Depression

Temporary moods of feeling low are a common and often normal reaction to the stress of our everyday lives. This is not what we meant when we talk about depression here.

Depression is an illness that can affect how you feel and behave for weeks or months at a time. When you are depressed, your low mood lasts, affecting your sleep, relationships, job and appetite.

Depression is linked with many conditions and stages of life, all with similar symptoms, but with different causes and treatment choices. You may have seen depression referred to in relation to:

• Postnatal depression – where a new mother becomes seriously depressed in the first months following the baby's birth. It can occur any time during the baby’s first year. 
• Depression in the elderly – often linked to health problems, Alzheimer’s disease or dementia.
• Physical illness – some symptoms of physical illness are difficult to distinguish from those of depression (eg, fatigue related to congestive heart failure).
• Children and adolescents – do suffer from depression, but may talk of being angry or irritated, rather than being depressed.

Myths about depression 

Depression is a sign of a weak character.

NOT TRUE The fact is that depression can strike anyone. While some particular personality types are more likely to develop depression, the vast majority of people who develop the condition have been previously healthy and led normal lives.

People with depression can just 'snap out of it' or just choose to 'pull their socks up'

NOT TRUE One of the most disabling symptoms of depression is the fact that it saps the will and makes doing anything an enormous effort. Depression is an extremely unpleasant experience, and most people with this condition would (and do) do anything to get well.

Who gets depression?

Depression can start at any age – from childhood through to old age. Most often it starts in the mid-20s, and it is more common in the 25 to 45-year-old age group. People with depression often have other problems such as anxiety disorders, substance use disorders and personality disorders, and may engage in deliberate self-harm. Very severe depression can result in symptoms of psychosis (loss of contact with reality). 

The risk of suicide in people with depression is significant. It is important that if you are having any suicidal thoughts you seek help immediately.

Depression can be effectively treated, and people will usually recover from it. The earlier effective treatment is started, the better the chance of recovery.

If you think you or someone you know is depressed, look for the signs and talk to them. Your support is important.

What causes depression?

Depression is linked to changes in how the brain works. Many things can be considered as factors that make you vulnerable to depression.

These include:

• Stressful events like the break-up of a relationship or financial trouble
• A family history of depression
• Physical illness, such as a stroke or heart attack
• Stressful or traumatic events in childhood can lead to depression later in life
• Certain medications can cause depression in some people
• Social isolation – i.e. having no friends or family near you.

Signs to look for (symptoms)

Symptoms of depression usually develop over days or weeks, though you may have a period of anxiety or mild depression which lasts for weeks or months beforehand. Not everyone with depression will complain of sadness or a persistent low mood. They may have other signs of depression such as sleep problems. Others will complain of vague physical symptoms.

Signs to look for in yourself or a loved one include:

• Persistent low, sad or depressed mood – this is described in varying ways by people, especially if they are from non-European cultures. The person may describe feeling empty, having no feelings, or may complain of pain.
• Loss of interest and pleasure in usual activities. This is a reduced ability for enjoyment. It includes loss of interest in sex.
• Irritable mood. This may be the main mood change, especially in younger people, and in men (especially from Maori and Pacific ethnic groups).
• Change in sleeping patterns. Most commonly reduced sleep, with difficulty getting to sleep, disturbed sleep, and/or waking early and being unable to go back to sleep. Some people sleep too much. Most people with depression wake feeling unrefreshed by their sleep.
• Change in appetite. Most often people do not feel like eating and as a result will have lost weight. Some people have increased appetite, often without pleasure in eating. This is often seen in those who also sleep more.
• Decreased energy, tiredness and fatigue. These feelings may be so severe that even the smallest task seems too difficult to finish.
• Physical slowing or agitation often comes with severe depression. The person may sit in one place for periods and move, respond and talk very slowly; or they may be unable to sit still, but pace and wring their hands. The same person may experience alternating slowing and agitation.
• Thoughts of worthlessness or guilt. As a result of feeling bad about themselves, people may withdraw from doing things and from contact with others.
• Thoughts of hopelessness and death. The person may feel there is no hope in life, wish they were dead or have thoughts of suicide.
• Difficulty thinking clearly. People may have difficulty in concentrating. They may not be able to read the paper or watch television. They may also have great difficulty making even simple everyday decisions.

Anxiety symptoms

These are very common as part of depression, but as the depression is treated these symptoms usually stop. Anxiety symptoms include:

• Excessive worry or fear, with associated physical symptoms such as muscle tension, pounding heart, dry mouth.
• Panic attacks. Sudden episodes of extreme anxiety and panic with physical symptoms of fear.
• Phobias. Specific fears regarding situations, objects or creatures.
• Excessive concern about physical health.

If you are concerned you may be depressed, a number of NZ websites have useful self-tests you can do. These are listed on the right hand side of this page.

How the doctor determines if you have depression (diagnosis)

There is a paper and pencil test to diagnose depression which is used by psychologists. Usually a diagnosis is made by your doctor based on whether you have some or all of the typical symptoms. For this reason it’s important that your doctor spends time with you to get a full understanding of the difficulties you have had, both from you and your family/ whānau's perspective.

While depression could be responsible for the symptoms listed above, the same picture can be seen with the depressed phase of bipolar affective disorder (manic depression) and in some medical conditions. This is why it's important your doctor may do tests necessary to exclude these conditions.

Remember, depression is a serious illness and you do need to see your doctor if you suspect you may be suffering from it.

Treatment options

Treatment of depression can involve a number of aspects, each of which can be tailored to your individual need. For most, a combination of medication and talking therapies such as counselling can be effective.

Medication

Your doctor may prescribe antidepressants. Finding the right medication can be a matter of trial and error – there is no way to predict which medication will be effective and tolerated (have fewer troublesome side effects) by any one person.

If you are prescribed medication you are entitled to know:

• the names of the medicines
• what symptoms they are supposed to treat
• how long it will be before they take effect
• how long you will have to take them for and what their side effects (short and long-term) are. 

If you are breast feeding no medication is entirely safe. Before making any decisions about taking medication at this time you should talk with your doctor about the potential benefits and problems.

It is important to see your doctor before stopping medication. A sudden stop can cause worse feelings.

Therapy, such as talking therapies

Supportive counselling is a treatment for milder forms of depression, where it is as effective as antidepressant medication. More specific therapies e.g. cognitive behaviour therapy (CBT) can be effective for more significant depression. Your doctor will explain what is available locally and which type of talking treatment is most suitable for you.

Psychoeducation (providing education)

Education about depression can be extremely important to help you, your family/ whānau and supporters. Your doctor will give you information about depression, suggests different ways to handle it, and discusses any complications which could occur.

Complementary therapies

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and that may be used to complement and support it.

Certain complementary therapies may enhance your life and help you to maintain wellbeing. In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress.

When considering taking any supplement, herbal or medicinal preparation you should consult your doctor to make sure it is safe and will not harm your health, for example, by interacting with any other medications you are taking. 

Physical health 

It's also really important to look after your physical wellbeing. Make sure you get an annual check up with your doctor. Being in good physical health will also help your mental health.

Thanks to Janet Peters, registered psychologist for reviewing this content. Date last reviewed:  September, 2014.