Depression is a condition characterized by low mood, sadness, anhedonia (decreased pleasure/interest), fatigue, changes in weight/appetite, irritability, sleep disturbance, agitation, impaired concentration, indecision, lack of motivation, pessimism/hopelessness, and suicidal thinking. Over-sensitivity to criticism/rejection and social withdrawal is not uncommon. It is often accompanied by feelings of excessive worthless/guilt, feelings of loneliness or lack of belongingness, feelings of numbness or emptiness, and feelings of inferiority or excessive self-criticism. Persistent aches, pains, headaches, cramps, and digestive problems that do not ease with treatment may also be related to depression.
When depression interferes with functioning or causes clinically significant distress, it can properly be called a depressive disorder. Depressive disorders come in two varieties — Major Depressive Disorder (MDD) and Persistent Depressive Disorder (PDD). The first tends to be episodic while the second tends to be chronic and unrelenting in nature. Depression is the most common psychological disorder, with a lifetime prevalence of 17%. The median onset age for depression is 32 years old. The disorder is more common in women than in men.
So what can be done about it?
For some people, depression resolves itself with time. The average untreated duration of a depressive episode is 3-6 months. However, for many individuals, recurrence occurs. To prevent recurrence or to cut down on the duration of symptoms, some form of treatment may be necessary.
Fortunately, 80% of people who seek treatment for depression show improvement. Many different types of psychotherapy have been shown to be effective in the treatment of depression, including Behavioral activation, Cognitive therapy, Cognitive-behavioral Therapy (CBT), Interpersonal Psychotherapy (IPT), Problem-solving Therapy, Self-management/Self-control Therapy, Acceptance and Commitment Therapy (ACT), Behavioral Couples Therapy, Emotion-focused Therapy (EFT), Rational Emotive Behavioral Therapy (REBT), and Short-term Psychodynamic Therapy. To find a psychotherapist, use Psychology Today or contact your state’s psychological association for a referral.
Medication is also a highly effective treatment for depression, either alone or in combination with therapy. There are numerous classes of drugs that have demonstrated efficacy in depression treatment, including Selective Serotonin Reuptake Inhibitors (SSRIs), Monoamine Oxidase Inhibitors (MAOIs), Tricyclic Antidepressants (TCAs), and Norepinephrine and Dopamine agonists. Atypical antipsychotics, stimulants, thyroid agents, and anxiolytics are also sometimes used as adjuncts. Consult with a psychiatrist or psychiatric nurse practitioner to see if you may be a good candidate for medication.
Some people notice seasonal dips in their mood. This may be due to lack of sunlight in fall/winter months. Fortunately, light lamps with brightnesses of 10,000 lux or more have been shown to improve mood and reduce depression (Golden et al., 2005), and can be purchased for around $150–$250. And getting outside on sunny days is free!
Physical exercise is associated with a variety of health benefits. Physical inactivity, on the other hand, may put people at risk for many disorders — including coronary heart disease, diabetes, certain cancers, obesity, hypertension, and anxiety and depression (Schuch et al., 2016). Fortunately, a great number of studies suggest that exercise training — aerobic and nonaerobic — may reduce depressive symptoms in both clinical and nonclinical populations (Strohle, 2009). Strohle writes: “the effects of physical activity might stimulate a complex system and trigger a cascade of events, which, for example, result in higher resilience against (stress-associated) mental disorders.”
Good sleep hygiene is important to mood stability. Sleep deprivation has been shown to strongly impair functioning, especially mood (Pilcher et al., 1996).
Some herbs have been shown to reduce depression. For example, St. John’s Wort has been shown to be effective in mild to moderately severe depressions (Linde et al., 1996). Others seem to be helpful with anxiety, such as Kava (Pittler et al., 2000). Often these herbal supplements can be purchased over the counter in pill form or in teas. Only use herbal supplements in coordination with your physicians.
Poor diet may be a risk factor for depression (Bodnar & Wisner, 2005), so eat healthy and take your vitamins. Initial evidence also suggests that a diet rich in omega-3 fatty acids may help with depression (Lin & Su, 2007). And to maintain balanced blood sugar, and thus stable mood, avoid sugars and don’t skip meals.
Use Complementary and Alternative Medicine
There is a reason Complementary and Alternative Medicine (CAM) has been around for centuries… It works! CAM includes healthy activities like mindfulness meditation, yoga, acupuncture, aromatherapy, hypnosis, massage therapy, qi gong, martial arts, and others.
