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Depression 101 – Proactive Prevention and Self Care During High Risk Times

Last updated on April 12, 2021

Depression, sometimes referred to as major depressive disorder, can be defined as a mood disorder defined by a continual feeling of sadness and disinterest in life. 

What separates depression from general sadness is its intensity, the length of time it persists, and the types of feelings/emotions that accompany the sadness, as well as the behavioral responses that develop as a result. 

Depression is severe and debilitating, can last for many days, weeks, months, or even years, and is linked to feelings of helplessness, hopelessness, worthlessness.

Causes of Depression

There are various factors that can be responsible for depression. Those factors can be singular or a combination of multiple. One such factor is brain chemistry which relates to chemicals in the brain called neurotransmitters which impact mood. However, if these chemicals don’t function properly, they can lead to depression. Hormones are another factor that can impact mood. 

As hormone levels shift as a result of pregnancy, menopause, menstrual cycles, and other elements, this can set off depressive symptoms. Another major factor is genetics.

While specific genes haven’t been isolated as being responsible for depression, it has been determined that a person is more likely to have depression if someone in their family has been diagnosed with it as well. 

Additionally, outside circumstances can be a major factor that influences our depression. Our family life, work-life, and community events can create enhanced stress and decrease our coping skill, thereby increasing our likelihood of depression (WebMD, 2008)

Thus, when traumatic events take place and grisly experiences occur, one is more prone to experience bouts of depression that correspond with the length and severity of the trauma, and even after the trauma has ended. 

Impact Of COVID On Depression

Covid-19 has no doubt impacted our overall state of mental health and wellness. This pandemic has brought along with it much chaos, uncertainty, fear, and stress. Research shows a correlation between the intolerance of uncertainty and anxiety, worry, and stress. 

Evidence suggests that the less comfortable a person is with not knowing what to expect in a particular situation, the higher the likelihood of anxiety. As a result of the increased anxiety, there is then increased worry and ultimately increased stress (Peterson, 2017)

This ultimately leads to a drastically higher risk of experiencing depression. As stress and anxiety increase, our ability to manage emotions, process events, and cope with stressors decreases, making us more susceptible to sadness, hopelessness, and other feelings that tend to be markers of depression.

A Chinese study looked at the impact of COVID-19 on mental health and found that 35% of respondents reported depression due to the pandemic. Those already living with depression prior to the pandemic reported facing an additional challenge. Even people who did not have clinical depression prior to the pandemic reported experiencing symptoms of depression during COVID-19.

Those who work in high-pressure environments or are considered frontline workers such as healthcare professionals and grocery store workers reported even higher instances of depression. This was also true for those directly impacted by COVID-19 whether that was contracting the condition, having a close friend/family member diagnosed with the condition, economic impacts, social isolation, or another means of being affected by the pandemic (Dresden, 2020)

A recent study has found that the number of adults in the U.S. experiencing depression has tripled. Researchers used the 2017-18 National Health and Nutrition Examination Survey as a baseline measure of depression rates before the beginning of the pandemic, where a total of 5,065 people responded to the survey.

This data was compared with the findings of the COVID-19 and Life Stressors Impact on Mental Health and Well-Being study, which surveyed 1,441 U.S. adults between March 31st – April 13th of 2020.

The study also used the PHQ-9 to facilitate the comparison of changes in the prevalence of depression among the population (Berman, 2020)

Prior to COVID-19, roughly 8.5% of US adults reported being depressed. Since the pandemic, that number has increased to 27.8%. 

That averages out to more than 1 in 4 adults in the U.S. now reporting that they are experiencing symptoms of depression. A similar pattern was also noted during other crisis events in the country such as the spread of Ebola and the terrorist attacks of 9/11 (Berman, 2020)

This survey also found that symptoms of depression had risen across all demographic groups in response to the pandemic. Additionally, concern regarding personal financial well-being was isolated as being the main driver of depression. Researchers specifically found that people with less than $5000 in savings were 50% more likely to experience symptoms of depression than those who possessed more than that amount (Berman, 2020)

It’s also worthwhile to note that there are certain challenges that a public health crisis like COVID-19 creates for those dealing with mental health challenges like depression according to experts. 

The pandemic has increased emotional stress levels, made accessing treatment more challenging, removed emotional supports that make coping and self-care more manageable such as gathering with peers or going to events/outings, and put a strain on the ability to continue to make healthy lifestyle choices.

