SALT LAKE CITY — Lonely. Like a you're in a black hole. Hopeless.
These are the words Cheryl Allred, 36, used to describe what her depression feels like at its worst. Most days, she says she deals with what she describes as mild depression, struggling to think through concerns and feeling overwhelmed by problems.
But she has found a way to deal with the ongoing mild depression.
"I've been able to manage it pretty well with just exercising," she said.
Mental health professionals have seen benefits from their clients participating in exercise, meditation or proper sleep as supplements for treating depression.
"In the middle of (depression), everything feels a bit darker and more difficult," said Anne Brown, a marriage and family therapist.
The use of exercise to treat depression — either as a supplement or replacement for medication — is debated among professionals.
One group of 95 adults ages 20 to 45 showed that aerobic exercise was an effective treatment for mild to moderate depression, according to a 2005 study in the American Journal of Preventative Medicine. In addition, the U.S. Department of Health and Human Services found that exercise can help guard against the onset of depression and reduce some of depression's negative effects.
A study by Debbie A Lawlor and Stephen W. Hopker published in the March 31, 2001 edition of the British Medical Journal, for example, indicated there was not enough evidence to prove the effectiveness of exercise on depression.
A review of studies on meditation showed slight improvement in treating anxiety and depression with a meditative practice, according to a study published in the March 2014 Journal of the American Medical Association.
Salt Lake psychiatrist Dr. Ted Wander said practices like prayer, meditation, yoga, singing and exercise are important supplements for treatment because they help reduce stress.
"Those things are so helpful rather than just relying on medication alone," Wander said.
He has clients who have been diagnosed with severe depression and have trouble with daily functioning. This group tends to experience a more gradual recovery, so exercise is often considered after the medication takes effect and the client begins to see progress with talk therapy. From there, someone can gradually introduce exercise as an additional push toward recovery, he said.
He agrees with the Utah Psychiatric Association that exercise is not a substitute for treatment, but a supplement to treatment.
What depression looks like
In suveys conducted in 2006 and 2008 roughly 9.1 percent of people reported experiencing any type of depression, according to an Oct. 2010 Morbidity and Mortality Weekly Report by Centers for Disease Control and Prevention. Between 3.9 and 4.2 percent experienced major depression and between 4.9 and 5.3 percent experienced other types of depression.
The same report said that 8.9 percent of Utahns experienced any sort of depression. Those who experienced major depression accounted for between 3.5 and 5.1 percent of Utahns, while those with other types of depression fell between 4.0 and 5.6 percent.
Depression occurs to different degrees on a scale, and severity is determined by the number of symptoms exhibited and the individual's ability to function, according to Loren Brown, a doctorate candidate in counseling psychology at BYU. He has been counseling patients with depression for three years.
For instance, someone who has mild depressive symptoms might feel gloomy for most of the day, tired and lose interest in activities they used to like, but they are still able to go to work or school, get out of bed and take care of themselves, he said. On the other hand, someone who has severe depression may feel hopeless, have consistent suicidal thoughts, not eat, sleep a little or a lot, be unable to make it to work or schoo, or feel overwhelmed by routine tasks such as getting dressed or showering.
Those who think they may be depressed should meet with their doctor or a licensed mental health practitioner, Loren Brown said, instead of relying solely on online tests, surveys or other resources.
"Although it can be helpful to talk to a family member, trusted friend or ecclesiastical leader, a medical or mental health professional has the training to make a diagnosis and recommendations for treatment," he said.
He also encourages people to come prepared with questions for their doctor.
"It is important for you to feel informed about what to expect. Also, be prepared to answer questions about how long you have felt this way, when you first noticed a change in your mood, etc.," he said.
Those who feel suicidal should not wait for an appointment, he said. Rather, they can call a suicide hotline or 911.
"Keeping yourself alive is the first priority in treatment," he said.
The National Suicide Prevention Lifeline is available 24 hours a day, toll-free at 1-800-273-TALK. Those who call will be connected with a person at a certified crisis center close to their location. For more information visit www.suicidepreventionlifeline.org.
Anti-depression medication seems to be an effective tool in treating those who are severely depressed. Those who experience mild to moderate depression might see limited effectiveness with medication, according to a study in the 2010 edition of the Journal of the American Medical Association. The study showed that those with major depressive symptoms benefited from depression medication versus a placebo, while those with mild to moderate symptoms did not see much difference between anti-depressant medication and placebos.
Another study published in a February 2002 edition of Journal of Clinical Psychopharmacology supports the claim that antidepressants tend to be more effective than placebos in severely depressed individuals.
And it appears recovery from depression can be accelerated with proper exercise, nutrition, sleep or meditation. Those with mild to moderate depression could consider exercise or other alternative methods, according to these studies.
Some people are averse to taking medication, according to Anne Brown. This means exercise may be the only treatment they are willing to try.
Her husband, Loren Brown, said general best practice is to make sure a physical component is not aggravating or causing the depression — such as vitamin or sleep deficiency or thyroid imbalance, he said. It is important to consider how the body and mind work together because physical health “can enhance (treatment), or they could make it so it’s not as effective.”
For many patients, it’s a matter of finding which treatments work best for them, whether it’s exercise, meditation or biofeedback, according to Loren Brown. Someone who is depressed often feels like they have little or no control over the direction of their lives and these treatment supplements “give people a sense of self-efficacy.”
Loren Brown has seen positive results when people treat depression in a holistic way, addressing concerns with both physical and mental health. The “complementary alternative treatments” of proper sleep, nutrition, exercise, meditation or biofeedback “can also help the gains they’ve seen in treatment last longer,” he said.
Allred said she would definitely seek medical advice if she became suicidal or severely depressed. As she is not in that situation, she continues to exercise daily and has seen her consistency pay off.
"You have more of a sense of it's not so overwhelming and it's not so hopeless," she said.