Depression
of mental health

Symptoms

Symptoms of depression can be very different from person to person. However, as a general rule, if you are depressed you feel hopeless, sad and lacking interest in things that used to make you feel happy.

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

Doctors describe depression in one of three ways, depending on how serious it is:

mild depression – it has some impact on daily life moderate depression – it has a significant impact on your daily life severe depression – this makes it nearly impossible to get through your life day to day

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

Below is a list of depression symptoms – it’s unlikely that one person would have all of them.

Psychological depression symptoms include:

continuous sadness or low mood losing interest in things losing motivation not getting any enjoyment in life feeling tearful feeling guilty feeling anxious feeling irritable finding it hard to make decisions feeling intolerant of other people feeling helpless feeling hopeless low self-esteem feeling worried thinking about suicide thinking about harming yourself

Physical symptoms include:

speaking or moving slower than usual aches and pains that can’t be explained losing, or sometimes gaining, appetite or weight constipation loss of interest in sex disturbed sleep (having trouble falling asleep, for example, or waking up very early) loss of energy changes in your menstrual cycle (the time of the month when you get your period)

Social symptoms are common too. These include:

avoiding talking to or spending time with your friends taking part in fewer social activities neglecting interests and hobbies doing poorly at work difficulties with your family or home life

It’s not always possible to tell that you’re having symptoms of depression right away – it can start and progress gradually. A lot of people don’t realise they’re ill and try to carry on and cope with their symptoms. Sometimes it takes a friend or family member to notice that there’s a problem.


People who have severe clinical depression feel sad and hopeless for most of the day, and feel no interest in anything. They feel this way practically every day, and getting through the day feels nearly impossible for them.

Other symptoms include:

fatigue (exhaustion) losing pleasure in things inability to concentrate difficulty making decisions sleep disturbance appetite changes feeling guilty feeling that they’re worthless having thoughts about suicide, or death

Read more about the different types of depression symptoms here.


Moments of psychosis are known as psychotic episodes. The person experiencing a psychotic episode will have:

Delusions – beliefs or thoughts that are likely to be false. Hallucinations – hearing, seeing or sometimes smelling, feeling or tasting things that aren’t there. Hearing voices is a common type of hallucination.

Hallucinations and delusions almost always reflect the deeply depressed mood of the person experiencing them. They may believe they have committed a crime or that they are to blame for something.

People with psychosis also commonly experience something called psychomotor agitation. People experiencing this cannot sit still or relax, and fidget all the time.

The opposite symptom can also happen – psychomotor retardation can cause a person’s thoughts and the movement of their body to slow down.

People who have psychotic depression are at a higher risk of thinking about suicide.

Causes

Symptoms of depression can be very different from person to person. However, as a general rule, if you are depressed you feel hopeless, sad and lacking interest in things that used to make you feel happy.

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

Doctors describe depression in one of three ways, depending on how serious it is:

mild depression – it has some impact on daily life moderate depression – it has a significant impact on your daily life severe depression – this makes it nearly impossible to get through your life day to day

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

Below is a list of depression symptoms – it’s unlikely that one person would have all of them.

Psychological depression symptoms include:

continuous sadness or low mood losing interest in things losing motivation not getting any enjoyment in life feeling tearful feeling guilty feeling anxious feeling irritable finding it hard to make decisions feeling intolerant of other people feeling helpless feeling hopeless low self-esteem feeling worried thinking about suicide thinking about harming yourself

Physical symptoms include:

speaking or moving slower than usual aches and pains that can’t be explained losing, or sometimes gaining, appetite or weight constipation loss of interest in sex disturbed sleep (having trouble falling asleep, for example, or waking up very early) loss of energy changes in your menstrual cycle (the time of the month when you get your period)

Social symptoms are common too. These include:

avoiding talking to or spending time with your friends taking part in fewer social activities neglecting interests and hobbies doing poorly at work difficulties with your family or home life

It’s not always possible to tell that you’re having symptoms of depression right away – it can start and progress gradually. A lot of people don’t realise they’re ill and try to carry on and cope with their symptoms. Sometimes it takes a friend or family member to notice that there’s a problem.


Depression doesn’t have one single cause – it can have a range of triggers, and there are many different reasons a person can develop the condition. Some people are affected after a stressful life event, like a bereavement or divorce. Other people experience depression related to illness, job loss, or money worries.

Different reasons can combine and trigger depression. If you’re feeling low after a job loss or health issues, and then experience something traumatic, like a bereavement, you can develop depression.

It’s common to hear about depression being brought on by a “downward spiral” – one thing causing other problems that combine to cause depression. For example, losing your job could make you feel sad, so you spend less time with family and friends and maybe drink more alcohol. These things all make you feel worse, which triggers depression.

There are studies that suggest people are more likely to become depressed when they get older. There’s also evidence that depression is more common for people whose economic and social circumstances are difficult.

Depression and illness

Long-lasting or life-threatening conditions like cancer or coronary heart disease can put you at higher risk of developing depression.

Many people don’t know that head injuries can cause depression, and a severe head injury can lead to emotional problems and mood swings.

Underactive thyroid (hypothyroidism) can happen as a result of immune system problems. It’s also possible, although rare, for a minor head injury to damage the pituitary gland. This is a gland the size of a pea which sits at the base of the brain and produces hormones that stimulate the thyroid. Damage to the pituitary gland can cause symptoms, including severe tiredness and a lack of interest in sex, which can then cause people to develop depression.

Depression and drugs and alcohol

“Drowning your sorrows” is actually a bad idea when it comes to depression. Alcohol is categorised as a “strong depressant” which can make depression worse, and drinking or taking drugs to cope can lead to a downward spiral by having a negative affect on other parts of your life.

There’s evidence that cannabis can cause depression, particularly in teenagers, even if it helps you relax.

Other causes of depression

There are a number of things that can lead to developing depression.

