Depression
If you think you might have depression, you’re not alone. Find out more about this common, treatable condition and what to do if you’re affected by it.
What is depression?
We all feel low or down at times, but if your negative emotions last a long time or feel very severe, you may have depression.
Depression is a mood disorder where you feel very down all the time. Depression can happen as a reaction to something like abuse, bullying or family breakdown, but it can also run in families.
Depression often develops alongside anxiety.
It’s not the same as manic depression, which is another term for bipolar disorder.
Depression is one of the most common types of mental illness. Although it’s hard to feel optimistic when you’re depressed, there is lots of support available to help you feel better.
Signs and symptoms
You may be depressed if, for more than two weeks, you’ve felt sad, down or miserable most of the time, or have lost interest or pleasure in usual activities, and have also experienced several of the signs and symptoms across at least three of the categories below.
It’s important to remember that we all experience some of these symptoms from time to time, and it may not necessarily mean you’re depressed. Equally, not everyone who is experiencing depression will have all of these symptoms.
Behaviour
- not going out anymore
- not getting things done at work/school
- withdrawing from close family and friends
- relying on alcohol and sedatives
- not doing usual enjoyable activities
- unable to concentrate
Feelings
- overwhelmed
- guilty
- irritable
- frustrated
- lacking in confidence
- unhappy
- indecisive
- disappointed
- miserable
- sad
Thoughts
- ‘I’m a failure.’
- ‘It’s my fault.’
- ‘Nothing good ever happens to me.’
- ‘I’m worthless.’
- ‘Life’s not worth living.’
- ‘People would be better off without me.’
Physical
- tired all the time
- sick and run down
- headaches and muscle pains
- churning gut
- sleep problems
- loss or change of appetite
- significant weight loss or gain
What causes depression?
While we don’t know exactly what causes depression, a number of things are often linked to its development. Depression usually results from a combination of recent events and other longer-term or personal factors, rather than one immediate issue or event.
Life events
Research suggests that continuing difficulties – long-term unemployment, living in an abusive or uncaring relationship, long-term isolation or loneliness, prolonged work stress – are more likely to cause depression than recent life stresses. However, recent events (such as losing your job) or a combination of events can ‘trigger’ depression if you’re already at risk because of previous bad experiences or personal factors.
Personal factors
- Family history – Depression can run in families and some people will be at an increased genetic risk. However, having a parent or close relative with depression doesn’t mean you’ll automatically have the same experience. Life circumstances and other personal factors are still likely to have an important influence.
- Personality – Some people may be more at risk of depression because of their personality, particularly if they have a tendency to worry a lot, have low self-esteem, are perfectionists, are sensitive to personal criticism, or are self-critical and negative.
- Serious medical illness – The stress and worry of coping with a serious illness can lead to depression, especially if you’re dealing with long-term management and/or chronic pain.
- Drug and alcohol use – Drug and alcohol use can both lead to and result from depression. Many people with depression also have drug and alcohol problems. Over 500,000 Australians will experience depression and a substance use disorder at the same time, at some point in their lives
Changes in the brain
Although there’s been a lot of research in this complex area, there’s still much we don’t know. Depression is not simply the result of a ‘chemical imbalance’, for example because you have too much or not enough of a particular brain chemical. It’s complicated, and there are multiple causes of major depression. Factors such as genetic vulnerability, severe life stressors, substances you may take (some medications, drugs and alcohol) and medical conditions can affect the way your brain regulates your moods.
Most modern antidepressants have an effect on your brain’s chemical transmitters (serotonin and noradrenaline), which relay messages between brain cells – this is thought to be how medications work for more severe depression. Psychological treatment can also help you to regulate your moods.
Effective treatment can stimulate the growth of new nerve cells in circuits that regulate your mood, which is thought to play a critical part in recovering from the most severe episodes of depression.
Remember
Everyone’s different and it’s often a combination of factors that can contribute to developing depression. It’s important to remember that you can’t always identify the cause of depression or change difficult circumstances.
