Depression and low mood (young people)
Getting a depression diagnosis - or not
Diagnosing depression can be difficult as it can manifest very differently in different people, and at different times. Diagnosis may be delayed because ‘symptoms’ are non-specific or masked by other health problems. Depression can often exist alongside other mental health problems, especially in young people, (also known as co-morbidity) which can also add to the difficulty of making a diagnosis.
Depression presents a range of physical and emotional ‘symptoms’ which need to be carefully explored to reach an accurate diagnosis. The process of diagnosis often entails a physical examination, filling in a depression symptom questionnaire and a careful exploration of symptoms, in the context of the person’s medical history. Sometimes depression is diagnosed after other possible conditions have been ruled out.
Many young people we spoke with had been given a depression diagnosis. Here they talk about the process of getting a diagnosis and their feelings about it.
Seeking help
For quite a few people it had taken a long time to seek help or to feel able to talk to someone about their problems. The barrier to seeking help seemed high for many, and sometimes the pressures people felt from home, in their peer groups or unpleasant past experiences of the health care system made it more difficult. A couple of people had felt “defensive” or been “in denial” about their problems, and hence reluctant to reach out.
Sara's mum got upset and angry about her wanting to see a psychiatrist so Sara decided not to...
Sara's mum got upset and angry about her wanting to see a psychiatrist so Sara decided not to...
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When I was having the anxiety attacks, ‘cos I was blacking out quite a lot, and my Mum took me to the doctor and he just kind of shrugged it off as growing up. And I got very angry in for that ‘cos I was like, “No, no, no blacking out is not part of growing up.” But I just left it and then last year when I started seeing the counsellor she, she said that I should try and see a psychiatrist about it. So I did, I went to the doctor and made an appointment and got an appointment with the psychiatrist but my Mum found the letter and she got very angry with it, so it was quite, I wanted to go on my own but she went with me. And for the whole bus journey there she was saying, you know you don’t need this, why are you being silly blah blah, so when I did have the interview with the psychiatrist, I just, I told them everything and he says, “What do you want from this?” And I said, “You know what, for now just leave it”. So I just left it, and I really regret doing that, and I did wanna go back, but I’m just worried about my Mum finding out about it, so I’m going to leave it until I absolutely have to have it, but I don’t think it’s a great idea to leave it, it’s like if I could take it without my Mum being angry then I would.
Ruby says it was "terrifying" to tell her teacher about the bulimia because her past experience...
Ruby says it was "terrifying" to tell her teacher about the bulimia because her past experience...
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Eventually like one night I plucked up the courage just to say to her, like when we were sat alone, I was just like, “What shall I do?” Like, “What, what do I do?” And she was just like saying, “Well we’ll get you into a counsellor and stuff like that,” and, it was just like; oh it took so much out, even though she already knew, just to sit there and go, “What do you think I should do?” And for her to know exactly what I was talking about. Oh it was terrifying, but honestly like…
I don’t know when like, ‘cos I’ve worked as a teacher and stuff, if a kid came up to me and said something like that, I’d be like exactly the same, like really, really caring, like, so I don’t get, I don’t understand why I was ever so terrified of authority and telling adult, but that was because I guess my only experience of adults were, “Oh what you’re doing, oh you’ve blocked the toilet again. Oh you’ve done it.” You know, so that was my yardstick of what normal adult reactions would be, to anything I said. So it took me years of not being silent to get that proved wrong and to fix that in my head that it wasn’t how adults normally react, you know like?
A couple of people had taken years to tell someone about how they were feeling, others had for a long time not been taken seriously by their doctor. Sometimes it was a parent or friend who noticed the change in behaviour or moods and encouraged them to seek help. Severe physical symptoms, like panic attacks or weight loss, had made a few people get help as they felt they could no longer “ignore” the problems.
Severe panic attacks made Jack finally contact the local counselling service.