Stressful events – big changes in your life, like bereavement, the end of a relationship or the loss of a job, can be difficult to deal with. When these things happen, it’s important to keep seeing friends and family instead of trying to deal with problems alone – this increases your risk of developing depression. Giving birth – pregnancy and birth can make some people vulnerable to depression. Postnatal depression can happen as the result of physical changes, hormonal changes, and the responsibility of taking care of a new baby. Loneliness – your risk of depression gets higher if you aren’t in contact or spending time with family and friends. Personality – some personality traits can put you at a higher risk of developing depression. These include low-self esteem or a habit of criticising yourself too much. These personality traits can come from your genes, which you get from your parents, or they can be as a result of experiences in your early life. Family history – it’s more likely for someone to develop depression if a family member, like a sibling or parent, has experienced it before.


We don’t fully understand what causes psychotic depression yet. However, we know that depression doesn’t have one single cause, and that the condition has a lot of different triggers.

Causes of psychotic depression

Big, stressful events like divorce, serious illness, financial worries, or bereavement can trigger depression for some people.

Severe depression can run in families, which suggests genes might play a role in depression, but the reason some people develop psychosis as part of severe depression is not known.

Many people who have psychotic depression have experienced a difficult time in childhood, like a traumatic event.

Learn more about causes of clinical depression

Treating psychotic depression

Treatment for psychotic depression has three main parts:

medication – taking a combination of antipsychotics and antidepressants can help to relieve psychosis symptoms psychological therapies – cognitive behavioural therapy (CBT) is a talking therapy done one-to-one with a trained counsellor, and it has succeeded in helping some people with psychosis social support – support with social needs like employment, education and accommodation

People with psychotic depression may have to spend some time in hospital to receive treatment.

Electroconvulsive therapy (ECT, or electric shock treatment) is sometimes recommended if other treatments, including antidepressants, haven’t worked for severe depression.

Although treatment for psychotic depression is usually very effective, people with the condition still need follow-up appointments with their treatment team so they can be continuously monitored.

Diagnoses

There’s no physical test for depression.

If you experience depression symptoms most of the day, every day, for more than two weeks, you should visit your GP. This is especially important if:

you have symptoms of depression that aren’t getting any better you have thoughts of self-harm or suicide your work, relationships with friends and family, or interests are affected by your mood

It can be hard for people with depression to imagine that anything can help them – but the sooner you seek help, the sooner the symptoms start to get better.

Your GP may examine you and perform blood or urine tests to make sure there isn’t another condition causing your depression symptoms, like an underactive thyroid.

When you see your GP, they’ll try to find out if you have depression by asking you questions. These are likely to be about your health, how you’re feeling, and how that is affecting you mentally and physically.

Telling your doctor your symptoms and the affect they are having on you will help your GP to tell if you have depression, and how severe the condition is. It’s important to be as open as possible.

Your conversation with your GP will be confidential. This rule can only be broken if your GP thinks there is a significant risk of harm to you or others, and that telling a family member or carer would make that risk lower.

Treatments

There’s no physical test for depression.

If you experience depression symptoms most of the day, every day, for more than two weeks, you should visit your GP. This is especially important if:

you have symptoms of depression that aren’t getting any better you have thoughts of self-harm or suicide your work, relationships with friends and family, or interests are affected by your mood

It can be hard for people with depression to imagine that anything can help them – but the sooner you seek help, the sooner the symptoms start to get better.

Your GP may examine you and perform blood or urine tests to make sure there isn’t another condition causing your depression symptoms, like an underactive thyroid.

When you see your GP, they’ll try to find out if you have depression by asking you questions. These are likely to be about your health, how you’re feeling, and how that is affecting you mentally and physically.

Telling your doctor your symptoms and the affect they are having on you will help your GP to tell if you have depression, and how severe the condition is. It’s important to be as open as possible.

Your conversation with your GP will be confidential. This rule can only be broken if your GP thinks there is a significant risk of harm to you or others, and that telling a family member or carer would make that risk lower.


The first place to go is your GP – they will refer to you local talking treatments for depression that are available on the NHS.

You may also have the option to self-refer, depending on where you live, so you can go directly to a professional therapist if you’d rather not talk to your GP.


There are a number of talking therapies for depression.

Cognitive behavioural therapy (CBT)

CBT helps you make sense of your thoughts and behaviour and the affect they have on you. Part of it’s recognising that past events may have played a part in making you who you are, but the main focus is changing how you feel, behave and think now.

You can use CBT to learn how to overcome negative thoughts – this can help you to tackle feelings of hopelessness, for example.

Most people have a course of six to eight CBT sessions that goes over 10 to 12 weeks. Sessions are one-to-one, between you and a CBT-trained counsellor. You might also be offered group CBT.

Computerised CBT (CCBT)

This type of CBT is done using a computer instead of face-to-face with the counsellor. It should be supported by a healthcare professional – your GP may prescribe it, and you might have to use the computer in the GP surgery to access it. CCBT involves a series of weekly sessions.

Interpersonal Therapy (IPT)

IPT is focused on your relationships with people around you, and problems that you might be having with them. These can include problems communicating, or dealing with a bereavement.

There’s evidence that suggests IPT can be as effective for depression as CBT or medication, but more research needs to be done.

Psychodynamic psychotherapy

This is also known as psychoanalytic psychotherapy. You’ll work with a therapist who encourages you to say whatever you’re thinking. This helps you to find hidden patterns and meanings in your words and behaviour that could be contributing to your depression.

Read more about psychotherapy here.

Counselling

Counselling is a type of therapy that works really well if you have good mental wellbeing overall but need help coping with a crisis that’s currently going on in your life. These can include anger, bereavement, infertility, relationship problems, job loss and serious illness.

On the NHS, counselling usually takes place over six to 12 sessions, each an hour long. The sessions are confidential.

A counsellor helps you to think about what’s going on in your life and find new ways of dealing with the problems. They’ll offer practical advice, support you, and help you find solutions, but they don’t tell you what to do.


There is a range of other treatments that people are given for depression.

