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1 Depression What is depression? Depression is one of the common human emotional states. It is common to experience feelings of sadness and tiredness in response to life events, such as losses or disappointments. In most cases, as you come to terms with changes in life, the sad feelings resolve. In situations such as bereavement, these feelings may persist for months and return at significant times such as birthdays and anniversaries related to the lost loved one. Sometimes people continue to feel sad, even if there seems to be no apparent reason. Some people may become depressed without any clear precipitating event. This is the type of depression which may need more assertive management. Depression may be seen along a continuum: from transient feelings of sadness, to a severe persistent mood change with physical symptoms. Between 20-30% of people will experience a major depressive episode at some stage in their lives. See also for an online treatment course. What is Major Depressive Disorder? Major depression is a syndrome characterized by persistent low mood, loss of enjoyment and biological symptoms. Its features include: Low mood or feelings of sadness or irritability, most of the time. The mood may be worse at certain times of day, typically in the morning. Loss of interest in one's surroundings, loss of enjoyment in activities, decreased sex drive. Sleep disturbance: difficulty getting off to sleep, or waking in the early hours of the morning and finding yourself unable to get back to sleep. Negative thoughts regarding yourself, surroundings and future. Often a person may become guilty over real or perceived misdeeds. In severe Page 1 thiswayupclinic.org.au/clinic

2 depressions of a 'psychotic' type, the person may develop untrue beliefs regarding themselves and others, and may experience hallucinations. Appetite disturbance: increase or decreased, which may be accompanied by weight changes. Fatigue and loss of energy Physical symptoms such as vague abdominal discomfort and headaches, often associated with anxiety. Problems with concentration and memory difficulties. Feelings of agitation or feeling 'slowed down'. Thoughts of death or suicide: such thoughts indicate the need for professional help. What causes depression? Descriptions of depressive illness have been documented as far back as in ancient Greece, in the writings of Hippocrates. In the 20th century, researchers have attempted to categorize different types of depression. There is still debate regarding types and causes. Theories include: Primary vs secondary: depression occuring independently, or as a manifestation of another psychiatric illness (eg bipolar disorder) or medical problems (eg thyroid illness, infections, anaemia, neurological illness eg. after a stroke, as a side effect of medications for other medical conditions, or secondary to substance use (alcohol, cannabis, cocaine, amphetamines etc). Reactive vs endogenous: depression as a direct result of life events, or arising for no apparent reason. Biological theories: researchers have found changes in the regulation of 'biogenic amines': brain chemicals (neurotransmitters), such as serotonin and noradrenaline. Other hormonal systems within the body, and the immune system may also be affected Page 2 thiswayupclinic.org.au/clinic

3 Genetic influences: first degree relatives of a person with major depression are at a 2-3 time higher risk of having an episode in their lifetime. Psychological and social influences: anxious and tense people may be at higher risk. Adverse life events may precede an episode of depression: childhood adversity, major losses in adulthood and low social support levels (friends, community) may increase risk. What treatments work? In general, the severity of depression will dictate the most appropriate treatment. The presence of biological symptoms may mean that biological treatment (eg medication) is indicated. Treatments for depression which have been proven to be of benefit in scientific trials include: Cognitive behavioural therapy Interpersonal therapy Antidepressant medication Electroconvulsive therapy How do I choose a treatment? Choice of treatment depends on many factors: including the severity of depression, availability of treatments, and your own feelings about the use of medication or other therapies. We suggest the following: Mild depression: may resolve with exercise, pleasant events scheduling and structured problem solving. Moderate depression: medication, or psychotherapy (cognitive behavioural or interpersonal), or both Severe depression: medication initially, which may later be supplemented by psychotherapy to reduce the likelihood of relapse Page 3 thiswayupclinic.org.au/clinic

4 Severe depression complicated by poor food or fluid intake, or psychotic symptoms: medication or ECT If you are currently suicidal: We encourage you to see a health professional as soon as possible. What happens if depression is left untreated? An untreated episode of major depression usually lasts six to twelve months. There is a significant risk of suicide (10-15%), and relapses are common (up to 50 percent in 2 years after the first episode). What are my chances of getting better? Of people treated with medication and/or psychotherapy, 60-70% of people can expect a full recovery within three to four months. Contact Us THIS WAY UP Clinic Website: St Vincent s Hospital, Sydney, Australia Page 4 thiswayupclinic.org.au/clinic

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