We all have times when we’re feeling sad or down, and for many different reasons. This is quite normal, and in most people these feelings pass on their own after a short time.

However, when someone feels like this for longer periods, sometimes for no apparent reason, and the feelings start to interfere with day to day life, then this could be a sign of depression.

Depression in its medical sense isn’t the occasional sad feelings that we all get. The feelings of ‘clinical depression’, as it is known, happen when certain chemicals in your brain stop functioning properly, or are not there in sufficient quantities. What causes these chemical imbalances is unclear, and is the cause of much debate. External factors such as traumatic experiences can trigger depression, but sometimes depression can happen with no apparent triggers at all.

Depression can be really debilitating, but it is treatable. There’s no need to suffer in silence, although often making that first step in going to speak to your doctor can be very difficult. Many people find that once they do make this step, things can really start to improve. Remember that depression is nothing to be ashamed of and it’s very common these days – about 1 in 20 adults in Britain suffer from depressive illness at any one time.

Depression isn’t something that you should be expected to just ‘snap out’ of by yourself. It’s a real medical condition, just as a broken arm is a real medical condition. No one would expect you to mend a broken arm on your own, so in the same way no one, including yourself, should expect you to mend your depression on your own. 

How can I tell if I am depressed?
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With clinical depression we’re not talking about occasional short-term low feelings. Clinical depression can have many symptoms that last for many weeks.

People who are depressed can feel really down or sad all the time. Depression can knock people’s self-confidence and self-esteem leaving them with feelings of worthlessness. Often people who are depressed lose interest in their normal day to day life, including work and socialising. Sleep patterns can be upset – people who are depressed often feel tired all the time and oversleep constantly, or on the other hand they can suffer from insomnia. Depression can cause people to find it hard to function normally and do usual day to day tasks. It can cause them to avoid people, even close friends. Other symptoms can include loss of appetite, tiredness, lack of energy, feelings of guilt, hopelessness, paranoia and loss of sex drive. In extreme cases it can lead people to self-harm and to suicidal thoughts.

If you have been suffering from some or all of these symptoms for most of the day, nearly every day, for at least two weeks then you could well be suffering from depression and it would be a very good idea to seek help.

What causes depression?
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No one really knows exactly what causes the actual chemical imbalance in the brain that leads to the feelings of depression. However there are situations that can make depression more likely.

People who have suffered from recent traumatic events are more likely to develop depression. Events such as losing your job, a relationship break-up, the death of someone close, or diagnosis with a chronic illness such as HIV can make depression more likely, as can living day to day with an illness such as HIV.

Certain physical factors can also be the cause – poor nutrition, excessive alcohol, and certain illnesses such as glandular fever, can make depression more likely. Some people may even be genetically more likely to suffer from depression.

Some people find that they are more prone to bouts of depression in the winter. This is known as Seasonal Affective Disorder (SAD) and is the result of a lack of sunlight caused by shorter daylight hours throughout the months between September and April, in particular during the winter months of December, January and February. If this does affect you, you could look into buying some natural light bulbs which produce broad spectrum light, similar to the natural light we get from the sun. These may help to counter the effects of SAD.

Anti-HIV drugs and depression
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Some of the symptoms of depression can be caused by side effects of anti-HIV drugs. This is why it’s a good idea to speak to your doctor at your clinic so they can assess whether this could be what’s happening, and to work out whether to try changing your HIV treatment.

If you are taking anti-HIV drugs and considering anti-depressants then your doctor will also be able to make sure that they can be taken with the anti-HIV drugs you are taking.

How can I treat depression?
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Whatever the reason for it, most depression is treatable. The first step would be to go and see your GP or HIV doctor who will be able to assess what would be the best treatment for you

This first step can seem like a really hard thing to do. You may feel that you’re wasting people’s time and that people won’t be interested. However it’s important to remember that these feelings are actual symptoms of depression in the first place.

Treatments can range from talking therapies, such as counselling or cognitive behavioural therapy (CBT), to drug treatments, such as anti-depressants, or a combination of both. What treatment you eventually decide to take will depend on how severe your depression is, what your doctor recommends after your assessment, and how you feel about the different options.

If you really don’t think you are able to talk about how you are feeling, remember that what you are going through is real, and that you are not making it up. This is a very common condition and going to see your doctor, however hard it is, really is the most important step you could make.

"I started to feel down a long time before I got help. For months I was feeling worse and worse. My work suffered, my relationship nearly ended, and I couldn’t get out of the deep hole I seemed to be in. I didn’t know what to do. I didn’t want to go to my doctor as I felt stupid and a time waster. Eventually I couldn’t go on. I went to my doctor and when he asked me what’s wrong I couldn’t speak. I just shook, unable to get any words out. I was so scared. He was fantastic. He said immediately that he could tell I was in trouble, and to take a deep breath and take it slowly. Hearing this made what I was feeling seem valid for the first time. At last I knew that it wasn’t me, and that I really wasn’t well. This was what I’d needed all along – making this most difficult and painful of steps was the beginning of the end of my bout of depression." (Adrian, 35)

What are the alternatives to anti-depressants?
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Not everyone being treated for depression takes anti-depressants. Some people rely only on talking therapies, such as counselling or cognitive behavioural therapy (CBT), and sometimes this can be enough. You may come across alternative therapies for depression, but be aware that one of them, a herbal remedy called St. John’s Wort, should never be taken with Protease Inhibitors or NNRTIs. St John’s Wort can reduce the amount of these anti-HIV drugs in your blood and therefore stop them working properly. 
Need help now?
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If you feel like you are in crisis and need help right now, going to see your GP or HIV doctor as soon as possible would be a good place to start. If you can’t wait to see your doctor, or if you’d rather talk to someone anonymously, then you could call the Saneline on 0845 767 8000 This is run by the charity Sane, and can provide information and crisis support between 12pm and 2am every day. You could also call the Samaritans who provide 24 hours emotional support on 08457 90 90 90, or visit their website.

Another good website that offers advice and support is run by the Depression Alliance.

If you really are in crisis right now and need to see a medical professional immediately then you could go to your local Accident and Emergency department and ask to see the duty psychiatrist. If you decide to do this try to take a friend with you so you won’t be on your own whilst waiting to be seen.