Introduction
A staggering 1 in 5 Canadians reported experiencing significant depressive symptoms, according to a 2020 national survey; this increased to 1 in 4 during the COVID-19 pandemic. Despite the fact that the peaks of the pandemic are now behind us, many depressive symptoms continue to linger and negatively affect people’s lives.
Definition
Depression is a mental health disorder that is commonly associated with low mood, loss of pleasure in activities, and difficulties in sleep, appetite, concentration, and energy. While it is normal to feel sad from time to time (e.g., after a breakup), depression persists over time and is associated with a number of other symptoms. It also causes significant difficulty in completing tasks of daily living.
Symptoms are as follows:
- Feeling sad
- Loss of interest or pleasure in activities once enjoyed
- Changes in appetite/sleep
- Loss of energy
- Increase in purposeless physical activity (e.g. hand-wringing or pacing) or slowed movements and speech (actions observable by others)
- Feeling worthless or guilty
- Difficulty concentrating or making decisions
- Thoughts of death or suicide
These symptoms must last at least 2 weeks (for a formal diagnosis of depression, known as Major Depressive Disorder) and must not be accounted for by a medical condition. For instance, hypothyroidism can produce symptoms of low mood and decreased motivation, similar to depression.
Research has found that depression can present very differently depending on the person. However, at its core, individuals are more likely to have the following symptoms: feelings of sadness and guilt; reduced sleep and appetite; and a sense of hopelessness about the future. Anxiety is a common symptom that accompanies depression as well.
A different form of depression (Atypical Depression) includes those that have symptoms of weight gain and increased sleep. Another type of depression (formally known as Seasonal Affective Disorder) pertains to those who experience depressive symptoms seasonally (e.g., during the winter months). For certain women, they may experience depressive symptoms at certain points of their menstrual cycle or during the perinatal period (e.g., Perinatal Depression). In a smaller portion of individuals, they may experience alternating depression with manic or hypomanic symptoms (e.g., feeling elevated or agitated; hurried speech; racing thoughts; increased energy; increased plans/ideas).
Depressive symptoms can change over time and fluctuate in severity and frequency. Some individuals may experience depression over a period of several weeks, while others may find that it lasts for months. As another example, some individuals may wait years before experiencing another depressive episode, while others may have them more frequently.
Causes
There are usually a number of biological, psychosocial, and cultural factors associated with the development of depression, such as genetics, stress, medical conditions (e.g., chronic pain), and side effects of certain medications.
Risk Factors
Several risk factors for developing depression include childhood adversity, trauma, loss, unemployment, and social isolation. For those with long-term depressive symptoms, they are more likely to have a family history of depression and first onset of depressive symptoms prior to the age of 25.
Prevalence
According to the Canadian Mental Health Association, about 8% of adults will experience depression at some point in their lives, but almost half of those will not seek treatment.
Consequences
According to the World Health Organization, depression is the leading cause of disability worldwide. This may be surprising to hear, as the leading cause of disability is not due to a physical health issue like cancer or diabetes. Depression can lead to suicidality and difficulty completing daily tasks (e.g., bathing, making meals, attending work/school, leaving the house, seeing friends, etc.). Those who are depressed are also more likely to engage in the use/misuse of alcohol, cannabis, and illicit substances. Similarly, those with depression are more likely to also have an anxiety disorder.
Treatment
Despite the prevalence of depression being so high, there is hope. Depression is highly treatable and science has uncovered strategies that are highly effective. Here is a guide of helpful strategies to help manage depressive symptoms.
When mood is low, there is a tendency to get stuck and do the bare minimum of what needs to get done. If nothing needs to get done, it is likely that very little is going to happen until you “feel like it”. If you fall prey to that line of thinking, you could be waiting a long time! Not to mention, there is an increased chance that your mood could dip further.
Instead, you want to make a plan for the next day before you go to bed. It does not need to be overly ambitious but it should provide some structure your day. If you are working or going to school, this will help you to maintain structure and routine during the week. If not, it’s likely going to be harder to get moving. One of the worst things that can happen with mood is sitting idle for too long. We are happier when we are busier and active
The basics are never fun and often overlooked; however, they are very necessary and definitely not worth skipping over. The basics include drinking water, eating regular meals, and getting exercise. As an analogy, you would not run well if you were a car that did not have oil, gas, transmission fluid, etc. Humans are no different. To think that we can run properly without our main fuel sources like water, food and air (via exercise) is pretty unrealistic. By drinking enough water and choosing whole, low inflammatory foods, we can help to keep our energy up and regulate our emotions better throughout the day. Moreover, exercise in any amount can contribute positive benefits to your mental health.
