What is depression?
It is completely normal to feel down, broken-hearted, or upset from time to time when faced with life’s inevitable adversities. In fact, it’s probably what makes you human, and what makes you really appreciate moments of happiness. However, if you find you are feeling extremely down for long periods of time, to the point where it is interrupting your usual daily routine, you may be suffering from depression. Depression is a general term for several mental illnesses characterised by extreme and/ or chronic feelings of sadness or absence of positive emotions. The scary thing about depression, which seems to be a condition purely affecting the mind, is that it is associated with, or a risk factor for, many physical illnesses such as cardiovascular disease, diabetes, heart attack, stroke, and more. It is one of the most prevalent emotional disorders worldwide, in both developing and industrialised countries. Affecting approximately 1 in 6 Australians at any point in their life, depression is more common amongst women (1 in 5) compared to men (1 in 8), people with low socio-economic status compared to those with high socio-economic status, and divorced-individuals compared to married individuals. Approximately half (50%) of those diagnosed with depression will experience a single episode lasting approximately 6 to 9 months. However, for many individuals, particularly those who do not seek treatment, depression will develop into a chronic condition.
What are the causal influences of depression?
There is no one specific cause for depression, rather there is a range of factors that most likely lead to the development of depression. Some researchers believe that depression is either caused primarily by biological factors (endogenous depression characterised by melancholy) or stressful factors (exogenous depression characterised by neuroticism). Both types of depression have very similar symptoms. However, people with endogenous depression are at an increased chance of suicide and believed to benefit more so from pharmacotherapy, whereas, individuals suffering from exogenous depression are believed to be less suicidal and to benefit more so from psychotherapy. Then there is ‘secondary depression’ which is also referred to as ‘organic depression’, whereby, depression is caused by a change in consciousness as a result of a range of diseases, drugs or brain trauma/ malfunction. Examples of biological (endogenous), environmental (exogenous) and secondary causes of depression are presented below.
- Chemical imbalances including serotonin, noradrenaline and dopamine.
- A combination of genes.
- Hormonal factors.
- Getting older, as it is believed that as a brain ages, neurotransmitter pathways can be interrupted.
Environmental factors (including stressors and psychosocial factors learned from one’s experiences)
- Long-term stress.
- The death of a loved one.
- Relationship difficulties.
- Economic problems.
- The presence of another mental illness such as anxiety.
- Low self esteem.
- A big life event such as having a child.
- Being fired from a job or failing school.
- Being a victim of crime.
- Illnesses – endocrine diseases, viral infections, collagen disease, cancers, vitamin deficiencies and more.
- Drugs – alcohol, steroids, interferon, methyldopa and more.
- Brain malfunction – from a stroke, Alzheimer’s disease, Parkinson’s disease and more.
General symptoms of depression:
- Diminished interest or pleasure in once enjoyable activities.
- Reduced ability to control your emotions.
- A continuously low mood, which may include feelings of overwhelming sadness or emptiness.
- Lack of concentration or indecisiveness.
- Feelings of guilt and worthlessness.
- Negative thoughts.
- Tiredness and loss of energy.
- Change in appetite or significant weight loss or gain.
- Sleep problems such as insomnia or hypersomnia.
- Feeling sluggish, experiencing body aches or moving slowly.
- Recurrent thoughts of death and suicide.
Different depressive disorders and their specifications
Major Depressive Disorder (MDD) is also referred to as ‘clinical depression,’ ‘unipolar depression,’ or just ‘depression’ and is characterised by low mood and loss of pleasure, to the point where it impedes on an individual’s daily functioning. To be diagnosed with MDD a person must experience such symptoms almost all day, every day for at least two weeks. The depression experienced may be classified as mild, moderate or severe.
