In the 1990 Global Burden Disease study, depression was listed as the fourth largest cause of disability worldwide. In the 2000 study, it came in third; in the 2010 study, it was second. Perhaps a third of Americans will eventually become clinically depressed. It’s also increasingly affecting younger people. Recent surveys show that perhaps 17 percent of American female secondary students show 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.
Matthew J. Edlund M.D. researches rest, sleep, performance and public health, and is the author of Healthy Without Health Insurance, The Power of Rest, The Body Clock Advantage, and Designed to Last; his previous articles can be found at therestdoctor.com.
Editor: Arman Ahmed
Among clinicians, there’s a general sense that prevention of depression is not feasible. Much of the public similarly expresses surprise at the notion. But with rates of depression this high, and treatment so scattered, we should consider these four suggestions for helping people of all ages prevent depression:
In most studies, the more sunlight a city or area gets, the lower its rate of clinical depression. Numerous studies of treating depression with light now find it more successful than anti-depressants—including for people without seasonal depression, for which lack of light is the presumed cause. An extended piece of the Sun Belt’s increase in population over the last five decades may be related to light rather than warmth: Up to half the population of the Northeastern United States 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 your windows. Morning light works better than evening light for improving mood. Light boxes are relatively cheap and effective; they also generally lack cancer-inducing UV light. Put a light box 14-22 inches away from your face at a 45-degree angle for a half hour during any activity—exercising, eating breakfast, reading.
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 of the results were about 75 percent more likely to have a depressive diagnosis than those in the top third. Other studies suggest 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 is not conclusive, it appears that high-intensity interval training may be even more effective. One trick is to walk the first 50 seconds of a minute moderately, and the last 10 as fast as you can. Will other exercise work? Running may be better than walking at preventing depression. The same is true for biking, especially if it feels fast—for you. Exercising inside should be aided by additional light, either via a window or a lightbox.
3. Social support.
People with more colleagues, acquaintances, friends, and 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 schoolchildren and teachers know it, too. That means real contact—face to face, engaging direct emotional engagement and support. Social support is effective not just in warding off depression, but in preventing heart disease as well. More social connections may lead to fewer heart attacks and strokes—in some studies, the rates were reduced by more than half.
Studies show that 140 people is the maximum number with whom we can keep relatively frequent close contact, but much of the population never approaches this number. Some surveys claim that a quarter of adults feel they have no real friend; many students today feel bullied. The jury is still out on social media: Many young people 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 cognitive behavioral therapy(CBT) receives, especially for students. 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. The next time, evaluate what worked and didn't, to try to come up with the next series of approaches. (Getting professional help on this can be beneficial.) Three minutes may not seem like a lot of time, but CBT effects can generalize, making for a new outlook on getting through everything you face.