3 Hidden Risk-Factors for Depression

If you struggle with depression, you know that part of what makes the experience so tough is how sudden and “out of the blue” it can feel: One day you’re perfectly fine then, within a matter of hours or days, just getting out of bed feels like a monumental struggle.

To make things worse, the seemingly unpredictable nature of depression leads to a lot of fear of getting depressed—even when you’re feeling good. And all this hypervigilance over depression tends to become a self-fulfilling prophecy that makes depression more likely: The more you think and worry about depression or getting depressed, the more likely they are to fall into depression-triggering thought patterns like rumination, self-criticism, or catastrophizing.

In other words…

When you’re constantly worried about getting depressed, you’re more likely to get depressed.

But it doesn’t have to be this way.

In my experience, many cases of depression are not nearly as mysterious as they seem. And with the right approach, you can learn to see the underlying patterns which give rise to it and undo them.

Of course, you have to know where to look…

If your entire theory of depression is that your serotonin system is a little wonky, or that you get depressed because you were bullied as a child, well… that kind of reductive thinking is not going to lend itself to an especially nuanced understanding of how depression works in your life.

On the other hand, if you’re willing to accept that depression is a complex phenomenon, and frequently maintained by a diverse set of factors, that level of openness and curiosity tends to shine a light on many of the previously unnoticed risk factors for depression. And once you start seeing these risk factors, you can start to address them proactively and reduce your susceptibility to depression in the first place.

In the rest of this article, I’m going to share three of the most common “hidden” risk-factors for depression. Of course, it’s unlikely that every single one applies to you and your life. But, if you experience chronic and unexplained episodes of depression, there’s a good chance one or two of these are at play in your life and significantly contributing to both the frequency and intensity of your depression.

1. Constant Busyness

In some ways, busyness might seem counterintuitive as a risk factor for depression. After all, a hallmark of most people’s depression is a significant lack of motivation and activity. In fact, one of the best (if still underrated) treatments for depression is behavioral activation, which essentially involves forcing yourself to take small meaningful actions each day regardless of whether you feel like it.

But remember, we’re talking about risk factors for depression, not symptoms of depression. And very often the behaviors that make us vulnerable to depression are almost polar opposites of the behaviors that characterize it once we’re in it.

For example:

Not getting enough sleep can make it harder to manage difficult emotions like anxiety or anger.
As a result, we fall back on unproductive ways of coping or managing those emotions, often in the form of negative mental habits like worry and self-criticism, which only make those difficult emotions more intense.
Eventually, this combination of low mood and negative thinking patterns can trigger a depressive episode.
But once you’re depressed, you frequently end up sleeping too much!

The point is…

While being constantly active and busy all the time might seem antithetical to depression, it can actually be a risk-factor for it.

And there are a couple of ways this can happen…

1. Busyness as emotional avoidance

First of all, many people use busyness and constant motion as a defense mechanism to avoid dealing with uncomfortable emotions. And while emotional avoidance feels good in the moment because it gives you relief, the long-term effects of constant busyness actually fragelize us and make us more vulnerable to depression.

Here’s one example from a former client of mine:

A woman in her mid-60s harbors tremendous guilt and sadness about her son being a drug addict.
But to avoid those feelings, she stays constantly busy: working non-stop, exercising fanatically, and in what little spare time she has, volunteering for charitable organizations.
As a result, she almost never sits still long enough to have quality one-on-one time with friends and loved ones. And it becomes increasingly uncomfortable and awkward for her to “go deep” or be vulnerable with anyone—even people close to her.
Eventually, her relationships begin to lose intimacy. And while she feels more and more distant and isolated from people, she also can’t slow down enough to re-establish those relationships.
Now, despite having a high quantity of relationships, she’s increasingly lonely and isolated because the quality of those relationships is superficial as a result of her constant busyness and acquired discomfort with intimacy and vulnerability.
So, when she eventually gets hit by an especially big stressor—her son overdosing, for example—she has little social support (which is one of the primary buffers against depression) and she spirals into a depression.

