Depression

What Depression really means

Depression is more than feeling a little sad, it is a medical condition. It can have a devastating effect on the life of someone affected by it, depriving them of the ability to take pleasure or interest in things, making them feel cut off from the world and alienated from family and friends. Often, everything in life is seen in a negative way.

Once diagnosed, for the great majority of people Depression is a very treatable condition. Understanding that these symptoms may be signs of a medical condition which can be successfully treated, is a first big step in fighting back against Depression.

What causes Depression?

Depression may be caused by a number of factors. Research shows that some people are born with a genetic disposition to develop Depression. Stressful events, such as bereavement or the break up of a relationship, can also trigger depressive symptoms, especially where there is an underlying vulnerability.

How many people are affected?

Depression affects up to 20% of Australians at some stage in their lives. Around 6% of the population is affected by it every year – that’s close to one million people. Women are affected almost twice as commonly as men.

Teenagers and children

Teenagers and children can experience Depression. Symptoms may be difficult to distinguish sometimes from normal changes in mood, which occur in adolescence, or from worries about school or relationships.

Older people

Older people, too, can experience Depression. Symptoms may not be recognised, and assumed to be inevitable as ‘part of growing older’.

Whatever someone’s age, any concerns about Depression should be discussed with a GP, who can make an assessment and prescribe the best treatment to help the person.

What do people experience if they have Depression?

People who have experienced Depression describe it as feeling far away inside yourself; feeling as though your senses have been deadened, finding great difficulty doing things which used to be easy or enjoyable. Even something as straightforward as getting up in the morning and having a shower can seem impossibly challenging.

What are the symptoms of Depression?

It is natural to feel sadness in response to an unhappy event. People with Depression, however, experience a persistent feeling of misery, without reason, that lasts for at least two weeks and cannot be shaken.

Depression has a variety of symptoms and may affect people in different ways.

For no clear reason, a person may:

• feel extremely sad, anxious, agitated or tearful.
• have difficulty concentrating on simple tasks or making decisions.
• lose interest in things they usually enjoy; have no motivation and become withdrawn.
• move and talk slowly.
• sleep badly, or sleep excessively and still be tired.
• experience early morning waking.
• either lose or gain weight or lose interest in eating.
• lose sexual interest.
• think seriously about killing themselves; feel hopeless, guilty and that life is not worth living.
• worry, without reason, about physical complaints.

People’s individual experience of the above symptoms can vary from mild to severe.

One person can also experience depressive episodes of varying degrees at different times in life.

People with Depression often say that symptoms are especially strong in the morning, when it can also be very difficult to become motivated to do things – to ‘get the engine going’.

In some cases, Depression can be so severe, that the person experiences psychotic symptoms such as delusions and hallucinations. For further information, see the Psychosis guide.

Why Depression can be difficult to recognise

Faced with the symptoms of depression, many people assume they are due to some other cause, for example:

• Having a persistent ‘low’ mood or negative thoughts leads some people to think ‘that’s just how I am’ or ‘that’s how the world is’.
• Other people experience depression in association with symptoms such as aches and pains, digestive problems or headaches, and think there must be some physical cause.

Reluctance to seeking advice from a doctor

Symptoms may seem hard to describe. Fear of being shrugged off as ‘neurotic’ or not listened to, can make people reluctant to talk to a doctor, or to describe symptoms fully.

The stigma attached to having Depression can also discourage some people from seeking help. They may feel that admitting to having a mental illness is somehow shameful or labels them as a ‘failure’. This makes it all the more necessary to understand that depression is a medical condition, is no one’s fault, and – importantly – is treatable.

When Depression is present alongside another illness

Depression can sometimes be difficult to recognise when it is present at the same time as another illness.

People who experience chronic illness often become understandably depressed. This may be another mental illness such as schizophrenia or an anxiety disorder, or it may be a physical illness.

When the focus is on treating the known illness, symptoms of Depression may not be recognised by the doctor. It is essential that once identified, Depression is treated in its own right.

