(File image) Photo: Marika Khabazi
What's the difference between normal sadness and depression?
"Lots of people don't really know and they can't really tell the difference between normal sadness, normal reaction to life events - things that we all have to cope with - and what it's like to really be clinically depressed," said Professor Ian Hickie, a psychiatrist and co-director of health and policy at the University of Sydney's Brain and Mind Centre.
He is one of Australia's leading authorities on mental health and is trying to help people get a deeper and often, more correct, understanding about depression and how to treat it in his latest book The Devil You Knew.
Hickie told Saturday Morning if a person was not physiologically ill, then they were not depressed, using the example of jet lag.
Prof Ian Hickie: busting the myths around depression
"[Jet lag is] that physiological feeling of being, 'Oh, I'm just really not right, I can't sleep right, my gut's not right, I'm just lacking in energy, I can't really enjoy things'.
"Just imagine if you were like that, not for a few days ... imagine if you stayed like that. The physiological disturbance, the body is not right and it's not putting itself right - that's what being seriously depressed is really like. It's not just a psychological thing, its a physiological thing."
There was greater awareness of depression in comparison to when he was growing up, Hickie said, but he believed what was really needed was a deeper understanding of the myths around the illness and how to climb out of it.
Disinformation could risk putting people with clinical depression off using potentially successful treatments, he said.
Antidepressants and agency
Photo: Penguin/University of Sydney
There was a common myth that antidepressants did not work or that needing to rely on them meant a loss of agency, Hickie said.
Was life less authentic if people had to take pills to keep their brains chemically happy and well? His answer was a firm no.
"I happen to have an irregular heartbeat and I take medicines twice a day that allows my heart to beat normally. I don't turn around and beat myself up, I go, 'Great, I can do things, I can stay well, I'm not going to have a heart attack or drop off.'
"Same with your brain, same with your mood, same with depression."
People were fortunate to live in an age where there were medicines available to help bodies come back into alignment so they could enjoy their lives, he said.
"I don't see it as a loss of agency but some people do feel that about these issues," he said.
Psychedelics
About one in five people did not respond positively to all current treatments for depression, Hickie said.
Meanwhile, there were individual reports that people who had tried psychedelics had improvements and there was some degree of brain imaging evidence that psychedelics helped some people to think differently.
"[Psychedelics] is one of the most controversial areas at the moment.
"There's a great deal of reservation worldwide about how many people actually benefit, for how long and what might be the risks associated with that ... these are not placebos, these are substances that have real effects on people and there are dangers for people who are prone to developing psychotic experiences if they take these sorts of medicines."
Hickie said it was very important to continue clinical trials, monitoring doses, the benefits and the range of side effects.
"I think the hype at the moment exceeds the evidence, but it is a really interesting area that's being developed."
What's best for you?
And if you were thinking about trying to unearth what led you to depression, Hickie had another suggestion.
While risk factors, such as poverty and genetics played a part, the illness was different for everyone.
"People waste a hell of a lot of time trying to work out how they got there, most of the emphasis in the book is, 'Don't waste a lot of time on an archaeological dig to find stuff that you're never going to really understand'.
"Find what works to get you out of the hole and then what works to keep you out of the hole."
Hickie said often that included a bit of trial and error and exploration, but it was important to get specific.
"Getting effective treatment early is the key to leaving the devil behind, to much better mental health.
"You can get over it and have a good life if you find out what works best for you and put that into practice."