Julia Reynolds is a Clinical Psychologist and e-hub Clinical Services Manager at the Centre for Mental Health Research at the Australian National University. In May this year, she gave a public seminar on how to deal with depression and anxiety. This article is based on the content of her seminar.

Public perceptions around depression and anxiety are changing. A study by the Australian Bureau of Statistics (2007) has found that 45 percent of the general Australian population will experience a mental health problem at some point in their lifetimes. In the last year alone, 20 percent of Australians experienced one of these conditions. This means that all of us will either experience one of these disorders ourselves or know someone who does. Depression and anxiety will affect us all in some way at least once in our lives.

The study also found that in the last 12 months, only 35 percent of people with one of these disorders sought help for their condition. People often do not seek help because they are not clear on whether they are just feeling a “bit depressed” or a “bit anxious”, or whether they are experiencing an actual treatable disorder.

Depression and anxiety are closely related conditions. The ABS study found that 39 percent of people with depression also have anxiety, and 44 percent of people with anxiety also have depression. People with anxiety are also nine times more likely to develop depression.

What is depression?

Depression affects how we feel physically and emotionally, how we think and how we behave. It causes actual physiological changes that prevent a person from functioning as they usually would. Scans have shown visible changes in the brain when a person is depressed.

“I just want to bust a few myths about depression. Depression is not weakness, it’s not craziness, it’s not someone being lazy, and it’s different from grief and sadness. It is not incurable too. It is very, very curable.”

There is not one specific cause of depression, but a combination of a variety of factors for each individual. We do know some of the factors; biological factors such as genetic differences, differences in brain function, alcohol and some medication can all have an impact; life experience and our personality can also play a role; and those who experience loss and increased stress are more susceptible to developing depression.

Depression is a complicated condition and different for every individual. It can be caused by a combination of a number of the above factors and can affect all aspects of our experience.

Types of depression

There are a number of different types of depression, and the symptoms vary:

  • major depression: depression that lasts for at least two weeks
  • dysthymia: a less severe form of depression that lasts for years
  • atypical: a form of major depression or dysthymia, where the person’s mood improves in response to positive events
  • melancholic depression: a severe form of depression
  • bipolar mood disorders: periods of feeling low and periods of feeling high.

What is anxiety?

All of us will feel anxious at some time in our lives, but one in four of us will experience an anxiety disorder in our lifetime. Anxiety can often be confused with stress. Stress is the name given to the body’s response to any kind of threat. At a very high level, the stress response, also commonly known as the “fight or flight” response, is preparing your body to run away or stay and fight. Such a high level of stress is what we call anxiety. A low level response is what most people would call “feeling a bit stressed”. Stress varies from a very low level up to a very high level, and the high level is where we rate anxiety.

Types of anxiety

There are many different types of anxiety and all are treatable:

  • Generalised Anxiety Disorder: worry occurring most days for at least six months.
  • Social Anxiety Disorder: intense fear of social or performance situations.
  • Panic Disorder: repeated attacks of intense fear when there is no real danger.
  • Obsessive Compulsive Disorder: a person experiences persistent distressing thoughts and uses repetitive behaviours or mental acts to reduce their anxiety.
  • Post-traumatic Stress Disorder: a person repeatedly re-experiences traumatic events.
  • Agoraphobia: intense fear of being in places where escape or help may feel difficult.
  • Specific phobias: an intense fear of a specific situation or object.

Depression and RSI

“If people call depression the black dog, I’m not sure what colour dog pain is, but the two of them are very close companions.”

Pain and depression are very closely linked. Some studies have shown that up to 80—90 percent of people with chronic pain have depression.

A study from the US looked at people with RSI specifically and found that, four years after being involved in workers compensation claims, many of them were still experiencing RSI symptoms and 31 percent had depression, a much higher rate than for the general population.

Other research has shown that pain can lead to depression. This is not surprising, chronic pain can be exhausting and difficult to deal with. It also works in the reverse, with depression making pain worse. Depression causes actual physical processes which make the brain much more sensitive to pain signals. Depression can also make it much harder for a person to cope with pain and the other life changes that a person with RSI or other chronic pain condition may be experiencing.

“Depression is kind of like turning up the volume on pain.”

People with RSI have an increased risk of developing depression

Some aspects of RSI may increase the risk of developing depression or anxiety disorders:

  • Pain can be worse at night—disturbed sleep can contribute to depression.
  • Difficulties in maintaining exercise—for those who enjoyed exercise the loss of the ability to exercise can be devastating. Exercise itself can help to ease anxiety and depression.
  • Concerns about seeking help—attempting to deal with RSI alone and worrying about the consequences of reporting their conditions, particularly to their employer, can be stressful and increase risk of depression.
  • Uncertainties in diagnosis and treatment, some reactions from medical professionals and workers compensation, negative stigma—all cause stress and increase risk of depression.
  • Difficulties in coping with changes in lifestyle—dealing with significant life changes is a major contributing factor to depression.
  • Increased muscle tension—anxiety disorders cause muscle tension which can increase pain.

There is something you can do about it

There are many different techniques and treatments for depression and anxiety disorders, with varying effectiveness for each individual. Be prepared to try something else if the first technique or treatment you try isn’t effective. The most important thing is to not give up.

