What is depression?

Depression is among the most common of all mental health conditions, and impacts many Australians every day. While we all get sad, feel low or lacking in energy at times, people with depression experience these feelings more intensely and for longer. They can find it difficult to carry on with regular daily tasks during periods of depression.

Depression is common — it affects 1 in 16 Australians each year. If you or someone you care about is experiencing an episode of intensely low mood remember that depression can be treated and support is available. It’s important to seek help.

What are the symptoms of depression?

Symptoms of depression involve the way a person feels, thinks and behaves. There are also physical signs of depression. People with depression may feel:

• sad or teary
• overwhelmed
• guilty
• restless or angry
• lacking in confidence
• hopeless or disappointed

People with depression may have recurring negative thoughts, such as:

• 'I’m no good.'
• 'It’s all my fault.'
• 'Life’s not worth living.'
• 'People would be better off without me.'

People with depression may also have altered behaviours, such as:

• not taking part in activities and hobbies they used to enjoy
• staying in, rather than going out socially
• being less productive at school or work
• drinking more alcohol
• losing interest in sex

People with depression may experience these physical symptoms:

• sleep problems: difficulty sleeping and/or feeling tired during the day
• changed appetite: with or without weight loss or gain
• feeling run down or sick
• headaches
• muscle pain
• churning stomach

While anyone with depression can experience any symptom, men and women tend to experience and report symptoms differently. Men are more likely to talk about the physical symptoms of depression such as feeling tired, irritable or angry, rather than saying they feel low.

If you or someone you care about has been experiencing these signs and symptoms for 2 weeks or more, it’s time to get some help from a health professional, such as your GP.

Types of depressive disorder

There are several types of depression, and while they are all characterised by intense low mood, there are also important differences.

Major depression is also known as major depressive disorder. The most recognised symptom is low mood and loss of interest in activities that were once considered pleasurable. These symptoms can be mild, moderate or severe, but will probably interfere with daily life and relationships. The low mood will persist for at least 2 weeks, and will be experienced on most days. Sub-types of major depression include:

• melancholic depression, ­ a severe form of depression that includes physical as well as emotional symptoms
• psychotic depression, which includes hallucinations (hearing or seeing people or things that aren't there); delusions (false beliefs that other people don’t experience or agree with); or paranoia (feeling suspicious of other people or feeling that everyone is against them).

Bipolar disorder is characterised by extreme mood changes that disrupt daily life. Symptoms of manic episodes include showing extremely high energy in speech and activity, agitation and a reduced need for sleep.

Symptoms of depressive episodes are similar to those of major depression. People who have bipolar disorder can also experience episodes of psychosis (hallucinations, delusions and/or paranoia).

Cyclothymic disorder is sometimes described as a milder form of bipolar disorder. The person experiences changing moods for at least 2 years. They have periods of hypomania (a mild-to-moderate level of mania) and episodes of depressive symptoms. They may also have very short periods of even moods, with fewer than 2 months in between. Symptoms tend to be less severe and are shorter lasting than in bipolar disorder or major depression.

Dysthymic disorder is similar to major depression but with fewer severe symptoms that persist for at least 2 years.

Seasonal affective disorder (SAD) is a mood disorder (either depression or mania) that has a seasonal pattern. Depressive symptoms tend to start in winter and fade by spring. It can take several winters to diagnose this type of depression. SAD is thought to be triggered by changes in exposure to light in the winter and is more prevalent in countries with short days and long periods of darkness, such as in the cold climate areas of the Northern Hemisphere. SAD is very rare in Australia.

Perinatal and postnatal depression occurs during pregnancy or after the birth of a baby and affects up to 1 in every 5 women in Australia. It is associated with the challenges and demands of parenthood as well as changes in hormones. For men, new routines and roles can also trigger depression. While tiredness and irritability is normal during pregnancy and after the baby is born, if you or your partner experience low mood that persists for more than 2 weeks, it’s important to talk to your GP about whether it may be perinatal depression.

All types of depression can be treated and the earlier you seek support, the better. Speak with your doctor about which treatment might be most effective for you.

What are the possible causes of depression?

Every person with depression is different, and everyone with depression has a unique set of circumstances. Usually, a combination of factors will contribute. While you often can't pinpoint the cause of the depression, understanding the circumstances can sometimes help you understand how to best manage it.

