Depression lasts longer than sadness and the blues, and commonly reduces one’s pleasure in life and is more disabling than mere sadness. Clinical depression is the term often used to describe depression that impairs a person’s functioning and quality of life. The cause of depression is a matter of debate but generally speaking it is believed to be a combination of biological factors (eg genetics,
chemical imbalance, medical conditions), psychological factors (eg thinking patterns, personality traits) and social factors (eg relationships, social support, life events).

The most common symptoms of depression are as follows: depressed mood (feeling depressed, sad, flat, unhappy), teariness, appetite and sleep problems (usually a decrease, sometimes an increase), reduced pleasure and interest, reduced energy and motivation, poor concentration, irritability, indecision, feelings of worthlessness and hopelessness, self-criticism, suicidal thinking, and reduced sex drive. Anxiety symptoms are frequently experienced in combination with depression. There are numerous types of depression (eg Major Depression, Dysthymic Disorder, Adjustment Disorder) and subtypes (eg single episode, chronic, melancholic) and these can be further discussed with your treating practitioner.

If I am depressed what should I do? After you have been diagnosed and referred for treatment you may consider the following tips to help you cope:

1. Education – recognise that depression does not mean you are weak, crazy, stupid or lazy, and you are not alone. Many people experience depression at some stage in their lives. Reading credible material may help you to understand what you are going  through. Visit www.depressionet.com.au and www.beyondblue.com.au for further information.

2. Accept having depression right now, but devote your energies to managing or overcoming it. Acceptance does not mean giving in or being defeated, but it is much more effective than denial, sticking your head in the sand or labelling yourself in a negative way.

3. Ensure you have regular activity including exercise that increases your heart rate; pleasurable activities; achievement activities; and social activities. When people feel depressed they often withdraw from activities, and potentially accentuate the feelings of depression and loneliness. It is important to learn to not give in to the feelings of lethargy and to make sure you remain active. Remember the metaphor of an old car – once it is running it runs almost like new but if you do not start it regularly it will get harder and harder to run. Structure and purpose are essential for overcoming depression so try and make your activity a routine. For further information please ask for a handout on the lethargy circuit.

4. Lifestyle – Looking after your body and ensuring that you have a balanced diet will help minimise stress. Stress affects a physically unfit person or depressed person more than someone who is in good shape. Lifestyles that involve skipping meals,  overworking, and other excessive stress often result in feelings of irritability and depression. The key to a healthy lifestyle is to balance your time across work, leisure, family and other interests so that no one area dominates. This means keeping up your commitments at work but not to the exclusion of your relationships. It also means taking time off to enjoy your hobbies and interests.

5. Helplessness is a common factor in depression. Therefore focus on what you can control, and accept what you can’t control. We often have little control over whether we contract an illness but we can choose to dwell on how unfair it is and how it shouldn’t have happened to me, or we can focus on doing everything we possibly can to increase our chances of overcoming the illness. This will enhance your sense of control.

6. Sleep hygiene – If your sleep is a problem there are many things you can do to improve your sleep. Please ask for a handout on sleep hygiene if required.

7. Thinking patterns – How we feel is often a result of our thinking. Depressed people often have depressive and pessimistic thinking even when they do not feel depressed. The unhelpful thinking can therefore be a cause and consequence of depression, and even if a depression started off as a ‘chemical imbalance,’ unhelpful thinking can trigger, enhance and maintain your symptoms. Thinking patterns that are particularly relevant are excessive worry, perfectionism, expecting negative outcomes, self-criticism and black and white thinking. Please ask for a handout on improving your thinking.

8. Consider if your depression is related to ongoing sadness or negative feelings over an event such as a death, loss or relationship issue. If this is the case you will probably need to discuss this further with a trained practitioner such as a Psychologist or Psychiatrist. The aim is to understand the connection between the issues and your depression, to help you express your feelings, and to generate coping strategies. If grief or loss is an issue ask for a handout on this topic.

9. Problem solving – Try to solve problems that arise rather than simply worrying about them. Steps include defining the problem, weighing up all your options, implementing the best option and then reviewing the outcome.

10. Learn to express your feelings through writing and communicating verbally. Discussing your feelings is generally more effective than suppressing feelings and isolating yourself.

11. Anti-depressant medication may be required if the depression is moderate to severe and/or chronic. Many people prefer herbal anti-depressants such as hypericum/St Johns Wort and Same. Evidence regarding these drugs is not conclusive but generally suggests that they are effective for mild depression. Consult your GP for further advice regarding prescribed and herbal anti-depressants.

12. Finally, when reviewing the above points keep in mind the factors that seem to have a strong correlation to happiness include the following: a sense of belonging including good social support, helpful thinking, a sense of control, a sense of purpose, focusing on what we have rather than what we don’t have, and self acceptance. Are any of these factors missing in your life? If so please discuss them with your treating practitioner.

Two psychological therapies that are evidence based and highly regarded for the treatment of depression are cognitive-behavioural therapy (CBT) and interpersonal psychotherapy (IPT). CBT particularly targets points 1,2,3,5, 7 and 9. IPT particularly targets points 1,8,9 and 10.

For further reading in addition to the websites consider the following books:

• Taming the Black Dog – Bev Aisbett

• Beating the Blues – Susan Tanner and Jillian Ball

Written by Paul Rushton, Clinical Psychologist