Everyone feels sad, moody or low from time to time. Depression, however, is a serious mental health issue where sadness, flat or low mood, or a sense of ‘emptiness’ is prolonged – lasting weeks, months and sometimes years.
Depression isn’t just about ‘feeling down’. It presents with a number of other symptoms and interferes with daily life and relationships.
A person may be depressed if, for more than two weeks, they have experienced either (or both) of the following1:
- a sense of sadness, emptiness or low mood for most of the day, nearly every day
- a loss of interest or pleasure in almost all activities, even ones usually enjoyed.
For a diagnosis of depression, a psychologist will look for specific symptoms that impact on a person’s daily life. Some of these include changes to their appetite and sleep, lethargy, worry and negative thinking patterns.
There is no single cause for depression. In some individuals, stressful life events such as the loss of a job, long-term unemployment, physical health issues, family problems, the death of a loved one, or the end of a close relationship might trigger depression. For other people, there is no obvious cause.
Experts no longer believe that depression is caused by a ‘chemical imbalance’, but that the risk for developing depression is more likely to be related to a combination of a person’s genes, biology, life experiences, stress and thinking style.2
For many people, genetics may play a part, with research suggesting around 30-40% of the risk for developing depression may be due to genetic factors.3-5
Research has found some differences in areas of the brain, and brain activity in people with depression compared to people without. The areas of the brain that differ relate to emotional responses and emotion regulation, the interpretation of information (with a bias for negative information) and response to stress. Interestingly, many of these differences decrease with treatment.6
Stressful life events
Research suggests that the greater the number of stressful live events a person experiences, the greater their chances of developing depression.7 Early life stress and trauma can also increase the likelihood of developing depression later in life.8,9
People who tend to dwell on negative events, worry excessively, or hold a more negative view of themselves, the world, or the future are more prone to depression.10-13
Check your self-talk
We can sometimes say negative things to ourselves when we are upset. Unhelpful self-talk might include things like, “I’m hopeless”, “Why should I even bother?”, or “I’ll never get all this work done”. Negative self-talk can make our mood worse by reinforcing how bad we feel, and stopping us from using helpful coping strategies. Constructive self-talk, on the other hand, can help us to cope with life’s difficulties.
Notice what you say to yourself and work on more helpful, calming and encouraging self-talk, such as, “This is a rough period but it will pass”, “I will use this time to look after myself”, or “Regardless of how I am feeling, I am always a worthy person”.
Keep things in perspective
When we are upset, it is easy to see things as worse than they really are, and to start anticipating even more problems down the track. Take a step back and look at something that is upsetting you. Ask yourself:
- am I getting ahead of myself, assuming something bad will happen when I really don’t know the outcome?
- is the outcome certain to happen, possible, or quite unlikely?
- if the worst were to happen, what could I do about it?
Sometimes thinking about how you would cope, even if the worst were to happen, puts things into perspective.
Make a list of things that you usually enjoy. It might include activities like light exercise, reading, meditating, listening to music, or spending time with a friend. Then, write down a list of things that are important to you that would give you a sense of achievement – things that would feel good to get done. This might include household chores, errands, work tasks or study. Now, take your weekly schedule and make time each day to attend to a task from each list. It is important to set realistic goals and then work towards achieving them.
Practise relaxation or mindfulness
Practise relaxation, meditation, or mindfulness on a regular basis to allow your body and nervous system to routinely settle and readjust to a calm state. Mindfulness in particular has been shown to help people to respond to difficult emotions without feeling overwhelmed by them.
Look after your health
Exercise, diet and other health behaviours can support recovery from depression, so it is important to:
- make sure you are eating well
- get regular exercise
- avoid using alcohol, tobacco and other drugs to cope when you are finding things difficult.
Depression is a common reason for people to seek help from mental health professionals, and research suggests that there are a number of effective psychological treatments available. The most effective psychological treatments for depression are cognitive behavioural therapy, problem-solving therapy, behavioural activation and interpersonal psychotherapy. Mindfulness-based cognitive therapy has also been shown to be effective in preventing future periods of depression in those people who have previously experienced depression.14
Cognitive behaviour therapy (CBT) can bring about lasting change that can decrease the chance of having depression again in the future. It helps the person to change unhelpful thoughts and behaviours which can contribute to depression, and aims to build skills to manage depression in an ongoing way.15-17
Problem-solving therapy helps people gain mastery over day-to-day difficulties, stresses and problems which otherwise might seem overwhelming.15, 18
Behavioural activation aims to increase motivation and help a person to return to their usual activities. In behavioural activation, activities and behaviours that can help to improve mood and quality of life are planned for in an ‘activity schedule’. Typically, a mix of activities are selected including some which the person finds enjoyable and some which give them a sense of satisfaction and achievement.15, 19, 20
Interpersonal psychotherapy (IPT) involves addressing problems in the person’s relationships and expectations about others that might be contributing to their mood. IPT helps people to:
- find new ways to develop and nurture relationships
- resolve conflicts with others
- express emotions and communicate more effectively
- adapt to changes in life roles
- improve social support networks.15, 21
Mindfulness-based cognitive therapy (MBCT) is an eight-week group-based program designed to reduce the risk of depression returning (relapse prevention), by teaching participants mindfulness meditation combined with cognitive-behavioural techniques.14, 22
Mindfulness meditation helps the person to focus on the present moment without judging these experiences or trying to change them. MBCT has been found to be effective in preventing relapse, and there is some evidence that it may be effective as a treatment of depression as well.23 MBCT is also being offered as individual rather than group-based therapy however research on the effectiveness of this format is currently limited.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington DC: Author.
