Sometimes an obstacle like demotivation or procrastination is actually hiding a bigger mental health issue. Sometimes what we assume is a normal state of mind for us, is actually depression or anxiety.

Getting help for a mental condition can be the difference between success and staying stuck, it can literally change your life!

To give you a better understanding of the situation and to work out if you may be suffering from anxiety or depression, we’ve enlisted the help of three experts in the field: professional counsellor Clare Grange; Suzanne Leckie, psychologist and helpline manager at Sane; and Janine Clarke, psychologist and e-health program manager at Black Dog Institute.

Changing attitudes

If you broke your arm, the chances are that you would immediately go and get help from a doctor. And depending on the type of break, you would get varying levels of ongoing care until that break healed. Although mental health problems require the same care, they are rarely thought of in the same way.

In Australia around 45% of people will suffer a mental health condition at one point in their lives, and on average 1 in 6 people will suffer depression and 1 in 4 will suffer from anxiety.

So if you are at a dinner party, or standing in line at the supermarket, or dropping the kids off at school among other parents, the chances are you will be in the company of someone who is suffering anxiety or depression.

Unfortunately, despite the huge numbers of sufferers, very few people actually seek out help.

“There’s definitely some stigma attached to having a mental health condition, there’s some shame, so people don’t seek help” said counselling expert and educator Clare Grange.

“People with anxiety or depression can feel that it’s who they are, rather than something that they’ve got. They say ‘I am depressed’ rather than ‘I have depression’. We need to be better educated about mental health.

“When we have a cold we are not ashamed that we are sick because we know what a cold is. We know that we will cough, we’ll have a running nose, and we know that we can get treatment and get better. It is the same with anxiety and depression, the more we realise that they are treatable conditions that have a set of symptoms, the less stigma there will be,” she added.

What is depression?

We all feel sad, low, hopeless and moody at times, that is part of being human. So what is the difference between just being sad or low, and depression?

The short answer is time. How long have you felt this way? If it is longer than two weeks, you may have depression.

There are many different types of depression, ranging from relatively minor (but still restricting) to severe.

Depression can affect people differently and sufferers can experience symptoms which affect their behaviour, feelings, thoughts and physical body.

These can include: sadness, a feeling of being overwhelmed, hopelessness, irritation, guilt, frustration, indecision, disappointment and misery.

People with depression may not go out anymore, they might find it hard to get things done, they may withdraw from friends and family, may not be able to enjoy everyday activities and may find it hard to concentrate.

They may experience thoughts like “I’m a failure”, “nothing good ever happens to me” or “life is not worth living” and they may feel tired, sick and run down, and have significant weight loss or gain.

“You might suddenly find yourself feeling less likely to go out. You might be thinking very negatively about yourself and your future. You may start to isolate yourself more. You may have very little motivation and just won’t want to get out of bed in the morning,” said Suzanne Leckie, psychologist and helpline manager at Sane.

“There’s also a very strong tendency for people with depression to think about the past. So they troll through all the memories of the things that have gone wrong in the past, the things that they’ve done wrong and the things people have done wrong to them,” she added.

What is anxiety?

It is normal to get stressed or worry at times, we all do it. If we have a job interview coming up, or get a large phone bill, or if we are running late and are stuck in traffic.

Anxiety, however, is different. It is a condition where the person lives in a state of stress, worry or dread, and it can be extremely debilitating.

Like depression, there are many different forms and levels of anxiety, and interestingly, it is the most common mental condition in Australia.

Generalised anxiety disorder (GAD) is diagnosed if over a 6 month period the person has spent the majority of their time feeling worried or has struggled to do everyday things because of anxiety.

People suffering from GAD generally feel restless or on edge, tired, have difficulty concentrating, feel irritable, and have trouble sleeping.

Anxiety can also present itself in the form of phobias, such as social phobia where a person gets anxious in social situations.

Panic disorder is a condition where the person suffers repeated panic attacks and lives in fear of having another panic attack. Often they avoid activities or things that they think will trigger an attack.

Obsessive compulsive disorder and post-traumatic stress disorder are also anxiety conditions.

