What is depression and when should I be concerned?

Whether someone becomes depressed can be influenced significantly by the level of social support that they have and also the degree of loneliness that they experience. For example, when someone is bereaved, if they are experiencing a high level of loneliness and are socially isolated, that person is more likely to become clinically depressed than someone who has plenty of supports and is not lonely.

The graph below is from our research with community-dwelling older people. It shows the effect of loneliness and social support on the number of people who become depressed. What you see here in the graph is:

• On the yellow line are the people who have a lower level of support.
• One the blue line there are people with a higher level of support.
• The degree of loneliness goes from left to right.

You will notice two important things:

1. If you have more support (blue line), there is less depression.
2. You can also see the striking effect of loneliness on the numbers that get depression. In effect, the higher the degree of loneliness, the more depression, whether or not you have social supports.

Here are some strategies for combating depression in your daily life:

1. Exercise: Aerobic exercise, where you get your heart beat up, is good for you because it releases chemical messengers that can lift your mood state. People often exercise in the company of others (e.g. walk with others or meet people in the gym) and this social connection can also have a positive effect on your mood.
2. Keep connected: You might feel like withdrawing, but try to do the opposite as it can help maintain or improve your mood.
3. Challenge those negative thoughts: If you have a negative thought, challenge it to see if it’s logical; don’t just accept it as true. Sometimes, people get negative thoughts about their life, their past or future, and these thoughts cause them to feel more depressed or get stuck in a depression. For example, you may feel like you’re a failure or that you have let someone down even though it’s not true. Don’t just accept this thought or idea as true or push it away. Dwelling on it or accepting a thought when it’s not true can make you feel worse. Acknowledge the thought and the feeling by challenging your assumptions.
4. Problem solve and look for solutions: When you’re depressed, sometimes it’s hard to be positive and figure out solutions. It can help to make a list of your problems and then put a possible solution beside each problem. When you do this, your problems may not seem so insurmountable.
5. Just talk about it: Don’t be afraid to let you friends and family know how you feel. Their support and encouragement can be of great benefit in dealing with depression. Likewise, there are tremendous benefits in helping others.
6. Don’t be afraid to talk to your General Practitioner or see a mental health professional: Seek help beyond friends and family if you’re really feeling stuck.

• As an example, not everyone who has a bereavement develops depression. What can you do to decrease your risk of developing depression after a person that you are very close to moves away or dies?
• How would you distinguish between grief and depression?

Brian Lawlor is Professor of Old Age Psychiatry at Trinity College Dublin.