Depression is a medical condition characterised by feelings of extreme sadness and dejection. It is not just feeling sad. There are different types and symptoms of depression. Early detection is important, as untreated depression can lead to suicide.
Everyone feels sad sometimes, particularly when faced with loss or grief, but depression is more than low mood and sadness at a loss. It is a serious medical illness. It is the result of chemical imbalances in the brain. A person with depression feels extremely sad, dejected and unmotivated.
Depression is common
One in four women and one in six men suffer from depression at some time in their life. Only about 20 per cent of people are correctly diagnosed, because depression can mask itself as a physical illness (like chronic pain, sleeplessness or fatigue).
Different types of depression exist, with symptoms ranging from relatively minor (but disabling) to very severe.
Symptoms of depression
You may be depressed if, for more than two weeks, you have felt sad, down or miserable most of the time, or have lost interest or pleasure in most of your usual activities, and if you have also experienced several of the symptoms across at least three of the groups of symptoms below.
Remember that everyone experiences some of these symptoms from time to time – it may not necessarily mean you are depressed. Equally, not every person who is experiencing depression will have all of these symptoms.
Behavioural symptoms of depression
A person with depression may:
- Have stopped going out
- Not be getting things done at work or school
- Be withdrawing from close family and friends
- Be relying on alcohol and sedatives
- Have stopped their usual enjoyable activities
- Be unable to concentrate.
Thoughts caused by depression
A person with depression may have thoughts such as:
- ‘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’.
Feelings caused by depression
A person with depression may feel:
Physical symptoms of depression
A person with depression may experience:
- Feeling sick and ‘run down’
- Headaches and muscle pains
- Churning gut
- Sleep problems
- Loss or change of appetite
- Significant weight loss or gain.
Causes of depression
Generally, depression does not result from a single event, but from a mix of recent events and other longer-term or personal factors, which cause chemical imbalances in the brain. These factors might include life events, family history, personality, serious medical illness, and drug and alcohol use.
You can’t always identify the cause of depression or change difficult circumstances. The most important thing is to recognise the symptoms and seek help.
Life events and depression
Continuing difficulties – such as long-term unemployment, living in an abusive or uncaring relationship, long-term isolation or loneliness, or prolonged stress at work – are more likely to cause depression than recent life stresses. However, recent events (such as losing a job) or a combination of events can trigger depression in people who are already at risk because of past bad experiences or personal factors.
Family history and depression
Depression can run in families, but this doesn’t mean a person will automatically experience depression if a close relative has had the illness. Other factors are still important.
Personality and depression
Some people may be more at risk because of their personality, particularly if they tend to worry a lot, have low self-esteem, are perfectionists, are sensitive to personal criticism, or are self-critical and negative.
Serious medical illness and depression
Serious illnesses can bring about depression directly or can contribute to depression through the associated stress and worry, especially if it involves long-term management of illness or chronic pain.
Drug and alcohol use and depression
Drug and alcohol use can lead to and result from depression. Many people with depression also have drug and alcohol problems.
Changes in the brain and depression
We do not fully understand what happens in a person’s brain to cause depression. Depression may be related to changes in certain chemicals that carry messages within the brain – particularly serotonin, norepinephrine and dopamine, the three main chemicals related to mood and motivation. Changes to stress-hormone levels may also play a part.
Research suggests that behaviour can affect brain chemistry – for example, long-term stress may cause changes in the brain that can lead to depression. Changes in brain chemistry have been more commonly associated with severe depression than with mild or moderate depression.
Seek help for symptoms of depression
If you experience some or most of the symptoms of depression, seek advice from a doctor or counsellor. Don’t delay. Tackling depression early can help you address problems quickly and stop symptoms becoming worse.
Depression is often not recognised and can go on for months or even years if left untreated. A range of treatments, health professionals and services is available, and there are many things that people can do to help themselves. Different types of depression require different treatment.
Types of depression
Different types of depression often have slightly different symptoms. The five main types of depression are:
- Major depressive disorder
- Bipolar disorder (used to be called ‘manic depression’)
- Cyclothymic disorder
- Seasonal affective disorder (SAD).
