Can We Prevent Depression?
Self-care strategies to use before depression gets the best of you
This is the first in a four-part series on preventing depression, a serious and growing mental disorder that can strike at any age and, if untreated, persist and worsen.
Naomi Osaka’s withdrawal from the French Open — precipitated by “huge waves of anxiety” the 23-year-old feels over obligatory press events and the “long bouts of depression” she says she has dealt with since 2018 — highlights the reality of the shadowy world of depression, an increasingly common condition that can sneak up on any of us, at any age, for reasons obvious or mysterious.
Osaka’s decision to “exercise self-care,” as she put it, is wise beyond her years. And without pretending to understand her experience or suggest what she should do, I see her challenges as raising an important question that’s more relevant than ever before: Are there effective strategies to prevent the onset of depression?
The short answer: Absolutely, at least to some extent for most people.
The longer answer: Prevention strategies ranging from relatively simple self-care to professional therapy sessions can reduce, but not necessarily eliminate, the risk of developing depression. But the earlier in life we start working proactively to outrun the dark lord of depression, the better.
Clearly, as Osaka has helped the world realize, more and more of us could use some help.
- From 2005 to 2017, symptoms of major depression in the United States in kids ages 12 to 17 jumped from 8.7% to 13.2%.
- Nearly half of parents this spring said their teens have experienced worsening symptoms of depression or sadness during the pandemic.
- Adults with depression symptoms tripled from 8.5% before the pandemic to 27.8% in spring 2020.
- By spring 2021, 28% of U.S. adults still met the criteria for moderate to severe depression, including a whopping 42% of those ages 18 to 24.
You might be surprised to learn that people 65 and older were the least affected, with only 10% reporting moderate to severe depression in that most recent survey. This stark difference illustrates that depression is not a natural or inevitable part of aging. Looked at another way, seniors are more likely than younger adults to say they’re generally satisfied with life.
Being blue is normal
Being in a depressed mood now and then is a normal part of life, and a little gloom can help us appreciate good times, explains Deanna Barch, PhD, a professor of psychological and brain sciences at Washington University in St. Louis. But severe depression, which can come and go in phases or settle in for the long haul, is an entirely different beast.
“When people are chronically depressed, they have low motivation, don’t enjoy things, have disrupted sleep, can’t function, can’t concentrate, can’t engage with people,” Barch said in a phone interview.
If that describes you or a loved one, it’s vital to seek help from a health care provider. There are several psychotherapies that, with guidance from a trained therapist, can effectively treat serious depression, and there are some medications that may be useful complements.
So where does depression come from? Depending on who you ask, it’s somewhere between 30% and 50% driven by heredity, with genes playing a bigger role in the most severe cases. Among other risk factors:
- Poor relationships or lack of social support.
- Neuroticism, which makes minor frustrations seem overwhelming.
- Traumatic events, now or in childhood.
- Drug or alcohol abuse.
“The absence of those things suggest that you are at a lower risk, but I don’t think there’s any evidence that anybody is truly immune,” Barch says. “Terrible life events can elicit clinically relevant depression in even the most psychologically healthy people.”
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You never know when
Depression often emerges in childhood or adolescence, but it can hit you for the first time as a young adult, in midlife, or later.
When depression first kicks in after age 40 or so, it is likely driven by different factors than childhood onset, Barch explains. It is more likely to involve brain changes that can be related to normal aging or problematic aging. Clear differences in white matter, detected in brain scans, have been linked to late-onset depression. Those changes can have genetic roots, but research also indicates there’s an aspect we have some control over: How we treat our minds and bodies throughout life can affect whether we suffer depression later on.
Regardless when depression emerges, there’s typically a triggering event.
“Loss of any kind is the most common trigger of an episode of depression in someone who is vulnerable,” says Peter Bolo, MD, medical director of behavioral health at the Atlantic Health System.
“Loss may be of a loved one, a job, a pet, one’s self-esteem, or any number of other things,” Bolo explained by email. “It is not simple to prevent depression entirely, since each of us will experience numerous losses beyond our control across our life span, and none of us control our genetics — but many good strategies exist.”
DIY depression-prevention tools
Among the ways you can help forestall depression on your own are five strategies that each have well-recognized broader benefits for mental and physical health at any age:
- Eat a healthy diet.
- Avoid drugs and alcohol in excess. (Boomers, I’m talking to you.)
- Cut back on exposure to news and social media.
- Get regular physical activity.
- Sleep well. (Here are some science-backed tips.)
Before you dismiss this short list as simplistic, ask yourself if you truly do a good job of all five. The vast majority of us do not, and extensive research has proven that these lifestyle strategies can do wonders on many levels—boosting moods, building the body’s resistance to disease, and helping us live longer. Plus, each feeds off the other, creating a circle of healthy goodness.
Executing against those strategies might just mean you’ll need to step back from work a little, which for most of us can be a self-care strategy all by itself. A recent study by the World Health Organization found that working 55 hours or more per week causes physical and mental stress that is, to put it bluntly, deadly.
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Bolo adds another fantastic suggestion: Get outside.
“Walking for 30 to 60 minutes (or running or cycling) outdoors, is a great choice, as one not only gets aerobic exercise but also necessary sunlight on your eye, which has a powerful antidepressant benefit — even on a cloudy or cold day,” Bolo says. “This is the single best strategy to prevent the winter blues more than half of us experience during the dark days of fall and winter.”
At least two hours of natural sunlight a day — not through a window, but actually being outside — is critical for setting your internal biological clock, promoting alertness during the day and the release of sleep-inducing melatonin at night. Not surprisingly, spending more time outdoors, especially in green spaces or the wild, is known to lift moods and improve overall health.
Another helpful depression-prevention tool: mindfulness or meditation, which can improve focus and reduce stress by developing awareness through focusing on the present in a nonjudgmental way. Earlier this year, scientists published a review of 136 studies on mindfulness, many of which involved community-based programs or self-instructionals. In most but not all cases, it proved helpful.
“For the average person and setting, practicing mindfulness appears to be better than doing nothing for improving our mental health, particularly when it comes to depression, anxiety, and psychological distress,” said the study’s lead author, Julieta Galante, PhD, a mental health researcher at the University of Cambridge. “But we shouldn’t assume that it works for everyone, everywhere.”
There’s one more very important DIY strategy for reducing the risk of developing depression in ourselves and others.
“Cultivating positive, open relationships with friends and family provides a wonderful source of support to help absorb the upset of stressful life events,” Bolo points out. “Stay in touch with others, and this will help reduce the likelihood of depression.”
If you or a loved one is depressed, it’s vital to talk about it. Because depression increases the risk of suicide, consider calling the confidential National Suicide Prevention Lifeline at 1-800-273-TALK (8255) for English, 1-888-628-9454 for Spanish.
Part 2: Scientifically tested therapies that can help prevent a downward spiral of depression. Read >>>