In its lay use, the term ?depression? is used to convey a whole range of emotional and psychological states ? unhappiness, low mood, misery, apathy etc. Indeed, many use the term interchangeably with any and all of these words. The psychiatric profession uses the term ?depression? in a more specific way. To differentiate the lay and psychiatric use, it may be useful to use the term ?clinical depression? to denote the condition recognised by psychiatrists. This differentiation is significant for several reasons. To be ?depressed? at times is to be human; to be ?clinically depressed? is (to the psychiatrist) to be mentally unwell. It is for the clinically depressed that doctors and psychiatrists prescribe medication. Finally, it is on clinically depressed patients that these medications are trialled to determine efficacy.



To determine if a patient is clinically depressed, the psychiatrist will interview them face to face. Typically this interview lasts somewhere in the region of one hour (for an initial assessment ? follow up interviews tend to be shorter). The majority of this interview will focus on the patient's current symptoms (see below), the remaining time being used to look for so-called ?risk factors? for clinical depression. Thus they will ask a number of questions covering areas such as the patients childhood, time at school, family life, occupational history, physical medical history, alcohol and other drug use, past psychological and emotional difficulties, and the patients current social situation (occupation, relationships etc). In addition, whilst talking with the patient, the psychiatrist will also be conducting a ?mental state examination?. That is, they will be observing the language and behaviour of the patient (the tone, volume and speed of their speech, their dress and demeanour, the presence of any abnormal facial or bodily movements etc).

The diagnosis of ?clinical depression? will be made on the basis of the patient's current psychological and emotional symptoms ? relevant symptoms are listed below.

1. Low or depressed mood.

2. Lowered energy levels and increased tiredness.

3. Lack of interest in and pleasure from usual activities (?apathy?).

Symptoms 1-3 are usually present in all cases of clinical depression. Other symptoms that are also frequently found include:

4. Lack of concentration.

5. Sleep disturbance (typically waking early in the morning).

6. Low self-confidence.

7. Hopelessness about the future.

8. Reduced appetite, often with associated weight loss.

9. Thoughts of suicide.

10. Feelings of guilt.

The symptoms will usually be present for at least two weeks for the diagnosis to be made. It is to be noted that these symptoms are typical of a depressive episode but are not exclusive. Some clinically depressed patients suffer from agitation and an inability to sit still, others will sleep excessively. Furthermore, the psychiatrist will often grade the diagnosis (mild/moderate/severe) depending on symptom severity.

The treatment prescribed for a clinically depressed patient will depend on their particular symptoms, their general health, their personal preferences and other factors. Typically, severe cases will be prescribed medication and will be monitored closely - some may require hospitalisation, particularly if suicidal. Moderate and mild cases are usually offered antidepressant medication and/or possibly some form of ?talking therapy? (if it is available).

There is a wealth of information concerning antidepressant available from GP surgeries, mental health units, pharmacies, books and the Internet. As such, I will not discuss them further, save to say that they're not everyone's choice of treatment.

Many patients prefer the ?talking therapies?. Such therapies vary enormously in their scope and intensity. The traditional psychotherapies (e.g. psychodynamic psychotherapy) can require a patient to attend weekly sessions for many years. Others, such as relationship or bereavement counselling, are less formal and much briefer (e.g. weekly sessions for six weeks). The last decade has seen a growing interest in the so-called ?cognitive therapies? such as Cognitive Behavioural Therapy (CBT) and Neuro-Linguistic Programming (NLP), Hertfordshire. These modern therapies have good evidence of effectiveness when compared to the older style talking treatments, and treatment periods are shorter. However, they are not ?magical cures? and require significant effort and contribution from the patient ? a case of ?you get out what you put in?. Once the patient has mastered the techniques explained in the sessions they will be able to use them throughout their life, hopefully preventing any recurrence of their symptoms.

This is the philosophy behind tretament approaches at NLP and CBT, therapy in Hertfordshire - to equip people with life-long skills to manage their own mental-wellbeing through cogntive techniques.