Classified as an affective disorder, depression intricately weaves together a tapestry of subdued moods, diminished interest and enthusiasm, heightened fatigue, and a noticeable decline in motivation. Within this emotional tapestry lie pervasive feelings of guilt, a profound sense of worthlessness, eroded self-confidence, and a marked reduction in focus. While brief spells of sadness are natural, clinical depression, also known as major depressive disorder, presents a significantly more debilitating challenge, distinguished by the unyielding gravity of its symptoms. This intense suffering often engulfs individuals, encapsulating them in a cocoon of desolation and inertia. Life’s triumphs and joys struggle to penetrate this melancholic shield. More often than not, the individuals feel trapped, and require external help to navigate their way out. Over time, the brain, in its remarkable adaptability, reshapes itself to these depressive states, adjusting its neural pathways, brain chemistry, and overall function. This neural transformation further complicates the restoration of positive thought patterns, making the emotional landscape of those with depression elusive to the external world.
Depression’s manifestations are multifarious. It can manifest at any life stage, with varying intensities, across diverse durations, and may progress in numerous ways. Many individuals with depression experience physical symptoms – such as chronic pain, sleep disturbances, fatigue, and changes in appetite or weight – despite the absence of an identifiable underlying medical condition. Some may also experience cardiovascular issues or diminished libido. At times, depression alternates with episodes of mania, marked by heightened euphoria and vigour, leading to the diagnosis of bipolar disorder. Between these oscillations, periods of mood stabilization may occur.
Factors that elevate the risk of developing depression include exposure to trauma during formative years and a family history of the disorder, particularly when a parent has been affected. Negative thought patterns acquired in childhood, coupled with low self-esteem or pervasive feelings of helplessness, often lay the groundwork for depression. Life’s tumultuous events or circumstances – such as job loss, relationship turmoil, the death of a loved one, or prolonged stress – can also act as catalysts. In some cases, individuals may internalize their distress, suppressing emotions rather than addressing them. Other triggers include seasonal transitions, the postpartum period, stages of dementia, or the onset of severe physical illnesses. Additionally, depression may be linked to nutritional deficiencies, such as a lack of vitamin D, or underlying chronic inflammation.
The complex nature of depression can hinder accurate diagnosis for both individuals and medical professionals, particularly in its early stages. Initial symptoms are often mistaken for fleeting mood fluctuations or misattributed to physical ailments. Societal stigmas, intensified by personal reservations, frequently deter people from seeking professional help. Without treatment, depressive episodes can last for extended periods, shadowed by a significant risk of recurrence. In some individuals, depression may evolve into a chronic condition, persisting relentlessly for years.
Globally, the World Health Organization estimates that nearly 300 million people live with depression. The combined costs of treatment and lost productivity make depression one of the most economically taxing illnesses. Tragically, depression is a leading contributor to suicide, with an estimated 800,000 people taking their own lives each year. Experiencing suicidal thoughts warrants immediate action, whether through emergency services, a psychiatric clinic, or a specialized helpline. (For example, in the UK call 116 123; in the US, call 1-800-273-8255.)
Conventional treatments for depression include medication, which can have side effects, and psychotherapy. While patient and empathic support from loved ones can be highly valuable, unsolicited advice or criticism can be detrimental. Therapy aims to help individuals understand and change entrenched negative thoughts and behaviors, replacing them with healthier coping mechanisms. This often involves exploring past traumas, establishing new routines of thinking and acting, and learning new strategies to manage emotions. In addition to therapy, lifestyle factors play a crucial role. Other powerful tools in overcoming depression include physical activity, a balanced diet – and engagement with music.
Music’s Therapeutic Role in Managing Depression
Within the sphere of mental health, music serves as a potent instrument, providing comfort, insight, and healing. However, it is important to be aware of the potential pitfalls of music use for those experiencing depression.