Persistent Depressive Disorder (Dysthymia) (PDD) is similar to Major Depressive Disorder such that they share similar symptoms, however, the conditions differs in terms of symptom duration and severity. MDD is more commonly understood as an acute episode of depression, whereas, PDD is often referred to as ‘chronic depression’ characterised by less severe symptoms. A person can only be diagnosed with PDD if they experience depressive symptoms for at least two years. It is possible for a person to be diagnosed with both MDD and PDD.
Premenstrual Dysphonic Disorder (PMDD) is a serious condition affecting approximately 3-8% of women and is marked by symptoms of depression, irritability, anger, anxiety and sensitivity. Symptoms are experienced in accordance with one’s menstrual cycle, beginning after ovulation, worsening as the period draws nearer, and subsiding for a week after menstruating. For one to be diagnosed with PMDD, they must experience this pattern of symptoms for approximately one year, significantly impacting the individual’s daily functioning and quality of life. Note: PMDD is not the same as Premenstrual Syndrome (PMS).
Substance/Medication-Induced Depressive Disorder (SMIDD) is a type of secondary depression (see above) caused by alcohol, illicit drugs or medication. In order to be diagnosed with SMIDD, one’s symptoms of depression must occur after a substance is taken, either whilst one is intoxicated or after intoxication whereby withdrawal begins. Substances that may cause depression include alcohol, phencyclidine, hallucinogiens, inhalants, opoids, sedatives, hypnotics, anxiolytics, amphetamines, cocaine, steroids, L-dopa, antibiotics, central nervous system drugs, dermatological agents, chemotherapeutic drugs and immunological agents. Note: SMIDD is not the same as the general hangover one experiences after consuming recreational substances; it is a more severe condition.
Depressive Disorder Due to Another Medical Condition (DDDAMC) is a type of secondary depression (see above) caused by a medical illness that interrupts physiological functioning in a way that causes depression. It is not due to the stress and adversity associated with an illness; in this case an individual may be diagnosed with adjustment disorder (depressive type). For one to be diagnosed with DDDAMC there must be evidence that depressive symptoms are a direct pathophysiological result of another illness. Medical conditions known to cause DDDAMC include stroke, Huntington’s disease, Parkinson’s disease, traumatic brain injury, Cushing’s disease and hypothyroidism.
Depressive disorders listed above may present with different specifications including anxious distress such as worry or tenseness, mixed features such as an elevated mood or racing thoughts which may be an early indication of bipolar disorder, melancholic features for example loss of pleasure in most activities or slow motor movements, atypical features characterised by positive reactions to positive situations as well as rejection sensitivity, psychotic features including delusions and/or hallucinations, catatonia marked by unresponsiveness, peri-partum onset whereby symptoms present before, during, or after pregnancy, seasonal pattern whereby symptoms present exclusively at the same time every year.
Caution – Don’t get depression confused with something else!
|Depression & Grief|
|· Grief and depression share symptoms such as sadness, insomnia, and appetite disturbances, however…||· …Unlike the grieving person, the depressed person will consider feelings of sadness/low mood to be normal.|
|· Both may involve feelings of guilt, however….||· …A person suffering from grief will feel guilt in relation to their loss, whereas a depressed person will experience guilt more generally and intensely.|
|· Both depressed and grieving individuals may suffer from lowered self-esteem or self worth, however…||· …It is much more common and severe in depressed individuals, and if experienced by a grieving individual, it is only temporary.|
|· Both grief and depression are associated with hopeless and powerless feelings, however…||· …Grieving individuals experience these feelings specific to their loss, whereas depressed people experience these feelings about the world in general and also have suicidal thoughts.|
|· Depressed people have difficulty with basic day-to-day functioning, such as work, home and school.|
|· Grieving is associated with an influx of happy and sad memories/feelings, whereas in depression, negative emotions are fairly constant.|
|· Depression is considered a mental illness and requires intervention. Grieving individuals may benefit from therapy but it is not a necessity.|
|Depression & Sadness|
