Help and Support

Overview

Depression is more than simply feeling unhappy or fed up for a few days.

Most people go through periods of feeling down, but when you're depressed you feel persistently sad for weeks or months, rather than just a few days.

Some people think depression is trivial and not a genuine health condition. They're wrong – it is a real illness with real symptoms. Depression is not a sign of weakness or something you can "snap out of" by "pulling yourself together".

The good news is that with the right treatment and support, most people with depression can make a full recovery.

How to tell if you have depression

Depression affects people in different ways and can cause a wide variety of symptoms.

They range from lasting feelings of unhappiness and hopelessness, to losing interest in the things you used to enjoy and feeling very tearful. Many people with depression also have symptoms of anxiety.

There can be physical symptoms too, such as feeling constantly tired, sleeping badly, having no appetite or sex drive, and various aches and pains.

The symptoms of depression range from mild to severe. At its mildest, you may simply feel persistently low in spirit, while severe depression can make you feel suicidal, that life is no longer worth living.

Most people experience feelings of stress, anxiety or low mood during difficult times. A low mood may improve after a short period of time, rather than being a sign of depression.

When to see a doctor

It's important to seek help from a GP if you think you may be depressed.

Many people wait a long time before seeking help for depression, but it's best not to delay. The sooner you see a doctor, the sooner you can be on the way to recovery.

What causes depression?

Sometimes there's a trigger for depression. Life-changing events, such as bereavement, losing your job or giving birth, can bring it on.

People with a family history of depression are more likely to experience it themselves. But you can also become depressed for no obvious reason.

Treating depression

Treatment for depression can involve a combination of lifestyle changes, talking therapies and medicine. Your recommended treatment will be based on whether you have mild, moderate or severe depression.

If you have mild depression, your doctor may suggest waiting to see whether it improves on its own, while monitoring your progress. This is known as "watchful waiting". They may also suggest lifestyle measures such as exercise and guided self-help.

Talking therapies, such as cognitive behavioural therapy (CBT),may also be used for mild depression.

For moderate to severe depression, a combination of talking therapy and antidepressants is often recommended. If you have severe depression, you may be referred to a specialist mental health team for intensive specialist talking treatments and prescribed medicine.

Living with depression

Many people with depression benefit by making lifestyle changes, such as getting more exercise, cutting down on alcohol, giving up smoking and eating healthily.

Reading a self-help book or joining a support group are also worthwhile. They can help you gain a better understanding about what causes you to feel depressed. Sharing your experiences with others in a similar situation can also be very supportive.

Symptoms

The symptoms of depression can be complex and vary widely between people. If you're depressed, you may feel sad, hopeless and lose interest in things you used to enjoy.

The symptoms persist for weeks or months and are bad enough to interfere with your work, social life and family life.

There are many other symptoms of depression and you're unlikely to have all of those listed below.

Psychological symptoms

The psychological symptoms of depression include:

• continuous low mood or sadness
• feeling hopeless and helpless
• having low self-esteem 
• feeling tearful
• feeling guilt-ridden
• feeling irritable and intolerant of others 
• having no motivation or interest in things
• finding it difficult to make decisions
• not getting any enjoyment out of life
• feeling anxious or worried 
• having suicidal thoughts or thoughts of harming yourself

Physical symptoms

The physical symptoms of depression include:

• moving or speaking more slowly than usual 
• changes in appetite or weight (usually decreased, but sometimes increased) 
• constipation 
• unexplained aches and pains
• lack of energy
• low sex drive (loss of libido)
• disturbed sleep – for example, finding it difficult to fall asleep at night or waking up very early in the morning

Social symptoms

The social symptoms of depression include:

• avoiding contact with friends and taking part in fewer social activities
• neglecting your hobbies and interests
• having difficulties in your home, work or family life

Severities of depression

Depression can often come on gradually, so it can be difficult to notice something is wrong. Many people try to cope with their symptoms without realising they're unwell. It can sometimes take a friend or family member to suggest something is wrong.

Doctors describe depression in adults as either less severe (mild) or more severe (moderate or severe), based on:

• the symptoms, including how often you get symptoms and how bad they are
• how long depression lasts
• the impact on your daily life

A few people with severe depression may have symptoms of psychosis.

You'll usually be asked to answer a set of questions to help doctors assess how severe your condition is.

