Depression signs and the treatment options that help

The alarm goes off and your first thought is how many hours until you can be back in bed. Work gets done, joylessly. The programme you used to look forward to is just noise in the corner now, there are nineteen unanswered messages from people you actually like, and when someone asks how you are you say you are fine and busy without thinking. This has been going on since February.

Everybody has flat weeks. What makes depression different is not how sad you feel on the worst afternoon, it is how long it goes on, how much of the day it colours, and how much it quietly takes away. It is also far more physical than most people expect, which is why plenty of people first speak to a doctor about exhaustion and back pain rather than mood.

Low mood, or depression

Low mood after something difficult is a healthy response. It moves, it lifts for an evening, and there are moments of relief inside it. Depression is more constant. Two weeks or more of feeling low most of the day, most days, or of losing interest and pleasure in almost everything, is the point at which it has stopped being a rough patch.

Losing interest is the symptom people underestimate. Written down it sounds mild. In practice the things that used to reliably lift you now do nothing at all, and it is often what family notice first: not tears, but somebody who has quietly stopped doing what they liked.

What it looks like day to day

• Low mood, or emptiness and numbness rather than sadness, and irritability, which is often how it shows in men and in teenagers.
• No pleasure or interest in things that used to matter, people included.
• Sleep changes. Waking at four in the morning is the classic pattern, though sleeping far more and still waking tired is just as common.
• Appetite up or down, with weight following it.
• Tiredness that sleep does not repair.
• Poor concentration, and a memory that feels untrustworthy. Reading the same paragraph three times.
• Aches with no clear cause: headaches, back pain, a body that feels heavy.
• Guilt, and self criticism you would never aim at anybody else.
• Thoughts that life is not worth living, or of harming yourself.

Those physical symptoms deserve attention rather than dismissal. Persistent tiredness has plenty of other causes and depression is never the automatic answer, so it is reasonable to have it looked into, and our article on how persistent fatigue is assessed and treated works through that overlap. An underactive thyroid can look remarkably like depression too, which is one reason a doctor asks about more than mood. Anxiety and depression also turn up together more often than separately, so anxiety treatment reviewed each month is frequently part of the same plan.

If things feel unsafe

If you are in distress, or having thoughts of suicide or of harming yourself, please talk to someone rather than sitting with it alone. The Samaritans are on 116 123, free, at any hour of any day, and you do not have to be at a crisis point or have your thoughts neatly in order before you call. Ring 999 or go to an emergency department if you have harmed yourself, or if you feel you cannot keep yourself safe right now, and use 111 when you need urgent help and it is not an emergency. Thoughts like these are a recognised part of depression rather than a sign of weakness, and they ease as the depression is treated.

Other reasons to be seen quickly

• Thoughts of ending your life, particularly if you have begun thinking about how.
• Not eating or drinking, or being unable to look after yourself or anyone who depends on you.
• Hearing voices, or holding beliefs that people around you find alarming.
• Severe agitation, or a sudden swing into feeling elated and barely needing sleep.
• Feeling markedly worse or more agitated in the first weeks after starting a new medicine.
• New depression after having a baby, in either parent.

For any of those, 999 and 111 remain the right numbers depending on how urgent it feels, and the Samaritans line is there for the conversation in between.

What treatment involves

Talking therapy and medication are both legitimate treatments, neither is the inferior option, and they are frequently used together. What is right for you depends on how severe things are, what you have tried before, and what you would actually be willing to do.

Talking therapy. Cognitive behavioural therapy and other structured therapies have a solid record in depression. The work is practical: noticing the thoughts that keep you flat, and rebuilding activity in a planned way rather than waiting to feel like it. A doctor can talk through what is available and write a referral letter where that is the right next step.

Medication. Antidepressants, commonly those of the SSRI class, may be prescribed where a doctor judges they are appropriate for you. They take a few weeks before much changes, sleep and appetite often improve before mood does, and some people feel unsettled in the first days. That is not a reason to abandon them alone in week one, it is a reason to have a review already booked.

The scaffolding round both. A get up time you keep even on bad days, daylight early, movement of any kind, less alcohol, one human contact a day. Depression removes motivation and then asks you to wait for it to return, so action usually has to go first. Being told to go for a run is maddening when you cannot get dressed, but this is the ground treatment stands on.

Never stop or reduce an antidepressant on your own, including when you feel much better. Feeling well is usually a sign that treatment is working rather than that it is no longer needed, and the timing of any change should be worked out with a doctor.

How treatment is reviewed over time

1. The first appointment. How long it has gone on, how much it affects your life, your safety, sleep and appetite, and which options make sense.
2. An early review. A couple of weeks in, this one is not asking whether you are better. It checks side effects, safety, and whether you are managing to take treatment at all.
3. A month or two in. Now the question is whether anything has genuinely shifted, and if not, the plan changes rather than drifting on unaltered.
4. Once you are well. Treatment usually carries on beyond the point of feeling better, because stopping the moment the fog lifts is a common reason depression returns.
5. Coming off. Planned, gradual, and with someone keeping an eye on how you are.

How an online consultation works for this

Getting help with depression is hardest at the first sentence, and a waiting room is a difficult place to say it out loud. Doing it by video from your own front room removes that obstacle, and for many people that is the difference between asking this month and putting it off again. A UK registered doctor will take a proper history, ask directly about how safe you feel, prescribe where it is clinically appropriate, write a referral letter where therapy or specialist input is needed, and keep reviewing it with you.

One video appointment does not cure depression. What it does is start treatment and put a review in the diary, which is where the improvement comes from, and that is the thinking behind a monthly depression treatment plan or a broader mental health care plan reviewed each month. You can read what happens before, during and after an appointment, costs are listed on our page of prices, and there is no pressure about timing: book a consultation with a UK registered doctor whenever you feel able to.

If you are worried about somebody else

Ask them directly and plainly, including about suicidal thoughts if that is your worry. Asking does not plant the idea, and most people are relieved that somebody finally noticed. Listen without trying to argue them out of how they feel, because cheerfulness aimed at a person with depression usually lands as being told they are wrong. Practical help beats advice: a lift to an appointment, a meal, sitting with them while they make the call. And when someone dies by suicide it is the end point of an illness rather than a freely made choice.

Depression is treatable, it responds to being taken seriously, and months of feeling like this is not something you have to keep absorbing alone. Whenever you are ready, you can talk to a doctor about how you have been feeling.