Also, those living with depression during the pandemic also find themselves facing increased levels of anxiety, more withdrawn due to social isolation, facing difficulty accessing their medications, and feeling an enhanced sense of helplessness and hopelessness with so many negative outcomes and so many aspects of COVID-19 out of personal control (Dresden, 2020)

Link Between Stress, Anxiety, and Depression

There is a link between stress, anxiety, and depression. In research published in the journal Nature Neuroscience, researchers Ferguson, Magalhaes and their colleagues used a behavioral mouse model and series of molecular experiments to reveal the biological connection between stress, anxiety, and depression. 

The study found that the linking mechanism between the three conditions involves the interaction between corticotropin releasing factor receptor 1 and specific types of serotonin receptors. CRFR1 works to increase the number of 5-HTRs on cell surfaces in the brain, which leads to abnormal brain signaling. 

Since CRFR1 activation leads to anxiety as a response to stress, and 5-HTRs lead to depression, thus indicating how stress, anxiety, and depression pathways connect through distinct processes in the brain (Nauert, 2018)

This then implies that depression which often occurs in conjunction with anxiety is most often linked to stressful experiences. Stressful experiences can also make anxiety and depression symptoms worse. 

Signs Of Depressive Symptoms

It is also important for us to know the signs of depressive symptoms, especially during COVID-19, which is a time that makes us more susceptible to depression. This awareness can help us catch ourselves before we fall into a deep depressive pit and take measures to pull ourselves out of that pit. 

Those experiencing depressive symptoms cannot simply “snap out of” a depressive state. There are supports and strategies needed to help people effectively cope with their depression and symptoms. 

There are a variety of symptoms that might indicate someone is depressed or leaning in that direction. A person can have a combination of these symptoms and typically experiences them on a persistent basis in a manner that impacts all aspects of their daily lives. 

The DSM-5, a manual doctors use to diagnose mental disorders, outlines a list of symptoms, and categorizes depression as when an individual has five or more of the outlined symptoms lasting for at least two weeks. 

These symptoms include:

  • Feelings of sadness and hopelessness
  • Anxiety, restlessness, and agitation
  • Outbursts of anger, irritability, and frustration
  • Lack of energy and tiredness
  • Loss of interest/pleasure in normal activities or hobbies once enjoyed
  • Decreased appetite/weight loss or increased cravings/weight gain
  • Trouble thinking, concentrating, remembering things, or making decisions
  • Disrupted sleep patterns including insomnia or sleeping too much
  • Feelings of worthlessness or guilt, and fixating on self-blame and past mistakes
  • Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
  • Unexplained physical problems, such as back pain or headaches

20 Ways To Prevent And Manage Depression During COVID

There are various ways that we can implement strategies to prevent and manage depression and these strategies are of great importance during such unstable times. By implementing these strategies, we can. 

