Anxiety and depression - An information booklet - Beyond Blue
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Anxiety and depression An information booklet www.beyondblue.org.au 1300 22 4636
Urgent assistance People who are depressed or who have anxiety may be at risk of suicide, and if so, they need urgent help. If you, or someone you care about, is in crisis and you think immediate action is needed, call emergency services (triple zero – 000), contact the person’s doctor or mental health crisis service, or go to your local hospital emergency department. Thank you beyondblue would like to thank members of its national reference group, blueVoices, for sharing their personal experiences for this booklet. Their comments are quoted throughout and their feedback has been invaluable.
Contents
Introduction 2 Anxiety and depression
affects everyone 21
Anxiety 3 Women 22
What is anxiety? 3 Men 23
How do you know if someone Older people 24
has anxiety? 4
Young people 25
What causes anxiety? 5
Different types of anxiety 7 Getting support 26
Treatments for anxiety 8 Treatments for anxiety
and depression 27
Depression 9 Who can assist? 33
What is depression? 9 Confidentiality 38
How do you know if someone What will it cost? 38
has depression? 9
How to get the right treatment 42
What causes depression? 11
Different types of depression 13 Recovery and staying well 44
Treatments for depression 15 Learn new ways to reduce
and manage stress 44
Emergency and crisis situations 17 How to stay well 50
Suicide 17
Self-harm 18 Caring for someone with anxiety
Supporting yourself through or depression 52
thoughts of self-harm or suicide 18 Things you can do to
Make a safety plan 19 support someone with anxiety
or depression 53
Seeking support from others 20
How carers can look
Seeking support from
after themselves 53
health professionals 20
1
Introduction
Anxiety and depression are common This booklet aims to provide clear and
in Australia. In any one year, comprehensive information about
around 1 million adults in Australia anxiety and depression, including:
experience depression and over • what the conditions are
2 million experience anxiety.1
• common symptoms and how to
While anxiety and depression are recognise them
different conditions, they share many • how to get support for yourself or
causes and some symptoms. This can for someone you know
sometimes lead people to think they
• how to stay well.
have, for example, depression, when
they’re actually experiencing an anxiety Please hold on to this booklet – it’s been
condition. It is not uncommon for anxiety designed so you can read and refer back
and depression to occur together – over to the parts that are relevant to you; you
half of those who experience depression don’t necessarily have to read the whole
also experience symptoms of an anxiety booklet in one go.
condition1 – and in some cases, one can For more detailed information about
lead to the onset of the other. anxiety and depression, or to find the
The good news is that, just like physical other resources mentioned in this
conditions, anxiety and depression can booklet, visit www.beyondblue.org.au
be treated. Both conditions share many or call the beyondblue Support Service
of the same treatments, and with the on 1300 22 4636.
right treatment, most people recover.
The sooner a person with anxiety and/or
depression seeks support, the sooner he
or she can recover.
2
Anxiety
What is anxiety? Anxiety is when these anxious feelings
don’t subside. Anxiety is when they are
Anxiety affects over 2 million ongoing and exist without any particular
people in Australia.1 Anxiety is reason or cause. It’s a serious condition
more than just feeling stressed or that makes it hard for a person to
worried. While stress and anxious cope with daily life. We all feel anxious
feelings are a common response to a from time to time, but for a person
situation where a person feels under experiencing anxiety these feelings
cannot be easily controlled.
pressure – for example, meeting
work deadlines, sitting exams or Anxiety is common – on average, one in
speaking in front of a group of people three women and one in five men will
– it usually passes once the stressful experience an anxiety condition at some
situation has passed, or ‘stressor’ stage in their life.1 The sooner a person
is removed. with anxiety seeks support, the more
likely they are to recover.
3
How do you know if someone Some common symptoms include:
has anxiety? • hot and cold flushes
The symptoms of anxiety can often • racing heart
develop gradually over time. Given that • tightening of the chest
we all experience some anxiety, it can
be hard to know how much is too much. • snowballing worries
In order to be diagnosed with an anxiety • obsessive thinking and
condition, it must have a disabling compulsive behaviour.
impact on the person’s life. There are
If you are familiar with any of these
many types of anxiety, and there is a
symptoms, check the more extensive
range of symptoms for each.
list of symptoms common to
anxiety below.
Common symptoms of anxiety
Behaviour Thoughts
• withdrawing from, avoiding, or • “I’m going crazy.”
enduring with fear objects or • “I can’t control myself.”
situations that cause anxiety
• “I’m about to die.”
• urges to perform certain rituals to
• “People are judging me.”
try and relieve anxiety
• having upsetting dreams or
• not being assertive (i.e. avoiding
flashbacks of a traumatic event
eye contact)
• finding it hard to stop worrying
• difficulty making decisions
• unwanted or intrusive thoughts
• being startled easily
Physical Feelings
• increased heart rate/racing heart • overwhelmed
• shortness of breath • fear (particularly when having to face
• vomiting, nausea or stomach pain certain objects, situations or events)
• muscle tension and pain (e.g. sore • worried about physical symptoms
back or jaw) (e.g. fearing there is an undiagnosed
medical problem)
• feeling detached from your physical
self or surroundings • dread (e.g. that something bad
is going to happen)
• having trouble sleeping (e.g.
difficulty falling or staying asleep) • constantly tense, nervous or on edge
• sweating, shaking • uncontrollable or overwhelming panic
• dizzy, lightheaded or faint
• numbness or tingling
• hot or cold flushes
• difficulty concentrating
4
The list of symptoms is not designed to Ongoing stressful events
provide a diagnosis – for that you need Stressful events can also trigger
to see a doctor – but it can be used as symptoms of anxiety. Common
a guide. triggers include:
If you are concerned you or someone • job stress or job change
you know is experiencing anxiety, • change in living arrangements
please consult a GP or other health
• pregnancy and giving birth
professional.
