I’m going to give you the real truth about depression taking the key facts provided by Consultant Psychiatrist, Dr Sarkhel in a podcast interview I did with him.

To make this blog easier to read, I’m going to provide you with the questions you will no doubt have surrounding depression in bold and the answers below.

To be clear, I’ve gathered my answers following the podcast with Dr Sarkhel who is a Consultant Psychiartrist and an expert in this area. I’ve not simply answered the questions with my unqualified views!

Here we go:

What is depression? More importantly, what isn’t depression?

The feeling of being depressed is not necessarily clinical depression that will need psychiatric or psychological treatment.

Depression becomes clinical depression (which needs treatment) when it starts to affect your professional life and your social life.

Clinical depression affects how you function.

What causes depression?

Depression can be caused by a biological issue, psychological issue and sometimes a social issue.

The biological cause of depression is generally where there are a lack of neurotransmitters, particularly serotonin between the synapses.

Psychological causes could be a loss of a loved one for example or a break-up of a relationship.

Social causes could be debt or losing a home.

What are the common symptoms of depression?

You can experience different symptoms of depression.

But the following are some general symptoms that may be prevalent:

  • Low mood
  • Losing interest in the things you used to enjoy.
  • Reduced energy. Tired all the time.
  • Lack of concentration. Can’t focus on tasks that used to be easy.
  • The future feels bleak.
  • Disturbed sleep. In particular waking up very early in the morning – biological symptom.
  • Losing appetite – biological symptom.
  • Feeling unworthy or guilty.
  • Reduced self-esteem.
  • Diminished confidence levels.
  • Ideas of self-harm or suicide.

What are the different types of depression?

There are two main types of classification for depression:

  1. According to the cause of the depression – reactive or endogenous.
  2. According to the symptoms displayed – unipolar or bipolar.

Reactive depression (Adjustment Disorder with Depressive Reaction) is depression that comes as a reaction to stressful circumstances. For example, you’ve witnessed something traumatic or lost someone. This is a depression that has manifested because of the circumstance, that if it hadn’t happened, you wouldn’t be depressed. The more modern term for reactive depression is called Adjustment Disorder with Depressive Reaction.

Endogenous Depression (Inherent Depression) is depression that is irrespective of the circumstances, where the mood continues to be low generally, often showing diurnal variation which means the depression is worse in the morning for example or in the evening.

There are then two further sub-groups of depression that fall within the above two. So, you may be diagnosed within one of the above and then be further diagnosed as being one of the following:

Unipolar is a depression that displays only depressive symptoms of low mood.


Bipolar Affective Disorder (Manic Depressive Illness) is depression that displays the symptoms of typical depression (low mood) and also manic or hyper manic episodes that are characterised by hyperactivity, elation in mood, lack of sleep, erratic behaviour and sometimes psychotic symptoms such as having delusions about have superpowers, identifying personally with someone who is eminent.



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How is depression diagnosed?

Firstly, Dr Sarkhel stressed that depression can’t be identified through a test.

Depression has to be diagnosed following a thorough clinical assessment which takes a good history from the patient, taking history from people who know the patient well and doing an objective state examination – known as Mental State Examination.

How can depression be reduced?

Dr Sarkhel stressed that the best way to start reducing depression is to:

  1. Firstly accept it and not to bury the fact that you have it. He advocates you discussing how you feel with your nearest and dearest, close friends and close colleagues. There is nothing to be ashamed of.
  2. Actively purse the activities that give you pleasure and having lots of “me time”.
  3. Try to mix with different social networks because your brain needs different types of social stimulation to remain healthy.
  4. Finally, he said, it’s really important to ask for professional help as soon as possible.

I would like to add here that exercise and a good diet are phenomenal in helping to reduce depression. Plenty of fresh air (daily walk) and exposure to the sun (without sun block) for 30 minutes in the morning also have huge benefits.


Where can you go for help with depression and what treatments are available?

It depends on the severity of how your feeling, but if you’re having suicidal thoughts then you must go to your GP immediately for help. If it’s out of hours, then telephone  the local Home Treatment Team or Crisis Team (google your “Local Health Trust) or call 111 (or 999 if appropriate).

If your symptoms are not as severe as the above, Dr Sarkhel recommends you still visit the GP in the first instance.

Treatment 1 – Talking Therapy

When you visit as GP and depending on the severity of your symptoms, in the first instance your GP will probably direct you to the local psychology team, of which there is a specialist team now available in most locations (UK only) called IAPT – Improvement in Accessing Psychological Therapies. They deliver psychological treatment in primary care normally by way of Talking Therapy.

