Here’s help for the one out of three Americans who struggle with depression.
Here’s what depression is not: a chemical imbalance in your brain, a moral failing or a personal “weakness.” What it is: a problem with the way key circuits in your brain regulate and communicate with each other. That’s good news: It means depression is “based in your neurobiology and it can be reshaped,” says Alex Korb, neuroscientist at UCLA and author of The Upward Spiral. Talk therapy, medication and other treatments can help reshape that neurobiology, but so can small changes in sleep and eating habits, exercise, even creative pursuits.
To be diagnosed with “major depression” (according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders), you must have at least five of nine possible symptoms every day for two weeks or more. The big two are a depressed mood—feeling sad, empty or irritable—and losing interest or pleasure in activities you usually enjoy. The other seven symptoms include changes in weight and/or appetite; insomnia or sleeping too much; restlessness or feeling slowed down; loss of energy; feeling worthless or guilty to an excessive degree; trouble concentrating or making decisions; and recurrent thoughts of death or suicide.
There’s nothing fundamentally “wrong” with a depressed brain. Your brain is made up of billions of nerve cells called neurons. Neurons “talk” to each other constantly by firing electrical pulses. When a pulse reaches the end of the long branch on a neuron, it squirts out a chemical signal called a neurotransmitter. Neurotransmitters float around in the space between neurons and bind to other neurons and communicate information. Depression happens when there are changes in the levels of these neurotransmitters, which include serotonin, norepinephrine, dopamine, oxytocin and others.
There’s no one “cause” for depression, says psychiatrist Diane McIntosh, author of This Is Depression and co-host of the podcast Blindsided. Your biology, your temperament, your early experiences, your current life circumstances—all affect the levels of these neurotransmitters and how they communicate. The COVID-19 pandemic created what McIntosh calls the “trifecta” of conditions perfect for depression: worries about our health and that of loved ones; job stress and financial woes; and social isolation. “Not everyone’s going to have a mental illness, but people’s mental health has certainly suffered. The worst kind of stress for your brain is chronic, unpredictable stress and that’s what we’ve all been living in.”
Depression rates in the U.S. tripled in the early months of the pandemic in 2020, and in 2021 that number grew to 32.8 percent, meaning one out of every three American adults was struggling with depression. “My practice has never been busier,” says Adam Borland, clinical psychologist with Cleveland Clinic.
Often depression starts with some kind of stressor that becomes overwhelming, then you develop symptoms—sadness, anger, loss of energy, appetite and sleep changes—that lead to a diagnosis. Sometimes you feel better once the original stress lifts. “But once you have that constellation of symptoms going on for several weeks that are impacting your functioning,” McIntosh says, “then you meet criteria for depression.”
If you can’t get an appointment with a mental health specialist, see your primary care doctor or PA, someone who can determine if you are depressed, and if your depression is mild, moderate or severe. If it’s not severe, you often don’t need medication but could benefit from talk therapy or a number of other interventions, like changes in diet, sleep and exercise. There isn’t one solution for everyone because depression is different in each individual. “It’s more helpful to see that there’s a whole menu of options for different ways to modulate your brain,” says Korb.
If you’re feeling blue, it’s natural to think that walking more often or taking up painting is not going to make a difference. Try it anyway. “The ability to be skeptical and critical is useful but also may be contributing to you staying stuck,” Korb says. “I was very dismissive of things like yoga or gratitude until I started to understand the neuroscience.”
Here, based on the science, are seven ways to cope.
How to deal with depression
“We’re not looking for a 4-minute mile here,” says McIntosh. “A 30-minute walk every day is enough to impact your mental health.” Numerous studies have shown that exercise is as effective as medication or psychotherapy in reducing symptoms of depression. And recent research analyzing data from 15 different studies found that people who did the exercise equivalent of 2.5 hours of brisk walking a week cut their risk of developing depression by 25 percent. Exercising even half that much lowered depression risk by 18 percent.
Do something creative
“I’ve had patients pick up musical instruments they hadn’t played in many years, and it really helped,” says Borland. In a 2018 study at the University of California San Francisco, researchers found that older adults who sang in a community choir every week were much less lonely and more interested in life than a control group. A 2013 study found that guided poetry writing sessions were “significantly effective” in alleviating symptoms of depression in adolescents.
Limit social media use
“Stop dread scrolling,” says Borland. Last year, researchers found that when they asked people who weren’t depressed about their social media use, those people who used social media the most (particularly Snapchat, Facebook and YouTube) were substantially more likely to report feeling depressed than adults who didn’t.
Focusing on what you appreciate about your life and expressing it—either by telling someone or writing it down—can affect the serotonin and dopamine systems in your brain and produce changes in the reactivity of key brain regions that last for weeks or months, says Korb. In a 2015 Indiana University study, researchers found that writing letters expressing gratitude made subjects’ brains more reactive to positive events, changes that could be seen in the brain even three months later.
Find a mantra
Borland brainstorms with his patients to help them find a phrase that’s easily remembered and that they can feel a connection to. “One example is ‘I’m doing the best that I can,’” he says. “It’s very simple—some say clichéd—but very powerful. It’s got ‘I am doing, I am active, I’m not just waiting for things to happen,’ and ‘the best that I can’ is humanistic. We’re not robots. There’s something freeing about that.”
Changing your sleep patterns changes a variety of neurotransmitter systems, says Korb. “Sleep reduces your emotional reactivity and reduces the rewarding pull of unhelpful behaviors,” like bingeing on ice cream.
Talk to friends and family
“Talking to others about your depression can really be giving the other person a gift,” says Borland. “The other person might be dealing with something similar that they haven’t been able to talk about. Mental health and treatment are finally getting destigmatized.”
ScienceDirect: The effects of gratitude expression on neural activity
The Washington Post: Exercising even half the recommended amount can help prevent depression
JAMA Psychiatry: Association Between Physical Activity and Risk of Depression
National Library of Medicine: Is Exercise a Viable Treatment for Depression?
National Library of Medicine: A Look Back and a Path Forward: Poetry's Healing Power during the Pandemic
National Institute on Aging: Participating in the arts creates paths to healthy aging