Depression Symptoms and Treatment

Depression is a condition in which people may have low mood, a loss of interest in everyday activities, feelings of low self-worth, a lack of energy and poor concentration, all of which last more than two weeks.

About depression

Depression is very common. According to beyondblue, around one in five people in Australia have depression at some point in their lives. People can be affected by depression at any age.

Depression is characterised by a number of symptoms including a loss of interest and enjoyment in the ordinary things in life and a significantly lowered mood, that last for more than two weeks.

It's normal to have days or weeks when things aren't going right and you feel unhappy. Depression however, is more than just a low mood - it is a serious illness that often goes unrecognised. You're said to have depression when your unhappy feelings don't go away quickly and the symptoms start to affect your enjoyment of life and your motivation to participate in family, work, and other activities you once enjoyed.

The impact on people living with depression can be severe and it is the leading cause of non-fatal disability in Australia. The good news is that it's treatable. If you have concerns that you might be depressed, talking to your doctor is a good first step to exploring how you might be able to address your symptoms and start to feel better again.

Types of depression

There are a number of ways to categorise depression. You may hear it referred to in terms of severity:

Mild depression. This doesn't usually stop you leading your daily life but makes everything harder to do and seem less worthwhile
Moderate depression. This has a significant impact on your daily life, and you may have more symptoms than people with mild depression
Severe depression. This makes you feel uninterested in doing anything - daily activities are almost impossible.

There are also specific forms of depression, which include:

Dysthymia. This is mild depression, lasting at least two years
Bipolar affective disorder. This can also be known as manic depression or just bipolar disorder. This is a condition that causes mood swings. Your mood varies from excitement to depression and despair. You may also have hallucinations
Seasonal affective disorder (SAD). This is a type of depression with a seasonal pattern, occurring most commonly in the winter months
Postnatal depression. This develops two to three weeks after childbirth and lasts for months or even years. For more information about postnatal depression, click here.

Although these different types often have slightly different symptoms and may require different treatments, two main features of depression are a lowered mood and loss of interest or pleasure in activities that used to be enjoyable.

Symptoms of depression

If you have depression, you may have a number of different symptoms including:

a continuous low mood
feeling irritable
crying a lot
a loss of interest in your social life
lack of pleasure from events or activities that you would normally enjoy
loss of confidence and self-esteem
reduced energy or feeling tired
reduced ability to think or concentrate
difficulty in making decisions
feeling helpless, guilty, worthless or hopeless
recurrent thoughts of death or suicide or any suicidal/self-harming behaviour Anxiety
a loss of sex drive (libido)
disturbed sleep (not enough/too much/poor quality)
disturbed eating patterns - either loss of appetite or eating too much, with associated weight change
unexplained or worsening aches and pains and other physical symptoms
physical agitation or slowness.

For most people, the most common symptom is low mood. In addition to feeling sad, you may also feel irritable and have a tendency to lose your temper more easily than usual. Some people notice that they feel worse either first thing in the morning or last thing at night.

Complications of depression

Depression can be a recurring condition. At least half of the people who have an episode of severe depression will have at least one more episode. If you've had two episodes there's a 90 per cent chance of a third. You're more likely to have several episodes of depression if you're under 20 or of an older age.

Depression is often accompanied by anxiety. In about one third of cases, depression comes before anxiety, in one third the anxiety comes on first and in a third you may experience them together. Symptoms of anxiety include fearfulness, palpitations and even panic attacks. Often these feelings subside when the depression is treated. For more information about anxiety disorders, click here.

One of the most serious aspects of depression is the thoughts you may have about yourself and your life. You may judge yourself too harshly or critically, and think of harming yourself or feel that life is not worth living.

If you are feeling suicidal, please seek immediate help. There are a number of options available.

Your GP can provide you with a range of options for treating and managing mental health issues. The emergency department at your local hospital will also be able to help you.

If you are in Australia, you can ring Lifeline on 13 11 14 or Kids Helpline on 1800 551 800 for specialised 24-hour help, support and advice.

Local help lines for other parts of the world are listed at befrienders.org

Causes of depression

Depression varies from person to person and everyone's experience is different. The exact cause of depression isn't fully understood at present, but there seem to be certain factors that make a person more likely to develop depression.

While a bout of depression can be set off by a stressful event, often involving some form of loss such as when somebody dies or when a relationship breaks down, depression is often brought on by a mix of recent life events and long-term or personal risk factors.

Research suggests that ongoing stressors, such as financial worries, a stressful job, redundancy or fear of unemployment are more likely to trigger a depressive episode in vulnerable people than one-off events in life. Long-term or serious illnesses such as diabetes or cancer can also lead to a bout of depression.

A personal risk factor that can be an important influence in whether or not you develop depression is your personality. Some people tend to always look on the darker side of things. According to beyondblue, personality traits that may put you at higher risk of developing depression include:

perfectionism
sensitive to personal criticism
unassertive
self-critical
shy, socially anxious
low self-esteem.

