Pathways to understanding depression

Part 2

As promised, it is not only important to learn about depressive disorders, but we also have to establish coping strategies. Remember, coping strategies tend to be context specific and they are subjective depending on the individual and their preference.

In Part 1, we spoke about elevation and lowering of a person’s mood being associated with depressive disorders. Essentially, we want to be intentional in exploring the “it” that boosts mood. Again, it may be helpful to know which depressive disorder you meet diagnostic criteria for, or qualify as having, given your symptoms.

As I highlighted earlier, presentation of symptoms can help guide treatment. Think of it this way, there are individuals who can experience five or more symptoms of depression for a 2-week period (Major depressive disorder).

Then, there are people who experience symptoms of depression for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least two years.

The presence of two or more symptoms of depression have to be there. This is what is defined in the DSM-5tr as Persistent Depressive Disorder. It is equally important to know if the symptoms are severe (do they affect normal functioning), moderate (you can function but still feel neither here nor there), and mild (you can function while having the symptoms).

This is my layman’s understanding of specifiers of severity. Is it a single episode or recurring episode, is it in partial or full remission, what features is it presenting with?

The first intervention that I want to propose is that of a healthy diet. Depression is linked to the food that we eat. Research has shown that there is a complex relationship between diet and depression. While there is no single “anti-depression” diet, a balanced and healthy diet can help support mental health and reduce the risk of depression.

As much as it is weird to be consulting with a mental health provider and they ask about your food intake, trust that you are better off just being honest and forthcoming. Missing meals may contribute to mood swings by causing fluctuations in blood sugar levels.

There is a whole science behind this that we will not go into. Processed foods that are high in sugar, refined carbohydrates, and unhealthy fats have been linked to an increased risk of depression. Similarly, fast foods are often high in calories, unhealthy fats, and sodium, and can contribute to feelings of fatigue and low mood.

The reason we tend to ask about your alcohol intake is part to the knowledge that consuming excessive amounts of alcohol can disrupt neurotransmitter function and contribute to feelings of depression and anxiety. There are also foods that may prevent depression like whole grains, fruits and vegetables, and whole foods among others. It rings true that “We are what we eat.”

Ours is a fast-paced life, we are as busy as can be expected. This unintentionally robs us of pursuing our personal hobbies and interests, which can be rewarding to our mental health. This is the second intervention I invite you to think about.

Identifying and pursuing positive and productive hobbies and interests can be a helpful tool for managing depression and improving overall well-being. I find that often times we regard pursuing hobbies as time-wasting. Anything but, it is a cost effective way to boost one’s mood which in turn does wonders to our mental health.

Third coping strategy is gym/working out. We discussed this in Part 1, that exercising has been shown to have a positive impact on mental health by reducing symptoms of depression and anxiety, improving mood, and increasing self-esteem.

Exercising can also have a positive impact on physical health by reducing the risk of chronic diseases such as diabetes and heart disease. In terms of the types of workouts that are most helpful for managing depression, it is important to find a form of exercise that is enjoyable and sustainable. I recently learned that mine is singing along to my favourite songs. It just makes me feel so good!

Some folks opt for the aerobic exercise also. Running, cycling, and swimming can also be helpful for managing depression by increasing the production of endorphins, which are natural mood-boosters. Strength training such as lifting weights can be helpful for managing depression by improving muscular strength and endurance.

This can increase overall physical function and improve self-esteem.

The fourth that I can think of is use of medications. These can be context-specific depending on what qualifies as medicines in that context. In some parts of the world there is use of psychotropic medications, in others there is use of traditional medicines to quiet the depression down. I can think of a few that Africans tend to use, but I dread the ‘evidence-based’ confrontations.

Last but not least, is talk-therapy. My colleagues at Healthline define it as what mental health professionals use to communicate with their patients. The purpose of talk therapy is to help identify issues causing emotional distress.

Specific to depression, we want to uncover and process the things that cause sadness most of the day, nearly every day, low mood, markedly diminished interest, or pleasure in all, or almost all, activities most of the day, nearly every day, feelings of worthlessness, etc.

People that live with, and are challenged by depression are not lazy, weak, or attention seeking. They experience alterations in their mood which affect their overall functioning, as well as their ability to enjoy a happy life.

• ‘Makamohelo Malimabe, the author works as a Psychotherapist. She holds a Master’s in Counseling Psychology. She has certifications in Global Health Delivery, Policy Development & Advocacy in Global Health, Leadership & Management in Health, as well as Fundamentals in Implementation Science. Her views are independent and not representative of her professional roles. She is ambitious about equitable health delivery, health policy and decolonised mental health approaches.