About depression
Depression is a mental health problem that can affect how you feel and behave for weeks or months at a time.
When you are depressed, your low mood lasts, affecting your sleep, relationships, job and appetite.
When you are depressed, your low mood lasts, affecting your sleep, relationships, job and appetite.
Anyone can experience depression – it can be caused or triggered by different things but the symptoms will be similar.
Symptoms
Signs to look for (symptoms)
Symptoms of depression usually develop over days or weeks, though you may have a period of anxiety or mild depression which lasts for weeks or months beforehand. Not everyone with depression will complain of sadness or a persistent low mood. They may have other signs of depression such as sleep problems. Others will complain of vague physical symptoms.
Signs to look for in yourself or a loved one include:
Signs to look for in yourself or a loved one include:
- Feeling low, sad or depressed. You might feel sad or empty, you might not feel anything at all. You might experience pain that’s hard to describe or locate. You may cry for no apparent reason. Some people feel sad or low all the time, others have periods where they feel better that do not last longer than a day or two. People from non-European cultures might have different words to describe this feeling. If you’re Māori, you might think of it as feeling wainuku (really low or down in the dumps), whākama (shame) or whākamaemae (emotional pain or distress).
- Loss of interest and pleasure in usual activities. This means you don’t enjoy what you usually do – including sex, playing sport, spending time with loved ones or doing hobbies.
- Irritable mood. This may be the main mood change, especially in younger people and in men (especially Māori and Pasifika).
- Change in sleeping patterns. Sleeping less, finding it difficult to get to sleep, disturbed sleep, waking early. Some people find they need much more sleep than usual. Most people with depression wake feeling unrefreshed by their sleep.
- Change in appetite. Most often people do not feel like eating and as a result will have lost weight. Some people (usually those who sleep more than usual) have increased appetite, often without pleasure in eating.
- Decreased energy, tiredness and fatigue is common. You may feel that the smallest and simplest things are impossible.
- Physical slowing or agitation often comes with severe depression. You may sit in one place for periods and move, respond and talk very slowly; or you may be unable to sit still, pace and wring your hands.
- Feeling worthless or guilty involves loss of self-confidence, and this may make you withdraw from friends and whānau. You may also feel you’re a bad person, parent, friend or whanau member.
- Thoughts of hopelessness and death. You may feel there is no hope in life, wish you were dead or have thoughts of suicide. These thoughts and feelings must always be taken very seriously – seek urgent help.
- Difficulty thinking clearly. You may have difficulty in concentrating. You may not be able to read the paper or watch television. You may also have difficulty making even simple everyday decisions.
What causes depression?
Depression can appear out of the blue and the exact cause isn’t known. Many things can be considered as factors that make you vulnerable to depression.
These include:
- Stressful events like the break-up of a relationship, financial trouble, work stress, redundancy or interpersonal conflict
- A family history of depression
- Physical illness, such as a stroke or heart attack
- Stressful or traumatic events in childhood can lead to depression later in life
- Certain medications can cause depression in some people
- Social isolation – i.e. having no friends or family near you; and, cultural isolation (being isolated from your culture or a group you identify with e.g. Rainbow groups).
Anxiety symptoms
These are very common as part of depression, but as the depression is treated these symptoms usually stop.
Anxiety symptoms include:
Anxiety symptoms include:
- Excessive worry or fear, with physical symptoms such as muscle tension, pounding heart, dry mouth.
- Panic attacks. Sudden episodes of extreme anxiety and panic with physical symptoms of fear.
- Phobias. Specific fears regarding situations, objects or creatures.
- Excessive concern about physical health.
If your main problem is feeling really down or losing interest in things that you usually enjoy, we call it depression.
If your main problem is panic, being on edge and worrying, we call it anxiety.
If you are concerned you may be depressed or anxious, a number of NZ websites have useful self-tests you can do. These are listed under Resources & Links (below).
How the doctor determines if you have depression (diagnosis)
Your GP or health professional will need to spend some time with you to determine if you have depression. They will talk to you about how you’re feeling and they may get you to fill in a test on paper. If you have difficulty reading or understanding the test, tell them and ask for a different way to understand how you’re feeling.
Your health professional should try to get an understanding of what you’re going through and, if appropriate for you, this can also involve your family/whānau's perspective.
Your health professional should try to get an understanding of what you’re going through and, if appropriate for you, this can also involve your family/whānau's perspective.
Your health professional should try to get an understanding of what you’re going through and, if appropriate for you, this can also involve your family/whānau's perspective.
Management of depression
Management of depression can involve several different things, each of which can be tailored to your individual needs.
Support from whānau and friends is important and, for most, a combination of medication and talking therapies such as counselling can be effective.
Support from whānau and friends is important and, for most, a combination of medication and talking therapies such as counselling can be effective.
Talk to someone you trust.
Reach out to a friend, workmate, someone at church or a neighbour and tell them how you feel. Depression is common so many people will understand what you are saying, or will have known of someone who has experienced it and got through.
