How does the medical community tell us to prevent depression?
January 18, 2011 1:02 PM   Subscribe

What, if any, is the current generally accepted method for preventing depression?

Ideally I'd like to know what the medical community (psychiatrists, medical doctors, etc) has to say about it, but I'm open to layperson suggestions too. There is lots of info out there for treating it, but I'm more interested in the gen about stopping it from happening in the first instance. (Googling just leads me to places like WikiHow.)
posted by Solomon to Health & Fitness (18 answers total) 39 users marked this as a favorite
It's my understanding that regular light exercise helps treat and prevent depression. Not a silver bullet, and I don't have any studies to link to. So this is layperson suggestion territory.
posted by jsturgill at 1:08 PM on January 18, 2011 [2 favorites]

Best answer: The thing is that there are multiple etiologies hypothesized for depression (and there may actually be different etiologies for different people experiencing depression). So preventing it would have to include addressing each potential etiology, from stressful or painful experiences to imbalance of the serotonin reuptake mechanisms to genetic predisposition factors.

Or do you mean preventing or forestalling a depressive episode in an individual who has been diagnosed with depression? In which case, there are cognitive approaches, psychopharmaceutical approaches, and lifestyle approaches out there.
posted by Sidhedevil at 1:08 PM on January 18, 2011 [3 favorites]

Sidehdevil has it on the button - and the add to that, it's likely that there are multiple causes in the one person. So you could have a predisposition to depression, have certain factors in your upbringing that make depression more likely, and finally have an episode triggered by a particular event (note that this is all hypothetical given that we don't really understand it right now). In that sort of situation there wouldn't be one thing that would prevent depression - various factors come into play as to whether the storm hits or doesn't.
posted by Coobeastie at 1:12 PM on January 18, 2011

Are you interested in how people with a history of depression keep from relapsing? Or in how people who have never had a depressive episode can avoid getting depressed in the first place?
posted by nebulawindphone at 1:27 PM on January 18, 2011

This is based on my own experience and that of friends and family members.

I think that a person who's prone to depression can benefit from all the non-medicinal things that can help once depression has taken hold.

Exercise, talking (especially with a therapist), having a creative outlet, not being isolated. Once a depressed person is feeling well enough, it's time to address various coping problems and learn new strategies. It would be really helpful to learn that stuff earlier on: things like setting boundaries, getting better at dealing with difficult people, improving communications with partner and family members. If you learn how to deal with parts of life that burn you out, stress you out, make you tune out, I believe it'll improve your psychological health.
posted by wryly at 1:41 PM on January 18, 2011

You might want to look at the research on gratitude.

Gratitude has been said to have one of the strongest links with mental health of any character trait. Numerous studies suggest that grateful people are more likely to have higher levels of happiness and lower levels of stress and depression.[29][30] In one study concerning gratitude, participants were randomly assigned to one of six therapeutic intervention conditions designed to improve the participant’s overall quality of life (Seligman et. all., 2005).[31] Out of these conditions, it was found that the biggest short-term effects came from a “gratitude visit” where participants wrote and delivered a letter of gratitude to someone in their life. This condition showed a rise in happiness scores by 10 percent and a significant fall in depression scores, results which lasted up to one month after the visit. Out of the six conditions, the longest lasting effects were caused by the act of writing “gratitude journals” where participants were asked to write down three things they were grateful for every day. These participants’ happiness scores also increased and continued to increase each time they were tested periodically after the experiment. In fact, the greatest benefits were usually found to occur around six months after treatment began. This exercise was so successful that although participants were only asked to continue the journal for a week, many participants continued to keep the journal long after the study was over. Similar results have been found from studies conducted by Emmons and McCullough (2003)[14] and Lyubomirsky et. all. (2005).[30]
posted by Brent Parker at 2:14 PM on January 18, 2011 [14 favorites]

What, if any, is the current generally accepted method for preventing depression?

Sad to say, there isn't one.
posted by Chocolate Pickle at 2:19 PM on January 18, 2011 [1 favorite]

Best answer: I probably should amplify that.

One reason is that "depression" is an omnibus term referring to a set of symptoms, but there seem to be a large number of different underlying causes.

In some people it can be caused by a major life-trauma e.g. losing a spouse. For such people it's a once-only event, but the only way to prevent it is to prevent the trauma which induced it.

