It's downright scary: More than 20 million Americans can
expect to suffer from depression in the coming year. But you don't have to be
one of them if you're alert to the events and situations that can turn the
blues into something more serious.
Here, the 10 most common depression triggers -- and what
to do to prevent them from dragging you down.
Loss of Job and Depression
Why losing a job may trigger depression: In addition to
causing financial stress, losing a job can jeopardize your sense of identity
and feelings of self-worth. Unemployment and financial stress also strain
marriages and relationships, bringing conflict that compounds stress and
unhappiness.
Who's most vulnerable: Statistics show that the older you
are or the higher you were paid, the longer it's likely to take to find work
again. Also, those employed in downsized industries and fields, such as the
auto industry, may have to retrain or start over in a new field, which can be
frightening and can undermine self-confidence.
What helps:
Connect with others in the same situation,
whether it's through a job skills class, training program, or job-search
support group. Also, if you can afford it, use a career counselor or coach to
help you create a plan, stay accountable, and feel supported. Experts also
recommend building a support network by reaching out to friends and colleagues
and setting up regular events throughout the week. The more you can structure
your time with lunches, walks, and other get-togethers, the better. Try signing
up for a morning exercise class or schedule regular morning walks to get you
going each day.
If time goes by and it doesn't look like you're going to
find a replacement job quickly, consider volunteering. It's not only a way to
boost your self-esteem and get out of the house but it's also great for
learning new skills and making new connections.
Sexual Problems and Depression
Why sexual problems may trigger depression: According to
sexual health expert Beverly Whipple, professor at Rutgers University and
author of The Science of Orgasm (Johns Hopkins University Press, 2006),
depression and sexual problems are interrelated in a vicious cycle. Sexual
problems and sexual health issues can trigger depression by removing one of the
most effective outlets we use to feel good. But many of the most common
antidepressant medications, particularly the group of drugs known as SSRIs
(brand names Prozac, Zoloft, Celexa) can sabotage your sex drive and make it
harder to achieve orgasm.
Who's most affected:
Loss of an active sex life due to
age -- or health -- related issues can trigger depression in both men and
women, but men may feel the loss more acutely. That's because sexuality is more
central to a man's sense of identity, says Whipple: "When a man
experiences a loss of libido or sexual dysfunction, his entire sense of self
may be affected."
What helps: In a nutshell, get medical or professional
help. While talking about sex and the health of our "equipment" isn't
easy for any of us, it's essential to breaking the cycle before it leads to
depression. If you're experiencing physical changes that are contributing to a
loss of interest in sex or to performance issues, it's essential to bring them
up with your doctor. And if the problem stems from relationship or other
emotional issues, make use of a couples counselor or sex therapist.
If you let embarrassment or shame prevent you from
speaking up, you're denying yourself one of the most effective weapons against
depression. Recent studies show that having regular orgasms relieves stress,
prevents prostate cancer, and releases feel-good brain chemicals that protect
against depression. One of Whipple's many studies even shows that regular sex
increases your pain-tolerance threshold, reducingchronic pain.
“Empty Nest” Syndrome and Depression
Why “empty nest” may trigger depression: Two of the
hardest things to deal with are loss and change, and when a child leaves home
you're suddenly hit with both, all at once. "Your entire routine changes,
from the minute you wake up in the morning to the moment you go to bed at
night," says Celestino Limos, dean of students at Lewis & Clark College
in Portland, Oregon. "Parents tend to focus on all the practical details
of getting a child ready for college, but they're unprepared for how much the
rhythm of their own lives changes from day to day."
Who's most vulnerable:
Women seem to suffer more acutely
than men, perhaps because their self-identity is more closely associated with
being parents, experts say. But men can suffer an acute sense of loss as well,
and they may be less prepared for the onslaught of emotions. Those who are
divorced or otherwise single are much more likely to be lonely once the kids
are gone, but married couples may also find themselves struggling, particularly
if the marriage is rocky or they've developed a tag-team approach to family
life and don't share many activities and interests. Parents of only children
are also more vulnerable.
What helps:
Plan in advance. Parenting experts suggest
that parents begin exploring independent interests during their child's last
year of high school. Sign up for a class one night a week, or subscribe to a
travel magazine and think about trips you might want to take.
When your child leaves home, give yourself a few weeks of
quiet time to grieve, but don't spend too much time alone. Set up regular
events you can look forward to. Organize weekly walks with friends, join a book
group, or sign up for a yoga, pilates, or dance class. Plan your weekends ahead
of time, so you're not caught off guard with time heavy on your hands. Try
something completely new, such as a cooking or language class. When you
discover a new interest or passion, having more time available becomes a good
thing rather than a liability.
Alcohol and Depression
Why alcohol abuse triggers depression: Recent research
backs up what addiction and depression experts have long argued: Alcohol abuse
and depression are often linked in what's called a "dual diagnosis"
or, colloquially, "double trouble." The reason for this complicated
interaction is the effect alcohol has on mood. When you stop into your local
tavern for a cold one, you might think you're staving off the blues with some
camaraderie and relaxation. But alcohol acts as a depressant in the central
nervous system, triggering depression in those who are susceptible.
