Depression: What it looks like.

Our mood is constantly changing and adapting to our life events and these variations are completely natural.  But sometimes a low mood might persist too long, like a car bogged in the mud. And the more we try, the more stuck we seem to become. When periods of low mood become too intense or last too long, you may be experiencing depression. 

But what is depression? How is it identified and what treatments are available at Brain Care to you or someone you love? Here we break down the what, who and why of depression. 

Symptoms: What does depression look like?

Depression affects everyone differently and can present with changes in behaviour, thoughts, feelings and physical symptoms. Symptoms are typically characteristic of feeling low or under aroused and a significant reduction in mood. While these changes are normal human responses, when they are excessive or persistent to the situation experienced they may be maladaptive.

Behaviours are what we do on an everyday basis and how we conduct ourselves. If you or someone you love is experiencing depressive symptoms, it may look like:

-       Avoiding social activities or interactions with loved ones.

-       Difficulties getting started, organising or completing tasks and goals.

-       Using alcohol or other substances to cope.

-       Disengaging from previously enjoyable activities.

Feelings refer to our emotional states or reactions we may feel at any given moment. These are influenced by mental and physical responses. Some common feelings associated with depression include:

-       Extreme sadness, hopelessness or misery.

-       Numbness (physically or emotionally).

-       Reduced confidence, self-esteem, self-belief or pessimism.

-       Guilt or remorse.

Thoughts are how we consciously process, reason, problem solve and understand our daily lives. Many cognitive processes are involved in thinking such as attention, working memory, executive function and self talk. For people experiencing depressive symptoms, thought processes are often significantly affected and can look like:

-       Negative self talk that is believed (i.e. ‘There’s no use trying.’ ‘I’m useless and people would be better off without me.’ ‘Life is pointless.’)

-       Difficulty concentrating or paying attention.

-       Not setting goals.

-       Having a hard time solving simple problems or organising yourself.

-       Suicidal ideation or plans.

Physical symptoms consider how our body is affected due to depressive symptoms. Common physical symptoms relating to depression include:

-       Feeling tired or finding it hard to ‘get going,’

-       Frequent illnesses, headaches or muscle pains.

-       Changes in weight or appetite.

-       Difficulties sleeping (falling asleep, staying asleep, waking up).

How Common is Depression?

In 2020-2021, the Australian Bureau of Statistics (https://www.abs.gov.au/statistics/health/mental-health/national-study-mental-health-and-wellbeing/2020-21#psychological-distress ) reported 1.5 million people (7.5% of the population) experienced an affective disorder consisting of depressive symptoms over a twelve month period.  This 7.5% was made up of:

-       Depressive Episode (4.6%); a period of depression that lasts at least two weeks at a time.

-       Dysthymia (1.7%); a slightly more mild but long-term form of depression. Also known as persistent depressive disorder.

-       Bipolar Affective Disorder (2.2%); a mood disorder consisting of extreme emotional mood swings from manic highs to depressive lows.

The lifetime prevalence of depression is also extremely high, with one in seven Australian likely to experience depression in their lifetime (Black dog institute -  https://www.blackdoginstitute.org.au/wp-content/uploads/2020/04/1-facts_figures.pdf ). Affective disorders mentioned above are more prevalent in women than men and have a greater prevalence in younger age groups (16-34). 

What Causes Depression?

There are many risk factors that contribute to developing depressive symptoms. Generally speaking, depression is likely to occur when a person perceives they are unable to cope with the stresses of life. Black Dog Institute (https://www.blackdoginstitute.org.au/resources-support/depression/causes/) highlighted the following factors that contribute to this may include:

-       Genetics; Twin study results revealed approximately ‘30% of predisposition to developing clinical depression is related to genetics.’

-       Stressful or traumatic events.

-       Long term pressures (bullying, work, difficult relationships)

-       Personality type. People who are anxious, irritable, socially avoidant, reserved, self-critical and rejection sensitive are more likely to develop depressive symptoms.

-       Ageing

-       Illness: Chronic or severe illnesses can be extremely stressful and increase risk of developing depression.

-       Brain Function can be affected by deficits in neurotransmitters, brain structures, or how areas of the brain communicate.

How do we assess depression?

Due to the wide range of symptoms, predispositions and ways depression can manifest, Brain Care prefers to work with you or your loved one to identify your individual and specific patterns of depression. We conduct comprehensive intakes and assessments to focus on the specific symptoms and how they affect you or your loved one personally. We do this through a range of methods such as counselling, psychological questionnaires, and comprehensive brain function profile assessments.

