagement rather than producing immediate recovery. Progress should be reviewed rather than assuming treatment is ineffective too early.

Can depression return after recovery?

Yes. Some people experience one episode while others experience recurrent depression. Identifying early warning signs and having a relapse-prevention plan can reduce future risk.

When might hospital admission be required?

Most depression can be treated without hospital admission. Inpatient care may be considered when symptoms are severe, safety cannot be adequately maintained outside hospital, or intensive treatment and monitoring are required.

Can a person with depression recover fully?

Many people improve substantially or recover with appropriate treatment and support. The course varies between individuals, and some people require longer-term treatment or relapse-prevention care.