I was shocked to learn that 17 million Americans are affected by depression each year. Is it on the rise?
“I do think that depression is on the rise,” says Michael McKee, PhD, a clinical psychologist at the Cleveland Clinic’s Department of Psychiatry and Psychology and author of Stress and Your Body, And What to Do About It. One major factor he cites is Americans. “Chronic stress can be a trigger for a depressive episode,” he says. Just how stressed are we? In a recent survey done by the American Psychological Association, 44 percent of Americans said their stress levels had increased in the past five years. Topping women’s list of stressors: worries about money, the economy, job stability, family, household, parenting responsibilities and being overscheduled.
Why are women more likely to be depressed than men?
In part, more women than men seek treatment for their depression, in the form of therapy or medication. “But hormonal issues are clearly at play as well,” says Dr. McKee. “Pre-puberty, the rates of depression are the same between the sexes, and then in late adolescence, early 20s and 30s we see twice as many women with depression. Monthly hormonal changes, pregnancy and the postpartum period are factors, as is seasonal affective disorder (SAD), a condition triggered by lack of sunlight that seems to have a biological component and affects women more often than men.
If I’m depressed, shouldn’t I feel sad or cry a lot? I haven’t felt or done either of these things.
It’s true that a deep feeling of sadness is the hallmark symptom of clinical depression, but there are other signs that signal the condition, including: overeating, lack of appetite, insomnia, excessive sleep, crying easily, irritability, persistent aches and pains, cramps or digestive problems, weight loss, loss of interest in activities that you once enjoyed (including sex), feelings of emptiness and/or guilt, difficulty concentrating or making decisions, thoughts of or attempts at suicide. Another way to look at this: ”If you think you’re depressed, you probably are. So get help,” says Michael F. Roizen, MD, chief wellness officer of the Cleveland Clinic’s Wellness Institute.
Why did it take so long for me to figure this out?
Depression has many faces. So if you’re not familiar with all the ways a person can experience depression, it’s easy to chalk your symptoms up to insomnia or feeling overwhelmed due to stress, lack of sleep or an inability to cope, for instance. The reality is that just like diabetes or heart disease, clinical depression is a very real illness that involves brain chemicals called neurotransmitters. The relationships of neurotransmitters — including dopamine, serotonin and norepinephrine — and mood disorders is complex. All of these neurotransmitters influence and regulate one another, and affect things such as mood, appetite and sleep.
What caused my depression?
Genetics can play a role, meaning you can inherit a predisposition toward depression. Depression can also be triggered by a traumatic life event, illness, a brain tumor and medications. Even low vitamin D levels have been associated with an increased risk for depression. The condition also tends to occur with or following other illnesses, such as anxiety disorder, social phobia, obsessive-compulsive disorder, and alcohol and drug dependence.
Won’t the depression eventually lift if I just give it some time?
When it comes to clinical depression, time doesn’t do such a great job at healing since you’re dealing with levels of brain neurotransmitters that essentially need to be boosted. When you think that you can work it out on your own, you only prolong your suffering. People also sometimes delay seeking help for their symptoms for fear of being labeled with a mental illness or appearing weak. But in the past decade, more people have gotten the message that depression is a bona fide illness and are being proactive about getting treatment, sharing their diagnosis with friends and family, and talking about the medications they take or the therapist they go to.
How do I know if it’s really depression and not just the blues?
Your health-care provider can help you determine this, or recommend a person who can. The American Psychiatric Association explains the difference this way: Sadness, grief or a case of the blues, in response to job loss or miscarriage, for instance, will often lessen over time and are often described as mild, rather than moderate or severe. But the disabling symptoms of clinical depression carry a much bigger emotional weight and can continue for months or even years if left untreated. Not treating depression also puts you at increased risk for other diseases, including diabetes and heart disease.
Isn’t there anything I can do on my own?
Anyone — whether they’ve been diagnosed with severe clinical depression or suffer from occasional mild bouts of sadness — will benefit from incorporating certain lifestyle habits that support emotional health and well-being. “Our bodies and brains communicate with each other. So what you do for one affects the other,” says Elizabeth Ricanati, MD, who founded the Cleveland Clinic’s Lifestyle 180 program. “This is good news! Symptoms of depression or anxiety can positively improve with an increase in physical activity, talk therapy and practicing stress-management techniques such as meditation and yoga.”
What are the go-to medicines docs prescribe for depression?
Docs have a few types of medications they use to treat depression. The most popular are a class of drugs called selective serotonin reuptake inhibitors (SSRIs), which are thought to work by blocking the reabsorption of serotonin, thereby leaving more of the feel-good hormone available to you. Brands include Prozac, Zoloft and Celexa. Effexor and Cymbalta are slightly different and in a class called serotonin norepinephrine reuptake inhibitors (SNRIs). Everyone responds to meds differently, so it’s essential that you work closely with your doc on finding the right drug and dosage for you and to be patient. Noticeable changes can take two to three weeks.
If lifestyle changes like regular exercise are so helpful in combating depression, why even take medication?
For some, the symptoms, such as feeling constantly overwhelmed or lacking any motivation to do everyday tasks such as getting the kids ready for school, are greatly helped with the use of medication. In fact, in a survey done by the American Psychological Association focusing on adults who reported high levels of stress, many were aware that exercise and good nutrition were two effective tools for reducing stress, but nearly half of the female respondents in this survey said they lacked the time and/or willpower to actually do these things. Taking medications is what makes it possible for some to incorporate supportive lifestyle habits “and at the same time, these lifestyle habits can increase a drug’s effectiveness,” says Dr. Ricanati. “Eventually, for some people, these lifestyle habits can replace medication altogether.”
