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Can a simple change in lifestyle reduce the risk of developing depression?

Depression is the second most prevalent mental illness in the United States, after anxiety. Officially called major depressive disorder (MDD) by the Diagnostic and Statistical Manual of Behavioral Disorders – Volume 5 (DSM-5), depression is a serious mental health issue that can cause significant disruption in almost all areas of life.

Here are the latest statistics on the prevalence of mental illness and depression in the U.S and around the world.

Mental Illness and Depression in the U.S. and Worldwide

United States

The National Institutes of Health (NIH) report:

  • Any Mental Health Diagnosis:
    • Adults 18+: 22.8% (57.8 million)
      • Received treatment: 46% (26.4 million)
    • Serious Mental Illness (SMI):
      • Adults 18+: 5.5% (14.1million)
        • Received treatment: 64% (9 million)
      • Depression:
        • Age 18+: 8.4%
          • Received treatment: 61% (12.6 million)
        • Age 18+ depression with severe impairment: 6%
          • Received treatment: 64.8% (9.1 million)

Worldwide

The World Health Organization (WHO) reports:

  • Any Mental Illness (AMI):
    • 12.5% of people live with some sort of mental illness
    • That’s around 970 million people
  • Depression:
    • 3.8% of people in the world report depression
    • That’s close to 30% of people with any mental health disorder
    • That’s around 280 million people

Those figures show us that mental health disorder affect hundreds of millions of people around the world, and tens of millions in the Untied States. Here in the U.S., roughly half of people diagnosed with depression receive evidence-based treatment. Worldwide, treatment prevalence ranges from around 23 percent in high-income countries to around 3 percent in low-income countries.

That’s what we call a treatment gap or a services gap. That’s the difference in the number of people who need treatment and people who receive treatment. Make no mistake: treatment for mental health disorders is essential, because the consequence of untreated mental health disorders is high. We’re writing this article because of that treatment gap, and recent research that shows how we can reduce that treatment gap through preventive lifestyle changes.

Before we talk about the lifestyle changes that can improve mental health – and depression, specifically – we’ll take a moment to talk about the consequences of untreated mental health disorders, including depression.

The Consequences of Untreated Depression

New information published by the National Alliance on Mental Illness (NAMI) describes the impact of mental illness on four categories of people: individuals, families, communities, and the total world population. This information is not specific to depression, but it’s relevant to our discussion of the impact of lifestyle on depression and mental illness, because it increases our awareness of what we have to gain by taking the basic steps required to reduce the likelihood of developing depression or another mental illness. It also shows us the importance of making simple lifestyle changes after diagnosis with a mental health disorder such as depression.

Impact on Individuals

  • Students with clinical mental health disorders are three times more likely to repeat a year of school
  • High school students with severe depression drop out at twice the rate of students without severe depression
  • People with depression are 40% more likely to develop heart problems and metabolic disease, such as diabetes
  • One third of people with a mental health disorder also develop a substance use disorder
  • People with a mental health disorder are almost twice as likely to be unemployed

Note: these consequences are in addition to the disruption caused by the symptoms of a mental health disorder. A mental health disorder can also have a significant negative impact on wellbeing, family life, friends, relationships, and the ability to manage the basics of daily life, such as eating, sleeping, and attending the personal hygiene.

Impact on Family

  • Families are often the first to experience the negative consequences of a mental health disorder, because they see the change in their loved one, and may be the direct or indirect target of externalizing symptoms such as anger and irritability
  • Over 8 million people in the U.S. provide home are to a family member with a mental health or behavioral disorder
  • On average, caregivers for family members with a mental health disorder spend 32 hours a week giving care (unpaid)

Impact on Communities

  • Mental health disorders cause over half a million emergency hospitalizations each year
  • Over 20% of people experiencing housing instability (homelessness) report a clinical mental health disorder
  • In 2020, close to 20 million military service veterans had a mental illness
  • 10% of active-duty military service people report a clinical mental health or substance use disorder
  • Disability associated with mental illness results in close to 200 billion dollars in lost income per year

Worldwide Impact

  • Depression is the second leading cause of disability worldwide, after back pain/back injury
  • Combined with anxiety, depression results in over a trillion dollars in lost productivity every year

When we understand depression – and other mental health disorders – as common occurrences, and further understand that (1) there’s no reason to stigmatize or judge people with mental health disorders and (2) evidence-based treatment works, then we can begin to make progress to eliminate the treatment and services gap we mention above.

