The question I get asked a lot is:
“how do you know it’s already depression and not just some bad mood?” And then there’s the next one that follows:
“what can I do to fight the bad mood and not let it transform into depression?”
The answer to the first one is pretty clear. Some indexes help us distinguish between the typical feeling of sadness or recurring worse mood and depression.
There are several key points a psychotherapist or a psychiatrist needs to recognize in the patient’s functioning to diagnose a depressive episode. Depending on where in the world you are, the list might be slightly different, but I’ll copy them here for your reference.
DSM 5 criteria for depression:
Depressed mood most of the day, nearly every day.
Markedly diminished interest or pleasure in all or almost all, activities most of the day, practically every day.
Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
Fatigue or loss of energy nearly every day.
Feelings of worthlessness or excessive or inappropriate guilt almost every day.
Diminished ability to think or concentrate, or indecisiveness, nearly every day.
Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
ICD 11 criteria for single episode depressive disorder:
"Single-episode depressive disorder is characterized by the presence or history of one depressive episode when there is no history of prior depressive episodes. A depressive episode is characterized by a period of depressed mood or diminished interest in activities occurring most of the day, nearly every day during a period lasting at least two weeks accompanied by other symptoms such as difficulty concentrating, feelings of worthlessness, or excessive or inappropriate guilt, hopelessness, recurrent thoughts of death or suicide, changes in appetite or sleep, psychomotor agitation or retardation, and reduced energy or fatigue. There have never been any prior manic, hypomanic, or mixed episodes, which would indicate the presence of a bipolar disorder."
It’s rarely a good idea to diagnose yourself. Suppose you’re feeling depressed, and you think some of the descriptions from the lists above apply to you. In that case, it’s best to seek professional help and consult a specialist with whom you can work.
Depression is a complex and multilayer condition, and it’s not my intention to go deeply into the areas of diagnosis in this article. But what’s really important to know is that depression may start in many different circumstances. It can happen after a life-changing event or a trauma, but it may also be a condition often present with some other physical illness. In many cases, you may not even understand why it’s happening at all.
There are situations when it’s virtually impossible to avoid a depressive episode, but it’s almost like with physical exercise. If you work out to gain strength – you’ll be able to lift heavier weights. Similarly, if you take care of your mental health, if your try and be mindful of what’s going on with you on a day-to-day basis, chances are should the episode appear, you’ll be healthier and better equipped to deal with it in the end.
This article is for you if:
you’re doing alright, but you’re trying to take care of your mental health,
you’ve experienced a depressive episode in the past, and you want to know what might work in the future,
you have swings of depressive moods coming back to you (you might be or have been in therapy before), and you want to find out how to work on your well-being.
So what exactly do you do?
Whenever I get asked the question about so to say ‘prevention’, I always answer the same. The first step is to acknowledge that our life is not a flat line. We experience ups and downs, days that are better, and then worse. Months even, when we might feel we’re confused – looking for a clue what’s next. There’s a whole range of emotions people experience, and it’s only natural. They all tell us something. What’s crucial is to be able to self-reflect. Feel the pulse of what’s going on. To do that you need to:
Know yourself – this one is worth starting with. We hear it from our patients constantly – people are not encouraged enough to learn who they are, what they like, and how to express themselves. Because of that, they might be making some unfortunate choices, feel lost and confused. What’s worse, a common notion in that is the belief they are the only ones feeling like that. The best and only way to approach this is to stay curious, and be mindful. Learn to discover yourself – through the world around you and with self-compassion. It might sound like obvious advice, but it is really the best way to start a relationship with yourself. Get to know yourself like you’d be getting to know somebody you love.
Be with people. We are social animals above all. Nothing beats a friend who cares for you and is willing to lend a hand and a listening ear. Too often, the lack of human connection is what deprives people of the sense of their humanity. Going out there, connecting, staying in the loop, sharing moments, situations laughs, and talking about the most ordinary things help you stay connected with yourself and feel you’re a part of something bigger.
Stay active: "Every single workout that you have will immediately cause the neurotransmitters’ levels – dopamine, noradrenaline, serotonin – to rise. This is your first added value – a recipe for a better mood right there. You’re also getting a better focus that will last" - claims Wendy Suzuki – the world-renowned neuroscientist. And that’s just the short span of it. Because according to neuroscience, you will also have long-term effects on your ‘good mood’ neurotransmitters (“The Big 3" – dopamine, noradrenaline, serotonin). And we are talking about one half an hour workout only! The same workout will also make your reaction time better. Suzuki says that exercise changes your brain’s anatomy, physiology, and function.”
Sleep well – Sleep may influence your mood. It’s a fact. What’s more, lack of sleep WILL affect your mood. “Sleep deprivation weakens the prefrontal cortex’s (where most of our reasoning is done) ability to control the amygdala (responsible for processing emotions), making it difficult to process and cope with emotions. When the brain is deprived of adequate sleep, it also struggles to concentrate and regulate growth and appetite. Sleep deprivation can have a profound effect on both the emotional and cognitive functioning of the brain. This results in bad moods, negative thinking, decreased empathy, and poor impulse control.” More about it HERE.
Avoid unnecessary stress/anxiety and find a way to deal with it – It’s only natural that some days are more stressful than others. That’s just the way it is, though it doesn’t make it any easier, too. And while the first part is quite obvious – avoid toxic situations, and relationships, the latter might cause some question marks. One of the best ways to deal with stress is to understand its nature and then find a way of dealing with it that feels good for you. For some people, it might be meditation, for some physical exercise, journaling, reading, meeting people, watching movies, listening to your favorite music – you name it. First things first – if you try to get to know yourself – you may already have a bunch of ideas about your personal preference in ways of coping with stress.
Eat well – while we don’t have any scientifically proven ‘anti-depressive’ diet that's one size fits all, we know that the way we eat has an enormous impact on our overall well-being. What we also know is that vitamin B12 deficiency impacts the condition of our nervous systems. It’s advisable to check with your doctor, but most people need to supplement this vitamin. Some studies show that there’s a higher likelihood of having depression in people with low levels of vitamin D. Read about it HERE. That’s the one that our bodies produce when we’re exposed to sunlight. Most of us have to supplement that during the no-sun’ season. Another crucial ingredient is Omega 3 fatty acids. “Different mechanisms of action have been proposed. For example, omega-3s can easily travel through the brain cell membrane and interact with mood-related molecules inside the brain. They also have anti-inflammatory actions that may help relieve depression “.
Explore some of the things that bring you JOY and SATISFACTION in life. However small, however insignificant, in your opinion – if there’s anything that lightens you up and gets you going – do more of that.
To sum it up
There’s no obvious answer to the question "what to do to avoid depression". It is a serious – potentially lethal illness, and sometimes you can’t avoid it. However, there are a lot of ways in which we can contribute to our overall mental health. Pretty straightforward and intuitive ways too. By taking care of our minds, health, bodies, and relationships, we can lower the chance or severity of an episode. We can also make the process of getting better, more efficient, and faster. If an episode occurs or you feel your sadness goes beyond what’s a natural feeling – reach out to a mental health specialist and ask for help. Sometimes it’s a talking therapy, and sometimes it has to be combined with a pill.
Also - there's more and more research about what the MBSR (Mindfulness-Based Stress Reduction) can do for people with anxiety and depression.
WHO fact sheet on depression: