Depression

We all have the blues from time to time, but if you have depression, this feeling is stronger, it affects your thinking and behaviour, and lasts from weeks to months. However, no matter how low you feel, there is hope. There are people who can help you and things you can do to get on the road to recovery.

Key points

  • Depression is very common and can affect anyone, at any age – from childhood through to old age. It’s not a sign of any kind of weakness or fault in you.
  • About 1 in 6 people experience depression at some time in their life. It affects women more than men, but men seem less likely to recognise the problem and seek help.
  • Key symptoms include constantly feeling down or hopeless, loss of enjoyment or interest in doing the things you used to enjoy doing, negative thinking and sleep problems. You may even feel so bad that you have thoughts of self-harm or even suicide.
  • Symptoms can range from mild to severe, and the support and treatment you need will depend on how severe your symptoms are.
  • Depression can usually be treated with a combination of psychological therapies, lifestyle changes and antidepressant medication.
  • If you’re depressed, it’s important to get help – the sooner you do, the sooner you'll start to feel better. Remember: there is hope. Many people have come out the other side of depression and have gone on to enjoy happy, healthy lives.

What are the symptoms of depression?

Depression is a change in mood, behaviour and feelings that can be mild, moderate or severe. Symptoms include:

  • low mood
  • frequently feeling sad and tearful
  • not wanting to socialise anymore
  • being unable to enjoy activities that once were fun
  • poor appetite or overeating
  • physical symptoms such as pain (eg, headache, back pain)
  • tiredness and too much or too little sleep
  • difficulty concentrating and making decisions
  • difficulty getting much done.

If your depression is more severe, you may also have thoughts of self-harm or suicide. If you have these thoughts, you should get help urgently from your doctor or one of the helplines listed on this page. There are people who can help you get through. Read more about severe depression.

What causes depression?

Sometimes depression appears out of the blue, while at other times something seems to trigger it. The exact cause of depression is unknown but many factors may play a role in depression. For example, you are more likely to experience depression if you:

  • have someone in your family who has been depressed, such as a parent or sibling
  • experienced trauma or abuse at an early age
  • have certain chronic physical health conditions, such as diabetes, cancer, heart disease, Parkinson’s disease or coeliac disease, or have had a stroke or have low thyroid hormone
  • are going through major life changes or have recently suffered a loss, such as a relationship break-up, redundancy, or a significant injury or accident
  • are LGBTI
  • are or have just been pregnant
  • are an older adult
  • use alcohol or recreational drugs
  • are taking certain medicines, such as for blood pressure or hormonal medication.

How is depression diagnosed?

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

If you have some, but not necessarily all, the symptoms mentioned above, it’s a good idea to see your doctor. They will ask you questions about your thoughts, feelings and behaviour, including sleeping and eating patterns, as well as how long you have been feeling this way. They will also ask if you have had any previous episodes of depression and may ask about what is happening in your life at the moment. They may also do a physical examination and blood tests to rule out other causes for your depression.

Your doctor will be assessing not only if you have depression, but what type of depression and whether you have mild, moderate or severe symptoms, as this will affect what treatment they recommend.

What are the different types of depression?

There are several types of depression. You can still be depressed even if you don't meet all the criteria for one of these types. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) divides depression into the following categories:

  • Major depressive disorder – depression symptoms that interfere with your ability to work, sleep, study, eat and enjoy life. These may be mild, moderate or severe.
  • Persistent depressive disorder – a depressed mood that lasts for at least 2 years.
  • Premenstrual dysphoric disorder – a severe form of premenstrual syndrome experienced by some women before their periods.
Other depressive disorders (not meeting major depressive disorder criteria due to substance abuse, medication side effects, medical conditions, or other specified or unspecified reasons).

Other conditions also include symptoms of depression, including the following:

Major depressive disorder

For a diagnosis of major depressive disorder, you will have experienced five or more of the following symptoms during the same 2-week period and this is a change from your previous functioning. At least one of your symptoms is either depressed mood or loss of interest or pleasure:

  • depressed mood most of the day, nearly every day, as self-reported or observed by others
  • diminished interest or pleasure in all or almost all activities most of the day, nearly every day
  • significant weight loss when not dieting, weight gain, or decrease or increase in appetite nearly every day
  • insomnia or hypersomnia nearly every day
  • psychomotor agitation or retardation nearly every day
  • fatigue or loss of energy nearly every day
  • feelings of worthlessness or excessive or inappropriate guilt nearly every day
  • diminished ability to think or concentrate nearly every day
  • recurrent thoughts of death, recurrent suicidal ideation without a specific plan.

