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Depression

Everyone feels sad, moody or low from time to time. Depression, however, is a serious mental health issue where sadness, flat or low mood, or a sense of ‘emptiness’ is prolonged – lasting weeks, months and sometimes years.

Depression isn’t just about ‘feeling down’. It presents with a number of other symptoms and interferes with daily life and relationships. Depression is also relatively common, and usually responds well to treatment. 

Symptoms

A person may be depressed if, over a certain length of time, they have experienced either (or both) of the following:

  • a sense of sadness, emptiness, or low mood for most of the day, nearly every day
  • a loss of interest or pleasure in almost all activities, even ones usually enjoyed

These symptoms may include changes to their appetite and sleep, lethargy, worry and negativing thinking patterns. For a diagnosis of depression, a psychologist will look for a range of symptoms that may impact on a person’s daily life.

Causes

There is usually no single cause for depression. In some individuals, stressful life events such as the loss of a job, long-term unemployment, physical health issues, family problems, the death of a loved one, or the end of a close relationship might trigger depression. For other people, there is no obvious cause.

Latest research no longer supports that depression is caused by a ‘chemical imbalance’, but that the risk for developing depression is more likely to be related to a combination of a person’s genes, biology, life experiences, stress and thinking style.

Genes

For many people, genetics may play a part, with research suggesting around 30-40% of the risk for developing depression may be due to genetic factors.

Biology

Research has found some differences in areas of the brain, and brain activity in people with depression compared to people without. The areas of the brain that differ relate to emotional responses and emotion regulation, the interpretation of information (with a bias for negative information) and response to stress. Importantly, many of these differences can decrease with treatment.

Stressful life events

Research suggests that the greater the number of stressful life events a person experiences, the greater their chances of developing depression. Early life stress and trauma can also increase the likelihood of developing depression later in life.

Thinking style

People who tend to dwell on negative events, worry excessively, or hold a more negative view of themselves, the world, or the future are more prone to depression.

Treatment

Depression is a common reason for people to seek help from mental health professionals, and research suggests that there are a number of effective psychological treatments available.

The most effective psychological treatments for depression are cognitive behavioural therapy, problem-solving therapy, behavioural activation and interpersonal psychotherapy. Mindfulness-based cognitive therapy has also been shown to be effective in preventing future periods of depression in those people who have previously experienced depression.

Cognitive behaviour therapy (CBT) can bring about lasting change that can decrease the chance of having depression again in the future. It helps the person to change unhelpful thoughts and behaviours which can contribute to depression, and aims to build skills to manage depression in an ongoing way.

Problem-solving therapy helps people gain mastery over day-to-day difficulties, stresses and problems which otherwise might seem overwhelming.

Behavioural activation aims to increase motivation and help a person to return to their usual activities. In behavioural activation, activities and behaviours that can help to improve mood and quality of life are planned for in an ‘activity schedule’. Typically, a mix of activities are selected including some which the person finds enjoyable and some which give them a sense of satisfaction and achievement.

Interpersonal psychotherapy (IPT) involves addressing problems in the person’s relationships and expectations about others that might be contributing to their mood. IPT helps people to:

  • find new ways to develop and nurture relationships
  • resolve conflicts with others
  • express emotions and communicate more effectively
  • adapt to changes in life roles
  • improve social support networks. 

Mindfulness-based cognitive therapy (MBCT) is designed to reduce the risk of depression returning (relapse prevention), by teaching people mindfulness meditation combined with cognitive-behavioural techniques.

Mindfulness meditation helps the person to focus on the present moment without judging these experiences or trying to change them. MBCT has been found to be effective in preventing relapse, and there is some evidence that it may be effective as a treatment of depression as well.

Seeking help

Seeing a psychologist

If you are experiencing feelings of sadness or loss of pleasure in activities or think you might be depressed, a psychologist may be able to help. Psychologists are highly trained and qualified professionals skilled in helping people with a range of mental health and wellbeing concerns, including depression.

There are a few ways you can access a psychologist. You can:

  • Use the Australia-wide Find a Psychologist service or call 1800 333 497
  • Ask your GP or another health professional to refer you.

If you are referred to a psychologist by your GP, you might be able to get a Medicare rebate that may assist you in meeting the costs of treatment. You may also be able to receive psychology services via telehealth so you don’t need to travel to see a psychologist. Ask your psychologist or GP for details.

Getting a medical check-up

A medical check-up with a GP is also important to see if a health issue might underlie your symptoms. A GP or other medical specialist might also offer advice and assistance where medication might be of benefit.

Tips to improve your mood

Check your self-talk

We can sometimes say negative things to ourselves when we are upset. Unhelpful self-talk might include things like, “I’m hopeless”, “Why should I even bother?”, or “I’ll never get all this work done”. Negative self-talk can make our mood worse by reinforcing how bad we feel and stopping us from using helpful coping strategies. Constructive self-talk, on the other hand, can help us to cope with life’s difficulties.

Notice what you say to yourself and work on more helpful, calming and encouraging self-talk, such as, “This is a rough period but it will pass”, “I will use this time to look after myself”, or “Regardless of how I am feeling, I am always a worthy person”.

Keep things in perspective

When we are upset, it is easy to see things as worse than they really are, and to start anticipating even more problems down the track. Take a step back and look at something that is upsetting you. Ask yourself:

  • am I getting ahead of myself, assuming something bad will happen when I really don’t know the outcome?
  • is the outcome certain to happen, possible, or quite unlikely?
  • if the worst were to happen, what could I do about it?

Sometimes thinking about how you would cope, even if the worst were to happen, puts things into perspective.

Take action

Make a list of things that you usually enjoy. It might include activities like light exercise, reading, meditating, listening to music, or spending time with a friend. Then, write down a list of things that are important to you that would give you a sense of achievement – things that would feel good to get done. This might include household chores, errands, work tasks or study. Now, take your weekly schedule and make time each day to attend to a task from each list. It is important to set small realistic goals and then work towards achieving them.

Practise relaxation or mindfulness

Practise relaxation, meditation, or mindfulness on a regular basis to allow your body and nervous system to routinely settle and readjust to a calm state. Mindfulness in particular has been shown to help people to respond to difficult emotions without feeling overwhelmed by them.

Look after your health

Exercise, diet and other health behaviours can support recovery from depression, so it is important to:

  • make sure you are eating well
  • get regular exercise, as this can help improve your mood
  • avoid using alcohol, tobacco and other drugs to cope when you are finding things difficult.

Additional resources

Head to Health

The Federal Government’s website linking the public to reputable and evidence-based digital mental health services.

www.headtohealth.gov.au

beyondblue

Provides information on anxiety, depression, and related disorders

www.beyondblue.org.au

headspace

Australia’s National Youth Mental Health Foundation, providing assistance for individuals aged 12-25

www.headspace.org.au

Lifeline

A 24-hour counselling, suicide prevention and mental health support service

Telephone: 13 11 14

www.lifeline.org.au

References

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