Woman struggling with depressionThere’s an old saying, “It’s hard to remember you were sent to drain the swamp when you’re up to your behind in alligators.” Loose translation: It’s easy to lose sight of the longer term goal when you get sidetracked by more immediate demands.

We are so focused on the immediacy of generating and delivering effective treatments for depression that too few of us pay attention to the potential for prevention. Can depression be prevented? The evidence strongly suggests the answer is yes. There is no place where the old adage that, “An ounce of prevention is worth a pound of cure” is more true than in the realm of depression. Depression is devastating in so many ways.

The fact is, depression is growing at the fastest rate in our young people. (I’ll say more about that in future blogs.) When someone suffers depression at a young age, it sets up a downward spiral that tends to get progressively worse over time. Negativity sets up more negativity, failure breeds more failure, and rejection breeds more rejection. To prevent that initial downslide would obviously have enormous lifelong benefits.

One of the curious findings from the domain of epidemiology, the study of the prevalence of a disease or disorder, is that the average age at which someone suffers their first depressive episode has been growing progressively younger. 25 years ago, the average age for depression’s onset was in the mid-thirties. 10 years ago, it was the mid-to-late twenties. Now it is the early twenties. It isn’t difficult to predict that in another ten years the average age of first onset will be in the late teens.

Why the age is dropping is an important topic to be visited another time. Right now, I want to draw your attention to some research in the area of prevention of depression in high risk teens that was published in the Journal of the American Medical Association’s June 3rd, 2009, issue. A cognitive behavioral therapy (CBT) program that teaches cognitive reappraisal (challenging and re-deciding the meanings of experience) and problem-solving skills to adolescents who are at high risk for depression (for a variety of reasons including family history, poor coping skills, family stressors, etc.) has been shown to help prevent them from developing depression.

The study involved 316 adolescents, aged 13-17 years, who had at least one parent or caretaker with either a history of or a current depression. The teens were enrolled in the multicenter study, conducted at 4 sites in 4 states over a span of over 5 years. The program consisted of 8 weekly 90 minute sessions, followed by six monthly sessions, with mixed-sex groups of 3 to 10 individuals. Through the sessions, the teens learned problem-solving skills and techniques to identify and manage unrealistic and negative thoughts. They also learned behavioral, relaxation and assertiveness skills.

Participants had more than 11% lower a rate of depression than equally matched kids who did not go through the program. Skill building as a means of empowering people of all ages is the core of both good treatment and prevention.

There have been other prevention programs developed by other researchers over the years, some with even more impressive success rates than this recent study. So, why aren’t prevention programs readily embraced and implemented, ideally with all kids, but at the very least, with kids at an elevated risk?

I think the answer has something to do with swamps and alligators… and the fact that there’s no financial profit to be had in prevention.