How to Prevent and Manage Depression

Studies consistently show that episodes of depression can be prevented even among people who have already suffered at least one episode of the disorder. Many factors contribute to bringing on a bout of depression, and it takes attention to many elements to depression-proof yourself.. There are lifestyle factors, such as diet and exercise, that play important biologic roles. Styles of emotion management and expression can contribute to susceptibility to depression or protect against it. Relationships carry great weight in mental life, and creating healthy relationships is one bulwark against depression. There are patterns of thinking and sets of beliefs that can pave the way for depression, and changing them—an aim of Cognitive and Behavioral Therapy (CBT)—can put a brake on depression. Having meaningful goals in life is a powerful antidepressant, and taking practical steps towards them is an evidence-based way of not only preventing but reversing depression.

A family history of depression raises the risk of the disorder, but it does not make it inevitable or even likely. There are many steps that can be taken to minimize the risk or avoid depression. In most cases it isn’t clear exactly what it is that’s transmitted in a family that creates susceptibility. Yes, there may be patterns of genes that lower the threshold for disorder, but families also tend to transmit to their children many mental habits that later influence susceptibility to difficulty. For example, the adults may have pessimistic thinking styles and fatalistic beliefs that get transmitted with every explanation they provide; they may have a positive or negative orientation to the future, or they may have difficulty mounting an effective approach to problem-solving. So too, there might be habits of handling emotions, especially negative feelings, that could pose problems later on in life, especially in the face of difficult experiences. Of the many traits that families pass on, many can be examined and modified as needed.

There are situations and experiences that raise a person’s risk of depression. Chief among them are abusive or chronically conflicted relationships, loss of a relationship or job or anything of significance, and major setbacks or disappointments in any realm of life. While the death of a spouse or the loss of a job may not be under anyone’s control, such situations can be met with the recognition that extra self-protective measures are needed—a heavy dose of self-care, including adequate sleep and exercise; extra emotional support from others; even help with the chores of daily living. Relationships are almost always open to improvement, and professional counseling can be very helpful.

There are also individual traits that create risk for depression. Chief among them are patterns of negative thinking and coping with emotions, particularly in response to difficult experiences. All of them can be changed, with attention and practice, and doing so is one of the main goals of Cognitive and Behavioral Therapy. While it may not be possible to change the amount of stress one is regularly subjected to, it is not only possible but desirable to change ways of perceiving and handling stress. Meditation has become a highly popular practice in Western countries for a reason—it is an effective way of lessening reactivity to stress.

Experiences of abuse, neglect, and loss can set the stage for depression, as can personal setbacks and disappointments, such as failure to achieve one’s goals. Any high-stress situation—conflict with the boss, financial problems—can lead to depression if it lasts for a long enough period of time, creates feelings of helplessness, and overwhelms the ability to cognitively and emotionally digest the experience. Because humans are fundamentally social creatures, relationship difficulties, social rejection, and divorce, even when it provides relief from conflict, can precipitate depression. Isolation and loneliness are major risk factors, and while they respect no age or stage of life, are special problems among the elderly. Any chronic illness carries a higher-than-normal risk of depression, and so does sudden life-threatening illness, such as a heart attack or cancer diagnosis. Any of them—or even the memory of them—can trigger the downward spiral of negativity, hopelessness, and immobility that typify depression, but depression is never inevitable in any situation.

Changing ways of handling stress can go a long way to minimizing the risk of depression. In relatively brief bursts, stress is good, fostering alertness, learning, and adaptation. Severe or prolonged stress, however, dysregulates the normal stress response and impairs memory, learning, and general brain functioning; depression is consistently associated with the number of stressors experienced in life. Because some stress is inevitable and not within human power to prevent, maintaining mental health requires a wide array of coping skills, from the ability to articulate feelings to the ability to stay focused.

In addition, it’s possible to cut stress off even before coping skills must be deployed. Attitude plays a major role in the perception of stress. People who see stress as a challenge rather than as a curse recruit positive rather than negative emotions and do not experience the harmful effects of stress hormones on body and brain. Further, learning any of various forms of meditation can enable people to interrupt the automatic response patterns to stress that prove so harmful. Changing perception of stress, curbing reactivity to it by meditation, acquiring an arsenal of coping skills—all are ways of lessening the burden of stress and protecting against depression.

It is possible to choose your thoughts, and the most effective treatment for depression, Cognitive and Behavioral Therapy, is based on that proven possibility. It itemizes the kinds of self-defeating and negative thoughts that appear to be almost automatic in the wake of stress or setback and offers a number of techniques for refuting and rechanneling them. There are many kinds of negative thoughts that destroy mental energy, from all-or-nothing thinking to discounting positives to catastrophizing. For example, after getting turned down for a job you tried hard for, you might get into a funk by concluding ”I’ll never get a job.” But that is an illogical conclusion from one piece of evidence and hardly the only possible outcome. Learning how to stop negative thinking does not require therapy, but therapy offers a well-tuned systematic approach, the opportunity to catch thinking errors, and support for correcting them.