Other types of Depression

There are other forms of Depression:

Dysthymia

A less severe but more persistent form of Depression, that can last for many months or even for years.

Perinatal depression

Depression experienced by a parent during pregnancy or following the birth of a child.

Bipolar disorder

Depression is a feature of Bipolar disorder, in which a person experiences extreme moods – very ‘high’ and over-excited or very ‘low’ and depressed. Symptoms of Bipolar disorder can be helped by mood-stabilising medications as well as by antidepressants.

For further information, see Medication and other Treatments and also Bipolar disorder.

Seasonal affective disorder (SAD)

SAD is where people experience the symptoms of Depression only during certain seasons, especially autumn and winter.

The road to recovery

Once Depression is recognised and diagnosed, there is much that can be done to treat it, so we can start to get on with our lives again.

Understanding treatment means we’re in a better position to make sure we get the best treatment we can. The first major step is making an appointment to see a doctor.

Why do I need to see a doctor?

While it affects how we feel, Depression is a medical condition. As with other medical conditions, a doctor can make a diagnosis, prescribe treatment, monitor progress and refer to a specialist if necessary.

Help your doctor to help you

Help your doctor to help you by giving as much information as possible. We all know what it’s like to leave a doctor’s surgery and remember something we forgot to say. Make sure this doesn’t happen by writing down a list of key facts beforehand and taking it with you, for example:

• The exact symptoms concerning you.
• How long you have been experiencing the symptoms.
• Any events associated with the Depression.
• If your sleep or work are being affected.
• Any physical symptoms, or other illnesses for which you are being treated.

It is also useful to ask for a longer appointment, giving you both time to talk without pressure.

If you find your doctor is not very helpful, try to discuss this with them, and go to another doctor if necessary.

How do psychological treatments help?

For people with mild to moderate Depression, psychological therapy is often the most effective treatment, either alone or in combination with antidepressant medication. These therapies include Cognitive Behavioural Therapy (CBT) and Interpersonal Psychotherapy (IPT), among others.

For further information, see the ‘Psychological treatments’ section in the Medication and other Treatments guide.

Do I really need to take medication?

For most people, the most effective treatment for Depression is psychological therapy. However, antidepressant medication can also be helpful, either short-term, or sometimes on an ongoing basis.

How medication works

Medical research suggests that Depression seems to be often associated with neurotransmitters in the brain. Just as people with diabetes may need to take insulin, so people with Depression may need to take medication to reduce symptoms.

Antidepressants are effective for most people, although a few medications may need to be tried by the doctor to find the one which is most helpful.

Tell the doctor if you are taking other medications, and take the tablets exactly when the prescription describes. If you have any questions, ask the doctor or pharmacist.

See the Guide to Medication and other Treatments for more information about antidepressant medications.

Misconceptions about antidepressant medication

There are a number of misconceptions about antidepressant medication, which can unfortunately discourage some people from getting help in this way.

For example, some believe that antidepressants are addictive, that they are dangerous, or that they put you into an unreal ‘dreamy’ state.

The fact is that medications in the new generation of antidepressants are not addictive, are generally safer than older antidepressants, and are certainly not the ‘happy drugs’ often portrayed in the media – they simply help restore your mood back to normal.

How long does it take for antidepressants to take effect?

It usually takes a few weeks for antidepressant medication to have a beneficial effect, and this effect should increase over the following weeks.

You may experience some side-effects, such as a dry mouth or stomach upset – these are normal and show the medication is starting to have an effect.

Side-effects generally fade away with time. If they don’t, or are causing you concern, always tell the doctor so that action can be taken to deal with them.

What about herbal products?

Some people find herbal products, such as St John’s Wort (Hypericum perforatum), helpful for Depression. If you wish to take such products, remember that they have side-effects of their own and can interact dangerously with prescribed medications. Always consult with your doctor before taking them.

How does ECT (electroconvulsive therapy) help?