External factors

Life events such as long-term unemployment, living in an abusive or uncaring relationship, long-term isolation or loneliness, and constant work stress are all associated with depression. Recent life events such as losing your job, illness, an accident, or the death of someone close to you can trigger depression — particularly if you are already at risk. Many Australians have been adversely affected by events such as the COVID-19 pandemic and natural disasters such as bushfires. Events like this can sometimes induce symptoms of anxiety and depression.

Internal factors

Personal factors such as family history, personality and drug and alcohol use can leave you more vulnerable to depression. People with a family history of depression are at greater risk, possibly because of genetic factors. However not everyone who has a parent or sibling with depression will develop it themselves. Personality traits — such as perfectionism, low self-esteem and a tendency to worry — can also make depression more likely, but here too the link is not direct.

Drug and alcohol use can be both the cause and a consequence of depression. Reducing alcohol consumption can be very helpful for people with depression, and you can get help from the National Alcohol and Other Drug Hotline on 1800 250 015.

Complex chemical changes that occur in the body, particularly in the brain, when people have depression. Medical conditions can affect the way your brain regulates your moods. Many of the medicines used to treat depression work on these chemical aspects of depression, and have been shown to be very effective in helping to manage severe depression.

How is depression diagnosed?

If you are concerned about your mental health, or the mental health of someone you care about, it’s important you speak with a health professional, such as a GP. A mental health assessment usually involves a discussion or answering a questionnaire, as well as a physical examination. This will help your doctor differentiate between mental and physical health problems.

Your doctor will want to understand how you feel and think, and check for any symptoms of depression, such as in your energy levels, appetite, sleep and whether you are feeling restless, hopeless or sad. If you have a family history of mental illness — either depression or some other condition — tell your GP since this can help with your diagnosis. Your answers will help your GP determine whether a specialist such as a counsellor, psychologist or psychiatrist might be helpful.

When should I see my doctor?

If you are experiencing symptoms of depression, its best to seek help early and your GP is a good place to start. There's no need to struggle on your own. Seek help:

• if you are feeling sad, teary or overwhelmed most of the time
• if these feelings have been with you for 2 weeks or more
• if your low mood affects how you cope at home, work or school.

Your GP can suggest effective treatment options, and the sooner your symptoms are addressed, the better the outcome will likely be.

Some people with depression feel that life is too difficult, not worth living or even that they themselves are worthless. If you are experiencing suicidal thoughts, don’t wait — seek help now.

Suicide and crisis support

If you or someone close to you is in an emergency, or at immediate risk of harm, call triple zero (000).

To talk to someone now, call Lifeline on 13 11 14 or the Suicide Call Back Service on 1300 659 467.

How is depression treated?

Depression is a serious health issue and should be managed by a qualified health practitioner. Your GP can assess your mood and your overall health, and will suggest treatment approaches based on several factors, including what type of depression you have, how severe your symptoms are and whether you are experiencing a first or recurrent episode.

There are 3 main approaches to treating depression: lifestyle changes (including reducing substance use, improving sleep, exercise); psychological treatments (‘talking therapies’ such as CBT, mindfulness and online therapies); and physical therapies (including medicines and ECT). Often these treatments are used in combination.

A wide range of medicines are used in treating depression, and your doctor will work with you to find the one that is right for you. It can take several weeks for an antidepressant medicine to work fully, and often your doctor may need to adjust your dose.

It is important that you receive full support during this time and Beyond Blue has a free telephone counselling support line with trained mental health professionals.

By working with your doctor, and drawing on the support available, there is a good chance your depression will improve.

Can depression be prevented?

Even if you are more vulnerable to depression, there is plenty you can do to keep symptoms away.

Some proven strategies to help you stay well include:

• exercising
• avoiding harmful levels of alcohol and other substance use
• improving your sleep
• reducing anxiety, such as through relaxation techniques
• staying active
• staying sociable, so you avoid becoming isolated

What are the complications of depression?

When depression becomes very severe, dark thoughts can emerge and these can even lead to suicide. If you are having thoughts of suicide, talking to someone you trust can help.

If someone you care about has severe depression, learn the warning signs, since they may be feeling so bad that they can’t see their way out alone.

Resources and support

If you or someone near you is in immediate danger of suicide:

• call triple zero (000); or
• go to the nearest hospital emergency department

If you are having negative thoughts and need someone to talk to:

• call Lifeline on 13 11 14
• call Beyond Blue on 1300 22 4636
• talk to:
• a GP, counsellor, psychologist or psychiatrist
• family or friends
• a teacher or coach
• a work colleague
• a religious leader

Beyond Blue have a factsheet on how to support someone with depression.