In section one we’ll be looking at how depression differs from everyday changes in mood and what treatments are commonly offered by health services.
We’ll introduce Deepak and Suhana, who are fictional characters representing typical experiences of depression.
Watch Masuma’s short intro video to learn more about section one of our BA learning resources.
Understanding depression
Looking at how depression differs from normal variation in mood and how it is diagnosed and screened for in the population.
What is depression and how is it different to normal mood variation?Depression is a clinical condition with 10 common symptoms. Not everyone with depression will experience all of these symptoms.
Two key symptoms of depression:
To recognize depression, we initially look out for two key symptoms.
Feeling low, sad or irritable for most of the time
Losing interest and having no pleasure in day-to-day activities, including interactions with other people
If someone experiences one or both of these symptoms, then we need to check for eight additional symptoms that may suggest the presence of depression.
Eight more symptoms of depression to look out for:
The eight additional symptoms that are commonly present in depression can be split into two groups:
How is depression different to just having a bad day or a bad week?We all feel low, irritable or unmotivated sometimes. When these feelings persist for many weeks and start affecting our ability to look after ourselves, work, socialise with other people, plan for the future or do things that are important in day-to-day life, then we need to look closer for symptoms of depression.
Depression is diagnosed by a health professional who checks for symptoms of depression and for changes in a person’s life and routines. The professional may also take note of how the person looks and acts during their discussion and may also speak to close family members. Finally, the professional checks for the presence of other conditions that may cause the same symptoms as depression.
Depression is a clinical condition with 10 common symptoms. Not everyone with depression will experience all of these symptoms.
Two key symptoms of depression:
To recognize depression, we initially look out for two key symptoms.
Feeling low, sad or irritable for most of the time
Losing interest and having no pleasure in day-to-day activities, including interactions with other people
If someone experiences one or both of these symptoms, then we need to check for eight additional symptoms that may suggest the presence of depression.
Eight more symptoms of depression to look out for:
The eight additional symptoms that are commonly present in depression can be split into two groups:
We all feel low, irritable or unmotivated sometimes. When these feelings persist for many weeks and start affecting our ability to look after ourselves, work, socialise with other people, plan for the future or do things that are important in day-to-day life, then we need to look closer for symptoms of depression.
Depression is diagnosed by a health professional who checks for symptoms of depression and for changes in a person’s life and routines. The professional may also take note of how the person looks and acts during their discussion and may also speak to close family members. Finally, the professional checks for the presence of other conditions that may cause the same symptoms as depression.
Let’s take a moment for personal reflection.
- Have you ever noticed how your mood changes?
- Have you ever experienced a time when you felt depressed?
- Can you think of a time when you felt sad or demoralised?
- Take a few moments to think about the 10 symptoms of depression.
- Do you recognise any of these in yourself when you are having a bad day?
What is depression like?Please watch Deepak or Aslam’s story. Take a few moments to reflect.
Deepak’s story (English version)
Aslam’s story (Urdu version)
- What stood out for you?
- What typical symptoms of depression can you recognise?
A depressed person can feel lost, hopeless and alone, even if they are surrounded by people who care about them. They may notice that they no longer get any joy or sense of achievement from everyday things, and so withdraw into themselves. If nothing changes, even attempting small tasks or trying to make simple decisions starts to be overwhelming and the person finds themselves trapped in a cycle of depression.
Some people living with symptoms of mild depression may still be able to carry on life as normal, although they may struggle to feel happy and optimistic. Severe depression, on the other hand, can be very debilitating and the person may have thoughts of death and suicide.
Not only does depression exist along a spectrum, the experience of it is different for everyone. In future steps we will meet several others who will share with us how depression affects them.
Let’s consider the experience of Suhana. Please watch the video and then take a few moments to reflect on her story.
- What stood out for you?
- How were Suhana’s experiences different to Deepak’s?
Screening for DepressionMany people with depression do not see a mental health specialist and may not receive a formal diagnosis. Still, it is possible to recognise depression and prompt further assessment by using simple screening tools.
These are usually brief questionnaires with statements that reflect different symptoms of depression. Each statement is scored by the person who completes it. The total score from all the answers indicates whether depression is likely to be present and whether it is likely to be mild, moderate or severe.
The 9-item Patient Health Questionnaire (PHQ-9) (Kroenke et al, 2001) is one such tool commonly used.