Severe panic attacks made Jack finally contact the local counselling service.
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I was kind of on the edge always saying, my Mum was always saying you know, “there’s a really good counselling service in this town, and why, why don’t you go for it?” I said, “Maybe,” and there was sometimes when I was thinking, “Look yes completely right, let’s call them up.” And by the time I’d got to the phone I’d realise, “No, I think I’m good, I’m good.” You know and I was I was so on the edge, and doing all of that.
But, when it really, and I don’t know whether this is this isn’t really related to depression really, but when it really hit was when the massive physical symptoms came in, panic attacks, panic attacks and stuff like that when I realised, I felt, I don’t think I was actually properly actually looking at everything, I think I was still ignoring a few things. Because I was adopting this massive scheme of structure and organisation, I was saying, “No I can’t have any emotion in, within this, very, I don’t know, business, not business, but organisational thing”.
And so I think I was ignoring my feelings and eventually I think my head was going, “Look no, no you’ve gotta, you’ve got to deal with this stuff and,” so it just sent out these messages of panic attacks.
Ruby says it took "absolutely everything to go wrong" for her to seek professional help.
Ruby says it took "absolutely everything to go wrong" for her to seek professional help.
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It’s one of those things they always say people with eating disorders or addictions and stuff is because they were never good enough. They never felt they were good enough. I never felt like I was bad enough to warrant love and care, do you know, like so instead of see, I guess you’d call it approval seeking, but not in a positive way. It was like I wanted someone to take care of me and clearly when I was such and such a weight I wasn’t thin enough for people to worry. When I was banging my wrists that wasn’t bad enough for people to worry. I was never bad enough. I was always just, I was never ill enough you know, to warrant love and care and stuff, which sounds so totally ridiculous, but that was what it was. It was almost like “Oh God, well I’ve been doing this and no-one gives a shit, what can I do to make them realise,” you know, ‘cos I just couldn’t articulate it, I couldn’t speak. So yeah I definitely knew it was a problem, I remember thinking oh I’ll have like, I remember sort of guiltily looking at that page of my student handbook where it says counsellor for eating disorders and stuff like that, I was kind of going, “Hmm.” You know, like, not that, I knew I needed it, but it was just like “Oh I’d never have the guts to walk up those stairs and ask for an appointment,” or something, you know like, you know it was ridiculous. So it took, everything went absolutely wrong for me to actually get professional help.
Some people felt that if they’d been diagnosed earlier, or at least someone had recognised depression, they might have been able to “hit it on the head” perhaps with fewer repercussions. Instead, their low moods had escalated over years and become more frequent. During this time some also developed panic attacks or anxiety.
“Just the teenage blues”
Initially, when seeing the doctor about their problems, many felt they weren’t taken seriously. A couple of people who went to their GP in their early teens were told they were “too young” to have depression and were given no information or advice. One woman said the doctor put her moods down to “hormones” and nothing was done until she went back a couple of years later.
Initially, when seeing the doctor about their problems, many felt they weren’t taken seriously. A couple of people who went to their GP in their early teens were told they were “too young” to have depression and were given no information or advice. One woman said the doctor put her moods down to “hormones” and nothing was done until she went back a couple of years later.
At 13 Erika-Maye was told she was "too young" for the doctor to do anything about her depression.
At 13 Erika-Maye was told she was "too young" for the doctor to do anything about her depression.
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I was seeing the school counsellor, because of some things that were already happening because, I can’t remember exactly how I ended up seeing him, but they basically told me I needed to start speaking to someone. My Mum said that some things weren’t right. So took me to see the doctor. He basically just blamed it on my hormones. Said that although it was depression they weren’t going to do anything because I was too young. Which was helpful [laughter]. There was a lot of stuff kind of going on at school at the time, ‘cos I was bullied quite badly. All the way through secondary school. And that was probably a major factor. One of my best friends attempted suicide in front of me when I was 11. Which isn’t really gonna help anyone. But the doctor seemed kind of reluctant to do anything because of my age.
