Clinical depression is classified as a Mood Disorder and is also referred to as ‘Unipolar Depression’ to differentiate it from ‘Bipolar Affective Disorder’ (also known as Bipolar Disorder, Bipolar Depression, and the older term Manic Depression). For some people, their depressive symptoms remain at a sub-clinical severity which means that they experience some depressive symptoms, but the range, severity and/or duration of their depressive symptoms is not severe enough to be classified as a clinical depression.

To be classified as a clinical depression, the following features must be met:

• A range of symptoms of required duration and severity
• Clinically significant impairment to social, occupational, or other important areas of functioning
• The depressive symptoms must not be due to a medical condition, or better classified under some other mental illness.

SIGNS & SYMPTOMS OF DEPRESSION:
You are probably wondering “how do I know if I am depressed?” The following signs and symptoms are what we would normally see in a person with a clinical depression, however it is not uncommon for a person to have just a few of these depressive symptoms. Please note that the information below is not for the purpose of a formal diagnosis of depression, but rather for educational purposes. To find out if you are suffering from depression, it is recommended that you see a Clinical Psychologist for assessment.
Common depressive symptoms can include:

• Lasting depressed mood – this means that your predominant mood is depressed. For some it may also be irritable. This is quite different from feeling a bit ‘blue’ or a bit ‘down’. When people are feeling a bit blue or down, the depressed mood is typically quite temporary, and things that can normally cheer them up normally do so. It is quite normal to have a down day or days here and there – most people experience this. However, someone with a clinical depression with a persistent and pervasive depressed mood would describe their mood typically as feeling ‘depressed’ or ‘sad’ most of the time, and sometimes they can find it hard to pinpoint why they actually feel depressed or sad. They find that almost no matter what they do, not a lot cheers them back up. They tend to feel as though they have a black cloud hanging over their head, or being in a black hole that they just cannot seem to get out of no matter how hard they try. More tearfulness than usual (even more males or ‘blokes’!) is also common. Many people will often say that they ‘cry at the drop of the hat’. It could be the smallest sad thing on TV that makes them cry.

• Loss of interest or pleasure – This is what we refer to as ‘anhedonia’. This means that what you used to enjoy or get pleasure out of, you just don’t seem to have much or any interest in these activities anymore. It’s quite a marked difference to what you used to feel. You may use to have loved playing footy, the guitar, going out for dinner, going to the beach, seeing your friends etc, but now you just ‘can’t be bothered’, or just not interested; these activities do not give you the same excitement and pleasure that they used to. Some people might say that they get a bit of enjoyment out of the activity, but it is very short lived now. Part of this is because of loss of motivation and lowered energy. Many people tend to withdraw from their friends and family, and rather stay in bed.
• Sleep issues – Most commonly, people with depression will report ‘initial insomnia’ which is trouble falling asleep for the first time of the evening. It may take you 30 minutes, or 3 hours+. Also commonly experienced is ‘middle insomnia’ which is waking up in the middle of the night. Some people may also wake up early for the last time of their sleep which is called ‘terminal insomnia’ without alarm, or for work etc. Through my clinical practice, I find the most common reason for sleep troubles (once medical reasons have been excluded) is over-active mind where the thoughts in the mind are very busy and the person has trouble quietening them enough to get their mind and body in a state of relaxation conducive of sleep. It is also not uncommon for people to report vivid or strange dreams, especially when there is also a lot of stress going on.

• Change in appetite – This is where the person will tend to have lost much or all of their appetite, or have an increase in appetite. They will often report that they no longer, or don’t tend to feel hungry anymore. Eating can feel like quite a chore, and for some people eating food can make them feel a bit sick or nauseous, particularly if there is some stress or anxiety going on as well. For some people, there can be quite a significant amount of weight loss over weeks or months due to reduced energy /food intake. In my clinical experience, reduced appetite is most commonly seen in clients. For those that have an increased appetite, there is usually cravings particularly for “comfort foods”, and this tends to be described as ‘comfort eating’ or ‘emotional eating’ such as for stress, feeling lonely, sad, or bored. Naturally, with increased food intake and reduced activity, there can be weight gain experienced. Depression is also a stress response within the body, so the increased cortisol can also contribute to weight gain.

• Reduced Energy – Feeling low on energy, or feeling as though you have ‘no energy at all’ compared to usual is also common with depression. For some people, they will also report feeling ‘fatigued’ where their body feels quite heavy, as though it is made of lead. Having low or no energy can make even the smallest tasks feel like such an effort, consequently contributing to a reduction in participation in activity.

