Mindfulness as a prescription for depression

When I was training to be a doctor, many of my teaching physicians liked to repeat the phrase “common things are common.” They meant that taking care of patients requires more than just recognizing a wide range of illnesses; it requires looking for the common conditions even when they are not obvious. In my practice today, we screen for high blood pressure, high blood sugar, cardiovascular disease and common cancers. We also screen for depression.

I encourage anyone suffering from depressed mood to have a conversation with their clinician. Doing so can help to gauge its severity and come up with treatment options. For those with mild symptoms or those simply trying to maintain a healthy mood, lifestyle interventions can be a good place to start.

By some estimates as many as one in four people will develop depression in their lifetime. The World Health Organization also estimates that as many as half of them will not seek medical care for their condition. Sometimes this has to do with cultural beliefs or stigma. Sometimes people don’t want to take medications if there are other options to improve their mood. Knowing what those options are and when they are most appropriate is worthwhile. I regularly have these discussions with my patients, but as many as have the conversation, there are likely just as many who do not.

Most of us have some idea of what they can do to cultivate a healthy mood. Perhaps we have heard about techniques for managing stress or elements of good self-care, like eating a healthy diet, exercising regularly and getting enough high-quality sleep. These are good practices to build resilience and promote many elements of good health. But the research doesn’t end there. There are several other things you can build into your routines that promote a healthy mood well before a bigger issue develops.

Get into nature

Numerous studies confirm what many of us seem to know intuitively – that spending time in nature is great for mood. Natural environments like parks and forests promote relaxation and have a calming effect. This can even be seen in the bloodstream when measuring cortisol levels, a stress hormone. Getting out into nature during the day also reinforces the wakefulness side of our circadian rhythm through exposure to sunlight. This leads to higher energy levels during the day and better sleep over night. Time spent in nature also tends to mean more activity walking, jogging or biking, leading to greater endorphin levels and feelings of well-being. On a spiritual level, time spent in nature encourages a sense of connection to the world around us that supports mood as well.

Mindfulness brings resilience

As humans we have an incredible ability to dwell on the past and anticipate the future. While this can help us to plan ahead or to learn from mistakes, too much of it can be detrimental. Learning to be present in the moment can enable us to enjoy all of life’s little pleasures. Learning to be mindful of our thoughts and emotions can help us learn to regulate emotion in a positive way. When negativity takes hold, it can shape our perception of events and experiences in a way that perpetuates that negativity. Mindfulness techniques like deep breathing exercises or meditation can help to break a negative cycle and over time to prevent negativity from taking hold. Practicing mindfulness is a way to foster resilience through greater emotional intelligence.

Practice gratitude

Have you ever written a thank you note when it wasn’t expected – maybe to a former teach, coach or mentor? How did you feel afterwards? Medical research would predict that you felt good. Practicing gratitude is about more than just positive thoughts. There is a mind-brain connection by which our thoughts impact our biochemistry. That is why getting stuck in a pattern of negative thoughts can be detrimental. It is also why positive thoughts, like gratitude, can have an outsized beneficial effect. Practicing gratitude cultivates a mindset of abundance and contentment counteracting feelings of dissatisfaction and despair. It also teaches us to recognize the positive things in our lives and savor them.

A sense of purpose

There is a reason why volunteers work for hours without pay and job seekers choose to take a position with lower salary at an organization with a social mission. A sense of purpose gives our lives greater meaning. There is data to back up these feelings of greater happiness and fulfillment. Helping others distracts from one’s own challenges and gives a new perspective as well as a connection to others and community.

When a patient in the office indicates on a screening questionnaire that mood symptoms have been less than ideal, we have a conversation about it. Often, after a minute or two, the patient says something like “but I don’t want a medication for it, and I don’t need to start counseling.” Usually, they are right.

For mild symptoms, a prescription isn’t always the best solution. At that point I often ask something like “what do you think you could do differently on your own?” This causes them to stop and think. The research indicates that there are many ways to impact mood. Perhaps it’s jogging on a trail instead of on a treadmill or practicing mindfulness throughout the day to catch negative thoughts before they spread. Perhaps it is practicing gratitude to generate positive thoughts that cascade into the rest of our day or giving back to a worthy cause that helps others and the community.

These habits are not a replacement for medical therapy with moderate to severe depression, and they are not a reason to avoid speaking with one’s healthcare provider. Clinically depressed individuals benefit from prescription medication and professional counseling. But just as many other health conditions benefit from early intervention – so does depression. And, like other health conditions, a bit of prevention can go a long ways.

Peter Barkett, MD, practices internal medicine at Kaiser Permanente Silverdale and writes a regular column for the Kitsap Sun. He lives in Bremerton.