For some people it's a cyclical thing. There is, for instance, Seasonal Affective Disorder, and in this particular case there is a pretty straightforward way to prevent it. Such people become depressed as the days become short, and if they spend a couple of hours in the evening reading under powerful lights, their depression doesn't occur.

Some cyclical depression is cased by various versions of bipolar disorder. The cycles can be years long, or in the case of "fast cyclers" can be months, or even days. No one knows why this happens, and no one has any idea how to prevent it.

And given the wildly different way that different people respond to drug treatments, it's entirely possible that even "bipolar disorder" is a collective term for a large number of unrelated diseases. A drug which is a miracle for one person can be living hell for another, and have little or no effect one way or the other to a third.

If you get into treatment, the only real way to figure out which drug can help you is to try different ones, often for months at a time. There are a lot of people out there whose therapists have come up with one or more drugs which collectively prevent any future bouts of depression. But the search can take years, and there are no guarantees.

Finding an effective treatment for any given patient is more art than science. No one knows how the drugs work. We know what kinds of underlying biochemical changes that most of them induce (e.g. to raise levels of monoamine neurotransmitters) but no one knows why that makes any difference.

That's because no one has yet identified the actual physiological changes which are implicated in depression. if someone tells you that they have a sure-fire way to prevent your depressive episodes, they're probably peddling snake oil.
posted by Chocolate Pickle at 2:34 PM on January 18, 2011 [3 favorites]

In my experience, intentional gratitude and optimism are key to preventing depression. Likewise, exercise and adequate hydration.
posted by dchrssyr at 2:42 PM on January 18, 2011 [2 favorites]

Best answer: What, if any, is the current generally accepted method for preventing depression?

As a life-long sufferer of depression, my initial response is "It depends on what you mean by depression." I'm not being flippant. In our culture, there's a whole lot of situational and transient sadness/unhappiness that gets labeled as "depression". I suspect a lot of this can be staved-off by many of the techniques others have mentioned. Chief among those, imho, is regular exercise.

Now, for someone in my situation, some of those techniques can (and do) help alleviate some of the outward manifestations of depression. Exercise, again, lifts my energy levels and allows me to operate in polite company on an almost even keel. Exercise does nothing, however, for the deep, underlying monster of depression. It's more like a coat of fresh paint on rotten timbers.
posted by Thorzdad at 2:46 PM on January 18, 2011 [7 favorites]

Yeah, a prevention strategy for depression is like a cure for cancer. In both cases, the disease is just too heterogeneous to have a single prevention or cure strategy. A former colleague of mine spent most of a year profoundly depressed, because his wife of 31 years had retired to bed with a migraine and apparently died in her sleep -- he found her six hours later, lifeless. That's a pretty good reason to be depressed, and the only real "prevention" strategy would have been to have his wife not die in the first place.

I have biochemical depression, and until recently, I thought I was going to be on SSRIs forever. What I've discovered is that cognitive behavioral strategies, regular vigorous exercise, and staying away from refined sugar in giant doses keep my depression in check as well as 50mg of Zoloft does. But my depression was always pretty mild unless triggered by circumstances, like lack of sleep or sexual assault; in the presence of other stressors, I pretty much go to pieces, exercise or no.
posted by KathrynT at 2:58 PM on January 18, 2011 [2 favorites]

As far as the biggest maintaining factors of depression (the negative thoughts that maintain cycles of negative feeling, and social isolation), here are the two things that my experience tells me are critically important:
1) The ability to be resilient and flexible when bad things happen, and
2) A strong, consistent support system (family, friends, doesn't matter--just people who are supportive).

As far as pure chemically-based depression, there is not really a hard-and-fast answer, because people who exercise regularly and get spectacular nutrition can still get depressed.
posted by so_gracefully at 4:21 PM on January 18, 2011

1) Do not inherit two copies of the short version of the serotonin transporter gene, and ideally, inherit the long-long phenotype. I'm not saying this is actually possible to control in any real way, but in a theoretical sense it's one of the few things the psychiatric community might agree on as a factor that would absolutely lower your lifetime risk of depression. Even so, people without the short-short phenotype still get depressed.