Grief and depression

It can be difficult to distinguish between grief and depression. They share many of the same characteristics, but there are important differences between them.

Grief is an entirely natural response to a loss, while depression is an illness.

People who are grieving may have symptoms of depression, but they usually improve with time. For some people, bereavement can lead to depression.

If you're grieving it's normal to have feelings of sadness. Some other symptoms of depression are rare with grief and bereavement, such as having suicidal thoughts, symptoms of psychosis and feeling hopeless or guilt-ridden.

Read more about coping with grief after bereavement or loss

Other types of depression

There are different types of depression, and some conditions where depression may be 1 of the symptoms. These include:

• postnatal depression - sometimes new mothers, fathers or partners develop depression after they have a baby; this is known as postnatal depression and it's treated in a similar way to other types of depression, with talking therapies and antidepressant medicines
• bipolar disorder - also known as "manic depression", in bipolar disorder there are spells of both depression and excessively high mood (mania); the depression symptoms are similar to clinical depression, but the bouts of mania can include harmful behaviour, such as gambling, going on spending sprees and having unsafe sex 
• Seasonal affective disorder (SAD) - also known as "winter depression", SAD is a type of depression with a seasonal pattern usually related to winter
• premenstrual dysphoric disorder (PMDD) – a severe type of premenstrual syndrome (PMS) where you have symptoms including feelings of depression and anxiety in the weeks before your period

When to seek help

See a GP if you experience symptoms of depression for most of the day, every day, for more than 2 weeks.

A low mood may improve after a short time.

Who can get it

There's no single cause of depression. It can occur for a variety of reasons and it has many different triggers.

For some people, an upsetting or stressful life event, such as bereavement, divorce, illness, redundancy and job or money worries, can be the cause.

Different causes can often combine to trigger depression. For example, you may feel low after being ill and then experience a traumatic event, such as a bereavement, which brings on depression.

People often talk about a "downward spiral" of events that leads to depression. For example, if your relationship with your partner breaks down, you're likely to feel low, you may stop seeing friends and family and you may start drinking more. All of this can make you feel worse and trigger depression.

Some studies have also suggested that you're more likely to get depression as you get older, and that it's more common in people who live in difficult social and economic circumstances.

It's thought that your chance of getting severe depression may be partly affected by the genes you inherit from your parents.

Stressful events

Most people take time to come to terms with stressful events, such as bereavement or a relationship breakdown. When these stressful events occur, your risk of becoming depressed is increased if you stop seeing your friends and family and try to deal with your problems on your own.

Personality

You may be more vulnerable to depression if you have certain personality traits, such as low self-esteem or being overly self-critical. This may be because of the genes you've inherited from your parents, your early life experiences, or both.

Family history

If someone in your family has had depression in the past, such as a parent or sister or brother, it's more likely that you'll also develop it.

It's thought that severe depression in particular may be partly caused by the genes you inherit from your parents.

But depression is usually caused by a combination of triggers such as life events, so having a family history of depression does not always mean that you'll develop it.

Pregnancy and giving birth

Some women are particularly vulnerable to depression after pregnancy. The hormonal and physical changes, as well as the added responsibility of a new life, can lead to postnatal depression.

Sometimes depression starts before you give birth. Depression in pregnancy is known as antenatal depression.

Menopause

Menopause is when your periods stop due to lower hormone levels. Sometimes menopause can trigger depression, particularly in the first few years.

Menopause can also cause symptoms such as sadness and mood swings. Mental health symptoms caused by menopause are different from depression.

Loneliness

Feeling lonely, caused by things such as becoming cut off from your family and friends can increase your risk of depression.

Alcohol and drugs

When life is getting them down, some people try to cope by drinking too much alcohol or taking drugs. This can result in a spiral of depression. 

Cannabis can help you relax, but there's evidence that it can also bring on depression, particularly in teenagers.

"Drowning your sorrows" with a drink is also not recommended. Alcohol affects the chemistry of the brain, which increases the risk of depression.

Illness

You may have a higher risk of depression if you have a longstanding or life-threatening illness, such as coronary heart disease, cancer or a condition that causes long-term pain.

Head injuries are also an often under-recognised cause of depression. A severe head injury can trigger mood swings and emotional problems.

In some people an underactive thyroid (hypothyroidism) can cause depression.

Diagnosis

If you experience symptoms of depression for most of the day, every day for more than 2 weeks, you should seek help from a GP.

