What is Depression / Major Depressive Disorder?
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You may be alarmed to learn that 1 in 16 Australians are currently living with depression, right now.
And, with 1 in 7 Australians expected to experience depression at least once in their lifetime, it is practically guaranteed that someone in your care is suffering (Beyond Blue Ltd 2019b).
The good news? The rate of support-seeking appears to be on the rise, with around half of those living with depression actively getting treated.
Unfortunately, particularly in older populations, stigmas remain around seeking help for mental illnesses. Rates of depression in people living in residential care are around 30 per cent higher than the rest of the population (Beyond Blue Ltd 2019b).
Looking after a resident or client’s mental health is directly outlined by Standard 3 of the Aged Care Quality Standards: Personal Care and Clinical Care. This article will help you recognise if someone in your care is displaying signs of depression and to know what you can do to support them.
What is Depression?
It’s human nature to feel down in the dumps, on occasion. Depression, however, is a diagnosable medical condition that presents in feelings of intense sadness, negativity and low-mood, lasting for a long period of time (MensLine Australia n.d.).
A characteristic of depression is that the route of the sadness is not always easy to pinpoint. Tough times can trigger a bout, but sometimes there is no obvious reason why a person may be depressed (ReachOut Australia 2019b).
Depression is often accompanied by a range of other physical and psychological symptoms, often affecting everyday living (SANE Australia n.d.). If low mood has become so intense that it is affecting your relationships, your work, or you are neglecting activities you once found to be simple or enjoyable, this could be a sign of depression, and help should be sought.
Types of Depression
The term ‘depression’ is generally used to refer to ‘major depression’, however, there are several types of conditions which can be classified under the ‘depression’ term.
1. Major Depression / Clinical Depression
Major depression, clinical depression or major depressive disorder (ReachOut Australia 2019a) is the most common form of depression and what most people mean when they think ‘depression’. The characteristics of major depression include a low-mood that is felt most days of the week, and that lasts for at least two weeks (ReachOut Australia 2019a).
Melancholia is a term for a very severe depression, which presents with more physical symptoms. Major characteristics of melancholia include moving slower than normal and suffering from a complete loss of pleasure in almost everything (Beyond Blue Ltd 2019c).
Dysthymia, also known as persistent depressive disorder, refers to a generally less-severe form of major depression, however with longer-lasting symptoms (Beyond Blue Ltd 2019c; ReachOut Australia 2019a).
4. Psychotic Depression
Psychotic depression is severe and is characteristically accompanied by a loss of touch with reality and episodes of psychosis, hallucinations and/or delusions (ReachOut Australia 2019a).
5. Perinatal Depression
Perinatal depression refers to depression experienced from conception, during (antenatal depression) and after pregnancy and childbirth (postnatal depression). Perinatal depression is more than a passing ‘baby-blues’, and can affect both mothers and fathers (Centre of Perinatal Excellence 2019).
6. Seasonal Affective Disorder
Often overlooked as a simple case of the ‘winter blues’, seasonal affective disorder (SAD), is a mood disorder that presents in a seasonal pattern. Most commonly felt in the cooler months, SAD can also occur through Spring and Summer, too (Gilkes, M 2018; Beyond Blue Ltd 2019c).
Depression, Delirium and Dementia
It is important to note the overlap that often exists between depression, delirium and dementia. High rates of delirium and depression are reported in people with dementia, and conversely, dementia and depression are further risk factors for developing delirium (health.vic 2018). It is recommended you familiarise yourself with the differences between the three conditions, as misdiagnosis is common, particularly in older patients and clients.
Causes of Depression
There are a number of possible causes of depression, however, it is difficult to narrow these down to one:
- Irregular mood regulation in the brain;
- Chemical imbalances (endogenous);
- Genetic inheritability;
- Exposure to stressful life events (such as trauma or loss);
- Effects of medication;
- Other health problems (such as traumatic brain injury);
- Other mental health conditions (such as bipolar);
- Environmental stressors.
(Harvard Medical School 2019; Jesulola et al. 2018; SANE Australia n.d.)
Who Can Get Depression?
Though depression can be developed by anybody at any stage of life, there are some populations who are at a greater risk than others, including:
- People living in residential care.
- Females are more likely than males to experience depression and anxiety (however, males are far less likely to report or seek help for mental health conditions).
- People who live in remote and regional areas are at a greater risk of depression and suicide.
- Pregnant or new mothers and fathers.
- Aboriginal and Torres Strait Islander people are nearly three times more likely to be psychologically distressed than non-Indigenous Australians.
- LGBTQI Australians are far more likely to be psychologically distressed than non-LGBTQI Australians.
(Beyond Blue Ltd 2019b)
Signs and Symptoms of Depression
Signs and symptoms of depression can vary from person to person and will range from mild to very severe. One or many of the following may be felt by someone experiencing depression:
- Feeling ‘down’, sad or close to tears;
- Feeling numb, overwhelmed, irritable, frustrated;
- Loss of interest or pleasure in usually enjoyable activities;
- Not going out / withdrawing from social circles;
- Relying on alcohol, sedatives or other self-medication;
- Difficulty concentrating;
- Negative thoughts and talk;
- Fatigue and lack of energy;
- Feeling worthless or guilty;
- Thoughts of self-harm or suicide;
- Feeling hopeless / helpless;
- Difficulty remembering things;
- Difficulty sleeping, sleeping more than usual or other disturbances to sleep patterns;
- Eating more;
- Loss of appetite;
- Weight loss or gain;
- Churning stomach, ‘knots’.
(ReachOut Australia 2019b; Beyond Blue Ltd 2019a; SANE Australia n.d.)
If any of the above symptoms are severe and last for two weeks or more, and begin to affect other aspects of a person’s life, professional help should be sought (Black Dog Institute n.d.).