• family and relationship problems
For more information on anxiety visit • major emotional shock following
www.beyondblue.org.au/anxiety or a stressful or traumatic event
call the beyondblue Support Service • verbal, sexual, physical or emotional
on 1300 22 4636. abuse or trauma
• death or loss of a loved one.
“I suffer heart palpitations, butterflies,
heartburn and nausea (to the point of Physical health problems
vomiting). My blood pressure rises Continuing physical health problems
and I get flushed. I get a stiff neck and can also trigger anxiety or complicate
pain in my shoulders, neck and back. I the treatment of anxiety or the physical
experience nightmares, panic attacks, condition itself. Common conditions that
the jitters, shaking hands, wobbly can do this include:
legs and just about every unpleasant
feeling of being sick imaginable.” • hormonal problems
– Gina, 38
(e.g. overactive thyroid)
• diabetes
What causes anxiety? • asthma
As with depression, often a • heart disease.
combination of factors leads to a
person developing anxiety. If there is concern about any of these
conditions, ask a doctor for medical
Family history of mental tests to rule out a medical cause for
health conditions the feelings of anxiety.
People who experience anxiety
often have a history of mental health
Substance use
conditions in their family. However,
this doesn’t mean that a person will Heavy or long-term use of
automatically develop an anxiety substances such as alcohol, cannabis,
condition if a parent or close relative amphetamines or sedatives (such as
has had a mental health condition. benzodiazepines – see page 30)
can cause people to develop anxiety,
particularly as the effects of the
substance wear off.
5
People with anxiety may find themselves
using more of the substance to cope with “I had a number of events over a period
withdrawal-related anxiety, which can of time – some work, some personal
lead to them feeling worse. – that contributed to depression. The
anxiety increased as I worked longer
hours, rested and relaxed less, and
“I wasn’t coping with changes to my
didn’t exercise or eat properly.”
social and work situations, and drugs
– Kylie, 47
and alcohol made things worse.”
– Jaci, 33
Everyone is different and it’s often
a combination of factors that can
Personality factors
contribute to a person developing
Some research suggests that people anxiety. It’s important to note that you
with certain personality traits are more can’t always identify the cause of anxiety
likely to have anxiety. For example, or change difficult circumstances.
children who are perfectionists, easily
flustered, lack self-esteem or want to
The most important thing is to
control everything, sometimes develop
recognise the signs and symptoms
anxiety during childhood or as adults.
of anxiety and to seek support. The
sooner you seek help, the sooner you
“I can’t pinpoint exactly what started can recover.
the panic attacks 20 years ago, but
over that time, it has been stress,
finances, unemployment, obsessive
thoughts and relationships.”
– Debra
6
Different types of anxiety Post-traumatic stress disorder (PTSD)
There are different types of anxiety. The This can happen after a person
six most common types of anxiety are: experiences a traumatic event (e.g. war,
assault, accident, disaster). Symptoms
Generalised anxiety disorder (GAD) can include difficulty relaxing, upsetting
dreams or flashbacks of the event, and
A person feels anxious and worried
avoidance of anything related to the
most of the time, not just in times of
event. PTSD is diagnosed when a person
exceptional stress, and these worries
has symptoms for at least a month.
interfere with their normal lives for a
period of six months or more. Their Panic disorder
worries may relate to any aspect of
everyday life, including work, health, A person has panic attacks, which
family and/or financial issues, even are intense, overwhelming and often
if there’s no real reason to worry uncontrollable feelings of anxiety
about them. combined with a range of physical
symptoms. A person having a panic
Social phobia attack may have symptoms such
as shortness of breath, increased
A person has an intense fear of being
heart rate, dizziness and excessive
criticised, embarrassed or humiliated,
perspiration. Sometimes, people
even in everyday situations, such as
experiencing a panic attack think they
speaking publicly, eating in public, being
are having a heart attack or are about
assertive at work or making small talk.
to die. If a person has recurrent panic
Specific phobias attacks or persistently fears having one
for more than a month, the person is
A person feels very fearful about a said to have panic disorder.
particular object or situation and may go
to great lengths to avoid it, for example,
“My heart would race. I felt
having an injection or travelling on a
overwhelmed and was so worried
plane. There are many different types
that I could not even rationalise
of phobias.
where to start.”
Obsessive compulsive disorder (OCD) – Greg, 42
A person has ongoing unwanted/
intrusive thoughts and fears that cause
“I became very irritable, talked very
anxiety. Although the person may
quickly and thought the whole world
acknowledge these thoughts as silly,
was ‘looking at me’. I had continuing
they often try to relieve their anxiety
thoughts of not being good enough
by carrying out certain behaviours or
and had difficulty finding the ‘right’
rituals. For example, a fear of germs
words when speaking with someone,
and contamination can lead to constant
which made me feel really stupid.”
washing of hands and clothes.
– Dorothy, 63
7
Many people with an anxiety condition moderate to severe, psychological and/
experience symptoms of more than one or medical treatments (see page 27)
type and may experience depression are likely to be required.
as well.
It is important to seek support early. “A holistic approach to both my
Symptoms may not go away by depression and anxiety has proven
themselves. If they are left untreated, most beneficial. The ‘management’ of
they can start to take over the person’s my body – sleeping patterns, exercise,
life. Not only can anxiety affect the alcohol intake and stopping my usage
person experiencing it, but it can also of recreational drugs – has left me
affect the people close to them. As feeling more mentally stable and able
with depression, untreated anxiety to combat negative thought patterns
can contribute to serious relationship that can result in anxiety, in the form
and family problems, difficulty finding of panic attacks.”
and holding down a job, and drug and – Bec, 21
alcohol problems.
If you are concerned you or someone
“I just want to switch off my brain and
you know is experiencing anxiety,
stop the endless chatter. I have this
please consult a GP or other health
unbearable pain in my chest and my
professional.
heart races. Sometimes, it is like my
heart actually skips a beat.”
