Depression | Mate pāpouri

Depression is a change in mood, behaviour and feelings that can be mild, moderate or severe. Symptoms last for longer than 2 weeks and include:

• low mood
• feeling sad and tearful
• feeling angry or irritable (men especially can feel this way rather than feeling sad)
• feeling worthless, guilty or bad about yourself all the time
• not wanting to socialise anymore
• being unable to enjoy activities that once were fun
• feeling stressed and anxious
• poor appetite or overeating
• physical symptoms such as pain (eg, headache, back pain)
• tiredness and too much or too little sleep
• difficulty concentrating and making decisions
• not thinking straight
• having difficulty getting much done.
  
  

In collaboration with the World Health Organisation, writer and illustrator Matthew Johnstone tells his story of the 'black dog of depression'.

Video: I had a black dog, his name was depression

(WHO, US, 2012)

Sometimes depression appears out of the blue, while at other times something seems to trigger it. The exact cause of depression is unknown but many things may play a part in depression. For example, you are more likely to experience depression if you:

• have someone in your family who has been depressed, eg, a parent, brother or sister
• experienced trauma or abuse at an early age
• have a physical health condition (eg, diabetes, cancer, heart disease, underactive thyroid, Parkinson’s disease or coeliac disease) or you've had a stroke
• are going through major life changes or have suffered a loss (eg, losing your job, a relationship break-up, redundancy, or a serious injury or accident)
• are LGBTQI+
• are or have just been pregnant
• are an older adult
• use alcohol or recreational drugs
• are taking certain medicines (eg, hormones or blood pressure medicines)
• are a woman
• are Māori – Māori are also more likely to have severe depression before asking for help.

There are changes in your brain when you have depression. Research has shown changes in neurotransmitters (the chemical messengers between brain cells), hormones, inflammatory chemicals (cytokines), neurogenesis (general brain cells becoming neurons), connections between brain cells, and activity in parts of your brain - especially your hippocampus.

The way you think, the way you cope with stress, and your circadian function (sleep/wake cycles) also affect depression. Research is continuing to help understand these differences so depression can be better treated and even prevented.

If you think you could have depression, there are online self-tests you can do, including the PHQ-9 (Patient Health Questionnaire 9) and the Kessler 10. Note that these tests are not designed to make a diagnosis but they can be helpful to show that it's time to talk with your family, friends or healthcare provider. 

If you have even some of the symptoms mentioned above, it’s a good idea to see your GP or nurse practitioner.

They will ask you questions about:

• your thoughts, feelings and behaviour, including sleeping and eating patterns
• how long you've been feeling this way
• mental health in your whānau
• whether you've had any episodes of depression before
• what's happening in your life at the moment.

They may also do a physical examination and blood tests to rule out other causes for your depression.

Your healthcare provider will be assessing whether you have depression, what type of depression and whether you have mild, moderate or severe symptoms – this will affect what treatment they recommend.

There are several types of depression. You can still be depressed even if you don't meet all the criteria for one of these types. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) divides depression into the following categories:

• Major depressive disorder – depression symptoms that interfere with your ability to work, sleep, study, eat and enjoy life. These may be mild, moderate or severe.
• Persistent depressive disorder – a depressed mood that lasts for at least 2 years.
• Premenstrual dysphoric disorder – a severe form of premenstrual syndrome experienced by some women before their periods.

Other conditions also include symptoms of depression, for example:

• Postpartum depression – a type of depression that some people experience after giving birth. This can happen during pregnancy too, which is called antenatal depression. Together, antenatal and postnatal depression are called perinatal depression. 
• Seasonal affective disorder (SAD) – depression during the winter months, when there's less natural sunlight.
• Bipolar disorder – this is different from depression, but includes episodes of extreme low moods as well as extreme high moods (mania).