So, you know you need to get moving as an initial cornerstone of any depression treatment plan. But simply put, you do not want to move. One way of getting started is to chunk time. For instance, complete an activity for just 10 minutes, and if you do not feel like continuing, you can stop. Likely, momentum will be on your side and you will be more likely to keep going. However, if you wait until you “feel good to do something” you’ll probably be waiting awhile, especially if you already feel depressed. In actuality, you need to commit to doing whatever it is you need to do, even if it’s for a short period of time, if you would intend to kick-start your depression treatment program.
How you carry and move your body is wired into your cerebral cortex. The cerebral cortex is a part of the brain that is responsible for higher level cognitive processes such as thinking, language, decision-making, etc. By making simple adjustments with your body, especially when done consistently, it can serve to improve mood. One example includes smiling (even fake smiling), which activates certain muscles of the face that can brighten your mood. Another example supported by research is talking in a higher tone with more intonation. In other words, a happier tone of voice is more likely to make people feel happier, while a sadder tone of voice makes people feel sadder.
Generally speaking, most people are in the habit of thinking about what they have to do and focusing on things that aren’t going well. Very little time, if any, is spent thinking about what’s going well. Not surprisingly, mood is negatively impacted with a thinking pattern like this. To help rectify this problem, try spending at least 5-10 minutes per day focusing on what is going well in your life. This can include, for example, your health, relationships, hobbies, and purposeful daily activities. Also, remember to always have something to look forward to in the future.
The goal here is not to challenge every single negative thought that enters your head, but rather, to take time when it’s available to address these thoughts. If you never take time to challenge your negative thoughts, you are more likely to accept them as true.
In order to challenge negative thoughts, first start by identifying them. Over the course of several days, it’s helpful to set aside 5 minutes each day and write down the most common negative thoughts you experience, including a rating for the frequency and intensity of the thought. This is called a thought record. The next steps include creating an exact definition for the thought, and determining if there is evidence for the thought being true or false. Generally speaking, you are going to find that most thoughts are primarily false.
On occasion, you may find that there is a little truth to a negative thought; that’s okay, but label it as such (“It’s just a little true in this case”). With this truth, it is okay to feel some guilt or other negative emotion from the thought. Use that negative feeling to learn a lesson, let go of the guilt, and resolve not to make the same mistake again. In the case where you cannot change the situation, learning acceptance is a key factor to moving on.
Mindfulness, also known as mindfulness meditation, involves being fully present in the moment. It is not only effective at treating mood, but it also happens to be just as effective as taking an antidepressant medication in many cases. Like exercise, any amount of mindfulness throughout the day can have positive benefits to your mental health. In addition, you can be mindful sitting, standing, jogging and even completing tasks.
The key is to get into a comfortable position and breathe slowly from your diaphragm. The goal here is to allow thoughts to come in and simply not to judge or engage them in any manner. Simply treat them as if they were thought bubbles showing up in a foreign language that you can’t understand. If you catch yourself drifting or engaging in your thoughts, no worries. Simply acknowledge that you are doing this and return your focus to slow, deep breathing.
Proper sleep is a key yet commonly overlooked factor to managing depressive symptoms. Here are some of the core components of a good night’s sleep:
- Have a sleep routine that includes at least a 1-hour “wind down period” before bed.
- Go to bed and wake up at the same time every day.
- Keep it dark.
- Keep it quiet (use white noise, or a fan if needed to block out distracting noise).
- Keep it cool.
- Avoid ruminating (excessive thinking about your past or upcoming day).
- Have an interesting thought to focus on (if you don’t fall asleep right away, you will need something to think about).
- Don’t toss and turn (if you aren’t asleep within 30-45 minutes, get up for 5-10 minutes to break-up the inevitable pattern of frustration that has likely set in).
- Do not check your phone.
- Do not put too much pressure on falling asleep (this will take you further away from relaxation, which you need to fall asleep).
Conclusion
When you do not feel good emotionally and your mood is low, little else can seem to matter. This article outlines several strategies you can use in a depression treatment plan. These strategies in an order you can utilize from the time you get up to the time you go to bed. Follow these strategies and it will put you on the fast-track to improving your mood.
Importantly, you may also want to work with a therapist/counsellor to learn additional strategies to help improve your mood. Research shows that people are most likely to attend therapy when their depressive symptoms are high; however, therapy can be helpful to you at any point. Similarly, working with a physician or psychiatrist for medication management can be helpful in some cases in treating depression, particularly those with more severe symptoms. However, to maximize outcomes, use a combination of the strategies listed above, in combination with therapy and/or medication (rather than simply medication alone).
Are you surprised by how many people struggle with depression? What strategies do you find helpful for improving your mood?