• Poor concentration – You may find that your concentration just isn’t as sharp as what it used to be. You may find that you have to keep re-reading written articles over and over again because it’s not sinking in as well anymore. You may find that you’re looking at the TV screen, but you’re not really paying attention. You may find it hard to have conversations with people because you keep losingtrack of what they’re saying or what you’re saying. You may also find that your short-term memory is not so great anymore; you may have ‘words on the tip of your tongue’, forget peoples’ names easier, forget to do certain tasks, make more errors/mistakes at work than usual. I commonly get asked by my clients, particularly when their concentration/memory is quite noticeably impaired if they’re developing alzheimer’s/dementia, and have worry if their concentration/memory will return to normal. The attention/concentration problems that are in relation to depression tend to resolve to normal once the depression starts to resolve. From my clinical experience, concentration/memory problems tend to start to improve sometime after other symptoms have improved.

• Feeling worthless or guilty – It is very common for people with depression to feel worthless, or more worthless than usual before they felt depressed. This is also generally the same thing as what people call feeling of ‘low self-esteem’ or ‘low self-confidence’. For some people, they had good self-esteem and confidence before they started feeling depressed, and for some people, they were already experiencing low self-esteem and/or low self-confidence before they started feeling depressed, which has become worse with the onset of the depression. In some situations, some people may also experience some unrealistic guilt that can be difficult for them to shift to a different perspective. Guilt typically being ‘I did something bad’ (behaviour).

• Suicidality – For people experiencing depression, it is actually not uncommon for people to report experiencing some thoughts of suicide, which may just be thoughts about “I prefer not to be here anymore” or “life would be easier if I wasn’t here anymore”, without desire, plan, or intent to not be alive anymore. However, for some people, particularly when they are feeling quite depressed, these suicidal thoughts of not wanting to be alive anymore can be quite strong, and can be associated with urge or intent to do something to take their life, and may even have a plan to take their own life, whether vague or specific.

• Rumination – this is the repetitive thinking of a situation where you keep replaying a particular situation over and over in your mind. You may find that not thinking about this situation really difficult that your mind just wants to keep focusing on this situation. For many people, they tend to ruminate because they think it will help them to try and make sense of the situation or problem, or to find ways to come to some sort of solution to sort the situation out. The situation could be anything from something your boss or co-worker had said to you about a task you had done that you have interpreted as them implying you have done something wrong, or something a friend said to you that you have taken to imply that they do not like you. It may be a financial situation that you are not sure how you are going to get yourself out of, or some upcoming event that you are trying to work out how it is all going to turn out. Rumination is a common feature for many mental health issues.

• Feelings of hopelessness and helplessness – this is where you feel like that things won’t get any better (hopeless), and/or that nothing you do will make your situation any better (helpless). This is a particular risk factor for suicide.

• Change to your thinking patterns – when people are depressed, it is very common for the person to report noticing that their thinking is just not as positive as what it used to be. Their thinking becomes quite ‘negative’. For some people, this negative thinking can be quite mild where it can be easily shifted to a more helpful, more positive perspective. For others, particularly when they are more depressed, their negative thinking or beliefs can be quite entrenched where they find it not so easy to shift their thoughts/beliefs to that which is more positive or helpful/realistic. The content of their negative thoughts may be may be about:
  • Aspects of their life that aren’t going well or working out for them they way they would like
  • How things always seem to go ‘wrong’ for them
  • People/the world are ‘bad’
  • Barriers/obstacles for things that may improve their situation e.g., “I wouldn’t be able to that because of XYZ”
  • Not being a ‘good enough’ person, or not being ‘worthy’ as a person
  • There is not much in the future that is worthwhile to look forward to

•  Anxiety – this can be general heightened anxiety, or can be worry about the future – “what if” thinking. It is also quite common for people who are feeling depressed to also start having many thoughts about other people judging them in a negative way, or looking at them in a negative way, or that people do not like them. This usually relates to a typically lowered self-esteem with depression. For these people, they tend to feel anxious in social situations when they did not used to before they started feeling depressed, or they feel more socially anxious than what they used to feel before they started feeling depressed.

Research shows that depression tends to be a stress response, meaning that the body shows indications of being in a state of stress, and this can include release of stress hormones like cortisol, adrenaline (epinephrine), and nor-adrenaline (nor-epinephrine), activation of the HPA (hypothalamic-pituitary-adrenal) axis, and increase in biomarkers of systemic immune inflammation (pro-inflammatory cytokines like Interleukin-1 [IL-1], and others). More about this stress response can be read in my research publications found here.

