Psychiatry · Condition guide

Depression

Depression is a common medical illness, not a weakness. With proper treatment, most people recover.

What depression is

Depression is more than sadness. It is a persistent change in mood, energy and interest that lasts at least two weeks and affects daily life.¹ In India's National Mental Health Survey, about one in twenty adults had experienced depression in their lifetime, and most had not received treatment.²

Symptoms

• Low, empty or irritable mood most of the day
• Loss of interest or pleasure, including in sex
• Changes in sleep or appetite
• Tiredness, feeling slowed down, or restlessness
• Poor concentration and difficulty making decisions
• Feelings of worthlessness, guilt or hopelessness
• Thoughts that life isn't worth living

Many people first notice physical symptoms, such as tiredness, aches or poor sleep, or a loss of interest in sex, before recognising low mood.

Depression and sex

Depression often reduces desire and can cause erectile difficulty or problems with orgasm. Some antidepressants can do the same.³ This is one of the commonest reasons people stop treatment early, so I discuss it openly and choose treatment with it in mind. See Low desire or depression? How to tell the difference.

How I assess it

• A careful history of symptoms, life events, previous episodes and family history.
• A validated questionnaire, the PHQ-9, repeated at follow-up.⁴
• A check for physical contributors, such as thyroid problems or anaemia, and for alcohol or other substances.
• A careful, private assessment of safety.
• Questions about mood highs, because this changes the right treatment.

Treatment

Treatment depends on severity and your preferences.^1,5

• Psychological therapy, such as cognitive behavioural therapy, for mild to moderate depression, and alongside medicines for more severe depression.
• Antidepressant medicines, which take a few weeks to work and are continued for several months after recovery to prevent relapse. They are not habit-forming.
• Managing side effects, including sexual ones, by adjusting dose, timing or medicine.
• Exercise, sleep and routine, which support recovery.
• Involving family or a partner, with your permission.

Common questions

Related guides

• Sexual health after cancer
• Anxiety and panic
• Sleep problems and insomnia

References

1. National Institute for Health and Care Excellence. Depression in adults: treatment and management (NG222). 2022.
2. Gururaj G, Varghese M, Benegal V, et al. National Mental Health Survey of India, 2015–16: Prevalence, Patterns and Outcomes. Bengaluru: NIMHANS; 2016.
3. Kennedy SH, Rizvi S. Sexual dysfunction, depression, and the impact of antidepressants. J Clin Psychopharmacol. 2009;29(2):157–164.
4. Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–613.
5. Gautam S, Jain A, Gautam M, Vahia VN, Grover S. Clinical practice guidelines for the management of depression. Indian J Psychiatry. 2017;59(Suppl 1):S34–S50.

This page is general information and does not replace a consultation with a doctor who has assessed you. Read how these pages are written in our editorial policy.