Depression is a change in mood, behaviour and feelings that can have subtle or dramatic effects on how you think, how you regard yourself, your life and the world, how well you cope with life’s problems., your ability to perform daily activities and still get satisfaction or enjoyment from them or the company of others. When these feelings are intense or show no signs of going away, they could be due to depression. Depression is a medical problem with physical and psychological parts. Most often, it can be effectively treated.

Who gets depression?

Depression can affect anyone. One in six people sometime in their life, and one in seven young people, have a problem with depression. It affects more woman than men, but men seem less likely to recognise the problem and seek help. Rather, men may dismiss the signs that they are not coping and become anxious, angry or fatigued by it, or may use alcohol to try to shut out the feelings.

Depression is also common during and after pregnancy and for people who are elderly or unwell due to other illnesses, or after surgery. Leaving depression untreated usually means poorer outcomes for people with long term conditions such as diabetes, heart disease or arthritis.

What causes depression?

Depression can often be traced back to a significant event. The event usually symbolises some form of loss, such as a relationship, a job, your health or independence, or an important idea/belief. It is normal (healthy even) to feel grief in many situations. Depression can be thought of as “grief gone wrong”, where it seems impossible to get off “rock bottom” or see any hope of the situation changing.

People also get depression without a significant trigger. Many people who get depression have a family history of depression. This family history can mean a person is more at risk of depression.

The idea that depression is caused by imbalances in the levels of brain chemicals, such as serotonin in the levels of brain chemicals, such as serotonin and noradrenaline, is an area of ongoing study. Antidepressant medicines aim to rebalance certain brain chemicals but lifestyle changes (eg, more exercise, better stress management) can also alter brain chemistry.

Alcohol and illicit drug use also have negative effects on brain health. They have been shown to trigger and worsen depression rather than provide an escape from it.
Some medicines (eg, blood pressure and hormonal medicines) and common medical conditions eg, stroke or low thyroid hormone) can also cause depression.

What are the symptoms of depression?

Depression can be mild, moderate or severe. The physical and psychological symptoms commonly described include:

  • Frequently feeling sad and tearful
  • Feeling like not socialising any more
  • Being unable to enjoy activities that once were fun
  • Strong feelings of guilt or worthlessness
  • Agitation, anger or restlessness
  • Unexplained appetite or weight changes
  • Physical symptoms such as pain (eg, headache, back pain) associated with low mood
  • Tiredness and too much or too little sleep
  • Difficulty concentrating and making decisions
  • Difficulty “getting much done”
  • Thoughts of suicide*

If some of these symptoms affect you often over the course of a few weeks it may help to talk to your doctor.

*If your thoughts include self-harm or suicide you should get urgent medical help or call the Depression Helpline on 0800 111 757 for support.

Talking about how you feel

It is important to talk to someone you trust about how you feel, and to know that depression is not a sign of weakness or failure. Many great and successful people, today and throughout history, have managed depression in their lives,

Today, it is possible to seek help from doctors and online through websites such as www.depression.org.nz to help you understand what you are feeling and why. Your doctor is likely to have talked to hundreds of patients like you with depression. Talking helps you to identify and acknowledge the main problems and, with your doctor, set some simple goals that should bring about improvements.

Your Doctor can help you to get help

Severe depression is often easy for the doctor to diagnose, and treatment may mean starting a course of antidepressant drugs.

Diagnosing mild or moderation depression can be less clear-cut for your doctor and your treatment may or may not include antidepressants. Your doctor is able to coordinate the different parts of your treatment, provide follow-up and be a trusted person to talk to, as you recover.

Psychological therapy

All people with depression are advised to have some form of personal psychological (talking) therapy if it is available, affordable and practical. It can help with thinking patterns and anxiety, problem-solving skills and self-esteem, among other things, even if you are using an antidepressant. It is commonly called cognitive behavioural therapy(CBT) or interpersonal therapy. Psychological therapy from a trained professional, or online, can help you recover and reduce chances of future bouts of depression.

Online therapy

For mild-to-moderate depression, there are several online e-therapies that are more convenient alternatives to face-to-face sessions. The National Depression Initiative (www.depression.org.nz) has an online Self-Management Programme and Journal that allow you to learn and set goals and daily routines to help you beat depression. It can be entirely confidential or it can include personal phone, text and email support from programme counsellors. You can also include your doctor or someone else you trust to help motivate you and give you feedback.

Lifestyle changes

Improvements to three aspects of your daily life can greatly affect your mood: sleep, exercise and the use of alcohol or drugs. It is worth discussing each of these with your doctor.

Antidepressant drugs

The most commonly used antidepressants for first-time treatment are selective serotonin reuptake inhibitors (or SSRIs), of which there are several types. Within two or three weeks, most people should feel a noticeable benefit from using them. The choice of antidepressants have improved but they still have possible side effects, which your doctor can explain. Often, SR side effects ease with time. If not, talk to your doctor about an alternative. When starting them, some people initially can find their mood or suicidal thoughts worse – if this happens contact your doctor urgently.

It is normal to use antidepressants for up to a year, or longer if you have had depression before. Antidepressants are not addictive but “coming off antidepressants” should be done slowly, supervised by your doctor, to avoid withdrawal side effects. You should also talk to your doctor if you become pregnant, or plan to be. Check also with the doctor before taking any other drugs – some have interactions with antidepressants that increase the risk of psychological and physical problems, even ones bought over the counter at a pharmacy and some herbal medicines.

Further information and support:

The National Depression Inititative – www.depression.org.nz

Mental health resources for young people, Maori and Pacific Islanders: www.mentalhealth.org.nz , www.hauora.co.nz, www.healthpoint.co.nz, www.thelowdown.co.nz

Depression Helpline 0800111757

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