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.
#1: Losing a job
Why: 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.
#2: Sexual issues
Why: 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, reducing chronic pain.
#3: "Empty nest" syndrome
Why: 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.
#4: Alcohol abuse
Why: 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.
#5: Illness
Why: 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.
#6: Divorce
Why: 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.
#7: Debt and financial stress
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.
#8: Infertility
Why: 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.
#9: Being a hands-on caregiver to someone with a debilitating disease, such as Alzheimer's or cancer
Why: 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 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.
#10: Menopause and "male menopause"
Why: 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.
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