Find out more about the PHQ9
The PHQ-9 has been translated into almost 50 languages, including British Sign Language (BSL); however, not all of these translated versions have been validated through research studies. When such studies took place to validate different language versions of the PHQ-9, their results showed that PHQ-9 remained a valid measure of depression after translation, but depression symptom scores were not always equivalent across different languages.
In sum, general practitioners, health and charity workers, teachers and other professionals can use depression screening tools, because they are:
- Quick and easy to administer without specialist training.
- Readily available, often without charge.
- Easy to understand and to interpret their scores.
- Available in different languages.
A word of caution
A screening tool on its own does not make a diagnosis of depression.
Screening tools can tell us whether it is worth having a follow-up assessment or a consultation with a mental health professional to confirm a diagnosis.
To make a diagnosis of depression, a health professional takes into account the impact of the symptoms in a person’s life, considers for how long the symptoms have been present and whether they change over time, and asks supplementary questions to rule out other physical or mental health conditions that may be expressed with the same symptoms as depression.
Routine screening for depression is not recommended for the general population because normal mood variations can mislead us into thinking that people may have depression when they do not. Screening tools are used as a way of gauging the likelihood and severity of depression when people feel that their low mood persists for a long time and has a major impact in their lives.
Please watch Deepak or Aslam’s story. Take a few moments to reflect.
Deepak’s story (English version)
Aslam’s story (Urdu version)
- What stood out for you?
- What typical symptoms of depression can you recognise?
A depressed person can feel lost, hopeless and alone, even if they are surrounded by people who care about them. They may notice that they no longer get any joy or sense of achievement from everyday things, and so withdraw into themselves. If nothing changes, even attempting small tasks or trying to make simple decisions starts to be overwhelming and the person finds themselves trapped in a cycle of depression.
Some people living with symptoms of mild depression may still be able to carry on life as normal, although they may struggle to feel happy and optimistic. Severe depression, on the other hand, can be very debilitating and the person may have thoughts of death and suicide.
Not only does depression exist along a spectrum, the experience of it is different for everyone. In future steps we will meet several others who will share with us how depression affects them.
Let’s consider the experience of Suhana. Please watch the video and then take a few moments to reflect on her story.
- What stood out for you?
- How were Suhana’s experiences different to Deepak’s?
Many people with depression do not see a mental health specialist and may not receive a formal diagnosis. Still, it is possible to recognise depression and prompt further assessment by using simple screening tools.
These are usually brief questionnaires with statements that reflect different symptoms of depression. Each statement is scored by the person who completes it. The total score from all the answers indicates whether depression is likely to be present and whether it is likely to be mild, moderate or severe.
The 9-item Patient Health Questionnaire (PHQ-9) (Kroenke et al, 2001) is one such tool commonly used.
Find out more about the PHQ9
The PHQ-9 has been translated into almost 50 languages, including British Sign Language (BSL); however, not all of these translated versions have been validated through research studies. When such studies took place to validate different language versions of the PHQ-9, their results showed that PHQ-9 remained a valid measure of depression after translation, but depression symptom scores were not always equivalent across different languages.
In sum, general practitioners, health and charity workers, teachers and other professionals can use depression screening tools, because they are:
- Quick and easy to administer without specialist training.
- Readily available, often without charge.
- Easy to understand and to interpret their scores.
- Available in different languages.
A word of caution
A screening tool on its own does not make a diagnosis of depression.
Screening tools can tell us whether it is worth having a follow-up assessment or a consultation with a mental health professional to confirm a diagnosis.
To make a diagnosis of depression, a health professional takes into account the impact of the symptoms in a person’s life, considers for how long the symptoms have been present and whether they change over time, and asks supplementary questions to rule out other physical or mental health conditions that may be expressed with the same symptoms as depression.
Routine screening for depression is not recommended for the general population because normal mood variations can mislead us into thinking that people may have depression when they do not. Screening tools are used as a way of gauging the likelihood and severity of depression when people feel that their low mood persists for a long time and has a major impact in their lives.
Common treatments for depression
Introducing two types of treatment for depression: medication and psychological therapies.
Overview of treatments for depressionThe two main interventions for treating depression are antidepressant medication and psychological therapies – also called talking therapies – which can be delivered by a professional or be self-directed.
Over the next few steps we explore each of these options and invite you to think about what the various strengths and weaknesses are of each approach.
The two main interventions for treating depression are antidepressant medication and psychological therapies – also called talking therapies – which can be delivered by a professional or be self-directed.
Over the next few steps we explore each of these options and invite you to think about what the various strengths and weaknesses are of each approach.
Before we elaborate on the treatments for depression, take a moment to gather your thoughts on the question below.