Will vitamin supplements help?
In several small studies, low intake of the omega-3 DHA (docosahexaneoic acid) was associated with depression and mood disorders. One form of omega-3 in particular, called eicosapentaenoic acid, or EPA, has been shown to improve symptoms in those who did not respond to antidepressant medication. The American Psychiatric Association recommends adults with depression take fish oil supplements. Fish oil is “the elixir for the 21st century,” says George Tesar, MD, chair of the Psychiatry and Psychology Department at the Cleveland Clinic. Omega-3s improve the cell-to-cell communication in your brain that the feel-good hormone serotonin depends on to work effectively. Talk to your doctor about how much you should be taking per day.
Isn’t there a connection between too little vitamin D and depression?
Yes, too little vitamin D in the blood can be associated with mood disorders. As many as 75 percent of American adults and teens are D-deficient. You can ask your doc for a “25-hydroxyvitamin D” blood test to find out what your levels are. In the meantime, start supplementing, says Thomas Morledge, MD, of the Center for Integrative Medicine at the Cleveland Clinic, who recommends aiming for 1,000 IU daily. You can find D in food, too, such as fortified milk (a glass has about 100 IUs of D) and fish (a 3.5-ounce serving of salmon contains 360 IUs). Ten minutes of sun (sans sunscreen) is also a good source of vitamin D. (In northern climates during the winter months, the sun isn’t strong enough to help the body produce D, so supplementing is key.)
Are there any other vitamins or minerals I should focus on to combat depression?
Too little vitamin B12 and folic acid in the diet has been associated with depression. Low magnesium levels have been associated with anxiety and PMS. So talk to your doc about whether she recommends additional supplements outside a daily multivitamin. While many foods, such as cereals, are fortified with B12 and folic acid, when it comes to magnesium 85 percent of Americans get less than the daily dietary recommendation for this mineral. Magnesium is also found in such foods as pumpkin and sunflower seeds, halibut, spinach and almonds.
What other dietary changes should I consider?
In the past 150 years, the American diet has changed dramatically and now includes far less fish, wild game and plants and much more saturated fat and processed foods. Doctors believe that this change in eating has created a constant state of inflammation in our bodies, which is triggering chronic disease, including rising rates of depression.
But how does inflammation breed depression?
Blame it on cytokines, which are released by the body when inflammation is present and can trigger symptoms of depression. What you can do: Start eating a diet that lowers inflammation and focuses on fruits, vegetables, 100 percent whole grains, legumes and omega-3-rich, such as wild salmon, sardines and tuna. Although there is no specific diet that can fight depression, a healthy diet can help decrease inflammation and have beneficial effects that we are just beginning to understand.
Can acupuncture treat depression symptoms?
Clinical trials have shown acupuncture to be as effective as antidepressants without negative side effects. One study involving participants who underwent an acupuncture session, followed by a PET brain scan, showed a significant increase in output of the feel-good hormone serotonin. “Practitioners of acupuncture believe that depression and anxiety can be triggered by an imbalance of chi, which is the balance and flow of energy in your body,” says Tanya Edwards, MD, MEd, of the Cleveland Clinic’s Center for Integrative Medicine. “I regularly recommend acupuncture to treat depression, as well as anxiety.”
Will exercise improve my depression?
“Exercise is the best type of antidepressant around,” says George Tesar, MD, a psychiatrist and the chair of the Psychiatry and Psychology Department at the Cleveland Clinic. In a national study, 60 percent of adults who exercised regularly experienced fewer episodes of depression and anxiety compared with folks who didn’t exercise at all. Physical activity releases neurotransmitters (brain chemicals) that make us feel better by inducing a relaxed state and distracting us from stress. The key is to exercise regularly, as in five or more days per week for at least 30 minutes.
But what if I can’t even find the motivation or energy to get out of bed?
“Start by getting out of bed and putting one foot on the floor,” says Dr. McKee. The next week do the same and add the other foot. If you haven’t already, starting on a prescription antidepressant can, within a matter of weeks, help lift your mood and give back to you the motivation so you can again accomplish your daily activities.
What type of workouts are the most effective for combating depression?
Whatever exercise you enjoy doing the most is a great place to start. For overall fitness, which also can be a great mood booster, create a workout that incorporates moderate to vigorous cardio and resistance training over the course of the week. So you might go for a brisk walk or a light jog or bike on one day, and then devote 30 to 45 minutes the next day to resistance training that works individual muscle groups (weight lifting, gardening, sit-ups). In one Australian study involving older adults with depression, those who incorporated resistance-training sessions three times per week saw significantly reduced symptoms of depression after 10 weeks.
I like to move at a slower pace. Is there any hope for me?
Yes, yoga! A 2005 German study had 24 women self-described as emotionally distressed take up yoga twice a week for 90 minutes each session. The results: After three months their anxiety, stress, fatigue and depression levels improved significantly, along with their energy and sleep. The possible link? Researchers from the Boston University School of Medicine found that yoga boosts levels of a neurotransmitter known as gamma-aminobutyric (or GABA), which is linked to both depression and anxiety.
Is there anything else I can do?
Find your inner om. A 2009 pilot study found that mindfulness meditation helped reduce symptoms of depression. By recognizing thoughts and feelings as they’re happening and then consciously deciding to let them pass and bring your attention back to the present, you empower your mind. Sounds so simple, and yet is so powerful.