It's particularly important to speak to a GP if you:

• have symptoms of depression that are not improving
• find your mood affects your work, other interests, and relationships with your family and friends
• have thoughts of suicide or self-harm

Sometimes, when you're depressed it can be difficult to imagine that treatment can actually help. But the sooner you seek treatment, the sooner your depression will improve.

There are no physical tests for depression, but a GP may examine you and carry out some urine or blood tests to rule out other conditions that have similar symptoms, such as an underactive thyroid.

The main way a GP will tell if you have depression is by asking you questions about your general health and how the way you're feeling is affecting your daily life, both mentally and physically.

A GP may use a questionnaire to assess your symptoms.

Try to be as open and honest as you can be with your answers. Describing your symptoms and how they're affecting you will help the GP determine whether you have depression and how severe it is.

Any discussion you have with a GP will be confidential. This rule will only ever be broken if there's a significant risk of harm to either yourself or others, and if informing a family member or carer would reduce that risk.

Treatment

Treatment for depression usually involves a combination of self-help, talking therapies and medicines.

The treatment recommended will be based on the type of depression you have.

Mild depression

If you have less severe (mild) depression, the following treatments may be recommended.

Wait and see

If a GP diagnoses you with mild depression, they may suggest waiting a short time to see if it gets better by itself. In this case, you'll be seen again by the GP after 2 to 4 weeks to monitor your progress. This is known as watchful waiting.

Guided self-help

Your GP may suggest trying guided self-help to see if it can help with your depression.

You'll usually have 6 to 8 sessions where you work through a workbook or online course, with support from a therapist. The sessions may be in person, by phone or online.

Guided self-help for depression is usually based on the principles of cognitive behavioural therapy (CBT). CBT is a type of therapy that can help you manage your problems by changing the way you think and behave.

Exercise

There's evidence that exercise can help depression, and it's one of the main treatments for mild depression. You may be referred to a group exercise class that's designed to help with depression.

Talking therapies

If you have mild depression that's not improving, you may find a talking therapy helpful.

There are different types of talking therapies for depression, including cognitive behavioural therapy (CBT) and counselling.

Moderate to severe depression

If you have more severe depression, which includes moderate or severe depression, the following treatments may be recommended.

Antidepressants

Antidepressants are medicines that treat the symptoms of depression. There are many different types of antidepressant.

They have to be prescribed by a doctor, usually for depression that's moderate or severe.

Combination therapy

A GP may recommend that you take a course of antidepressants plus talking therapy, particularly if your depression is quite severe.

A combination of an antidepressant and CBT usually works better than having just one of these treatments.

Mental health teams

If you have severe depression, you may be referred to a mental health team made up of psychologists, psychiatrists, specialist nurses and occupational therapists.

These teams often provide intensive specialist talking treatments as well as prescribed medicine.

Talking therapies

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) aims to help you understand your thoughts and behaviour, and how they affect you.

CBT recognises that events in your past may have shaped you, but it concentrates mostly on how you can change the way you think, feel and behave in the present.

It teaches you how to overcome negative thoughts – for example, being able to challenge hopeless feelings.

CBT is available on the NHS for people with depression or any other mental health problem it's been shown to help.

If CBT is recommended, you'll usually have a session with a therapist once a week or once every 2 weeks. This may be a group session or an individual session.

The course of treatment usually lasts for between 8 and 16 sessions, depending on how severe your condition is.

Interpersonal therapy (IPT)

Interpersonal therapy (IPT) focuses on your relationships with others and problems you may be having in your relationships, such as difficulties with communication or coping with bereavement.

If it's recommended you'll usually have 8 to 16 sessions with a trained practitioner, depending on how severe your condition is.

Behavioural activation

Behavioural activation therapy focuses on identifying links between your activities and your mood, rather than focusing on thoughts and feelings. It can be useful if depression has led to you withdrawing from social activities.

It helps you to make practical changes to your behaviour that may improve your mood.

If it's recommended you'll usually have 12 to 16 individual sessions with a trained practitioner, depending on how severe your condition is.

Individual problem-solving

Individual problem-solving is a type of therapy that focuses on identifying problems and developing plans to solve them. It's only recommended for more severe depression.

If it's recommended you'll usually have 6 to 12 sessions with a trained practitioner, depending on how severe your condition is.