In addition, these symptoms:

  • cause functional impairment (e.g., social, occupational)
  • are not better explained by substance abuse, medication side effects or other psychiatric or somatic medical conditions.

There are 3 degrees of severity of major depression defined in the DSM-5:

Mild depression: Few, if any, symptoms in excess of the 5 required to make the diagnosis, and symptoms result in only minor functional impairment.

Moderate depression: Symptoms or functional impairment are between mild and severe.

Severe depression: Most symptoms, and the symptoms markedly interfere with functioning. Can occur with or without psychotic symptoms.

Persistent depressive disorder 

For this diagnosis, you meet the above criteria for a major depressive disorder, or you have 3 or 4 of the following dysthymic symptoms including depressed mood, for 2 years or more. Your impairment compared with major depressive disorder may be less severe. Dysthymic symptoms are as follows:

  • depressed mood
  • appetite changes
  • sleep changes
  • low self-esteem
  • fatigue
  • poor concentration
  • hopelessness.

How is depression treated?

Depression can usually be effectively treated with a combination of psychological therapy, lifestyle changes and antidepressant medication. For some people, alternative approaches have been useful, such as mindfulness meditation, St John's wort and online tools and courses. Find out more about treatment for depression.

What self-care can I do if I’m depressed?

  • Small steps are the key to change – choose what feels manageable and build from there.
  • Making your own self-care matter builds your resilience so you can cope better with the challenges of life.
  • Looking after your physical health helps your mental wellbeing.
  • Having ways to reduce and manage stress increases your resilience.
  • Getting help when you need it is a sign of strength, not weakness.
  • Staying connected to family, whānau and friends can help you feel better.
  • Spending time in nature is key to your wellbeing.
  • Finding a purpose increases your sense of meaning and belonging.

Read more about Living well with depression.

Support

If you would like to talk to someone, try one of the following free helplines as a first step, or contact your doctor.

  • 1737 phone or text 24/7 to reach a trained counsellor
  • Depression Helpline (0800 111 757)
  • Lifeline (0800 543 354)
  • Samaritans (0800 726 666)
  • Youthline (0800 376 633)

See more support options. 

Learn more

The following links provide further information about depression. Be aware that websites from other countries may have information that differs from New Zealand recommendations.   

depression.org.nz information, tests, tools, videos and more
Depression Mental Health Foundation, NZ
The lowdown – for young people NZ
Depression explained Black Dog Institute, Australia
Depression Your Health in Mind, Royal Australian and New Zealand College of Psychiatrists 2017
Resources for women with depression Through Blue, NZ
Workplace wellbeing Mental Health Foundation, NZ
Other peoples stories depression.org.nz
Personal stories Mental Health Foundation
How dogs can help with mental health – mind boosting benefits of dog ownership UK, 2018
F*ck depression Download a
 free e-book of scientifically proven ways to get through things
The Big Feels Club Articles and podcasts about life + feelings

See more resources about depression and how to manage it.

References

  1. Depression – what you need to know National Institute of Mental Health, US
  2. Depression in the LGBT population Healthline, US, 2016
  3. Online insomnia treatment also prevents depression Black Dog Institute, Australia, 2016
  4. One hour of exercise a week can prevent depression Black Dog Institute, Australia, 2017
  5. Dipnall JF, Pasco JA, Berk M, Williams LJ, Dodd S, Jacka FN,Meyer D2.Getting RID of the blues: Formulating a risk index for depression (RID) using structural equation modelling. Aust N Z J Psychiatry. 2017 Aug 1.
  6. Depression Mental health Foundation, NZ, 2014
  7. Mindfulness holds promise for treating depression American Psychological Association, 2015
  8. Depression in adults – recognition and management NICE guideline, UK, 2018
Credits: Health Navigator Editorial Team. Last reviewed: 30 Oct 2017