|· Both depression and sadness are characterized by low mood however…||· …Sadness is a normal emotional reaction to an unfortunate event, whereas depressed people may feel sad for no particular reason. · …The low mood of depression is more severe, constant, and longer lasting than that of sadness. · …Sad individuals can still experience moments of genuine happiness and laughter; in depressed people this is less common.|
|· Everyone will experience feelings of sadness or depressed (low) mood multiple times throughout their life, however…||· …Only a certain proportion of the population will meet the criteria for a depression diagnosis. In Australia it is approximately 1 in 6 persons.|
|· Both depressed and sad individuals may suffer from lowered self-esteem or self worth, however…||· …It is much more common and severe in depressed individuals, and if experienced by a sad individual, it is only temporary.|
|· Both depression and sadness may share symptoms of negative thoughts, reduced interest/ enjoyment in activities, and interrupted sleeping patterns, however…||· …Only depressed individuals may have suicidal ideas, severe cognitive difficulties, or experience psychosis, significant weight changes, or prolonged insomnia/ hypersomnia.|
|· Depression can interrupt basic day-to-day functioning, such as work, home and school.|
|· Depression is considered a mental illness and requires intervention. Sadness is a normal human emotion whereby therapy is helpful but not necessary.|
|Unipolar Depression (those mentioned above) & Bipolar Disorder/Depression.|
|· Depression and bipolar share symptoms of low mood, however…||· …Low mood is almost a constant feature in depression, whereas bipolar is characterised by a combination of depressive, normal, and manic or hypomanic moods. Manic moods may consist of irritability, impulsivity, racing thoughts and feelings of grandiosity. Note: Bipolar may be misdiagnosed for depression because hypomanic/manic episodes can be rare.|
|· Both conditions present with depression however…||· …Compared to unipolar depression, the depression that bipolar individuals experience is more likely to present with melancholic features (particularly psychomotor retardation), psychotic features, difficulty thinking, and waking up early with depression being more severe in the morning.|
|· Both depression and bipolar are considered serious mental illnesses requiring treatment, however…||· …Treatment (psychotherapy and pharmacotherapy) differs between both conditions.|
|· Both illnesses are reported as more prevalent in women compared to men, however…||· …This difference is larger amongst depressed-affected individuals compared to Bipolar-affected persons.|
|· Depression is reported as more prevalent than bipolar disorder. Research shows depression affects 5.4% (MDD = 4.1%, Dysthmia = 1.3%) Australians over a 12-month period, compared to Bipolar that affects 1.8% of individuals.|
Common Treatments for Depression:
There are a number of effective treatment options for depression, with two very common treatments being Cognitive Behavioural Therapy (CBT) and Mindfulness therapy. CBT is a widely recognised therapy that works by changing the way we think (cognition) and act (behaviour) and consequently how we feel. CBT has been found to be successful in children, adolescents, adults and older people. CBT works by showing people how their mood is affected by their thinking styles. The main focus of this therapy is to help you understand how your mood is affected by your thinking styles, and to help you activate behavioural changes so that you start regularly engaging in enjoyable activities. Mindfulness therapy can help you promote a healthy mind and prevent relapse by teaching you how to focus on the here and now, improve your self-awareness, and to accept the negative feelings and thoughts without letting them take over.
How can Psylegal help you with Depression?
Depression can be successfully treated, even for those with severe depression. You or someone you know suffering depression may be reluctant to get help, but it is important to seek treatment for depression sooner rather than later as untreated depression can become chronic or recurrent.
Give us a call today to speak with one of our highly trained and experienced Psychologists. They will draw on evidence based treatment strategies to tailor an individualized treatment program taking into consideration your unique therapeutic goals and needs. At Psylegal we can provide you with one-on-one therapy with our psychologists, or you can attend one of our specialised group treatment courses for depression utilising a combination of Cognitive Behavioural Therapy and Mindfulness Training.
If you think that you may be suffering from depression, take the Mental Health Quiz to find out more information
Give us a call today on 1300 79 22 09
Medicare rebates are available. You will need a referral from your doctor.