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People sometimes say they feel ‘depressed’. What they generally mean is that at the time they are feeling ‘down’ or ‘blue’. These short lived feelings are quite normal with everyone experiencing them from time to time. ‘True’ depression, however, is quite different. It is characterised by a depressed mood for a period of two weeks or more and can include a number of other symptoms (see Symptoms). People with depression often have an imbalance of particular brain chemicals (eg., serotonin) in the brain. Depression is classified according to its severity; mild, moderate or severe. This factsheet does not cover depression associated with bi-polar disorder as this is a distinct condition. For information on bi-polar disorder contact beyondblue (see Other contacts). Depression is a very common condition and can affect people of all ages. Up to one in six men and up to one in four women will experience depression at some time during their life (1). From puberty onwards, women are twice as likely as men to be affected (2). It is quite common for a person with depression to also have an anxiety disorder. Frequently, the anxiety disorder precedes the depression. Having an anxiety disorder increases the chances of longer and more frequent bouts of depression (3). For more information on anxiety disorders see our factsheet (available on our website or by phoning Women’s Health). Unfortunately, about half of those with depression will not visit a health professional (4). While depression can be a serious condition, help is available. There are a number of effective treatments for depression. Seeking professional help early can help people recover more quickly. SymptomsIn addition to depressed mood, symptoms may include:
These symptoms will vary in severity from person to person. The symptoms of someone with mild depression will still allow them to function, although perhaps not as adequately as before. Conversely, severe depression will significantly disrupt the person’s work, social and domestic activities and there may be a risk of suicide. If a person is having suicidal thoughts or if friends and family are worried their loved one is suicidal they should contact Lifeline on 13 11 44. CausesA person’s depression is generally due to a combination of factors: Social-cultural
Biological and psychological
* People can inherent a tendency to get depression. It is thought that as much as 40% of major depression cases are due to genetics. In addition, it is also believed that ways of thinking and coping strategies associated with depression can be learnt within families. Depression can also be the result of particular medications or an underlying medical condition (eg., low thyroid function, stroke, Parkinson’s disease, dementia) (7). DiagnosisThe most important step in addressing depression is recognising that it is an illness requiring treatment. It is important that people receive an accurate assessment and diagnosis as this will ensure they receive the appropriate treatment. People are often confused by the range of health professionals working in the area of mental health and are unsure of the differences between them. A good place to start is to visit a general practitioner (GP). They can provide the person and their family with information on depression so they have a better understanding of the condition. Some GPs also provide psychological therapies. If necessary, a GP will refer the person to other relevant health professionals who treat depression, including a:
Finding a health professional that one feels comfortable with and confident in is important. Different health professionals and treatment styles will suit different people. It is often a good idea to meet with a health professional for an introductory session. This will provide an opportunity to ask about their qualifications and experience, their methods, fees and to get a general feeling about their attitude and approach. People may find it helpful to choose a health professional that belongs to a professional body such as the Royal Australian and New Zealand College of Psychiatrists (RANZCP), Australian Psychological Society (APS) or the Australian Counselling Association (ACA). Medicare rebates are available for some health professional visits related to the diagnosis and treatment of depression. People can ask their GP about the Medicare rebates or contact Medicare Australia on 13 20 11. TreatmentThe treatment required depends on the severity of a person’s depression. For example, someone with mild depression may find relief from self-help strategies and/or complementary medicines while a person with moderate or severe depression may require a combination of psychological therapies and medication. Psychological therapies Cognitive Behavioural Therapy (CBT) Common types of negative or distorted thinking include all or nothing thinking (if something is not perfect then it is a complete failure); ignoring positives over the negatives (the ‘glass is half empty’ notion); catastrophising (exaggerating things so they become more serious than they really are) and personalisation (seeing oneself as the cause of negative events that are not really ones fault) (9). CBT usually consists of a series of sessions taking place over a number of weeks. It may be conducted individually or in a group situation. CBT requires a certain level of commitment in both time and energy/motivation. For a person suffering from moderate to severe depression this can be an issue. This is why medication is sometimes prescribed in combination with psychological therapies as the medication will help the person feel well enough to attend sessions. Interpersonal therapy (IPT) Medication The most commonly prescribed antidepressants are selective serotonin reuptake inhibitors (SSRIs). The advantage of SSRIs are that they generally have fewer side effects than older types of antidepressants (ie., tricyclic antidepressants). Side effects can include nausea, diarrhoea, sleep disturbance, headache, dizziness and reduced libido. The side effects experienced generally subside after a short time. Other antidepressants used include serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants and monoamine oxidase inhibitors. People need to continue taking antidepressants for a length of time following an improvement in their symptoms. This is often referred to as maintenance therapy. It is very important that people do not stop their medication prematurely (even if they feel well) as this can cause a relapse of the depression as well as unpleasant side effects. All decisions around stopping the medication or changing the dose should be made in conjunction with one’s GP or psychiatrist. The most common reason people stop taking their medication is because of unwanted side effects. If a person is concerned about side effects they should discuss this with their GP or psychiatrist. There may be ways that side effects can be minimised or better managed. Some people may need to take antidepressants on an ongoing basis (in the same way that a person with high blood pressure needs to take medication). Electroconvulsive therapy (ECT) Self-help Exercise Books and internet-based programs There are now also internet-based programs that provide a cognitive behavioural therapy approach. While these programs are relatively new, there is some evidence to suggest they are effective in treating those with depressive symptoms (11). An Australian example of an internet-based program is MoodGYM (see Other contacts). Reducing alcohol and drug use Complementary therapies One of the most popular complementary therapies used for depression is the herbal remedy St. John’s wort (Hypericum perforatum). While a review of its use in treating depression found the current scientific evidence is “inconsistent and confusing”, researchers concluded there were “benefits of hypericum in patients with mild to moderate depressive symptoms” (12). However, it appears to be of only minor benefit to those with severe or chronic depression. Side effects of St. John’s wort can include dry mouth, dizziness, constipation, gastrointestinal symptoms and an increased sensitivity to the sun (13). Most importantly, St. John’s wort interacts with a large number of medications including warfarin (blood thinning drug), anticonvulsants, oral contraceptives and antidepressants. For this reason it is vital that people always inform their doctor they are taking it. Other complementary therapies for which there is some evidence include the amino acid S-adenosyl methionine (SAMe), folate supplementation, acupuncture, light therapy, massage, relaxation therapy, air ionisation (electrical devices which increase negative ions in the air) and yoga (14). Other therapies used in the treatment of depression include the herbs ginkgo biloba, vervain and lemon balm, homeopathy, natural progesterone, aromatherapy, music therapy, pet therapy and the supplementation of selenium, tyrosine, glutamine, Vitamin B, C, D and E. There is currently no evidence to support these treatments for depression (15). References 1 beyondblue. What is Depression? http://www.beyondblue.org.au/index.aspx?link_id=1.3 [website] date accessed: 3 June 2004 Further help and information from Women's Health Queensland WideHealth Information Line: Library: Website: Further readingSee our
Other Contacts/information sourcesbeyondblue Black Dog Institute BluePages Dark Side of the Mood depressioNet Mental Health Carers Arafmi Australia MoodGYM This factsheet was originally published by Women's Health Queensland Wide (Women's Health) in June 2000. It was revised by Kirsten Braun and the Editorial Committee at Women's Health in September 2004 and October 2007. Last Modified:October 30, 2007 |
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