  1. Meditation: Meditation is the practice of focusing on a specific thing (breathing, body sensation, or object) as a means of developing self-awareness, inducing calm, and increasing attention. Meditation can be used to maintain mental health by intentionally choosing to focus on something other than a chaotic situation. By regularly engaging in the practice of meditation as a means of redirecting and gaining control of your thoughts you can manage and calm your fears and thus manage the stress of the situation (NHS, 2020). This practice makes one better equipped to deal with feelings of anxiety and stress as they arise, and therefore more equipped to combat depression. 
  2. Breathing Techniques: Breathing is a good strategy for regaining a sense of calm in the midst of chaos. Breathing offers the opportunity to take the time to pause, refocus, and really process what is happening and what you are feeling. Breathing can ground you and help you get to a place where you can identify the root of your fear. Additionally, the breathing will have an immediate effect by reducing the heart rate and allowing the brain to more effectively process information This means one is better able to manage emotions and less likely to develop depression (Amatenstein, 2020).
  3. Mindfulness: Mindfulness is a practice that emphasizes awareness of thoughts, feelings, sensations as a means of gaining more insight, increasing attention, improving concentration, and enhancing self- control, among many other benefits. The ultimate idea being that via mindfulness producing improvements in these areas, positive changes can be made to influence our attitudes and behaviors for the better. Through mindfulness, we can reduce stress, gain greater control over our emotions, and decrease rumination which improves our mental health and our capacity to cope with fear and uncertainty during chaotic times (Davis & Hayes, 2012). If we are better able to reduce our stress, control our emotions, and decrease rumination we significantly decrease our risk and susceptibility for depression. 
  4. Relaxation Techniques: Relaxation techniques are forms of stress management that work to decrease the effects of stress on the mind and body. This can be especially useful during crisis situations where anxiety and panic can override and overwhelm. When practiced these techniques can improve mood, reduce stress hormones, slow breathing, decrease heart rate, and reduce frustration, all of which can be associated with fear. Relaxation techniques can include things such as yoga, massage, aromatherapy, music, and art among others (Mayo Clinic, 2020). These positive impacts on the body, emotions, and mind work to manage and prevent depression.
  5. Support of Friends/Family: Reaching out for the support of our friends and family can be quite beneficial for us during times of chaos when it comes to warding off depression. Friends and family can provide the emotional support we need when we are feeling overwhelmed, and offer the encouragement needed to ground us and keep us from hyper-focusing on the negative situation or the negative emotions that the situation creates (Capital FM, 2020). This prevents us from isolating ourselves and falling further into pits of despair and hopelessness often linked to depression. 
  6. Support Groups: Support groups are communities of people experiencing similar circumstances or emotions that we can turn to when we need additional support. These communities offer judgment-free zones to share emotions and struggles among likeminded people, while also being places where people can gain coping tools and learn how to deal with our depression and its symptoms in a healthy manner. 
  7. Counseling/Therapy: Sometimes a trained professional is the best route to take to deal with depression. They can offer techniques and strategies to help manage negative emotions, while also offering emotional support and a safe judgment-free space to discuss feelings and thoughts (Capital FM, 2020). While there may be limitations on in-person sessions, many therapists and counselors are offering virtual options during this time to accommodate people’s needs during COVID-19. 
  8. Journaling: During times like these, journaling can be a healthy grounding and calming mechanism. The University of Rochester Medical Center notes a couple of the benefits of journaling as helping to track and identify causes of stress and providing a space for you to work through negative thoughts, emotions, and behaviors. Thus, journaling can serve as a crucial support system allowing people to process through fear and decrease risks for depression and anxiety (Capital FM, 2020)
  9. Music: Music can have several helpful benefits for mental health. Research has shown that music, whether listening or playing, can improve various mental health conditions including schizophrenia, depression, and trauma, all of which can be experienced or exaggerated during times of chaos. Additionally, music can serve as a powerful medium for processing emotions such as fear or grief, as well as acting as a calming agent for anxiety and dysregulation (Capital FM, 2020)
  10. Rest: Sleep is an essential part of our mental wellness and helps us combat depression. When we sleep, we go into a relaxed state that allows for a release of stress and tension. Sleep can help us process fear and reason through negative feelings so that by the time we wake up the fear doesn’t seem so threatening and our stress levels aren’t so high (Mental Health Foundation, 2020). In doing so we are able to manage our emotions and get a hold on things that may lead us into depression. 
  11. Eat Well: The foods we eat can either support or break down mental health and increase our chances of developing depression. Certain foods combat the negative feelings of stress and anxiety that often arise during the chaos of a pandemic. Such foods include dark chocolate, turmeric, and chamomile which have relaxing properties and can create a calming effect in the body.
  12. Spend Time Outside: There is something about the outdoors that has the ability to help fight against mental health. Going for a walk, exercising outside, or even just sitting outside exposes you to vitamin D which is linked to healthy cognitive function and reduced risk/prevention of depression. One study found that adults with vitamin D deficiency who received high doses of the vitamin saw an improvement in their depressive symptoms in just 2 months (Bundrant, 2016)
  13. Art: Practicing some type of art, whether it’s painting or drawing or photography can prove to be very beneficial for fighting against depression. Art offers soothing and calming benefits that help individuals deal with stress, manage negative emotions, and combat anxiety and other mental health ailments such as depression (The Optimist Daily, 2020).
  14. Routines: Routines are a strong way to prevent depression, particularly during times of the COVID-19 pandemic. Routines add value during times of fear and uncertainty by acting as a type of grounding force to help us be more balanced (Finestone, 2020). By establishing predictability, routines reduce stress and anxiety and decrease fear. 
  15. Limit Media Intake: Though much of the media these days is rooted in trying to disseminate information, too much information which tends to be negative these days. All of this negativity can lead to enhanced stress and anxiety, which increases feelings and likelihood of depression. Limiting the amount of media we take in on a daily basis is a great way to keep ourselves sane and healthy mentally. Whether it’s setting daily limits or choosing days where there is a complete absence of media consumption, setting those boundaries can go a long way for preserving peace and avoiding depression (The Optimist Daily, 2020).
  16. Fitness: A little physical activity can produce a physical response in the body that is great for fighting against depression. When we engage in any kind of physical activity, there is a release of endorphins that cause an analgesic effect within the body. This means we feel calmer, less stressed, and have more mental clarity. Turning to exercise during COVID-19 can help immediately calm emotional reactions and help decrease the stress and anxiety that often lead to feelings of depression (Amastein, 2020)
  17. Spirituality: If you are a person who is spiritual or religious, tapping into that source can be a solid way to prevent and manage depression. Spirituality can act as a grounding force reminding you that there is a larger entity in control and that there is something larger than self. This can be of great significance when in a chaotic situation. When you remember that there is a greater power at work, you can find peace and manage stress/fear in a healthy way versus letting the uncertainty get the best of you and lead to depression (Mental Health Foundation, 2020).
  18. Boundaries: Boundaries are a crucial part of combating depression. Setting boundaries means setting firm limits on what you can/will do or allow and what you can’t/won’t do or allow as a means of protecting your peace and overall wellness. Setting boundaries can look like telling people “no” when asked to do things, turning down social invitations, staying off social media platforms, or implementing whatever other limits necessary to help keep you from getting stressed, anxious, or depressed (Power of Positivity, 2020).
  19. Self-Care: Self-care is a good way to combat depression on a very consistent basis. Self-care is about prioritizing the protection of well-being and happiness, particularly during times of chaos like a pandemic. Such methods of self-care can include mindfulness meditation, physical activity, or even journaling. Each of these activities and other self-care activities focuses on reducing stress and anxiety by providing an outlet to release feelings so they don’t build up and escalate into depression (Robbins, 2020).
  20. Hopefulness: It can be so tempting to lose the faith amidst all of the stress of COVID-19, but it is so important to remain hopeful if we want to prevent and manage depression. Hope gives us something to look forward to and something to hold onto in the midst of the negativity we face. When we think about the future of things getting better, we are able to find a silver lining that grounds us and helps us to stay positive. 