Reach out to a friend, workmate, someone at church or a neighbour and tell them how you feel. Depression is common so many people will understand what you are saying, or will have known of someone who has experienced it and got through.
Medication
Your GP may prescribe antidepressants. Finding the right medication can be a matter of trial and error – there is no way to predict which medication will be effective and tolerated (have fewer troublesome side effects) by any one person.
If you are prescribed medication you are entitled to know:
- the names of the medicines
- what symptoms they are supposed to treat
- how long it will be before they take effect
- how long you will have to take them for and what their side effects (short and long-term) are.
Sometimes people do not take their medication as prescribed – they may either take a lower dose than prescribed or stop one or all medications entirely. People may self-medicate and may change their medications without their GP’s knowledge.
This may be because:
- The side-effects are too severe - common ones are feeling ‘fuzzy headed’, feeling a loss of creativity and feeling ‘flat’
- Advice from friends or relatives who may be into ‘natural therapies’ such as ‘You don’t need to take medication - it’s bad for you’
- Having poor information or a poor understanding about what the medication is supposed to do
- Feeling better on medication so thinking that they are “all better now and don’t need to take medication”
- Thinking: ‘I’m not/never have been sick; I don’t need to be on medication. It’s the medication that’s making me feel ill!’
If you’re considering stopping taking your medication or changing your dose, it’s important to talk to a medical professional first. Suddenly stopping some medication can make you feel worse.
Therapy, such as talking therapies
Supportive counselling is a treatment for milder forms of depression and is as effective as antidepressant medication.
More specific therapies e.g. cognitive behaviour therapy (CBT) can be effective for more significant depression. Your GP will explain what is available locally and which type of talking treatment is most suitable for you.
More specific therapies e.g. cognitive behaviour therapy (CBT) can be effective for more significant depression. Your GP will explain what is available locally and which type of talking treatment is most suitable for you.
You might be worried you won’t know what to talk about with a counsellor. It might help you to make a list of what you’d like to discuss, things that are bothering you, feelings you’re experiencing. Bring it with you to your appointment.
The list might include:
The list might include:
- Issues in your family/whānau or other relationships
- Symptoms like changes in eating or sleeping habits
- Anger, anxiety, irritability or troubling feelings
- Thoughts of hurting yourself.
Most counselling and talking therapies are brief and focused on your current thoughts, feelings and life issues. Focusing on the past can help explain things in your life, but focusing on the present can help you cope with the present and prepare for the future.
Education about depression can be extremely important to help you, your family/ whānau and supporters. Visit www.depression.org.nz for more information.
Education about depression can be extremely important to help you, your family/ whānau and supporters. Visit www.depression.org.nz for more information.
Having a “Wellbeing Plan”
Many people find that having a written plan, developed together with your GP/psychiatrist can help you to feel you’re in control if difficult feelings return.
Make sure others (i.e. family/whānau, partners, and community mental health staff) are aware of your plan and what you’d like to happen if you become unwell again.
Plans can detail (in your own words) symptoms, what can trigger these feelings and what things help you.
They can also list the numbers of support people, helplines and more, and outline what you’d like to happen if you need professional support.
They can also list the numbers of support people, helplines and more, and outline what you’d like to happen if you need professional support.
Family/whānau support and involvement
The level of family/whānau support and involvement you need is up to you.
Family/whānau members may be struggling to know how to help. If there are specific things that would help you, try asking for them. Say: “it would be really helpful if you helped me fold the laundry/washed the dishes/make me some toast/take the kids out for a bit.”
Family/whānau members may be struggling to know how to help. If there are specific things that would help you, try asking for them. Say: “it would be really helpful if you helped me fold the laundry/washed the dishes/make me some toast/take the kids out for a bit.”
Remember it may be difficult and distressing for family/whānau and friends to see you feeling so low, and they may need to:
- seek support for themselves from friends, family/whānau and/or counsellors
- educate themselves on depression
- get help with understanding what is happening to you
- learn to set clear boundaries about behaviour
- learn to manage their own stress.
Family/whānau can learn to use words that may help you feel supported:
- “You are not alone in this. I'm here for you”.
- “You may not believe it now, but the way you're feeling will change”
- “I may not be able to understand exactly how you feel, but I care about you and want to help”
- “You are important to me. Your life is important to me".
Myths about depression
Depression is a sign of a weak character.
NOT TRUE The fact is that depression can affect anyone. While some particular personality types are more likely to develop depression, the vast majority of people who develop the condition have been previously healthy and led normal lives.
People with depression can just 'snap out of it' or just choose to 'pull their socks up'
NOT TRUE One of the most disabling symptoms of depression is the fact that it saps the will and makes doing anything an enormous effort. Depression is an unpleasant experience, and most people with this condition would (and do) do anything to get well.
Thanks to Janet Peters, registered psychologist for reviewing this content. Date last reviewed: June 2019.