What are your thoughts about medication compared to talking therapies for depression?
- Medication may be more effective
- Talking therapies may be more effective
- Neither are particularly effective
- Combining both may be more effective
There isn’t a necessarily wrong or right answer here, and your perspective may be different from the collective thinking.
Below is a snap shot of the opinions of all the people who have taken our online course to date (January 2023). See how your answer compares.
- Medication may be more effective (1%)
- Talking therapies may be more effective (19%)
- Neither are particularly effective (2%)
- Combining both may be more effective (78%)
Antidepressant medicationWhen are they prescribed?
Antidepressant medication is usually prescribed by a doctor for moderate to severe depression. There is less evidence to support that they are helpful in the treatment of mild depression.
What effects do they have?
It is thought that antidepressant medication works by increasing the levels of two chemicals in the brain, serotonin and noradrenaline, which have been linked to mood.
The most common types of antidepressants are:
– Selective serotonin reuptake inhibitors (SSRIs)
– Serotonin-noradrenaline reuptake inhibitors (SNRIs)
– Tricyclic antidepressants (TCAs)
It may take up to 4 weeks for antidepressant medication to begin to work but most people see some benefits after 1-2 weeks. Generally, antidepressants need to be taken for at least 6 months after depression improves to prevent it from coming back.
What side effects do they have?
As with quite a lot of medications, some people notice side effects when they first take antidepressants. Side effects vary according to the type of antidepressant medication prescribed: SSRIs and SNRIs tend to cause indigestion and stomach ache, whereas TCS may cause dry mouth. These side effects are usually mild and short-lived and settle as the body gets used to the medication.
Are they addictive?
Antidepressants are not addictive but should not be discontinued abruptly because this can cause restlessness and agitation, trouble sleeping, unsteadiness, sweating and stomach problems that can last from 2 weeks to several months. The person’s doctor usually recommends gradually reducing the dose of the antidepressant (tapering off) over a period of 4 weeks or longer. Some people can take antidepressants for life.
Read more on antidepressants
Psychological therapiesPsychological therapies are structured conversations and activities that aim to understand and change the symptoms, distress and disability associated with depression.
Therapy sessions with a professional
There are many different types of talking therapy. One of the most commonly used evidence-based therapies for depression is cognitive behaviour therapy, or CBT.
CBT is an umbrella term for a group of psychological interventions that draw on two distinct therapies: cognitive therapy and behaviour therapy.
- Cognitive therapy suggests that our emotional problems are maintained by unhelpful beliefs that we hold about ourselves, others, the world, our life or our future.
- Behaviour therapy proposes that our problems are the result of unhelpful or self-sabotaging behaviours – such as avoidance, withdrawal, rumination, rituals and habits – which are learned, therefore they can be ‘unlearned’.
In practice, CBT draws upon techniques from both behaviour and cognitive therapies, to help people with depression change the way they feel by changing the way they think and behave.
Behavioural activation is a psychological intervention that comes under the CBT umbrella. This is what this course will focus on.
Self-directed therapy
Self-help uses standardised, structured materials to enable people to understand and apply psychological therapy techniques with or without help from a professional.
Self-help, in the form of published workbooks, reputable websites and SMARTphone Apps, can guide a person with depression through step-by-step therapy activities. These activities start by identifying what depression means for each person, how the vicious cycle of negative thinking and inactivity can maintain their depression, and what techniques can be used to shape more helpful ways of thinking and rewarding activities that can improve depression.
Pure self-help without any professional support is suitable for people with mild symptoms of depression who can rely on self-motivation and self-monitoring. Guided self-help combines standardised materials with support from a professional, or a trained lay person, who understands and can motivate someone with depression to formulate their goals, apply therapy techniques, clarify misunderstandings and overcome barriers.
Reflect on these questions:
- What are the advantages of self-help for someone who experiences depression?
- If professional support is not readily available, what can friends and family do to help a person with depression make the most of a self-help workbook or a self-help app?
When are they prescribed?
Antidepressant medication is usually prescribed by a doctor for moderate to severe depression. There is less evidence to support that they are helpful in the treatment of mild depression.
What effects do they have?
It is thought that antidepressant medication works by increasing the levels of two chemicals in the brain, serotonin and noradrenaline, which have been linked to mood.
The most common types of antidepressants are:
– Selective serotonin reuptake inhibitors (SSRIs)
– Serotonin-noradrenaline reuptake inhibitors (SNRIs)
– Tricyclic antidepressants (TCAs)
It may take up to 4 weeks for antidepressant medication to begin to work but most people see some benefits after 1-2 weeks. Generally, antidepressants need to be taken for at least 6 months after depression improves to prevent it from coming back.