– Margaret, 55 For more information on anxiety visit
www.beyondblue.org.au/anxiety or
call the beyondblue Support Service
Treatments for anxiety on 1300 22 4636.
There are many health professionals
and services available to help with
anxiety information, treatment and
support, and there are many things
that people with anxiety can do to help
themselves. These are discussed in
the ‘Getting support’ and ‘Recovery
and staying well’ sections in this booklet.
Effective treatment helps people
with anxiety learn how to control the
condition – so it doesn’t control them.
The type of treatment will depend on
the type of anxiety being experienced.
Mild symptoms may be relieved with
lifestyle changes, such as regular
physical exercise, and self-help,
such as online e-therapies (see page
29). Where symptoms of anxiety are
8Depression
What is depression?
“I couldn’t eat, sleep or think straight.
While we all feel sad, moody or low As time went on, I was waking up
from time to time, some people earlier and earlier, sometimes not
experience these feelings intensely, sleeping at all. Half of my dinner
for long periods of time (weeks, months would end up in the bin. Everything
or even years) and sometimes without became so disorganised at home. I
any apparent reason. Depression is thought everyone was against me, so
more than just a low mood – it’s a I couldn’t talk to anyone about what
serious condition that has an impact was happening or how I was feeling.”
– Nerida, 51
on both physical and mental health.
On average, one in six people – one in
five women and one in eight men – will How do you know if someone
experience depression at some stage of has depression?
their lives.1 Depression is treatable and
Depression affects how people feel about
effective treatments are available. Over
themselves. They may lose interest in
1 million adults in Australia experience
work, hobbies and doing things they
depression every year.1
normally enjoy. They may lack energy,
9have difficulty sleeping or sleep more It’s important to note, everyone
than usual. Some people feel irritable, experiences some of these symptoms
and some find it hard to concentrate. from time to time – it may not
Depression makes it more difficult to necessarily mean a person is depressed.
manage from day to day. Equally, not every person who is
experiencing depression will have
A person may be depressed if, for more
all of these symptoms.
than two weeks, he or she has felt sad,
down or miserable most of the time or
has lost interest or pleasure in most of “I felt empty… like the life was just
his or her usual activities, and has also being drained from me. I felt isolated,
experienced several of the signs and inadequate and generally upset all
symptoms across at least three of the the time – like nobody understood me
categories in the list below. and I was trapped on the other side of
an invisible wall.”
– Bradley, 18
Common symptoms of depression
Behaviour Thoughts
• not going out anymore • “I’m a failure.”
• not getting things done at • “It’s my fault.”
work/school • “Nothing good ever happens to me.”
• withdrawing from close family • “I’m worthless.”
and friends
• “Life’s not worth living.”
• relying on alcohol and sedatives
• “People would be better off
• not doing usual enjoyable activities without me.”
• unable to concentrate
Feelings Physical
• overwhelmed • tired all the time
• guilty • sick and run down
• irritable • headaches and muscle pains
• frustrated • churning gut
• lacking in confidence • sleep problems
• unhappy • loss or change of appetite
• indecisive • significant weight loss or gain
• disappointed
• miserable
10Life events
If you are concerned you or someone
Research suggests that continuing
you know is experiencing depression,
difficulties, such as long-term
please consult a GP or other health
unemployment, living in an abusive or
professional.
uncaring relationship, long-term isolation
or loneliness or prolonged exposure to
For more information on depression visit stress at work, are more likely to cause
www.beyondblue.org.au/depression or depression than recent life stressors.
call the beyondblue Support Service on However, recent events such as losing
1300 22 4636. a job or a combination of events can
‘trigger’ depression in people who are
What causes depression? already at risk because of past bad
experiences or personal factors.
While the exact cause of depression
isn’t known, a number of things can
be associated with its development. “For me, it was hereditary, stresses,
Generally, depression does not and an emotionally abusive husband.
result from a single event, but from a Having to raise four children and a
combination of recent events and other husband became hard work, and I
longer-term or personal factors. had no time for myself. I was isolated
from family and friends.”
– Melissa, 37
MEDICAL CONDITIONS
AND/OR TREATMENTS
Source: Hickie et al. Educational Health Solutions; 2000. Reproduced with permission www.spheregp.com.au
11Personal factors
“I experienced an unhappy and
Family history unsettled transition from school to
Depression can run in families and some university, a relationship breakup
people will be at an increased genetic and stressful living circumstances.
risk. However, this doesn’t mean that There’s also a history of depression
a person will automatically experience and anxiety in my family.”
depression if a parent or close relative – Jaci, 33
has had the condition. Life circumstances
and other personal factors are still likely
Changes in the brain
to have an important influence.
Although there has been a lot of
Personality research in this complex area, there
Some people may be more at risk of is still much that we do not know.
depression because of their personality, Depression is not simply the result of
particularly if they have a tendency to a ‘chemical imbalance’, for example
worry a lot, have low self-esteem, are because you have too much or not
perfectionists, are sensitive to personal enough of a particular brain chemical.
criticism, or are self-critical and negative. There are in fact many and multiple
causes of major depression. Factors
Serious medical conditions such as genetic vulnerability, severe
life stressors, substances you may take
Having a medical condition can trigger
(some medications, drugs and alcohol)
depression in two ways. Serious
and medical conditions can lead to faulty
conditions can bring about depression
mood regulation in the brain.
directly; or can contribute to depression
through the associated stress and Most modern antidepressants have
worry, especially if it involves long-term an effect on your brain’s chemical
management of the condition and/or transmitters (serotonin and
chronic pain. noradrenaline), which relay messages
between brain cells – this is thought
Drug and alcohol use to be how medications work for more
Drug and alcohol use can both lead to severe depression. Psychological
and result from depression. Many people treatments can also help you to regulate
with depression also have drug and your moods.
alcohol problems. Over 500,000 people
Effective treatments can stimulate new
in Australia will experience depression
growth of nerve cells in circuits that
and a substance use problem at the same
regulate mood, which is thought to play
time, at some point in their lives.1
a critical part in recovery from the most
severe episodes of depression.
