Lost your mojo? I know it’s out there somewhere…
Dr Loretta Poerio
Senior Mental Health Adviser
Department of Veterans’ Affairs
While it may be tempting to snuggle down under the doona with a packet of Tim Tams and hibernate when life seems overwhelming, this approach needs a warning label.
In small doses, a doona day may restore the spirits. However, if this leads to more and more isolation from others and your connection to the outside world is becoming smaller, then it may be time to rethink your coping strategy.
We know that mental health or illness is not simply a yes/no proposition, but rather a fluctuating state that changes over time. The latest National Study of Mental Health and Wellbeing by the Australian Bureau of Statistics indicated that in 2020–2022:
- 1 in five Australians (21.5% or 4.3 million people) had a 12-month mental disorder
- 17.2% (3.4 million people) had a 12-month Anxiety disorder
- 7.5% (1.5 million people) had a 12-month Affective disorder
- 3.3% (647,900 people) had a 12-month Substance Use disorder.
This study, the first undertaken since 2007, indicated that more than two in five Australians aged 16–85 (8.6 million people or 43.7 per cent) have experienced a mental health condition at some time in their life.
A depressive episode is defined as lasting most of the day, almost every day for at least two weeks. This is termed Major Depressive Disorder. Other types of depressive disorders include Dysthymia, which is diagnosed when symptoms are present for most days for at least two years.
Bipolar Disorder is diagnosed in the presence of periods of depressive symptoms that are followed by manic symptoms.
Seasonal Affective Disorder has a seasonal pattern, with cycles of sadness coinciding with the colder, winter months and mood symptoms lifting in spring.
For many people, periods of feeling down can be managed with good self-care strategies (which I have discussed before). These include establishing a good sleep routine, getting regular exercise, eating nutritious food, connecting with friends and family, finding the joy in the day, active problem-solving to tackle the situation that is distressing you, and limiting social media exposure. Exercise, for example, has been shown to be helpful for mild to moderate depression.
Risk factors for depression such as chronic stressors, family history, ageing, personality traits and illness can affect how severe the symptoms are and how long they last. These symptoms range from mild right through to very severe and they can all impact your day-to-day functioning. Common symptoms are a lack of energy, loss of interest in once enjoyable activities, change in sleep pattern, loss or gain in appetite, feelings of worthlessness, and thoughts about dying and suicide.
If feelings of sadness, low energy and emptiness are prolonged and they interfere with daily life and relationships, then it is important to seek help from a health professional. Seeking help early is a key factor to optimise treatment success. A brief screener called a ‘Depression self test’ (not a diagnosis) is available on the Black Dog Institute website. If you are concerned, then see your GP for a review and possible referral.
If depression is diagnosed, the type of treatment offered will depend on your individual needs and the severity of the condition, including other conditions diagnosed at the same time, such as anxiety. Psychological treatments can teach people new ways of thinking, coping or relating to others, and can be accessed in person or online.
Psychological therapy, digital health programs (www.headtohealth.gov.au) and exercise work well for many people, such as those experiencing mild to moderate symptoms. There are also a range of antidepressant medications that are available and these can be used in conjunction with psychological therapy. Open Arms is a national service for veterans and families and offers counselling and group programs such as ‘Beating the Blues’.
Sometimes these interventions are not effective, or the depression may be severe and persisting. In these cases a referral to a psychiatrist is generally required. Here, additional treatment options such as electroconvulsive therapy (ECT), a neurostimulation treatment, may be recommended.
Innovation in recent years has led to new treatment modalities becoming available. These include repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation, which are both mild and targeted forms of brain stimulation that have been found to be effective with some patients.
Further research is underway to broaden treatment options available for individuals suffering persistent and debilitating depressive conditions. You can talk to your health care provider about treatments that are best suited to your needs.
A guide to what works for depression can be downloaded from the Beyondblue website. The guide also provides an indication of the level of evidence for the intervention. This is important to take note of as there are many activities that may purport to be a treatment that have little evidence, or significant side effects. The intervention may make you feel better in the moment, but may confer very little long-term benefit.
Being mindful of evidence-based treatment can assist people to make decisions that support their treatment and recovery.
What we know is that people recover well with the right care and support. For others, care and support is required over a longer time period, or at particular times. Remember, mental health and mental illness are not static, they fluctuate for all of us during our lifetimes, and need to be seen as part of our ongoing commitment to self-care.
There are many things we can do to help ourselves, you just need to take the first step.