St John’s Wort

St John’s Wort is a herbal treatment that you can buy from pharmacies and health food shops. Some people take it for depression. There’s some evidence that it can help the symptoms of mild-to-moderate depression, but doctors don’t recommend St John’s Wort because the amount of active ingredients change depending on the brand and batch. This means that you can never be sure what kind of effect it will have.

If you take St John’s Wort with other medications, like anticonvulsants, anticoagulants, antidepressants and the contraceptive pill, it can cause serious problems. St John’s Wort can interact with the contraceptive pill and reduce its effectiveness at preventing pregnancy.

You shouldn’t take St John’s Wort while pregnant or breastfeeding, as we can’t be certain that it’s safe.

Electroconvulsive therapy (ECT) – electric shock treatment

If you have severe depression and other treatments, like medication, haven’t worked, ECT might be recommended for you.

When receiving ECT, you will be given an anaesthetic and medication that relaxes your muscles to begin with. Electrodes will be placed on your head that give an electrical “shock” to your brain.

ECT is given over a series of sessions, normally twice a week for three to six weeks.

ECT can cause side effects including nausea, headaches, aches in the muscles and memory problems.

Most people find that ECT is good for relieving severe depression, but the beneficial effects tend to wear off when several months have passed.

Lithium

If you’ve tried several different antidepressants and had no improvement, your doctor may offer you a type of medication called lithium in addition to your current treatment.

There are two types of lithium: 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 three months to check your lithium levels while you’re on the medication.

You’ll also need to avoid eating a low-salt diet because this can also cause the lithium to become toxic. Ask your GP for advice about your diet.


We don’t fully understand what causes psychotic depression yet. However, we know that depression doesn’t have one single cause, and that the condition has a lot of different triggers.

Causes of psychotic depression

Big, stressful events like divorce, serious illness, financial worries, or bereavement can trigger depression for some people.

Severe depression can run in families, which suggests genes might play a role in depression, but the reason some people develop psychosis as part of severe depression is not known.

Many people who have psychotic depression have experienced a difficult time in childhood, like a traumatic event.

Learn more about causes of clinical depression

Treating psychotic depression

Treatment for psychotic depression has three main parts:

medication – taking a combination of antipsychotics and antidepressants can help to relieve psychosis symptoms psychological therapies – cognitive behavioural therapy (CBT) is a talking therapy done one-to-one with a trained counsellor, and it has succeeded in helping some people with psychosis social support – support with social needs like employment, education and accommodation

People with psychotic depression may have to spend some time in hospital to receive treatment.

Electroconvulsive therapy (ECT, or electric shock treatment) is sometimes recommended if other treatments, including antidepressants, haven’t worked for severe depression.

Although treatment for psychotic depression is usually very effective, people with the condition still need follow-up appointments with their treatment team so they can be continuously monitored.

Dermatitis herpetiformis
of skin hair and nails

DH can appear at any age, but is most commonly diagnosed in those between the ages of 15 and 40.

It’s more common in men than women and is rare in children.


It’s more common in men than women and is rare in children.

Symptoms

People with DH can have:

red, raised patches often with blisters that burst with scratching severe itching and often stinging

The rash can affect any area of the skin but is most commonly seen on the:

elbows knees buttocks

The rash usually occurs on both sides of the body, for example on both elbows.

Dermatitis herpetiformis often affects the knees.Source: https://dermnetnz.org/

Gut symptoms

Most people with DH will have the same kind of gut damage seen with coeliac disease, but may not complain of gut symptoms like:

diarrhoea constipation stomach pain bloating

Just over half (60%) of people with DH don’t have gut symptoms.

Treatments

Some patients will be given medication to help them over this period of recovery.

Medication will only be given to control the skin itching and blisters and doesn’t treat any other symptoms.

The drug most likely to be used is called Dapsone.

Dapsone

Dapsone is taken in tablet form and must be swallowed.

It helps ease the itching and controls the development of blisters. It should work within a few days.

If you stop taking Dapsone before the gluten-free diet has taken effect, the rash will return.

Side effects of Dapsone

The most common side effect of Dapsone is anaemia.

Less common side effects are headaches and depression, while nerve damage is rare.

You’ll always be prescribed the lowest effective dose to help prevent these side effects.  

DH should be monitored once the drug dose has been reduced.

Alternatives to Dapsone

Some people can’t tolerate Dapsone. If you’re one of these people, the following drugs can also be taken to clear the rash:

Sulphapyridine Sulphamethoxypyridazine

Diabetes
of diabetes

There are two main types of diabetes – type 1 diabetes and type 2 diabetes.

Type 2 diabetes is far more common than type 1. In the UK, around 90% of all adults with diabetes have type 2.

There are 4.7 million people living with diabetes in the UK. That’s more than one in 15 people in the UK who has diabetes (diagnosed or undiagnosed).

This figure has nearly trebled since 1996, when there were 1.4 million. By 2025, it is estimated that 5 million people will have diabetes in the UK.


Type 2 diabetes is far more common than type 1. In the UK, around 90% of all adults with diabetes have type 2.

There are 4.7 million people living with diabetes in the UK. That’s more than one in 15 people in the UK who has diabetes (diagnosed or undiagnosed).

This figure has nearly trebled since 1996, when there were 1.4 million. By 2025, it is estimated that 5 million people will have diabetes in the UK.


There are 4.7 million people living with diabetes in the UK. That’s more than one in 15 people in the UK who has diabetes (diagnosed or undiagnosed).

This figure has nearly trebled since 1996, when there were 1.4 million. By 2025, it is estimated that 5 million people will have diabetes in the UK.

Symptoms

The main symptoms of diabetes are:

feeling very thirsty urinating more frequently than usual, particularly at night feeling very tired weight loss and loss of muscle bulk itching around the penis or vagina, or frequent episodes of thrush cuts or wounds that heal slowly blurred vision

Type 1 diabetes can develop quickly over a few hours or even days.

Many people have type 2 diabetes for years without realising because the early symptoms tend to be general.