And how old were you at that time when they said you were too young for us to do anything?
13, was the first time I went to the doctor’s about that.
Many noted that it was hard to diagnose teenagers with depression as teenage years can be turbulent time anyway, with physical and emotional changes and mood swings. One woman said adolescence is the “worst time” to get depression because it’s so difficult to detect then. A couple of people themselves too had first thought their low moods were just a part of “difficult puberty” or their parents thought they were just “mopey teenagers”.
Joanna says distinguishing depression in teenagers is really difficult because it's not easy to...
Joanna says distinguishing depression in teenagers is really difficult because it's not easy to...
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I think the whole thing was exacerbated by the fact that I was a teenager. And I think in some ways actually getting depression, or getting any sort of illness when you are a teenager is the worst time for it to possibly happen because you are going through all those changes already, so, you know a lot of people would say when they were like thirteen or something, “Oh I don’t really know who I am,” or “I don’t feel that happy,” or “I feel ugly,” or whatever, so it’s the worst time to go through that, because you’ve got all of those feelings already. And having something on top of that just makes it a, a hundred times worse, and even more difficult to understand, and then in a way it can get belittled quite a lot because a lot of people say, “Well all teenagers go through that.”
And that’s why I think in a lot of ways in actually detecting mental health problems in teenagers becomes really difficult because people can’t distinguish as to what is normal adolescent behaviour and what is actually a serious problem. And it normally has to get to a stage where it’s so serious that it’s, it’s gone quite far and it needs more treatment than perhaps if it would have been detected earlier.
Several people felt diagnosing depression was questionable as it tended to be “fuzzy”, mental health was “unscientific” and the boundaries between what is seen as depression and “normal” was unclear.
Feelings about diagnosis
Most of the people who had been given a diagnosis felt the diagnosis had some positive outcomes. Many described getting a diagnosis as “a relief”. They felt it finally explained things and was a useful “label” for the experiences some of them had had for years. One man found getting a diagnosis took a huge “pressure off” his shoulders; a woman was relieved to hear a professional “say the word which had echoed” in her head for ages.
Jo was "relieved" about the diagnosis but at the same time felt her experiences weren't "severe"...
Jo was "relieved" about the diagnosis but at the same time felt her experiences weren't "severe"...
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It seemed really logical for me at the time. So I was really relieved in a way that somebody would pick up on it, because it was like the minute she said it, like oh yeah. But it is a long process, like at the time I sort of thought, like this is great, grief stored up, and yeah, but I still didn’t think of it in terms of like depression. ‘Cos depression is something that is so severe it just happens to other people. Like I didn’t have the right to consider myself to have a depression like, I’m just going through like a bad point.
And yeah like also like depressions often associated with suicidal thoughts, and I didn’t feel suicidal, so I thought like well as long as I’m not suicidal I don’t have depression which is, yeah, not true.
Craig describes feeling "nervous" before his appointment with the consultant but telling her, and...
Craig describes feeling "nervous" before his appointment with the consultant but telling her, and...
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[I felt] nervous, because I knew it was coming up. I suppose it’s like a driving test really, I suppose as you go in, or any test as a matter of fact, knowing that you’ve got that is like the, the hour before it, when you’re going to it, when you’re getting there, when you’re just, you, you’re sat there just waiting, you know twiddling your thumbs, and then you finally get in there, and then as soon as you say it, it’s out there for the world, and it’s like a massive pressure off your chest. It is just so much relief to know that you’ve finally told someone and that, not I mean, okay telling your Mum, yeah that’s okay. But your Mum can’t write a prescription. You actually tell a doctor or a nurse or you tell somebody of authority like that, as soon as you tell someone like that the pressure is just, it’s like an almost weight off your chest.
Filling out a depression symptom questionnaire made Dan realise that things weren't right.
