Depression

Feeling ‘down’ or sad is part of a normal human experience. These feelings can be in response to certain life events, or for no clear reason at all. Most of the time, these are passing feelings, that resolve with time. Sadness differs from depression, however, as in depression the feelings are more intense, last for a long period of time (two weeks or more) and cause serious interference with daily life. Depression can affect anybody, at any stage of life. It is estimated that approximately 6% of Australians experiences a depressive disorder each year [1].

TYPES OF DEPRESSION

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; p. 155 [2]) there are several different types of depressive disorders. In Australia, the most common form of depression is Major Depressive Disorder (sometimes called Major Depression, Clinical Depression or Unipolar Depression) [1].

Features of major depressive disorder (DSM-5) [1]:

• For a period of least two weeks, the person experiences low mood, loss of pleasure, or interest in usual activities for most of the day, nearly every day. This is accompanied by at least four of the following:

  • Significant weight loss or gain

  • Increased or decreased need for sleep

  • Restlessness or feeling slowed down

  • Fatigue or loss of energy

  • Feelings of worthlessness or excessive guilt

  • Difficulty concentrating or making decisions

  • Recurring thoughts of death or suicide

• The symptoms are significantly distressing or impair social, occupational, or other functioning.

• The mood disturbance isn’t due to the effects of a substance (e.g. medication) nor another medical condition.

• The mood disturbance isn’t better explained by another psychological disorder (e.g. schizoaffective disorder)

• There has never been a manic episode. 

DEPRESSION SYMPTOMS

Depression can have a serious impact across many important parts of life. There are three main categories of symptoms to be aware of – cognitive, physical, and behavioural. Here’s what they might look like in depression:

COGNITIVE SYMPTOMS OF DEPRESSION

Negative thoughts are central to the experience of depression. These negative thoughts tend to centre on:

• The self (e.g. “I am useless”)

• The world (e.g. “Everything is too difficult”)

• The future (e.g. “Things will never get better”)

Unhelpful thinking styles are often evident in depression, as are challenges with concentration, decision-making, memory, and attention [3].

PHYSICAL SYMPTOMS OF depression

Depression can cause many different physical symptoms, including:

• Changes to sleep patterns: Some people with depression experience difficulty falling asleep, disrupted sleep, or waking early. Some feel like they need to sleep a lot more, while others feel like they need less sleep than normal.

• Changes to appetite: For some, appetite can increase leading to weight gain. For others, it’s the opposite, and appetite may decrease, leading to weight loss.

• Changes to libido levels: Interest in sex may decline in people with depression.

• Changes to energy levels: Decreased energy is common in people with depression. Combined with other problems like decreased motivation and difficulty concentrating, this can make it very challenging to carry out every day activities.

BEHAVIOURAL SYMPTOMS OF depression

The cognitive and physical symptoms of depression often lead to some big changes in the way the person behaves. These behaviour changes might include:

• Withdrawing from friends and loved ones

• Stopping previously enjoyable activities and hobbies

• Not going out

• Difficulty completing daily routines (e.g. showering, cooking dinner, self-care)

• Not being productive at work or school

• Relying on unhelpful coping strategies like alcohol

Unfortunately, these changes to behaviour often mean that you miss out on opportunities for positive experiences and emotions. This means that these behaviours tend to make depression worse.

TREATMENT FOR depression

There are different treatment options for depression, including:

• COGNITIVE BEHAVIOURAL THERAPY (CBT). Cognitive Behaviour Therapy has been demonstrated to be one of the most effective treatments for depression [4]. In CBT for depression, the person is taught to identify unhelpful, negative beliefs and replace these with more rational and helpful thoughts. This is combined with changing the negative behavioural patterns that may be maintaining depression.

• MINDFULNESS-BASED COGNITIVE THERAPY and ACCEPTANCE AND COMMITMENT THERAPY (ACT). These ‘new wave’ therapies are based on the principles of CBT. While CBT typically involves directly challenging thinking styles, Mindfulness-Based Cognitive Therapy and Acceptance Therapy instead encourage the individual to change their relationship to thoughts. These approaches are often used to prevent depression from returning because the person is encouraged to notice feelings of sadness or negative thoughts early on, before they have become fixed. These approaches help the person to notice when are often used to prevent relapse in depression.

• PSYCHOPHARMACOLOGY. In some cases, mood and concentration may be affected to such a point that it becomes difficult to take on board psychological treatments such as CBT, MBCT, and ACT. If this is the case, it may be helpful to speak with your GP about whether medication is a suitable option.  

If you think depression may be affecting you, why not Contact Us for a tailored approach?

REFERENCES

[1] Australian Bureau of Statistics (ABS) 2008. National Survey of Mental Health and Wellbeing: summary of results, Australia, 2007. ABS cat. no. 4326.0. Canberra: ABS.

[2] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington: American Psychiatric Association.

[3] Rock, P. L., Roiser, J. P., Riedel, W. J., & Blackwell, A. D. (2014). Cognitive impairment in depression: a systematic review and meta-analysis. Psychological Medicine, 44(10), 2029-2040. doi: 10.1016/j.ejphar.2009.08.046

[4] Cuijpers, P., Berking, M., Andersson, G., Quigley, L., Kleiboer, A., & Dobson, K. S. (2013). A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. The Canadian Journal of Psychiatry, 58(7), 376-385.