Every year, almost 800,000 Australian adults experience depression.  The causes of depression are as varied as the people who suffer from this debilitating illness:  relationship conflicts, loss of a loved one, economic woes, health issues, eating disorders, social isolation, disappointment, fear, insecurity, abandonment, rejection, failure, emotional and physical abuse, substance abuse, workplace stress, and many more.

Depression is a medical condition generally characterised by a low mood with feelings of joylessness, deep sadness, misery, powerlessness, pessimism, anger, and/or discouragement (hopelessness).  All of us occasionally experience a blue mood, but it is usually a temporary emotional state.  A low emotional state can sometimes be helpful when it keeps us from doing something foolish, reckless, or dangerous.  What differentiates depression from ordinary blues is that it lingers and keeps a person in a chronic or recurrent state of negative thinking.  This disables an individual from living a full, satisfying life.

Since a depressed person is often distracted or has difficulty concentrating, his/her condition can lead to poor job performance and possible job loss.  In Australia, workplace depression accounts for six million days of absenteeism and more than 12 million days of reduced productivity each year.  Annually, undiagnosed (and therefore untreated) employee depression costs $4.3 billion in lost productivity.

A distracted frame of mind also poses a risk to personal health and safety due to carelessness or neglect.  Depression is the leading cause of disability in Australia.

In the case of a child or teenager, it can result in lower grades and antisocial behavior.  Poor academic and vocational performance and the lack of social skills can lead to low self-esteem and, in later life, decreased employment opportunities.  Depression can cause a person of any age to avoid social contact, aggravating his/her sense of loneliness and hopelessness.

Many researchers believe that depression occurs when chemical changes or imbalances in the brain affect the neurotransmitters, which send signals or messages that affect how we feel. Common medical tests performed to identify possible biological or chemical factors for depression include urine tests for sugar and protein, complete blood count and biochemistry, thyroid function tests, and, occasionally, a brain scan.

Many factors that play a role in depression

Medications and Other Substances  

Certain prescription drugs (such as sedatives, steroids, and high blood pressure medications) and hormonal treatments can cause symptoms of depression.  Depressed people are also more likely to engage in alcohol or substance abuse, which only worsens their condition.

Genetics  

Some types of depression seem to run in families.  However, depression can also affect people with no family history of it when stressful life changes occur.

Changes and Stressful Events  

A negative change in circumstances such as divorce, death, a breakup with a boyfriend/girlfriend, or unemployment may lead to depression if a person feels unprepared or inadequate to cope with it.  However, a positive change such as marriage, engagement, high school/college graduation, or employment in a new job can also cause depression when a person feels overly anxious about meeting the demands and responsibilities that come with it.

Trauma or Grief  

Traumatic events such as tragic accidents, physical violence, emotional abuse, or, conversely, emotional neglect can cause depression regardless of whether they occurred recently or earlier in a person’s life.  He/she might be constantly reliving the horror of the experience through flashbacks and nightmares.  The grief that accompanies the death of a loved one, friend or family member can also lead to depression if a person has trouble finding closure or accepting the finality of death.

Age   

Although depression is not a normal part of aging, elderly people are at also risk for depression since they are prone to chemical imbalances in the brain, illness, chronic pain, dementia and social isolation (particularly if an elderly person lives alone or lacks social support).

In addition, they are more likely to be taking medications that may cause symptoms of depression. They are also more resistant to change and thus have greater difficulty accepting and adapting or adjusting to new situations.  Since the elderly are less likely to acknowledge feelings of sadness or grief, their symptoms may be less obvious and are often overlooked.

However, depression has also been diagnosed in children and adolescents, especially due to stresses from school (tests and assignments), peers (social expectations) family (demands, conflicts, lack of communication), environment (living conditions), or personal health (malnutrition, physical defects, disability, serious illness, eating disorders).  Adolescence is a period of drastic hormonal change and heightened emotional vulnerability.  It is not surprising that depression often has its onset in the teenage years.

Health Conditions 

Thyroid problems (particularly hypothyroidism – an under-active thyroid condition), brain injury, chronic pain, cancer, heart disease, stroke, diabetes, HIV/AIDS, anorexia, bulimia, insomnia, anemia, post-traumatic stress disorder and other serious illnesses may increase a person’s risk of becoming depressed.

Gender  

Starting from puberty, women are twice as likely as men to experience depression.  Frequent major hormonal changes in a woman’s body during menstruation, pregnancy, childbirth, or menopause may increase incidents of depression.  Social and cultural stressors such as working outside the home, raising children, caring for aging parents, spousal abuse, poverty, and relationship strains also contribute greatly to depression in women.

