Depression is a disorder that is evidenced by excessive sadness, loss of interest in enjoyable things, and low motivation. It is normal to experience feelings of sadness and despair in response to adverse life events. Such events could include loss, major life changes, stress, or disappointment. In most cases, the sad feelings resolve as you come to terms with the changes in your life. In situations such as bereavement, these feelings may persist for months and return at signicant times, such as birthdays and anniversaries related to the lost loved one. Provided you have times when you can enjoy things, however, this sadness is not a sign of depression.

1. THIS WAY UP (https://thiswayup.org.au)
SIGN UP (HTTPS://THISWAYUPCLINIC.ORG/USERS/PATIENTREGISTRATION) LOG IN (HTTPS://THISWAYUPCLINIC.ORG/USERS/LOGIN) TAKE A TEST (/TAKE-A-TEST/)
CONTACT US (HTTPS://THISWAYUP.ORG.AU/CONTACT-US/) URGENT HELP (HTTPS://THISWAYUP.ORG.AU/HOW-WE-CAN-HELP/URGENT-HELP/)
I Feel Sad
Sadness can be a dif cult emotion to deal with, not only due to the pain it causes, but also because of
the factors that caused the sadness in the rst place. Sadness can be the result of loss, helplessness, or
disappointment, among many other things. It is important to remember, though, that sadness is one of
the most common and natural human emotions, and is something that will ultimately help us
appreciate our happy times.
Sometimes, though, it is possible for sadness to deepen, and this may be a sign that you are suffering
from a form of depression. If you feel as though you are increasingly sad, and feel like your sadness is
dif cult to explain, this information on depression may help.
On this page you can learn about:
1. What is Depression? 2. What are the Signs of Depression?
3. What Causes Depression? 4. How to Deal with Depression
4. Coping with Symptoms of Depression
What Is Depression?
Depression is a disorder that is evidenced by excessive sadness, loss of interest in enjoyable things, and low motivation.

2. It is normal to experience feelings of sadness and despair in response to adverse life events. Such events could include loss, major life changes,
stress, or disappointment. In most cases, the sad feelings resolve as you come to terms with the changes in your life. In situations such as
bereavement, these feelings may persist for months and return at signi cant times, such as birthdays and anniversaries related to the lost
loved one. Provided you have times when you can enjoy things, however, this sadness is not a sign of depression.
Depression is common. One in three people will experience a major depressive episode at some stage in their lives. While most cases of
depression are mild, about one person in ten will have a moderate or severe episode.
Boost Your Motivation
Sign up to our mailing list to receive a free guide to boosting motivation.
First Name
Last Name
Email
Download
What Are The Signs Of Depression?
The features of depression include:
Psychological Symptoms:
Feeling miserable. This misery is present for much of the day but may
vary in its intensity. The misery lasts for weeks.
Loss of interest or pleasure in usual activities.
Slowed or inef cient thinking with poor concentration, leading to
dif culties sorting out problems or making plans or decisions.
Recurring unpleasant thoughts, particularly about being guilty, being a
bad and unworthy person,
Thoughts that you would be better off dead or of harming yourself in
some way.

3. Physical Symptoms:
Loss of appetite with excessive loss of weight.
Loss of interest in sex.
Loss of energy, even when not physically active.
Loss of sleep despite feeling exhausted. Sleep is typically restless and
unsatisfying with early morning wakening (one to two hours earlier than
usual). Some people, however, may actually sleep a lot more than usual.

4. Slowed activity and speech.
Any of these features may serve as warning signs of depression. You need to exhibit at least ve of these symptoms to be suffering with a depressive disorder.
What Causes Depression?
No one knows exactly what causes depression. It is clear that genetic factors are important in many cases of depression.
Depression seems to run in families (as do other mood disorders), and about 30% of the predisposition for depression is due to
genetic in uences.
Stressful life events play a part in the onset or relapse of depression. Ongoing con icts with others can take their toll on our
well-being, as can other social and environmental stressors such as nancial dif culties, retirement, unemployment, childbirth,
loneliness, or loss of someone or something important. In vulnerable people, these unpleasant life events may be enough to
cause or worsen a depressive illness.
A person’s personality characteristics are an important factor. When people are depressed, they usually have a very negative
view of themselves and the world. They do not appreciate good things, and bad things seem overwhelming. Some people have a
tendency to view things this way even when they are not depressed. In other words, they may have a depressive personality
style.
Another possible cause of depression that should not be overlooked is physical illness or medications. Glandular fever,
in uenza, hepatitis, thyroid hormones, anaemia, diabetes, birth control pills, alcohol and other substances of abuse, or other
medications such as those for heart or blood pressure conditions, may all cause symptoms of depression.