There is increasing evidence that exercise can be very helpful for most people with depression, particularly for those experiencing mild to moderate levels of depression. Mindfulness-based therapies can also be effective for people with depression. This involves training your mind’s awareness through meditation and other practices to help reduce distress.

The following psychological therapies can be helpful:

  • Supportive counselling provides a space where you can be listened to and feel deeply understood and accepted. This allows your healing processes to function more effectively and increase your problem-solving capacity.
  • Interpersonal therapy focuses on solving relationship issues and dealing with isolation, changes in roles and settling disputes.
  • Cognitive behaviour therapy has a strong evidence base for its effectiveness. It is based on the concept that we can reduce unhelpful thought patterns and behaviours, and increase helpful ones, in order to cope with certain situations that are making us depressed. A study has found that cognitive behaviour therapy was effective in helping people with chronic work-related upper-limb pain cope better with their pain. Their anxiety, depression, distress and pain all improved after nine sessions of cognitive behaviour therapy.
  • Anti-depressant medications are also a common treatment for depression. All medications available tend to have similar effectiveness, but differing side effects. If you choose to take medication you are likely to find that one is more effective for you as an individual than others. Some of the older medications can be particularly helpful in easing pain. It is important that you give them a chance to work, both in terms of giving them enough time and also experimenting with different doses with your doctor. Be prepared to try another type if the first isn’t effective.
  • You need to seek professional help. If you feel that you may be suffering from depression, anxiety or other mental health disorder, it is important that you seek professional help. You need a proper assessment of your condition, as different treatments are more effective for different types of disorders. Visit your GP or another health professional, such as a practice nurse. Be open to different sorts of treatments including trialling medications and seeing a psychologist, psychiatrist or counsellor. It is important to be persistent, as different treatments will work for different people at different times of their life. You have to work out the best treatment there is for you.

Helping others with depression

Given the statistic that 45 percent of us will experience a mental health disorder at some point in our lives, it is likely that each of us will have other people in our lives that have these conditions.

Here are a few tips if you are supporting someone with one of these conditions:

  • Just listen—anxiety and depression reduces a person’s problem-solving ability and often causes them to repeat the same problem over and over. The solution may seem simple to you, but the person may find advice unhelpful. Just listen, and if they are open to it, talk them through some problem-solving instead of giving them the solution.
  • Encourage normal activities—particularly around eating and give them reassurance that everything will be alright.
  • Avoid alcohol—it can make depression much worse.
  • Take them seriously—if their condition is deteriorating or they have suggested they may harm themselves then you need to make sure they tell their doctor.
  • Get support for yourself.

Good information on the internet

Beyondblue (www.beyondblue.org.au) has a range of resources on its website as well as a 24-hour phone service (1300 22 4636) and can provide you with information and suggestions on how to access affordable counselling and therapy in your local area.

The Black Dog Institute (www.blackdoginstitute.org.au) also has an informative website with a particular focus on bipolar disorder. There is a variety of other websites that you can visit, see the end of this article for more details on where to go online.

The Centre for Mental Health Research at the Australian National University has five different online self-help programs. They are all free, accessible, anonymous and based on the best current evidence available.

Blue Pages (www.bluepages.anu.edu.au) is a comprehensive, evidence-based information website that looks specifically at what works and what doesn’t work for depression.

Mood Gym (www.moodgym.anu.edu.au) is an automated online program, made up of five modules based on cognitive behaviour therapy. Each take about 30 minutes to complete.

ECouch (www.ecouch.anu.edu.au) is an interactive online program suitable for all ages targeting both depression and anxiety as well as other mental health disorders. The program suggests different self-help activities that may assist including physical exercise, cognitive behaviour therapy and different relaxation techniques.

Beacon (www.beacon.anu.edu.au) lists a variety of different online programs for both physical and mental health conditions and looks specifically at how much evidence the programs have behind them.

Blue Board (www.blueboard.anu.edu.au) is a moderated online peer support program where people who are experiencing mental health disorders, or those caring for someone who is, can share ideas and provide support for one another.

The internet is a great place to start and find information, but it is important to seek professional help and gain a proper assessment from a health professional who can point you in the right direction. It is important to remember that depression and anxiety are treatable conditions. With help and support, it is possible to overcome depression and anxiety and regain your quality of life.

With a diagnosis and recommendation from your doctor, Medicare will subsidise up to 11 sessions with a psychologist each year. Sometimes, depending on the psychologist, this will cover all or most of the cost.

Our members have found that not all psychologists are equally helpful. Get a recommendation from a friend you trust or contact us for a recommendation. Be prepared to switch if you’re not making progress. Remember, the psychologist that suits your friend may not suit you!

Available Resources and Services

Information websites

Online Cognitive Behaviour Therapy Programs

24/7 Phone Services

Urgent help

If you are feeling suicidal or in need of urgent help call:

  • Emergency: 000 (or 112 from a mobile phone)
  • Mental Health Triage Service/Crisis Assessment and Treatment Team: 02 6205 1065 or 1800 629 354 (for 24 hour service)

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