WHAT IS IT?
Depression itself has many meanings depending on who is talking about it. We can all feel down on some days but that does not mean that we are depressed. Most of us will snap out of this funk when something good happens to us. We are not talking about just having a few days every now and again when you feel discouraged or overwhelmed.
On your personal risk profile the ‘Depression’ factor refers to the added risk you experience from a persistent low mood that has lasted for a significant period during the last 12 months.
Clinical depression means you had to experience this down mood persistently for at least a few weeks and usually for several months.
In addition to the length of the depression there are usually a number of symptoms that happen together. These include feeling sad, irritable, hopeless, helpless, or angry. Many people are unmotivated or lack the energy to engage in activities they normally enjoy. You will also notice physical changes: for example; you have lost your appetite, can’t sleep, or have no interest in sexual activity. Many will notice that their thinking is not what it used to be. While this is common – the fact remains that you are more prone to see the negatives in yourself, others, your future, or your life.
You do not have to exhibit all of these features to have ‘clinical depression’. You are likely to have some but not necessarily all. You’ll probably notice that these things are interfering with your daily life. This can hold you back from being your best at work, or block your interest in seeing your friends or family. Again this doesn’t mean that you’ve stopped going to work, or have become a hermit. It means a definite shift in how involved you feel, or how effective you are in these areas, compared to when you felt more your ‘normal’ self.
Does this Apply to You?
If you scored Moderate or High on the Heart Stress Risk Profile – then the above description reflects a good part of how you’ve felt in the past year. If you had an episode of depression earlier in life – you may find that these problems return along with a new crisis in your life (like having a heart attack). This means you will have a higher risk of heart problems from these recurring episodes of depression.
HOW DOES DEPRESSION AFFECT MY HEART?
Depression is not just something that is “in your head” it is in your body and your brain. The important thing to understand about depression is that your psychological upheaval is aggravated by this major shift in your brain and body chemistry. If you are struggling with depressed mood you will have higher levels of stress hormones in your blood causing your brain to function differently too. You’ll have more inflammatory markers in your brain (increased TNFa and Interlukin-6), lower levels of neurotransmitters (like serotonin), with the overall result that your brain does not function in the same way it does when you feel like yourself.
All these bodily changes underlying depression are what also affect your heart risk. They not only affect your mood and your subjective experiences, but the underlying changes in stress hormones, nervous system and immunological activity also impact your heart. Among the different physiological mechanisms that contribute to heart risk include increased blood stickiness (coagulability), persistent nervous system arousal (reducing your heart rate variability), hormonal changes like dysregulated cortisol rhythms, and changes in immune functions.
STEPS TO TAKE TO REDUCE YOUR RISK FROM DEPRESSION
Most importantly people with depression can be helped. Unless you are in the small group who are treatment resistant, you can take action to reduce or eliminate your depression.
Your options for depression treatments are broad. The majority of men and women do very well with these treatments. Below is an outline of areas that you can start with now, to improve your mood.
Steps to Take for ‘Moderate’ Depression
Everyone who is prone to depression is also prone to doing things that cause or aggravate it. It is therefore critical to understand that you become less prone to depression by learning new skills or ways of doing things.
Each of the items listed is proven to be effective. It is virtually impossible to do all of them. Choose one and begin. Don’t make this complicated or get overwhelmed
A. Learning new skills in five functional areas
♥ Handling emotions in more direct and effective ways
♥ Letting go of perfectionism and procrastination
♥ Examining the automatic thoughts that typically “lie” to you
♥ Establish effective relationships that are supportive and nurturing
♥ Become effective in self care
B. Interpersonal Changes
♥ Take time to connect with your most trusted confidante and talk honestly about the challenges that face you
♥ Determine where the conflicts in your day arise from, find ways of anticipating those situations, and test new ways of responding (listen more carefully, offer different solutions, and feel confident enough to assert yourself)
♥ Start each day by identifying something positive you can do for yourself
♥ Write that action into your day plan and make sure you do it every day
♥ Walk for 20-30 minutes every day (discuss with your doctor if you are ready for regular exercise)
D. Nutrition and Supplements
♥ B Vitamins (particularly Vitamin B-12)
♥ Omega 3s
Additional Steps to Take for ‘High’ Depression
A. Therapy and Counseling
♥ Working with a psychologist, social worker, or therapist who has experience working with depression, guiding you through changes that will tackle your life and mood problems
♥ The options include Cognitive Behavioral Therapy (CBT), Interpersonal Therapy (IT), brief Psychodynamic Therapy, and Behavioral Therapies
♥ Talk to your doctor about the range of options available. There are four classes of antidepressants and the first one you try may not work for you. Work together with your doctor to find an option that works for you.
You will find additional options and information on our membership pages. Below are more resources that I would highly recommend:
Undoing Depression (1997) Richard O’Connor, New York: Berkley Books.
Mind over Mood: Change how you Feel by Changing the Way you Think (1995) Dennis Greenberger and Christine Padesky, New York: Guilford Press.
The Feeling Good Handbook (1990) David Burns, New York: NAL-Dutton.
Doctors and health providers may be interested in current up to date scientific information on the relationship between depression and heart disease. I highly recommend starting with:
Psychiatry and Heart Disease: The Mind, Brain, and Heart (2012) Michelle Riba, Lawson Wulsin, Melvyn Rubenfire, and Divy Ravindranath (Eds.) Wiley-Blackwell: Oxford UK.
Depression and Physical Illness (2007) Andrew Steptoe (Ed.) Cambridge University Press: Cambridge UK.