What side effects do they have?
As with quite a lot of medications, some people notice side effects when they first take antidepressants. Side effects vary according to the type of antidepressant medication prescribed: SSRIs and SNRIs tend to cause indigestion and stomach ache, whereas TCS may cause dry mouth. These side effects are usually mild and short-lived and settle as the body gets used to the medication.
Are they addictive?
Antidepressants are not addictive but should not be discontinued abruptly because this can cause restlessness and agitation, trouble sleeping, unsteadiness, sweating and stomach problems that can last from 2 weeks to several months. The person’s doctor usually recommends gradually reducing the dose of the antidepressant (tapering off) over a period of 4 weeks or longer. Some people can take antidepressants for life.
Read more on antidepressants
Psychological therapies are structured conversations and activities that aim to understand and change the symptoms, distress and disability associated with depression.
Therapy sessions with a professional
There are many different types of talking therapy. One of the most commonly used evidence-based therapies for depression is cognitive behaviour therapy, or CBT.
CBT is an umbrella term for a group of psychological interventions that draw on two distinct therapies: cognitive therapy and behaviour therapy.
- Cognitive therapy suggests that our emotional problems are maintained by unhelpful beliefs that we hold about ourselves, others, the world, our life or our future.
- Behaviour therapy proposes that our problems are the result of unhelpful or self-sabotaging behaviours – such as avoidance, withdrawal, rumination, rituals and habits – which are learned, therefore they can be ‘unlearned’.
In practice, CBT draws upon techniques from both behaviour and cognitive therapies, to help people with depression change the way they feel by changing the way they think and behave.
Behavioural activation is a psychological intervention that comes under the CBT umbrella. This is what this course will focus on.
Self-directed therapy
Self-help uses standardised, structured materials to enable people to understand and apply psychological therapy techniques with or without help from a professional.
Self-help, in the form of published workbooks, reputable websites and SMARTphone Apps, can guide a person with depression through step-by-step therapy activities. These activities start by identifying what depression means for each person, how the vicious cycle of negative thinking and inactivity can maintain their depression, and what techniques can be used to shape more helpful ways of thinking and rewarding activities that can improve depression.
Pure self-help without any professional support is suitable for people with mild symptoms of depression who can rely on self-motivation and self-monitoring. Guided self-help combines standardised materials with support from a professional, or a trained lay person, who understands and can motivate someone with depression to formulate their goals, apply therapy techniques, clarify misunderstandings and overcome barriers.
Reflect on these questions:
- What are the advantages of self-help for someone who experiences depression?
- If professional support is not readily available, what can friends and family do to help a person with depression make the most of a self-help workbook or a self-help app?
Wrapping up Section 1
A summary of what has been covered this week, a quiz relating to this, plus links to further relevant resources.
Take-home messageIn section 1 we looked at depression as a clinical condition and how it differs from normal mood variation.
We described the first two symptoms that professionals look out for when they diagnose depression. We looked at other symptoms of depression that can affect a person’s body and mind, as well as psychological treatments and antidepressant medication. We introduced you to Deepak and Suhana, looking at how depression has affected their everyday lives. These are fictional characters and do not refer to specific individuals, but they describe typical experiences of depression.
The take-home message is:
-
Depression is a clinical condition that can be identified and treated.
-
It is different from normal mood variation because it persists over time and affects our ability to function.
In section 1 we looked at depression as a clinical condition and how it differs from normal mood variation.
We described the first two symptoms that professionals look out for when they diagnose depression. We looked at other symptoms of depression that can affect a person’s body and mind, as well as psychological treatments and antidepressant medication. We introduced you to Deepak and Suhana, looking at how depression has affected their everyday lives. These are fictional characters and do not refer to specific individuals, but they describe typical experiences of depression.
The take-home message is:
-
Depression is a clinical condition that can be identified and treated.
-
It is different from normal mood variation because it persists over time and affects our ability to function.
This short quiz aims to help you think about what you’ve been learning and if there is anything you’d like to go back to review or explore further.
The quiz is optional as a learning tool, and it is not an exam.
For each question, there are true and false answers to stimulate thinking. All you need is a pen and paper.
Question 1: The following symptoms can be typical of depression
Select all the answers you think are correct.