There are two key points to see here:

Emotional avoidance was the motivation for the constant busyness. Because she was unwilling to explore and work through her sadness and guilt around her son, she developed a habit of keeping herself constantly busy, which superficially looked and felt like a good thing. But long-term, her addiction to busyness and the emotional relief it provided, became pretty unhealthy.
Constant busyness made her much more vulnerable to depression. Did constant business cause her to get depressed? Not exactly. But it made her more emotionally fragile, in large part because it interfered with her ability to form authentic relationships, which is one of the most important components of resilience.

2. Busyness is exhausting

Another reason constant busyness makes us more vulnerable to depression is simple but surprisingly non-obvious: It’s exhausting. And exhaustion lowers resilience.

I had another client who serves as a good example of this:

He was a young man in his late 20s who, after talking to a therapist who told him that he needed to “stay busy” in order to not get depressed again, developed a habit of “saying yes to everything.”
Anytime a friend wanted to hang out, he said yes. Anytime his boss asked him to take on a new project, he said yes. Anytime he read about a new self-development habit like mindfulness or breathwork, he said yes and poured himself into it completely.
As a result of this constant busyness, he was constantly stressed and frequently sick. Ironically, because he was so often stressed and sick, it made it hard for him to follow through on all his commitments and promises.
Eventually, his self-esteem started to deteriorate because he was constantly making promises (both to himself and others) and not living up to them because he was so sick, tired, and exhausted.
The low self-esteem led to a lot of self-criticism and negative self-talk, which began triggering short but intense “bursts” of low mood and apathy. Eventually these evolved into longer lasting episodes. And by the time he started working with me, he was having multiple full-blown episodes of depression each year.
He came to me wanting to work on improving his negative self-talk and low self-esteem.
But what he didn’t realize was that both of those were caused by his constant busyness, which itself was a product of trying to avoid depression on the advice of his not-so-savvy former therapist.

Again, note that the constant busyness didn’t itself directly cause him to be depressed. Instead, it slowly made him more and more vulnerable to depression because it led to him being exhausted and sick all the time, which made everything in his life more of a struggle than it should have been—especially managing his self-doubt and negative self-talk.

So, does all this mean that being busy will make you depressed?

No, of course not.

Busyness becomes problematic when you start using it—consciously or not—as a coping mechanism.

Of course, the fall into busyness as a defense mechanism isn’t usually intentional. As the examples I gave above show, it’s very often a well-intentioned but misguided attempt at feeling better. And occasionally it comes from accepting some expert’s well-intentioned but misguided advice for feeling better.

In any case, the core problem is avoidance. The more you avoid rather than address your problems—including your problematic relationship with difficult emotions like sadness or guilt—the more emotionally fragile you become. And the more emotionally fragile you are, the more vulnerable you become to all sorts of emotional struggles, including depression.

On the other hand, when you learn to confront your struggles assertively, you become more resilient long-term, which makes future emotional struggles like depression less likely.

So, if you struggle with depression, it’s worth reflecting on the role of busyness in your life. And if you are a pretty busy and active person, I think it’s well worth your time to (difficult as it may be for you) slow down for 30 minutes and do some serious self-reflection about the motivation behind that busyness.

Here’s the key question to ask yourself:

Am I busy because I’m genuinely happy. Or am I using busyness as a way to avoid something—a difficult emotion, a relationship, a problem, a memory, myself?

2. Mimetic Desire

Mimetic desire is an unusual term for a surprisingly common phenomenon: We tend to want the things we see other people wanting.

A few decades ago, a literature professor at Stanford University named René Girard developed a theory which said that, despite the intuition we all have that our desires are our own—that somehow we create or construct what we want independently—in reality, most of our desires are mediated by other people.

