Dr Zana Marovic, Phd

Clinical Psychologist, Johannesburg



Feeling down from time to time is a normal part of life as it’s impossible to escape life’s ups and downs. Feeling unhappy or sad in response to disappointment, loss, frustration or a medical condition is normal. Many people use the word “depression” to explain these kinds of feelings, but that is really situational depressionwhich is a normal reaction to events around us. Clinical depression, though, overwhelms day to day life, interfering with one’s ability to work, study, eat, sleep, and have fun.

Signs and symptoms of depression

There’s a vast difference between “feeling depressed” and suffering from clinical depression. The despondency of clinical depression is unrelenting and overwhelming. Some people describe it as “living in a black hole” or having a feeling of impending doom. They can’t escape their unhappiness and despair. However, some people with depression don’t feel sad at all. Instead, they feel lifeless and empty. In this apathetic state, they are unable to experience pleasure. Even when participating in activities they used to enjoy, they feel as if they’re just going through the motions. The signs and symptoms vary from person to person, and they may wax and wane in severity over time:

  • Feelings of helplessness and hopelessness

  • Loss of interest in daily activities
  • Appetite or weight changes
  • Sleep changes
  • Agitation
  • Loss of energy
  • Self criticism
  • Concentration problem
  • Suicidal thoughts

Types of depression

Postpartum Depression

Strong emotions after giving birth, “the baby blues”, are normal. New mothers are recovering from birth, are most likely sleep deprived, and are adjusting to the responsibilities of parenthood. Postpartum depression, however, is a longer lasting and more serious. What can be especially terrifying to mothers suffering from postpartum depression are feelings of wanting to avoid or even harm the baby. Postpartum depression doesn’t have to occur right after delivery. It can occur up to a year after childbirth.

Seasonal Affective Disorder (SAD)

Some people experience depressive episodes in a seasonal pattern, normally in winter, when sunlight is limited and overcast days are frequent. This type of depression is more common in climates with more severe winter weather patterns and limited sunlight, like the northern climates.

Depression causes and risk factors

Some medical illnesses have a specific biological or chemical cause, making treatment, like a medication or surgery, more straightforward. Depression is more complicated.

It is not just a result of a chemical imbalance, and is not simply cured with medication. What makes depression so difficult to treat is what seems like depression may actually be something else. If you are stuck in a dead end job and feel hopeless and helpless, for example, the best treatment might be finding another job which challenges you more.

And if you are new to an area and feeling lonely and sad, the best treatment might be finding new friends at work or through a hobby. In those cases, the depression is situational and is remedied by changing the situation. Clinical depression is thought to be caused by a combination of biological, psychological and social factors. There are certain risk factors that may make you more vulnerable. Learning what the risk factors are and making lifestyle changes might help reduce the risk of developing depression.

  • Genetics. If you have family members who have suffered from depression, you may have a greater risk of developing depression yourself, although there is currently no direct gene that has been found to cause depression.
  • Early childhood trauma or abuse. If you had traumatic early life experiences, you may be more at risk to develop depression during or after a stressful life event.
  • Loneliness and lack of social support. Lack of support, whether it is family, friends or colleagues, makes coping with stress all the more difficult. Having marital and relationship problems can also make you feel alone and frustrated.
  • Recent stressful or traumatic life experiences. Some events, like losing a loved one, are clearly stressful and cause enormous disruption and strain in our lives. However, anything that causes change can be a stressful life experience, even if it is normally considered a happy event such as a big work promotion, a wedding, or childbirth.
  • Alcohol and drugs. Alcohol and drugs can cause strong depression symptoms on their own. They can also make you more vulnerable to depression even if you decide to stop using them. Some people try to treat themselves with alcohol and drugs to self-medicate, but this only worsens the problem.
  • Finances and employment. Financial strain can be an enormous stressor. Struggling to pay the bills or mortgage, or suddenly becoming unemployed, is a very stressful life event. Being unemployed can be a blow to self-confidence and can be a very difficult adjustment, especially for men.
  • Health problems or chronic pain. Health problems and chronic pain may reduce your mobility, your ability to work, or your spare time. They can chip away at supportive relationships and make you feel hopeless and frustrated.

Professional help

If positive lifestyle changes and support from family and friends aren’t enough, seek help from a mental health professional to create a personalized treatment plan.

Most plans include some form of therapy that gives you tools to treat depression from a variety of angles.

What’s more, what you learn in therapy gives you skills and insight to help prevent depression from coming back.

Some types of therapy teach you practical techniques on how to reframe negative thinking and employ behavioral skills in combating depression. Therapy can also help you work through the root of your depression, helping you understand why you feel a certain way, what your triggers are for depression, and what you can do to stay healthy.


Medication may relieve some of the symptoms of moderate and severe depression, but it doesn’t cure the underlying problem and it’s usually not a long-term solution. While advertisements for antidepressant drugs imply that chemical imbalances in the brain cause depression and that medication can correct this imbalance, the answer is not that simple. Depression involves much more than just “bad” brain chemistry. To successfully treat depression, it’s important to look at every aspect of your life and make any necessary changes.

South African Depression and Anxiety Group