Depression

Depression is common and treatable, and it doesn’t always look the way people expect. For some it’s a heavy sadness. For many others it’s flatness, a tiredness that sleep doesn’t fix, or a shorter fuse than usual. Here’s how it can show up, the different kinds, what Australia’s guideline puts first, and what the research says about the therapies.

How depression can show up

Depression changes how you feel, how you think about yourself, and how your body runs. Low mood is the best-known part, but it isn’t always sadness. It can feel like emptiness, numbness, or not caring about things that used to matter. When nothing feels like anything might be helpful if that describes how you feel.

Depression often shows up in the body too. Sleep goes wrong in either direction, too little or far too much. Appetite changes. You feel run down, get headaches or aches, and everything takes more effort than it should (healthdirect).

Thinking can slow down. Concentrating is harder, small decisions feel big, and the voice in your head can turn harsh: guilty, worthless, or sure that things won’t get better.

Some people, often men, notice it more as tiredness, irritability or anger than as feeling low. And it tends to shrink life. You pull back from people, drop things you used to do, and find work or study harder to keep up with.

For some people it brings thoughts of death, or of not wanting to be here. If that’s part of it for you, the numbers in the safety section below are there any time.

You don’t need all of this for it to be depression, and recognising some of it doesn’t mean it is. Only a proper assessment can say whether it’s depression, and whatever it’s called, it can be treated.

Different kinds of depression

Depression isn’t one thing, and the differences can matter for treatment.

• A depressive episode is what most people mean by depression: low mood or a loss of interest most of the day, nearly every day, for at least two weeks.
• Longer-running depression goes on for two years or more, often less intense but hardly lifting. It’s sometimes called persistent depressive disorder or dysthymia. Because it lasts so long, it can start to feel like just who you are.
• Depression during pregnancy or after a baby can come any time from pregnancy through the first year. It’s different from the “baby blues”, which are short-lived and come in the first couple of weeks after birth.
• A seasonal pattern is when mood drops at the same time each year, most often in winter.
• Mood that drops before a period can be premenstrual dysphoric disorder (PMDD). It comes in the week or two before a period and eases once it starts, and it’s more than ordinary premenstrual symptoms. It can be treated, so it’s worth raising with a GPGP (general practitioner) For most people, where getting help starts. A GP can write a Mental Health Treatment Plan, prescribe medication and refer you on, and some are trained to deliver a small number of structured therapy sessions themselves. More in the jargon decoder Close rather than putting up with it.
• Low periods that alternate with highs are part of a different condition, covered further down this page.

About 1 in 13 Australians aged 16 to 85 had a mood disorder such as depression in the past year (Australian Bureau of Statistics, 2020–22). About 1 in 6 have had one at some point. Young people aged 16 to 24 had the highest rate of any age group, nearly twice the overall rate.

What Australia’s guideline puts first

Australia’s guideline for depression starts with everyday foundations: sleep, being physically active, what you eat, and alcohol and other drugs (Royal Australian and New Zealand College of Psychiatrists, 2020). It then treats psychological therapy and antidepressants as first-line treatments, and leaves room for what the person prefers. The UK’s equivalent guideline recommends the same treatments in the same order.

The guideline sees those foundations as a first step, with treatment built on top. A GP is the person to talk them through with.

What helps

The well-studied talking therapies for depression bring symptoms down by about the same amount as each other (Cuijpers and colleagues, 2023, on treatments for depression). That makes access and fit the real questions: which approachApproach (modality) The kind of therapy someone uses, such as CBT or psychodynamic therapy. You'll also see it called a modality. More in the jargon decoder Close you can get to, and who you’d be doing it with.

Cognitive behavioural therapy (CBT), behavioural activation, interpersonal therapy and psychodynamic therapyPsychodynamic therapy A therapy that looks at the parts of your life you can't quite see from the inside. Its core idea is that a lot of what shapes how you feel and act sits outside your awareness, and was laid down early. More in the jargon decoder Close are among the well-studied ones. Interpersonal therapy works on relationships and the changes in your life around the time the low mood started. The evidence here is for these structured therapies.

For moderate depression, therapy and medication together worked better in the short term than either one alone, and each on its own came out about the same (Cuijpers and colleagues, 2020). Therapy and medication covers what’s known about the two together.

If it isn’t only low periods

If low periods have ever alternated with times of unusually high energy, racing thoughts or needing much less sleep than usual, tell your GP. That’s assessed and treated differently from depression, and it matters before any treatment starts. Bipolar disorder explains the condition and what helps. Getting a diagnosis covers who can assess you and what’s involved.

Finding help and paying for it

When you’re looking for someone, ask how much of their work is with low mood.

How you pay shapes what’s available. Paying the full fee has no session limit, and that includes seeing a counsellorCounsellor Someone trained to help people talk through and work on difficulties. The title isn't protected in Australia, so it's worth checking a counsellor's training and registration. Medicare doesn't give a rebate for counsellors. More in the jargon decoder Close or psychotherapistPsychotherapist Someone trained in therapy, often for longer-standing patterns. Like counsellor, the title isn't protected in Australia, and Medicare doesn't give a rebate for psychotherapists. More in the jargon decoder Close, whom MedicareMedicare Australia's public health insurance scheme. For mental health, it gives rebates on sessions with psychologists and some other professionals, usually through a Mental Health Treatment Plan. More in the jargon decoder Close doesn’t cover. Workplace programs usually offer three to six sessions, and community health services tend to have a set number too. headspaceheadspace A national youth mental health service for anyone aged 12 to 25, with centres around Australia and support online and by phone. It's free or close to it, you don't need a referral or a parent, and you can book it yourself. More in the jargon decoder Close offers free or low-cost support for people aged 12 to 25. A group usually costs less per session.

A Mental Health Treatment PlanMental Health Treatment Plan A document your GP writes with you. It makes you eligible for a Medicare rebate on up to ten individual sessions a calendar year: six, then a review with your GP, then the remaining four. The plan itself isn't therapy. More in the jargon decoder Close from your GP gives you a Medicare rebateRebate The amount Medicare pays back towards a session. It comes back to you after you've paid, so what you pay yourself is the fee minus the rebate. More in the jargon decoder Close on ten sessions a calendar year. Ten sessions a calendar year is a funding limit, not a judgement about how much therapy anyone needs. Free and low-cost options covers other ways to keep costs down.

Beyond Blue, on 1300 22 4636, offers support and information about depression.

Safety

If you’re having thoughts of suicide or of not wanting to be here, please contact one of the numbers below. You don’t need to be in crisis to call.

Kids Helpline is on 1800 55 1800, any time, for anyone aged 5 to 25. Lifeline is on 13 11 14 and, if you’re 15 or over, the Suicide Call Back Service is on 1300 659 467. In an emergency, call 000. Crisis and emergency support has the full list.

Where next

However good the treatment, how well you and your therapist work together matters a great deal. Why who you see matters more than what they do explains why.