Studies show that one factor consistently associated with depression is the number and degree of major stresses experienced in life. Meditation provides a way of reducing reactivity to the stressful thoughts, feelings, and situations that are a major precipitant of depression. There are many styles of meditation, and meditation has been incorporated into many behavioral therapies for depression. Meditation slows down reaction so that it is not automatic, and it trains people to recognize that, however troubling thoughts and feelings are in the moment, they are not facts, they are transient, and they can be acknowledged without needing to be acted upon. Mindfulness is a popular form of meditation that teaches people to focus on the rhythm of their breathing while letting thoughts and feelings come and go. The goal is to detach people from their thoughts so that they can choose what to pay attention to, rather than automatically buying the negative thoughts of depression and being dragged down by them.

Increasingly, diet is recognized as an important influence on susceptibility to depression, and a recent study shows that an overall healthy diet works against even severe depression. Essentially, any diet that’s good for the heart is also good for the brain, providing a number of nutrients that play key roles in the operations of the nervous system. Numerous studies link traditional Mediterranean-type and Japanese-style diets with low risk of depression. Both eating patterns involve lots of fruits and vegetables, fish more than meat, oils rather than solid fats, and moderate to minimal dairy consumption.

In addition to a generally heathy diet, specific nutrients have been shown to confer depression resistance. Omega-3 fatty acids, found in wild-caught fatty fish such as salmon, maintain cardiovascular integrity and combat inflammation. Normally found in the brain in high concentrations, they make up the membrane of nerve cells and facilitate efficient transmission of nerve signals. They also reverse the nerve cell degeneration that is an effect of depression. Colorful vegetables provide antioxidants, which are especially needed by brain cells and also counter inflammation. Vegetables are also good sources of B vitamins, which play multiple roles in maintaining brain health and, as cofactors for enzymes involved in production of neurotransmitters, directly influence mood. Studies show that berries, with their high antioxidant content, contribute to brain efficiency and protect against neurodegeneration. Olive oil is another food that aids brain function.

Exercise is one of the most effective antidotes to depression. Engaging in simple activity such as walking immediately stimulates the growth of new nerve cell connections—the exit ramp from depression. In addition, engaging in any form of exercise restores a sense of control over one’s life. Studies show that even 15 minutes of physical activity daily can have beneficial effects on mood, energy, and sleep, and it works even in those genetically predisposed to depression. Because depression robs people of motivation and energy, it is important to start somewhere—doing anything is better than doing nothing— and to start small, beginning with a few minutes of walking. Establishing a regular sleep routine helps, as sleep normalizes many body functions disrupted by depression. Depression causes people to shut down; they lose interest in doing things and their world contracts, robbing them of needed sources of stimulation and pleasure. Therefore, doing things, including maintaining social contact—even when it goes against all instincts—brings about benefits on many levels. Sunlight is another antidepressant, and adequate sunlight exposure helps sustain mood.

While stress is a common trigger for depression, exactly what people find stressful can be highly individualistic, as is the capacity to tolerate stress. Stress tolerance is to a large degree under personal control, and the ability to withstand stress can be deliberately cultivated—from knowing how to summon resources such as social support to accessing problem-solving skills. It is also possible to down-regulate another significant trip-switch for depression—negative reactivity to negative experiences, whether romantic rejection or job loss. Such experiences may not be avoidable in life, but the downwardly spiraling patterns of negative thinking they typically set in motion, while they feel automatic and inevitable, can in fact be interrupted and countered, once awareness is drawn to them.

Depression often starts surreptitiously—a disturbance in sleep patterns, feelings of apathy or irritability, withdrawal from friends—and because these shifts all tend to worsen mood, it is the nature of the beast to beget a downward spiral of thinking and feeling and reacting until hopelessness and immobility are all-consuming. It’s possible to intervene but only by becoming aware of the early signals. Then it’s important to quickly engage some countermeasures—which often means fighting the powerful desire to do as little as possible. That is one of the paradoxes of depression: It pulls you away from the very things that will actually make you better. Here’s where reaching out to a support network can be critical. And forcing yourself to take a 10-minute walk. If you find your mood cratering often enough, you might want to make a list of things to do when that happens and stick it on the refrigerator door, or slip it into your sock drawer for ready access when you need it.

Without exception, one of the goals of treating depression is to prevent future episodes, and that is why Cognitive and Behavioral Therapy is so effective, even for those at high risk of relapse: It teaches ways of stopping the negative thought patterns that feed on themselves to drag people down into depression. The more episodes of depression a person has, the more that negative patterns of thinking take on a life of their own and become automatic. Significantly, the same techniques that therapists teach are available for anyone to deploy—the trick is being able to step out of the thoughts as they’re occurring, becoming aware of them and their oppressive effects, and then opposing them. Studies consistently show that stopping negative rumination is one of the most powerful tools for relapse prevention. So is taking steps to resolve situations that can engender despair, such as chronically conflicted relationships.