While the exact cause of depression isn’t known, a number of things can be associated with its development. Generally, depression does not result from a single event, but from a combination of recent events and other longer-term or personal factors.
Research suggests that continuing difficulties – long-term unemployment, living in an abusive or uncaring relationship, long-term isolation or loneliness, prolonged exposure to stress at work – are more likely to cause depression than recent life stresses. However, recent events (such as losing a job) or a combination of events can ‘trigger’ depression in people who are already at risk because of past bad experiences or personal factors.
- Family history – Depression can run in families and some people will be at an increased genetic risk. However, this doesn’t mean that a person will automatically experience depression if a parent or close relative has had the illness. Life circumstances and other personal factors are still likely to have an important influence.
- Personality – Some people may be more at risk of depression because of their personality, particularly if they have a tendency to worry a lot, have low self-esteem, are perfectionists, are sensitive to personal criticism, or are self-critical and negative.
- Serious medical illness – Having a medical illness can trigger depression in two ways. Serious illnesses can bring about depression directly, or can contribute to depression through associated stress and worry, especially if it involves long-term management of the illness and/or chronic pain.
- Drug and alcohol use – Drug and alcohol use can both lead to and result from depression. Many people with depression also have drug and alcohol problems. Over 500,000 Australians will experience depression and a substance use disorder at the same time, at some point in their lives.
Changes in the Brain
What happens in the brain to cause depression is not fully understood. Evidence suggests it may be related to changes in the levels or activity of certain chemicals – particularly serotonin, norepinephrine and dopamine – which are the three main chemicals related to mood and motivation that carry messages within the brain. Changes to stress hormone levels have also been found in people with depression. Research suggests that behaviour can affect brain chemistry – for example, long-term stress may cause changes in the brain that can lead to depression. Changes in brain chemistry have been more commonly associated with severe depression rather than mild or moderate depression.
Everyone is different and it’s often a combination of factors that can contribute to a person developing depression. It’s important to note that you can’t always identify the cause of depression or change difficult circumstances. The most important thing is to recognise the signs and symptioms and seek help.
Signs and Symptoms
A person may be depressed if, for more than two weeks, he or she has felt sad, down or miserable most of the time or has lost interest or pleasure in usual activities, and has also experienced several of the signs and symptoms across at least three of the categories below.
It’s important to note that everyone experiences some of these symptoms from time to time and it may not necessarily mean a person is depressed. Equally, not every person who is experiencing depression will have all of these symptoms.
It has been my experience that gifted and talented persons are more likely to experience a type of depression referred to as existential depression. Although an episode of existential depression may be precipitated in anyone by a major loss or the threat of a loss which highlights the transient nature of life, persons of higher intellectual ability are more prone to experience existential depression spontaneously. Sometimes this existential depression is tied into the positive disintegration experience referred to by Dabrowski (1996). I have gone into detail about this in my blog, which you can read here.
- not going out anymore
- not getting things done at work/school
- withdrawing from close family and friends
- relying on alcohol and sedatives
- not doing usual enjoyable activities
- unable to concentrate
- lacking in confidence
- ‘I’m a failure.’
- ‘It’s my fault.’
- ‘Nothing good ever happens to me.’
- ‘I’m worthless.’
- ‘Life’s not worth living.’
- ‘People would be better off without me.’
- tired all the time
- sick and run down
- headaches and muscle pains
- churning gut
- sleep problems
- loss or change of appetite
- significant weight loss or gain
If you think that you, or someone you know, may have depression, there is a quick, easy and confidential checklist you can complete to give you more insight. The checklist will not provide a diagnosis – for that you need to see a health professional.
Treatments for depression
There is no one proven way that people recover from depression. However, there is a range of effective treatments and health professionals who can help people on the road to recovery.
There are also many things that people with depression can do for themselves to help them recover and stay well. The important thing is finding the right treatment and the right health professional for the individual’s needs.
(also known as talking therapies) help people with depression to change negative patterns of thinking and improve their coping skills so they are better equipped to deal with life’s stresses and conflicts. Psychological therapies may not only help a person to recover, but can also help to prevent the depression from reoccurring.
There are several types of psychological treatments shown to be effective in the treatment of depression:
Cognitive behaviour therapy (CBT)
CBT is a structured psychological treatment which recognises that a person’s way of thinking (cognition) and acting (behaviour) affects the way they feel. CBT is one of the most effective treatments for depression, and has been found to be useful for a wide range of people, including children, adolescents, adults and older people.
In CBT, a person works with a professional (therapist) to identify the patterns of thought and behaviour that are either making them more likely to become depressed, or stopping them from improving once they become depressed.
CBT has an emphasis on changing thoughts and behaviour by teaching people to think rationally about common difficulties, helping them to shift their negative or unhelpful thought patterns and reactions to a more realistic, positive and problem-solving approach.
CBT is also well-suited to being delivered electronically (often called e-therapies).
Interpersonal therapy (IPT)
IPT is a structured psychological therapy that focuses on problems in personal relationships and the skills required to deal with these problems. IPT is based on the idea that relationship problems can have a significant impact on a person experiencing depression, and can even contribute to the cause.
IPT is thought to work by helping people to recognise patterns in their relationships that make them more vulnerable to depression. Identifying these patterns means they can focus on improving relationships, coping with grief and finding new ways to get along with others.
