Depression: signs, causes and what really helps

Almost everyone has days when nothing feels worth doing. Depression is different: for months it can drain the colour from life, sap your energy and take away your belief that things can get better. The World Health Organization estimates that about 5 per cent of adults worldwide live with depression. It is one of the most common reasons people come to a psychologist, and the good news is that it responds well to treatment.

Signs of depression

Depression affects not only mood but also thinking, the body and behaviour. People most often notice:

• A low, empty or numb mood for most of the day.
• Losing interest and pleasure, even in things that used to bring joy.
• Tiredness and lack of energy, when even taking a shower feels like a huge effort.
• Changes in sleep: insomnia, waking too early or, the opposite, sleeping much longer than usual.
• Changes in appetite and weight.
• Feeling slowed down or, the opposite, restless inside and unable to sit still.
• Trouble concentrating, remembering and making decisions.
• Guilt, a sense of worthlessness, harsh self-criticism.
• Thoughts that it would be better not to exist, or thoughts about death.

When it is depression

Professionals look at three things: how long the state lasts, how often it happens and how much it gets in the way of living. If your mood has been low or your interest gone nearly every day for at least two weeks, and it affects work, relationships or looking after yourself, it is worth seeing a specialist. Some illnesses, such as thyroid problems or anaemia, can cause similar symptoms, so a check-up with a doctor is a good idea too.

Sadness, grief and depression

Sadness and grief are natural responses to loss: they hurt, but they usually come in waves, with room in between for warm memories and good moments. In grief, people usually keep their sense of self-worth. In depression the state is flat and constant, and thoughts like “I am worth nothing” or “it is all my fault” often join in. Sometimes grief turns into depression, and then help matters even more.

What causes depression

Depression has no single cause. Usually several factors come together: heredity and biology, long-term stress, losses and big life changes, traumatic experiences, loneliness, chronic illness, poor sleep. It is important to remember that depression is not a lack of willpower or laziness, and it does not go away when someone says “pull yourself together”.

What helps

• Psychotherapy. Cognitive behavioural therapy and behavioural activation are among the most studied methods. In therapy we work with the thoughts, feelings and habits that keep depression going.
• Medication. For moderate and severe depression a psychiatrist may prescribe antidepressants. Therapy and medication together often give the best result.
• Body and routine. Regular sleep, daylight, even short walks and movement all support recovery.
• Connection with people. Depression pushes you to withdraw, and even a short talk with someone you trust weakens its hold.

Small steps you can start today

• Choose one small task for the day and count it as a win, even if it is only a walk around the block.
• Get up and go to bed at roughly the same time.
• Go out into daylight every day, for at least 15 minutes.
• Message one person you trust. You can simply say: “Things are hard for me right now”.
• Do not wait for motivation: with depression, action usually comes before the wish to act.

How to support someone close

Listen without advice or judgement, and avoid “cheer up” or “others have it worse”. Offer concrete help: a walk together, cooking a meal, help booking an appointment with a specialist. And remember to look after yourself as well.

If thoughts of death or of harming yourself come up, do not keep them to yourself: tell someone close, write to me or call 911.

Where to start

If you have doubts, you can take the PHQ-9 test on this site: it takes a few minutes. The test is not a diagnosis, but it helps you see how serious things are, and you can send the result to me for free and talk it over. Getting out of depression is possible, and it is easier with support beside you.