Causes

The amount of glucose in the blood is controlled by a hormone called insulin, which is produced by the pancreas (a gland behind the stomach).

When food is digested and enters your bloodstream, insulin moves glucose out of the blood and into cells, where it’s broken down to produce energy.

However, if you have diabetes, your body is unable to break down glucose into energy. This is because there’s either not enough insulin to move the glucose, or the insulin produced doesn’t work properly.

Type 1 diabetes

In type 1 diabetes, the body’s immune system attacks and destroys the cells that produce insulin. As insulin production decreases until no more is produced, your glucose levels increase, which can seriously damage the body’s organs.

Type 1 diabetes usually develops before the age of 40, often during the teenage years.

Type 1 diabetes is less common than type 2 diabetes. In the UK, it affects about 10% of all adults with diabetes.

If you’re diagnosed with type 1 diabetes, you’ll need insulin injections for the rest of your life.

You’ll also need to pay close attention to certain aspects of your lifestyle and health to ensure your blood glucose levels stay balanced.

For example, you’ll need to eat healthily, take regular exercise and carry out regular blood tests.

Read more about living with type 1 diabetes

Type 2 diabetes

Type 2 diabetes is where the body doesn’t produce enough insulin, or the body’s cells don’t react to insulin. This is known as insulin resistance.

If you’re diagnosed with type 2 diabetes, you may be able to control your symptoms simply by eating a healthy diet, exercising regularly, and monitoring your blood glucose levels.

However, as type 2 diabetes is a progressive condition, you may eventually need medication, usually in the form of tablets.

Type 2 diabetes is often associated with obesity. Obesity-related diabetes is sometimes referred to as maturity-onset diabetes because it’s more common in older people.

Read more about living with type 2 diabetes

Treatments

You should therefore visit your GP as soon as possible if you have symptoms, such as feeling thirsty, passing urine more often than usual, and feeling tired all the time.

It’s also advised to see your GP if you have risk factors of diabetes and are worried about developing diabetes in future.

Diarrhoea
of stomach liver and gastrointestinal tract

It affects most people from time to time and is usually nothing to worry about. It can be distressing and unpleasant. It normally clears up in a few days to a week. 





Phone 999 or got to A&E if you or your child: might have swallowed something poisonous  have a stiff neck and pain when looking at bright lights have a sudden, severe headache or stomach ache 

Speak to your GP if: You or your child has diarrhoea and:  it’s particularly frequent or severe it lasts for more than 7 days  you’re concerned  poo with blood on it  persistent vomiting and are unable to keep fluid down a severe or continuous stomach ache  weight loss have passed a large amount of very watery diarrhoea  it occurs at night and is disturbing sleep have recently taken antibiotics or been treated in hospital have signs of dehydration – including drowsiness, peeing less than usual, and feeling lightheaded or dizzy have poo that’s dark or black – this may be a sign of bleeding inside your stomach  Your child:  has had 6 or more episodes of diarrhoea in the past 24 hours  has diarrhoea and vomiting at the same time has stopped drinking fluids while they’re ill is a baby and has vomited 3 times or more in the past 24 hours  is under 12 months with diarrhoea and you’re worried If your GP is closed, phone 111.

Symptoms

Phone 999 or got to A&E if you or your child: might have swallowed something poisonous  have a stiff neck and pain when looking at bright lights have a sudden, severe headache or stomach ache 

Speak to your GP if: You or your child has diarrhoea and:  it’s particularly frequent or severe it lasts for more than 7 days  you’re concerned  poo with blood on it  persistent vomiting and are unable to keep fluid down a severe or continuous stomach ache  weight loss have passed a large amount of very watery diarrhoea  it occurs at night and is disturbing sleep have recently taken antibiotics or been treated in hospital have signs of dehydration – including drowsiness, peeing less than usual, and feeling lightheaded or dizzy have poo that’s dark or black – this may be a sign of bleeding inside your stomach  Your child:  has had 6 or more episodes of diarrhoea in the past 24 hours  has diarrhoea and vomiting at the same time has stopped drinking fluids while they’re ill is a baby and has vomited 3 times or more in the past 24 hours  is under 12 months with diarrhoea and you’re worried If your GP is closed, phone 111.

Causes

There are many different causes of diarrhoea. A bowel infection (gastroenteritis) is a common cause in both adults and children. 

Gastroenteritis can be caused by: 

a virus – such as norovirus or rotavirus  bacteria – such as campylobacter and Escherichia (E. coli), which are often picked up from contaminated food  a parasite – such as the parasite that causes giardiasis, which is spread in contaminated water 

These infections can sometimes be caught during travelling abroad, particularly to areas with poor standards of public hygiene. This is known as travellers’ diarrhoea. 

Diarrhoea can also be the result of anxiety, a food allergy, medication, or a long-term condition, such as irritable bowel syndrome (IBS).

Preventions

Diarrhoea is often caused by an infection. You can reduce your risk by making sure you maintain high standards of hygiene.

Do wash your hands thoroughly with soap and warm water after going to the toilet and before eating or preparing foodclean the toilet, including the handle and the seat, with disinfectant after each episode of diarrhoea avoid sharing towels, flannels, cutlery, or utensils with other household membersavoid potentially unsafe tap water and undercooked food when travelling abroad

Discoid eczema
of skin hair and nails

Discoid eczema is a long-term skin condition that causes skin to become itchy, reddened, swollen and cracked in circular or oval patches.

It’s also known as discoid dermatitis.

The patches can be a few millimetres to a few centimetres in size and can affect any part of the body, although they don’t usually affect the face or scalp.

The patches are often swollen, blistered (covered with small fluid-filled pockets) and ooze fluid at first, but become dry, crusty, cracked and flaky over time.

The patches may clear up on their own eventually, but this can take weeks, months or even years if not treated, and they can recur.

Read more about the symptoms of discoid eczema.