5. How To Deal With Depression
There are a range of ways to deal with depression, and often they are best used in conjunction with each other.
The primary medical options are Cognitive Behavioural Therapy (CBT), antidepressant medication, and in some
severe cases, Electroconvulsive Therapy (ECT). Education and coping strategies are also important when
learning to manage your depression.
Cognitive Behavioural Therapy (CBT)
CBT is an excellent treatment for depression, alone or in conjunction with medication. CBT involves learning:
to control the negative thoughts that lead to loss of interest and feelings
of worthlessness;
to combat the emotions of sadness and hopelessness, and;
Loss of energy, even when not physically active.
to counteract the behaviours related to poor concentration and
thoughts of death

6. Techniques for problem solving are also taught whether the problem is a consequence or cause of the depression. CBT is very
effective and 80% of people with mild, moderate or severe depression improve.
CBT will often be recommended when:
The depression is mild, moderate, or severe.
The person has had a prior positive response to CBT.
A competent, trained clinician who has expertise in CBT is available, or
the person is prepared to use internet CBT.
There is a medical contraindication to taking medications.
The depressed person prefers CBT or iCBT.
Learn More
Behavioural Strategies:
A key feature of depression is inactivity. People nd that they are doing less and then feel even worse because
they are doing less. Behavioural strategies for depression aim to identify and change aspects of behaviour that
may worsen depression. People are encouraged to act against the depression by increasing activities, even
though this is the last thing that they feel like doing. Relevant behavioural strategies include activity scheduling,
social skills training, structured problem solving, and goal planning. One of the advantages of this form of
treatment for depression is that once acquired, these new behavioural styles can be applied throughout life,
minimising relapse or recurrence of depression.
Cognitive Strategies:
People who are depressed will usually show a style of thinking that focuses on negative views of the world. They
often think of themselves as worthless and of the world as being a bad or unfair place, and they are without hope
that their lives will improve in the future. When something bad happens, they blame themselves, but when good
things happen, they tell themselves they are just lucky. Furthermore, people with depression are less likely to
recognize and appreciate positive events when they happen; rather, they tend to be more tuned into the bad
things in their lives and brood over those events.

7. The aim of a cognitive approach is to help people identify and correct their distorted and negatively biased
thoughts. This approach identi es and challenges underlying assumptions and beliefs. With encouragement to
reframe the way they think about life, people are able to recover from failures more effectively and to recognise
and take credit for the good things in their lives. People learn that they have some control over what happens to
them. As with behavioural strategies, having these skills reduces relapse and recurrence of depression.
Medication
For some people, antidepressant medication will be the rst line of treatment for the elimination of severely depressed mood. It
would be unadvisable to manage very severe depression without a trial of medication. For mild to moderate depression,
antidepressant medications are not often recommended as a rst line treatment.
Different antidepressant medications work in different ways. You may need to trial more than one type to nd the medication
that works best for you. Make sure to keep in close contact with your prescribing physician during the early stages of taking
medication, as the side effects can often be dif cult to deal with.
Some things to remember when taking antidepressant medication are:
Take the medication daily.
Don’t stop the medication without contacting the health professional
who prescribed it.
Side effects lessen as your body adjusts. If the side effects don’t diminish,
or are unreasonable, contact your health professional.
Don’t stop the medication when you feel better, or your depression may
return.
Electroconvulsive therapy (ECT)
ECT is an effective form of treatment for depression, especially if:
there are medical contraindications to medication.
there is a need for a rapid improvement because of suicidal intent or
refusal to eat;
the person has experienced treatment failure following CBT, several
medications, or combined medication and CBT treatment trials;
the person has had a previous positive response to ECT;
somatic symptoms are prominent;
psychotic symptoms are present;

8. ECT involves the application of a brief electric current to carefully selected sites on the scalp. These electric currents,
which are administered by a psychiatrist and anaesthetist, produce a minor seizure in the brain. Prior to the procedure,
the person is given a short-acting general anaesthetic and a muscle relaxant to reduce awareness of the procedure and to
prevent a physical seizure.
Although many people are fearful of ECT, this technique is arguably the safest and most effective medical treatment for
severe depression although there can be some memory related side effects. ECT is more rapid in its effect than
antidepressant drugs, and CBT and antidepressants remain useful adjuncts to treatment since they can help prevent
relapse after ECT is completed.
Education
Education for people with depression is extremely valuable. Education provides a knowledge base that potentially gives the
person greater control over his or her disorder. Greater control in turn may lead to reduced feelings of helplessness and an
increased sense of well-being. Providing education for families or carers is also very important to help increase the support and
assistance they provide to the person.
The most essential pieces of information for a person with a major depressive episode are that depression is a common disorder
and that effective treatments are available. It is important to remember:
Depression is an illness, not a sign of weakness or a character defect.
Recovery is the rule, not the exception.
Treatment is effective, and there are many treatment options available.
There is a suitable treatment for most people.
The goal of treatment is to get completely well and stay well.
The rate of recurrence is quite high: half the people who have had one
episode of depression will have a recurrence, and the rate increases with
the number of previous episodes.
The person and his or her family can be taught to recognise and act upon
early warning signs of depression.By seeking early treatment, the
severity of the episode may be greatly reduced.