Severity of depression

There are 3 levels of severity of depression:

Mild depression: Core symptoms that only mildly affect what you do. 
Moderate depression: More, or worse, symptoms.
Severe depression: Most of the symptoms listed above, that are severely affecting how you function. They can occur with or without psychotic symptoms (eg, delusions and hallucinations). Read more about this on the severe depression page.

Persistent depressive disorder 

For this diagnosis, you need to meet the criteria for a major depressive disorder, or you have 3 or 4 of the following dysthymic (mood-related) symptoms, including depressed mood, for 2 years or more. Dysthymic symptoms are:

• depressed mood
• appetite changes
• sleep changes
• low self-esteem
• fatigue
• poor concentration
• hopelessness.

• Small steps are the key to change – choose what feels manageable and build from there.
• Making your own self-care a priority can help you cope better with the challenges of life.
• Looking after your physical health helps your mental wellbeing.
• Having ways to reduce and manage stress increases your resilience.
• Getting help when you need it is a sign of strength, not weakness.
• Staying connected to family, whānau and friends can help you feel better.
• Spending time in nature is key to your wellbeing.
• Finding a purpose increases your sense of meaning and belonging.

Read more about living well with depression.

Lifestyle changes

Looking after your physical health is an important way to improve your mental health. Improvements to 4 aspects of your daily life can greatly reduce your depression: sleep, exercise, diet and the use of alcohol or other recreational drugs.

Sleep

Trouble sleeping or insomnia is closely associated with many mental illnesses, both as a symptom and a possible trigger. It happens most commonly in major depression, with about 80% of people with depression experiencing insomnia.

Good sleep can improve your mood and also give you more resources for coping with life’s challenges. Find out about why sleep is important and read more about these sleep tips or sleep apps. If you're still having problems with your sleep, talk to your healthcare provider about it.

Physical activity

People who are inactive are up to twice as likely to have depressive symptoms as active people. Even 1 hour of exercise a week has been found to help with depression.

Find out more about physical activity and mental health and the general benefits of being active.

Diet

What we put into our bodies effects not only our physical health but also our mental wellbeing. A direct link has been found between nutrition and depression. Find out about healthy eating basics to make sure your food is providing you with the nutrients to help keep depression at bay.

Alcohol and other recreational drugs

Alcohol and other drugs feel like they give you a lift in mood straight away, but the overall effect is to make things worse. Read more about alcohol and mental health.

Other things that may help

Mindfulness

Mindfulness, the practice of being aware of each moment of your day as it happens, has been shown to be effective for some people with depression by helping to ease tension and promote calmness. You can learn how to do this from mindfulness videos or look for a local group in your area. Read more about mindfulness.

Daily Planning

Our bodies have circadian (daily) patterns which are interrupted when we have depression. This might be part of getting depression in the first place. Having structure in your day helps. Here are some things to try:

• Set a time to get up and a time to go to bed each day, and stick to it.
• Set small, doable goals which are important to you. That might be having a shower, or talking to a friend on the phone for 10 minutes.
• Plan 1 fun thing to do every day. That might be listening to your favourite song or lying on the grass.
• Plan exercise 2 or 3 days a week – every day if you can. That might be walking to the letterbox, or going for a bike ride, depending on how severe your depression is and how your physical health is going.

St John’s wort

Research has found that St John's wort is useful in the treatment of mild-to-moderate depression, but not effective in severe depression. How St John’s wort works isn't fully understood but it's believed to affect chemicals in your body, eg, serotonin and noradrenaline.

You can buy St John’s wort from your pharmacy. However, many of the chemicals in St John's wort interact with medicines used to treat depression and other illnesses. It's important to let your healthcare provider know if you want to try St John's wort so that they can check if it might interfere with other medicines you're taking.

Hauora Māori

For Māori, Western models of mental health and mental healthcare may not be a good fit. An approach based on a Māori model of health has a holistic understanding of wellbeing. For example, the 4 cornerstones (or sides) of Māori health in the Te Whare Tapa Whā model of health are: 

• whānau (family health)
• tinana (physical health)
• hinengaro (mental health)
• wairua (spiritual health).

