Depression

The clinical psychologists and psychiatrists at Mindcare Centre offer expert assessment and treatment of depression in older adolescents and adults. To make an appointment call Mindcare Centre during business hours on (02) 9212 4445 or email us to book an appointment with one of our depression experts.

What is depression?

Everyone feels depressed in their mood from time to time. Depression is a normal human emotion, just like anxiety, anger and joy. However for some individuals depressed mood can be particularly severe or persistent disrupting their usual life activities to a significant degree. These individuals might be experiencing a depressive illness often referred to as Major Depressive Disorder.

Major Depressive Disorder (from hereon simply referred to as depression) is a  common mental health problem.  Approximately one in seven Australians will experience an episode of depression in their lifetime with the rates being slightly higher in women than in men1. The majority of these people will have more than one episode2. Depression can occur for the first time at any age but most first episodes occur for the first time in the 20’s3. Depression especially the first episode is often triggered by life stress such as work or relationship issues and it commonly occurs in association with health issues such as heart disease, cancer or childbirth. However depression can also occur for no obvious reason at all especially for recurrent episodes of depression.

 What are the symptoms of depression?

The most common symptoms of depression are:

  • Feeling low, down, blue, sad or flat
  • Loss of pleasure and loss of interest in doing things (everything feels like an effort)
  • Negative thoughts and feelings of guilt, shame or worthlessness
  • Irritability or anger outbursts
  • Difficulty making decisions
  • Feeling like you would be better off dead or wishing you were dead, possibly with a plan to commit suicide
  • Loss of appetite possibly with weight loss or overeating possibly with weight gain
  • Problems concentrating
  • Problems getting to sleep or staying asleep or waking early and being unable to get back to sleep
  • Loss of libido
  • Aches, pains or digestive problems that seem resistant to treatment
  • Fatigue and lethargy

It is not uncommon for depression to occur hand in hand with other mental health problems the most common being anxiety and alcohol or substance use problems.  Depression may also occur in the context of bipolar disorder where individuals will at some point in their lifespan experience a significant and troublesome elevation in mood (hypomania or mania). A diagnosis of depression relies upon careful clinical assessment of current functioning as well as whole of life functioning to date in order to rule out other causes of depressed mood and to plan an effective treatment pathway. The clinicians at Mindcare Centre are trained to conduct these sorts of assessments.

How is depression treated?

Depression is considered to be a treatable illness. That is the expected outcome is that full recovery will occur. However depression can have many causes and many treatments so it is important to work out the best treatment plan for each individual. There are many effective treatments available. The clinical psychologists and psychiatrists at Mindcare Centre use treatments that are supported by scientific evidence.

Depression responds very well to talking therapy. By this we don’t just mean talking about how you feel – most people can do this with a friend or family member often with considerable benefit. Rather we are referring to evidence based (well researched) psychological therapy that follows clear models and structure typically including suggestions or skills training for cognitive or behavioural change in between sessions.

Talking therapy feels different for everyone and some people can find it a bit daunting especially if they are not used to talking about their feelings and life problems. This can be particularly true for some men who may tend to deal with emotional problems by ignoring them, toughing it out or drinking more alcohol. However most people tend to feel comfortable fairly quickly once they get over the initial hurdle of acknowledging their difficulties to a stranger. The process of talking therapy starts in the initial assessment phase and involves explaining your current difficulties and symptoms in detail as well as how these problems fit into your overall life history. Therapy might involve teaching you strategies for behaviour activation and activity planning during periods of low mood as well as helping you develop more flexible and adaptive ways of dealing with ineffective or unhelpful thoughts and beliefs about yourself and the world around you. Our aim is always to look at what maintains your depression and work towards changing this in order to reduce your symptoms both now and in the future.

There are a number of psychological therapies that have a good evidence base including Cognitive Behaviour Therapy (CBT), Interpersonal Psychotherapy (IPT),  Acceptance and Commitment Therapy (ACT), Mindfulness Based Cognitive Therapy, and Brief Psychodynamic Therapy.  Because one size does not fit all the clinicians at Mindcare Centre have the training and experience to integrate a range of approaches as needed so that treatment is tailored to each individual’s needs.

Most cases of mild to moderate depression respond well to psychological therapy on its own. However, for more severe or recurrent episodes of depression, or where there are significant comorbid disorders such as an anxiety disorder the addition of an antidepressant medication may be helpful or necessary. Often but not always a well rounded and pragmatic approach for the treatment of moderate to severe depression is a combination of medication plus psychological therapy. Only a medical practitioner can prescribe antidepressant medication (typically a GP or a psychiatrist).

In terms of who is best to see for treatment of depression it typically depends on the severity of the depression and the types of complicating factors that may be present. In many cases depression can be managed effectively by a GP or a GP plus clinical psychologist.  Referral to a psychiatrist is usually only necessary if the depression is particularly severe if the depression does not respond to psychological treatment plus GP managed care if there are complicated health issues or if the clinical picture is complicated by the presence of other mental health problems that make diagnosis unclear interfere with recovery or require more experienced medication management.

What to do if you feel suicidal

Severe depression can be life threatening. If you are suicidal right now and seriously fear that you might act on these thoughts ring 000 or go to the emergency department of your nearest hospital. Lifeline also has some very helpful resources including telephone crisis support.

How to get help if you are depressed but not at immediate risk of suicide

If your depression is not immediately life threatening there are a number of simple steps you can take to get yourself on the road to recovery. Ring your GP and make an appointment (preferably a double appointment slot so you have time to talk). If you do not have a regular GP and usually to go to a bulk billing medical centre now is a good time to consider finding a good GP that you can stick to during this course of illness and hopefully beyond. Ask friends and family who they recommend.

Call Mindcare Centre’s helpful reception staff during business hours on (02) 9212 4445 to make an appointment with one of our clinical psychologists or psychiatrists or send us anemail to make an enquiry. Mindcare Centre houses both clinical psychologists and psychiatrists so stepped care is available within a team-based setting. This form of group practice provides good communication between treating health professionals and the right level of support for each individual’s needs.

Further information and Resources:

Books

Overcoming Depression by Paul Gilbert

Manage your Mood by David Veale and Rob Wilson

The Mindful Way Through Depression by Mark Williams et al.

The Happiness Trap by Russ Harris

Websites:

Beyond Blue

The Black Dog Institute

The Moodgym Training Program. Learn cognitive behaviour therapy skills online for preventing and coping with depression

Centre for Clinical Interventions: Back from the Bluez

References

1.    Australian Bureau of Statistics (2009). National Survey of Mental Health and Wellbeing: Summary of Results, 4326.0, 2007. ABS: Canberra.

2.    Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines Team for Depression (2004). Australian and New Zealand clinical practice guidelines for the treatment of depression. Australian and New Zealand Journal of Psychiatry, 38:389–407. (https://www.ranzcp.org/Files/ranzcp-attachments/Resources/Publications/CPG/Clinician/CPG_Clinician_Full_Depression-pdf.aspx)

3.    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-V), 5th edn. Washington, DC: American Psychiatric Press, 2013.

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