Who's most vulnerable: Those already prone to depression
or those prone to overusing alcohol are at greatest risk. In either group, the
combination of alcohol abuse and depression is dangerous. According to studies,
between 30 and 50 percent of alcoholics suffer from major depression. And the
relationship works the other way too: Studies have found that alcohol use
causes relapse in people with depression, and that when people with depression
drink they're more prone to suicide.
What helps:
Cut back on drinking and seek help for
alcohol abuse or addiction. "There's a reason we've got the stereotype of
the weepy drunk," says Liliane Desjardins of Pavillion International, a
treatment center in Texas. "Alcohol triggers a mood crash." But
people who drink too much rarely attribute their misery to drinking, she adds.
Instead they blame it on other people and factors.
There's only one solution: Cut back and see if, over
time, you feel better. If you repeatedly promise yourself or others not to
drink and your efforts fail or your drinking brings other negative consequences
into your life, you may need help to stop. Alcoholics Anonymous and other 12-step
programs are effective for some people. Others need the physical restriction
and concentrated services of a residential alcohol rehabilitation facility or
the supervised medical detox of an inpatient program. No matter what type of
alcohol treatment program works for you, you'll find it has the additional
benefit of preventing depression.
Serious Illness Diagnosis and Depression
Why a diagnosis may trigger depression: When you're
diagnosed with a serious illness, it changes your sense of what's possible in
the present and affects your outlook for the future. Finding out you have
diabetes, cancer, or another condition can set in motion a chain of events that
profoundly alters your sense of yourself, your relationships, and your
expectations for what life may hold in store.
"People call diagnosis of a serious illness a
'wake-up call,' but often it's more like a slap in the face," says Gloria
Nelson, a senior oncology social worker at Montefiore-Einstein Medical Center
in New York. "Nothing is as it seemed even a few days ago, which can be
disorienting and terrifying." Pain and fatigue are physical symptoms, but
they take an enormous emotional toll as well.
Who's most vulnerable: At highest risk are those
diagnosed with cancer, Alzheimer's, COPD, multiple sclerosis, Parkinson's,
chronic pain, or any other debilitating condition.
What helps:
A support group. "I can't say it
strongly enough -- no one is going to understand what you're going through like
your fellow patients," says Nelson. "Your spouse, your friends, your
family -- they all love you and support you, but they can't really 'get it'
like others going through the same thing."
Advocating for yourself to obtain effective treatment is
important, too. If you aren't getting the answers or help you need from your
doctor, ask for a second opinion or referral to a specialist. For many
conditions, such as cancer, a social worker can be a valuable addition to your
team, offering access to additional resources the doctor may not tell you
about. In some circumstances, a patient advocate can be valuable in helping you
pursue aggressive or experimental treatment.
Divorce and Depression
Why a divorce may trigger depression: Although every
divorce is different, they all have in common one thing: a huge, sudden change
in social status. You were part of a social unit, and now you're not.
Loneliness and fear -- how can I make it on my own? -- are common reactions
after divorce or separation. Divorce can also bring with it added financial
strain. And if there are children involved, custody arrangements and
coparenting decisions can cause ongoing conflict and stress.
Who's most vulnerable: Everyone involved in the divorce
is vulnerable. A common myth is that the person who initiates a divorce or
separation is better off than the person who gets left, but this isn't true, at
least not over time, experts say. Even if you were the one who initially asked
for the divorce or separation, it's likely the decision came after a long
period of pain and unhappiness. And both parties are likely to feel a
complicated mix of anger, sadness, resentment, guilt, and a pervasive sense of
failure.
What helps:
Therapy can be extremely beneficial while
going through a divorce or separation. Individual therapy can help you work
through the complicated emotions you're feeling and take concrete steps to move
forward. Couples therapy, sometimes known as divorce therapy, can help you and
your ex resolve your issues with a minimum of anger, bitterness, and
recrimination. And family therapy is invaluable in helping kids express their
emotions; studies show that kids tend to blame themselves for divorce, which
can result in depression for them as well. Family therapy has also been shown
to more quickly and successfully resolve custody issues and help divorced parents
coparent effectively. Divorced-parent or single-parent support groups are also
a great place to find support.
Debt, Financial Stress, and Depression
Why: Worrying about how to pay the bills causes an
ongoing "buzz" of stress that, over time, sabotages your mood and
self-esteem and can lead to depression.
Who's most vulnerable: Those who feel alone dealing with
their financial problems are at most risk. Not knowing where to turn is scary,
and feelings of shame and secrecy can compound the fear and anxiety.
What helps: Sit down with your bills and a calculator and
take stock. Look at what's coming and what's going out. Buy a book or two on
financial management and set up a step-by-step plan for yourself. If you're not
good with money or feel unable to come up with a plan of action on your own,
look for a reputable financial counselor or debt advisor. Many communities
offer free financial services, particularly around tax preparation time, and
your bank or financial services provider may also have free services you can
take advantage of.