12The person is also more likely to have a
Everyone is different and it’s often depressed mood that is characterised by
a combination of factors that can complete loss of pleasure in everything
contribute to a person developing or almost everything.
depression.
It’s important to note that you Psychotic depression
can’t always identify the cause Sometimes people with a depressive
of depression or change difficult condition can lose touch with reality.
circumstances. This can involve hallucinations (seeing
The most important thing is to or hearing things that are not there)
recognise the signs and symptoms or delusions (false beliefs that are not
and seek support. shared by others), such as believing they
are bad or evil, or that they are being
watched or followed. They can also be
Different types of depression paranoid, feeling as though everyone is
against them or that they are the cause
There are different types of depression. of the condition or bad events occurring
The symptoms for each can range from around them.
relatively minor (but still disabling)
through to very severe. Antenatal and postnatal depression
Women are at an increased risk of
Major depression
depression during pregnancy (known
Sometimes this is called major as the antenatal or prenatal period) and
depressive disorder, clinical depression, in the year following childbirth (known
unipolar depression or simply as the postnatal period). You may also
depression. It involves low mood come across the term ‘perinatal’,
and/or loss of interest and pleasure which describes the period covered by
in usual activities, as well as other pregnancy and the first year after the
symptoms such as those described baby’s birth.
earlier (see page 10). The symptoms
are experienced most days and last The causes of depression at this time
for at least two weeks. The symptoms can be complex and are often the
interfere with all areas of a person’s life, result of a combination of factors. In
including work and social relationships. the days immediately following birth,
Depression can be described as mild, many women experience the ‘baby
moderate or severe; or melancholic blues’ which is a common condition
or psychotic. related to hormonal changes, affecting
up to 80 per cent of women.2 The ‘baby
Melancholia blues’, or general stress of adjusting
This is the term used to describe a to pregnancy and/or a new baby, are
severe form of depression where many common experiences, but are different
of the physical symptoms of depression from depression. Depression is longer
are present. For example, one of the lasting and can affect not only the
major changes is that the person can mother, but her relationship with her
be observed to move more slowly. baby, the child’s development, the
13mother’s relationship with her partner Bipolar disorder seems to be most
and other members of the family. closely linked to family history. Stress and
conflict can trigger episodes for people
Up to one in 10 women will experience
with this condition and it’s not uncommon
depression during pregnancy. This
for bipolar disorder to be misdiagnosed
increases to one in seven in the first
as depression, alcohol or drug abuse,
three months after having a baby.3
attention deficit hyperactivity disorder
(ADHD) or schizophrenia.
For more information on antenatal
Diagnosis depends on the person having
and postnatal depression visit www.
had an episode of mania and, unless
beyondblue.org.au/beyondbabyblues
observed, this can be hard to pick. It is
or call the beyondblue Support Service
not uncommon for people to go for years
on 1300 22 4636.
before receiving an accurate diagnosis
of bipolar disorder. It can be helpful for
the person to make it clear to the doctor
“If you find yourself depressed, tell or treating health professional that he
an elder you know and trust – parent, or she is experiencing highs and lows.
teacher, other family member, doctor, Bipolar disorder affects approximately
sports coach etc. There is no shame or 2 per cent of the population.1
embarrassment in this whatsoever, you
are doing a brave thing, the right thing.” Cyclothymic disorder
– Jeff, 47
Cyclothymic disorder is often described
as a milder form of bipolar disorder. The
Bipolar disorder person experiences chronic fluctuating
Bipolar disorder used to be known as moods over at least two years, involving
‘manic depression’ because the person periods of hypomania (a mild to moderate
experiences periods of depression and level of mania) and periods of depressive
periods of mania with periods of normal symptoms, with very short periods (no
mood in between. more than two months) of normality
between. The duration of the symptoms
Mania is like the opposite of depression are shorter, less severe, and not as
and can vary in intensity – symptoms regular, therefore don’t fit the criteria
include feeling great, having lots of of bipolar disorder or major depression.
energy, having racing thoughts and
little need for sleep, talking fast, having Dysthymic disorder
difficulty focusing on tasks, and feeling
The symptoms of dysthymia are similar
frustrated and irritable. This is not just
to those of major depression, but are less
a fleeting experience. Sometimes the
severe. However, in the case of dysthymia,
person loses touch with reality and has
symptoms last longer. A person has to
episodes of psychosis. Experiencing
have this milder depression for more than
psychosis involves hallucinations (seeing
two years to be diagnosed with dysthymia.
or hearing something that is not there) or
having delusions (false beliefs that are not
shared by others).
14“There is nothing wrong with being “Help is always there. Do not be
sick. We all get sick, but this sickness ashamed. Many other people suffer
is curable. You can get better and from depression as well and it is not
you will.” some untreatable disease. With time
– Gina, 38 and support, even the deepest of
wounds can be healed.”
– Bradley, 18
Seasonal affective disorder (SAD)
SAD is a mood disorder that has a
seasonal pattern. The cause of the Treatments for depression
disorder is unclear; however it is
Depression is often not recognised and
thought to be related to the variation
can go on for months or even years if left
in light exposure in different seasons.
untreated. It’s important to seek support
It’s characterised by mood disturbances
early as the sooner a person gets
(either periods of depression or mania)
treatment, the greater the chance of a
that begin and end in a particular season.
faster recovery. Untreated depression
Depression that starts in winter and
can have many negative effects on
subsides when the season ends is the
a person’s life, including serious
most common. It’s usually diagnosed
relationship and family problems,
after the person has had the same
difficulty finding and holding down a
symptoms during winter for a couple
job, and drug and alcohol problems.
of years. People with seasonal affective
disorder depression are more likely to
experience lack of energy, sleep too “Begin the process. No matter how
much, overeat, gain weight and crave hard it may seem, just BEGIN.
carbohydrates. SAD is very rare in Talk to your local doctor or obtain
Australia, and more likely to be found information. There is light at the end
in countries with shorter days and of the tunnel, and I can’t urge people
longer periods of darkness, such enough to take that first step.”
as in the cold climate areas of the – Dorothy, 63
Northern Hemisphere.