Find a healthcare provider who has a kaupapa Māori approach to wellbeing(external link).

Alternative approaches

Some complementary therapies may enhance your life and help you to maintain wellbeing. In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri massage and aromatherapy have all been shown to have some effect in easing mental distress.

Image credit: Canva

Apps reviewed by Healthify

You may find it useful to look at some Depression apps and Mental health and wellbeing apps.

Depression can usually be effectively treated with a combination of lifestyle changes, talking therapy and antidepressant medicines. 

Psychological (talking) therapy

If you have depression, it’s a good idea to have psychological (talking) therapy. This can help you with your thinking patterns and anxiety, problem-solving skills and self-esteem, amongst other things. For mild depression this can be an online course. Here are some free ones which have been shown to work well:

• The Journal(external link) – a free personalised online programme to help you to stay positive, create lifestyle changes, and learn steps for problem-solving.
• Beating the Blues(external link) – an evidence-based online cognitive behavioural therapy (CBT) tool for treating depression. Your healthcare provider can provide free access to this programme.
• SPARX(external link) – a free online game-based tool to help young people learn to deal with depression and anxiety.
• Back from the bluez(external link) – an online course with strategies to help you manage your mood. 

For moderate or severe depression talking therapy is best done face-to-face if possible. Counselling or psychotherapy from a trained professional can help you recover and can reduce the chances of future bouts of depression. A number of psychotherapy approaches have been found to be helpful with depression, including cognitive behavioural therapy (CBT). You can ask your healthcare provider to recommend someone or find a counsellor(external link) yourself.

You may be eligible for free or low-cost counselling. Programmes vary across Aotearoa New Zealand. If you're on a benefit or low income you may be able to get a disability allowance for counselling from Work and Income(external link). 

Antidepressant medicines

Antidepressants are not routinely used for people with mild depression because psychological therapy and lifestyle changes usually work well for mild symptoms. If you have moderate to severe depression, or psychological therapy and lifestyle changes haven't been enough for your depression to go away, it's likely that your healthcare provider will talk to you about antidepressant medicines. They work best when used together with psychological therapy and lifestyle changes.

If your healthcare provider recommends antidepressants, they will regularly review how well they're working for you. This will include considering whether your dose needs adjusting or you need a different medicine, and working out when you're ready to start coming off them.

• There are various kinds of antidepressants. The ones most commonly used for first-time treatment are selective serotonin re-uptake inhibitors (SSRIs, eg, citalopram, escitalopram, sertraline and fluoxetine). Most people will start noticing an improvement within 2 or 3 weeks but it can take 6 months or longer to get the full benefit. If you have upsetting side effects, or little improvement in your symptoms after 6 weeks, talk to your healthcare provider about changing the dose or trying a different antidepressant.
• It's normal to use antidepressants for up to a year, or longer if you've had depression before. Antidepressants aren't addictive but coming off them should be done slowly, supervised by your healthcare provider. This is to avoid withdrawal side effects. You should also talk to your healthcare provider if you become pregnant or plan to become pregnant.
• Check with your doctor or pharmacist before taking any other medicines or supplements – some have interactions with antidepressants that increase the risk of psychological and physical problems. This also applies to ones bought over-the-counter at a pharmacy and some herbal medicines.

Find out more about antidepressants.

Depression can get better without treatment. On average this takes 6 to 8 months. Living with depression feels miserable and is difficult for your whānau and friends. It can affect your relationships, your job and make you turn to alcohol and drugs or self-harm. For these reasons most people chose to have treatment.

If treatment in your community isn't working, your healthcare provider may refer you to a psychiatrist (a mental health doctor). Your psychiatrist may discuss less common antidepressants, light therapy, electroconvulsive therapy (ECT) or transcranial magnetic stimulation with you.

After an episode of depression is a good time to do a stock take of your lifestyle and work out ways to prioritise the things that keep you well. It's common to have a one-off episode of depression, but some people have repeated episodes of depression. For these people long term antidepressant treatment or preventative talking therapy can help.

