Depression; Prevention

Depression; Prevention

Self-help strategies play an important role in maintaining mental health. Among the most useful are:

exercise — aerobic workouts such as walking or jogging can greatly improve your mood if you are mildly depressed or anxious. Even non-aerobic exercise, such as weight-lifting, can boost your spirits, improve sleep and appetite, reduce irritability and anger and produce feelings of mastery and accomplishment. Be sure to check with your health care professional before you start any new exercise program.

if you’re suffering from a condition that causes unrelievable pain symptoms, discuss depression with your health care professional; pain can be a trigger for depression.

tune into your problems — analyze recent events to identify possible sources of stress, either alone or with a close friend or loved one, to help you regain a better perspective. However, if you find yourself ruminating-that is, focusing too much on a problem-then try one of the other techniques listed here because ruminating can make a depressed mood worse.

self-talk — if your inner voice is constantly critical, you should try to make note of unrealistically negative or critical remarks and focus more on the things you like about yourself.

journaling — write about problems and concerns in a journal to ease anxiety and help work through painful feelings. To get started, reflect upon each day or week, and identify the most meaningful parts or moments. If you experience an intense emotion-positive or negative-write down the circumstances and the effects of the experience. Analyze any encounter that makes you feel bad.

self-help or support groups — talk with people with similar problems through hospital- or community health-sponsored support groups. Such groups, especially those associated with a specific problem such as depression or alcoholism, also help in preventing recurrences and relapses.

The holidays are a stressful time of year for many people. The “holiday blues” are a common response to the additional responsibilities the holiday season can impose. Additionally, feelings of loss may be felt more acutely during the holidays as people remember deceased loved ones. Part of the holiday blues stem from bereavement memories.

Symptoms of the holiday blues can include: feeling overwhelmed, anxious, or angry; crying spells; withdrawal; or self-medicating with food or alcohol. While these symptoms can be similar to those experienced by someone who is clinically depressed, they are temporary. Depression is not. If holiday blues become incapacitating and/or persist for two or more weeks, professional help is advised. Some simple interventions can help you prepare for the holiday hustle, minimize stress and keep the holidays healthy:

Talk about the person you’re missing

plan ahead and prioritize activities

be realistic about what can be accomplished in the upcoming weeks

alter a tradition that is particularly uncomfortable or overwhelming

be honest about feelings

focus on something positive and not a memory of a negative experience

take time off for yourself

recognize that alcohol, cigarettes and caffeine increase stress; limit use of these substances

exercise, eat nutritiously and get enough sleep to prevent exhaustion

try to find companionship if you don’t have a support network during the holidays

New Treatments on the Horizon

New medications for depression under development hold the promise of decreasing unwanted side effects, enhancing efficacy and providing targeted symptom relief. For example, monoamine neurotransmitter medications are currently under development and are designed to correct an imbalance of monoamines (chemicals used by brain cells to communicate); research suggests that monoamines play a major role in depression. Other medications target novel neurotransmitters such as substance P, another brain chemical that may have a role in depression.

Hormonal therapies under investigation include drugs that target the hypothalamic-pituitary-adrenal axis, the hormonal system that regulates the body’s response to stress. Drugs include dehydroepiandrosterone (DHEA) and Lupron.

A phototherapy technique called Dawn simulation therapy is currently in phase III clinical trials for the treatment of winter depression. This treatment utilizes a device that is attached to a bedside lamp and gradually increases light exposure while the patient is sleeping to simulate summer dawn during the winter.

A medication called Reboxetine (brand name Vestra or Edronax) that has already made an appearance in Europe, is currently under study in the U.S. Reboxetine is a unique approach to depression treatment in that it targets the neurotransmitter norepinephrine.

Researchers are investigating the use of an epilepsy treatment called Vagus Nerve Stimulation (VNS) for the treatment of resistant mood disorders. The device used for this therapy (approved for epilepsy treatment only), consists of a pulse generator and a nerve stimulator electrode that is usually programmed to send 30-second electrical impulses every five minutes to the left vagus nerve, via connecting leads. The generator is surgically placed in a pocket formed under the skin, below the left collarbone. Results of a VNS pilot study showed that 40 percent of the treated patients displayed at least a 50 percent or greater improvement in their condition, and the condition of several patients improved so substantially that they were able to return to work or other normal activities.

New lower-dose hormone therapy treatments also are in development. A low-dose version of the combination estrogen-progesterone hormone therapy sold as Prempro is expected to be available in the summer of 2003. These products will carry the same FDA ‘black box’ warning as other estrogen products currently on the market do.

Researchers are carrying out trials using electrical magnets as a treatment for depression – targeting those people who fail to get better with conventional drug therapy. Transcranial Magnetic Stimulation (TMS) uses pulses of magnetic energy on a very small area of the brain where triggers for depression are thought to be centered.