Sometimes this is called major depressive disorder, clinical depression, unipolar depression or simply depression. Symptoms can include:
- Low mood
- Loss of interest and pleasure in usual activities
- Significant sleep disturbance
- Loss of appetite
- Unexpected weight loss
- Loss of energy
- Feelings of guilt or worthlessness
- Suicidal thoughts.
A person with major depression will experience symptoms nearly every day for at least two weeks. Changes in lifestyle and attitude do not help. The symptoms interfere with all areas of a person’s life, including work and social relationships.
Major depression requires immediate professional help – it is a serious medical condition.
The term ‘melancholia’ describes a severe form of depression involving many of the physical symptoms of depression. For example, the person moves more slowly and is more likely to have depressed mood characterised by complete loss of pleasure in everything or almost everything.
Sometimes people with a depressive disorder can lose touch with reality. Psychosis can involve hallucinations (seeing or hearing things that are not there) or delusions (false beliefs that are not shared by other people). A person with psychotic depression may believe they are bad or evil, being watched or followed, or that everyone is against them (paranoia), or that they are the cause of illness or bad events occurring around them.
Antenatal and postnatal depression
Women are at higher risk of depression during pregnancy and in the year following childbirth. The causes of depression at this time can be complex. In the days immediately following birth, up to 80 per cent of women experience the ‘baby blues’ – a common condition related to hormonal changes – but this is 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 other members of the family. Almost 10 per cent of women will experience depression during pregnancy and 16 per cent in the first three months after having a baby.
Bipolar disorder used to be called ‘manic depression’ because the person experiences periods of depression and periods of mania. In between, there are periods of normal mood. Mania is like the opposite of depression and can vary in intensity – symptoms include feeling great, having plenty of energy, racing thoughts, little need for sleep, talking fast, 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. This involves hallucinations or delusions. Bipolar disorder seems to be most closely linked to family history. Stress and conflict can trigger episodes for people with this condition.
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 symptoms last for a shorter period of time, are less severe, and not as regular as those of bipolar disorder or major depression.
Dysthymia (or dysthmic disorder) has symptoms similar to major depression, but less severe. However, symptoms of dysthymia last longer than those of major depression. A person has to have this milder form of depression for more than two years to be diagnosed with dysthymia.
Seasonal affective disorder (SAD)
SAD is a mood disorder that has a seasonal pattern. The cause is unclear, but may be related to the variation in light exposure in different seasons. SAD is characterised by mood disturbances (either periods of depression or mania) that begin and end in a particular season. Depression in winter only is the most common.
SAD is usually diagnosed after the person has had the same symptoms during winter for two or more years. People with SAD are more likely to experience lack of energy, sleep too much, overeat, gain weight and crave carbohydrates. SAD is rare in Australia, and more likely to be found in places with short winter days such as Scandinavia.
Where to get help
- Your doctor
- Your local community health centre
- beyondblue Info Line, or to find a GP who specialises in mental health Tel. 1300 22 4636
- Lifeline Tel. 13 11 14
- Kids Helpline Tel. 1800 55 1800
- SuicideLine Tel. 1300 651 251
- SANE Mental Health Information Line Tel. 1800 18 7263, Monday to Friday, 9am to 5pm
- Australian Psychological Society – Find a Psychologist Service Tel. 1800 333 497
- AREFEMI (Association of Relatives and Friends of the Emotionally and Mentally Ill) Tel. (03) 9810 9300
Things to remember
- Depression is a constant feeling of dejection and loss, which stops you doing your normal activities.
- Different types of depression exist, with symptoms ranging from relatively minor (but disabling) to very severe.
- Generally, depression does not result from a single event, but from a mix of events and factors, which cause chemical imbalances in the brain.
- If you feel depressed, see your doctor for an assessment.
- Don’t delay. Tackle depression early to address problems quickly and stop symptoms becoming worse.
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Last reviewed: March 2013
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