One in 10 New Zealanders are expected to have an episode of depression at some stage in their lives. Nicole Senior investigates how we can tell if we're depressed – or just feeling blue – and what we can do about it.
What is depression?
Everybody feels down in the dumps now and then. Termed 'normal depression', this usually resolves in a day or two.
'Clinical depression' is defined as a disabling and pervasive sadness which persists for most of the day, most of the week, for over two weeks. There may be reduced energy and tiredness, loss of interest in normal activities, low self-esteem, and sleep and appetite changes. Depressed people are often physically unwell, as the immune system, hormones, heart and gut can be affected.
Who gets depressed?
Depression is one of the most common mental health problems with one in five people experiencing depression at some time in their lives. Around six per cent of people will experience a severe case of the condition.
Depression is most common between the ages of 18 and 44, and women are diagnosed more frequently than men.
Children and teens are not immune − about 20 per cent of young people will experience one or more episodes of major depression by adulthood.
What causes depression?
While depression is an illness associated with an imbalance of chemical messengers (neurotransmitters) in the brain, other factors also play a role.
Negative life experiences, stress, use of drugs and alcohol, personality traits and relationship pressures all play a part.
The death of a loved one or being the victim of prolonged abuse can be a trigger, and personality traits such as perfectionism can make people more vulnerable.
Depression can run in families, but in some cases it occurs seemingly at random.
Depression can be treated
Less than half of people with depression seek professional help. But, like asthma or allergies, depression needs to be seen as just another health problem that can be treated.
The first port of call is a visit to your GP to assess the condition and recommend appropriate treatment. For mild depression, professional counselling and lifestyle measures may be enough. For moderate or severe depression, the combined approach of psychological therapy, such as CBT (cognitive behavioural therapy) and/or medication may be helpful.
Antidepressants which influence serotonin or noradrenalin levels are usually the first-line treatment. Reading a good self-help book based on CBT can also be effective in treating mild depression, says UK research.
Luckily, many people with clinical depression will recover fully and, with effective treatment, recover faster.
Depression and exercise
Exercise is an effective treatment for depression, and may prevent relapses. While being physically active reduces the risk of depression occurring, around half of adult New Zealanders are not active enough to obtain health benefits.
We need to do at least 30 minutes of moderate-intensity physical activity on most, if not all, days. Moderate intensity activities include walking, cycling, housework and gardening – any activity which moderately increases your breathing and heart rate.
The recommended 30 minutes doesn't have to be done all at once. It's okay to accumulate several bouts of 10 or 15 minutes throughout the day. Doing more than this – or including some vigorous activity such as jogging or aerobics – will provide even more benefits.
When it comes to physical activity, a little is good, but more is definitely better.
Depression and weight
Depression can make people more inclined to overeat for comfort, and less inclined to exercise – leading to weight gain. Being overweight can lead to loss of self-esteem and create poor mood in itself – all of which creates a vicious cycle. To break the cycle, schedule healthy routines of shopping, cooking, and exercise. Ask family and friends to help ensure it happens. Having shortcuts on hand, like healthy frozen dinners, can be a big help.
Commonly asked questions
Do antidepressants cause weight-gain?
Weight-gain is not an expected side effect in the most commonly used serotonin or noradrenalin type antidepressant medications (SSRIs and SNRIs), however there are other types used for severe depression which typically cause moderate weight gain (for example, Mirtazapine). Antipsychotics and mood stabilisers used to treat other mental illnesses are more likely to cause significant weight gain.
Do herbal medicines work?
St Johns Wort (hypericum perforatum) is an effective herbal antidepressant. However, it is vital to discuss this with your doctor as it can interfere with other medications.
Does alcohol affect antidepressants?
Many people drink more alcohol when they are depressed in an attempt to feel better. However, this carries a risk of harm. Alcohol can also interfere with antidepressant medication and cause unwanted weight gain, not to mention the negative effects of a hangover on mood.
Eat better, feel better
Certain nutrients may help prevent and treat depression by influencing the chemical balance of neurotransmitters in the brain.
The contentedness you feel after a carbohydrate-rich meal, such as pasta, is due to the boost in serotonin levels. Keep up your serotonin supply by eating regular meals with carbohydrates such as bread, cereal, rice, pasta, legumes, fruit, and dairy foods.
Keep up your tryptophan
An amino acid which also boosts serotonin, tryptophan is found in turkey, chicken, beef, brown rice, nuts, milk, cheese and eggs. To ensure a ready supply, include protein-rich food at every meal. For example, milk or yoghurt at breakfast, a turkey sandwich at lunch, and lean meat, brown rice and vegetables at dinner.
Boost your B-vitamins
Folate, vitamin B6 and vitamin B12 help maintain production of neurotransmitters and low levels may contribute to depression. Find folate in green leafy vegetables, oranges, whole grains, chickpeas, yeast extract and nuts. Rich sources of B12 are found in animal foods such as meat and fish, eggs and dairy foods. It may also be added to vegetarian meat substitutes and some soy milks. Keep up B6 levels by eating potatoes, salmon, chicken, spinach and bananas.
The good oils: omega-3 fatty acids
While more research is needed, there are now many encouraging studies showing beneficial effects of long-chain omega-3s from fish oils on various types of depression. One study of 60 people showed supplementing with fish oil was as effective as an SSRI drug (fluoxetine) for major depression, with best results from a mix of both. Aim for the 'Suggested Dietary Target' for long-chain omega-3 fats recommended by the Ministry of Health: 610mg for men, 430mg for women, or two to three serves of oily fish a week.
How to get help
If you are suffering with depression, the Depression Helpline (Freephone 0800 111 757) provides support from trained counsellors who can offer information and advice. Or go to www.depression.org.nz, a supportive and informative website designed to help New Zealanders understand and deal with depression.