Just don't let yourself stay "stuck" in denial
while panic builds under the surface. Taking any action, even just talking to a
friend or family member about your situation, will help you move forward and
formulate a plan.
Infertility and Depression
Why infertility may trigger depression: Wanting to have a
baby and not being able to can be a powerful depression trigger, particularly
in women. Having a miscarriage or multiple miscarriages often sends a women
spiraling into depression. Going into early menopause as a result of surgery,
chemotherapy for cancer treatment, or illness can also lead to depression when
a woman realizes her window of fertility has closed.
Who's most vulnerable: Women with age- or health-related
fertility issues, women who've suffered multiple miscarriages, and women who've
had a surgically induced menopause are most prone to distress over infertility
issues.
What helps:
Advance planning and exploring all options
for parenthood can help you if you're nearing the end of your fertile years.
Look into the services available for preserving your eggs; whether or not you
choose to do so, simply researching the option makes some women feel less
vulnerable and powerless, one study has shown. If you're a single woman and
lack of a partner is leading you to despair, look into the option of single
parenthood by choice via a sperm donor. Whether or not you choose to take this
route, investigating what's involved can make you feel more in charge of your
choices, experts say. Exploring adoption and familiarizing yourself with the
options available there can also be empowering.
Caregiving and Depression
Being a hands-on caregiver to someone with a debilitating
disease, such as Alzheimer's or cancer
Why caring for someone with a debilitating disease may
cause depression: Taking on a caregiver role places enormous demands on your
time and energy, adds the stress of constant decision making, and often forces
you to choose between conflicting obligations, which can result in resentment,
guilt, and feelings of inadequacy.
Who's most vulnerable: At greatest risk are women in
their 30s and older who are juggling multiple pressures, such as being a
[caregiver][1] along with working or raising children. Men assume the role of
caregiver less commonly, but when they do they may be particularly prone to
depression because they're less likely to have strong social bonds and to seek
support from their family and community.
What helps:
For starters, set boundaries around your
caregiving responsibilities. Do what you can, and be clear with the person
you're caring for and with other family members about what you can't do and
need others to do. This is key to preventing guilt and feeling overwhelmed,
both of which are major setups for depression.
Set up a support system for yourself: Schedule respite
care, so you get occasional breaks; delegate tasks to others or outsource tasks
in your own home. If you're spending many hours on the upkeep of your parent's
home, for example, consider paying someone to clean yours, so you don't walk in
the door to face more cleaning tasks. If you have siblings in a less active
caregiving role, tell them the thank-you gift you'd most appreciate is a
cleaning service for your home or gift certificates to restaurants, so you
don't have to cook.
And don't neglect your own health and well-being. No
matter how tough and strong you are, you won't be able to be an effective
caregiver if you don't care for yourself first. Clear time each day to do
something for yourself, whether it's to take a walk, cut a few flowers in the
garden, meditate, or have a cup of tea with a friend. You need to replenish
your inner resources or you won't have anything left for the others who need
you.
Hormone Imbalance and Depression
Why menopause and "male menopause" may cause
depression: The hormonal fluctuations that accompany aging can cause levels of
key hormones to drop, setting off a cluster of symptoms that can include
depression and other problems, such as fatigue, low libido, and anxiety that in
turn contribute to depression.
Who's most vulnerable: Women ages 40 to 55 are the most
likely to suffer the wide-ranging symptoms of perimenopause -- the period
leading up to menopause -- and menopause itself. Less well known, though, is
that men go through their own midlife decline in energy and mood, a phase
popularly known as "male menopause." In some men, this is caused by a
drop in testosterone levels, but other men experience symptoms even when their
testosterone levels remain within the normal range. Experts believe other age-related
symptoms such as prostate problems, weight gain, and decline in muscle mass and
fitness may be at fault when this happens.
In younger women, early-onset menopause caused by surgery
or cancer treatment can trigger extreme hormonal symptoms.
What helps:
Talk to your doctor, and be prepared to be
extremely specific about the symptoms you're experiencing. Keep an ongoing
written record of your moods and physical symptoms so you can document what's
happening when, and how frequently.
If a hormonal imbalance is the problem, treating the
imbalance is key to an overall solution. This doesn't necessarily mean taking
hormone replacement therapy, although -- despite negative publicity -- that's
one option that's effective for many women and that appears to pose little risk
to most. For men, testosterone supplementation has been shown to treat sexual
dysfunction and other symptoms of male menopause if done carefully and
correctly.
Many men and women can also stabilize hormones and combat
midlife depression by using vitamins, herbs, and other supplements, or by using
stress-management techniques such as meditation and yoga. Interestingly,
studies show that stress itself inhibits testosterone release, says sexual
health expert Beverly Whipple. In men, stress can be a direct cause of sexual
issues and depression. Treating underlying conditions such as thyroid disorders
can also get hormone levels back on track.