For example:

Do I want that new iPhone because I’ve spent hours doing a careful cost-benefit analysis of why the iPhone is the superior smartphone given my unique use-cases, values, and temperament? Or do I want that new iPhone because all my friends want it and Apple is really good at marketing to people like me?
Do you want to start doing yoga because, as a result of a careful inquiry into the nature of yoga as a practice and its benefits relative to other health and wellbeing practices, you’ve decided it will be good for you? Or do you want to start doing Yoga because every day you watch amazingly fit and beautiful Instagram influencers talk about how much yoga has improved their lives?
Or even take a much bigger desire like the profession you chose… Did you really want to become a doctor because at the age of 18 you really knew “deep down” that becoming an orthopedist and repairing torn ACLs was the right path for you? Or did you become a doctor because that’s what you saw a lot of successful people wanting and doing—including your parents who obviously wanted that for you?

Now, wanting what other people want isn’t necessarily a bad thing. I’m not expecting you to buy into this theory wholesale. Because I’m sure that you, like everyone else—myself included—thinks you’re the exception to this process of mimetic desire.

But I would strongly encourage you to simply entertain the idea and be a bit curious about it: That a lot of the time what we want (and choose to pursue) is less about what we ourselves actually want as it is about what other people want.

Now, at this point you may be wondering what all this mimetic desire stuff has to do with being vulnerable to depression.

Here it is:

A great way to end up depressed is to live someone else’s life instead of your own.

If you spend too much time pursuing goals that you don’t really care about (because ultimately their other people’s goals, not yours), you are likely to end up pretty unhappy, likely chronically frustrated and resentful, and depending on your unique vulnerabilities, depressed.

For example:

Marrying someone because they conform to other people’s ideas of a great spouse: Beautiful, charming, hard-working, and successful.
Skip ahead a decade or two and you finally realize that you don’t really care that much about 9/10 physical beauty, charm, or an intense work ethic in a partner.
And what you really want is someone who’s kind, supportive, funny, and easy-going.
Trouble is that you have three kids and have built up an entire life together.
You feel trapped—committed to someone you don’t actually want to be with but unable to go after what you do want.
Eventually, the frustration, disappointment, and resentment lead to hopelessness and apathy, which make you far more vulnerable to depression.
All because, ultimately, you didn’t have enough awareness to realize what you really wanted in a spouse—because you spent your time wanting what you saw other people wanting.
And so, you ended up unhappily living someone else’s life rather than your own.

Another example I see all the time:

Embracing a career as an attorney (for example) because it “looked good” when you were in college: Respectable, make lots of money, argue for a living, what could be better, right?!
Turns out, being an attorney is not nearly as respected amongst the type of people you enjoy spending time with, you do make a pretty good income but spend 70 hours a week at the office to do it, and while you do enjoy professional arguing in court, that makes up approximately 2% of your professional time, the rest being taken up by mind numbing amounts of paperwork and meetings.
But you’re stuck because the lifestyle you and your family have become accustomed to depends on a career you actually hate.
So everyday, you walk into the office full of regret about what could have been instead.
The regret leads to a habit of brooding and rumination, which makes you irritable and moody, which in turn negatively affects your most important relationships: your spouse and your kids.
Again, all because you didn’t realize that you were wanting (and chose) someone else’s career, likely because you never even took the time to seriously consider what you really wanted out of a career and what would be a good fit given your talents, preferences, and values.

Here’s the takeaway from these examples:

Don’t assume that what you want is in your best interest.

Because our desires are so easily and powerfully influenced by other people, we need to be thoughtful and reflective about what we want and the decisions we make based on that wanting.

Otherwise it’s very easy to “wake up” years down the road only to realize we’re living someone else’s vision of the good life, which, by the way, is probably based on someone else’s desiring of someone else’s idea of the good life.

Here’s a final twist on this idea:

One of the best ways to stay resilient to depression is to be self-aware.

But true self-awareness—including self-awareness of what we actually want—is surprisingly hard to come by. And like any other skill in life, it takes a lot of practice to develop.

A good way to start is to regularly reflect on the following question when faced with a significant decision:

Do I really want this or do I want it because I see other people wanting it?

And if you really want to go deeper on this topic, doing some values clarification work can be very helpful.

