Vast numbers of people have their wellness impaired by depression. What is depression? What causes depression? Which approaches work to overcome depression? What can you do if you experience the early indicators to prevent deterioration? What do we understand and not understand about depression? What best protects you against depression?
Although there are no reliable figures for the number of people who experience depression in their lifetime, there are broad indicators. Around 20% of people experience suicidal thoughts. That means, in all likelihood, every family is impacted by at least one person who experiences depression.
What causes depression is a question most people can answer, in part, from personal experience. Almost everyone has experienced reactive depression after a major loss. The death of a loved one can trigger depression. In many cases that reactive depression is an entirely normal reaction to major life adversity. In time, most people regain their spirits.
Clinical depression, or as it is more recently known, major depressive disorder, is another matter. Frankly, we don’t know what causes most cases. There are many factors known to be strongly connected to depression, such as sleep deprivation, poor social conditions, cognitive style, life experiences, gut biome, biological changes, genetics, environmental hazards, and substance misuse.
Although we can list many implicated factors, we are still unable to determine if or how those factors lead to depression. Some appear to be unidirectional, others, bidirectional, some appear to compound each other, and some may be mediating variables. Our understanding is rudimentary, to say the most.
The widespread medicalisation of depression implies that there is some known cause, some pathogen, some medical, some clinical cause. In almost all cases there is NO discernable medical cause.
Some medical conditions are associated with depression, such as hepatic diseases, hypothyroidism, diabetes, and Parkinson’s diseases. In many cases, if the disease is treatable, and treated, the depression abates. That tells us that there are some known biochemical causes of depression.
It is not to say that we know precisely what is going on chemically in the body to cause the depression, or to say that any chemical changes that take place are the direct or indirect causes of depression. We just don’t know enough about the interplay of the biological systems to say what is going on.
With no single verifiable cause of the depression problem, there can be no single failsafe solution. As is the case with many mental health problems, it is likely there is no single cause of depression, and that a multitude of variables interact in ways that we currently do not understand.
The best we can currently do is observe and seek to identify its characteristics and strive to ameliorate depression based on flimsy theories, many of which are either untestable (because they are circular theories) or cannot be scientifically tested for practical or ethical reasons.
According to the DSM V, TR, quoted directly at the end of this article, for educational purposes, much of the mental health practitioner’s assessment on whether or not someone suffers from a normal depressive reaction to loss or something more serious is a “judgment based on the individual’s history and the cultural norms for the expression of distress in the context of loss.”
Let’s flesh that out, in plain language: there is no agreed, or recognised distinction between normal response to loss, and more enduring and serious depression. Problematic, too is the inclusion of “cultural norms.” That means there is tacit acknowledgment that depression has a cultural element. Context, too, is admitted to play a part. Depression, even to people who have spent much time analysing and thinking about it, may be, in large part, a social rather than medical phenomenon.
To my knowledge, rarely, if ever, in history has any medication cured a contextual, cultural or social phenomenon.
Here is a brief summary of the characteristics of depression
Subdued or depressed mood. Feeling low, sad, empty or hopeless. Feeling worthlessness, or guilty. Finding no or little pleasure in anything. Normal appetite is disrupted; either over or undereating. Either lack of sleep or excess sleep.Either restless or reduced speed in all physical movements. Low energy levels or fatigue. Impaired ability to concentrate. Frequent thoughts of death, suicide or planning for self-termination.
If you have ever tried to communicate with someone who is really depressed, not just dealing with a short-term loss, you may have sensed the depth of their sense of hopelessness.
There is no medication that can cure depression, but some can offer amelioration. However, all have either side effects or the risk of serious side-effects, including worsening the depression. Others cause such horrible withdrawal symptoms, that they create addicts. Here is an even more alarming observation: we have no way of predicting who will suffer the most dangerous side-effects (which can include increased risk of suicide).
In the absence of any effective cure, and the presence of dangerous side-effects, and risk of addiction, the best treatment is prevention.
Some people seem to be able to keep themselves happy, and avoid depression, and all other mental health problems, for life. Why? How? Which techniques do they use? Fortunately, all the methods are free (or very low cost), and easy to understand, although they may take time to master.
