We often think that mild depression isn’t that serious and doesn’t require treatment. It is mild, after all. People also confuse mild depression with “subclinical” depression.* That is, they assume it’s not full-blown, true-blue depression. They might assume it doesn’t meet diagnostic criteria for the illness (the criteria laid out in the Diagnostic and Statistical Manual of Mental Disorders, which clinicians use to diagnose disorders.)
However, in actuality, a person with mild depression does meet criteria for a major depressive episode. They do have depression. But their symptoms are mild in intensity and impairment, said Melanie A. Greenberg, Ph.D, a clinical psychologist in Marin County, Calif., who specializes in managing mood, stress and relationships.
Depression comes in different intensities: mild, moderate, severe and profound, according to Deborah Serani, PsyD, a clinical psychologist who specializes in treating mood disorders. These categories are based on how disabling the symptoms are, how much they interfere with daily functioning and whether a person can still work or fulfill household roles, said Greenberg, author of the forthcoming book The Stress-Resistant Brain.
In mild depression, the hallmark symptoms of depression — “tearfulness, hopelessness, helplessness, irritability, fatigue and negative thinking” — manifest in less intense forms, Serani said. “Mild depression can feel as if you’re extra tired, extra moody, extra achy — more so than usual.”
Some people aren’t even aware that they’re depressed, she said. Others know they’re struggling. But “they can make it through the day without too much effort.” Still, mild depression can pose significant health risks, including cardiac issues and premature mortality, said Serani, author of the books Depression and Your Child and Living with Depression.
“Some mild depression can be short-lived,” remitting after a stressful event gets better, Serani said. (This stressful event might be a divorce, illness, financial issues or unemployment.) “Others are chronic, and can last for many months, even years.” Still other mild depression may develop into moderate or severe depression, she said.
There’s also the risk of double depression. According to Serani, “This occurs when a mild chronic depression [called dysthymia] worsens to the degree that a serious second depressive disorder occurs on top of it.” Research has found that 75 percent of people with dysthymic disorder will experience double depression during their lifetime.
Serani experienced two double depressions, one as a teenager and the other after giving birth. “Early treatment helped me. And I’ve seen early treatment reduce the effects of double depression in many of my own patients, too.”
This is why it’s essential to seek treatment. First, Serani suggested seeing your primary care physician for a complete physical evaluation. This helps you rule out any medical conditions, which may be “mimicking mild depression.” Then see a mental health professional to be screened for depression. “Together you can understand the issues that are causing your mild depression and ways to treat it.”
Holistic measures, such as light therapy, aromatherapy and exercise, can be very effective in treating mild depression. For instance, Greenberg cited this review, which found yoga decreases symptoms of depression. She also cited this piece, which summarizes several studies about the power of exercise for mild (and moderate) depression.
Serani worked with a teen who was having trouble adjusting to his new school. They used cognitive behavioral strategies to reduce his social anxiety and problem solve. They used aromatherapy with mood-boosting scents, such as peppermint, sandalwood and lemon verbena. They also used color therapy to help him adjust to his new home, “choosing new bedsheets, blankets and accessories that were calming and soothing in blues and sand tones.” After three months of therapy, his symptoms were gone.
Greenberg worked with a client who was experiencing mild depression after a breakup. She blamed herself, and her self-esteem took a nosedive. Even though she had friends, she felt alone. Seeing her friends only reminded her of being with her ex. Some nights she couldn’t sleep.
In therapy they worked on practicing self-care, reaching out to friends, exercising regularly and planning pleasant activities. They challenged her beliefs that there was something wrong with her and the breakup was all her fault. Greenberg also encouraged her client to consider different perspectives. “What pieces may have been his issues? Was he really ready to commit to anyone?”
In addition to therapy, some individuals may require medication. For instance, Serani worked with a client nearing retirement. They worked on making plans for the future, finding ways to leave work with a sense of accomplishment and coping with medical issues (her high blood pressure and diabetes).
They also explored holistic interventions. The client started practicing yoga, Tai Chi and water aerobics. This improved her fatigue but didn’t eliminate her depressive symptoms. She still felt sad and had trouble concentrating.
Next with the supervision of her doctor, she started taking St. John’s Wort and increased her vitamin D for several months. This still didn’t help. She stopped taking St. John’s Wort and started taking a low-dose selective serotonin reuptake inhibitor (SSRI). (St. John’s Wort can’t be taken with antidepressants.) Within weeks she was feeling better. Today, Serani sees this client once a month. But soon she’ll discontinue therapy. She’s “learned how to manage and cope with her chronic mild depression, and will continue taking her antidepressants as prescribed.”
Again, mild depression can become serious. Getting an evaluation and treatment right away is important. As Serani said, “The truth is that getting in early when symptoms are mild and learning techniques to deal with them helps to prevent further illnesses or worsening of depressive symptoms.”
* If your depression is subclinical (i.e., doesn’t meet all the criteria for major depression), increasing exercise, socializing more and using a self-help workbook based on cognitive behavioral therapy principles may help, Greenberg said.
Tired man photo available from Shutterstock