“Anxiety is quite like depression in that there’s a variety of components to it,” said Leckie.

“There’s physical element, where someone will be experiencing that kind of stomach churn or an anxiety attack with a racing heart and sweat, and there’s also the psychological aspect to it, which is a constant tendency to catastrophise things – so, whatever is happening, someone experiencing anxiety will take it to the worst possible conclusion.

“Ultimately, it’s the mental stuff that then brings on the physical sensation, the stomach churn and the sweats and the heart palpitations.

“If someone with anxiety is just standing there waiting for a train, (an example of their catastrophic thinking may be) ‘the train is not going to come. I’m going to be late to work. My boss will be really mad. I’ll probably lose my job.

“And just like how depression is kind of fuelled and maintained by dwelling on the past, anxiety is really fuelled and maintained by the tendency to catastrophise,” she added.

Can I have depression and anxiety?

“Depression and anxiety frequently co-exist. In other words, someone who has depression will very often,  but not always, have symptoms of anxiety and vice versa. They seem to go hand in hand,” said Janine Clarke, psychologist and e-health program manager at Black Dog Institute.

How do I know when to get help?

If you have experienced depressive feelings or anxiety for two weeks or more, it’s best to make an appointment with your GP to go through a simple test which will determine whether you are suffering from a mental health condition.

“For some people a trip to the GP may reveal a health reason why they are feeling the way they are,” said Grange.

“People might say I’ve had this for years and years and I’ve never been cured, and then they realise that they have an underactive thyroid. Women may have hormonal problems, PCOS or something that’s causing hormonal hell.

“For others, a trip to the GP will get them a referral to a psychologist or counsellor, and they will find out about medications which might help,” she added.

What treatments are available?

Depending on your condition and it’s severity you may see a counsellor, a psychologist or a psychiatrist, and you may have medication prescribed alongside therapy.

Counsellor, psychologist, psychiatrist, what’s the difference?

A counsellor is trained help people develop an understanding of themselves, clarify their issues and develop coping strategies. Generally counsellors will deal with short-term clients and they are concerned with practical or immediate issues and outcomes. They are great for people with mild to moderate depression and anxiety.

In Australia there are no laws governing who can call themselves a counsellor, so it is best to check with the Australian Counselling Association to find a qualified counsellor with a Certificate, Diploma or Degree in Counselling.

A psychologist studies human behaviour and will delve deep into root causes of issues, offering a range of therapies to diagnose and treat mental conditions. Psychologists deal with clients on short, mid and long-term basis and are great for treating mild, moderate and severe mental conditions.

To practice in Australia a psychologist needs a 4 or 5 year psychology degree, plus 1 or 2 years of supervised practice, or a 2 year Master’s degree.

A psychiatrist is a medical doctor who has additional qualifications in psychiatry. Great for long-term care of moderate to severe cases, in addition to offering talking therapies, a psychiatrist prescribes medications to treat mental health conditions.

To offer services in Australia a psychiatrist must have a 6 year medical degree, plus additional qualifications in psychiatry.

Therapies offered

Like medical doctors, counsellors, psychologists and psychiatrists will all have their own way of treating patients, based on the methods that they prefer to work with.

These methods may include:

• Cognitive Behavioural Therapy. CBT therapy is a combination of cognitive therapy and behaviour therapy and works to help people challenge and change their thoughts and behaviours.

• Interpersonal Therapy. IT focuses on personal relationships and life skills and is designed to help people gain control of their moods and functioning through dealing with issues in relationships and their feelings about them.

• Acceptance and Commitment Therapy. This works on the principal of accepting what is out of a person’s control and committing to action that improves and enriches their life.

• Mindful Cognitive Therapy. MCT combines thought changing therapy with mindfulness to help people live in the present moment, not stuck in the past or worrying about the future.

What can I expect from therapy?

In your first session your therapist will ask you questions to get an idea of your life and your issues. They will be looking at how you have come to be at the place that you’re at.

In your following sessions you will start working with your therapist’s chosen therapy method or, most likely with a number of methods combined.

“With a good psychologist there’ll be a variety of strategies, and they’ll use the ones that resonate most for the client and are the most applicable for the situation,” said Leckie.

