Many different factors can cause depression and unravelling the cause takes time, empathy and expertise. We have extensive experience in providing treatment for depression using a range of approaches, from medication to therapy. We also understand the importance of using other evidence-based approaches like psychoeducation (providing education and support for mental health problems) and lifestyle interventions (such as nutrition or exercise).
We will do our best to support you in this difficult period and we can help you identify the psychiatrist best suited to your needs who will recommend a holistic treatment plan tailored to your unique circumstances and preferences. Our patients typically choose a combination of the following approaches: psychological therapy, medication (if appropriate), nutritional intervention, exercise, or mindfulness and meditation.
There are many evidence-based interventions that can potentially help reduce depressive symptoms in some people, such as using specific high-grade supplements (such as Vitamin B12, Vitamin D or Omega-3 in some cases), repetitive Transcranial Magnetic Stimulation (rTMS) or Vagus nerve stimulation (VNS), just to mention a few. We generally explore these options when the depression has not satisfactorily improved with conventional treatments. In this case we use the term “treatment-resistant depression”, which does not mean that the depression will not improve with any treatments, but rather that it has not improved with the treatments we tend to use initially for most people with depression.
Very often, depressive symptoms that haven’t improved with one type of treatment will start to improve when a different approach is used. For example, when depression has not improved with a serotonin antidepressant (such as fluoxetine or sertraline) it may respond to another antidepressant with a different mechanism of action (e.g. venlafaxine, which also works on the noradrenaline receptors in the brain).
Depression is a common mental health condition characterised by persistent feelings of sadness, hopelessness, and a lack of interest or pleasure in activities. It can also involve physical symptoms like changes in sleep, appetite, and energy levels. Depression can affect your ability to function in daily life and often requires treatment through therapy, medication, or a combination of both. At London Psychiatry Clinic, we offer tailored treatments to help manage and overcome depression.
Many of our patients are unsure whether they have depression because they don’t always feel sad or low in mood. However, most people don’t realise that depression can affect us in many different ways. Perhaps you, or someone you know, has recently lost interest in doing things or maybe they have felt flat for a while (known as anhedonia). Maybe they are having trouble focusing or making decisions, or maybe they feel guilty, hopeless, or have persistently low self-esteem (which was not the case some time ago, before the depression started). Or it might just be an ‘indefinable feeling that something isn’t quite right’. Any of these could in fact be a sign of depression.
Many people might not realise that depression can affect you just as much physically as it can mentally. Depression can disrupt sleep, by either stopping you from sleeping enough, or it can make you sleep too much. You might lose your appetite and unintentionally start losing weight, or you might start feeling hungry more often and begin gaining weight. Although most people with depression will experience a reduction in their appetite and some form of insomnia, people with a type of depression called atypical depression can experience the opposite: increased appetite and oversleeping. You might also feel tired all the time, or like your arms and legs are too heavy, or you might be fidgety and restless in a way that you did not feel before the depression started.
Depression can come with any combination of symptoms and these symptoms might change over time, or they may even disappear for a few weeks or months before returning. This demonstrates why it’s so important to understand your unique set of symptoms and circumstances so that we can provide you with the best treatment plan.
If you’re feeling persistently sad, hopeless, or lose interest in activities you once enjoyed, you might be experiencing depression. Other signs include changes in sleep, appetite, or energy levels, and difficulty concentrating. It’s important to speak with a professional for an accurate diagnosis and to explore your treatment options. Our specialists at London Psychiatry Clinic can help determine if you’re experiencing depression and provide the support you need.
If you’re struggling with depression, therapy can be highly beneficial. Therapy provides a supportive space to explore your emotions, understand the underlying causes of your depression, and develop effective coping strategies. At London Psychiatry Clinic, we offer tailored therapy options to help you manage and overcome depression, so you can regain control of your life.
Due to the complex nature of depression symptoms, there are many different diagnostic labels for different versions of depression. Although these diagnostic labels can be helpful for characterising symptoms, we endeavour to see people as individuals with a unique set of symptoms, life circumstances and personality when formulating a diagnosis and discussing the treatment plan.
Research has shown that people with different types of depression might even respond to different types of medication and therapy differently. This is why it’s so important to carry out a comprehensive assessment, in order to gain as much information as possible about the type of depression. Often, people have symptoms of depression that do not clearly conform to a particular depressive subtype.
A depression that is reactive tends to happen when somebody has been under intense pressure or stress for some time or in response to a specific traumatic event. We also use the terms ‘circumstantial’ or ‘exogenous’ to refer to this type of depression.
When someone develops depressive symptoms without being able to point to a specific trigger as the cause, we tend to refer to this as clinical depression, depression with biological features or endogenous depression (‘endogenous’ is Latin for ‘from within’).
Some people may experience several episodes during their lifetime, and if that is the case we use the term Recurrent Depression. We used to think that this depression was mostly triggered by a genetic predisposition, but research now shows that some external factors (such as a period of intense stress) can also play a significant role in triggering this type of depression.