Counselling

The counselling process is a person centred approach to understand your unique situation. During a consultation, clinicians may ask you about your current concerns, their severity and history of symptoms. This may include how they affect your thoughts, feelings, behaviours, physical health, relationships, and day to day life. As a result, the clinician will be able to gain a deep understanding of you and work with you to understand and overcome these challenges.

Psychological Questionnaires

To help quantify your concerns, we may also ask that you complete some questionnaires to measure your symptoms. Brain Care uses a secure online platform that is easily accessible via phone or computer so you can complete these questionnaires. Results are compared to a normative database that allows for an understanding on the severity of your symptoms compared to the general population. Assessments may measure:

-       General levels of depression, affect and mood

-       how well you can regulate yourself when faced with stress or challenging emotions

-       perceived quality of life and wellbeing

-       risks of substance use

-       thought patterns

-       Sleep

-       other mental health issues such as anxiety, OCD and PTSD.

This information helps inform our therapeutic approach and also provides a way to measure progress throughout the process.  

Brain Function Profile

The brain function profile is our most comprehensive and detailed assessment of brain activity and cognitive function. It is comprised of two assessments; An online computerised assessment of cognitive function and a Quantitative Electroencephalography with Event Related Potentials (QEEG - link to what is QEEG).

The online assessment of cognitive function measures how well you can remember, problem solve, reason, sustain attention, effectively use working memory, recognise emotion, and ability for fine motor function. This can help us identify any specific cognitive deficits that may be contributing to depressive symptoms.

The QEEG/ERP’s is a precise measurement of your brain waves and the functioning of underlying brain areas. Sensors on a cap pick up the electrical activity of your brain to help identify what areas are functioning well or a too over or under active. This assessment gives us great insight into how your brain is functioning so we can formulate a completely personalised neurofeedback program to correct these brain patterns.

How to Treat Depression

Due to our personalised and comprehensive approach to assessing depression and related symptoms, Brain Care is able to manage and reduce psychological distress. We offer a range of counselling approaches, biofeedback modalities, and neuromodulation. Often these are used together for optimal results.

Counselling for Depression

Brain Care uses a variety of psychological strategies to address symptoms. These include:

-       Cognitive Behavioural Therapy (CBT): identifies thoughts and behaviours underlying depressive symptoms before reframing and replacing these with more positive replacements.

-       Eye Movement Desensitisation and Reprocessing (EMDR): Assists in reprocessing and resolving past trauma’s or distressing life events that may contribute to depressive symptoms.

-       Person Centred Therapy: A therapy focused on empathy, unconditional positive regard and genuine interactions to guide you to positive choices, life outcomes, and psychological wellbeing.

Biofeedback and Neuromodulation for Depression

Biofeedback and Neuromodulation are therapies that aim to help a person regulate specific aspects of the nervous system contributing to symptoms of depression. Our biofeedback and neuromodulatory therapies include:

-       Heart Rate Variability Biofeedback; this refers the natural moment to moment increase and decrease in our heart rate. A baseline measurement provides us with an insight into arousal levels and whether we may be more prone to fight or flight, rest and digest, or social engagement. Through various breathing exercises and consciously trying to elicit positive emotions we can learn to control this and improve symptoms of depression.

-       EEG Biofeedback refers to learning to retrain brain waves associated with depressive symptoms and make them more adaptive. Outcomes typically include improved mood, reduced anxiety, and improvements in executive function such as focus, organisation, planning and motivation.

-       Transcranial Direct Current Stimulation (TDCS) uses a very electrodes and a very small electrical current to stimulate or suppress brain areas that may be under or over active to manage symptoms of depression.

-       Audio Visual Entrainment elicits frequencies of gentle light and sound to entrain your brain to increase mood, calmness, improve sleep, and cognitive functioning.  

If you or someone you love is suffering from depression and are ready to get support, Brain Care has appointments available with a range of clinicians. You can find our contact details here.  We also have information on accessing our services (link) through medicare, NDIS, and EAP services.

If you or someone is currently in a crisis, immediate support is available by calling Lifeline on 13 11 14.

If you would like more resources for you or someone experiencing depression, the following resources may be helpful also:

-       Black Dog Institute (https://www.blackdoginstitute.org.au/resources-support/ ) for resources and more information about depression.

-       Beyond Blue (https://www.beyondblue.org.au/get-support/have-the-conversation/talking-to-someone-you-are-worried-about) have some great resources on how you can facilitate a conversation with a loved one you may be worried about.