Dr Mark Winwood, Clinical Leand for Mental Health Services for AXA Health

What is depression?


16 January 2017

Depression image 700x300

What is depression?

According to our psychological health expert, Dr Mark Winwood,

“Depression is one of the commonly occurring mental health problems, characterised by a constant feeling of sadness, and is very different from temporarily feeling low. People living with depression often experience intense feelings of guilt, low self-esteem and poor energy and concentration, all of which can have a severe impact on day-to-day life.

While many of those who experience depression believe they are alone in their symptoms, in reality this is not the case.”

Research by the Office for National Statistics found that almost one in five people in the UK aged over 16 showed some evidence of depression or anxiety symptoms co-existing with depression.

Despite this, depression isn't treated as seriously as it should be. AXA Health research in 2015 found that two-thirds of senior business managers and owners did not believe that suffering from stress, anxiety or depression was a serious reason for staff absences. Depression, like anxiety, is an illness not a character trait and should be treated as such. Depression can happen to anyone, and according to the Mental Health Foundation, half of those who have experienced it will do so more than once.

Symptoms and causes of depression are different for everyone, and treatment usually involves a combination of medication, self-help and talking therapy.

Signs and symptoms of depression

Depression can often be difficult to self-diagnose, although it is possible to do so by analysing any recent changes in the way you think, feel or behave. Those close to you, in moderate to severe cases, are also more likely to recognise symptoms, and are often able to see through the 'mask' some of those living with depression wear to cover their true feelings.

One of the reasons why depression is so hard to overcome completely is because everyone that lives with it experiences a different combination of the symptoms listed below:

Thoughts and feelings

  • Lack of self-confidence and self-esteem
  • Sudden forgetfulness, concentration issues and/or indecisiveness
  • Negative thinking
  • View of life as pointless
  • Suicidal thoughts
  • Constant sense of guilt
  • Sense of worthlessness
  • Helplessness
  • Low sex drive
  • Easily agitated and/or irritated
  • Numbness
  • Unable to relate with others / feeling misunderstood (link to new loneliness content)
  • Consistently feel low
  • Isolation (link to new loneliness content)
  • Numb or empty
  • No interest in usual hobbies


  • Detachment from others
  • Difficulty talking to people
  • Cry regularly
  • Avoiding usually enjoyable activities or social events
  • Self-harm
  • Sleeping or eating much more or less than usual
  • Increasing alcohol, tobacco or drug intake


  • Sudden increase or loss of appetite
  • Loss of sex drive and lack of interest in sex
  • Lack of energy
  • Increased feeling of aches and pains
  • Constipation
  • Disturbed sleep patterns
  • Menstrual cycle changes in women

While it is no substitute for a consultation with your GP, an online self-assessment depression test such as this provided by the NHS can help you to work out if you may be depressed.

If you feel like you're experiencing four or more of these symptoms daily for more than two weeks, it is likely you are living with depressed mood and we recommend you visit your GP to discuss the symptoms further.

Depression and anxiety

Depression and anxiety are frequently mentioned together, largely because people who experience one often have the other, too.

Those with anxiety generally feel excessively worried, restless and irritable, have a constant feeling of dread and struggle to concentrate.

Causes of depression

As with the feelings mentioned above, causes of depression are deeply personal, and can differ wildly from one person to the next. Some people experiencing depression do so as a result of a variety of different triggers, however usually causes of depression will fall into one of the following categories:

Traumatic or life changing events

  • Losing a job
  • Breakdown of a relationship
  • Giving birth
  • Victim of assault – physical, sexual or emotional
  • Childhood trauma
  • Work issues / workplace bullying
  • Diagnosis of health issue
  • Death of a close friend or relative
  • Moving house
  • Changing jobs
  • Retirement
  • Children growing up / leaving home
  • Poverty or financial concerns

Physical conditions

  • Brain and nervous system conditions
  • Hormonal changes (from teenage angst to menopause)
  • Sleep issues
  • Chronic pain
  • Agitation due to side-effects of certain new medications
  • Alcohol or drug abuse

Genetics and family

  • Genetic predisposition
  • Living with, or caring for, a depressed person

The above are just a selection of the many different causes of depression. While it may be tricky to work out exactly what has caused you to experience it, doing so is an important first step on the road to recovery.

Types of depression

While there are many different strands of depression, the most common kinds are as follows:

Mild depression

Limited effect on daily life

Clinical depression

Severe disruption to daily life – could be either one standalone episode or multiple episodes experienced throughout a lifetime

Bi-polar disorder

Extreme mood swings from elation to despair, coupled with odd or illogical behaviour

Post-natal depression

Prolonged feelings of inadequacy (in the face of new parental responsibility and loss of former freedoms), often coupled with negative feelings towards the newborn

Seasonal Affective Disorder (SAD)

Though still under debate, this term has become popular to describe a serious form of depression, usually experienced from winter till spring, with lack of daylight believed to be the cause.

Diagnosing depression

If you are experiencing any of the symptoms listed above daily for more than two weeks, or have recently been exposed to any of the causes of depression and have noticed your behaviour change as a result, you should immediately seek help from your GP.

A common feeling for those living with depression is that treatment won't help – the general gloom and negative thinking that comes with the condition can cloud your judgement. However depression will not just get better on its own, and the sooner you can seek help, the better.

Speaking with your GP is a good first step. You will be asked a series of questions relating to your general well-being, which will help them to diagnose the existence and severity of the condition. While it will be hard, it is very important to be as open as you can with your GP, giving them as much information as possible. This will lead to a better diagnosis and a higher likelihood of treatment improving your day-to-day life.

Treatments for depression

Once depression is diagnosed, your GP will then use the information provided to suggest the best treatments for you. Treatment is different for everyone and depends on your unique set of circumstances, however it will usually include a mixture of the following:

Self help

  • Make plans to do things that you enjoy
  • Reconnect with others
  • Moderate your use of drugs and alcohol
  • Set achievable goals
  • Improve your diet
  • Exercise
  • Self-help groups
  • Sleep


  • Cognitive behavioural therapy (CBT) – from self-help books to sessions with a therapist
  • Counselling– regular sessions with a trained advisor
  • Interpersonal psychotherapy – focusing on relationships
  • Behavioural activation – looking at simple everyday tasks you're avoiding and starting to do them
  • Other evidence based therapies such as Interpersonal Psychotherapy (IPT), Acceptance and Commitment therapy (ACT) and Mindfulness-based Cognitive Therapy (MBCT.)


  • Antidepressants

Combination therapy

  • Usually a mixture of antidepressants and CBT

Other treatments

  • Arts therapies – using music or art to help you express your feelings

No matter what treatment you're prescribed, it's important to remember that depressed mood may not be resolved instantly, sometimes it is a long and gradual process with the risk of a relapse always possible. If after a while you feel the treatments suggested aren't working for you, book another appointment and discuss the effect they are having openly.

Depression: you're not alone

Isolation is a common symptom of depression, however it is always important to remember you're not alone. Learning how others have learned how to live with and cope effectively with periods of depression can be comforting and help you to make that first step to seek help.


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