Many of these individuals, often without conscious awareness, employ music in ways that may be counterproductive, particularly during the depths of depressive episodes. They may find themselves drawn to melancholic tunes, even though this type of music often evokes negative thoughts and emotions rather than eliciting enjoyment. While sombre tunes can provide a sense of understanding by giving voice to shared struggles, they can also reinforce destructive thoughts and emotions. In fact, those with depression frequently report heightened despondency after listening to such melodies.Footnote 1
Notably, individuals at risk for depression, marked by difficulties in controlling and regulating their negative emotions, are impacted in similar ways. They frequently experience feelings of nervousness, insecurity, and anxiety without manifesting the clinically relevant symptoms of depression. (This particular tendency is often termed ‘neuroticism’ within the realm of personality psychology.) Immersing themselves in sorrowful music exacerbates their depressive symptoms and heightens the risk of full-blown depression. One reason is that such tunes can instigate a downward spiral of negative moods and prolonged rumination. At times, individuals intentionally select music to nurture and intensify these adverse moods and memories – a potentially risky practice that can make the onset of depressive symptoms more likely.
However, as they listen to music mirroring their current negative mood, they remain caught in the emotional undertow of despondency. Despite feeling burdened by such music, they still ‘like’ it and frequently choose it over uplifting tunes. Most are unaware that the music they listen to perpetuates their depression. One constructive approach involves not merely listening to music that mirrors one’s existing mood but also to melodies that align with the desired emotional state. One potentially effective solution is to create a playlist that begins with a song resonating with the current mood and gradually transitions to tracks with a more positive tone.
Social interactions significantly influence our relationship with music and mood. Individuals with depression, or those at elevated risk, often gravitate towards listening to sombre music in group settings. This shared experience can lead to co-rumination, where conversations are laden with negativity, painful memories, and persistent pessimism.Footnote 2 Such group rumination is even more harmful than solitary brooding, as shared negative emotions amplify each other. This is particularly detrimental for those with depressive tendencies, as ruminating on negativity against the backdrop of melancholic music can deepen destructive thought patterns and emotions. If conversations within your social circle frequently focus on negativity without seeking constructive solutions, it might signal underlying depression or unhealthy dynamics. Encouraging positive interactions or seeking professional guidance may help break these cycles.
Conversely, when individuals with depression intentionally choose music that avoids provoking negative rumination, they frequently discover it to be a proficient means of managing symptoms (see the subsequent recommendations below). Dancing also appears to offer benefits for some with depression. In a study, researchers divided participants into three groups: a dance group, an ergometer exercise group, and a group that listened to music.Footnote 3 Each group engaged in their respective activities for twenty minutes. Surprisingly, all groups reported a reduction in depressive symptoms afterwards. However, it was the dance group that experienced the most significant decrease in symptoms. Strikingly, the effects emerged after a mere single session, illuminating the remarkable benefits of even a fleeting dance experience.
For those navigating depression, music offers both therapeutic benefits and potential pitfalls. The incorrect use of music can intensify negative moods or ruminative thoughts. This guide aims to assist individuals, whether diagnosed with depression or at risk, in harnessing music’s therapeutic effects for their well-being. Note that these guidelines are meant to complement, not replace, essential medical advice.
1. Crafting mood-lifting playlists
◦ To positively affect your mood, include music that aligns with the emotional state you aim to achieve. Do not focus solely on tracks that echo the typical negative moods you experience at times.
◦ Mood-transition playlist: ideally, during a time of well-being, take the time to curate a playlist. It is perfectly fine to begin with a track that resonates with the mood you often find yourself in during melancholic or even depressive episodes. Such tracks can provide emotional resonance and convey understanding. However, it is crucial to thoughtfully transition, track by track, towards music that mirrors the emotional state you aim to inhabit – whether that state is motivating, uplifting, or calming.