15There can also be negative physical Different types of depression require
effects on the body’s systems, including different types of treatment. Mild
brain function, the sleep-wake cycle, symptoms may be relieved with lifestyle
stress response system, immune changes, such as regular physical
system and gastrointestinal system. exercise, and self-help, such as online
e-therapies (see pages 29 and 45).
Remember, depression is treatable For moderate to more severe depression,
and effective treatments are psychological and/or medical treatments
available – the earlier you seek (see pages 27 and 31) are likely to be
support, the better. required.
Often, a combination of treatments is
There is no one proven way that people most useful. For example, psychological
recover from depression. However, there treatments improve people’s coping skills
is a range of effective treatments and so they feel more able to deal with life’s
health professionals who can help people stresses and conflicts. Psychological
on the road to recovery. treatments may also help to prevent
relapse once the person is well again.
There are also many things that people Medication has a physical effect, changing
with depression can do for themselves the brain’s chemicals. When these two
to help them recover and stay well. These treatments are combined, they can
are discussed in the ‘Getting support’ and tackle the symptoms of moderate to
‘Recovery and staying well’ sections in severe depression successfully. There
this booklet. The important thing is to find are different types of psychological and
the right treatment and the right health medical treatments, which are discussed
professional for a person’s needs. in detail in the ‘Treatments for anxiety and
depression’ section in this booklet.
16Emergency and crisis situations
When a person’s mental health • experiencing a traumatic life event,
deteriorates, or they find themselves such as abuse, bullying or violence
in an acute situational crisis, he or • experiencing discrimination and
she may consider suicide or harming isolation due to sexuality, culture
him or herself. or disability
• going to court for legal matters;
This is not necessarily the case for
threat of incarceration
everyone with depression or anxiety,
but for some people, their condition • experiencing chronic pain
becomes so desperate, they feel so • the suicide of a close friend or
overwhelmed and hopeless, that they family member
may feel suicide is their only option.
They might be feeling so unbearably • experiencing drug and alcohol
unhappy that they are unable to sleep, problems.
eat, or enjoy any part of their life. Sometimes suicidal thoughts can be
triggered as a response to feeling that
you don’t have any control over your
Suicide life, or that things are hopeless and
Suicide is a very complex behaviour and will never improve.
there are many reasons why people may
Suicidal thoughts can limit your thinking
think about suicide. Extremely stressful
and problem-solving abilities and it is
life events may be the trigger for these
important to surround yourself with the
feelings and can include:
right information and supports during
• feeling alone, isolated, alienated and these difficult times.
without any friends or family
• feeling like you don’t belong anywhere If you or someone you care about
is in crisis and you think immediate
• going through a difficult relationship
action is needed, call emergency
breakup
services (triple zero – 000), contact
• a major argument with a loved one your doctor or local mental health
or significant person crisis service, or go to your local
• losing a job; failing a big exam hospital emergency department.
Do not leave the person alone,
• experiencing a financial crisis unless you are concerned for
• feeling like you are a burden on your own safety.
those around you
17It is important to keep these emergency They may injure themselves in response
numbers handy; perhaps have them to a specific situation and stop once
readily available in your mobile the problem is resolved. Others may
phone contacts. self-injure over a much longer period,
whenever they feel pressured or
distressed, and use it as a way of coping,
Self-harm particularly where they don’t have
There are many reasons why people healthier coping strategies.
self-harm. It may be a way of telling
others about their distress and asking
for help, a way of coping with stress
Supporting yourself through
or emotional pain, or a symptom of a thoughts of self-harm or suicide
mental health condition like depression. It is not uncommon for people with
Sometimes it suggests that the person suicidal thoughts to feel disconnected
is thinking about suicide. Most people from life and those around them.
who self-harm are not suicidal, but Connections to other people and a
sometimes people die as a result of their strong sense of belonging can support
self-harm behaviour. people through suicidal and self-
The most common reasons people self- harming thoughts.
harm is that they are releasing tension. Work with people that you trust to help
Self-harm can actually be a means identify ways to reconnect with things
of survival – the person’s best way of you find meaningful. It can also be a
coping with overwhelming psychological time to enhance your wellbeing and
pain, and communicating it to others. discover new things that are deeply
It can also arise from feelings of important to you.
numbness, disconnection and unreality.
In the short-term, this could mean:
Self-harm can occur in many ways and
for many reasons. It’s not just about • catching up regularly with friends,
cutting oneself or causing physical neighbours and family members
self-harm. Self-harm may include risk- • learning about mindfulness and other
taking behaviour such as driving fast coping strategies
and recklessly in a car, being careless
• spending time actively doing things
on public transport, high rates of alcohol
you enjoy
use, drug use and sexual promiscuity.
This behaviour can also put other • joining a group and doing something
people at risk. you have always been interested in.
Deliberate self-harm varies with In the longer-term, this could mean:
each person. Some people deliberately • thinking about work and whether it
self-harm regularly, while others is fulfilling for you, or considering
only do it once or twice and then stop. voluntary work
• thinking about study, such as courses
at TAFE or university
18• taking a holiday to places that you • Keep the use of alcohol and drugs
have always wanted to see. to a minimum (preferably not at all).
Other things to consider are: This is because alcohol and drugs
can impair your judgment and cause
• Lifestyle improvements – choosing the dark thoughts and feelings of
to live a physically healthier life. hopelessness and despair to return.