People with depression can even have completely opposite symptoms. For example, those who experience symptoms such as worse mood in the morning, difficulty sleeping (insomnia), loss of appetite and weight loss, tend to have a type of depression that is sometimes named typical depression (sometimes we use the word ‘melancholic’ for this type of depression). In contrast, people who experience worse mood in the evening, struggle with sleeping too much (hypersomnia), increased appetite and weight gain, tend to fall under the diagnosis of atypical depression.
Some of our patients feel apprehensive when they hear the term ‘treatment-resistant depression’ because they think it means that their depressive symptoms can’t be treated. However, treatment-resistant depression’ (also known as refractory depression) actually refers to depressive symptoms that don’t improve after initial treatment, which could mean only taking one course of antidepressants or trying one type of therapy. There is always help available for depression.
Treatment-resistant depression is far more common than people might think, as it can be challenging to choose the best treatment for such a complex illness the first time around. Often, GPs will prescribe a standard serotonin antidepressant (such as citalopram or sertraline) to someone who experiences depression for the first time. Approximately 50% of people with depression will notice an improvement in their symptoms after 6-8 weeks.
Our psychiatrists have successfully treated many patients with treatment-resistant depression, by taking the time to understand the previous history and circumstances leading to these symptoms. It is also important to rule out what hasn’t worked so far. Treatment plans are formulated using a wide variety of evidence-based approaches that might involve incorporating therapy or switching to a different type of antidepressant (which work on alternate neurotransmitters and receptors).
Sometimes we find that depressive symptoms can improve after adjusting the nutritional content of our patient’s diets or after implementing an exercise plan or other lifestyle changes. In some cases, long-standing symptoms of depression can be related to previously undiagnosed ADHD, and these symptoms of depression often improve once the ADHD is treated.
Sometimes depressive symptoms don’t fit into any of the above categories. The symptoms may sometimes not be as severe, but they could still have a negative impact on many areas of a person’s life, such as their relationships, work, or academic performance.
Persistent Depressive Disorder, which is also known as dysthymia, occurs when depressive symptoms persist continuously for two years or more.
Postnatal depression
Postnatal depression is a type of depression that can affect parents (mothers and fathers) after the birth of a child. Postnatal depression can be caused by hormonal or biological changes after pregnancy, stress associated with the pregnancy or birth, or stress associated with parenthood.
Getting help for postnatal depression is important as dealing with depressive symptoms could prevent you from bonding with your child.
Depression with psychotic features, or psychotic depression, is a form of depression that is also accompanied by hallucinations or delusions.
Approximately 20% of people with depression will experience some psychotic symptoms. These symptoms could be related to common depression symptoms, such as hallucinations or delusions related to feelings of guilt, worthlessness, detachment or suicidality. Occasionally, the psychotic symptoms can even be completely unrelated to the depressive symptoms.
Getting help for depression with psychotic features is crucial, as it can be extremely distressing and increase the risk of suicide.
Depression is a highly complex disorder that is caused by a range of interacting factors. We still don’t understand why some people develop depressive symptoms, and others don’t.
There are a number of neurotransmitter systems that are known to be involved in depression, including serotonin, dopamine, norepinephrine, glutamate, GABA and acetylcholine. An imbalance in these neurotransmitter systems can lead to depressive symptoms, but we don’t know exactly what causes the imbalance in the first place.
Antidepressants work by rebalancing some of these neurotransmitters, but they also work differently on different people. For example, antidepressants like fluoxetine (Prozac) work by rebalancing the serotonin neurotransmitter system, but they may only work for people who have an imbalance in their serotonin levels. Other antidepressant medications have more of an effect on dopamine or noradrenaline receptors, so they may suit other people better.
Finding the right medication and dosage can be complicated and time-consuming, which is why psychiatrists are needed to prescribe and tweak medications. If someone wishes to take an antidepressant, we will always follow UK guidelines set out by the National Institute for Healthcare and Excellence (NICE) recommending that patients try a selective serotonin reuptake inhibitor (SSRI) first, before trying other types of antidepressants.
Depression has a genetic component, meaning that the risk for developing depression is higher for some individuals based purely on their genetic makeup.
The heritability of depression is estimated to be 37%, with other factors (such as environment) making up the remaining 63% of the risk factors involved in developing depression.
Heritability essentially refers to the percentage of chance that traits (such as eye colour or height) are passed on from our parents and grandparents. Even traits such as height, which is 80% heritable, are still influenced by our environment growing up. For example, we all know the nutritional content of a child’s diet can greatly influence how tall they grow.
Interestingly, some genes can also be turned ‘on and off’, based on environmental cues and stressors (a process called epigenetics). Essentially, what this means is that our DNA and gene expression can change over time, leading to changes in our biology and behaviour. Just as the nutrients we eat in our childhood influence the genes controlling our height, the food we eat day to day can also affect depressive symptoms. Our DNA is actually changing all the time based on our environmental exposure, which could include everything from hobbies and relationships, to exercise habits and sleep schedules.