- Being worried about health issues
- Feeling irritable most of the time
- Not being able to make decisions and think clearly
- Getting tired even by doing small everyday things
Question 2: Antidepressants have the following features
Select all the answers you think are correct.
- They affect the neurotransmitter serotonin in the brain
- They are addictive
- They should not be discontinued abruptly
- They start working within a couple of days
Question 3: What are the benefits of brief questionnaires as screening tools for depression?
Select all the answers you think are correct.
- They can be administered without specialist mental health training
- They can be used to diagnose depression
- They are easy to translate
- They can differentiate mild, moderate or severe depression
Question 4: The following are characteristics of self-directed psychological therapy (self-help)
Select all the answers you think are correct.
- Self-help uses structured materials that guide a person through therapy step by step
- Self-help always requires additional support from a professional
- Can be delivered through books, apps or websites
- It involves a group of people with the same difficulties getting together and talking about how they cope
Question 1: The following symptoms can be typical of depression
Being worried about health issues
- Being worried about health issues is not typical of depression but more typical of anxiety.
- Feeling irritable most of the time
- Feeling irritable most of the time can be a typical symptom of depression. Although we expect low mood to be the defining symptom of depression, irritability can replace low mood as the defining symptom and is more common in men or adolescents.
- Not being able to make decisions and think clearly
- Not being able to make decisions and think clearly is a typical symptom of depression.
- Getting tired even by doing small everyday things
- Getting tired even by doing small everyday things is a typical symptom of depression.
Question 2: Antidepressants have the following features
- They affect the neurotransmitter serotonin in the brain
- It is thought that antidepressant medication works by increasing the levels of two chemicals in the brain, serotonin and noradrenaline, which have been linked to mood.
They are addictive
- Antidepressants are not addictive but should not be discontinued abruptly because this can cause restlessness and agitation, trouble sleeping, unsteadiness, sweating and stomach problems that can last from 2 weeks to several months.
- They should not be discontinued abruptly
- Antidepressants should not be discontinued abruptly because this can cause restlessness and agitation, trouble sleeping, unsteadiness, sweating and stomach problems that can last from 2 weeks to several months. The person’s doctor usually recommends gradually reducing the dose of the antidepressant (tapering off) over a period of 4 weeks or longer.
They start working within a couple of days
- It may take up to 4 weeks for antidepressant medication to begin to work but most people see some benefits after 1-2 weeks.
Question 3: What are the benefits of brief questionnaires as screening tools for depression?
- They can be administered without specialist mental health training
They can be used to diagnose depression
- A screening tool on its own does not make a diagnosis of depression. Screening tools can tell us whether it is worth having a follow-up assessment or a consultation with a mental health professional to confirm a diagnosis. To make a diagnosis of depression, a health professional takes into account the impact of the symptoms in a person’s life, considers for how long the symptoms have been present and whether they change over time, and asks supplementary questions to rule out other physical or mental health conditions that may be expressed with the same symptoms as depression.
- They are easy to translate
- The PHQ-9 has been translated into almost 50 languages, including British Sign Language (BSL); however, not all of these translated versions have been validated through research studies. When such studies took place to validate different language versions of the PHQ-9, their results showed that PHQ-9 remained a valid measure of depression after translation, but depression symptom scores were not always equivalent across different languages.
- They can differentiate mild, moderate or severe depression
Question 4: The following are characteristics of self-directed psychological therapy (self-help)
- Self-help uses structured materials that guide a person through therapy step by step
- Self-help, in the form of published workbooks, reputable websites and SMARTphone Apps, can guide a person with depression through step-by-step therapy activities. These activities start by identifying what depression means for each person, how the vicious cycle of negative thinking and inactivity can maintain their depression, and what techniques can be used to shape more helpful ways of thinking and rewarding activities that can improve depression.
Self-help always requires additional support from a professional
- Pure self-help without any professional support is suitable for people with mild symptoms of depression who can rely on self-motivation and self-monitoring.
- Can be delivered through books, apps or websites
- Self-help, in the form of published workbooks, reputable websites and SMARTphone Apps, can guide a person with depression through step-by-step therapy activities.
It involves a group of people with the same difficulties getting together and talking about how they cope
- Self-help in the context of self-directed psychological therapy is not the same as self-help groups. Self-help is a way of learning and applying therapy principles and activities.
How did you get on?
We hope you found the quiz a helpful way to reflect on everything you have learnt so far.
Further resources
Below are links to some websites with useful further information and resources relating to depression.
Below are links to some websites with useful further information and resources relating to depression.
We hope you’ve enjoyed section one of our BA learning resources.