The most important thing is to recognise the signs and symptoms and seek support.
Types of depression
There are different types of depressive disorders. Symptoms can range from relatively minor (but still disabling) through to very severe, so it’s helpful to be aware of the range of conditions and their specific symptoms.
Major depression
Major depression is sometimes called major depressive disorder, clinical depression, unipolar depression or simply ‘depression’. It involves low mood and/or loss of interest and pleasure in usual activities, as well as other symptoms. The symptoms are experienced most days and last for at least two weeks. Symptoms of depression interfere with all areas of a person’s life, including work and social relationships. Depression can be described as mild, moderate or severe; melancholic or psychotic (see below).
Melancholia
This is the term used to describe a severe form of depression where many of the physical symptoms of depression are present. One of the major changes is that the person starts to move more slowly. They’re also more likely to have a depressed mood that is characterised by complete loss of pleasure in everything, or almost everything.
Psychotic depression
Sometimes people with a depressive disorder can lose touch with reality and experience psychosis. This can involve hallucinations (seeing or hearing things that aren’t there) or delusions (false beliefs that aren’t shared by others), such as believing they are bad or evil, or that they’re being watched or followed. They can also be paranoid, feeling as though everyone is against them or that they are the cause of illness or bad events occurring around them.
Antenatal and postnatal depression
Women are at an increased risk of depression during pregnancy (known as the antenatal or prenatal period) and in the year following childbirth (known as the postnatal period). You may also come across the term ‘perinatal’, which describes the period covered by pregnancy and the first year after the baby’s birth.
The causes of depression at this time can be complex and are often the result of a combination of factors. In the days immediately following birth, many women experience the ‘baby blues’ which is a common condition related to hormonal changes and affects up to 80 per cent of women. The ‘baby blues’, or general stress adjusting to pregnancy and/or a new baby, are common experiences, but are different from depression. Depression is longer lasting and can affect not only the mother, but her relationship with her baby, the child’s development, the mother’s relationship with her partner and with other members of the family.
Almost 10 per cent of women will experience depression during pregnancy. This increases to 16 per cent in the first three months after having a baby.
Bipolar disorder
Bipolar disorder used to be known as ‘manic depression’ because the person experiences periods of depression and periods of mania, with periods of normal mood in between.
Mania is like the opposite of depression and can vary in intensity – symptoms include feeling great, having lots of energy, having racing thoughts and little need for sleep, talking quickly, having difficulty focusing on tasks, and feeling frustrated and irritable. This is not just a fleeting experience. Sometimes the person loses touch with reality and has episodes of psychosis. Experiencing psychosis involves hallucinations (seeing or hearing something that is not there) or having delusions (e.g. the person believing he or she has superpowers).
Bipolar disorder seems to be most closely linked to family history. Stress and conflict can trigger episodes for people with this condition and it’s not uncommon for bipolar disorder to be misdiagnosed as depression, alcohol or drug abuse, attention deficit hyperactivity disorder (ADHD) or schizophrenia.
Diagnosis depends on the person having had an episode of mania and, unless observed, this can be hard to pick. It is not uncommon for people to go for years before receiving an accurate diagnosis of bipolar disorder. If you’re experiencing highs and lows, it’s helpful to make this clear to your doctor or treating health professional. Bipolar disorder affects approximately 2 per cent of the population.
Cyclothymic disorder
Cyclothymic disorder is often described as a milder form of bipolar disorder. The person experiences chronic fluctuating moods over at least two years, involving periods of hypomania (a mild to moderate level of mania) and periods of depressive symptoms, with very short periods (no more than two months) of normality between. The duration of the symptoms are shorter, less severe and not as regular, and therefore don’t fit the criteria of bipolar disorder or major depression.
Dysthymic disorder
The symptoms of dysthymia are similar to those of major depression but are less severe. However, in the case of dysthymia, symptoms last longer. A person has to have this milder depression for more than two years to be diagnosed with dysthymia.
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