Referrals to Psychologists and Psychiatrists in the NHS (UK only) is rare nowadays unless you go private.

Treatment 2 – Medication

Another treatment for depression are antidepressants. Depression is a treatable condition and antidepressants are a very effective treatment that contrary to popular belief ARE NOT ADDICTIVE. To stress, antidepressants are not addictive – both old generation and new generation.

The addictive tablets are from the benzodiazepine family which are sleeping pills and minor tranquillisers NOT antidepressants.

If after 4 to 6 weeks you’re not responding well to an antidepressant your GP may change the dose or change your antidepressant or refer you onto a Psychiatrist. There are many antidepressants available so if you don’t respond to one, it’s not an issue, you can generally easily swap to another one that will be more suitable.

Generally, it takes antidepressants at least 3 weeks to kick in and often during the first 3 weeks you can feel worse and have some side effects such as feeling anxious, agitation or feeling sick.

Treatment 3 – Social Intervention.

This is where, if the cause of the depression comes from financial stress for example, practical advice will be woven into the treatment to help the patient – such as recommending they visit the Citizens Advice Bureau or Bank Manager or Financial Advisor for example.

The Real Truth About Depression

What are the alternative treatments to help depression?

Additional to the above 3 treatments, Dr Sarkhel is an advocate of an integrated approach to treating depression, which means rather than one size fits all (using one form of treatment – for example tablets only or talking therapy only) he will use the best bits from all.

Treatment 4 – Mindfulness

He is a big promoter of a mindfulness to help with depression. As you probably know, mindfulness is essentially about living in the present moment and it was originally researched as a medical treatment (originally for pain management) in Massachusetts, USA.

He said mindfulness is an amazing tool to use to help a person absorb their difficult moments. He said it’s not just about doing a meditation, but it helps to accept the difficult moments, validating feelings, rather than total avoidance of the hard times.

The mindfulness approach takes away the “why” of feeling depressed and promotes a person to accept their depression and to find a way forward.

The result being increasing a person’s mental resilience, acceptance of being depressed and being open about having depression.

He said mindfulness doesn’t only help a person with depression but also is an effective treatment.

If you’re interested Dr Sarkhel has a set of mindfulness meditations on iTunes which you can access by clicking here.

He went onto explain that brain imaging studies have shown that mindfulness improves the function of your frontal lobe of your brain which is often implicated in symptoms of depression.

Treatment 5 – Repetitive Transcranial Magnetic Stimulation (RTMS)

This is a treatment that delivers magnetic pulses to a particular part of the brain (THIS IS NOT ELECTRIC SHOCK TREATMENT) called the dorsolateral pre-frontal cortex (front part of the brain) and the magnetic pulses induce a small current to two specific circuits in the cortex which are responsible for symptoms of depression. It’s a very focussed biological treatment without any side effects at all.

There is no aesthetic needed and it can be given on an outpatient basis and is recommended by NICE to be used in treatment resistant depression (where a patient has not responded to two or more antidepressants) situation.

RTMS has to be given by a qualified technician, under the supervision of a Psychiatrist.

It’s currently not widely available on the NHS.

Treatment 6 – Acupuncture

Western medical science has proven that acupuncture has a sound scientific basis to help with both physical and mental health. Often acupuncture has been shown to stimulate neurotransmitters which is why it’s good to help with the treatment of anxiety and depression.

He stressed that acupuncture is not “THE” treatment for depression, but it’s good to be used alongside other treatments for depression.

How to help someone who has depression?

Dr Sarkhel said try to reassure whoever has the depression that there is help out there available and persuade them to visit their GP. It may be worth you booking the GP appointment which can sometimes in itself be stressful and taking the person to the appointment.

He stressed it’s about helping someone to ask for help.

Book recommendation for depression

Mind Over Mood by Christine Padesky. There are two books available by her so make sure you get the book that is NOT for the professionals.

He says it’s the best self-help book for depression available.


I hoped this blog helped you.

To stress, I wanted to bring you the facts, as relayed to me from a professional in this area.

I highly recommend you listen to the interview I did with Dr Sarkhel by clicking here.

If you’re suffering from depression you’re not alone.

1 in 4 of you will experience a bout of depression every year.

In England, 1 in 6 of you will experience a mental health problem every week.

If you think you’re suffering from depression, please please please don’t suffer alone.

Ask for help.

Useful Links

Dr Sarkhel – Living Mind

Mind  – Mental Health Charity UK

Mental Health Foundation



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