Remedying the treatment gap will take a combination of evidence-based practices, prevention initiatives, and lifestyle changes – both in the U.S. and worldwide – and a commitment to provide them to as many people as possible.

We have one more thing to talk about before we share the lifestyle changes that can help mitigate the effects of depression, and in some cases, prevent depression from developing in the first place: the standard clinical treatments.

Treatment for Depression: Common Clinical Approaches

The standard approach to treating depression is a combination of psychotherapy, medication, peer support, and lifestyle changes. Second-line approaches include methods such as brain stimulation therapies and psychedelic psychotherapy.

Psychotherapeutic approaches include individual or group therapy based on these techniques:

  • Cognitive behavioral therapy (CBT)
  • Dialectical behavior therapy (DBT)
  • Acceptance and commitment therapy (ACT)

Common medications for depression include:

  • Antidepressants, including:
    • Prozac
    • Zoloft

Recently approved medications for depression include:

  • Spravato®
  • Ketamine

Ketamine and Spravato® are in the psychedelic psychotherapy category.

Brain stimulation techniques include:

Lifestyle changes include:

  • Improved diet
  • Increased exercise
  • Managing stress

Adjunct techniques, used in addition to standard treatment:

  • Yoga, tai chi
  • Mindfulness
  • Music, drama, writing, dance, visual art

All those approaches can help people with depression – even treatment-resistant depression (TRD) – manage the symptoms of their disorder and live a full and fulfilling life. However, additional evidence from NAMI shows that for millions of people in the U.S. and worldwide, it’s not always easy to access these basic, standard types of care – especially for people who live in rural or non-metro areas.

Barriers to Care: Rural and Non-Urban Locations

Patients in Non-Metro Areas:

  • 21% had a mental health disorder
    • 6% had a severe mental health disorder
    • 5% considered suicide
  • 13% had a substance use disorder
  • 48% of people with a mental health disorder received treatment
  • 62% of people with a serious mental health disorder received treatment
  • Rural residents travel twice as far to access care, compared to metro residents
  • Rural residents lack sufficient access to broadband for virtual care
  • Over 25 million people live in areas where the demand for support exceed the capacity of the infrastructure and the number of qualified providers

Additional Challenges for Patients in Non-Metro Areas:

  • Youth in rural areas show increased suicide risk
    • Rural areas have fewer suicide prevention resources
  • Several rural states have higher rates of post-partum depression than the national average
  • Over half of rural adults report negative mental health consequences from the COVID-19 pandemic
  • 66% of people who work on farms report negative mental health consequences from the COVID-19 pandemic
  • 71% of young adults (18-34) in rural areas report negative mental health consequences from the COVID-19 pandemic

In this article so far, we’ve demonstrated the real need for depression treatment in the U.S. and around the world, listed the most common evidence-based treatments, identified the treatment and service gap, and presented various reasons people may not have easy access to standard evidence-based care.

Now let’s get to the concept we introduce in the title: lifestyle habits that can help improve depressive symptoms, or prevent the development of depression.

Lifestyle Habits That Improve – Or Prevent – Depression

The habits we’ll share may not be surprising. In fact, they’re a component of a majority of comprehensive, holistic treatment plans for people with depression. The study that has our attention on this topic – The Brain Structure, Immunometabolic And Genetic Mechanisms Underlying the Association Between Lifestyle Aand Depression – was published in the journal “Nature” in September 2023. The research team formed an important research goal:

“…to investigate combining an extensive range of lifestyle factors, including alcohol consumption, diet, physical activity, sleep, smoking, sedentary behavior, and social connection, that contribute to depression, and examine…the protective roles of seven lifestyle factors and combined lifestyle score on depression.”