Psychodynamic psychotherapy

In psychodynamic (psychoanalytic) psychotherapy, a psychoanalytic therapist will encourage you to say whatever is going through your mind.

This will help you become aware of difficult feelings in significant relationships and stressful situations, and how patterns in what you do or say may be contributing to your problems.

If it's recommended you'll usually have 8 to 16 sessions with a trained practitioner, depending on how severe your condition is.

Counselling

Counselling is a form of therapy that helps you think about the problems you're experiencing in your life so you can find new ways of dealing with them.

Counsellors support you in finding solutions to problems, but do not tell you what to do. You can talk in confidence to a counsellor, who supports you and offers practical advice.

On the NHS, you may be offered 8 to 16 sessions of counselling, depending on how severe your condition is.

It's ideal for people who are generally healthy but need help coping with a current crisis, such as anger, relationship issues, bereavement, redundancy, infertility or a serious illness.

Behavioural couples therapy

You may be offered behavioural couples therapy if relationship problems could be contributing to your depression, or if involving your partner could help with your treatment.

If it's recommended you'll usually have 15 to 20 sessions over 5 to 6 months.

Getting help

See a GP for more information about accessing NHS talking therapies. They can refer you for local talking therapies for depression.

You also have the option of self-referral. This means that if you prefer not to talk to a GP, you can go directly to an NHS talking therapies service.

Waiting times for talking therapies can be several weeks or months. A GP can tell you how long you might need to wait, and what to do if your condition gets worse or you need support during this time.

Antidepressants

Antidepressants are medicines that treat the symptoms of depression. There are many different types available.

Most people with moderate or severe depression benefit from antidepressants, but not everybody does. 

You may respond to 1 antidepressant but not to another, and you may need to try 2 or more treatments before you find one that works for you.

The different types of antidepressant work about as well as each other. But side effects vary between different treatments and people.

When you start taking antidepressants, you should see a GP or specialist nurse every week or 2 for at least 4 weeks to assess how well they're working.

Contact a GP straight away if you have any feelings of hopelessness or suicidal thoughts that start or get worse after starting antidepressants.

You should find that your symptoms start to improve within 4 weeks of starting antidepressants.

If they're working, you'll need to continue taking them at the same dose for at least 4 to 6 months after your symptoms have eased.

If you have had episodes of depression in the past, you may need to continue to take antidepressants long term. You'll be reviewed at least twice a year to see whether you need to keep taking them.

Antidepressants are not addictive, but you may get some withdrawal symptoms if you stop taking them suddenly or you miss a dose.

Selective serotonin reuptake inhibitors (SSRIs)

If a GP thinks you'd benefit from taking an antidepressant, you'll usually be prescribed a modern type called a selective serotonin reuptake inhibitor (SSRI).

Examples of commonly used SSRI antidepressants are sertraline (Lustral), paroxetine (Seroxat), fluoxetine (Prozac) and citalopram (Cipramil).

They help increase the level of a natural chemical in your brain called serotonin, which is thought to be a "good mood" chemical.

SSRIs work just as well as older antidepressants and have fewer side effects, although they can cause nausea, headaches, a dry mouth, tiredness, sleeping problems and problems having sex. But these side effects usually improve over time.

SSRIs may not be prescribed for people with certain health conditions, or for children and young people under 18 years of age. Research shows that the risk of self-harm and suicidal behaviour may increase if they're taken by under-18s.

Fluoxetine is the only SSRI that can be prescribed for under-18s and, even then, only when a specialist has given the go-ahead.

Tricyclic antidepressants (TCAs)

Tricyclic antidepressants (TCAs) are a group of antidepressants used to treat moderate to severe depression.

TCAs, including imipramine (Imipramil) and amitriptyline, have been around for longer than SSRIs.

They work by raising the levels of the chemicals serotonin and noradrenaline in your brain. These both help lift your mood. 

Side effects of TCAs vary from person to person but may include a dry mouth, blurred vision, constipation, problems passing urine, sweating, feeling lightheaded and excessive drowsiness.

Some of the side effects may gradually improve as your body gets used to the medicine.

Serotonin-noradrenaline reuptake inhibitors (SNRIs)

Antidepressants such as venlafaxine (Efexor) and duloxetine (Cymbalta or Yentreve) work in a slightly different way from SSRIs and TCAs.

