In the last few years, the COVID-19 pandemic has accelerated the number of people battling depression. The Centers for Disease Control (CDC) reports that symptoms of depressive disorder rose considerably from April-June 2020 over the same period in 2019.
Depression itself is a serious condition. Defined as a mood disorder, depression causes unrelenting sadness and a loss of interest in usual activities and social events. But it presents a special challenge for patients with chronic conditions. According to an article published by the Cleveland Clinic, “…an estimated one-third of people diagnosed with a serious, life-changing chronic illness or disease will experience symptoms of depression.”
For many patients, a chronic illness can cause an actual or perceived loss of control and independence, while at the same time requiring patients to make wholesale lifestyle changes. Depression impairs a patient’s ability to make the necessary changes and engage in the self-care behaviors needed to manage their condition.
Knowing the Signs
It is important to recognize the symptoms of depression in your patients, as the earlier depression is identified, the quicker providers can put a treatment plan into place.
The Mayo Clinic offers a list of key symptoms that may be indicative of depression including:
- Feelings of sadness, tearfulness, emptiness, or hopelessness
- Angry outbursts, irritability or frustration, even over small matters
- Loss of interest or pleasure in most or all normal activities, such as sex, hobbies, or sports
- Sleep disturbances, including insomnia or sleeping too much
- Tiredness and lack of energy, so even small tasks take extra effort
- Reduced appetite and weight loss or increased cravings for food and weight gain
- Anxiety, agitation, or restlessness
- Slowed thinking, speaking, or body movements
- Feelings of worthlessness or guilt, fixating on past failures or self-blame
- Trouble thinking, concentrating, making decisions, and remembering things
- Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
- Unexplained physical problems, such as back pain or headaches
While these symptoms can be indicative of many conditions, there are a variety of screening tools that health coaches and allied health professionals can use to help identify depression and other psychological problems patients may be confronting. Silver Fern’s Behavioral Health Barriers module is a digital assessment that screens for depression, anxiety, post-traumatic stress disorder, binge eating disorder, and alcohol abuse disorder. The assessment measures depression using the industry-standard PHQ-9, which is scored by assigning point values to the levels of answers for each question. This tool can help providers identify emerging signs of depression and make appropriate referrals.
The Lifestyle Connection
While not a substitute for professional behavioral health treatment, there are a variety of lifestyle measures that have been shown to be salubrious in the face of depression. One of the most well-studied and evidence-supported is physical activity. In people with depression, the hippocampus, which controls emotional response, is diminished. According to an article from Harvard Medical School, exercise can cause the nerve cells in the hippocampus to expand, helping patients feel better.
In addition to exercise, dietary modification, social activities, and other care strategies are being used to help control depression in patients. It is important to note that lifestyle measures are not a replacement for drug therapy or counseling, but the table below, published in BMC Psychiatry, provides a list of lifestyle measures and the current state of evidence of their effectiveness in treating depression.
Table 1: Lifestyle Medicine for Depression
CS = Cross-sectional, OB = Observational study, LO = Longitudinal, CTs = Clinical Trials, NAT = Nature-Assisted Therapy, PA = Physical Activity
| Lifestyle Element | Evidence Level | Cost | Comment |
| Diet | CS, LO | Moderate expense | Relationship found between dietary quality and depression; RCTs now required to validate |
| PA/Exercise | CS*, LO*, CTs | Inexpensive | Strong evidence of efficacy for improving mood |
| Recreation | OB, CTs | Variable expense | No studies exploring recreational activities for depression (aside from music therapy) |
| Relaxation & meditative techniques | CTs | Variable expense | Evidence supports relaxation techniques (especially with a mindfulness component) in improving mood |
| Sleep | CS, LO, CTs | No expense | Strong causal link between sleep amount and quality and depression risk |
| Environment | CS, LO, CTs | Potentially not adjustable | Association between reduction of pollution and mood; CTs showing NAT improves mood |
| Socialization | CS, LO | No expense | Strong association between social support/networks and mental health |
| Animal/Pet therapy | CS, CTs | Moderate expense | Studies support the psychological benefits of animals and pets |
| Vices (smoking, alcohol) | CS, LO | Potential to save money | Association between smoking and alcohol and depressed mood |
Uncovering the Presence of Depression
Silver Fern offers three chronic disease management programs: Type 2 Diabetes; Hypertension; and Heart Failure. Each program contains a Behavioral Health Barriers module, which allows providers to screen patients quickly and easily for psychological issues that can negatively impact self-care, such as depression, anxiety, post-traumatic stress disorder, binge eating, alcohol dependence, and substance abuse. Once depression or other psychological issues are identified, a referral to an appropriate health care professional is in order.
Depression can have a devastating effect on patients’ quality of life and ability to care for their chronic condition. As allied health professionals, our ability to recognize the risks and signs of depression, coupled with educating our patients on healthy lifestyle options, will help empower them to successfully manage their chronic conditions and live their best lives.