Discoid eczema caused the skin to become dry, red and itchy. The rash is circular or oval shape.Source: https://dermnetnz.org/

Discoid eczema can appear as swollen and blistered patches.Source: https://dermnetnz.org/

Symptoms

Discoid eczema causes distinctive circular or oval patches of eczema.

The patches can appear anywhere on the body, including the:

lower legs forearms trunk (torso) hands feet

The face and scalp are not normally affected.

The first sign of discoid eczema is usually a group of small red spots or bumps on the skin. These then quickly join up to form larger pink, red or brown patches that can range from a few millimetres to several centimetres in size.

Initially, these patches are often swollen, blistered (covered with small fluid-filled pockets) and ooze fluid. They also tend to be very itchy, particularly at night.

Over time, the patches may become dry, crusty, cracked and flaky. The centre of the patch also sometimes clears, leaving a ring of discoloured skin that can be mistaken for ringworm.

You may just have one patch of discoid eczema, but most people have several patches. The skin between the patches is often dry.

Patches of discoid eczema can last for weeks, months or even years if not treated, and they can keeping recurring – often in the same area that was affected previously.

Occasionally, areas of skin affected by discoid eczema can be left permanently discoloured after the condition has cleared up.

Discoid eczema can occur anywhere on the body, including the ankles.Source: https://dermnetnz.org/

Causes

The cause of discoid eczema is unknown, although it is often accompanied by dry skin and is thought to be triggered by irritation of the skin.

Discoid eczema tends to affect adults and is rare in children. It is more common among men aged from 50 to 70 and women in their teens or twenties.

Some people with discoid eczema may also have other types of eczema, such as atopic eczema.

Read more about the causes of discoid eczema.


The cause of discoid eczema is unknown, although it may occur as a result of having particularly dry skin.

Dry skin means your skin cannot provide an effective barrier against substances that come into contact with it, which could allow a previously harmless substance, such as soap, to irritate (damage) your skin.

It’s important to look carefully at all the chemicals in cosmetics and toiletries that may have come into contact with your skin.

Contact dermatitis, a type of eczema caused by coming into contact with a particular irritant, may therefore have a role in discoid eczema.

Some people with discoid eczema also have a history of atopic eczema, which often occurs in people who are prone to asthma and hay fever. However, unlike atopic eczema, discoid eczema does not seem to run in families.

Treatments

Discoid eczema is usually a long-term problem, but medications are available to help relieve the symptoms and keep the condition under control.

Treatments used include:

emollients – moisturisers applied to the skin to stop it becoming dry topical corticosteroids – ointments and creams applied to the skin that can help relieve severe symptoms antihistamines – medications that can reduce itching and help you sleep better

There are also things you can do yourself to help, such as avoiding all the irritating chemicals in soaps, detergents, bubble baths and shower gels.

Additional medication can be prescribed if your eczema is infected or particularly severe.

Read more about treating discoid eczema.


You should see your GP or pharmacist if you think you may have discoid eczema, as the condition can take a long time to improve without treatment and it may keep recurring.

You should also seek medical advice if you think your skin may be infected, as you may need to use antibiotic cream or, in very severe cases, take antibiotics tablets.

Read more about diagnosing discoid eczema.


There is no simple cure for discoid eczema, but there are medications that can help ease the symptoms.

These include:

emollients – to use all the time soap substitutes – to replace irritating soaps and cleaning products topical corticosteroids – for flare-ups oral corticosteroids – for severe flare-ups antibiotics – for infected eczema antihistamines – for severe itching

There are many different preparations for each type of medication and it is worth taking time with your pharmacist to find the best one for you.

A range of emollient products, soap substitutes and some topical corticosteroids can be bought from pharmacies without a prescription. Some of them are cheaper to buy this way than with a prescription.

Ask your pharmacist for advice on the different products and how to use them. See your GP if your eczema does not improve after using an over-the-counter preparation.


If the treatments prescribed by your GP are not successfully controlling your symptoms, they may refer you for assessment and treatment by a dermatologist (specialist in treating skin conditions).

Further treatments that may be available from your dermatologist include:

phototherapy – where the affected area of skin is exposed to ultraviolet (UV) light to help reduce inflammation bandaging – where medicated dressings are applied to your skin immunosuppressant therapy – medicines that reduce inflammation by suppressing your immune system

Diverticular disease and diverticulitis
of stomach liver and gastrointestinal tract

Diverticular disease and diverticulitis are related digestive conditions that affect the large intestine (colon).

In diverticular disease, small bulges or pockets (diverticula) develop in the lining of the intestine. Diverticulitis is when these pockets become inflamed or infected.

Symptoms of diverticular disease include:

lower abdominal pain feeling bloated

The majority of people with diverticula will not have any symptoms; this is known as diverticulosis.

Symptoms of diverticulitis tend to be more serious and include:

more severe abdominal pain, especially on the left side high temperature (fever) of 38C (100.4F) or above diarrhoea or frequent bowel movements

Read more about the symptoms of diverticular disease and diverticulitis.

Symptoms

Symptoms of diverticular disease and diverticulitis include abdominal pain, bloating and a change in normal bowel habits.

Causes

Diverticular disease is caused by small bulges in the large intestine (diverticula) developing and becoming inflamed. If any of the diverticula become infected, this leads to symptoms of diverticulitis.

The exact reason why diverticula develop is not known, but they are associated with not eating enough fibre.

Fibre makes your stools softer and larger, so less pressure is needed by your large intestine to push them out of your body.

The pressure of moving hard, small pieces of stools through your large intestine creates weak spots in the outside layer of muscle. This allows the inner layer (mucosa) to squeeze through these weak spots, creating the diverticula.

There is currently no clinical evidence to fully prove the link between fibre and diverticula. However, diverticular disease and diverticulitis are both much more common in Western countries, where many people do not eat enough fibre.

Diagnoses

Diverticular disease can be difficult to diagnose from the symptoms, alone because there are other conditions that cause similar symptoms, such as irritable bowel syndrome (IBS).

As a first step, your GP may recommend blood tests to rule out other conditions such as coeliac disease (a condition caused by an abnormal immune response to gluten) or bowel cancer.

