Often, people with depression know they need help, but they lack awareness of these six important factors, which can influence both the duration of their depression and the course of this chronic and episodic condition.

 kwest
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1.  Thinking that another person caused you to feel depressed.  While the words or actions of another person can certainly trigger thinking, it is very often what you tell yourself about their words/actions that contributes or even leads to a depressed mood.

  • Psychologists sometimes call this your "cognitive style," and your cognitive style/your way of thinking is the reason you respond as you do to adversity.  
  • Researchers found that cognitive style mediates whether a person with depression will practice self-compassion or hopelessness.1 
  • Your inner conversation might be a good place to put your energy, rather than using it to correct another person's words or actions.  

2.  Realistic explanatory style.  People with depression tend to explain things either pessimistically or realistically.  Very often, however, their way of explaining things to themselves leads them to into greater helplessness, self-isolation, and withdrawal.  

  • An optimistic explanatory style tends to help you feel happier, according to the multiple research studies in positive psychology.
  • Recent studies revealed that a pessimistic explanatory style has been linked to greater depression, especially when social support is low.2,3

3.  Vitamin D deficiency.  I ask my patients with depressed moods to have their physician rule-out vitamin D deficiency.  Far too often, vitamin D deficiency mimics depression and goes untreated.

  • In a recent large scale study, a sample of adults aged 18-65 from the Netherlands Study of Depression and Anxiety (NESDA) including 1,102 with current depression and 790 with remitted depressive disorder, as well as 494 healthy adults, had their serum levels of vitamin D evaluated.4  
  • Of these, a third (33.6%) had deficient or insufficient serum D. As compared with the healthy adults.  
  • The lowest D levels were found in participants with current depression, particularly in those with the most severe symptoms.
  • In their studied sample of currently depressed people, low vitamin D was associated with more severe symptoms of depression at a 2-year follow-up!
  • Low vitamin D levels may create a real vulnerability for depression, so if you're depressed, get your vitamin D levels checked.

4.  Hypothyroidism.  This physical condition can also mimic depression.  

  • Up to 1/3 of people who don't respond to antidepressants may be suffering from a thyroid condition. This is another condition to have your physician rule-out!

5.  A lack of social support and cognitive challenge.  Social support serves as a buffer against life stress, though a depressed mood may con you into disengaging socially.  

  • Social support can challenge set ways of thinking/viewing reality, such as challenging your perfectionism and thereby helping your mood.  
  • If you self-isolate and continue thinking the same thoughts, this can also be associated with greater depression.  Researchers found that high levels of disengagement coping was a particular risk factor for depressive symptomatology, diminishing the advantage of high self-esteem.7​

6.  A lack of physical stimulation.  According to Chiropractic Neurologist Dr. Roger Clifford, sitting in front of the T.V. and computer many hours a day can often lead to a lack of brain stimulation.  

  • Clifford states, "We are designed to have the cross-crawl movements stimulate our cerebellum, which in turn stimulates our cortex.  When people sit around too much, they don't get this type of brain stimulation."
  • Have to stay put on a chair?  Clifford suggests trying a rocking chair. At least you'll get more physical stimulation than sitting with stability, and this stimulation can allow you to think more clearly, potentially leading to some relief from your poor mood. 
  • Physical stimulation through exercise is helpful for depression if you are able to exercise.  A review of the literature of people who are hospitalized for various mental illnesses found that exercise was helpful for inpatients with depression, while this was not the case with other major mental illnesses.8

It may be helpful to print these out and take them to your doctor or therapist.  While it is important to find what works for you, a holistic approach is good to consider.  For example, in addition to considering the above 6 factors, using a combination of cognitive behavioral therapies and exercise, or cognitive behavioral and interpersonal therapies with medication can help you treat your depression.  Bibliotherapy, including self-help reading and workbooks designed to help you change your cognitive and behavioral style may also support you during therapy.

References:
1.  Lulinyan, S. (2013). Negative Cognitive Style As A Mediator Between Self-Compassion and Hopelessness Depression. Social Behavior & Personality: An International Journal, 41(9), 1511-1518.
2.  Mileviciute, I. D. (2013). The Role of Explanatory Style and Negative Life Events in Depression:  A Cross-sectional study with youth from North American Plains Reservation. American Indian & Alaska Native Mental Health Research: The Journal Of The National Center, 20(3), 42-58.
3.  Rueger, S. K. (2011). Effects of Stress, Attributional Style and Perceived Parental Support on Depressive Symptoms in Early Adolescence: A Prospective Analysis. Journal Of Clinical Child & Adolescent Psychology, 40(3), 347-359.
4.  Milaneschi, Y. H. (2014). The association between low vitamin D and depressive disorders. Molecular Psychiatry, 19(4), 444-451.
5.  Stanley, P. H. (1997). Depression or endocrine disorder?: What mental health counselors need to know about hypothyroidism. Journal Of Mental Health Counseling, 19(3), 268.
6.  Zhangtaisheng, C. (2013). Perceived Social Support As Moderator of Perfectionishm, Depression, and Anxiety in College Students. Social Behavior & Personality: An International Journal, 41(7), 1141-1152.
7.  Lee, C. N. (2014). A Closer Look at Self-Esteem, Perceived Social Support, and Coping Strategy: A Prospective Study of Depressive Symptomatology Across the Transition to College. Journal Of Social & Clinical Psychology, 33(6), 560-585.
8.  Stanton, R. B. (2014). Exercise for mental illness: A systematic review of inpatient studies. International Journal Of Mental Health Nursing, 23(3), 232-242.

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