So then what causes the stress response? Many situations and factors can cause a stress response within a person. These can include but are not limited to:

• Mental health issues of some other nature e.g., eating disorder, addictions, social anxiety disorder etc
• Negative or unhelpful thought patterns or beliefs, also called ‘subconscious beliefs’
• Personal stress such as with work (difficult colleague/boss, too much pressure to get work done and not enough time), financial stress, relationship issues with family/friends/partner, housing issues, legal issues, etc.
• Bodily stress – poor nutrition, inadequate sleep, working excessive hours under high pressure, not enough time for rest and relaxation

People do not tend to wake up one day feeling really depressed, when the day before they were feeling fine. Generally depression will come on gradually over a period of weeks, or months before it becomes severe enough to be a clinical depression. For many people, the do not tend to notice the initial change in their well being as they are usually preoccupied with daily life. Rather they tend to notice a change once it becomes quite obvious, or other people point these changes in them out to them.

Yes! Depression can be treated. So you are probably wondering ‘how can depression be treated?’. Depression can be treated with the help of psychological therapies alone, medications (psychotropics) prescribed by their GP or psychiatrist alone, or a combination of psychological therapy and medications.

How psychological therapy or psychology can help with your depression:
One aspect of psychological therapy for depression treatment is that our thoughts and beliefs are the primary driver of our emotions; how we feel. Our emotions are a good indicator of whether we are having positive thoughts or beliefs, or whether we are having negative thoughts or beliefs. If we have a positive thought, we tend to feel good. If we have a negative thought, we tend to feel unpleasant. When a person repeatedly has a pattern of negative thoughts of a particular theme, these thoughts can turn into a ‘belief’. Research shows that our thoughts have a significant influence over not only our brain but also the cells in our body. Through repetition of a certain pattern of thoughts (whether positive or negative), we strengthen neural connections in our brain for that way of thinking so that that tends to become our more automatic way of thinking. Our thoughts affect the chemicals in our brain called ‘neurotransmitters’ and ‘hormones’ that are released into our body through our blood. These chemicals then affect the health of the 50 trillion cells in our body. The other way psychology can help with depression is by learning more healthy behaviours including healthier ways of coping with situations. Our behaviours also have a large influence over our thoughts, and thus our emotions we feel. For example, if you engage in a self-sabotaging behaviour (e.g., alcohol, unhealthy relationships, avoidance) that causes you problems, then you may start to mentally beat yourself up about this or let it determine your self-worth, which is likely then to bring your mood down and probably give you some anxiety also.

Psychological therapy can also help you receive support for the tough times that you are currently going through and having someone you can talk to about things that you may not feel comfortable talking to other people about, helping you to problem-solve your way through current situations, helping you to understand the current difficulties you’re experiencing and why you might be feeling the way you feel. Psychological therapy can also help you to work through unresolved issues contributing to your depression such as grief, past trauma or abuse for example.

The answer to this question is not so black and white as how long it takes for a person to get better from their depression various from person to person as there are multiple factors that influence recovery progress. For some people that I have had with a clinical depression, they have had full resolution from their depression with psychological therapy alone in 6 weeks, for some it can take longer.

Things that help a person to recover from depression quicker include:

• Regular attendance of psychological therapy sessions as scheduled by your psychologist
• Engagement in the therapy process during the session and practice of the recommended strategies provided to you to help you with your particular issues between the sessions
• Keeping alcohol use to minimal or nil
• Living your life in as much harmony as possible e.g., eliminating stressors as much as you can such as unhealthy relationships, work issues, healthy eating/nutritious foods, exercise etc
• Good social support available and making use of this support from others

Things that tend to prolong a person’s recovery from depression include:

• Not attending the psychological sessions as scheduled
• Not participating in the therapy process or practicing the recommended strategies set by your psychologist
• Having experienced a clinical depression in the past
• Co-morbid psychological issues (having another mental health condition e.g., PTSD, anxiety disorder, eating disorder etc)
• Substance use of alcohol and drugs
• Abuse of prescription medications
• Having unhealthy/toxic relationships in your life that cause you stress
• Work stress, bullying/harassment
• Other on-going psychosocial stressors such as legal issues/impending court cases, financial stress, housing issues

If you find that you have been experiencing some of these circumstances yourself and have some current depression or mental health concerns, psychological therapy is still able to help you get better and start living the life you desire. If this is the case for you, it will be even more important for you to get professional help for your mental health sooner rather than later so that your current concerns are able to resolve easier and quicker.