Filling out a depression symptom questionnaire made Dan realise that things weren't right.
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Whenever I went to the counselling service, and whenever I went to the GP you fill out the standard sort of depression, depression indicator test, which is a sort of, it’s a-one or two-page-test, just like questions about how you’re feeling and how often you feel that way and things like that, so. That’s
That was pretty clear to you?
Yeah, I mean it was, and it was kind of good to sort of have that form, and sort of if I filled it out and looked at it and went, it kind of made me realise if I’d filled this out a year ago, it would have been zero, zero, zero, zero, zero, zero, well zero, zero, one, zero, one or whatever, but it was I just sort of looked and went that isn’t normal for me, that that’s not where I would’ve been six months ago, this is different, quite different so that, so making that realisation I guess helped.
People also felt that after depression diagnosis they were taken more seriously; because “something was actually wrong”, it made the experience of depression “more real” and gave some a sense of validation that they were right and their experiences were not ‘normal’. As one man said'
“You can only move on when you know what’s wrong with you”
One man said when he got the diagnosis it was “vindicating” to know his instincts about the diagnosis had been right all along and a woman described how diagnosis confirmed to her, and others, that what she’d been experiencing hadn’t been normal. Diagnosis could also give access to care or medication and hence enable recovery. One woman described the diagnosis as “the start of my journey back from depression”.
Tom says diagnosis is the most important thing and gives "a little bit of hope".
Tom says diagnosis is the most important thing and gives "a little bit of hope".
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Diagnosis is just the most important thing, just, of having I think to trust that you’ve got depression, regardless of whatever that means is a good step. ‘Cos at least then you know you can kind of visualise how long an outcome would be till you’re ready to, you know, wanting to lead a good life again. So, diagnosis would at least give you the hope, you know that you’re gonna be okay in x-amount of time. You know, that’s dependant on you. But at least you know, on average is x-amount of time, or whatever. Which gives you a little bit of hope.
Some people weren’t happy about the “label” of depression and felt that diagnostic labels were there more to help professionals rather than the young person. They described labels as a way to “categorise” or “plant titles” on them, but with no real benefit behind them in the form of interventions, for example. A couple of people had disagreed with the diagnosis they’d been given. One woman hadn’t been told the actual diagnosis and found out about it from elsewhere. For some, the depression diagnosis had also changed confusingly over years. One woman felt that although the label of “depression” helped at first, it didn’t truly describe her feelings and experiences.
Mandy and Frankie say first they felt psychiatric diagnoses were just a way for the doctors to ...
Mandy and Frankie say first they felt psychiatric diagnoses were just a way for the doctors to ...
Sex: Female
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Frankie' I’ve been able to accept them more if you know, it wouldn’t like, if I was getting help with them and stuff the way I’m supposed to having diagnoses wouldn’t bother me, but I don’t like, I don’t know, when I first got them I thought oh they’re labelling me, they put me into categories, now I’m just…
Mandy' We don’t fit. We actually don’t fit, we, we’re in that sort of broader ones,
Frankie' Yeah.
Mandy' Because they just, they can’t pinpoint stuff with us.
Frankie' That many, I mean I’ve got a hell of a lot and, disorders and you know, I’ve got depression, paranoia, I’ve got a hell of a lot. And basically you know, they do try and find, I’ve basically just been said, “Yeah you’ve got severe depression, paranoia, and suicidal tendencies.” They’ve just basically put it all into three.
Mandy' Self harm?
Frankie' Well they don’t say that anymore, ‘cos I don’t tend to do it, or they don’t know whether or not I do it. I could say, yeah I self harm, but they, I think they just put that down as severe depression category. They categorise us. Like filing cabinets.
Mandy' They categorised me as severe depression because of the self harm, and stuff like that. I used to have depression,
Frankie' I think it depends on who you see.