ECT can be a highly effective treatment for moderate to severe Depression where: other treatments have not helped, if the person has responded well to ECT in the past, or because they are at risk and a rapid response is required.

ECT (sometimes called ‘shock treatment’) is used more sensitively and effectively than in the past. It should be given only after the treatment has been fully explained to the person involved, and any questions have been satisfactorily answered.

ECT is generally given only with the person’s consent. If someone is extremely ill and their psychiatrist believes they are unable to give informed consent, then the psychiatrist can consent for them, with certain conditions.

What does ECT involve?

This form of treatment involves giving a general anaesthetic and muscle-relaxant, after which an electrical current is passed through the brain.

Any side-effects, such as headache or mild loss of memory, are usually temporary and pass after a while.

What other support is there?

There are other support services which offer help for people with Depression.

Community mental health services

Some people with Depression find it helpful to meet with others who have the same diagnosis, and had similar experiences – at support groups in their local area or online.

As well as overcoming isolation, this can be a useful way of sharing information about things that help, and getting together to advocate for improved services.

Other support services

In addition to community mental health services, there is a range of other support services which can help those who have been severely affected by mental illnesses, including Depression. This includes support with accommodation, psychosocial rehabilitation, recreation and employment, as well as support for family and other carers too.

Some States and Territories offer more of this type of support than others. Metropolitan areas also tend to have more services available than rural areas.

Enquire at the mental health service or council office about programs offered locally, and ask others what services they would recommend.

Related information:

• See the ‘Support in the community section’ in the Medication and other Treatments guide.
• For more information about services in your area, contact the SANE Helpline on 1800 18 SANE (7263).

Practical steps to help yourself

There are lots of things you can do to fight back against the symptoms of Depression.

Understanding makes all the difference

A good example of this is the flow of negative thoughts into the mind, a common feature of Depression. Sometimes we are hardly even conscious of these thoughts, which may cause us to feel that things will always turn out for the worst or that a task is completely beyond us.

Once we understand why this happens, however, we can start looking out for and tackling these thoughts. They are often unjustified or irrational. They are often negative about things that are just as likely to turn out well.

There are often alternative, more practical and positive ways of dealing with these concerns, which can be discussed with the treating doctor or other health professional.

Recognise the warning signs

Depression is often an episodic illness. This means we need to recognise our own early warning signs that an episode of Depression is coming on, so that we make sure we see a doctor promptly, for example:

• Are there certain thoughts or attitudes that start coming to mind when a period of Depression starts?
• Do we become more anxious and short-tempered?
• Are there physical symptoms which we recognise as occurring with Depression?
• If family or friends observe a change in us, take these concerns seriously and don’t dismiss them.

When you notice warning signs, don’t dwell on them and start worrying, take action and make an appointment to see a doctor so that an episode is averted or alleviated.

Get the best treatment and support you can

Unfortunately, not everyone affected by Depression recognises that they have a treatable medical condition and asks for help, not everyone receives the very best treatment and support they need either. This is especially the case in country areas, where services are thinner on the ground.

If symptoms persist and you feel you are not getting the best from your treatment, discuss what other options there are with your doctor, such as referral for psychological treatment or trying a different medication.

If you still feel that not everything is being done which could help, remember we are all entitled to consult a different doctor.

Keep stress at bay

Too much stress is not good for anyone. This is especially true for people who are susceptible to Depression. Learning to recognise and keep stress at bay can play an important part in avoiding depressive symptoms.

For further information on handling stress, please see the ‘Helping yourself’ section in the Medication and other Treatments guide.

Learn to relax

We all cope with stress better when we’re relaxed. We feel better able to cope with things and it’s easier to keep things in perspective. Yet many of us forget to make a space in our lives for relaxation.

Tips on how to relax:

• Get plenty of regular sleep – it’s essential for everyone.
• Think about things that help you to unwind and feel comfortable, then think about how often you actually do those things.
• Look after yourself by making regular times to relax, and don’t feel guilty about doing ‘nothing’ for a change. It might be taking a long bath before going to bed each night or setting a regular evening to go out and see a movie every week.

