Could you be almost depressed?

2013-10-28

By Shelley Carson, Special to CNN

Editor’s note: Shelley Carson is an associate of the Department of Psychology at Harvard University. She’s the co-author of “Almost Depressed: Is My (or My Loved One’s) Unhappiness a Problem?“

Consider whether the following questions describe you or someone you love:

Are having trouble enjoying things in life that used to be fun?

Do you find that you are constantly irritable and overreacting to petty incidents? Are you are regularly finding excuses to avoid spending time with friends or family?

Does it seem like you’re “just going through the motions” and barely getting through the day? Do you feel overstressed and believe there is no way you can ever catch up with what you have to do?

If any of these questions rings true, you may be almost depressed. And you are not alone. Research suggests that as many as 12 million people in the United States may be suffering from low-grade depression symptoms that are not severe enough to warrant clinical treatment.

Almost depression is not a mental disorder. It is a state of low mood that can leave you exhausted and de-energized, keeping you from savoring life and working at your peak performance level. It is a gray area of mood problems that lies on a continuum between the ups and downs of normal mood, and full-blown major depression.

(You may wonder how you can tell if your mood symptoms put you in the almost depressed range, or if they are serious enough to be considered major depression. If you are thinking about death or suicide, have lost a significant amount of weight because of appetite changes, or have feelings of hopelessness or extreme guilt, or if you believe your symptoms may be severe enough possibly to warrant a diagnosis of major depression, please contact a mental health professional.)

At Harvard Medical School, we have been investigating the effects that almost depression and other subclinical conditions can have on an individual’s quality of life. People who are almost depressed report a number of issues, including lower job satisfaction, lower satisfaction with their marriage and other personal relationships, more anxiety issues, less control over their lives and lower overall well-being than people who do not fall into the almost depressed range.

In fact, on some of these measures, people who are almost depressed report feeling worse off than people who actually fall into the clinically depressed range. Clearly, even though almost depression does not rise to the level of a diagnosable mental disorder, it is nevertheless associated with a substantial amount of distress and suffering.

There is also another more serious problem: Research indicates about 75% of cases of low-grade depression will devolve into full-blown major depression if they are not recognized and arrested.

Major depression is a deadly disorder. People who are depressed have four times the risk of heart disease and almost six times the risk of dying after a cardiac event than people who are not depressed.

People who are depressed also have between nine and 16 times the risk for suicide than people who are not depressed.

It is therefore vitally important to recognize the symptoms of almost depression in yourself and your loved ones, and to take steps to reduce the suffering it causes.

There are a number of things you can do to combat almost depression that have been shown to be effective in randomized clinical trials (the gold standard of treatment testing). Here is a list of some these “evidence-based” steps:

Make sure you are getting enough exercise. The minimum amount for treating depression is 30 minutes of continuous aerobic exercise (70% to 85% of maximum heart rate) plus a 10-minute warm-up and cool-down period three times a week.

Integrate activities you have found pleasurable in the past into your weekly calendar. Even if you feel that you no longer enjoy them, such activities will increase the activation of the pleasure centers in your brain. As your symptoms resolve, you will regain pleasurable feelings.

Use creative outlets to express your negative feelings. You don’t need experience or talent to express yourself creatively, so paint, write or play music. Expressive creative work reduces depressive symptoms.

Manage your stress level. Stress has negative effects on both the brain and the body and can be a major source of depressive symptoms.

Challenge the way you think. Our moods are dependent not upon what happens to us in our lives, but in how we interpret what happens. Changing your interpretation has been shown to reduce depressive symptoms.

Increase your level of mindfulness. Mindfulness training and practice is an effective way to keep depression at bay.

Reduce the power you give to your “inner critic.” Often the negative and critical things we say to ourselves lead to feelings of depression and powerlessness.

Increase your social support circle. Having a strong social support system is a known protective factor against depression.

Improve your self-care. Poor nutrition and poor sleep habits can augment feelings of depression. In some cases, specific nutritional supplements can work wonders.

The steps that work for you will be dependent upon your specific signs and symptoms, the severity of your symptoms and your personality. If one step doesn’t work, do not give up.

There are many pathways to wellness, and with patience you will find the way that works for you.

You don’t have to be almost depressed. You can take charge of your symptoms and make your way out of the gray shadows and into the full light of good mental health.