This story video below is based on an actual lived experience that aims to encourage families to have healthy discussions on mental well-being and support. The videos may take a few moments to load.

Video: Just Ask. Just Listen.

(external link) 
(Vaka Tautua, NZ, 2019)

Video: Don't be a know-it-all. Just ask. Just listen.

(Nōku te Ao: Like Minds, NZ, 2018)

Video: Get over the awkward. Just ask. Just listen.

(Nōku te Ao: Like Minds, NZ, 2018)

Video: Kindness helps someone with depression

The video below by Tangata Atumotu Trust shows how kindness helps support a person with depression. 


(external link) 
(Tangata Atumotu Trust, NZ, 2018)

In this section you will find the following videos:

• What depression and anxiety look like
• Suggestions for recovery
• Witi Ashby Tauparapara
• Kaumatua advice
• Traditional healing approaches

These videos were sourced from depression.org.nz

Video: What depression and anxiety look like

The Pasifika communities living in Aotearoa come from many different cultures and speak a range of languages. While that makes our lives richer, it can be tricky when it comes to talking about difficult things, like mental health. For many of our communities there are strong feelings of shame and guilt around mental health problems. These feelings can make it hard to open up to our families, elders or friends.

If you can’t talk to anyone about what you are going through, it’s easy to stay away or hide your feelings from those who love you. But if you find someone to talk to, things will start to get better. 

(Depression.org.nz, 2018)

Video: Suggestions for recovery

For many of us, family is important to us, as is our faith. Being part of a church and other community groups can help us feel like we belong. These connections to family, friends, and other groups can be a big source of strength. These are the people who care about you and will want to help you feel better. While it’s good to have the support of family or friends, sometimes you might want to talk to someone who doesn’t know you or who knows a lot about mental health. 

(Depression.org.nz, 2018)

Video: Witi Ashby Tauparapara

(Depression.org.nz, 2016)

Video: Kaumātua advice

(Depression.org.nz, 2016)

Video: Traditional healing approaches

(Depression.org.nz, 2016)

Video: K Lee – my story of depression 

Depression can affect anyone. K Lee, singer, songwriter, presenter and mum of two talks about her journey and recovery from depression. 

More videos from K Lee

• K Lee – My way through depression(external link) 
• K Lee – Staying well(external link)

Video: Jamie – my story of depression 

Support

If you or a loved one are in a crisis situation with your mental health, here are some places to get help:

• 1737(external link) Free call or text 1737 any time, 24 hours a day to talk or text with a trained counsellor
• Lifeline Aotearoa(external link)  24/7 counselling and support 0800 534 354
• Youthline(external link) (0800 376 633)

For more support options see our depression support page. 

Online programmes and courses

• Small Steps(external link) – practical tools, strategies and advice to maintain wellbeing, find relief or get help.
• SPARX(external link) – a free online tool to help young people learn to deal with depression and anxiety.
• myCompass(external link)– an Australian interactive self-help service that aims to promote resilience and wellbeing for mild to moderate stress, anxiety and depression
• MoodGYM(external link) and e-couch(external link) – low cost CBT-based programmes from the Australian National University to help you identify and overcome problem emotions and develop good coping skills.
• Depression course(external link) – an evidence-based online course, especially if you have had more than 1 episode of depression (Note: this course has a fee). This Way Up, Australia, available in Chinese. 
• Depression 101(external link) 20 minute course that provides an overview on depression for people who are concerned about themselves, family or friends or people with mental health problems they encounter through their work.
• Computer-assisted learning for the mind – CALM (NZ)(external link) Developed by Dr Antonio Fernando at the University of Auckland, NZ. This free website includes a range of sections, eg, mental resilience, managing stress and healthy relationships. It includes audio files with exercises and information you can download. 
• Togetherall online community(external link) UK based, available free to Auckland residents only.