About depression
Depression is a mental health problem that can affect how you feel and behave for weeks, months or years at a time.
When you are depressed, your low mood lasts, affecting your sleep, relationships, hobbies, job and appetite.
Anyone can experience depression. It can be caused or triggered by different things, but the symptoms will be similar.
It can be very hard to ask for help and to believe that there is a way out of depression, but depression can be treated, and most people do recover. The earlier support is given, the better your chances of recovery.
Symptoms
Signs to look for (symptoms)
Symptoms of depression usually develop over days or weeks. You may have a period of anxiety or mild depression which lasts for weeks or months and then turns into more severe depression. 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 physical symptoms. 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. Te ao Māori concepts of wainuku (really low or down in the dumps), whakamā (shame) or whakamaemae (emotional pain or distress) are another way to think about these feelings. They are a natural part of life, but, when you are depressed, they go on for a long time and make day-to-day living very hard.
- Loss of interest and pleasure in usual activities. This means you don’t enjoy what you usually do – including playing sport, socialising, spending time with loved ones or doing hobbies.
- Irritable mood. This may be the main mood change that you notice, rather than sadness.
- 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 are 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 whānau member.
- 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.
- Psychosis (loss of contact with reality) can, in rare cases, be a part of severe depression.
- 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. If you are experiencing this, it’s important that you seek help and let someone know how hard things have become for you.
Helplines
If you are in crisis
If you are in crisis, you may feel your world has fallen apart, that everything is black, that nothing makes sense or that you may hurt yourself.
If you are extremely distressed and need immediate help, you or your family can call the mental health crisis team or call 111 for an ambulance.
Either way, you will be assessed by a mental health clinician. Options for care and treatment following a crisis situation are:
- support in your own home (i.e. medication management)
- respite care in a house staffed by mental health or peer workers
- admission to an inpatient psychiatric ward for assessment and management of your symptoms and distress.
Who gets depression?
Depression can start at any age. It is most common in people aged 25–45. 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, which can lead to depression later in life
- Certain medications, which 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. They include:
- Excessive worry or fear that leads to a physical stress response, 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 fear, being on edge and worrying, we call it anxiety.
If you are concerned you may be depressed or anxious, a number of New Zealand websites have useful self-tests you can do. These are listed under Resources & Links (below).
How the doctor determines if you have depression
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 will be looking to understand the context of your life and how your mood fits into this. 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 whānau/family’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.
Resources that you find yourself, such as websites and self-help books, can help support your treatment, but help from health professionals is important and will give you the best chance of recovery.
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 (one in five of us will experience a mood disorder across our lifetime), so many people will understand what you are saying, or will know of someone who has experienced it and got through. Unfortunately, some people don’t understand depression, and their responses may be dismissive, unhelpful or judgmental. If this happens, try to reach out to someone else – you will find someone who can support you.
It is understandable to have hard times, and it is okay if it takes time to heal. That doesn’t mean there is something wrong with you. Depression does not need to become an identity. It is an experience that can occur in life, sometimes often, or sometimes for a long period of time, but it is not who you are.
Other people with depression have found these strategies useful when accessing health services:
- Ask to communicate through email or text, if this is easier for you
- Ask a support person to help you get the information you need, e.g. cost and appointment times
- Use a calendar to keep track of your appointments, adding as much detail as you can, e.g. the name of the person you’re meeting with, the location, how long it takes to get there, which bus route – this makes it easier to go to appointments on the day
- If you didn’t make it to an appointment, book another one and keep trying – the professional will understand.
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
- what the process of stopping taking them (withdrawal) could look like.
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 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) or Acceptance and Commitment Therapy (ACT), 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, and feelings you’re experiencing. Bring it with you to your appointment.
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.
If you feel therapy isn’t working for you, try different styles of therapy or therapists until you find one that is right for you. There are lots of options, and no one approach will work for everyone.
What can I do to help myself?
You’re the expert in your own mental health and wellbeing. Taking charge of your recovery and doing things that make you feel better, stronger and more in control will help your recovery from depression.