Eating a balanced diet, reducing
• If people are trying to be helpful,
alcohol consumption to a more
acknowledge and respond to them.
moderate level, exercising a little
Although you may not be in a space to
each day and establishing a good
talk in any detail, let them know you
sleep pattern can all be helpful.
appreciate their efforts and you will
• Meditation and relaxation – making talk more when you feel ready and
sure healthy relaxation is built into able to do so.
your routine; breathing exercises,
• If people from your support network
progressive muscle relaxation,
are not available and you feel worried,
meditation, yoga and Tai Chi
unsure or suicidal, consider calling
can be good ways to do this.
a telephone counselling or support
• Interests and contributing – giving service such as the beyondblue
back to the community often helps Support Service or Lifeline (both
our sense of purpose and connection available 24 hours a day, 7 days
with others. Think about what you a week).
used to find interesting or have
been passionate about (such as
animal welfare, environmental
Make a safety plan
issues, swimming, astronomy, A safety plan is a written, prioritised
reading, playing music) and join an list of coping strategies and resources
organisation that is involved in this. for reducing suicide risk. It is a tool that
There are no one-size-fits-all answers is designed to help those who struggle
or guaranteed solutions but there are with suicidal thoughts and urges to
several things you can do to make survive. A safety plan can be developed
life easier. to help you get through tough times and
help you to manage difficult feelings as
• Let other people know you are they start to arise. Safety plans usually
suffering and let them assist you. include a list of signs or triggers that tell
• Follow the advice of doctors and take you that you are becoming overwhelmed
any medication they have prescribed. or suicidal and strategies you can use to
help get through those times when the
• Try to establish a routine with urge to end your life is greatest.
sleeping, meals and exercise.
This can be a combination of distractions
• Keep appointments with counsellors
and things that make you feel a bit
and doctors.
better, such as talking to a good friend,
• Remove things in and around going for a walk, watching a movie or
the house that you might use to having dinner with family.
harm yourself.
19Your safety plan should incorporate
people you can talk to when you are For more information on supporting
struggling. This might include family someone during an emergency
members and friends, as well as or crisis situation, see pages 22
doctors, counsellors, community or to 24 of The beyondblue guide for
religious leaders. carers booklet, available at www.
beyondblue.org.au/resources or
It should also refer to professional by calling the beyondblue Support
services, including those that are Service 1300 22 4636.
available 24 hours a day, such as crisis
telephone support services, hospitals
and Emergency Services. Seeking support from health
Find out more at: professionals
• www.suicideline.org.au/at-risk/how- Sometimes you need more than the
to-make-a-suicide-safety-plan assistance of your support network.
By seeing a health professional you
• www.suicideline.org.au/content/
can begin to address feelings and/
uploads/self-help_for_suicidal_
or situations without feeling judged
feelings.pdf
and instead be supported to find new
ways to cope with difficult decisions,
Seeking support from others experiences or emotions.
Finding the right mix of support people You might also find sessions with
is a key step in looking after yourself. a health professional useful to:
Having supportive people around you
• sort through how you are feeling
is always important. Surround yourself
and why
with people that you trust, who will
listen to you without judgment, who • provide a different perspective
understand you and that you enjoy • link you in with other doctors or
being with. experts when necessary
Giving a suicidal person the opportunity • help develop new coping strategies
to express their feelings can give relief
from isolation and pent-up negative • help locate self-help or peer
feelings, and may in fact reduce the support options.
risk of suicide.
20Anxiety and depression
affects everyone
Anxiety and depression are common
conditions and can affect anyone, at “We carry a great amount of
any life stage. Most Australians have responsibility on our shoulders
had some experience with anxiety, as mothers, lovers, carers,
grandmothers, sisters, daughters,
depression or a related condition,
friends… so we need to look after
whether they’ve experienced it
ourselves before we can look after
themselves or had family, friends those around us.”
or work colleagues go through it. – Gina, 38
This section looks at anxiety and
depression in women, men, older
people and young people.
21Women
Good mental health is essential to the
overall health of both men and women,
but women experience some mental
health conditions, including anxiety
and depression, at higher rates than
men. One in three women in Australia
will experience anxiety during their
lifetime and one in five women will
experience depression.1
Negative life experiences such as
poverty, discrimination, violence and
abuse, unemployment and isolation
can have an impact on women’s mental
health and wellbeing. Major life events
such as pregnancy, motherhood and
menopause can create major stresses
for some women.
While anxiety and depression can happen
at any time, women are more likely to
experience these conditions during
pregnancy and the year following the It is important that women don’t dismiss
birth of a baby. Depression affects up to signs and symptoms of mental health
one in 10 women while they are pregnant conditions in themselves, especially when
and almost one in seven women during they are busy caring for others.
the first year after the birth.3 Anxiety is
thought to be even more common than
“I’ve had to accept I can’t be
depression during pregnancy and the
Superwoman any longer, but I can
following year, and many women experience
still be a positive, capable person and
both conditions at the same time.
make my contributions to the world
In addition, caring for family members in a way that isn’t at a cost to my
who are unwell or unable to look after physical and mental health.”
themselves can affect a person’s physical – Kylie, 47
and mental health. Over half of people
who care for a family member or friend
in Australia are women. Women are also
much more likely to provide the majority
of help to a person with a disability.
Sometimes, taking on the role of carer
may be to the detriment of their own
employment, relationships, social life,
physical and/or mental health.
For more information visit www.beyondblue.org.au/women
22Men
On average, one in five men will
experience anxiety and one in eight men
will have depression at some stage of
their lives.1 While women are more likely
to experience anxiety and depression,
men are less likely to talk about it.
This increases the risk of their anxiety
or depression going unrecognised
and untreated.
Men are more likely than women to
recognise and describe the physical
symptoms of depression (such as
feeling tired or losing weight). They may
acknowledge feeling irritable or angry,
rather than saying they feel low.