Mandy' Self harm, suicidal tendencies, unstable relationships, which I didn’t agree with, but then you know you find traits occasionally that kind of point that way. That’s ‘cos you’re looking.
Frankie' Exactly. If they tell you you’ve got something, you look for it.
Rather than thinking of the clinical diagnosis, Joanna says she was "broken". (Read by an actor).
Rather than thinking of the clinical diagnosis, Joanna says she was "broken". (Read by an actor).
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That’s really difficult so recently when I’ve looked back, I actually don’t like the idea of having these diagnoses, although they did help at the time. They helped because I was able to put some sort of name to the problems that I was having, it meant that people were taking me seriously, that they didn’t think I was just you know got all these issues or whatever, or that I was just a bit, just a bit troubled, at least there was a name to it. And you know there was something actually wrong with me, which helped. But when I look back at it now, I prefer to think that actually I was just broken. Rather than thinking I had a clinical diagnosis of so and so, I prefer to think of it as, well actually no, I just I became, I had difficulties with my mood, I was very low in mood, and I was very sad and because of that sadness I behaved in a certain way and society didn’t approve of that, so I was put away and treated, but really all it was is that I was, I was broken, I wasn’t able to think properly, and I had a broken mind. And that can be an easier way of looking at it.
Lisa's diagnosis changed after a while but her medication stayed the same which she couldn't...
Lisa's diagnosis changed after a while but her medication stayed the same which she couldn't...
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I said I actually want an answer, what’s my diagnosis, well we can’t give you one, can’t give you one, and then eventually it was, “You have a personality disorder, mood disorder.” I said, “So why am I on anti-psychotics and stuff like that?” Because your mood disorder”. But, well, I, I do see things, I do get psychotic symptoms, but it was the fact that they put me on them because they thought I had bipolar. And then all of a sudden I had something else. So I just can’t understand why I’m on that medication then.
Is it quite confusing, with all the different things that they say and the diagnosis?
I switch off after a while, when I don’t wanna hear what they say and I’ll just switch off.
Oliver was diagnosed both with ADHD and bipolar disorder and was told that they had some similar...
Oliver was diagnosed both with ADHD and bipolar disorder and was told that they had some similar...
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He said that he thought I had early onset bipolar disorder, and that if you think of a continuum between ADHD and bipolar disorder, I’m right there. And so it wasn’t, it wasn’t just sort of an either / or situation, but um, and it was interesting ‘cos I spoke to a friend of mine who’s doing Experimental Psychology here and he says that in children ADHD and bipolar disorder are almost indistinguishable from a diagnostic perspective. And, and yeah so that was kind of terrifying and kind of vindicating but also frustrating and, I mean you know I’ve been told you have ADHD, since I was 8. I’ve been tested for it in various ways from various different people, and it was like, “Oh, now I’m hearing something different.”
And one of the questions I asked them was like, “How many, what’s the likelihood that I will get this diagnosis from someone else?” And he said it would be pretty unlikely, and I appreciated his honesty about it, and there was another, there was another doctor that I’ve seen kind of for ADHD stuff and he concurred. He said that he had wondered whether I had issues with a mood disorder before and thought that that was a reasonably accurate.
For some, receiving the diagnosis was a “shock”, they felt “scared” or “numb”. Several people described how these feelings gradually subsided. They “got used to” the diagnosis and it “didn’t matter” to them in the end. One woman said she didn’t care about the labels because “I am just me”.
Emma-Jane felt 'numb' when she was given the diagnosis.
Emma-Jane felt 'numb' when she was given the diagnosis.
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I just remember feeling numb. Just ‘cos it was kind of like, as I said it had been echoing around my head, but along with the thoughts of, “You’re wasting time.” And I’d kind of sit there and, “Okay.” It was kind of like, like if, like you know you’ve got a cold and you can just hear it coming, then you listen to someone kind of goes, “Oh you sound like you’ve got a cold,” and you’re like, “Yeah, I’ve got a cold.” And kind of like, it was the, it was the fact that someone outside of me and outside of my own head and outside of a computer screen, saying, “Here’s, this is, if you’ve got, if you’re doing this, this, this and this, you might be depressed.”
