It’s Time to Really Talk About Depression
Several strategies can help prevent a downward spiral — they all start with reaching out
This is the second 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.
Rainy days often get me down. Even a little overcast can put me into a funk. Sometimes I just get moody for no good reason. That’s all normal. But when feelings of sadness persist day after day, any of us — me, you, a family member, or a friend — runs the risk of plunging into debilitating depression. There is no immunity. There are, however, effective prevention strategies.
“There is ample evidence that depression can be prevented,” says Tracy Gladstone, PhD, a senior research scientist at the Wellesley Centers for Women. “People who participate in prevention programs have about a 20% decrease in the incidence of depression, relative to similar people who get a control (nonactive) intervention.”
You don’t have to wait for depression to derail your life before seeking help. In fact, the sooner you reach out, the better, several experts tell me.
“People do not need a diagnosis of depression to benefit from depression interventions, and, in fact, there is ample evidence to suggest it is possible to prevent depression in people with depressive symptoms but no clinical diagnosis,” says Gladstone, who leads Wellesley’s depression-prevention research.
When to seek help
Depression is far more common than you might realize. The number of U.S. adults with depression symptoms tripled during the pandemic and remains staggeringly high — around 28%. Nearly half of parents say depression symptoms among teens, already rising in recent years, worsened during the pandemic.
Genetics can be a significant driver, particularly in the case of severe depression. But in most cases, depression is at least 50% determined by environment, lifestyle, and events. At least one traumatic event — early in life or later on — typically acts as a trigger that can, if left untreated, initiate a downward spiral.
“Depressive disorders can emerge when people, in the face of mild symptoms of depression, respond to those low periods in an unhealthy manner,” Gladstone explains by email. “Depression-prevention strategies can help people to manage the low moods we all experience so that they do not respond in an unhealthy manner, leading to more significant problems with depression.”
A formal diagnosis of depression can be made if you feel sadness or a depressed mood most of the day for at least two weeks, along with any of a range of other symptoms, including:
- Loss of interest in regular activities
- Poor sleep or oversleeping
- Fatigue or loss of energy
People who’ve never met the criteria for clinical depression can, through either natural aging of the brain or other, more negative effects of aging, become more prone to it later in life, explains Deanna Barch, PhD, a professor of psychological and brain sciences at Washington University in St. Louis, MO.
Before you get to that point, and likely feel unable to deal with the symptoms — a key aspect of clinical depression — there are several preventive actions you can take.
Helpful prevention tactics include “super basic things” like sleep, exercise, and eating well, Barch says. (In Part 1 of this series, I explored these tactics and more.)
Beyond the basics, Barch suggests trying mindfulness, sometimes called mindfulness meditation. This common and effective strategy for managing or preventing depression is also one of the easiest to embrace, supported by countless apps, self-help books, and online instructionals.
“Mindfulness-based stress reduction is often used as a preventative intervention for adults who may be at risk for depression, or may not be at risk but want to make sure that they can manage life stressors,” Barch says in a phone interview.
Whether explored alone or with help from a trained therapist, mindfulness is not the flaky woo woo some skeptics might imagine. It can involve simple breathing methods and mental exercises like being hyperattentive to smells, sounds, and other sensory input, which is known to be effective in relaxing and focusing the mind and directing attention away from negative, unproductive thoughts.
In one study, group mindfulness was found to be as effective for treating depression and anxiety as individual cognitive behavioral therapy (more on CBT below). Another study involved people who had “subthreshold depression.” Half got mindfulness training, the other half, as a control group, did not. After a year, 11% of those in the mindfulness group had developed major depressive order, compared to 27% in the control group.
Therapies that can help
Several other depression-prevention programs proven by science to be helpful are based on cognitive behavioral therapy (CBT), a fancy word meaning to recognize your thoughts and then change your behaviors.
“People are taught to keep track of their moods, to recognize errors in their thinking, and then are taught strategies for challenging and replacing their negative thoughts with more positive counterthoughts,” Gladstone explains.
Another evidence-based approach, called interpersonal psychotherapy, teaches communication strategies to improve relationships and social functioning and better resolve conflicts.
A third type, called behavioral activation, stresses how participation in activities gives you more chances for rewarding experiences, which can add up to an improved mood. It can be as simple as scheduling inexpensive activities like listening to music or taking a walk with a friend. (One study showed that a combination of behavioral activation therapy and mindfulness training can reduce depression symptoms.)
You can find DIY instructional for CBT and other therapies online. Some research finds the self-directed CBT approach can be effective, at least for people with only mild to moderate depression symptoms.
“We know, however, that combining some types of self-guided interventions with professional support, such as from a therapist or clinician, can increase the benefits people receive from using them,” Gladstone says.
CBT via telehealth, an increasingly popular way to get professional support for therapy without office visits, reduced symptoms of depression, stress, and anxiety, and tended to leave participants highly satisfied, according to a 2018 study published in the journal, Psychiatric Services. More recent evidence suggests telehealth is a lifeline for many people, and patients are more apt to keep appointments than if they’re forced to trudge to a therapist’s office.
My goal is not to suggest the best preventive treatment for you or your loved one, but to emphasize that there are many therapies proven to work, and that approaches vary depending on each person’s circumstances. Step one, the experts say, is to talk to a family doctor, a psychiatrist, a family member, or a best friend — whoever you trust — and openly discuss your mood and your concerns.
“Seeking a therapist before a depressive episode gets too bad is a wonderful idea to address the issues which may be triggering the condition,” says Peter Bolo, MD, medical director of behavioral health at the Atlantic Health System.
Note that if you are diagnosed with depression, a health care provider might recommend medication to complement psychotherapy, both to treat existing depression and to help prevent future episodes.
“The combination of talking therapy plus antidepressant medication is typically the most helpful to resolve a serious depression,” Bolo tells me. Meanwhile, he offers these suggestions for successful depression prevention:
- Find a good psychiatrist and remain with them for the long haul.
- Strongly consider staying on an effective antidepressant medication for the long term as this can prevent relapsing depression.
Most of all, Bolo and other experts stress: Don’t let stigmas or other barriers prevent you from reaching out, starting with those closest to you.
“Involve family or other loved one’s as partners in preventing and resolving depression,” Bolo advises. “Both should get as much education as possible on depression, prevention, and treatment as another prevention approach.”
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.
Next week: Prescriptions for antidepressants are rising, but often the drugs don’t work, and other effective treatments are dismissed.