Special Considerations For Seniors 

Seniors are already at increased risk of depression as they age. This risk increases exponentially during times like these created by the pandemic, which is incredibly chaotic and stressful. If they are not careful, seniors can experience an enhanced rate of depression and experience symptoms with more severity. 

Taking a series of specific measures can help ensure seniors are in the best position to thrive during this time of COVID-19 in spite of the unique hardships and challenges that this season presents. 

The first and most significant of these measures is getting support from outside sources. Whether this is from family, people in the neighborhood/community, or professionals, having people who can check-in, provide help, and offer support is crucial during these times. 

Support can look like having neighbors call in, having family members visit, or having professionals whose job it is to come to the home and check-in. In instances where a senior has to be physically isolated for their own safety and health, it’s important to maintain the virtual community as much as possible. 

Video chats, letters and cards, and pictures can be a great way of maintaining communication and continuing to stay connected to important people in the senior’s life. This can boost mood and help keep depression and negative emotions at bay. 

A healthy lifestyle is another key consideration. Eating well, getting regular exercise, staying mentally engaged, and getting proper amounts of rest will do a lot to help seniors stay well mentally and keep depression at bay. As previously mentioned, each of these measures has protective benefits for mental health. They can reduce stress, combat feelings of anxiety, and boost overall mood among other things which all help ensure depression is managed and ideally prevented in people of older age. 

Treatments for Depression 

1| Psychotherapy

Consulting a mental health professional on a regular basis about depression and the triggers of depression can help you learn to cope with negative situations and the emotions that come with them. Various methods of psychotherapy include cognitive behavioral therapy and talk therapy (WebMD, 2008)

2| Medication

Antidepressants can be an effective treatment for people dealing with depression. There are various types of antidepressants. Some work to stabilize mood, some work as antipsychotics, others work as anti-anxiety medication, and others act as stimulant medicine (WebMD, 2008)

3| Electroconvulsive Therapy

ECT is brain stimulation therapy that passes electric currents through the brain to help your neurotransmitters work better. This is typically only a method of treatment in the instance antidepressants aren’t effective or one is unable to take antidepressants for a medical reason (WebMD, 2008)

4| Transcranial Magnetic Stimulation

TMS is another form of therapy for depression that is generally only described in the event that antidepressants have not been effective. This treatment used a coil to send magnetic pulses through the brain to help stimulate nerve cells that regulate mood (WebMD, 2008)

Hospital or Residential Care: In the event that depression becomes so severe a person is considering self-harm or harming others, psychiatric treatment within a hospital or residential treatment facility may be needed to address these serious concerns under the watchful eyes of trained medical professionals (WebMD, 2008)

Final Thoughts

Depression is not something we have to suffer with or even come to accept during COVID-19. While it’s true that the pandemic has created a chaotic scenario with many unknowns, and that stress and anxiety which often lead to depression are normal responses to such chaos, we aren’t powerless to deal with depression. 

There are measures we can take and support we can obtain as a means of helping us deal with stress, manage anxiety, recognize signs of depression, and implement necessary tools or resources to help us cope before our depression spirals. 

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