While we all feel sad, moody or low from time to time, some people experience these feelings intensely, for long periods of time (weeks, months or even years) and sometimes without any apparent reason. Depression is more than just a low mood – it's a serious condition that has an impact on both physical and mental health.
Depression is common
In any one year, around one million people in Australia experience depression. One in five women and one in eight men will experience depression at some time in their life. The good news is that just like a physical illness, depression is treatable and effective treatments are available.
The sooner a person with depression seeks support, the sooner they can recover.
Symptoms of depression
Depression affects how people feel about themselves. They may lose interest in work, hobbies and doing things they normally enjoy. They may lack energy, have difficulty sleeping or sleep more than usual. Some people feel irritable, and some find it hard to concentrate. Depression makes it more difficult to manage from day to day.
A person may be depressed if for more than two weeks, they have felt sad, down or miserable most of the time or have lost interest or pleasure in most of their usual activities, and have also experienced several of the signs and symptoms across at least three of the categories in the list below.
It’s important to note, everyone experiences some of these symptoms from time to time – it may not necessarily mean a person is 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:
- lacking in confidence
Physical symptoms of depression
A person with depression may experience:
- being tired all the time
- feeling sick and ‘run down’
- headaches and muscle pains
- a churning gut
- sleep problems
- loss or change of appetite
- significant weight loss or gain.
Causes of depression
While the exact cause of depression isn’t known, a number of things can be associated with its development. Generally, depression does not result from a single event, but from a combination of recent events and other longer-term or personal factors.
Life events and depression
Research suggests that continuing difficulties, such as long-term unemployment, living in an abusive or uncaring relationship, long-term isolation or loneliness or prolonged exposure to stress at work are more likely to cause depression than recent life stressors. 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.
Personal factors that can lead to depression
Personal factors that can lead to a risk of depression include:
- Family history – depression can run in families and some people will be at an increased genetic risk. However, this doesn’t mean that a person will automatically experience depression if a parent or close relative has had the condition. Life circumstances and other personal factors are still likely to have an important influence.
- Personality – 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 conditions – can trigger depression in two ways. Serious conditions can bring about depression directly or can contribute to depression through the associated stress and worry, especially if it involves long-term management of a condition or chronic pain.
- Drug and alcohol use – can both lead to and result from depression. Many people with depression also have drug and alcohol problems.
Changes in the brain
Although there has been a lot of research in this complex area, there is still much that we do not know. Depression is not simply the result of a ‘chemical imbalance’, for example because a person has too much or not enough of a particular brain chemical.
Some factors that can lead to faulty mood regulation in the brain include:
- genetic vulnerability
- severe life stressors
- taking some medications, drugs and alcohol
- some medical conditions.
Most modern antidepressants have an effect on the 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 treatments can also help people to regulate their moods. Effective treatments can stimulate new growth of nerve cells in circuits that regulate mood, which is thought to play a critical part in recovery from the most severe episodes of depression.
Seek help for symptoms of depression
Depression is often not recognised and can go on for months or even years if left untreated. It’s important to seek support as early as possible, as the sooner a person gets treatment, the sooner they can recover.
Untreated depression can have many negative effects on a person’s life, including serious relationship and family problems, difficulty finding and holding down a job, and drug and alcohol problems.
There is no one proven way that people recover from depression. However, there is a range of effective treatments and health professionals who can help people on the road to recovery. There are also many things that people with depression can do for themselves to help them recover and stay well. The important thing is to find the right treatment and the right health professional for a person’s needs.
Types of depression
There are different types of depression. The symptoms for each can range from relatively minor (but still disabling) through to very severe.
Sometimes this is called major depressive disorder, clinical depression, unipolar depression or simply depression. It can involve low mood and loss of interest and pleasure in usual activities, as well as other symptoms such as those described above. The symptoms are experienced most days and last for at least two weeks. The symptoms interfere with all areas of a person’s life, including work and social relationships. Depression can be described as mild, moderate or severe; or melancholic or psychotic.
This is the term used to describe a severe form of depression where many of the physical symptoms of depression are present. For example, one of the major changes is that the person can be observed to move more slowly. The person is also more likely to have a depressed mood that is characterised by complete loss of pleasure in everything or almost everything.
Sometimes, people with a depressive condition can lose touch with reality. This can involve hallucinations (seeing or hearing things that are not there) or delusions (false beliefs that are not shared by others), such as believing they are bad or evil, or that they are being watched or followed. They can also be paranoid, feeling as though everyone is against them or that they are the cause of the condition 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). This time frame (the period covered by pregnancy and the first year after the baby’s birth) may also be referred to as the perinatal period.
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, affecting up to 80 per cent of women. The ‘baby blues’, or general stress of adjusting to pregnancy 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.
Up to one in 10 women will experience depression during pregnancy. This increases to one in seven in the first three months after having a baby.
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. The symptoms of mania are opposite to the symptoms of depression and can vary in intensity. They include:
- feeling great
- having plenty of energy
- racing thoughts
- little need for sleep
- talking fast
- having difficulty focusing on tasks
- 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 or delusions. A family history of bipolar disorder can increase a person’s risk of having bipolar disorder. Stress and conflict can trigger episodes for people with this condition and it is not uncommon for bipolar disorder to be misdiagnosed as depression, alcohol or drug abuse, attention deficit hyperactivity disorder (ADHD) or schizophrenia.
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 time, are less severe, and are not as regular, so they don’t fit the criteria of bipolar disorder or major depression.
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.
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 experience of SAD.
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 countries with short days and longer periods of darkness, such as the cold climate in the Northern Hemisphere.
Where to get help
- Your doctor
- Local community health centre
- beyondblue Support Service Tel. 1300 22 4636
- Lifeline Tel. 13 11 14
- Kids Helpline Tel. 1800 55 1800
- SuicideLine Tel. 1300 651 251
- SANE Australia Helpline Tel. 1800 18 SANE (7263)
- Australian Psychological Society – Find a psychologist service Tel. 1800 333 497(outside Melbourne) or (03) 8662 3300 (in Melbourne)
- mind Tel. 1300 AT MIND (286 463)
Things to remember
- Depression is common and treatable.
- It’s important to seek professional help as early as possible. The sooner people take action, the sooner they can recover.
- Everyone is different and it’s often a combination of factors that can contribute to a person developing depression.
- If you are concerned that you or someone you know is experiencing depression, please consult a doctor or other health professional.