In some cases, you may be offered treatment for IBS and diverticular disease at the same time.

Colonoscopy

To make sure there is not a more serious cause of your symptoms, your GP may refer you for a colonoscopy, where a thin tube with a camera at the end (a colonoscope) is inserted into your rectum and guided into your colon. Before the procedure begins, you will be given a laxative to clear out your bowels.

A colonoscopy is not usually painful, but it can feel uncomfortable. You may be offered painkilling medication and a sedative beforehand to make you feel more relaxed and help reduce any discomfort.

CT pneumocolon or colonography

Another technique for confirming the presence of diverticula is a computerised tomography (CT scan). A CT scan uses X-rays and a computer to create detailed images of the inside of the body.

As with a colonoscopy, you will be given a laxative to clear out your bowels before you have the CT scan.

Unlike a regular CT scan, the colonography scan involves a tube being inserted into your rectum, which is used to pump some air up into your rectum. The CT scan is then taken with you lying on your front, and again lying on your back.

You may need to have an injection of contrast dye before the scan, but this is not always necessary.


If the infection has badly scarred your large intestine, it may become partially or totally blocked. A totally blocked large intestine is a medical emergency because the tissue of your large intestine will start to decay and eventually split, leading to peritonitis.

A partially blocked large intestine is not as urgent, but treatment is still needed. If left untreated, it will affect your ability to digest food and cause you considerable pain.

Intestinal blockage from diverticular disease is very rare. Other causes, such as cancer, are more common. This is one of the reasons your GP will investigate your symptoms.

In some cases, the blocked part can be removed during surgery.

However, if the scarring and blockage is more extensive, a temporary or permanent colostomy may be needed.

Treatments

A high-fibre diet can often ease symptoms of diverticular disease, and paracetamol can be used to relieve pain – other painkillers such as aspirin or ibuprofen are not recommended for regular use, as they can cause stomach upsets. Speak to your GP if paracetamol alone is not working.

Mild diverticulitis can usually be treated at home with antibiotics prescribed by your GP. More serious cases may need hospital treatment to prevent and treat complications.

Surgery to remove the affected section of the intestine is sometimes recommended if there have been serious complications, although this is rare.

Read more about treating diverticular disease and diverticulitis.


Contact your GP as soon as possible if you think you have symptoms of diverticulitis.

If you have symptoms of diverticular disease and the condition has previously been diagnosed, you do not usually need to contact your GP as the symptoms can be treated at home. 

Read more about the treatment of diverticular disease.

If you have not been diagnosed with the condition, contact your GP so they can rule out other conditions with similar symptoms, such as:

a stomach ulcer pancreatitis cholecystitis bowel cancer

Irritable bowel syndrome (IBS) can also cause similar symptoms to diverticular disease.


Treatment options for diverticular disease and diverticulitis depend on how severe your symptoms are.

Preventions

Eating a high-fibre diet may help prevent diverticular disease, and should improve your symptoms.

Your diet should be balanced and include at least 5 portions of fruit and vegetables a day, plus whole grains. Adults should aim to eat 18g (0.6oz) to 30g (1.05oz) of fibre a day, depending on their height and weight. Your GP can provide a more specific target, based on your individual height and weight.

It’s recommended that you gradually increase your fibre intake over the course of a few weeks. This will help prevent side effects associated with a high-fibre diet, such as bloating and flatulence (wind). Drinking plenty of fluids will also help prevent side effects.

If you have established diverticular disease, it may be suggested that you avoid eating nuts, corn and seeds due to the possibility that they could block the diverticular openings and cause diverticulitis. People usually find out themselves if these foods cause symptoms. Probiotics have also been recommended, but evidence is lacking. Overall, there is a lack of good quality scientific evidence on how to prevent diverticular disease.

Complications

Complications of diverticulitis affect 1 in 5 people with the condition. Those most at risk are aged under 50.

Dizziness (lightheadedness)
of brain nerves and spinal cord

The term “dizziness” means different things to different people – some use it to describe feeling lightheaded or off balance, while others use it to describe a feeling that their surroundings are spinning.

Because the symptom is quite vague and can be caused by a wide range of things, it may not always be easy to identify the underlying cause.

This page explains what you should do if you feel dizzy for no apparent reason, and outlines the most common causes.


Because the symptom is quite vague and can be caused by a wide range of things, it may not always be easy to identify the underlying cause.

This page explains what you should do if you feel dizzy for no apparent reason, and outlines the most common causes.


This page explains what you should do if you feel dizzy for no apparent reason, and outlines the most common causes.

Symptoms

The term “dizziness” means different things to different people – some use it to describe feeling lightheaded or off balance, while others use it to describe a feeling that their surroundings are spinning.

Because the symptom is quite vague and can be caused by a wide range of things, it may not always be easy to identify the underlying cause.

This page explains what you should do if you feel dizzy for no apparent reason, and outlines the most common causes.


This page explains what you should do if you feel dizzy for no apparent reason, and outlines the most common causes.

Causes

The most common causes of dizziness are:

labyrinthitis – an inner ear infection that affects your hearing and balance, and can lead to a severe form of dizziness called vertigo migraine – dizziness may come on before or after the headache, or even without the headache stress or anxiety – particularly if you tend to hyperventilate (breathe abnormally quickly when resting) low blood sugar level (hypoglycaemia) – which is usually seen in people with diabetes postural hypotension – a sudden fall in blood pressure when you suddenly sit or stand up, which goes away after lying down. This is more common in older people dehydration or heat exhaustion – dehydration could be due to not drinking enough during exercise, or illness that causes vomiting, diarrhoea or fever vertebrobasilar insufficiency – decreased blood flow in the back of the brain, which may be caused by the blood vessels that lead to the brain from the heart being blocked (known as atherosclerosis)


Less common causes of dizziness include:

having a severe illness or condition that affects the whole body using recreational drugs or consuming excessive amounts of alcohol (either binge drinking or long-term alcohol misuse) certain types of prescription medicine – such as antidepressants or blood pressure medication having a heart rhythm problem – such as atrial fibrillation (a fast, irregular heartbeat) carbon monoxide poisoning

Treatments

Speak to your GP if you: are feeling lightheaded or off balance have fainting episodes  experience headaches

Your GP will want to establish exactly what you mean by dizziness, and check that you’re not actually describing vertigo – a severe type of dizziness, where you feel your surroundings are spinning or moving.

