Depression

What is depression?

  • Depression, also known as major depressive disorder or unipolar depressive disorder, is a very common and serious mood disorder.
  • It is characterised by many different feelings including sadness, despair, anxiety, guilt, lack of self-worth, hopelessness and emptiness.
  • Depression can overlap with other conditions, especially anxiety, which can make it difficult to diagnose.

How common is depression?

  • One in seven Australian will experience depression in their lifetime
  • One in six Australian women will experience depression at some point in their lifetime
  • One in eight Australian men will experience depression at some point in their lifetime
  • One in 16 Australians are currently diagnosed with depression
  • One in eight Australians are taking antidepressants

Who is at risk of depression?

  • Females
    • It is unclear whether females experience depression more than males due to environmental factors, genetic factors or both. No matter what the underlying reason, one in six females will experience depression at some point in their life compared to one in eight men. Women also report higher rates of depression compared to men.
  • Members of LGBTI community
    • LGBTI individuals are far more likely to be psychologically distressed than non-LGBTI individuals.
  • Young Australians
    • Over 75% of all mental health problems occur before the age of 25. Depression is most commonly diagnosed in the 3rd decade of life.
  • Residents of aged care facilities
    • Rates of depression in older Australian living in residential aged care facilities is 30%.
  • People living in rural/ regional areas
    • Remoteness remains a huge risk factor contributing to suicide, with the likelihood of someone dying from suicide increasing the further away from a city that they live.

What are the causes of depression?

Depression can be caused by different things that occur within a person’s life. Some of the factors that may contribute to depression include:

  • Family history
    • One in 10 people who have a first-degree relative with depression will also experience depression at some point in their lives.
  • Certain personality traits
    • Unfortunately, we are all born with certain characteristics and some of these may predispose a person to depression. These traits include perfectionism, a tendency to worry a lot, being prone to being pessimistic, being self-critical, “black-and-white” thinking, having lack of self-esteem and lacking self-confidence.
  • Serious medical conditions/illnesses
    • 70% of people who are suffering from a serious medical condition are diagnosed with depression.
  • Adverse life events
    • Childhood or adulthood trauma
    • Parental loss
    • Divorce
    • Low social supports
    • Low education
    • Low socioeconomic status

What are the signs and symptoms of depression?

The Diagnostic and Statistical Manual of Mental Disorders (DSM), which is now in its fifth edition, outlines the following signs and symptoms of depression:

  • Depressed mood most of the day, nearly every day
  • Anhedonia, which means a significant reduction in enjoyment or pleasure from activities most of the day, nearly every day
  • Significant unintentional weight loss or weight gain
  • A noticeable increase or decrease in appetite
  • Inability to sleep or sleeping much more than usual
  • Tiredness, fatigue and loss of energy
  • Feelings of guilt, worthlessness or hopelessness
  • Reduced ability to concentrate or focus on tasks
  • A slowing down of thought and reduction in physical movement
  • Recurrent suicidal ideations or thoughts of death

What are the different types of depression?

For people wanting to learn more about depression, there are various different subtypes of depression that are characterised by specific symptoms or that occur in different conditions., These subtypes tend to have different underlying causes, and therefore may importantly have different treatments.

Anxious-distress

  • This is the most common type of depression, with two out of three people diagnosed with depression also suffering from clinically significant symptoms of anxiety. These symptoms include feeling tense, restless, having a fear of losing control, and anxious ruminations.

Atypical depression

  • As the name suggests, atypical depression is characterised by clinical features that are not normally associated with depression. The key feature of atypical depression is a brightening of your depressed mood in response to positive events, which does not normally happen in major depression disorder. The other common features of atypical depression are increased appetite or over-eating (polyphagia), over-sleeping (hypersomnia), a feeling of heaviness in your arms and legs (leaden paralysis), and feeling rejected.

Catatonia

  • Catatonia is defined as a behavioural syndrome characterised by the inability to move normally despite having normal physical capacity to move the body. There is a wide range of abnormal movements that can be classified as catatonia, ranging from complete immobility, to impaired movement, to excessive and purposeless over-activity.