A diagnosis of depression is generally made in accordance with the recognised criteria described in the Diagnostic and Statistical Manual of Mental Disorders, or DSM 5. Clinicians will ask a series of screening questions to determine a score from mild to severe to help guide a course for treatment (Healthdirect Australia 2017).
It is important to remember that depression is treatable, just like any other illness.
A treatment plan should be person-centred and developed in collaboration with the patient, so to best tailor options to suit their personal circumstances (ReachOut Australia 2019b).
Treatment options are many, however, most will commonly include:
- Psychological interventions such as CBT, interpersonal therapy (IPT), family therapy, mindfulness-based cognitive therapy (MBCT), other forms of psychotherapy;
- Pharmacological interventions such as antidepressant medications;
- Lifestyle changes including regular exercise, eating a well-balanced and varied diet, maintaining a healthy sleep routine, practising relaxation and meditative activities, and seeking support from others.
(Black Dog Institute 2018; The Australian College of Mental Health Nurses Inc. 2012)
Timely interventions are key. Each person may respond differently to treatments and finding the right treatment may take time, therefore It is important that the patient is supported through this process (ReachOut Australia 2019b).
If you suspect someone in your care is suffering from depression and has been displaying any of the signs and symptoms listed above, they should be referred to a GP, mental health nurse, psychologist or psychiatrist.
If you or a person in your care expresses they are feeling suicidal, seek immediate help.
Immediate Support Services
24-hour support services and counselling are available, including:
- Lifeline: 13 11 14 www.lifeline.org.au
- Beyond Blue: 1300 22 4636 www.beyondblue.org.au
- NHMRC approved Clinical Practice Guidelines: https://www.beyondblue.org.au/health-professionals/clinical-practice-guidelines.
- National Perinatal Mental Health Guideline: https://www.cope.org.au/health-professionals/health-professionals-3/review-of-new-perinatal-mental-health-guidel ines/.
- National Standards in mental health services: https://www.safetyandquality.gov.au/our-work/mental-health/national-standards-in-mental-h ealth.
Multiple Choice questions Q1. How many Australians are expected to experience depression at least once in their lifetime?
- 1 in 16
- 1 in 7
- 1 in 10
- 1 in 100
- Q2. Which of the following is not a possible sign of depression?
- Difficulty concentrating.
- Loss of appetite.
- Not going out / withdrawing from social circles.
- Calling out, moaning or making other sounds.
- Q3.True or False: Females are more likely than males to experience depression.
- The Australian College of Mental Health Nurses Inc. 2012, Depression Fact Sheet, ACMHN, viewed 22 August 2019, http://www.acmhn.org/images/stories/Resources/depressionfactsheet.pdf.
- Beyond Blue Ltd 2019a, Signs and symptoms, Beyond Blue, Hawthorn (VIC), viewed 22 August 2019,https://www.beyondblue.org.au/the-facts/depression/signs-and-symptoms.
- Beyond Blue Ltd 2019b, Statistics, Beyond Blue, Hawthorn (VIC), viewed 22 August 2019, https://www.beyondblue.org.au/media/statistics.
- Beyond Blue Ltd 2019c, Types of depression, Beyond Blue, Hawthorn (VIC), viewed 22 August 2019, https://www.beyondblue.org.au/the-facts/depression/types-of-depression.
- Black Dog Institute 2018, Treatments of Depression, Black Dog Institute, Randwick (NSW), viewed 22 August 2019, https://www.blackdoginstitute.org.au/clinical-resources/depression/treatment.
- Bla ck Dog Institute n.d., Symptoms of depression, Black Dog Institute, Randwick (NSW), viewed 22 August 2019, https://www.blackdoginstitute.org.au/docs/default-source/factsheets/symptomsofdepressi on.pdf?sfvrsn=2.
- Centre of Perinatal Excellence 2019, Postnatal depression, COPE, Flemington (VIC), viewed 22 August 2019, https://www.cope.org.au/new-parents/postnatal-mental-health-conditions/postnatal-depression/.
- Gilkes, M 2018, 'Seasonal Affective Disorder', Ausmed, 9 July, viewed 22 August 2019, https://www.ausmed.com/cpd/articles/seasonal-affective-disorder.
- Harvard Medical School 2019, ‘What causes depression?’, Harvard Health Publishing, Cambridge (MA), viewed 22 August 2019, https://www.health.harvard.edu/mind-and-mood/what-causes-depression.
- Healthdirect Australia 2017, Diagnosis of Depression, Healthdirect Australia, Sydney (NSW), viewed 22 August 2019, https://www.healthdirect.gov.au/diagnosis-of-depression.
- Jesulola, E, Micalos, P & Baguley, IJ 2018, ‘Understanding the pathophysiology of depression: From monoamines to the neurogenesis hypothesis model - are we there yet?’, Behavioural Brain Research, vol. 341, pp. 79-90, viewed 22 August 2019, https://www.sciencedirect.com/science/article/pii/S0166432817318521.
- MensLine Australia n.d., Depression, MensLine Australia, Footscray (VIC), viewed 22 August 2019, https://mensline.org.au/signs-and-symptoms-of-depression/depression/.
- ReachOut Australia 2019b, What is Depression?, ReachOut Australia, Pyrmont (NSW), viewed 22 August 2019, https://au.reachout.com/articles/what-is-depression.
- ReachOut Australia 2019a, Types of Depression, ReachOut Australia, Pyrmont (NSW), viewed 22 August 2019, https://au.reachout.com/articles/types-of-depression.
- SANE Australia n.d., Depression, Mi Networks Australia, viewed 22 August 2019, http://www.minetworks.org.au/images/info%20sheets/Depression.pdf.
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