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WHAT IS DEPRESSION?
While we all feel sad, moody or low from time to time, some people experience these feelings intensely, for long periods of time (weeks, months or even years) and sometimes without any apparent reason. Depression is more than just a low mood – it's a serious illness that has an impact on both physical and mental health.
WHAT CAUSES DEPRESSION
While the exact cause of depression isn't known, a number of things can be associated with its development. Generally, depression does not result from a single event, but from a combination of recent events and other longer-term or personal factors.
Research suggests that continuing difficulties – long-term unemployment, living in an abusive or uncaring relationship, long-term isolation or loneliness, prolonged exposure to stress at work – are more likely to cause depression than recent life stresses. However, recent events (such as losing a job) or a combination of events can ‘trigger' depression in people who are already at risk because of past bad experiences or personal factors.
Family history – Depression can run in families and some people will be at an increased genetic risk. However, this doesn't mean that a person will automatically experience depression if a parent or close relative has had the illness. Life circumstances and other personal factors are still likely to have an important influence.
Personality – Some people may be more at risk of depression because of their personality, particularly if they have a tendency to worry a lot, have low self-esteem, are perfectionists, are sensitive to personal criticism, or are self-critical and negative.
Serious medical illness – Having a medical illness can trigger depression in two ways. Serious illnesses can bring about depression directly, or can contribute to depression through associated stress and worry, especially if it involves long-term management of the illness and/or chronic pain.
Drug and alcohol use – Drug and alcohol use can both lead to and result from depression. Many people with depression also have drug and alcohol problems. Over 500,000 Australians will experience depression and a substance use disorder at the same time, at some point in their lives.
Changes in the brain- Although there has been a lot of research in this complex area, there is still much that we do not know. Depression is not simply the result of a ‘chemical imbalance’, for example because you have too much or not enough of a particular brain chemical. There are in fact many and multiple causes of major depression. Factors such as genetic vulnerability, severe life stressors, substances you may take (some medications, drugs and alcohol) and medical conditions can lead to faulty mood regulation in the brain. Most modern antidepressants have an effect on your brain’s chemical transmitters (serotonin and noradrenaline), which relay messages between brain cells – this is thought to be how medications work for more severe depression.
Psychological treatments can also help you to regulate your moods. Effective treatments can stimulate new growth of nerve cells in circuits that regulate mood, which is thought to play a critical part in recovery from the most severe episodes of depression. Everyone is different and it's often a combination of factors that can contribute to a person developing depression. It's important to note that you can't always identify the cause of depression or change difficult circumstances. The most important thing is to recognise the signs and symptoms and seek help.
DO I HAVE DEPRESSION?
The key symptoms of depression include one or both of the following:
Feelings of sadness, emptiness or lowered mood that lasts for most of the day, nearly every day
Loss of interest in activities that were previously enjoyable, like going out, seeing friends, or pursuing interests and hobbies.
These symptoms are experienced persistently for at least two weeks, along with several other symptoms over the same period. These vary from person to person, but can include:
Significant changes in appetite and/or weight in the absence of dieting
Difficulty sleeping or excessive sleeping
Fatigue and loss of energy
Feelings of worthlessness, helplessness or hopelessness, or excessive guilt
Trouble concentrating or making decisions
Decreased interest in sex
Thoughts of suicide or a feeling that life is not worth living.
WHAT CAN I DO?
How a psychologist can help
Your psychologist will ask some questions about your history, circumstances, thoughts, feelings and behaviours. They might also use questionnaires to gather more information.
Together, you will work towards an understanding of factors that might be involved in the development and maintenance of depression. A treatment plan is then developed between you and the recommended psychologist.
A good psychologist might use CBT, IPT, STPP, or other psychological strategies such as mindfulness and relaxation to help in recovery.
Evidence-based psychological interventions
There are many effective psychological treatments for depression. Certain specialised forms of psychological intervention tend to be more effective than general supportive counselling, as they address current issues and symptoms and also aim to reduce the likelihood of having future episodes of depression.
Cognitive behaviour therapy (CBT)
Cognitive behaviour therapy (CBT) focuses on negative and unhelpful thoughts about the self, others, and the future which may contribute to depression. The goal of this type of therapy is to identify, examine, and modify these unhelpful thoughts and the behaviours that follow, and increase behaviours that might improve mood and quality of life. This includes ensuring a balance of enjoyable activities throughout each day, and a range of activities that give the individual a sense of achievement. Problem-solving, to help address possible causes of stress and lowered mood is also an important compotent.
Interpersonal psychotherapy (IPT)
Interpersonal psychotherapy (IPT) involves addressing problems in the individual’s relationships and expectations about others that might be contributing to the symptoms of depression. The aims of this type of therapy include helping the individual to find new ways to develop and nurture relationships, resolve conflicts with others, express emotions and communicate more effectively, adapt to life-role changes, and improve social support networks.
Short-term psychodynamic psychotherapy (STPP)
Short-term psychodynamic psychotherapy (STPP) can help the individual to overcome internal conflict and resistance by bringing unconscious feelings, desires, motivations and thoughts into awareness. The goals of this therapy are to identify and change unhelpful defences which may be getting in the way of a healthy life, decrease vulnerability to depression, and build resilience.