A note on expectations

If you injured your shoulder and went to a physiotherapist to get exercises to strengthen and restore your shoulder, you wouldn’t expect to get results unless you actually did the work. The same goes for therapy.

“People must assume that therapy is going to be collaborative; that they will work with their therapist to set goals for treatment and they will have to practice the things that they learn outside of their sessions ” said Clarke.

“What we know is that people who are willing to engage in the therapeutic process are likely to experience the greatest gains. But there needs to be that willingness to try new things, to take on board some of the strategies that are being talked about in therapy and often confront things that are really difficult,” she added.

Can I be cured?

“Certainly it is the case that the benefits from treatment for a majority of people are enormous, so it’s not something people have to live with” said Clarke.

“Sometimes people feel that they do relapse, but seeking treatment for symptoms at the time of the relapse is often effective,” she added.

Quick tips

Anxiety
According to Grange, when people with anxiety imagine worst case scenarios and ‘What if’s’ they are involved in catastrophic thinking.

“Thoughts are not harmful on their own. The problem is when thoughts lead us to emotions and then emotions lead to behaviours,” she said.

Because thoughts happen so fast, you may not even be aware you’re having them. You feel the physical symptoms of an anxiety attack, without even realising you’ve had a trigger thought.

So to deal with the issue, you need a simple way of calming yourself down. One simple way to do this is to do a breathing exercise.

Breathing Exercise: Sit or stand, whichever you are most comfortable with. Relax your hands, drop your shoulders and relax your jaw. Breathe in slowly through your nose and count to six, keep your shoulders down and allow your lower stomach to expand as you breathe deeply. Hold your breath for three seconds and breathe out for eight seconds. Repeat for a few minutes.

Once you have completed the breathing exercise you can ask yourself what the thought was that started the catastrophic thinking and anxiety.

When you know what the trigger thought was you can begin to examine the evidence for the thought and challenge it with logic.

“The thoughts have the effect of a real or imagined fear, so we try to combat the thoughts by giving an alternate thought,” said Grange.

“You’re negating the fear. You confront the fear with logic,” she added.

One logical way of looking at the thought is to ask, realistically, what the odds are of your fear coming true? Is there any evidence to support the fear? And how strong is this evidence?

Depression

According to Grange, a great way to start the journey out of depression is also by challenging thoughts with logic. She also recommends small amounts of exercise daily.

Going for a walk, or having a dance, basically any physical exercise you may enjoy, or at the very least don’t dislike.

“It’s working in the reverse,” she said, adding, “you get the body moving, you get the energy going, then you can say, what was the thought? What is it that’s stopping me?”

Interestingly, studies have shown that exercise can have similar effects on the brain as anti-depression medication.

However, for many with depression, exercise is the last thing you feel like doing. So if you really can’t manage a 30 minute walk, then Grange suggests you do one “soul food” thing for yourself every day.

“Soul food is something you enjoy,” Grange said.

“What is your soul food? Is it listening to music, painting, walking in the park? Is it a really good meal? Soul foods are things that nurture us. They can give us a little spark and then we can fan that little flame, and we can focus on that, on how good that moment feels,” she added.

Meanwhile, Leckie recommends mindfulness.

“Mindfulness increases your ability to stay focused on the present moment. It teaches us to be completely immersed in the present,” she said.

“So if you’re sitting on a train travelling to work, all you’re doing is sitting on the train. You’re paying attention to what you can see, what you can hear, how you’re feeling. You’re in the moment. You’re not going back over an argument that you had this morning. You’re not criticising yourself for where you are in your life. You’re simply in that moment on the train. There’s a lot of kind of peace that flows from that.

“But we’re terrible at it when we start. We don’t have the attention span. So you often need to be quite gentle with yourself and understand that as you build that mental muscle and pay attention to the present, you’ll get better and better at it and a lot of benefits will flow,” she added.

How do I find help?

It’s always best to do a bit of research about a counsellor, psychologist or psychiatrist before you seek a referral.