They're known as serotonin-noradrenaline reuptake inhibitors (SNRIs). Like TCAs, they change the levels of serotonin and noradrenaline in your brain.

Studies have shown that an SNRI can be more effective than an SSRI, but they can lead to a rise in blood pressure.

Mirtazapine

Mirtazapine is an antidepressant that increases the amount of serotonin and noradrenaline in your brain.

It's sometimes used together with other types of antidepressant.

It can make you feel sleepy. This can be helpful if you have depression and difficulties getting to sleep.

Vortioxetine

Vortioxetine (Brintellix or Lundbeck) is recommended by the National Institute for Health and Care Excellence (NICE) for treating adults who are having a first or recurrent major depressive episode, if the current episode has not responded to 2 other antidepressants.

Common side effects associated with vortioxetine include abnormal dreams, constipation, diarrhoea, dizziness, itching, nausea and vomiting.

Withdrawal symptoms

Antidepressants are not addictive in the same way that illegal drugs and cigarettes are, but you may have some withdrawal symptoms when you stop taking them.

You'll be advised to reduce your dose gradually to help avoid withdrawal symptoms.

These can include:

• an upset stomach
• flu-like symptoms
• anxiety
• dizziness
• vivid dreams at night
• sensations in the body that feel like electric shocks

In most cases, these are quite mild and last no longer than 1 or 2 weeks, but occasionally they can be quite severe.

They seem to be most likely to occur with paroxetine (Seroxat) and venlafaxine (Efexor).

Contact a doctor if you get withdrawal symptoms and they do not improve after 1 or 2 weeks or they get worse.

Other treatments

Mindfulness

Mindfulness involves paying closer attention to the present moment, and focusing on your thoughts, feelings, bodily sensations and the world around you to improve your mental wellbeing.

The aim is to develop a better understanding of your mind and body, and learn how to live with more appreciation and less anxiety.

Group mindfulness is recommended by NICE as an option for treating less severe depression.

St John's wort

St John's wort is a herbal treatment that some people take for depression. It's available from health food shops and pharmacies.

There's some evidence that it may help less severe depression, but it's not recommended by doctors.

This is because the amount of active ingredients varies among individual brands and batches, so you can never be sure what sort of effect it'll have on you.

Taking St John's wort with other medicines, such as anticonvulsants, anticoagulants, antidepressants and the contraceptive pill, can also cause serious problems.

You should not take St John's wort if you're pregnant or breastfeeding, as we do not know for sure that it's safe.

Also, St John's wort can interact with the contraceptive pill, reducing its effectiveness.

Brain stimulation

Brain stimulation is sometimes recommended by a specialist to treat severe depression that has not responded to other treatments.

Electromagnetic currents can be used to stimulate certain areas of the brain to try to improve the symptoms of depression.

There are a number of different types of brain stimulation that can be used to treat depression.

These include:

• transcranial direct current stimulation (tDCS)
• repetitive transcranial magnetic stimulation (rTMS)
• electroconvulsive therapy (ECT)
• vagus nerve stimulation

The mental health charity Mind has more information on brain stimulation.

Lithium

If you have tried several different antidepressants and there's been no improvement, a specialist may offer you a medicine called lithium in addition to your current treatment.

There are 2 types: lithium carbonate and lithium citrate. Both are usually effective, but if you're taking one that works for you, it's best not to change.

If the level of lithium in your blood becomes too high, it can become toxic. You'll therefore need blood tests every 3 to 6 months to check your lithium levels and check for side effects while you're on the medicine.

You'll also need to avoid eating a low-salt diet because this can also cause the lithium to become toxic. 

Living with

There are some key steps you can take to lift your mood and help your recovery from depression.

Take your medicine

It's very important to take your antidepressants as prescribed, even if you start to feel better. If you stop taking them too soon, your depression could return. Stopping suddenly can also increase the risk of withdrawal side effects.

Talk to a doctor or pharmacist if you have any questions or concerns about the medicine you're taking. The leaflet that comes with your medicine will have information about possible interactions with other medicines or supplements.

Check with a doctor first if you plan to take any over-the-counter remedies such as painkillers, or any nutritional supplements. These can sometimes interfere with antidepressants.

Diet and exercise

Exercise and a healthy diet can make a significant difference to how quickly you recover from depression. Both will improve your general health as well.

A healthy diet can help lift your mood. In fact, eating healthily seems to be just as important for maintaining your mental health as it is for preventing physical health problems.