Behaviour therapy is a major component of cognitive behaviour therapy (CBT), but behaviour therapy focuses exclusively on increasing a person’s level of activity and pleasure in their life. Unlike CBT, it does not focus on changing the person’s beliefs and attitudes. Instead it focuses on encouraging people to undertake activities that are rewarding, pleasant or give a sense of satisfaction, in an effort to reverse the patterns of avoidance, withdrawal and inactivity that make depression worse.
Mindfulness based cognitive therapy (MBCT)
MBCT is generally delivered in groups and involves learning a type of meditation called ‘mindfulness meditation’. This meditation teaches people to focus on the very present moment, just noticing whatever they are experiencing, be it pleasant or unpleasant, without trying to change it. At first, this approach is used to focus on physical sensations (like breathing), but later it is used to focus on feelings and thoughts.
MBCT helps people to stop their mind wandering off into thoughts about the future or the past, or trying to avoid unpleasant thoughts and feelings. This is thought to be helpful in preventing depression from returning because it allows people to notice feelings of sadness and negative thinking patterns early on, before they have become fixed. It therefore helps the person to deal with these early warning signs better.
Other sources of support
Depression and anxiety can go on for months, even years, if left untreated, and can have many negative effects on a person’s life.
Whatever treatments are used, they are best done under the supervision of a GP or mental health professional. If you have taken the first step and enlisted the help of your GP or another health professional, there are additional things you might like to try to get your recovery underway.
Just remember that recovery can take time, and just as no two people are the same, neither are their recoveries.
Family and friends
Family members and friends play an important role in a person’s recovery. They can offer support, understanding and help. People with depression and anxiety often don’t feel like socialising, but spending time alone can make a person feel cut off from the world, which makes it harder to recover. That’s why it’s important for them to take part in activities with family members and close friends, and to accept social invitations, even though it’s the last thing they may want to do. Staying connected with people helps increase levels of wellbeing, confidence and the chance to participate in physical activities.
A number of studies have found that exercise is a good way to help prevent or manage mild to moderate depression and anxiety. Research shows that keeping active can help lift mood, improve sleep, increase energy levels, help block negative thoughts and/or distract people from daily worries, increase opportunities to socialise, and generally increase wellbeing. Exercise may also change levels of chemicals in the brain, such as serotonin, endorphins and stress hormones.
Food can play a vital role in maintaining mental health as well as physical health. In general, eating a nourishing diet gives people an overall sense of wellbeing. There are also some specific nutritional strategies that can help improve mood, maintain healthy brain functioning and help people with depression and anxiety.
Support groups and online forums
Mutual support groups for people with depression and anxiety are conducted by people who have experienced similar problems. These groups can provide an opportunity to connect with others, share experiences and find new ways to deal with difficulties. Contact your local community health centre or the mental health association/foundation in your state or territory to find your nearest group, or try searching online.
Some people prefer to share their stories and information, or seek and offer support, via online forums. You can visit the Australian Government’s mindhealthconnect website to find trusted communities, or join beyondblue’s online community.
Relaxation training is used as a treatment for anxiety. Because anxiety can lead to depression, it may reduce depression as well. People with anxiety are thought to have tense muscles. As relaxation training helps to relax muscles, it may also help to reduce anxious thoughts and behaviours. Relaxation training may also help people feel as if they have more control of their anxiety.
There are several different types of relaxation training. The most common one is progressive muscle relaxation. This teaches a person to relax voluntarily by tensing and relaxing specific groups of muscles. Another type of relaxation training involves thinking of relaxing scenes or places. Relaxation training can be learned from a professional or done as self-help. Recorded instructions are available for free on the internet or they can be bought on CD and/or MP3.
E-therapies, also known as online therapies or computer-aided psychological therapy, can be just as effective as face-to-face services for people with mild to moderate anxiety and depression.
Cognitive behaviour therapy (CBT) and behaviour therapy are helpful for anxiety and depression when delivered by a professional. The structured nature of these treatments means they are also well suited to being delivered electronically.
Most e-therapies teach people to identify and change patterns of thinking and behaviour that might be keeping them from overcoming their anxiety or depression. An individual works through the program by themselves, and although e-therapies can be used with or without help from a professional, most programs do involve some form of support from a therapist. This can be via phone, email, text or instant messaging, and will help the person to successfully apply their newly learnt skills to everyday life.
This online mode of delivery has several advantages. It:
- is easy to access
- can be done from home
- can be of particular benefit for people in rural and remote areas
- can be provided in many cases without having to visit a doctor.
You can visit the Australian Government’s mindhealthconnect website to find a library of online programs.
It’s not uncommon for people with depression or anxiety to try to manage the illness themselves. It’s important to know that while there are other non-medical or alternative treatment approaches available, these may differ in effectiveness. Some non-medical treatments have undergone scientific testing and there’s no harm in trying them if the depression or anxiety is not severe or life threatening.
The beyondblue booklets, A guide to what works for depression, A guide to what works for anxiety and A guide to what works for depression in young people (links below), provide a summary of what the scientific evidence says about each treatment.
However, when a treatment is shown to have some effect in research, this does not mean it is available, used in clinical practice, will be recommended or will work equally well for every person. There is no substitute for the advice of a mental health practitioner, who can advise on the treatment options available. The best approach is to try a treatment that works for most people and that you are comfortable with. If you do not recover quickly enough, or experience problems with the treatment, then try another.