The main thing is to remember the principle that there are things which help you relax, so don’t forget to make them a regular part of your life.

Take a holistic view

Our mental and physical health is intimately bound together. Looking after your physical well-being is a good general rule, of course, but this is especially valuable for people with Depression.

For further information, please see Guide to Healthy Living for more suggestions.

Try to avoid negative thinking

Try to avoid getting carried away by negative ways of thinking, which are usually quite out of proportion or unrealistic when looked at objectively. The aim is to recognise that negative thinking is a symptom of Depression and not just ‘how things are’ – and then to discourage it from happening unconsciously and colouring how you view life.

Talk to your doctor or other health professional about strategies to do this, ask others with Depression what works for them, or contact SANE for details of programs or resources which may be helpful.

Keep in contact with others

Try to keep in contact with others – whether it’s by making an effort to stay in touch with family and friends, joining in conversations when you’re with other people, or simply by exchanging a few words with a shop-keeper when you go to buy a newspaper, for example. It’s natural that this might feel an effort at times, but you’ll feel better for having done so afterwards.

Pets

Having a pet can also be a positive sociable step. Taking a dog for a regular walk means you exercise and get to chat with other dog-owners. Dogs and cats can also be good company, they bring affection into our lives, and they’re good listeners too!

Tackling suicidal thoughts

It’s not uncommon for people to have thoughts about harming or even killing themselves when they are depressed. It’s very important to remember that such thoughts are just thoughts, and you do not have to act on them that they will pass and that you should talk to someone about them.

For further information, please see our guide to staying alive, which is specifically for helping anyone who has suicidal thoughts, their family and other carers, and those bereaved by suicide.

When someone experiences Depression, it’s not surprising that family and close friends are affected, making life difficult for them too.

A friend or family member of someone with Depression may be confused and frustrated at the person’s changed behaviour, they may:

• Become angry that the person won’t ‘get up and do something about it’ – even while knowing that low motivation is a major symptom of Depression.
• Feel resentment towards the person with the illness.
• Feel grief, fear and other emotions.
• Feel that they have caused the illness in some way; that they are not helping the person enough, or even that the illness is the fault of the person who has it.
• They are also likely to feel guilty about reacting in this way.

It is essential to realise that neither, the person with Depression, nor anyone else is to blame for it, and that a serious illness is bound to stir up strong emotions, which are best discussed openly rather than left ‘bottled up’.

How family and friends can be supported

Family and friends can feel isolated and helpless, as well as the person directly affected.

Learning about Depression

Along with the person affected, families and friends are also helped by learning about Depression in order to understand about the symptoms, about treatment and other things that help, and about how they can find as well as give support.

For further information, please see the Families guide.

Joining a mutual support group

It can be helpful for relatives and friends to join a mutual support group. This helps them to feel less isolated and means they can give each other support.

Some support groups also run education and training courses for carers.

For details of local support groups, ask the doctor or other treating health professional, or contact the SANE Helpline on 1800 18 SANE (7263).

SANE Forums provide a safe, moderated online space where people affected by mental illness, as well as family and others carers, can share information and advice and provide mutual support.

Support for children who have a parent with Depression

Having a parent with Depression can be confusing and even distressing for children. Emotional contact is especially important for the young, and Depression often affects how well we are able to relate and communicate our feelings to other people.

Children may need reassuring, therefore, that the parent with Depression has not changed how they feel towards them. If at all possible, the illness should be explained to the child by both parents, using words and concepts that they will find familiar and understand.

For more information for young people in families affected by mental illness, see Children of Parents with a Mental Illness (COPMI).

• Contact the SANE Helpline on 1800 18 SANE (7263).
• Information and advice for young people is available at reachout

In a crisis

If you or someone you know experiences a mental health crisis, it can be difficult for others to know what to do. See How to help in a crisis for advice on how to help.