Depression can also run in families and some people may be at increased genetic risk of the condition. However, researchers have yet to find a simple genetic explanation, and this doesn't mean that you will automatically develop depression if a parent or a close relative has it. Life events and your personal risk factors are as likely to determine your chance of developing depression. Other biological factors for depression include illnesses, ageing and gender.

Diagnosis of depression

If you're depressed, recognising the problem is the first, yet hardest, step. Often others around you may suggest that you seek help. If you take that step and visit your GP, you will find the support and treatment you need to stop depression from taking over your life. Left untreated, depression can become more severe and have greater impacts on the quality of your life.

Your GP will ask you about your home life, your relationships, any previous experience of depression, and whether you have had suicidal or self-harming thoughts. Your story may have important clues such as a family history of depression, anxiety, other mental health conditions, recent life events or long-term personal risk factors. He or she will ask you about your symptoms, their duration, and how much they are affecting your everyday life. Your GP may also ask you to fill in a questionnaire about your symptoms.

Your doctor may order some tests to try to investigate possible causes of your symptoms, or to eliminate other conditions that could be causing symptoms similar to that of depression. These tests may include:

full blood count and biochemistry
thyroid function tests
urine tests for sugar and protein
a brain scan, if necessary.

It may not always be possible to find the cause of your depression and at other times it may not be possible to change the difficult life circumstances that have brought on an episode of depression. The important thing is to recognise the signs of depression and get help to manage them.

Treating and managing depression

Depression may interfere with the way you want to live your life. Many people living with depression may feel unable to go to work or do any of the things they used to enjoy - and yet, many don't seek help for their problems. You may feel embarrassed about your feelings, considering them a sign of weakness, or you may blame yourself for your misfortune. But it's important that you seek help for depression. Your brain is an organ just like your heart or lungs. Sometimes, organs need medicines or other treatments to function as effectively as they can. Fortunately, a number of treatments are available for depression and talking to a qualified medical professional is the first step.

The two main approaches to treating depression are psychological therapies such as counselling and medical treatment with antidepressants.

Psychological treatments

For mild forms of depression, psychological treatments (or talking therapies) are often the first thing to try to help you manage your condition. For more severe depression, a combination of psychological treatment and antidepressant drugs may be recommended.

Psychological treatment is very important as it may not only help you recover from an episode of depression but it may also help to prevent a recurrence. There is a wide range of psychological and counselling services available in the community. The type of talking therapy you have will depend on what's available, your preferences, and how severe your depression is.

The common type of psychological treatment for depression is Cognitive Behaviour Therapy (CBT). The way you think affects the way you feel, so CBT attempts to change the way you may think about your moods and how you react to life situations. People who are depressed may often think negatively about themselves, the world around them and the future. CBT helps you to recognise negative thoughts you may be having, teaches you how to replace them with more realistic thoughts and helps you find new, more positive ways of going about your daily life.

For more information about finding psychological help for mental health problems, click here.

Self-help

Learning to manage stress can be another important factor in the prevention and treatment of depression. Stress is a highly individual experience as we all have different things in our lives that cause frustration or unhappiness. You need to be aware of how you react to and feel about certain pressures in your life, and develop positive ways of coping with those stressful situations. This may simply mean making more time to relax and learning to talk more openly with people you're close to. Relaxation and meditation may also help your symptoms.

Doing some exercise in addition to your medication and/or counselling may help your symptoms. Try a few sports or activities to find something you enjoy, and that you can keep doing in the long term.

Some people may turn to alcohol or illegal drugs to try and blot out their difficult feelings. Unfortunately, this tends to make things worse. If you drink alcohol, it's important that you don't drink more than the recommended guidelines because it can affect your sleep and lower your mood, and can lead to a range of long-term health problems including liver damage.

Medicines

Medications called antidepressants are also used to treat depression. These medicines can only be prescribed by your GP or psychiatrist. Antidepressant medicines aren't always needed in mild or moderate depression. A large number of people with depression get better within six months without medication.

Antidepressants can help treat moderate-to-severe depression as well as some anxiety and related conditions. While these medications are effective in some people with depression, most antidepressants take at least two weeks to start working and their effects begin quite gradually. You may be required to take them for six to twelve months to treat an episode of depression, even if the symptoms seem to clear up sooner. This is because it's been shown that a longer course makes a relapse of depression less likely.

There are several different types of antidepressant medicine available. All can have side effects, so it's important to find the medicine that suits you best. Always read the Consumer Medicines Information leaflet that comes with your medicine and if you have any questions ask your doctor or pharmacist for advice.

