Depression

Get help straight away if

These are uncommon, but they need same-day care — go to an emergency department, do not wait for an appointment.

• Thoughts of ending your life, or of harming yourselfCall 911, or call or text 988 for the Suicide Crisis Helpline. You do not have to be certain, or to have a plan, for it to be worth talking to someone now.
• Not eating or drinking, or unable to keep yourself safeGo to an emergency department.

Contact us promptly if

Not an emergency, but worth being seen sooner rather than waiting it out.

• Feeling worse, more agitated, or having new thoughts of self-harm in the first weeks of starting or changing an antidepressantContact us. This period needs closer attention, and it is a reason to be seen rather than to stop on your own.
• Wanting to stop your medicationWorth a conversation first — stopping abruptly causes withdrawal symptoms that are easily mistaken for the depression returning.

What usually happens

Depression is not sadness. People often expect to feel sad and are confused to feel flat, numb, exhausted or irritable instead — and physical symptoms like disturbed sleep, appetite changes and unexplained aches are part of it rather than something separate.

If you start an antidepressant, expect weeks rather than days. Sleep and appetite often improve first, mood later, and the first fortnight can feel worse before it feels better. Most people who conclude the treatment does not work stopped during that window.

There is a period early in treatment when energy and drive return before mood does, and that combination carries risk. It is the reason we follow up sooner after starting than people expect, and the reason to tell someone if you feel worse rather than waiting.

Treatment is not only tablets. Talking therapies work as well as medication for many people and better in combination for some, and exercise, sleep and reducing alcohol have effects large enough to count as treatment rather than advice.

Coming off is a planned process, not a stop. Reducing gradually avoids withdrawal symptoms that are easily mistaken for relapse, and the two get confused often enough that it is worth planning in advance.

At your appointment

We will ask directly about thoughts of suicide and self-harm. It is a routine question, asking about it does not make it more likely, and an honest answer changes what we can offer.

Questions about periods of unusually high energy or reduced need for sleep in the past, because that history changes which treatment is safe to start.

Blood tests where indicated — thyroid, anaemia and vitamin deficiencies can all contribute and are worth excluding.

Earlier follow-up than you might expect after starting or changing treatment, because the first weeks are when it matters most.

Worth asking

• —How long before I should expect to feel a difference?
• —What should I do if I feel worse in the first couple of weeks?
• —What are the options besides medication?
• —How long would I stay on it, and how would I come off?