Churchill described it as a black dog lurking behind him, while comedic genius Spike Milligan said his depression was both a blessing and a curse. At one point or another most people talk of feeling depressed, but there’s a big difference between ‘feeling blue’ and clinical depression.
In the last decade there has been a significant effort to boost public awareness of mood disorders – especially depression – and provide support for those affected by the illness.
In reality, depression is more akin to a feeling of numbness than a feeling of sadness. While it can be triggered by a particular event like loss of a job or a loved one, it can also come on for no apparent reason.
If you or someone you know needs help, call:
- Emergency on 000 (or 112 from a mobile phone)
- Lifeline on 13 11 14
- Kids Helpline on 1800 551 800
- MensLine Australia on 1300 789 978
- Suicide Call Back Service on 1300 659 467
It’s unfortunate that we use the same word for two different things – a low mood, and a diagnosable illness. It means people often fail to recognise the symptoms of depression, and don’t get treatment for it. At its worst, severe depression can end in suicide.
In reality, everyone is vulnerable to depression: in Australia one in four women and one in six men will experience an episode of clinical depression during their lifetime, and an estimated 6 per cent of Australian adults are affected by a depressive illness.
What causes depression?
Depression is caused or triggered by genes, biology, psychology, personality, life events … it’s an incredibly complex condition.
Family and twin studies have shown that some depressions can have a genetic component. If someone in your immediate family has been diagnosed with depression or bipolar disorder (manic depression), you are two to three times more likely to have a similar diagnosis yourself. Twin studies have found that genetics increase the risk of developing clinical depression by roughly 40 per cent.
Certain medical conditions can also increase the likelihood of depression. For example, having an under-active thyroid gland can contribute to depression, and research shows that people who’ve had a heart attack, stroke, cancer, or diabetes, for example, have higher than average rates of depression. Some prescription medications can increase the risk of depression.
Depression is also more likely if you are female, are under stress or experience a stressful life event such as the death of a loved one, a relationship ending or losing a job. A history of abuse or childhood deprivation can also predispose people to depression.
People who are prone to worrying and feeling anxious, the extremely shy, those who engage in negative self-talk or people who are extremely sensitive are all more likely to experience depression. Often those with a tendency to set unrealistic goals and exhibit certain kinds of perfectionism also have also been associated with an increased risk of depression, particularly in the face of work or schoolrelated stressors.
What is depression?
How do you distinguish between clinical, “capital D” depression and the common old blues? For some people, the symptoms are obvious. But others manage to keep up their daily routine, not really knowing what’s wrong.
The short answer is that depression becomes an ‘illness’ when it’s severe, it persists for two weeks or more, and it affects someone’s ability to function at work and home.
For a person to be diagnosed with clinical depression, they must show five or more of the following symptoms, including at least one of the first two, for at least two weeks *:
- an unusually sad or irritable mood that does not go away;
- loss of enjoyment and interest in activities that used to be enjoyable;
- lack of energy and tiredness;
- feeling worthless or feeling guilty when they are not really at fault;
- thinking about death a lot or wishing they were dead;
- difficulty concentrating or making decisions;
- moving more slowly or, sometimes, becoming agitated and unable to settle;
- having sleeping difficulties or, sometimes, sleeping too much;
- loss of interest in food or, sometimes, eating too much. Changes in eating habits may lead to either loss of weight or putting on weight.
(* From Mental Health First Aid – Depression First Aid Guidelines)
Grief or depression?
One area of recent controversy around the diagnosis of clinical depression is related to grief that follows the recent death of a loved one.
In previous versions of what is considered to be the ‘psychiatry bible’, there was a ‘bereavement exclusion’, which recommended that clinicians not diagnose major depression in an individual who had experienced the death of a loved one in the previous two months.
The argument was that normal grieving could present as depression and be misdiagnosed. However, in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the expert committee decided to remove the ‘bereavement exclusion’, arguing that it may have resulted in major depression being overlooked in these grieving individuals.
While everyone grieves differently, and grief shares many of the same features as depression, the expert committee behind the DSM-5 identified some key features separating them.
“In grief, painful feelings come in waves, often intermixed with positive memories of the deceased; in depression, mood and ideation are almost constantly negative,” they write.
“In grief, self-esteem is usually preserved; in MDD, corrosive feelings of worthlessness and self-loathing are common.”
Biology of depression
With regards to the underlying biology of depression, previous theories focused around the idea of low levels of neurotransmitters.
Today, researchers believe that the brain changes which accompany depression may be even more fundamental, and that altered levels of neurotransmitters reflect these changes. There is evidence that the structure of brain cells can be altered with stress and depression, with the result that their functioning is affected.
This would explain why people often complain of poor concentration and memory when depressed. However, the good news is that treatments, including antidepressant medications and electroconvulsive therapy, can reverse these changes, causing brain cells to grow back to their healthy states.
