In the 1990 Global Burden Disease study, depression was listed as the fourth largest cause of disability worldwide. In the 2000 study, it was third. In the 2010 study, second. Perhaps a third of Americans will eventually get clinically depressed. It’s also hitting younger ages. Recent surveys point to perhaps 17% of American female secondary students showing considerable symptoms of depression. And the large majority of people with depression don’t get any kind of treatment.
It’s time to push prevention.
Among clinicians, there’s a general sense that prevention of depression is not feasible. Much of the public expresses surprise at the entire notion.
With rates this high, and treatment this scattered, here’s a few suggestions for helping both the child and adult population, and individuals:
1. Light. In most studies, the more sunlight a city or area gets, the less its rate of clinical depression. Numerous studies treating depression with light now find it more successful than anti-depressants – including for people without seasonal depression, where lack of light is the presumed cause. An extended part of the sunbelt’s increase in population over the last five decades may be related to light rather than warmth – up to half the AMerican northeast experiences low moods in winter.
What To Do: Get a minimum of half hour of sunlight in the morning. It can be outside (best) or inside through windows. Morning light works better than evening light for improving mood. If sunlight – and darkening, cloudy days can work particularly in conjunction with exercise (see below), light boxes are relatively cheap and effective. They also generally lack cancer inducing UV light. Put a light box 14-22 inches away at a 45% degree angle for a half hour during any activity – exercising, eating breakfast, reading – and you may have a good preventive of depression.
2. Exercise. A recent pooled analysis study, reported by Gretchen Reynolds in the New York Times, looked at aerobic fitness as a better indicator of exercise than self report. People in the lowest tertile were about 75% more likely to have a depressive diagnosis than those in the top third. Other studies argue that moderate to vigorous exercise does best in treating and preventing depression.
What to Do: Walk 30 minutes every day, preferably outdoors in the morning to get the added advantage of sunlight. Though the data are not yet in, it looks like high intensity interval training may be more effective. One trick is to walk the first 50 seconds of a minute moderately, the last ten as fast as you can.
Will other exercise work? Running may do better than walking at preventing depression. Ditto biking, especially if it feels fast – for you. Exercising inside should be aided by additional light, either through a window or with a lightbox.
3. Social Support. People with lots of colleagues, acquaintances, friends, interested co-workers, have a lot less overall depression.
What To Do: Recognize that social engagement and support are a critical factor in human health, and let schoolkids and teachers know it, too. That means real contact – face to face, engaging direct emotional engagement and support. Social support is particularly effective not just in depression, but in preventing heart disease. People should also know that more connections = less heart attacks and strokes, in some studies cutting the rates more than half. Trust me, you won’t hear that from cardiologists.
Humans seem to top out at about 140 people with whom we can keep relatively frequent/close contact, but much of the population never approaches that number. Some surveys claim a quarter of adults feel they have no real friend. Many students today feel bullied.
The jury is still out on social media. Many younger kids find the curating function of social media highly stressful, not supportive.
4. Cognitive behavioral techniques. In a time of self-treatment, it’s surprising how little attention CBT gets in classes from middle schools to universities. Looking at the world relentlessly in terms of solutions rather than problems should fit the traditional American “can do” spirit. So why don’t we teach it and use it?
What To Do: Every evening for three minutes write down one to three problems, and short prescriptive solutions for each – always emphasizing solutions. Then, the next time, evaluate what worked and did not work – trying to come up with the next series of approaches. Getting professional help on this can also help – a lot.
Three minutes may seem like a lot of time, but CBT effects can generalize, making for a new outlook on getting through everything you face.
Depression is a major problem worldwide. It’s getting worse. It’s mostly not treated. When treated, much of the treatment is ineffective.
It’s time to try out population and individual efforts that prevent depression, using the body’s native biological intelligence to thwart what may soon be the biggest cause of health disability in the world.