he U.S. Centers of Disease Control and Prevention have reported that approximately 10% of adults in the U.S. report suffering from some level of depression. The percentage of individuals reporting suffering from depression appears to increase with age up to the age of 50, with more females vs. males reporting the problem. You probably know someone, or have known someone, dealing with the debilitating effects of depression.
There was a fairly dramatic event in my life that introduced me to depression. With time, I bounced back, but that encounter made me appreciate how it can just draw the life out of someone.
What was odd about that time was that I always had the confidence – the faith – that I would come out of my depression. There was something about me, something beyond my mind’s ability to grasp, that I knew would bring me out of it. My research over the past 25 years has helped me to understand what the something is, and how many other adults in the U.S. appear to have it. I will say more about this shortly.
Many things in life may bring us to depression. The common list includes things like divorce, loss of a job, death of a loved one, or contracting a major illness. Suffering from chronic emotional abuse can also lead to the development of depressive symptoms. Alcohol and smoking have associations with depression. Of course, if depression has occurred in your family, the risk that you might suffer from depression goes up. The genetic link to depression can show up in a number of ways. For example, the absence of a simple neuropeptide, Neuropeptide Y, has been linked to depressive risk. A number of factors in the brain, such as a small hippocampus (the region of the brain involved in long-term memory), have been associated with depression.
My own research has revealed a number of health-related behaviors associated with depression: Increasingly, as a person agrees with the statement, “I make my own healthcare decisions”, his or her risk of depression goes up 22% to 41%; as a person agrees with the statement, “I only seek medical care when I am really sick because it is too expensive”, their risk of depression increases between 20% and 28%; and as a person more strongly agrees with the statement, “I look for health information to learn about different healthcare treatments,” their risk of depression increases between 14% and 22%. What this research shows is that a person’s basic approach to health decisions, their avoidance of medical care due to concerns about cost, and their attitude toward seeking treatment-related health information can add to the risk of depression.
Many Interacting Parts
Because there are so many factors within us and without us that can impact our risk of depression, is it fair to treat them as separate things? If one thing affects another, which then influences two others, and those two others then loop back to interact with the first, isn’t it like a dog chasing its tail? It is really helpful to see them as parts, as opposed to a system of factors.
Here is what I mean. A person with heart disease who also has depression and anxiety is more likely to die than a person who only has heart disease. This is because the interaction of the three things together sends the biological, psychological, and social systems of the person into a potential death spiral, leading to greater risk of system failure.
Depression and anxiety influence the physiological mechanisms and operations of the cardiovascular systems in people suffering from heart failure. They do this by changing the neurological and hormonal behavior of a chain of centers composed of the hypothalamus and pituitary glands in the brain, and the cortical portions of the adrenal glands. Together, these centers make up the hypothalamic-pituitary-adrenocortical axis or HPA axis.
Depression and anxiety cause the autonomic system to go haywire. This causes the HPA axis to constantly and abnormally pump out cortisol. The cortisol in turn leads to the production of waves and waves of immune response proteins called cytokines, which then leads to increased production of platelets. The platelets then further worsen the functioning of the heart. People suffering from the combination of heart failure, depression and anxiety may end up in the “dog chasing her tail” downward spiral of heart failure; a downward spiral of interacting parts that follows a pattern.
The explanation of how depression and anxiety negatively impact heart disease is captured in the pattern formed by the many interacting parts.
Depression and “Lifestyle Medicine”
Recent research has pointed to “lifestyle medicine” as a way to promote protection against depression and to promote general good health. Lifestyle medicine includes things like increasing physical activity or exercise, changing diet and the way a person eats, making sure a person gets adequate relaxation and sleep, addressing and improving social interactions, using mindfulness-based meditation to manage stress, and reducing the recreational use of nicotine, drugs, and alcohol.
Lifestyle Medicine as a Pattern of Health
In fact, most of what lifestyle medicine promotes in terms of protection against depression and promotion of health already exists in a pattern of adaptive health behavior. This pattern of health behavior is found in approximately 10% of adults, and is described in detail in my book, Pattern of Health. My research has affirmed that this pattern of health is highly protective against mental health disorders such as depression, anxiety, and emotional stress. In fact, adults who emulate this pattern of health have a 27% reduced risk of suffering from depression or anxiety.
What those researchers of lifestyle medicine have, in fact, tapped into, are elements of this pattern of health. In other words, the behavioral goals of lifestyle medicine relating to exercise, good nutrition, cessation of smoking, reduced alcohol consumption, low stress, and healthy sleep are reflected in an already existing natural pattern of behavior. Adults in this pattern display the healthiest levels of exercise, the healthiest attention to diet, and the healthiest levels of sleep, stress and overall health status found among the U.S. adult population. My research into this pattern of health has shown that it also extends to family health issues, the use and pursuit of health information, a specific level of healthcare service use, compliance and adherence to medications, and a number of other issues not reflected in the focus of lifestyle medicine.
A fascinating thing about this pattern of health is that those adults who emulate it are not aware that their positive state of health is due to this pattern. These adults follow this healthy pattern completely unconsciously. Like these people, it was a number of years before I learned that my health-related behavior followed this same pattern. And, that was the ‘something’, unknown to me at the time, which implicitly gave me the confidence that I would eventually come out of my depression.
I also learned how health-related behavior may conform to a number of patterns, with different numbers of adults following each one of them. These patterns of health are linked to entirely different health outcomes and predict a number of other physical and mental health conditions including anxiety, depression, emotional stress, bipolar disorder, heart disease, cancer, and many more. Adults following these patterns of health have no idea that the health issues they deal with on a daily basis, or are at risk of developing in the future, are outcomes of the pattern of health they follow.
The Transtheoretical Model of Behavior Change posits that the beginning of behavior change involves moving a person from the stage of Precontemplation, at which the person is unaware or does not acknowledge a problem, to the stage of Contemplation, at which the person becomes aware of the ramifications of the problem, and starts to think about behavior change. This is why I wrote, Pattern of Health, to begin the process of making people aware of these patterns and their role in shaping health, and to set the stage for their contemplation of change.