One component of the study was identifying the underlying genetic risk factors common to the development of depression, but when they analyzed the data, the research team found that lifestyle factors trumped genetic factors. Therefore, we’ll focus on those, but we won’t ignore the genetic component entirely. In addition, one of our goals in writing this article is to demonstrate the critical role lifestyle plays in both the development and treatment of major depressive disorder – hence our focus on and preoccupation with that component of the study.

This research has our attention for two more reasons, First, the sample size of close to 300,000 people allows for population-level conclusions. Second, the duration of the study: a nine-year follow-up period after attaining baseline data adds weight to the findings. The researchers compared a total of 13,000 patients with depression with a matching group of control patients without depression to determine which lifestyle factors functioned as protective factors. After an exhaustive statistical analysis, they identified the seven factors we mention above.

Each factor was associated with a decreased risk of depression.

The Impact of Lifestyle on Depression: The Results

Let’s look at the details of the data now.

Lifestyle and Depression: Protective Factors

  • Healthy sleep: 22% decreased risk of depression
  • Never smoking: 20% decreased risk
  • Frequent social connection: 18% decreased risk
  • Regular physical activity: 14% decreased risk
  • Low-to-moderate sedentary behavior: 13% decreased risk
  • Moderate alcohol consumption: 11% decreased risk
  • Healthy diet: 6% decreased risk

After this phase of analysis, researchers placed participants in three categories, based on their overall lifestyle scores. The categories include a favorable group, an intermediate group, and an unfavorable group.

Impact of Category of Lifestyle Habits

  • Favorable: 57% less likely to develop depression
  • Intermediate: 41% less to develop depression
  • Unfavorable: No decreased likelihood of developing depression

Next, we’ll share the impact of genetic risk on the development of depression.

Genetic Risk Scores, Lifestyle, and Depression

  • Low genetic risk: 25% decreased risk of developing depression
  • Moderate genetic risk: Risk mitigated by both favorable and intermediate lifestyle sfcores
  • High genetic risk: Risk of depression mitigated by both favorable and intermediate lifestyle scores

The final factors the team examined were physiological. To understand the contribution of lifestyle factors to reduced depression risk, he team examined brain volume and blood markers for problems associated with various health issues that may contribute to depression.

Physiological Foundations of Lifestyle Impact on Depression

  • MRI scans on 33,000 patients showed increased volume in 4 brain areas associated with reduced risk of depression:
    • Pallidum
    • Thalamus
    • Amygdala
    • Hippocampus
  • Blood markers:
    • C-reactive protein, associated with stress, was higher in people with lower lifestyle scores
    • Triglycerides, which are fat storage molecules, were higher in people with lower lifestyle scores

Both the blood markers were associated with decreased or compromised immune function, which increases risk of metabolic disease and dysfunction, which increases risk of depression. What all that means is something very simple: an unhealthy lifestyle can increase depression risk by impairing immune and metabolic function.

Summing it All Up: Things to Do Today

Here’s how Dr. Christelle Langley, a lead researcher on the study, explains these results:

“We’re used to thinking of a healthy lifestyle as being important to our physical health, but it’s just as important for our mental health.”

Dr. Barabara Sahakian adds:

“Although our DNA – the genetic hand we’ve been dealt – can increase our risk of depression, we’ve shown that a healthy lifestyle is potentially more important. Some of these lifestyle factors are things we have a degree control over, so trying to find ways to improve them – making sure we have a good night’s sleep and getting out to see friends, for example – could make a real difference to people’s lives.”

Let’s make sure this message is loud and clear:

A healthy lifestyle can decrease depression risk.

What’s a healthy lifestyle?

In this context, a healthy lifestyle means:

  • Low alcohol consumption
  • Plenty of exercise
  • No smoking
  • Healthy eating
  • Active lifestyle
  • Good sleep
  • Social connection

We’ve heard this type of advice about healthy living our whole lives. And virtually every day – okay, every month or so – a new, peer-reviewed journal article appears and supports this practical advice with robust data and sophisticated statistical analyses.

The evidence is in: lifestyle plays a large role in depression prevention and treatment. It’s time for this concept to become dogma, rather than a novel new approach. We’re in that place already, and we’re committed to supporting all our patients with this holistic, comprehensive approach to depression and m mental health treatment.