Decrease Drugs and Alcohol
Some drugs — prescription, over-the-counter, and illicit — can be depressogenic, meaning that they can cause symptoms of depression. If you are on certain drugs, check with a doctor or pharmacist to see if they may be contributing to poor mood. Alcohol is a commonly abused depressogenic substance (Schuckit et al., 1988). Cutting back or eliminating your alcohol intake can significantly improve mood.
For many people, stressful life events can precipitate depression. One study concluded that 42-67% of depressed individuals report a very serious life event in the year before the depression began. Reducing the amount of “inbound” stress that you have to contend with on a daily basis can greatly reduce depression. Work with your therapist to identify your sources of stress! Some of us have taken on way too much, leading to burnout. Re-evaluate your list of responsibilities, and cut down on extra commitments.
Many of us do not take care of ourselves sufficiently. We do not engage in good proactive coping (engaging in regular self-care activities) or good reactive coping (responding to stressful events with self-care). For a large list of emotion-focused coping mechanisms, click here.
Many people who encounter grief bounce back in time. The same is true for people who encounter trauma. However, some people do not bounce back as quickly and need extra help to work through these experiences. If you fall into this latter category, consider seeing a therapist or joining a grief/trauma group.
Increase Social Support
One of the most important balms for depression is social support. Interpersonal relationships prevent depression and help us heal from it more quickly. Note: Social support does not simply mean hanging out with other people. It means interacting in ways that meet emotional needs.
It is important that we take time to create a life worth living. Meaningful endeavors — inside or outside of work — give life importance and direction, and make it easier to bear difficulties. For many people this is related to service work, often volunteering to help others in need. For others, this may be related to Religion and Spirituality. If you are wrestling with existential issues — such as death, meaning, freedom, and isolation — make sure to bring this up with your therapist or clergy member.
How can you increase the amount of reinforcements you receive while reducing the amount of punishments? This is the basic question behind Behavioral Activation (BA). You can’t get positive reinforcement by just sitting around the house. Sitting around the house is not good for depression. So get up, get out! Stay active, even when you don’t feel like it. This increases the likelihood that you will access positive reinforcements, which in turn combat depression.
Anxiety tends to run with depression. In fact, 60% of people with depression also have an anxiety disorder. Anxiety can exacerbate depression. For some people, what starts as anxiety later leads to depression. So nipping anxiety in the bud can prevent depression.
Challenge Negative and Irrational Thinking
We all have negative thinking, but those with depression tend to suffer from it on a much larger scale. Common cognitive distortions include: all or nothing thinking, overgeneralizing, mental filter, disqualifying the positive, jumping to conclusions, magnification and minimization, emotional reasoning, shoulds and musts, labeling, and personalization. Ask your therapist about irrational thinking styles.
Positive Activity Scheduling
Do more of what makes you feel good. Get a calendar and add positive activities to it. Schedule a dinner with friends. Or a trip to a ballgame. Or a walk in the park.
Applications have been developed to help you monitor your mood over time and improve it throughout the day. For example, Moodivator helps track mood over time so that patterns can be identified. It also helps motivate you to set and reach your achievable goals.
For some people, information is helpful. Reading more about depression can help to normalize what you are going through and facilitate healing. Some examples of good reads on the subject of depression include The Noonday Demon (Solomon) and Feeling Good (Burns). Other good books that can facilitate healing include Learned Optimism (Seligman), Authentic Happiness (Seligman), The Mindful Way Through Depression (Williams), Radical Acceptance (Brach), and When Things Fall Apart (Chodron).
Be Kind to Yourself
Few of us are as kind to ourselves as we are to others. We need to work on this. The following books may be helpful in facilitating healthy self-love: Self-compassion (Neff) and Lovingkindness (Salzburg).
Improve Your Problem-solving
Some of us need to work on our problem-solving. Our lack of effectiveness in various areas of our life causes problems, which creates stress. Becoming more effective reduces stress.
Increase Your Interpersonal Effectiveness
Similar to the last section. Constant difficulties in your interpersonal relationships create stress. To find out how to become more effective interpersonally, consult your therapist. Or better yet, join a therapy group!
Once you have achieved remission from depression, it is important to maintain it. Ask your therapist about how to maintain remission through therapies like Mindfulness-based Cognitive Therapy.
For some people with more severe depression, interventions like Electroconvulsive Therapy (ECT) and Transcranial Magnetic Stimulation (TMS) can be helpful. There are also new biological-based intervention being explored, such as Vagal Nerve Stimulation (VNS) and neuroelectrode implantation. New techniques are being discovered everyday for those with treatment-resistant depression.
Got other ideas? Share them in the comments below.