Depression

Also called Clinical depression, Major depressive disorder

Not sadness. A condition that removes motivation, pleasure and energy, and then argues that it was always like this.

What it is

Depression is not the low mood everybody has. Sadness has a subject. Depression frequently does not, which is one of the reasons people feel guilty about having it.

What it actually takes is motivation and pleasure. Things that mattered stop mattering. Not because the person has decided they don't, but because the machinery that generates wanting has gone flat.

It also lies convincingly. It tells people this is permanent, that they are a burden, that they were always like this. Those are symptoms presenting as insights, and recognising that is genuinely useful.

Around one in six adults in England has a common mental health problem in any given week.

Signs you might notice

Low mood most of the day, most days, for at least a fortnight.

Anhedonia: the loss of pleasure in things that used to give it. This is the more reliable symptom of the two.

Sleep wrong in either direction, and early morning waking in particular.

Appetite and weight changing. Concentration failing. Everything physically slowed, or agitated.

Guilt out of proportion. Thoughts of being better off dead.

In men and in older people it often presents as irritability, physical complaints or drinking rather than as visible sadness.

How it can affect day-to-day life

The cruellest mechanism is the loop. Depression removes energy, so people do less, so they get less of the reward that lifts mood, so they have less energy. That is why behavioural activation, doing things before you feel like it, is one of the most effective treatments.

Work goes. Then structure. Then contact. Each loss is reasonable in isolation and devastating together.

In older people, depression is regularly mistaken for dementia, because concentration and memory suffer. It is treatable, and getting that the wrong way round costs years.

And it kills people. That is the plainest reason not to wait and see.

Supporting someone well

Do not tell somebody to cheer up, to count their blessings, or that others have it worse. All three are heard as "your suffering is a failure of perspective".

Offer concrete company rather than open questions. "I'll pick you up at two, we'll walk to the park" gets a yes far more often than "let me know if you fancy anything".

Small activity beats waiting for motivation. Motivation follows action in depression, not the other way round.

Ask about suicide directly, using the word. Asking does not plant the idea. It is the single most protective conversation available, and evidence supports it clearly.

Keep going past week three. Support usually thins out exactly when recovery gets hardest.

Fiducia Life holds a feelings and wellbeing record. Depression distorts memory of the recent past, so somebody genuinely improving often cannot feel it, and a fortnight of records showing three good days is evidence they can hold on to.

Where to get help

In England, self-refer to NHS Talking Therapies without going through a GP.

See a GP as well if it has lasted weeks, or is affecting eating, sleeping or work. Medication and therapy work well together.

If somebody is at immediate risk, call 999 or go to A and E. Samaritans are free on 116 123, day or night.