Depression

If you or someone else may act on suicidal thoughts, has already self-harmed, cannot stay safe, is severely confused or hearing or seeing things others do not, call local emergency services or go to the nearest emergency department now. Stay with the person if it is safe to do so, reduce access to medicines, weapons or other means of harm, and do not delay urgent care to try a home remedy. Catatonia, extreme agitation, or being unable to eat or drink also needs urgent assessment.

What is depression?

Depression is a common mental health disorder, not a personal weakness and not the same as an ordinary period of sadness. During a depressive episode, low or irritable mood or loss of interest or pleasure is present for most of the day, nearly every day, for at least two weeks. Other symptoms and a meaningful effect on daily life are also considered. Depression can affect people of every age, culture and background, and effective treatment is available.

There is no single cause. Depression develops through a complex interaction of biological, psychological and social factors. Genetics, previous episodes, trauma, bereavement, loneliness, poverty, major life changes, chronic illness, pain, sleep problems and alcohol or drug use can all influence risk. Experiencing a risk factor does not make depression inevitable and is never the person’s fault. The idea that every case is simply a “chemical imbalance” is too narrow.

Signs and different presentations

Symptoms can include persistent sadness, emptiness or irritability; loss of interest; low energy; disturbed sleep; changes in appetite or weight; slowed or restless movement; poor concentration; guilt, worthlessness or hopelessness; and thoughts of death or suicide. Not everyone has every symptom. Physical aches, digestive complaints, withdrawal, anger, increased risk-taking or greater alcohol or drug use may sometimes be prominent.

Children and adolescents may appear irritable, anxious, clingy, withdrawn or troubled at school rather than describing sadness. Older adults may report loss of interest, physical symptoms, memory difficulties or lack of emotion. These are possible patterns, not rules: an individual assessment matters at every age. Grief and understandable distress can overlap with depression, but persistent symptoms, functional impairment or safety concerns deserve professional attention.

How depression is assessed

A clinician asks about symptoms, duration, functioning, previous episodes, medicines, physical health, sleep and substance use. They should assess thoughts of suicide or self-harm and whether there is a plan, intent or access to means. They also look for psychosis and for past periods of unusually elevated or irritable mood, increased energy, very little need for sleep, rapid speech, impulsive behaviour or other signs of mania or hypomania. This bipolar assessment is important before an antidepressant is started.

Questionnaires can help measure symptoms and follow progress, but they do not make the diagnosis alone. A physical examination or targeted tests may be needed when thyroid disease, anaemia, infection, medicine effects or another condition could contribute. Tell the clinician about prescription and non-prescription medicines, supplements, alcohol and other substances. Do not stop prescribed treatment without advice.

Treatment and shared decisions

Treatment should match symptom severity, safety, age, previous response, health conditions, access and personal preference. Evidence-based psychological treatments include cognitive behavioural therapy, behavioural activation, interpersonal psychotherapy and problem-solving therapy. They may be delivered individually, in groups or through supported digital programmes. Medication, psychotherapy or a combination may be appropriate for moderate or severe depression; for less severe depression, psychological and guided self-help options are commonly considered first.

An antidepressant is selected with a prescriber after discussing expected benefits, adverse effects, interactions and monitoring. Improvement takes time. Contact the prescriber promptly if agitation, marked mood change or suicidal thoughts appear or worsen, particularly early in treatment or after a dose change; younger people need especially careful monitoring. Never share antidepressants, change the dose independently or stop suddenly. When stopping is appropriate, the dose is usually reduced gradually in a plan agreed with the prescriber to limit withdrawal symptoms.

Depression in children and adolescents needs age-appropriate assessment and treatment. Antidepressants are not a first treatment for mild depression in young people, and when medication is considered it should be part of specialist-guided care with psychological treatment and close monitoring. Pregnancy, breastfeeding, frailty and multiple medicines also require an individual benefits-and-risks discussion.

When initial treatment is not enough

A lack of early improvement is not a personal failure. The clinician may revisit the diagnosis, adherence, side effects, bipolar symptoms, substance use and physical or social contributors, then adjust psychotherapy or medication. For selected severe, psychotic, catatonic or treatment-resistant episodes, specialist services may consider electroconvulsive therapy or another brain-stimulation treatment. These are medical procedures with specific benefits, risks and consent requirements, not home treatments.

Practical self-care and support

Regular sleep and meals, manageable physical activity, daylight, reduced alcohol, avoidance of illicit drugs and continued contact with trusted people can support recovery. Start with small, achievable activities rather than waiting to feel motivated. These measures complement care; they should not replace assessment or treatment when symptoms are persistent, severe or unsafe. Herbal products and supplements can cause adverse effects or interact with medicines, so discuss them with a clinician or pharmacist.

A written safety plan can list warning signs, coping steps, supportive contacts, professional services and ways to make the environment safer. Family or friends can listen without blame, offer practical help and encourage appointments. Recovery is possible, although it may be gradual and some people experience recurrence. Follow-up should include what helped, early warning signs and an individual relapse-prevention plan.