Depression

Also known as major depressive disorder

Having the blues is something that we all experience from time to time, but for people with depression, this feeling persists over weeks to months.

In addition to a low mood, depression can also bring other symptoms including sleep problems, feelings of hopelessness, loss of enjoyment and negative thinking. Some people may even feel so bad that they have thoughts of suicide. Even though you may be feeling bleak, there is much you can do to help get onto the road to recovery. 

 Key points:

  1. Depression is very common and can affect anyone.
  2. Key symptoms include constantly feeling down or hopeless and loss of enjoyment or interest in doing the things you used to enjoy doing.
  3. Talk to your doctor, pharmacist or phone the Depression Helpline for if you are concerned about depression – the sooner you get help, the sooner you'll start to feel better.
  4. Depression is a medical problem which can in many cases be effectively treated with a combination of psychological therapies, lifestyle changes and anti-depressant medication.
  5. Treating depression commonly also leads to improved health outcomes for people with long-term conditions such as diabetes, heart disease or arthritis.

What is depression?

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 or still get satisfaction or enjoyment from them or the company of others.

What causes depression?

The exact cause of depression is unknown. Sometimes depression appears out of the blue, other times something seems to trigger it. Many people who get depression will find close relatives experienced depression also. This family history can mean a person is more at risk of depression.

Triggers

If depression is triggered by an event, this 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 such situations. But depression can be thought of as 'grief gone wrong', where it seems impossible to get off rock bottom or see any hope of this situation changing.

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.

Chemical imbalance theory

The idea that depression is caused by imbalances 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, such regular exercise and better stress management, can also alter brain chemistry.

Who is vulnerable to depression?

Depression is very common and can affect anyone.

  • One in six people sometime in their life and one in seven young people have a problem with depression.
  • It affects women more than men, but men seem less likely to recognise the problem and seek help.
  • Men are at risk of dismissing the signs and become anxious, angry or fatigued by it or use alcohol to try to shut out the feelings.
  • Depression is also common during and after pregnancy.
  • Other risk groups include older people or people who are unwell due to other illnesses, or after surgery.

Symptoms

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

  • frequently feeling sad and tearful
  • not wanting to socialise anymore
  • 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 free call Lifeline 0800 543 354 anytime for support.

Self tests

If you are unsure whether you have depression, there are also online self-tests you can do:

Diagnosis

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

Diagnosing mild or moderate 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.

Treatment

Depression is a medical problem with psychological and physical elements. Most often, it can be effectively treated with a combination of psychological therapies, lifestyle changes and anti-depressant medications. 

Psychological therapy

All people with depression are advised to have some form of psychological, or 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 already 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 the chances of future bouts of depression.

Online therapy

For mild-to-moderate depression, online programmes have proved very popular, helpful and are more convenient alternatives to face-to-face sessions. Here are some national programmes or well-researched programmes worth looking at:

  • The National Depression Initiative – an online self-management programme and journal that allow you to learn and set goals and daily routines to help you beat depression.
  • Beating the Blues – available as part of your treatment.
  • SPARX  – a free online tool to help NZ young people learn to deal with depression and anxiety.
  • myCompass – an Australian interactive self-help service that aims to promote resilience and wellbeing for mild to moderate stress, anxiety and depression
  • MoodGYM & e-couch  – cognitive behavioural therapy (CBT) based programs from the Australian National University. They help you identify and overcome problem emotions and develop good coping skills.

These programmes can be entirely confidential. Some 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 for the NZ based ones.

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.

  • Address your basic needs – stay physically active, make time for pleasurable activities and practice relaxing.
  • Break problems down into simple goals and small steps, and give yourself credit for each step you accomplish.
  • Spend time with people who can support you – just being in the company of friends and loved ones can help to boost your mood.
  • Avoid alcohol and drugs which often make depression worse.
  • If you are not sleeping well, read more in our sleep section.

Antidepressant medications

The most commonly used antidepressants for first-time treatment are selective serotonin reuptake inhibitors (or SSRIs), of which there are several types. Within 2 or 3 weeks, most people should feel a noticeable benefit from using them. The choice of antidepressants has improved but they still have possible side effects, which your doctor can explain. Often, SSRI 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 worsen – 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.

Also, check with your doctor or pharmacist before taking any other medicines or supplements – 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.

Self care

There are a number of things you can do that may help you in overcoming depression:

  • Talk to someone: 
    • a friend or family member
    • your GP – who will talk with you the best treatment options
    • a counsellor or member of your local community mental health team (contact them through your GP).
    • your pharmacist - who can connect you with support teams
  • Keep active – going for a walk or doing something active has been shown to improve mood and wellbeing.
  • Refuel yourself with healthy food such as 5+ fruit and vegetables per day, water rather than juice, less packet food or junk food. 
  • Make time to plan and enjoy cooking a special meal at home with friends or family
  • Eat a healthy breakfast every day
  • Eating fish or taking fish oils may help.

Support

The NZ Mental Health Foundation and Webhealth both have comprehensive lists of mental health support services.

If you would like to talk to someone, try one of the following helplines. These are all free to call from a NZ landline:

  • Depression Helpline (0800 111 757)
  • Lifeline (0800 543 354)
  • Samaritans (0800 726 666)
  • Youthline (0800 376 633)

See also: postnatal depression support groups

Learn more

Depression Mental Health Foundation
The lowdown – depression explained for young people NZ government website
Depression explained Black Dog Institute (AU)
Support and education for women with experience of depression ThroughBlue, NZ
Some of the common myths of antidepressants Mothers Helpers NZ

Credits: Health Navigator. Last reviewed: 02 Mar 2015