They’ll also want to know:

whether the dizziness started for no apparent reason, or if it followed an illness whether you have repeated episodes of dizziness and, if so, when you tend to experience these how long the dizziness lasts

Dizziness can sometimes be caused by an ear condition. A simple way of distinguishing between ear-related dizziness and dizziness due to other causes is to determine whether it occurs only when you’re upright or also when you’re lying down.

If feeling dizzy occurs when you’re upright is probably not related to the ear. Dizziness that happens when you’re lying down is usually caused by a viral ear infection, which can’t be treated with antibiotics.

It’s a good idea to keep a diary recording when and where you experience dizziness and take it with you to your GP appointment. It’s helpful to note:

what you were doing at the time you felt dizzy how long it lasted and how bad it was whether you had any other symptoms – such as fainting, vomiting, nausea, blurred vision, headache, hearing loss or tinnitus

If you’re taking prescription medicine, your GP will probably review this to check whether dizziness is a possible side effect. If necessary, they can prescribe a different medication for you to try.

You may be referred to a specialist for further tests and investigations.

Down’s syndrome
of

People with Down’s syndrome may lead active, healthy and independent lives into their 60s, 70s and beyond.

Most will have mild to moderate learning disabilities and some may have more complex needs.

It cannot be known before birth if a person will need any additional help and support.


Most will have mild to moderate learning disabilities and some may have more complex needs.

It cannot be known before birth if a person will need any additional help and support.


It cannot be known before birth if a person will need any additional help and support.

Dry mouth
of mouth

Contact your dentist or GP if: You have a dry mouth and: your mouth is still dry after trying home or pharmacy treatments for a few weeks you have difficulty chewing, swallowing or talking you’re struggling to eat regularly you’re having problems with your sense of taste that are not going away your mouth is painful, red, swollen or bleeding you have sore white patches in your mouth you think a prescribed medicine might be causing your dry mouth you have other symptoms, like needing to pee a lot or dry eyes

The GP can check what the cause might be and recommend treatment for it.



This is often the result of dehydration. This means you do not have enough fluid in your body to produce the saliva you need. It’s also common for your mouth to become dry if you’re feeling anxious or nervous.

A dry mouth can sometimes be caused by an underlying problem or medical condition, such as:

medication – many different medications can cause a dry mouth including antidepressants, antihistamines and diuretics a blocked nose – breathing through your mouth while you sleep can cause it to dry out diabetes – a lifelong condition that causes a person’s blood sugar level to become too high radiotherapy to the head and neck – this can cause the salivary glands to become inflamed (mucositis) Sjögren’s syndrome – a condition where the immune system attacks and damages the salivary glands

If you contact your dentist or GP, tell them about any other symptoms you’re experiencing. Also tell them about any treatments you’re having. This will help them work out why your mouth is dry.

Symptoms

If medication is suspected as a cause, for example, your doctor may lower your dose or suggest trying a different treatment.

Some of the conditions mentioned have specific treatments, like:

nasal decongestants for a blocked nose insulin for diabetes

Things to try yourself

There are things you can do to help relieve your symptoms.

Do drink plenty of cold water – take regular sips during the day and keep some water by your bed at night suck on ice cubes or ice lollies sip on cold unsweetened drinks chew sugar-free gum or suck on sugar-free sweets use lip balm if your lips are also dry brush your teeth twice a day and use alcohol-free mouthwash – you’re more likely to get tooth decay if you have a dry mouth

Don’t do not drink lots of alcohol, caffeine (such as tea and coffee) or fizzy drinks do not eat foods that are acidic (like lemons), spicy, salty or sugary do not smoke do not sleep with dentures in do not use acidic artificial saliva products if you have your own teeth do not stop taking a prescribed medicine without getting medical advice first – even if you think it might be causing your symptoms


Do drink plenty of cold water – take regular sips during the day and keep some water by your bed at night suck on ice cubes or ice lollies sip on cold unsweetened drinks chew sugar-free gum or suck on sugar-free sweets use lip balm if your lips are also dry brush your teeth twice a day and use alcohol-free mouthwash – you’re more likely to get tooth decay if you have a dry mouth

Don’t do not drink lots of alcohol, caffeine (such as tea and coffee) or fizzy drinks do not eat foods that are acidic (like lemons), spicy, salty or sugary do not smoke do not sleep with dentures in do not use acidic artificial saliva products if you have your own teeth do not stop taking a prescribed medicine without getting medical advice first – even if you think it might be causing your symptoms

Causes

A dry mouth can happen when the salivary glands in your mouth do not produce enough saliva.

This is often the result of dehydration. This means you do not have enough fluid in your body to produce the saliva you need. It’s also common for your mouth to become dry if you’re feeling anxious or nervous.

A dry mouth can sometimes be caused by an underlying problem or medical condition, such as:

medication – many different medications can cause a dry mouth including antidepressants, antihistamines and diuretics a blocked nose – breathing through your mouth while you sleep can cause it to dry out diabetes – a lifelong condition that causes a person’s blood sugar level to become too high radiotherapy to the head and neck – this can cause the salivary glands to become inflamed (mucositis) Sjögren’s syndrome – a condition where the immune system attacks and damages the salivary glands

If you contact your dentist or GP, tell them about any other symptoms you’re experiencing. Also tell them about any treatments you’re having. This will help them work out why your mouth is dry.