In general, men tend to put off getting
any kind of assistance because they
think they are supposed to be tough,
self-reliant, able to manage pain and
take charge of situations. This can make
it hard for men to acknowledge they Suicide is the leading cause of death for
have any health problems, let alone one men under the age of 44, significantly
which affects their social and emotional exceeding the national road toll.6
wellbeing. It is also very common for men
in particular, to manage their symptoms It’s important to remember that anxiety
by using alcohol and other drugs, which and depression are illnesses, not
make the symptoms of anxiety and weaknesses, and effective treatments
depression worse. are available. Taking action may not be as
hard as you think.
Other factors that can contribute to
anxiety and depression in men include
“Men are supposed to be ‘strong’,
physical health problems, relationship
‘assertive’ and ‘not show emotion’.
problems, employment problems, social
In a sense, I think it is perceived
isolation, a significant change in living
as a weakness for a man to suffer
arrangements (e.g. separation or divorce),
depression and talk about his
a partner’s pregnancy and birth of a baby.
feelings. We live in a time when
Depression is a high risk factor for equality should exist in every form. If
suicide, and in Australia, there are women can seek help, so can men.
approximately 2,200 suicides each year. Never be ashamed of this sickness.
Eighty per cent of people who take their Find help and work through it.”
lives are men – with an average of five – Bradley, 18
men dying by suicide every day.
For more information visit www.beyondblue.org.au/men
or www.mantherapy.org.au
23Older people
Many people, including older people,
think that it is normal to become
depressed as we age, but ageing does
not itself cause anxiety and depression.
They are common conditions for which
effective treatments are available.
It is thought that between 10 and 15
per cent of older people experience
depression and approximately 10
per cent experience anxiety. Rates
of depression among people living in
residential aged-care facilities are
believed to be much higher, ranging
from 34 per cent to 45 per cent.4
Older people are at greater risk of
developing mental health conditions
because of the cumulative effect of
numerous risk factors, including chronic
illness, personal loss and isolation.
However, there is no evidence that
ageing itself is a risk factor for anxiety
or depression in late-life. “(The older generation) has been
brought up to believe you just ‘get
Older people are also more hesitant to
on with it’ and there is still a stigma
share their experiences of anxiety and
attached to this issue. As we age,
depression with others, often ignoring
other medical factors can come into
symptoms over long periods of time and
play resulting in similar symptoms
only seeking professional help when
and unless your GP looks further into
things reach crisis point.
the issue, depression and anxiety can
The thing is, anxiety and depression are go undetected. I would urge anyone
common. They affect almost 3 million of any age to seek help/treatment if
Australians every year.1 There’s no need they feel what they are experiencing
for older people to feel they have to live is not ‘normal’ for them. Read as
with anxiety or depression. Effective much as you can, and if you are not
treatments exist for older people a reader, join a senior citizens club
and the good news is, with the right where sometimes, guest speakers
treatment for anxiety and depression, chat about these issues. No matter
most people recover. what your age, there is help out there
for you.”
– Dorothy, 63
For more information visit www.beyondblue.org.au/older-people
24Young people
Anxiety and depression are among the
most common mental health conditions
experienced by young people. Around
one in four Australians aged 16 to 24
experiences a mental health condition.1
More than 80 per cent of males and
nearly 70 per cent of females with these
conditions aged 16 to 24 years do not use
any services or get the professional help
they need.5 Often, the symptoms aren’t
recognised or they are simply passed off
as ‘just part of growing up’.
“For me it was a huge challenge to
seek help because I did not want
people knowing what was going
on in my head, and I kept hearing
negative comments by others and
their thoughts on depression. I later
realised those comments were due to
lack of knowledge and understanding
about the illness.”
– Jess, 18 “I was a student and a prefect and
as a result, many people felt I was a
‘perfect’ student. It was hard to deal
Common causes of anxiety and
with the ignorant comments made
depression in young people include
by people who didn’t understand
being abused or bullied, having parents
what I was going through. The best
separate or divorce, the death of
encouragement I could give, would
someone close, losing a job or moving
be for people to realise depression
to a new town. In some cases, anxiety
is a legitimate disease. Do not feel
and depression may be associated with
ashamed about it as there are many
a combination of factors, such as feeling
people who have or are suffering with
stressed, not feeling able to cope with
it. Stay strong, seek help and stick to
things, trouble at home, school or work,
the treatment.”
low self-esteem, not being able to talk
– Bradley, 18
to people or not having someone to talk
to. Prejudice, discrimination, bullying
and abuse about sexuality or gender
are major factors contributing to the
development of anxiety and depression
for young lesbian, gay, bisexual,
transgender and intersex people.
For more information visit www.youthbeyondblue.com
25Getting support
People with anxiety and/or
depression can find it difficult to “My initial fear was that when I sought
take the first step in seeking support. help, I became consciously aware it
They may need to get help with the was a problem. I recognised it as a
support of family members, friends large issue and that was daunting.
and/or a health professional. The first step was the hardest.
However, after taking it, everything
There is no one proven way that people became much easier to deal with and
recover from anxiety and depression. move forward.”
The good news is that there is a range – Bradley, 18
of treatments, health professionals and
services available to help with anxiety
and depression. There are also many
things that people with these conditions
can do to help themselves.
26The reality is, anxiety and depression are Treatments for anxiety
unlikely to simply go away on their own.