Depression with psychotic features

  • Depression with psychotic features has key features of both major depressive disorder and psychosis. The most common additional psychotic features are delusions and hallucinations that often focus around feelings associated with depression such as guilt, worthlessness and hopelessness.

How is depression diagnosed?

The DSM-5 states that in order to diagnose depression, the signs and symptoms outlined above must be present for at least two weeks and at least one of depressed mood or anhedonia must be one of the symptoms being experienced.

How is depression treated?

The evidence shows that initial treatment of depression should consist of both psychotherapy (counselling) and pharmacotherapy (medication). The dual therapy has been shown to have the best chance of recovering fully from depression.

Treatment Options for Psychotherapy

  • Cognitive-behavioural therapy (CBT)
    • CBT involves the therapist helping you to identify disordered or unhelpful thought processes and using exercises and real experiences to help improve your depressive symptoms. CBT aims not only to reduce symptoms but to improve your overall functioning. CBT has been shown to be effective for many psychiatric disorders, including depression. It requires a highly motivated patient who will practice the cognitive and behavioural skills outside therapy sessions in their daily life.
    • Click here to read more about CBT
  • Interpersonal psychotherapy (IPT)
    • IPT is a time-limited, structured, manual-guided treatment for patients with depression. It focuses on improving difficult interpersonal relationships that have been identified as the underlying cause for the depressive episode. It has been shown to be most effective for pregnant women, post-partum women or women with infants and toddlers.
    • Click here to read more about IPT
  • Behavioural activation
    • Behavioural activation is based on the fact that an increase in doing pleasurable activities increases our mood. It aims to make your life meaningful and pleasurable again by encouraging you to take parts in activities that you enjoy whilst you are experiencing symptoms of depression, even if you do not feel motivated to be active at the time.
    • Click here to read more about behavioural action
  • Family / couples therapy
    • Family therapy specifically focuses on changing the interactions between family members and to improve the functioning of the family as a whole, with the hope that this will improve the function of the patient suffering from depression. All types of family therapy – systems-based therapy, psychoeducation, emotion-focused therapy, and cognitive-behavioural therapy – have all been shown to be effective in treating a family with a depressed member.
  • Psychodynamic psychotherapy
    • Psychodynamic therapy focuses on improving a patient’s insight into various aspects of their lives – such as their childhood, past unresolved conflicts, and difficult relationships – to improve the patient’s overall function. It is based on the idea that unconscious patterns of dealing with difficult life events stem from childhood. The therapy aims to unmask these unconscious patterns and work with the patient to find healthier thought patterns and coping mechanisms.
  • Supportive psychotherapy
    • Supportive psychotherapy focuses on providing the patient with empathy and compassion, as well as educating the patient about available services, and giving advice, respect, praise and encouragement.

Treatment Options for Pharmacotherapy

See APA’s document on Drugs for Depression for more information

When should I get help?

  • If you notice any of the signs or symptoms of major depressive disorder for at least two weeks without a significant cause (such as losing a loved one, missing out on a promotion, having an argument with someone), you should seek help by firstly booking at appointment with your local GP.

Where can I go to for help?

  • Your loved ones
    • Connecting with your family and close friends, and opening up to them about how you are feeling, is an effective way to feel better and help manage your depression. You may not feel like doing this at the time, but most people report feeling better after opening up to their loved ones about their struggles. Your family and friends may not be able to treat your depression like a doctor or psychologist might, but the simple act of letting it out can be very therapeutic.
  • Your local GP
    • As stated above, if you have any signs or symptoms of depression it is important that you book an appointment with your local GP as soon as possible. When you are in the midst of your depression, you might not be extremely motivated to go out and get help, but it is vital to push through this barrier so you can start your journey of recovery. Depression is a treatable illness and you can recover fully to your healthy self. Your GP can be someone to open up to about your experiences and give empathy, advice, and respect to you. Your GP can also organise a mental healthcare plan for you which gives you 10 Medicare rebates to see a psychologist. Additionally, your GP can prescribe antidepressant medication.
  • Various websites and helplines