Selective serotonin re-uptake inhibitors (SSRIs). These work by raising the levels of the natural chemical serotonin in the brain, which in turn tends to lift the mood. They are often best taken in the morning as they can interfere with sleep. SSRIs may cause some nausea and mild dizziness but these symptoms are generally short lived. Some people who take SSRIs have lowered libido or some alteration in sexual function. This may dissipate over time and clears up when the medicine is stopped.
Less common side effects include persistent sweating, weight gain and headaches. SSRIs are not considered to be addictive. Nevertheless, some people may have temporary withdrawal effects such as anxiety, stomach upset or flu-like symptoms when treatment is first stopped. Reducing the dose progressively may help to reduce the risk of these symptoms and this should be done with the guidance of your doctor. Examples of SSRIs include fluoxetine and paroxetine.
Selective serotonin and noradrenaline reuptake inhibitors (SNRIs). These are similar to SSRIs but they work more broadly and so they may be effective in some patients where SSRIs have not worked. Side effects and withdrawal symptoms are similar to those of the SSRIs.
Noradrenaline reuptake inhibitors (NARIs). These are designed to affect one type of brain chemical called noradrenaline, which is associated with improving mood and increasing energy. NARIs are less likely to cause drowsiness than some other antidepressants.
Noradrenaline-serotonin specific antidepressants (NaSSAs). These are relatively new antidepressants that are generally less likely to cause sexual side effects but are more likely to cause weight gain.
Reversible inhibitors of monoamine oxidase (RIMAs): are relatively non-sedating. They can be helpful for patients who are experiencing problems with anxiety or having difficulty sleeping.
Monoamine oxidase inhibitors (MAOIs). These are used less frequently than other antidepressants because they can cause serious side effects if you eat certain foods such as cheese. Your GP will explain these side effects and give you a list of foods to avoid.
Tricyclic antidepressants (TCAs). These work by delaying the absorption of the natural brain chemicals noradrenaline and serotonin, so that there are more of these chemicals in your brain for longer). This is thought to help with depression. They are older medications that are highly effective but have more troublesome side effects, including increased appetite, weight gain, dizziness, sweating, drowsiness and shaking, than newer medicines. They are more often used in pain management than in depression nowadays. Dothiepin and clomipramine are examples of TCAs.

The medication information outlined is for general explanatory purposes only and is not medical advice. You should always check with your doctor prior to taking any medications as they may cause side effects. If you are experiencing side effects from your medication or symptoms you feel might be caused by taking the medication, contact your doctor as soon as possible. You may also have to be careful about mixing the medication/s you are on with other medications and/or alcohol.

Treating depression needs to take into account that it can be a chronic condition and needs to be managed long-term, sometimes life-long. Studies show that if antidepressants help a person to treat depression, they should be taken for at least six months.

For most people, treatments for depression should be used for as long as necessary for the person to stabilise. This is to make sure they get the most benefit out of their treatment as well as decreasing the chance of relapse. When stopping antidepressant medication, your GP will usually reduce your dose gradually over at least four weeks. Don't stop taking your medication suddenly because you may experience withdrawal reactions.

Complementary therapies

St John's wort (Hypericum perforatum) is a complementary medicine that has shown some promising results in treating mild-to-moderate depression. You can buy this as tablets in health food stores and pharmacies.

Note: Always ask for advice from your doctor or pharmacist before taking St John's wort. There can be harmful interactions with other commonly used prescription or non-prescription medicines, such as the contraceptive pill, anti-depressants and others.

Hospital treatment

Most people who have depression can be successfully treated without being admitted to hospital. However, if you have severe depression and have suicidal thoughts, you, your family, or your psychiatrist may feel you need the shelter and protection of a hospital.

Before going into hospital, you may have a mental health assessment. This involves talking with your doctor and answering some questions about how you are feeling.

Major general public hospitals have psychiatric inpatient units attached to them while there are also private hospitals dedicated to psychiatric problems.

Electroconvulsive therapy (ECT)

ECT is a medical procedure that has long been used to treat severe depression. It involves giving a brief electric current to the brain while the person is under general anaesthetic. ECT often works very quickly, greatly lifting your depression. However, it doesn't appear to stop depression coming back in the future. ECT is relatively safe and the main side effect is memory problems that tends to improve after a few months.

However, it can be a controversial treatment because it's not absolutely clear how it works.

This treatment is only considered if you're severely depressed and experiencing psychotic symptoms such as hallucinations or if you're severely depressed and treatment with medicines hasn't worked for you.

ECT is always given in hospital under general anaesthesia, which means you will be asleep during the procedure and feel no pain. People tend to have ECT sessions twice a week for six to 12 sessions.

Repetitive transcranial magnetic stimulation (rTMS)

This is a newer treatment for depression that has been developed in Australia and overseas over the past 15 years. Clinical trials suggest it does work for some patients in whom medication has not been successful. It has been approved for use in a number of countries including the USA and Australia, while research into its use continues.

Crisis services

In addition to hospital-admitted or outpatient services, many regions have a Crisis Team that can be contacted 24 hours a day. They are designed to give urgent, short-term help. Crisis services provide intensive treatment and support, usually in the person's own home. Crisis Teams are attached to psychiatric inpatient units and specialist community health services. To find the nearest local Crisis Team, contact your local public hospital or Community Mental Health Service.

Further information

Beyondblue
1300 22 4636
www.beyondblue.org.au

SANE Australia
1800 18 7263
www.sane.org/

Headspace (aimed at younger people)
(02) 6201 5343
www.headspace.org.au

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