- Lacasse, J. R., & Leo, J. (2015). Antidepressants and the chemical imbalance theory of depression. The Behavior Therapist, 38(7).
- Cohen-Woods, S., Craig, I. W., & McGuffin, P. (2013). The current state of play on the molecular genetics of depression. Psychological Medicine, 43(4), 673-687. doi: http://dx.doi.org/10.1017/S0033291712001286
- Flint, J., & Kendler, Kenneth S. (2014). The genetics of major depression. Neuron, 81(3), 484-503. doi: http://dx.doi.org/http://dx.doi.org/10.1016/j.neuron.2014.01.027
- Lohoff, F. W. (2010). Overview of the genetics of major depressive disorder. Current psychiatry reports, 12(6), 539-546. doi: http://dx.doi.org/10.1007/s11920-010-0150-6
- Singh, M. K., & Gotlib, I. H. (2014). The neuroscience of depression: Implications for assessment and intervention. Behaviour Research and Therapy, 62, 60-73. doi: http://dx.doi.org/http://dx.doi.org/10.1016/j.brat.2014.08.008
- Risch, N., Herrell, R., Lehner, T., & et al. (2009). Interaction between the serotonin transporter gene (5-httlpr), stressful life events, and risk of depression: A meta-analysis. JAMA, 301(23), 2462-2471. doi: http://dx.doi.org/10.1001/jama.2009.878
- Carr, C. P., Martins, C. M., Stingel, A. M., Lemgruber, V. B., & Juruena, M. F. (2013). The role of early life stress in adult psychiatric disorders: A systematic review according to childhood trauma subtypes. J Nerv Ment Dis, 201(12), 1007-1020. doi: http://dx.doi.org/10.1097/NMD.0000000000000049
- Heim, C., & Binder, E. B. (2012). Current research trends in early life stress and depression: Review of human studies on sensitive periods, gene–environment interactions, and epigenetics. Experimental Neurology, 233(1), 102-111. doi: http://dx.doi.org/http://dx.doi.org/10.1016/j.expneurol.2011.10.032
- Vanderhasselt, M.-A., & De Raedt, R. (2012). How ruminative thinking styles lead to dysfunctional cognitions: Evidence from a mediation model. Journal of Behavior Therapy and Experimental Psychiatry, 43(3), 910-914. doi: http://dx.doi.org/10.1016/j.jbtep.2011.09.001
- Raes, F. (2012). Repetitive negative thinking predicts depressed mood at 3-year follow-up in students. Journal of Psychopathology and Behavioral Assessment, 34(4), 497-501. doi: http://dx.doi.org/10.1007/s10862-012-9295-4
- Beck, A. T. (2002). Cognitive models of depression. Clinical advances in cognitive psychotherapy: Theory and application, 14, 29-61.
- Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). The cognitive therapy of depression. New York, NY: Guilford Press.
- Piet, J., & Hougaard, E. (2011). The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: A systematic review and meta-analysis. Clinical Psychology Review, 31(6), 1032-1040. doi: http://dx.doi.org/http://dx.doi.org/10.1016/j.cpr.2011.05.002
- Barth, J., Munder, T., Gerger, H., Nuesch, E., Trelle, S., Znoj, H., . . . Cuijpers, P. (2013). Comparative efficacy of seven psychotherapeutic interventions for patients with depression: A network meta-analysis. PLoS Med, 10(5), e1001454. doi: http://dx.doi.org/10.1371/journal.pmed.1001454
- Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). New York, NY: Guilford Press.
- Tolin, D. F. (2010). Is cognitive–behavioral therapy more effective than other therapies?: A meta-analytic review. Clinical Psychology Review, 30(6), 710-720. doi: http://dx.doi.org/http://dx.doi.org/10.1016/j.cpr.2010.05.003
- Bell, A. C., & D’Zurilla, T. J. (2009). Problem-solving therapy for depression: A meta-analysis. Clinical Psychology Review, 29(4), 348-353.
- Mazzucchelli, T., Kane, R., & Rees, C. (2009). Behavioral activation treatments for depression in adults: A meta-analysis and review. Clinical Psychology: Science and Practice, 16(4), 383-411. doi: http://dx.doi.org/10.1111/j.1468-2850.2009.01178.x
- Ekers, D., Webster, L., Van Straten, A., Cuijpers, P., Richards, D., & Gilbody, S. (2014). Behavioural activation for depression; An update of meta-analysis of effectiveness and sub group analysis. PLoS ONE, 9(6), e100100. doi: http://dx.doi.org/10.1371/journal.pone.0100100
- Brakemeier, E.-L., & Frase, L. (2012). Interpersonal psychotherapy (IPT) in major depressive disorder. European Archives of Psychiatry and Clinical Neuroscience, 262(Suppl 2), 117-121. doi: http://dx.doi.org/10.1007/s00406-012-0357-0
- Segal, Z., Teasdale, J., & Williams, M. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York: Guildford Press.
- Parikh, S. V., Quilty, L. C., Ravitz, P., Rosenbluth, M., Pavlova, B., Grigoriadis, S., . . . Group, t. C. D. W. (2016). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: Section 2. Psychological treatments. The Canadian Journal of Psychiatry, 61(9), 524-539. doi: http://dx.doi.org/10.1177/0706743716659418
If you are depressed or think you might be, a psychologist may be able to help.
- Life Psychologists are highly trained and qualified professionals, skilled in providing effective interventions for a range of mental health concerns, including depression.
- A Life Psychologist can help you to identify and address factors that might be contributing to your stress and the most effective ways to address stress using techniques based on best available research.
- Life Psychologists usually see clients individually, but can also include family members to support treatment where appropriate.
A medical check-up with a GP might also be helpful to see if there is an underlying health issue.