In fact, if ignored and left untreated,
and depression
anxiety and depression can go on for Psychological treatments
months, sometimes years, and can have
many negative effects on a person’s life. Psychological treatments have been
found to be an effective way to treat
Every person needs to find the treatment anxiety and depression. They may not
that’s right for them. It can take time, only help a person to recover, but can
strength and patience to find a treatment also help to prevent a recurrence.
that works. After seeking appropriate Psychological therapies help people
advice, the best approach is to try a with anxiety and depression to change
treatment you’re comfortable with and negative patterns of thinking and
that works for most people. If you do not improve their coping skills so they
recover quickly enough, or experience are better equipped to deal with life’s
problems with the treatment, discuss stresses and conflicts. There are
this with your health professional and several different types of psychological
consider trying another approach. treatments including cognitive behaviour
therapy (CBT), interpersonal therapy
“I found it very difficult to ask for help. (IPT) and mindfulness based cognitive
I felt like I was beyond help. And therapy (MBCT). For information on who
frankly, I didn’t deserve help.” can provide psychological treatments,
– Margaret, 55 see pages 33 to 37.
Cognitive behaviour therapy (CBT) is
a structured psychological treatment
that recognises that a person’s way
“My fears and worries were plenty. I of thinking (cognition) and acting
believed I was weak, incompetent, (behaviour) affects the way they feel.
‘mental’, if I took medication or sought CBT is one of the most effective
psychological help. Yes, the first treatments for anxiety and depression,
steps are hard, but hey, so is crying and has been found to be useful for a
all the time and not being able to think wide range of people, including children,
or have fun. For me, it was about adolescents, adults and older people.
priority and getting back the person I
was and liked.” In CBT, a person works with a
– Gina, 38 professional (therapist) to identify the
patterns of thought and behaviour that
are either making them more likely
“After many years of ‘ups and downs’, to become anxious or depressed, or
I felt like the only thing which could stopping them from improving once they
save me from death was getting help. become anxious or depressed. CBT has
This was a last resort effort. Don’t an emphasis on changing thoughts and
wait until you get to your last chance.” behaviour by teaching people to evaluate
– Greg, 42 their thinking about common difficulties,
helping them to shift their negative
or unhelpful thought patterns and
27reactions to a more realistic, positive diminish without the need to avoid or
and problem-solving approach. CBT escape the situation and that their fears
is also well-suited to being delivered about the situation often do not come
electronically (often called e-therapies). true or are not as bad as they thought.
Interpersonal therapy (IPT) is a
“CBT provided me with the skills structured psychological therapy
to question and indeed, challenge that focuses on problems in personal
my thoughts. I found myself taking relationships and the skills required
control of my thoughts, rather than to deal with these problems. IPT is
letting them control me.” based on the idea that relationship
– Margaret, 55 problems can have a significant impact
on a person experiencing depression,
and can even contribute to the cause.
“I have had CBT sessions which have IPT is thought to work by helping
helped me to think in new ways. people to recognise patterns in their
Some things that used to really upset relationships that make them more
me are now ‘water off a duck’s back’… vulnerable to depression. Identifying
and other things I thought too hard for these patterns means they can focus
me, I feel confident to try.” on improving relationships, coping with
– Damien, 39 grief and finding new ways to get along
with others.
Behaviour therapy is a major component Mindfulness based cognitive therapy
of cognitive behaviour therapy (CBT). (MBCT) is generally delivered in
However, it is different to CBT because groups and involves learning a type
it focuses exclusively on increasing a of meditation called ‘mindfulness
person’s level of activity and pleasure meditation’. This meditation teaches
in their life. people to focus on the very present
Unlike CBT, it does not focus on changing moment, just noticing whatever they
the person’s beliefs and attitudes. are experiencing, be it pleasant or
Instead, it focuses on encouraging unpleasant, without trying to change it.
people to undertake activities that are At first, this approach is used to focus
rewarding, pleasant or give a sense of on physical sensations (like breathing),
satisfaction, in an effort to reverse the but later it is used to focus on feelings
patterns of avoidance, withdrawal and and thoughts.
inactivity that make depression worse. MBCT helps people to stop their mind
Behaviour therapy can help with anxiety wandering off into thoughts about the
problems that often persist because future or the past, or trying to avoid
the person avoids fearful situations. unpleasant thoughts and feelings. This
Avoiding these situations means that the is thought to be helpful in preventing
person does not have the opportunity to depression from returning because
learn that he or she can actually cope it allows people to notice feelings of
with the fear. With the ‘graded exposure’ sadness and negative thinking patterns
component of behaviour therapy, early on, before they have become fixed.
the person learns that their fear will
28It therefore helps the person to deal with • can be of particular benefit for people
these early warning signs better. in rural and remote areas
• can be provided in many cases
“The strategy I found most helpful without having to visit a doctor.
(and I still use) is asking myself what
You can visit the Australian Government’s
are the triggers that cause my anxiety.
www.mindhealthconnect.org.au website
I can then process what and why I am
to find a library of online programs.
feeling the way I am. I also tell myself
that I am ok just as I am. I don’t have To find out about other psychological
to change to suit anyone else.” treatment approaches and the level
– Dorothy, 63 of evidence behind them, download
beyondblue’s A guide to what works for
anxiety and A guide to what works for
e-therapies, also known as online
depression booklets from
therapies or computer-aided
www.beyondblue.org.au/resources
psychological therapy, can be just as
effective as face-to-face services for
people with mild to moderate anxiety and “Therapy has helped me to legitimise
depression. CBT and behaviour therapy my depression and anxiety. When I
are helpful for anxiety and depression feel like I have failed a task or feel
when delivered by a professional. The down or act out of character, I no
structured nature of these treatments longer have the burden of constant
means they are also well suited to being self-blame and guilt.”
delivered electronically. – Bec, 21
Most e-therapies teach people to
identify and change patterns of thinking
and behaviour that might be keeping
them from overcoming their anxiety
or depression. An individual works
through the program by themselves,
and although e-therapies can be used
with or without help from a professional,
most programs do involve some form
of support from a therapist. This can
be via telephone, email, text, or instant
messaging, and will help the person
to successfully apply what they are
learning to their life.
This online mode of delivery has several
advantages. It:
• is easy to access
• can be done from home
29You can also read