“FDA Plans to Evaluate Results of Women’s Health Initiative Study for Estrogen-Alone Therapy.” U.S. Food and Drug Administration. “FDA Talk Paper.” March 2, 2004. Accessed March 2004.

Effects of Estrogen plus Progestin on Health-Related Quality of Life. J. Hays et al. NEJM, May 8,2003; Vol. 348, No. 19.

FDA Approves Lower Dose of Prempro, a Combination Estrogen and Progestin Drug for Postmenopausal Women. FDA News (press release). March 13, 2003.

“FDA Approves New Labels for Estrogen and Estrogen with Progestin Therapies for Postmenopausal Women Following Review of Women’s Health Initiative Data.” FDA News/Press Release. January 8, 2003. Accessed March 2003.

“St. John’s Wort.” National Center for Complementaty and Alternative Medicine. Accessed July 2002.

Hypericum Depression Trial Study Group. Effect of Hypericum perforatum (St. John’s wort) in major depressive disorder: a randomized, controlled trial. JAMA, 2002; 287:1807-14.

Shelton RC, Keller MB, Gelenberg AJ, et al. Effectiveness of St. John’s wort in major depression. JAMA, 2001; 285:1978-86.

“Summit on Women and Depression: Proceedings and Recommendations.” American Psychological Association. April 2002.

Grady D, Herrington D, Bittner V, et al, for the HERS Research Group. Heart and estrogen/progestin replacement study follow-up (HERS II): Part 1. Cardiovascular outcomes during 6.8 years of hormone therapy. JAMA 2002;288:49-57.

Hulley S, Furberg C, Barrett-Connor E, et al, for the HERS Research Group. Heart and estrogen/progestin replacement study follow-up (HERS II): Part 2. Non-cardiovascular outcomes during 6.8 years of hormone therapy. JAMA 2002;288:58-66.

Writing Group for the Women’s Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA 2002; 288:321-333.

“Women’s Health Initiative,” National Heart, Lung and Blood Institute. Updated Aug. 2003; accessed Aug. 2003.

The Menopause Guidebook: Helping Women Make Informed Healthcare Decisions through Perimenopause and Beyond. North American Menopause Society: May 2003; Accessed Aug. 2003.

Public Alert on St. John’s Wort. National Institutes of Mental Health. Feb. 20, 2001. Accessed Oct. 2001.

“Depression: Investigational Treatments” Veritas Medicine. Reviewed Jan. 10, 2001. Accessed Aug. 2003.

“Pharmacologic Treatment of Acute Major Depression and Dysthymia” Annals of Internal Medicine 2000; 132:738-742. Clinical Guideline, Part 1. Accessed Aug. 2003.

Rush, A. John, et al. “Vagus Nerve Stimulation (VNS) for Treatment-Resistant Depressions: A Multicenter Study.”Biol Psychiatry Vol. 47, No. 4, February 15, 2000:276-286.

For the Public. National Institute of Mental Health. Updated Jan. 2003. Accessed June 2003.

“Fact Sheets” National Mental Health Association. Date published: n/a. Accessed June 2003.

Help Center. American Psychological Association. Accessed June 2003.

Public Information. American Psychiatric Association. Accessed June 2003.

“Introducing New Lexapro” Forest Pharmaceuticals, Inc. Copyright 2002. Accessed Nov. 2002.

Morris M.S, et al. “Depression and Folate Status in the US Population” Psychotherapy and Psychosomatics, Vol 72, No 2, 2003. Accessed June 2003.

“Bone Loss in Premenopausal Women with Depression” National Institute of Mental Health. Updated Aug. 2002. Accessed June 2003.

“Magnets that can fight depression” Depression and Bipolar Alliance (DBSA). Aug. 20, 2003. Accessed Aug. 2003.

“Rates of Dementia Increase Among Older Women on Combination Hormone Therapy” NIH News, May 27, 2003. Accessed Aug. 2003.

Caspi, A. et al. “Influence of Life Stress on Depression: Moderation by a Polymorphism in the 5-HTT Gene.” Science, vol. 301, pages 386-389. July 18, 2003.

“Depression & Women” National Women’s Health Report, Vol. 25, No. 4. Published Aug. 2003. National Women’s Health Resource Center. Accessed Aug. 2003.

Kessler R.C., et al. National Comorbidity Survey Replication. “The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R).” JAMA. 2003 June 18; 289(23): 3095-105.

Lexapro [package insert]. St. Louis, MO. Forest Pharmaceuticals. 2002.

Keywords: depression, support groups, holiday blues, symptoms, medications, epilepsy treatment, hormone therapy

COPYRIGHT 2005 National Women’s Health Resource Center

COPYRIGHT 2007 Gale Group