Copyright (c) 2017 by Lynn D. Johnson.
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Depression is increasing worldwide. It hits us younger, and hits more of us.
When I was a new intern in psychology, the average of onset for depression was 37. That was way back in 1975. Twenty years later, the average of onset was 15[1] That number continues to get lower, as younger children are suffering from depression.
In 1989, Gerald Klerman and Myrna Weissman reported that from 1900 to 1989, the number of people becoming depressed has risen dramatically. While that study was hotly debated, their conclusions have held up, what scientists call a “robust finding.” In 1900 you would have had one chance in twenty of ever becoming depressed. Today that risk is more like one in five for depression, and one in four for anxiety disorders[2]
It is clear that the younger one is, the higher the risk. Someone who is fifty has half the risk of ever having been depressed as someone who is in the 18-25 age range[3]. It is opposite of how things should be. The longer I live, the greater risk of, say, cancer. But with anxiety and depression it is reversed.
I don’t pretend to know all the answers, but I want to suggest a simple practices that dramatically reduce the risk to young people, and to all of us.
Traditional treatment does work. Talking to a therapist has a very good impact on depression. Taking an antidepressant does help. Combining those two, the talk and the pills, certainly has the most impact. But it isn’t good enough.
Take pills, for example. If you are depressed, and take a medication, you have one chance in three of full recovery. You have one chance in three of improving but not recovering. That leaves a full third without any help. My psychiatrist colleagues call those folks “treatment resistant.” It isn’t that they emotionally resist getting better, they just don’t respond to the pills.
If you see a therapist, you have a slightly better chance. Perhaps 40% to 45% are blessed with a full recovery, and about 30% will improve. Yet again, 25% of patients just do not get any better from talking to a head shrinker!
Yes, combining the two does improve things somewhat, with more getting fully recovered, but we still cannot help 20% to 25% of depressed patients.
In the last few years I have been experimenting with a couple of other interventions.
Exercise seems to have a very good impact on depression. While the Cochrane review in 2013 said that exercise was good, but not better than medication[4], not everyone agreed with that. Felipe Schuch and colleagues found a bias against the therapeutic value of exercise in the literature, and they showed that when corrected for that bias, the impact of exercise was much better than either medication or psychotherapy[5]. (I admit Schuch and his colleagues didn’t actually say that, but I know what the effect sizes are for medication [around .25 or .35] and psychotherapy [around .4 or .45] are, so their effect size [1.11] was substantially larger than either of the two “gold standards.”)
When I mention this to mental health professionals, they say that we cannot get depressed patients to exercise. Whiny answer but some truth. One thing I have tried is to ask a patient to estimate how he feels now, and how he thinks he will feel after a brisk ten minute walk. Then I actually take him (or her, to be fair) out of the office and we walk around the neighborhood for ten or twelve minutes. My average patient says he is 3 / 10 as he sits in the office. He predicts he will be 2 or 3 out of 10 at the end of the walk. The average patient is actually 5 out of 10, a nice little boost, for a ten minute investment. My best result was a fellow who went from 3 up to 7! (I keep saying “he” because I hate using a plural pronoun for a singular case. I know that makes me a geezer. I apologize for being old.)
This “prediction task” helps people be less loyal to their depressive thinking. Through the week, they (now the plural pronoun is justified) write down their prediction, they walk 20 minutes, and then rate how they actually feel. Brisk walks of 20 -30 minutes, or similar exercise, give us a very nice response, and some of these folks are people who have not done well with either medication or with psychotherapy.
Next time I’ll write about the surprising results from changing what we eat.
Walk more and eat healthier. Two simple changes that are yielding impressive results.
(Please share this. About the author: Lynn Johnson, Ph.D. is a psychologist trying to retire. He doesn’t want new patients, but he is glad to come and speak to your club or organization. You can download some of his ideas at https://drlynnjohnson.com or contact him at DrJ@DrLynnJohnson.com.)
[1] http://www.sciencedirect.com/science/article/pii/S0890856709642829, retrieved Sept. 25, 2017.
[2] http://jamanetwork.com/journals/jamapsychiatry/fullarticle/208678, retrieved Sept 25, 2017.
[3] https://www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-adults.shtml, retrieved Sept 25, 2017.
[4] http://www.epocrates.com/dacc/1310/ExerciseForDepressionCochrane1310.pdf, retrieved Sept 25, 2017.
[5] http://www.journalofpsychiatricresearch.com/article/S0022-3956(16)30038-3/fulltext, retrieved Sept 25, 2017.
One Response
Dr. Marilyn R. Rogers
This is great results including exercise and next what we eat to improve depression.
We do kinow that meds don’t help everyone. In fact, some people are worse with meds alone even with therapy. One reason is some patients just are uncomfortable sharing feelings. Keep trying everything until we find what really helps them. Thanks.