Below Ambergate, the river flows through the town of Belper and the villages of Milford and Duffield, where it is joined by the River Ecclesbourne. It then enters the city of Derby near Darley Abbey and flows through the centre of the city. The river ends at Derwent Mouth, east of Shardlow, where it joins the River Trent at a height of above sea level; a total drop of . Its course meanders somewhat, especially in its lower reaches, adding to its apparent length of . Its waters ultimately reach the North Sea via the Humber Estuary.