" All it takes is a beautiful fake smile to hide an injured soul and they will never notice how broken you truly are.
According to the Mental Health Foundation Depression is the predominant mental health problem world wide. Globally it was the second cause of years lived with a disability, and in 26 countries it was the primary driver of disability.
So what about the UK? Well, 19.7% of people in the UK aged 16+ showed symptoms of anxiety or depression (22.5% were females and males 16.8%).
The Mental Health Foundation also reports that 43.4% of adults think that they have had a diagnosable mental health condition at some point in their lives, yet the 2016 report states that 36.3% of those who self-identified as having a mental health condition have never been diagnosed by a professional.
Now this fascinated me. Why is that the case? Is it because that we are blind to the symptoms and signs of depression, and not recognising it in ourselves or others when it arises? Is it that we are ashamed to seek help? Perhaps we lack confidence that the help actually offered can alleviate our symptoms.
The truth is I don't know for sure, but what I can tell you with complete confidence is that there is a growing body of evidence showing us ways to help alleviate depression, and some clear signs that we can all look out for.
A Definition of Depression & Symptoms
Depression is a clinical medical mood disorder that impacts the way you feel, think and act. This can persist for weeks, months or years.
Some forms of depression can develop under specific circumstances, or present slightly different symptoms. Here are a few of the different types of depression
While some of the forms of depression mentioned above are conditions in their own right, lets explore the individual nature of each form.
Persistent depressive disorder
A depressed mood that lasts for at least two years or more. This form of depression is often characterised by major depression with periods of less severe symptoms.
Not to be confused with the "Baby blues" that women can experience after birth. Women with postpartum depression can experience full blown depression during pregnancy as well as after the birth.
Extreme sadness, exhaustion, and anxiety that these women experience, mean that they are unable to adequately care for not only the child, but themselves, on an emotional level, as well as ADL's (Activities of Daily Living).
This is when a person has depression accompanied by a form of psychosis. Whether this is a false fixed belief (delusion) or hearing or seeing upsetting things that others cannot hear or see (hallucinations). The themes of the delusions or hallucinations work to support the depression.
Seasonal Affective Disorder (SAD)
A form of depression linked to the winter months, lack of sunlight, and reduction in vitamin D uptake. This form of depression lifts during the spring and summer months, and increased vitamin D uptake. During the winter months, social withdrawal, increased sleep, and weight gain are often typical.
Premenstrual Dysphoric Disorder
Similar to PMS but differing in severity. It occurs 1 - 2 weeks prior to the start of a period and causes severe depression, irritability, panic attacks, mood swings, food cravings or binge eating, joint pain and inflammation. There are a host of other symptoms, which usually subside 2 - 3 days after a period starts.
While a medical condition in it's own right, Bipolar is characterised by periods of low moods (which meet the criteria for depression) often labelled Bipolar Depression. The difference being that a person with Bipolar also experiences a euphoric state or irritable moods. While this is not an exhaustive list of differences, it gives you an insight.
Clinical Considerations & Medical Management
Genetic and epigenetic factors can play a significant role, with modfications of genes interacting with each other and environmental factors to increase the potential for depression.
Then there is neurotransmitter synthesis. Two families of neurotransmitters that play an integral role
Insufficient intake (or excessive excretion) of amino acids, B Vitamins, Zinc, Magnesium, and Vitamin C can lead to a functional neurotransmitter deficiency.
The Gut-Brain Axis - beneficial gut bacteria metabolise glutamate into GABA, and influence serotonin signalling among other things.
Guilia Ender's book, GUT is worth checking out if you want to learn more, and practical things you can do to improve gut health.
The hyper-secretion of cortisol by the adrenal glands is common in the depressed state, and can lead to corticosteriod receptor signalling being impaired, impacting depression and adrenal fatigue.
Get the basics right - reduce stimulants and sugar intake, this includes alcohol, caffeine (and smoking)
Increase wholefood intake - increase your vegetables and your fruit intake (think 5/7 a day as your base level). Get adequate protein intake, the dietary reference intake (DRI) is a minimal of 0.8g of protein, however this can be inadequate if you are physically active, or ill and in a state of repair. The International Society of Sports Nutrition (ISSN) recommend 1.4 - 2.0g per kg of bodyweight per day for exercising individuals.
Omega 3 Fatty Acids - Have been shown to potentially decrease the symptoms of depression, this could be through regulation of inflammation and cell membrane function . Vegan sources of omega 3 fatty acids include algae oil.
Probiotics - particular strands such as Lactobacilli and Bifidobacterium metabolise glutamate into GABA and influence serotonin signalling . Serotonin is a chemical which contributes to a sense of wellbeing and happiness.
Zinc & Vitamin D - Have been shown to support neural growth in the brain, and significantly lower symptoms of depression . Supplementing with Vitamin D in the winter months, when exposure to sunlight is inadequate can prove beneficial. Food Sources of zinc include,
5 - HTP - is required so serotonin synthesis (your wellbeing and happiness chemical).
B Vitamins - are cofactors for nerutotransmitter synthesis and can reduce the risk of depression. Neruotransmitters are essentially chemicals that allow nerves and different parts of your brain to communicate effectively. This is not an exhaustive list, but food sources include,
Exercise has been shown to improve depression and mood 
Getting quality, consistent restful sleep has also been shown to improve mood. I'm sure you've noticed how irritable, short tempered or fatigued you feel when you don't get enough sleep.
Seeing a therapist or support group can also be useful. There are also mental health charities and organisations such as Mind, or The iAM Project which can assist you in different ways.
If you need to, get in touch with your doctor who may be able to point you in the direction of services you can use. Sometimes medication can be either a short term or long term solution to manage symptoms depending on your situation - there is no shame in that.
Getting out in nature has also been shown to be effective for reducing depression. The growing research field known as ecotherapy, has shown a strong connection between time spent in nature, and reduced stress, anxiety and depression 
I've personally found keeping a journal helps me to dump all the thoughts from my mind onto a page, so that my mind becomes less cluttered, I use the Mood Cards which I think are a great tool for writing, or even just sharing what's going on for you.
As challenging as it can be at times, and as much as we want to be alone, human contact can also help us. Our social, living or relationship situation can all impact our ability to manage our depression. Making small changes, over time can have a powerful impact.
I recently saw in a meme online that what people view as the causes of depression include,
You and I both know that this is just plain wrong. There are many factors from genetic, social, life circumstances, economic, cultural, and political systems that can lead to a person experiencing depression.
Depression is not personal failure, and there are things you can do to alleviate the symptoms. Remember that.
 Kraguljac et al. Efficacy of omega-3 fatty acids in mood disorders - a systematic review and meta-analysis. Psychopharmacol Bull. 2009; 42 (3): 39-54.
 Foster, McVey Neufeld. Gut-brain axis: how the microbiome influences anxiety and depression. Trends Neurosci. 2013; 36 (5): 305-12.
 Lai et al. The efficacy of zinc supplementation in depression: systematic review of randomised controlled trials. J Affect Disord. 2012; 136(1-2): e31-9.
Khoraminya et al. Therapeutic effects of vitamin D as adjunctive therapy to fluoxetine in patients with major depressive disorder. Aust N Z J Psychiatry. 2013; 47 (3): 271-5.
 Lynette L. Craft, Ph.D. and Frank M. Perna, Ed.D., Ph.D., The Benefits of Exercise for the Clinically Depressed,
 Harvard Health, July 2018, Sour mood getting you down Get Back To Nature: https://www.health.harvard.edu/mind-and-mood/sour-mood-getting-you-down-get-back-to-nature.