9. Coping With The Symptoms Of Depression
The symptoms of depression can be addressed to help you feel better. Here are some ways to deal with these symptoms.
BEHAVIOURAL STRATEGIES:
Set goals for daily activity. Plan full days of useful activity by making a
list of the activities you are going to engage in at different times during
the day. Try to stick to this plan as closely as possible.
What activities do you enjoy? Try to increase the amount of time you
spend on these enjoyable activities.
Avoid comparing the way you are behaving or feeling now while you
are depressed with the way you used to behave or feel before
becoming depressed.
Reward yourself for your efforts. Ask others around you to encourage
and praise you for each small step you take. Recovering from
depression is a bit like learning to walk again after breaking your leg.
If a task seems too dif cult, do not despair. Break the task down into
even easier steps and start again more slowly.
LOSS OF APPETITE
Eat small portions of food that you particularly like. Take your time and do not feel under pressure to nish if you
are eating with others. Drink plenty of uids.

10. SLEEP DISTURBANCE
Get up at the same time every morning.
Avoid sleeping during the day.
Reduce tea and coffee intake if excessive (no more than two or three
cups per day and none after about 4:00 p.m.).
Do not lie awake for more than about thirty minutes—get up and nd a
relaxing activity.
Try relaxation exercises.
WORRYING OR INEFFICIENT THINKING
Put your worry to a useful purpose. Rather than endlessly pinpointing your problems, pick out one or two that
seem really important and make a decision to resolve them. You may like to ask a friend to help you.
Go through the following steps:
1. Say exactly what the problem (or goal) is.
2. List ve or six possible solutions to the problem. Write down any ideas that occur to you, not merely the
good ideas.
3. Evaluate the good and bad points of each idea in turn.
4. Choose the solution that best ts your needs.
5. Plan exactly the steps you will take to put the solution into action.
6. Review your efforts after attempting to carry out the plan. Praise all efforts. If unsuccessful, start again.
With assistance, the right treatment, and a solid understanding of the disorder, you can overcome depression.

11. LOSS OF INTEREST IN SEX
Seek nonsexual activities with your partner that you still enjoy. Explain to your partner that your loss of interest
and affection is a symptom of your depression, not a rejection of him or her, and that these symptoms will be
temporary.
MISERABLE FEELINGS, UNPLEASANT THOUGHTS
These negative thoughts and feelings tend to focus your attention on things you do not like about yourself or your
life situation. These thoughts also tend to make your problems seem worse than they really are. As well as
concentrating on your negative features and experiences, when you are depressed, you tend to underestimate
your positive characteristics and your ability to solve problems. A number of strategies may help you achieve a
more balanced view of things:
Make a list of your three best features—perhaps with the help of a friend
or relative. Carry the list with you and read it to yourself whenever you
nd yourself focusing on negative thoughts.
Keep a daily record of all the small pleasant things that happen and
discuss these events with your friends when you see them.
Recall pleasant occasions in the past and plan pleasant occasions for the
future (this may best be done in conversation with a friend).
Consider alternative explanations for unpleasant events or thoughts.
Although your initial explanation may be that you are at fault, rethink
these conclusions and write down all other possible explanations for
these events or thoughts.
Keep yourself busy doing useful activities. Avoid sitting or lying about
doing nothing.
Icons made by Freepik (http://www.freepik.com/) from www. aticon.com (http://www. aticon.com/) is licensed by CC 3.0 BY
(https://creativecommons.org/licenses/by/3.0/)

12. Copyright © St Vincent's Hospital Sydney Limited
THIS WAY UP is a registered trade mark of St Vincent's Hospital Sydney Limited
Take control of your wellbeing
THIS WAY UP online courses have been clinically proven to help.
S TA RT L E A R N I N G TO DAY ( / H O W-W E
THIS WAY UP™ provides online learning
programs, education and research in anxiety,
depressive disorders and physical health.
At THIS WAY UP, we empower individuals by
giving them access to online help.
Funded by the Australian Government
Department of Health and Ageing under the
Telephone Counselling, Self Help and Web-
Based Support Programmes measure
Links
Terms of Use (/terms-and-conditions)
Privacy (/privacy)
Our site has been approved as a head to health
(https://headtohealth.gov.au/)information
partner site
(https://headtohealth.gov.au/)
Contact Us
Level 4, The O’Brien Centre
St. Vincent’s Hospital
394-404 Victoria Street
Darlinghurst NSW 2010

(02) 8382 1437
contact@thiswayupclinic.org
(mailto:contact@thiswayupclinic.org)

Like us on Facebook
(https://www.facebook.com/thiswayupAU/)

Watch our YouTube videos
(https://www.youtube.com/user/THISWAYUPau)

Take our online Depression course
THIS WAY UP offers a highly effective internet delivered course for people with depression. 80% of people who complete all
lessons bene t substantially, 50% to the point of no longer being troubled by depression.
The course can be undertaken on the prescription of a GP or on a self-help basis, and costs just AUD$59 for 90 days access.
View course