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Mental Illness Fellowship Victoria. (n.d.). Factsheet – Understanding depression. http://www.mifellowship.org/sites/default/files/styles/Fact%20Sheets/UDepression.pdf

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Most people experience lows throughout their life. However, we are talking here about a depression that is not just a low mood but a persistent low mood with physical and psychological symptoms.

The expression ‘clinical depression’ describes a group of illnesses that are characterised by an excessive or long-term depressed mood that affects the person’s life. Depression is often associated with anxiety.

Depression is often not recognised and, as a consequence, left untreated.

Depression has been described medically in many ways over time. Recent explanations of reactive (triggered by a stressful event) and endogenous (not seen to have any obvious trigger) are less popular at the moment. It is now more commonly described in terms of severity or degree - a judgment made on a number, type and severity of symptoms present.

Mild depression – decreases interest in things that were once pleasurable, reduces motivation, and increases irritability. Work or usual life activity is not necessarily interrupted and the depression often goes undiagnosed because it does not cause a crisis which must be attended. People experiencing this degree of depression will often reduce stressful issues in their life to relieve the depression. If ignored however, mild depression may develop further.

Moderate depression – decreases pleasure in life even further, hence the impact on life is greater. Motivation becomes a real issue and important aspects of life and relationships may be neglected causing further problems and isolation. Untreated at this point, depression can exacerbate into severe depression.

Severe or major depression – severely interferes with life. A person with this severity of depression will experience low self esteem, distress, feelings of uselessness, sleep disturbance, appetite change, suicidality, and loss of libido as well as other unique features. In some cases, major depression may develop psychotic features.

Often there are many interrelated factors associated with depression including inherited disposition, a chemical imbalance in the brain, life stresses, past bad experiences and personality. Medical illness, drugs and alcohol can also play a part.

People experiencing feelings of sadness which have persisted for a long time should firstly contact their family doctor or community health centre. Treatment depends on each person’s symptoms. The options may include:

psychological interventions and general supportive talking therapies so that the person can understand their thoughts and behaviours and sort out practical problems and conflicts
anti-depressant medications to relieve depressed feelings, restore normal sleep patterns and appetite and reduce anxiety
hospitalisation, where safety of the person, monitoring of psychotic symptoms, monitoring of any physical illnesses and substance use issues and monitoring of medications can be carried out
for some severe forms of depression, electroconvulsive therapy (ECT) is a safe and effective treatment. It may be life saving for people at a high risk of suicide or who, because of the severity of their illness, have stopped eating and drinking and will die as a result.

The recovery phase involves responding to the broader range of issues that impact on people who are susceptible to depression, including examining actual stress levels and the person’s ability to deal with stress. Cognitive Behavioural Therapy (CBT) is the talking therapy of choice for recovery from depression. Being involved in experiences that create a sense of achievement is another important aspect to recovery. Learning new communication techniques can create a sense of achievement and improve relationships. Sometimes medication will need to be ongoing and there may be maintenance doses of ECT administered.

Insight into the experience of depression

Symptom	Associated behaviour Remember, these behaviours are out of keeping with the person’s normal value system	Helpful interventions
Depressed mood, loss of interest or pleasure in nearly all activities	Characterised by expressions of helplessness and hopelessness Depressed most of the day Loss of interest or pleasure in activities, and the person may not move much or just stares into space Skin may become coarse and dry, and hair limp and greasy or sparse Sometimes a person can articulate having no feelings, but a depressed mood can be inferred from the person’s facial expression or demeanor Sometimes, depressive mood can be exhibited in irritability rather than sadness, including persistent anger, overreaction to events, angry outbursts and blaming others Social withdrawal Sometimes a significant reduction from previous levels of sexual interest or desire	Be aware you cannot jolly the person out of this state Connect with the emotion of the experience rather than try to change someone’s mind eg ‘It must be very hard to feel so low’ Reinforce your love for the person Try to sit beside and be in the person’s space – often people who are depressed do not like to make demands on others but they appreciate company. Likewise, you will need to do the talking rather than expecting the person to do so Keep up good levels of communication even when not reciprocated eg Let the person know where you are going even if there is no response
Inability to concentrate	Poor concentration and poverty of thought, where the person has difficulty putting sentences and thoughts together, may give monosyllabic responses and need prompting May appear easily distracted or complain of memory difficulties A reduction in ability from previous levels to achieve intellectually demanding tasks	Attend to safety issues that poor concentration can cause eg If someone works with knives or drives a vehicle Set realistic tasks Have realistic expectations
Suicidal ideation	Recurrent thoughts of death May talk about death or suicide May attempt suicide	Always treat talk of suicide seriously Be aware of suicide risk. Ask the appropriate questions and communicate with treating team about this issue. This issue may be a reason for hospitalisation If the person expresses unexpected happiness and begins to give possessions away, seek assistance immediately
Decreased energy, tiredness and fatigue	A person may report sustained fatigue without physical exertion Smallest tasks seem to require substantial effort May take twice as long as usual to do things eg washing and dressing in the morning	Avoid placing unrealistic demands on the person Be patient Affirm small achievements
Sense of worthlessness or guilt	May translate into belief that the person has done something terrible and needs to be punished May include unrealistic negative evaluation or self’s worth Guilty about preoccupations over minor past failings Misinterprets neutral or trivial day-to-day events as evidence of personal defects Exaggerated sense of responsibility for untoward events	Connect with the emotion of the experience rather than try to change someone’s mind eg ‘It must be very hard to feel so low’ Affirm small achievements Avoid too much attempt at problem-solving. The person probably will not be ready Avoid long self-effacing, self-defeating talk from the person
Changes in appetite	Most commonly reduced appetite Sometimes an increase in appetite but usually cravings for particular foods, eg sweets or carbohydrates Significant loss or gain in weight	Be aware of hydration and nutrition issues. Again, these issues may need to be attended to in hospital
Reduction in libido	Reduced sexual desire	Increase communication through expressions of intimacy such as massages

In addition to the specific interventions previously mentioned, there are many things friends and family can do to help.

Always remember that depression is a medical condition that requires medical treatment. Just as you cannot stop a person’s leg bleeding by talking to them, you cannot stop depression without medical intervention. Treatment is effective.

Find out as much about the condition as you can. Knowledge is power and gives you a much better chance of developing good coping strategies.

Be patient. People experiencing depression need to come to some insight regarding their illness. This is not always easy and takes time.

Know what to expect of the mental health system and be prepared to be assertive in seeking appropriate care.

Link in with community organisations that offer supports and services that complement the mental health service system. They often provide educational programs, counselling and local support groups.

Remember to stay healthy yourself. Do not underestimate the impact of the illness on you. Depression often involves trauma and grief and has an impact on whole families. Be prepared to seek support to develop strategies that keep you well.

Depressionet
www.depressionet.com.au

Mental Illness Fellowship Victoria www.mifellowship.org
Mental Health Services Website (Vic)
www.health.vic.gov.au/mentalhealth

National Alliance of the Mentally Ill (NAMI) (USA)
www.nami.org

Mental Health Council of Australia
www.mhca.com.au

SANE Australia
www.sane.org

Beyond Blue
www.beyondblue.org.au

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M00794A

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