2) Exercise. Pretty solid research on this, although the bulk of it approaches exercise as a treatment and not a preventative measure, but there is good reason to think it would be preventative, since it alters physiological factors contributing to positive mood in most people. Type and intensity matter.

3) Get married*, regularly attend church or some other social group that meets often, especially to work on projects, etc. Statistically people that do those things get less depressed than people who don't. The link is not causative.
*unless your relationship is bad, in which case a bad marriage would increase your risk for depression.
posted by slow graffiti at 4:36 PM on January 18, 2011 [1 favorite]

I think everything David Burns says in Feeling Good is applicable to everyone all the time.

Be kind to yourself. Be gentle with yourself. Don't minimize your accomplishments and better qualities, and don't over-emphasize your failings. When you don't have all the facts, stay neutral (optimally: stay optimistic) instead of deciding that everything's automatically going to shit and everyone hates you.

I've personally been stealing all of the harm reduction principles that work so well for disease prevention/reduction with regards to drug use and safer sex. If I were an injection drug user, that might mean using just as many drugs but using my own clean needle every time. Withdrawal is much more difficult than finding clean new needles, so do that part.

Since I'm prone to depression and self-judgement, I say things like "Well, maybe in a perfect world I would be able to do ABCDEFGHIJKL, but I'm actually only able to do AB, and so that's what I'm going to aim for today. And then I'll be proud of myself for that!" This gets me much farther than aiming for perfection. Zero tolerance feeds depressive thinking.

Then I have small successes, which may spur me on to doing CDE and then FGHI and then JKLMNOP and suddenly I'm done! Who knew! But even if I go back to doing AB, CD, E, F, GH... that is still okay. That is what I can do today. I take the harm reduction stance that working within my limits is a healthy and responsible way to approach my life, not a failure.
posted by heatherann at 5:43 PM on January 18, 2011 [6 favorites]

Exercise. Kinesthetic activity is good for the body and soul. Use an mp3 player and do something you enjoy. I've biked 5-6 times a week for years.

I also swear by brewer's yeast, full of B vites, to keep a positive emotional outlook and to keep energy levels high. It's available at GNC in powdered or pill form.

Do something to help others. Volunteer. Smile at all you meet.
posted by ragtimepiano at 6:55 PM on January 18, 2011

Best answer: Sad to say, there isn't if someone tells you that they have a sure-fire way to prevent your depressive episodes, they're probably peddling snake oil.

Have you actually read any literature from real psychologists about preventing depression? Have you ever seen anybody make such a claim? Do you think this is what the OP was even talking about when asking about 'generally accepted' methods - a 'sure-fire', magic bullet guarantee? I mean, I've seen some straw men in my time, but wow.

Solomon, there's a growing body of evidence that cognitive behaviour therapy, when delivered as a targeted (selective / indicated) rather than universal program, can result in a measurable (though small to moderate overall) improvement in the risk factors linked with depression and reduce symptoms associated with an eventual diagnosis of depression.

Obviously, depression is complex, and various factors (age, depressed parents, culture, gender) will affect the efficacy of such programs on a case by case basis. But overall, you probably wouldn't be wasting your time learning how to adjust your mental models to improve your chances of better managing the various factors that can contribute to an eventual diagnosis of depression.
posted by obiwanwasabi at 9:19 PM on January 18, 2011

Response by poster: There are some very interesting responses here folks, thank you.

To answer some questions:

nebulawindphone said: "Are you interested in how people with a history of depression keep from relapsing? Or in how people who have never had a depressive episode can avoid getting depressed in the first place"

Both. I would imagine that a given situation would require quite a different method of prevention that the other. I realise that X cause will require X-a and X-b treatments, where Y cause would require Y-a treatment. I'm trying to find out what one can do to increase one's resilience or "depression immune system". Of course, if one is genetically disposed to depression, there's not much one can do, whereas with something like SAD, vitamin D supplements might be helpful.
posted by Solomon at 11:37 PM on January 18, 2011

Best answer: I found this graph based on survey of a internet depression community to be quite interesting.

I'm sure there may be be statistical / scientific issues with this, but I was surprised at just how effective exercise is, and how useless alcohol is. At the very least it offers some ideas on the range of treatments being used.
posted by spongeboy at 2:40 AM on January 19, 2011 [2 favorites]

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