When you have depression, it can be hard to find the energy or motivation to look after yourself. Start small – return a text message, open a window, close your eyes and listen to the birds singing. Slowly build up to bigger things and try to notice what makes you feel better.
Make a list of things that feel good and keep it on your phone, in your diary or on the fridge. When you’re struggling, check your list and pick one thing you can do right now that might help.
Other people with depression have found these things helpful:
- Learn about depression. Find information and read/listen to stories of other people who have found a way through.
- Keep a mood diary. This will help you learn your particular early signs of depression and the things that can cause your mood to change.
- Simplify your routine. Identify stressful activities and, where possible, reduce them. Create a regular routine for yourself.
- Physical health. Try to eat a balanced diet and get enough sleep. Get some exercise, even something as brief and gentle as a walk around the block or a few minutes of stretching. Cut back on non-prescribed drugs and alcohol. Make sure you get an annual check-up with your doctor. Being in good physical health is known to help your mental health.
- Complementary therapies. Use relaxation exercises, yoga, meditation (there are many free online resources for these) or, if possible, massage. There might be practices from your own culture (e.g. Māori or Pasifika therapies) that you find helpful.
- Time in nature. Even just sitting in the sunshine listening to the birds singing for a few moments can be really helpful.
- Peer support (e.g. support groups). The wisdom of people who have experienced depression themselves can be very useful. You could also look for support from people with the same background as you, if that is important to you (e.g. age, ethnic group, sexual orientation).
- Entertainment. Watch comedies or other gentle TV shows and movies. Have a playlist of music that you know helps.
- Be kind to yourself. This could mean treating yourself to something small but special, like a cupcake or a new pen. It also means letting your feelings exist without judging them or trying to suppress them.
- Fun. Make sure you regularly do things that you enjoy and that give your life meaning.
- Express yourself. This might be through writing, art or music.
- Make small connections. If you don’t feel like having a conversation, you can still reach out with something as simple as sending a gif, or asking your friends to spam you with pictures of cute animals.
- Find cheats of hacks for daily self-care. For example, dry shampoo and baby wipes instead of a shower, ready meals, mouthwash, a small “capsule wardrobe” of clothes that you like and feel comfortable in.
- Keep yourself safe. Put things that you could use to hurt yourself in a locked box or cupboard and give the key to someone you trust.
- Make small goals. For example, to get out of bed. Write it down, and celebrate when you achieve it.
- Change position. Lie on the sofa instead of bed or try to spot something in the room that you’ve never noticed before. If you are up to people-watching, sit somewhere and try to spot a certain thing, e.g. happy faces or nice shoes.
And remember: it’s okay to feel sad sometimes – you’re human. For someone who is depressed, the pursuit of “happiness” can feel overwhelming and impossible. Working with a therapist, you will learn skills to help you to cope with the full range of human emotions, including sadness, so you can tolerate these emotions and not get swept away by them.
Looking after yourself
Have a wellbeing plan
Many people find that having a written plan, developed together with your support team, 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 phone numbers of support people and helplines, and outline what you’d like to happen if you need professional support.
Family/whānau support and involvement
If a member of your family/whānau has depression, you may be unsure about how to help them. Let them decide the level of support and involvement that is right for them. Encourage them to ask for help with specific things. They might say something like: “It would be really helpful if you folded the laundry/washed the dishes/made me some toast/took the kids out for a bit.”
To support your own wellbeing, you may need to:
- seek support for yourself from friends, family/whānau and/or counsellors
- educate yourself on depression
- get help with understanding what is happening to your family/whānau member
- learn to set clear boundaries
- learn to manage your own stress.
You can learn to use words that may help your family/whānau member 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 Some people are more likely to develop depression, due to genetics or environmental factors, but depression can affect anyone.
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 Joanna Macfarlane clinical psychologist, and members of the Thriving Madly peer support network in Christchurch for reviewing this content. Date last reviewed: September, 2022.
Thanks also to Sutherland Self-Help Trust for making the 2022 updates possible.