Have a look on the Australian Counselling Association’s website to find a qualified counsellor, the Australian Psychological Society website for a psychologist and The Royal Australian & New Zealand College of Psychiatrists for a psychiatrist.

Once you have a name, do a bit of a Google search to see what therapies the professional offers and whether you feel they would benefit you.

Your next stop is your local GP. Speak openly and honestly about how you are feeling. Depending on their assessment they may refer you to see a counsellor, psychologist or psychiatrist. If they offer a referral, give them the name of the therapist you have researched and wish to visit.

If you want to speak to a GP with an interest in mental health, beyondblue has a list GPs on their website. All you need to do is pop in your postcode and they will provide you with GPs nearby. To view this, click here.

Other avenues of help

There are a few really excellent online programs for people with mild to moderate depression or anxiety. These include:

My Compass. Created by experts at the Black Dog Institute, My Compass is designed as a self-help program for people with depression, anxiety and stress.

Fully online, automated and self-directed, the program features education modules which are each broken up into three 10 minute sessions people can do over the course of a week. There are also home activities assigned, and you can get reminders to do their symptom monitoring by email or mobile phone.

“It is a tailored program, so when people register they will go through a bit of a screening process and the program will identify the sorts of things that are particularly problematic for the individual at that point in time, and it will make some recommendations to them about how they might like to use the program, modules they might like to try, and what symptom monitoring they might like to do,” said Clarke.

The program is free of charge and you can access it at www.mycompass.org.au.

Crufad. Run in partnership by St Vincent’s Hospital and the University of NSW, Crufad’s This Way Up clinic offers short, innovative and effective online courses (taking 6 – 8 weeks) for anxiety and depression.

Courses include: Sadness (Depression),  Worry (Generalised Anxiety Disorder), Worry and Sadness (Mixed Depression and Anxiety), Obsessions and Compulsions (Obsessive Compulsive Disorder), Panic (Panic/Agoraphobia) and Shyness (Social Phobia) and cost $59.

You can access This Way Up here: https://thiswayup.org.au.

MoodGYM is a depression prevention program designed and developed by staff at the National Institute for Mental Health Research at The Australian National University. The program teaches the principles of Cognitive Behaviour Therapy and is free of charge.

You can access MoodGYM here: moodgym.anu.edu.au.

A lot of Australian workplaces will also offer Employee Assistance Programs (EAP). These services offer phone counselling for people in distress, or those in need of a bit of guidance. These are often free, and are a good way to get clarity and guidance with issues. Check with your workplace to see if these services are available.

How much does therapy cost?

This will depend on the therapist themselves and how much they charge. Your GP may be able to organise a mental health care plan for you which provides you with Medicare rebates for up to ten visits to a psychologist or psychiatrist.

Support networks

Support networks are hugely helpful for people suffering depression or anxiety.

Tell someone that you trust about what is happening. If that is hard, try starting by calling one of the free helplines, like beyondblue or Sane and chat to them, you may find once you have had that first conversation, it’s a bit easier to tell your family and close friends.

If you think that your family or friends may react badly, chat to your counsellor or psychologist about the best ways to approach them. A good way to approach the conversation is to simply describe what you are going through and avoid portioning blame.

Further resources

• Sane features a whole raft of information and resources about anxiety and depression, as well as forums and online communities where you can chat to and connect with people also working through depression and anxiety. For more information visit www.sane.org.
• Black Dog Institute offers a great range of information about mood disorders such as depression and anxiety, including cutting-edge research. For more information visit www.blackdoginstitute.org.au.
• Beyondblue is a fantastic resource for learning more about depression and anxiety, and it also offers forums where you can speak to other people walking the same road. You can access beyondblue by visiting www.beyondblue.org.au.

Are you in crisis?

If you feel like you are in a crisis, or about to hurt yourself or others, make sure that you call 000, or speak to the trained counsellors at Lifeline by calling 13 11 44.

Final thoughts

If you think that you may be suffering depression or anxiety, you are not alone. Hundreds of thousands of people stand beside you. Seek help, it is widely available and while sometimes it can be hard, it will change your life if you commit to it. You don’t need to live a life of suffering, you can get help and you can make it through this.