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I seem to get depressed about things more than my friends do. What can I do about it?
A patient recently asked me this question. At some point, everyone gets depressed - for instance, when a relationship ends or we lose a loved one or a job. Usually, these feelings are short lived, lasting a few minutes, hours or days. But millions of people have symptoms that persist for longer.
Rates of depression have been steadily increasing. Every year, about 10 percent of Americans, including about 17 percent of adolescents and young adults, have what is known as major depression - when significant symptoms last at least two weeks. About 8 percent of us will experience major depression, and about 6 percent will suffer from milder but longer-lasting depression, known as dysthymia. Depression prevalence is higher among women and people who have less education or have never been married.
Symptoms can vary from mild and passing to severe and disabling, including loss of appetite, energy, concentration and ability to enjoy life. Depression can also interfere with our immune system, leading to infections and other medical problems such as cancer.
Depression results from a combination of biological and environmental factors. Many people have genetic predispositions, probably involving many different genetic variants (more than 100 have been identified). Various medical conditions, including heart disease, cancer and certain infections, can also trigger symptoms. Life stresses and how we respond to these play crucial roles, too. - - - Ways to cope with depression
Luckily, for many people, depression can be prevented and treated. Here are some ways to address and cope with it.
Exercise. Physical activity is critical, partly because it releases endorphins - healthy opiates that our body makes and that improve our mood. The more exercise, the better: Risks of depression decrease more with exercise over 150 minutes per week than with exercise less than 150 minutes per week. But even relatively short periods of exercise - of only 10 to 20 minutes - can help.
Eat a healthy diet. Several studies have suggested that a Mediterranean diet may reduce the risk of depression. Such diets emphasize, for instance, fruits, vegetables and olive oil, rather than dairy products. Unhealthy diets containing too much junk food and sugary snacks can also cause obesity, which precipitates other medical problems and consequently stresses that can contribute to depression.
Avoid extra weight. Obesity can lower self-esteem and can cause heart disease and diabetes that, in turn, can worsen mood.
Get adequate sleep. Getting sufficient rest assists our body in countering stress. Good sleep hygiene, such as avoiding caffeine late in the day, benefits many of us.
Limit drug and alcohol use. Alcohol and recreational drugs may make us feel jubilant momentarily, but they foster depression over the long run. A vicious cycle can ensue: Drinking makes us depressed, which leads us to drink more, which lowers our mood even further.
Deepen social connections. Depressed people tend to engage in negative thoughts - ruminating about past mistakes; wondering 'why me;' feeling isolated, unloved and unappreciated; and losing hope. Conversations with others can provide social support and helpful reality testing that reminds us that such gloomy emotions are commonly unfounded. Interactions with friends, including discussion groups, whether about books, art, gardening or other hobbies, are beneficial.
Reduce social media use. Social media can put us in touch with friends, which aids us, but it may also encourage "doomscrolling" or "doomsurfing." We may engage with social media to pass time when we could pursue other, far more beneficial activities such as exercise, mindfulness and seeing friends in person. And social media can fuel envy of others who seem to have better vacations or more fun than us. Such negative thoughts can spiral us downward.
Lower stress. Try to manage your time as best as possible. Avoid becoming overcommitted, without adequate time to decompress and care for your mental well-being.
Practice gratitude. Appreciate and acknowledge positive aspects of your lives - beautiful sunsets and flowers, loving relationships, good health and the extraordinary phenomenon of life itself. Such positive reframing gets us to avoid ruminations.
Explore mindfulness and meditation. Mindfulness helps us experience and appreciate the present moment, rather than letting our minds wander into bleak self-doubt. Even if only for a few minutes a day, these activities can be rewarding. Several apps, some of which are free, can help.
Believe in something greater than yourself. Strong religious or spiritual beliefs are associated with extra neuronal reserves that buffer against depression. Such beliefs do not need to be part of a traditional faith; they can simply reflect a "higher power" - something larger than ourselves, including an appreciation of nature, the universe, math, physics, art, music or literature.
Have a sense of meaning, purpose and goals. Having a goal and working toward it helps focus our mind and energy in positive directions, and it gives us a sense of accomplishment in achieving steps toward this endpoint, boosting our self-confidence.
Get regular medical checkups and pursue treatment for medical conditions. Various medical conditions such as thyroid disease, and allergy, blood pressure, birth control and other medications can impair our mood.
Consider psychotherapy and antidepressants. Speaking to a professional can help you explore some of the issues that can lead to depression. And selective serotonin reuptake inhibitors such as Prozac and Zoloft have helped millions of people to overcome and prevent recurrence of depression
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Robert Klitzman is a psychiatrist and director of the Masters of Bioethics program at Columbia University and the author of "Doctor, Will You Pray for Me? Medicine, Chaplains, and Healing the Whole Person."