Men experience depression differently from women.  Among males, it is more often expressed in anger, irritability, agitation or restlessness, and sleep problems (either lack of sleep or excessive sleeping).

Women are more likely to suffer from feelings of sadness, worthlessness or excessive guilt.

Both genders may develop addictions such as cigarette smoking, drug abuse, or alcohol abuse.  They may also experience dramatic changes in appetite leading to weight loss or weight gain.  Depressed individuals often feel fatigued or lethargic (lacking in energy) as well.

Depressed men and women may also become physically inactive, withdraw from previous activities (e.g. bathing regularly, going to church and other social gatherings) and/or exhibit a lack of interest in pursuits that were once enjoyed (e.g. sex, sports, and hobbies).  .

At its worst, a depressed condition can prompt a person to take his/her own life and/or commit acts of violence that threaten other people’s lives.  Depression is reported to be the leading cause of suicide in Australia, yet it is often unrecognized or untreated.

This is why it is so important to have the condition professionally diagnosed and treated if you suspect that you or someone you know may be depressed.

Depression can take several forms

Major Depressive Disorder, also called major depression, interferes with a person’s ability to work, study, eat, sleep and enjoy activities that used to be pleasurable.  It is so disabling that it prevents an individual from going through life normally.  Occasionally, an episode of major depression occurs only once in a person’s lifetime.  In most cases, however, it recurs throughout a person’s life and needs to be treated on a continuing basis.

Dysthymic Disorder, also known simply as dysthymia, is a long-term condition with less severe symptoms that are not disabling but may prevent a person from feeling well or functioning normally.  It can last two years or longer.

Bipolar Disorder, also referred to as manic-depressive illness, biploar disorder is characterized by a cycle of mood changes ranging from extreme highs (mania) to extreme lows (depression) and back again.

Psychotic Depression occurs when depression is accompanied by some form of psychosis such as hallucinations or delusions.

Postpartum Depression or postnatal depression is diagnosed when a new mother develops a major episode of depression within a month after giving birth.  This is experienced by an estimated 10 to 15 percent of women.

Seasonal Affective Disorder (SAD), as its name implies, has its onset during the winter season when there is less natural light and usually lifts during spring and summer.  SAD is effectively treated in almost half of sufferers with light therapy.   The other half needs a combination of light therapy with antidepressant medication and psychotherapy.

Effective treatments for depression

The two most common treatments for overcoming depression are psychotherapy and antidepressant medicine.  Stubborn depression that does not respond to either treatment may be helped by electroconvulsive therapy, which is humanely administered under anesthesia so that the patient will not consciously feel the electrical impulse.

Psychotherapy or “talk therapy” may be short-term (10-20 weeks) if the depression is mild or moderate, longer-term if the depression is severe.  For mild to moderate depression, counselling or psychotherapy may be the only treatment necessary.  Cognitive behavior therapy (CBT) teaches new ways of behaving and thinking to replace the previous negative, self-defeating, or self-destructive patterns.  Interpersonal therapy (IPT) helps people understand and work through troubled personal relationships that may be causing the depression.

Antidepressants regulate mood by normalizing the occurrence of the brain chemicals serotonin, norepinephrine, and dopamine.  Studies have indicated that adolescents and older adults respond most favorably when given a combination of medication and psychotherapy.

The newest and most popular types of antidepressants fall into the generic category of selective serotonin reuptake inhibitors (SSRIs).  Other antidepressant medications often prescribed are serotonin and norepinephrine reuptake inhibitors (SNRIs), trycyclics, and monoamine oxidase inhibitors (MAOIs).  People taking MAOIs must avoid certain foods and medications that may interact in a harmful way with this particular class of antidepressant.

For all classes of antidepressants, regular dosage for a minimum of three to four weeks is necessary in order for the patient to experience the full therapeutic effect.  It is very important to remember that patients should always consult a mental health professional before starting or stopping an antidepressant regimen.  They should continue taking the medication for the length of time prescribed in order to prevent a relapse, even though they may be tempted to stop when they start feeling better.  However, they can help themselves feel better faster by engaging in exercise and enjoyable activities, getting proper nutrition, and sleep, spending time with trusted friends and family members, practicing positive thinking and self-talk, and setting realistic goals and expectations for improvement.

Related Articles:

How a Support Group can Help Depression

How to Recognise Postnatal Depression

Biploar Disorder: A Fact Sheet

 f you or someone you know is suffering from depression, Australia Counselling links you with professional counsellors in Sydney, Melbourne, Perth, Brisbane, Adelaide and country areas of Australia. Search under depression for counsellors that focus on this area of practice in a location near you.