Saliva plays an important role in keeping your mouth healthy. If you have a dry mouth, you may experience some other problems, such as:

a burning sensation or soreness in your mouth dry lips bad breath (halitosis) a reduced or altered sense of taste mouth infections that keep coming back, such as oral thrush tooth decay and gum disease difficulty speaking, eating or swallowing

It’s important to maintain good oral hygiene if you have a dry mouth. This can reduce the risk of dental problems. You should also see a dentist regularly, so they can identify and treat any problems early on.

Treatments

If your doctor or dentist is able to find out what’s causing your dry mouth, treating this may help your symptoms.

If medication is suspected as a cause, for example, your doctor may lower your dose or suggest trying a different treatment.

Some of the conditions mentioned have specific treatments, like:

nasal decongestants for a blocked nose insulin for diabetes

Things to try yourself

There are things you can do to help relieve your symptoms.

Do drink plenty of cold water – take regular sips during the day and keep some water by your bed at night suck on ice cubes or ice lollies sip on cold unsweetened drinks chew sugar-free gum or suck on sugar-free sweets use lip balm if your lips are also dry brush your teeth twice a day and use alcohol-free mouthwash – you’re more likely to get tooth decay if you have a dry mouth

Don’t do not drink lots of alcohol, caffeine (such as tea and coffee) or fizzy drinks do not eat foods that are acidic (like lemons), spicy, salty or sugary do not smoke do not sleep with dentures in do not use acidic artificial saliva products if you have your own teeth do not stop taking a prescribed medicine without getting medical advice first – even if you think it might be causing your symptoms

Dysphagia (swallowing problems)
of stomach liver and gastrointestinal tract

Dysphagia is the medical term for swallowing difficulties.

Some people with dysphagia have problems swallowing certain foods or liquids, while others can’t swallow at all.

Other signs of dysphagia include:

coughing or choking when eating or drinking bringing food back up, sometimes through the nose a sensation that food is stuck in your throat or chest persistent drooling of saliva 

Over time, dysphagia can also cause symptoms such as weight loss and repeated chest infections.

You should see your GP if you have swallowing difficulties.

Causes

Dysphagia is usually caused by another health condition, such as:

a condition that affects the nervous system, such as a stroke, head injury, or dementia cancer – such as mouth cancer or oesophageal cancer  gastro-oesophageal reflux disease (GORD) – where stomach acid leaks back up into the oesophagus

Dysphagia can also occur in children as the result of a developmental or learning disability.

Dysphagia can be caused by problems with the:

mouth or throat, known as oropharyngeal or ‘high’ dysphagia oesophagus (the tube that carries food from your mouth to your stomach), known as oesophageal or ‘low’ dysphagia

Read more about the causes of dysphagia.


As swallowing is a complex process, there are many reasons why dysphagia can develop.


The nervous system is made up of the brain, nerves and spinal cord. Damage to the nervous system can interfere with the nerves responsible for starting and controlling swallowing. This can lead to dysphagia.

Some neurological causes of dysphagia include:

a stroke  neurological conditions that cause damage to the brain and nervous system over time, including Parkinson’s disease, multiple sclerosis, dementia, and motor neurone disease brain tumours myasthenia gravis – a rare condition that causes your muscles to become weak


As you get older, the muscles used for swallowing can become weaker. This may explain why dysphagia is relatively common in elderly people. Treatment is available to help people with age-related dysphagia.

Chronic obstructive pulmonary disease (COPD) is a collection of lung conditions that make it difficult to breathe in and out properly. Breathing difficulties can sometimes affect your ability to swallow.

Dysphagia can also sometimes develop as a complication of head or neck surgery.

Diagnoses

See your GP if you’re having any difficulty swallowing. They’ll carry out an initial assessment and may refer you for further tests and treatment.

Tests will help determine whether your dysphagia is the result of a problem with your mouth or throat (oropharyngeal, or ‘high’ dysphagia), or your oesophagus, the tube that carries food from the mouth to the stomach (oesophageal, or ‘low’ dysphagia).

Diagnosing the specific type of dysphagia can make treatment more effective and reduce your chances of developing complications of dysphagia, such as choking or pneumonia.

Your GP will want to know:

how long you’ve had dysphagia whether your symptoms come and go, or are getting worse whether dysphagia has affected your ability to swallow solids, liquids, or both whether you’ve lost weight

Treatments

Treatment usually depends on the cause and type of dysphagia. The type of dysphagia you have can usually be diagnosed after testing your swallowing ability and examining your oesophagus.

Many cases of dysphagia can be improved with treatment, but a cure isn’t always possible. Treatments for dysphagia include:

speech and language therapy to learn new swallowing techniques  changing the consistency of food and liquids to make them safer to swallow alternative forms of feeding, such as tube feeding through the nose or stomach surgery to widen the narrowing of the oesophagus by stretching it or inserting a plastic or metal tube (known as a stent)

Read more about diagnosing dysphagia and treating dysphagia.


Most swallowing problems can be treated, although the treatment you receive will depend on the type of dysphagia you have.

Treatment will depend on whether your swallowing problem is in the mouth or throat (oropharyngeal, or ‘high’ dysphagia), or in the oesophagus (oesophageal, or ‘low’ dysphagia).

The cause of dysphagia is also considered when deciding on treatment. In some cases, treating the underlying cause, such as mouth cancer or oesophageal cancer, can help relieve swallowing problems.

Treatment for dysphagia may be managed by a group of specialists known as a multidisciplinary team (MDT). Your MDT may include a speech and language therapist (SLT), a surgeon, and a dietitian.

Complications

Dysphagia can sometimes lead to further problems. One of the most common problems is coughing or choking when food goes down the ‘wrong way’ and blocks your airway.

If this occurs frequently, you may avoid eating and drinking because you fear choking, which can lead to malnutrition and dehydration.

Some people with dysphagia have a tendency to develop chest infections, such as aspiration pneumonia, which require medical treatment.

Dysphagia can also affect your quality of life as it may prevent you enjoying meals and social occasions.

Read more about the complications of dysphagia.


The main complication of dysphagia is coughing and choking, which can lead to pneumonia.