3. Grief Avoidance

Something I noticed early on in my work as a psychologist was that people who were chronically depressed were pretty anxious too.

Specifically, they tended to be anxious about depression. Which’s s we talked about earlier, makes sense: Depression is awful, so if you get depressed, it’s not surprising that you might feel anxious about getting depressed again.

But it’s not just anxiety about depression that’s characteristic of people whose struggle with depression. It’s also anxiety about sadness and grief. In other words, a lot of folks who struggle with chronic depression seems to be very nervous around anything pertaining to sadness:

In their speech, they tend to intellectualize and substitute abstract terms like stressed or overwhelmed for emotions like sadness or grief.
They avoid situations or people who might trigger sadness or grief.
They even have a tendency to fall into false positivity (constantly smiling and talking about how great everything is) as a way to buffer against even the smallest experience or feeling of sadness, remorse, grief, or similar related emotions.

Taken together, I call this pattern of behaviors Grief Avoidance because they’re all motivated by a desire to avoid experiencing grief or sadness.

Now, the origin of this grief avoidance behavior comes from an understandable but inaccurate assumption:

Feeling sad will make me depressed.

Of course, just seeing it spelled out like this shows its limitations. But a surprising number of chronically depressed people maintain this as a core belief—that if they allow themselves to feel grief or sadness, it will throw them into a spiral of depression.

As a result, they start avoiding sadness and grief. But like all avoidance, this teaches their brains that sadness and grief are dangerous, making them even more afraid of them. Consequently, they feel even more pressure to avoid and escape these feelings and any situations associated with them.

You can see how this vicious cycle progresses…

Grief avoidance eventually leads to a full blown phobia of sadness.

And like everyone with severe phobias, it not only makes you incredibly anxious, worse, it narrows and constricts your life because you have to avoid more and more aspects of your life because they might trigger sadness or grief.

And to make matters worse, the more restricted and anxiety-filled your life becomes, the more vulnerable you are to depression. Another vicious cycle.

The implication of all this is straightforward, if counterintuitive:

If avoiding grief and sadness makes you fragile and anxious, approaching them will make you resilient and confident.

One of the best ways to make yourself less vulnerable to depression is to spend more time with sadness and grief. Not wallowing in them or ruminating—but allowing, listening, being willing to feel them.

For one thing, you often learn something about yourself. Despite feeling uncomfortable, sadness and grief often have a lot to teach us—including about ourselves.

But more importantly, by willingly approaching and spending time with your grief and sadness, you change your relationship to it. When your brain sees you deliberately approaching sadness and grief, it learns that—however uncomfortable—they’re not bad or dangerous. And the stronger that belief becomes, the more confident and resilient you will be in the face of sadness and grief.

So, how do you actually do this—start approaching sadness and grief instead of dodging and avoiding them?

Often the best place to start is to practice the skill of emotional validation.

To validate your sadness or grief means simply that you take a second to acknowledge what you’re feeling and remind yourself that, despite feeling bad, grief and sadness are not bad or dangerous. They’re perfectly normal experiences. And that it’s okay to feel them.

To sum up:

The more you avoid your grief and sadness, the more vulnerable to depression you become.
Resilience comes from welcoming grief and sadness and building a healthier relationship with them.
The best way to start doing this is to practice the skill of emotional validation.

All You Need to Know

If you struggle with chronic depression, one of the best things you can do is to stop searching for—or assuming you know—the cause of your depression. And instead, consider what factors in your life make you more vulnerable to depression.

And while there are many, many things that increase vulnerability to depression—from your genes and childhood upbringing to your diet and sleep patterns—some of the most important vulnerabilities are our own behavioral patterns which are “hidden” in plain sight:

Constant Business
Mimetic Desire
Grief Avoidance

The more aware of these patterns you become, the easier it will be to modify them and become more resilient to depression in the future.

Work With Me

I don’t treat depression clinically anymore. But several times a year I take a small group of students through a five-week emotional resilience training program called Mood Mastery.

Learn about Mood Mastery here →