Here are 21 techniques to minimise your chances of getting down, and maximise your chances of getting up, if you do.
1. Eat a varied and healthy diet. That is important to maximise the chances that your gut biome is as healthy as possible, and to ensure that you get all the minerals and vitamins you need.
2. Avoid nervous system depressants such as alcohol and opioids.
3. Exercise regularly. Enough to stay healthy, but not so much as to injure yourself or leave yourself feeling permanently fatigued.
4. Avoid smoking, and exposure to other toxic chemicals, including those in vapes.
5. Keep your weight under control and within healthy limits.
6. Avoid chemicals that cause swings in mood, such as caffeine and sugar. It is easier to regulate your mood when you don’t have to deal with chemically induced instability.
7. Keep a stable routine. For most people a regular life pattern is beneficial for mental health. For others, endless variety works best. Find out which is best for you and follow it.
8. When you have life’s common negative experiences, seek support from friends and relatives; be honest about your feelings and thoughts, and listen to those who have successfully dealt with the challenge.
9. Surround yourself with people who take responsibility for their thoughts, feelings and behaviours; those, who in the face of adversity, look for solutions, ways of coping, and adjusting.
10. When negative thoughts jump into your head, note them, remember that you can’t choose what jumps into your head, but you can choose what stays there.
11. Apply the same technique with your emotions. Accept that you cannot control what emotions will surface quickly, but you can choose what emotions you dwell on.
12. Choose your behaviours to maximise your mood and build your mental health. Most of what is on this list is designed to give you ideas in that regard.
13. Choose what goes into your brain. Negative and depressing material going in will create the ideal conditions for depression. Feed your brain with positive and uplifting material.
14. Engage in activities and hobbies that you enjoy. Why? Getting in to the zone is very good for our mental health.
15. Avoid sitting in one place for too long; stay mobile.
16. Get fresh air regularly. Take walks in green spaces, be out in nature.
17. Engage in meaningful conversations with others.
18. Help others, especially those who are in no position to return the favour. As someone who has served multiple charities over the years, I can promise you, normally, it feels great to do good for others who need help.
19. Adopt an attitude of gratitude. No one has a perfect life, despite the appearance many try to create on social media. We all have problems and things to be grateful for. If you are reading this, you are alive and breathing, literate or can hear (if you are listening to the audio version), and have access to an electronic device.
20. Learn something new, whether that is theoretical, artistic or practical. For instance, I am currently learning to play a musical instrument. I know I will never perform professionally, but the joy of learning is wonderful. What will you choose to learn?
21. Watch a video or listen to an audio programme you know will fill you with a sense of awe. For instance, I find cosmology fascinating and love watching documentaries on anything connected with it.
There is good reason to believe that the more of the above techniques you use, the less likely you are to become depressed and the more likely you are to improve if you are.
If you decide to adopt just one technique a week until all of them are part of your pattern of habits, you will be better able to deal with the factors that may otherwise have led to depression. To protect your mental health, which of the 21 above will you start with?
Major Depressive Disorder – Diagnostic Criteria – Extract from DSM V, TR
A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from the previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly attributable to another medical condition.
1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: It can be an irritable mood in children and adolescents.)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month) or decrease or increase in appetite nearly daily. (Note: In children, consider failure to make expected weight gain.)
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The episode is not attributable to the physiological effects of a substance or another medical condition.
Note: Criteria A–C represent a major depressive episode.
Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural disaster, a serious medical illness or disability) may include feelings of intense sadness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion A, which may resemble a depressive episode.
Although such symptoms may be understandable or considered appropriate to the loss, the presence of a major depressive episode in addition to the normal response to a significant loss, should also be carefully considered.
This decision inevitably requires the exercise of clinical judgment based on the individual’s history and cultural norms for expressing distress in the context of loss.
D. At least one major depressive episode is not better explained by schizoaffective disorder. It is not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.
E. There has never been a manic episode or a hypomanic episode.
Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance-induced or attributable to another medical condition’s physiological effects.
Professor Nigel MacLennan runs the performance coaching practice PsyPerform.