Like it was, it was someone outside and kind of a bit of that, “Oh, okay. Right. Right okay.” And it was, it was, that was literally just, “Right, dot, dot, dot, blank space.” But it was relieving to hear someone, it was relieving and just kind of like, a realisation that it, that this wasn’t just normal that this wasn’t how like everyone felt, every hour of every day. That this, that I was different, that I was kind of outside of the normal kind of block. And that someone other than me had said it. And someone else like other than the one friend who I’d spoke to, other than that one, those two people, it was someone else who said it, and that kind of made it slightly more real.
Mandy, Sian and Frankie say you become so used to the diagnostic labels that they become ...
Mandy, Sian and Frankie say you become so used to the diagnostic labels that they become ...
Sex: Female
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Sian' You get used to it [diagnosis]. So, so first of all when they plant the title on you, you’re like, “No, that’s not me,” and then you look for things you know like, well maybe it could be, and then eventually it just grows on you, and you think, well I am who I am, so.
Mandy' Yeah, it becomes more important,
Sian' I don’t care about the label really.
Mandy' It becomes like completely less than boring, it just doesn’t matter in the end, that you know you just sort of give it up as okay, you can decide what you want, I’m just gonna deal with how I’m feeling in the best way I can type of thing.
Frankie' As far as I’m concerned the diagnoses are basically just the way of, that’s what annoys me a diagnosis is a, is a way of the experts knowing what you’ve got and knowing how to deal with it. And what annoys me is they know what I’ve got, and they know how to deal with it, but they’re not dealing with it.
Very few people recounted negative outcomes of the depression diagnosis, apart from being shocked at first. But one woman said once she got the diagnosis she just stopped looking after herself and things got worse for her rather than better.
We also spoke to a few people with multiple psychiatric diagnoses. A couple of people had been given the diagnoses of borderline personality disorder or ADHD, in addition to depression. For a few, the initial depression diagnosis had changed to bipolar disorder. A couple of these people felt they didn’t neatly “fit” the established narrow diagnostic criteria or categories and were just given a list of diagnoses to help the professionals to deal with them.
Not having a diagnosis
Several people we spoke with hadn’t been given a diagnosis. For some, this wasn’t a relevant issue, or they’d never been to a doctor about their low moods, whereas others were eager to get a diagnosis but hadn’t been referred for a specialist assessment. They wanted a diagnosis to gain access to medication or to validate their experiences. Some also said that a diagnosis would end the uncertainty around their ongoing mood problems. One man, for example, said that having a diagnosis would help to explain his behaviour and reduce the blame he was burdened with.
Sara says that without a formal diagnosis, she won't be able to get the medication she would want...
Sara says that without a formal diagnosis, she won't be able to get the medication she would want...
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I don’t think having a diagnosis makes a difference because if you’re suffering from something, you’re suffering from something whether or not it’s kind of accepted. But the only thing I’d say with diagnosis is because I think medication does make a difference I think with a formal diagnosis that would’ve been an option.
But because I haven’t had a formal diagnosis and until I see a psychiatrist and get one, it’s, medication is kind of not going to happen. So that’s the only kind, only kind of benefit, but I wouldn’t say medication’s the only way out, you’d have to have like, medication would be just on of the things. So it’s, it doesn’t matter as much. But it, I think it does make a bit of a difference because, just because then your doctors and your family and, because if someone else says you’ve got a problem then other people are more likely to listen. If you say you’ve, you personally have got a problem they’re just gonna, kind of brush it away. If someone else says, “Oh this person has actually got a problem.” Then people are more, it just seems people are more likely to listen.
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Last reviewed June 2017.
Last updated January 2011.
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