Getting the right diagnosis
In real life, getting a diagnosis of depression is not as easy as ticking off a checklist of symptoms.
The majority of people with the symptoms described above don’t go to a doctor in the first place – partly because they don’t see their low mood as a medical problem, but rather as a problem with themselves or their lives. But while symptoms such as sleeping badly and feeling worthless may seem mundane, it’s not normal to feel that way for weeks or months on end.
The other problem is that even doctors don’t always find it easy to recognise depression, especially if the patient comes to them complaining of physical rather than psychological symptoms. Australian and international research shows that up to half the people presenting to GPs with depression or anxiety are not diagnosed, and even then a significant proportion are not treated.
Some people are relieved to get a diagnosis of depression. It provides an explanation for their extended misery and puts their suffering in the medical realm. If depression is caught early, it’s much easier to stop it doing too much damage. But most people don’t recognise the early signs or know what to do.
To distinguish depression from everyday sadness, ask how long the symptoms have lasted (is it more than two weeks?), whether the person is different from their usual self, and whether they have lost interest in things that they used to enjoy.
Suicide warning signs
- Expressions of hopelessness or helplessness
- An overwhelming sense of shame or guilt
- A dramatic change in personality or appearance
- Irrational or bizarre behaviour
- Changed eating or sleeping habits
- A severe drop in school or work performance
- A lack of interest in the future
- Written or spoken notice of intention to commit suicide
- Giving away possessions or putting affairs in order
From: Better Health Channel, ‘Suicide and mental illness explained’
Once you’ve identified that someone needs help what do you do? Both the Black Dog Institute and beyondblue provide good, credible information on how to help someone who is depressed.
Here are some of their tips:
Talk to the person – If you’re concerned someone you know is depressed then try talking to them about your concerns in a supportive, non-confrontational manner. Once you’ve raised your concerns give them a chance to talk, and listen to what they have to say before offering them too many suggestions.
Get professional help – If depression seems likely, the best thing you can do is encourage the person to get professional help, and help them make an appointment with a GP or mental health professional if necessary. If it’s an emergency there are crisis services you can contact. See the emergency contacts section for a list of contact details.
Seek out information – check out the info section for a list of organisations that provide credible information, there are plenty of fact sheets and easy to read brochures available online. You’ll find a comprehensive list of organisations providing information on depression in the emergency contacts section below.
Encourage treatment – It’s vital that people with depression take any medications they are prescribed. As some medications bring unwanted side effects, you might need to encourage the depressed person to persist with their medication. Therapy can also bring unexpected surprises – carers are urged to have patience through the process and continue to support their loved ones even though sometimes their behaviour may be hurtful.
Take care of yourself – Supporting someone with depression isn’t always easy. If you haven’t experienced depression yourself (and even if you have), it can be very difficult to live with. Instead of being grateful (which would be much more satisfying), a depressed person may be hostile to your care and concern, further isolating themselves; or alternatively, they can take everything you are willing to give – maybe more!(For more information on how to look after yourself when someone you love has depression check out our feature Mental illnesses’ ripple effect on family and friends.)
If you, or someone you know, needs help, you can call Lifeline 13 11 14, Suicide Callback Service on 1300 659 467, Kids Helpline on 1800 551 800, or MensLine Australia on 1300 789 978. For an extensive list of national and state-based counselling contacts go to our Emergency Contacts page.
This article was reviewed by Associate Professor Vijaya Manicavasagar, the director of psychological services at the Black Dog Institute.
- Online therapy: helping treat depression in rural areas 25/06/2009
- Internet-based intervention for depression
The Health Report (09/10/2006)
- Black Dog Institute
An educational, research and clinical centre for mood disorders, especially depression and bipolar disorder.
- Omega-3 fatty acids and mood disorders
The Health Report (28/06/2006)
Australia’s national depression initiative, with information and further resources.
Comprehensive source of information on depression developed by the Australian National University’s Centre for Mental Health Research and the CSIRO.
A comprehensive website offering free counselling and support. It is also a good source of information, personal stories, and contacts for each Australian states and territories.
- Mental Health First Aid
Information, tips and course information for mental health first aid – operated through the ORYGEN research centre at the University of Melbourne.
- Mood Gym
Free online cognitive behaviour therapy program
A service to help young people get through tough times. The depression page includes fact sheets on a range of mental issues, including supporting someone who is depressed.
- Youth beyondblue
Mental health information for youth from beyondblue.
- SANE Australia
A consumer organisation for Australians with mental illness.
- Treating depression: not one-size-fits-all – ABC Health & Wellbeing
- Depression’s many shades of blue – ABC Health & Wellbeing
The National Youth Mental Health Foundation, helping young people aged 12 to 25.