Research suggests that exercise may be as effective as antidepressants at reducing the symptoms of depression.

Being physically active can lift your mood, reduce stress and anxiety, encourage the release of endorphins (your body's feel-good chemicals) and improve self-esteem. Exercising may also be a good distraction from negative thoughts, and it can improve social interaction.

Mindfulness

It can be easy to rush through life without stopping to notice much. Paying more attention to the present moment – to your own thoughts and feelings, and to the world around you – can improve your mental wellbeing. Some people call this awareness "mindfulness", and you can take steps to develop it in your own life.

The National Institute for Health and Care Excellence (NICE) recommends group mindfulness and meditation as a treatment option for less severe depression.

Talking about it

Sharing a problem with someone else or with a group can give you support and an insight into your own depression.

You may not feel comfortable about discussing your mental health and sharing your distress with others. If this is the case, writing about how you feel or expressing your emotions through poetry or art are other ways to help your mood.

Smoking, drugs and alcohol

If you have depression it may be tempting to smoke or drink to make you feel better. Cigarettes and alcohol may seem to help at first, but they make things worse in the long run.

Be extra cautious with cannabis. You might think it's harmless, but research has shown a strong link between cannabis use and mental illness, including depression.

A GP can give you advice and support if you drink or smoke too much or use drugs.

Work and finances

If your depression is caused by working too much or if it's affecting your ability to do your job, you may need time off to recover.

It's important to avoid too much stress, and this includes work-related stress. If you're employed, you may be able to work shorter hours or work in a more flexible way, particularly if job pressures seem to trigger your symptoms.

Under the Equality Act 2010, all employers must make reasonable adjustments to make the employment of people with disabilities possible. This can include people who've been diagnosed with a mental illness. Find out more about the Equality Act 2010 on the GOV.UK website.

If you're unable to work as a result of your depression, you may be eligible for a range of benefits, depending on your circumstances. You can find out more about these benefits from GOV.UK:

• Statutory sick pay 
• Incapacity Benefit 
• Personal Independence Payment 
• Attendance Allowance 
• Carer's Allowance 
• Council Tax Reduction 
• Housing Benefit

Looking after someone with depression

It's not just the person with depression who's affected by their illness. The people close to them are also affected.

If you're caring for someone with depression, your relationship with them and family life in general can become strained. You may feel at a loss as to what to do. Finding a support group and talking to others in a similar situation might help.

If you're having relationship or marriage difficulties, it might help to contact a relationship counsellor who can talk things through with you and your partner.

Men are less likely to ask for help than women and are also more likely to turn to alcohol or drugs when depressed.

Coping with bereavement

Losing someone close to you can be a trigger for depression.

When someone you love dies, the sense of loss can be so powerful that you feel it's impossible to recover. However, with time and the right help and support, it's possible to start living your life again.

Depression and suicide

The majority of suicide cases are linked with mental disorders, and most of them are triggered by severe depression.

Warning signs that someone with depression may be considering suicide include:

• making final arrangements, such as giving away possessions, making a will or saying goodbye to friends
• talking about death or suicide – this may be a direct statement, such as "I wish I was dead", but often depressed people will talk about the subject indirectly, using phrases like "I think dead people must be happier than us" or "Wouldn't it be nice to go to sleep and never wake up"
• self-harm, such as cutting their arms or legs, or burning themselves with cigarettes
• a sudden lifting of mood, which could mean that a person has decided to attempt suicide and feels better because of this decision

Contact a GP as soon as possible if you're feeling suicidal or are in the crisis of depression. They'll be able to help you.

If you cannot or don't want to contact a GP, call the Samaritans on 116 123 (the helpline is open 24 hours a day, 365 days a year). You can also email jo@samaritans.org.

Helping a suicidal friend or relative

If you see any of the above warning signs in a friend or relative:

• help them to get professional support
• let them know they are not alone and you care about them
• encourage them to talk about how they're feeling
• offer support in finding other solutions to their problems

If you feel there's an immediate danger, stay with the person or have someone else stay with them, and remove all available means of attempting suicide, such as medicine.

Over-the-counter medicine, such as painkillers, can be just as dangerous as prescription medicine. Also, remove sharp objects and poisonous household chemicals such as bleach.

Someone may be at increased risk when they start or change their antidepressant treatment, or when they're facing particularly stressful situations.