Major Depression

This article is the third in my series on the most common psychological disorders in Australia. Although a depressive episode was the third most common disorder at the time of the 2007 survey, much evidence suggested that Major Depression is the most common psychological disorder in most parts of the world over the course of a lifetime.

What is it?

We all feel sad sometimes. When people die or when we have a big loss it is natural to feel grief. Depression is different. When depression hits, thinking, feeling and functioning properly becomes all but impossible.

For Major Depression to be diagnosed, there must be one or more depressive episodes. A depressive episode includes significantly sad or flat mood most of the time over a two-week period and/or loss of interest or pleasure in most activities (called anhedonia).

Along with these mood changes, there must be some additional symptoms. Such as:

• Weight or appetite changes
• Sleeping too much or too little
• Becoming physically more jittery and keyed up, or the opposite becoming dulled
• Lack of energy or fatigue
• Feeling excessive guilt or feelings of worthlessness
• Poor thinking ability, for example concentration difficulties or indecisiveness
• Recurrent thoughts of death or suicide

Not all these symptoms need to be present for a depressive episode to be diagnosed, but most do. In addition to these symptoms, there need to be clinically significant distress and/or functional impairment. A trained clinician, like a GP, Psychologist or Psychiatrist must make this judgment.

How does it happen?

There is no one common pathway to depression. Depression is complex and still not fully understood. Research gives us some clues as to the elements that lead to depression. Key factors include genetics, early life experiences, recent life experiences and maladaptive coping styles.

There is a strong genetic contribution to depression. Twin adoption studies (where identical twins are placed in two different families) demonstrate that if one twin has depression there is about a 40-50% chance that the other will also.

Certain early life experiences are more strongly associated with depression in later life. These include being bullied, sexual or physical abuse, educational underachievement, emotional deprivation and parental divorce.

More recent events can also contribute to depression. Job loss, traumatic events, relationship break downs and any major life set back might help bring about depression. Living under sustained periods of stress and anxiety can also result in depression.

Once a depressive episode starts, it usually kept going by maladaptive coping strategies. These strategies can be thought of as bad habits. Habits like sleeping throughout the day, or avoiding other people, or numbing with food, alcohol or the internet, all feel better in the short term but keep depression around in the long term.

What now?

Evidence based treatments exist for depression. Your GP is the first place to go for treatment for depression. A GP can prescribe antidepressant medication and can write a mental health plan which will give you 10 subsidised sessions with a psychologist. Your psychologist will work with you on changing patterns (maladaptive coping strategies) that maintain depression.