◦ Classical music lovers might appreciate such mood transitions in all Bach cantatas in minor, and most of Beethoven’s compositions in minor. Meanwhile, jazz enthusiasts might start with a soulful blues piece, progressing towards the lively rhythms of bebop or swing. You might also think about incorporating pieces from Chapter 10 into your playlist.
◦ Exclusively positive playlists: consider creating playlists that consist exclusively of tracks with a positive tone. You can use these in times of good health to practise cultivating positive thoughts.
2. Immersion in the musical experience
◦ Do not simply let the music play in the background – immerse yourself fully in the experience. Engage by tapping to its rhythm, silently humming the melody, or even synchronizing your breathing with its tempo. Such active involvement not only deepens your connection to the music but also serves as a diversion from negative ruminations by occupying your mental resources.
◦ If your mind strays into less positive terrains, gently remind yourself that now is not the time for such thoughts. Redirect your focus back to the music or pivot to positive thoughts, as outlined in the next recommendation. For additional strategies, see Chapters 5 and 20.
3. Channelling positive thoughts
◦ As you listen to music, intentionally direct your thoughts towards positivity. Music that radiates positivity often acts as a potent catalyst for this shift. However, during challenging phases, such a task might seem daunting. To assist in these moments, during a period of wellness, prepare a note listing a few of your personal strengths, cherished memories, and affirmations. Read this note during your listening sessions to bolster positive thinking, and let the music’s Good Vibrations unleash their healing effects within you.
◦ Mantras such as ‘breathe, relax, let it flow’ or ‘it is right that I exist’, accompanied by a gentle, slow stroke of your arm or torso, can be grounding.
◦ To help prevent new episodes, incorporate this practice into your daily routine. Doing so will bolster your resilience and enhance your ability to counteract rumination and negative emotional spirals. You might consider using those of your playlists consisting exclusively of positive-sounding tracks for this practice.
4. Setting small, achievable goals
◦ Dedicate yourself to manageable, music-related tasks. For instance, aim to listen to at least one track from your therapeutic playlist each day. Alternatively, dance or take a walk, syncing your movements to the rhythm of a single song. Even if the joy you feel is not as intense as in the past, these small actions are vital stepping stones in your journey through depression.
◦ Let music be a motivating force for physical or mental activities. Upbeat or invigorating tunes can energize you to engage in physical movement or tackle tasks you?ve been postponing. Try aligning your pace and actions with the rhythm – this can make tasks feel easier and more enjoyable.
5. Shared music experiences
◦ Consider joining group musical activities such as choirs, dance groups, or ensemble performances. Participating in these activities offers multiple benefits: it facilitates social interaction, fosters a sense of belonging, and mitigates the feelings of isolation that often accompany depression.
◦ Strive for positive experiences in these group musical activities. Aim for sessions that evoke feelings of joy, fulfillment, and connection.
6. Beyond music
◦ Helpful resources: Consider utilizing workbooks tailored for individuals with depression, such as Depression for Dummies. These resources provide structured guidance and are invaluable not only for individuals navigating depression but also for their loved ones seeking to better understand and support them.
7. Music therapy
◦ Consider formal music therapy. A typical course involves twelve to twenty sessions and can yield significant therapeutic benefits. During these sessions, a trained music therapist employs a range of music-based activities designed to help individuals express emotions, build self-esteem, and manage stress.
Music Therapy in Managing Depression
Beyond listening to music and engaging in music making or dance, music can also unfold its healing effects through music therapy. The Finnish music therapist Jaakko Erkkilä spearheaded a clinical study to examine the therapeutic benefits of music therapy in patients with clinical depression.Footnote 4 Adult participants were divided into two groups: one received standard treatment, which included medication and psychotherapy, while the other received music therapy in addition to standard care. The research team utilized improvisation-based music therapy as their method. In this therapeutic framework, the therapist’s role is multifaceted: they may accompany the patient’s musical activities, offer creative cues, or mirror the patient’s musical expressions. (For a more detailed account, see Chapter 14). Each therapy session was structured to alternate between phases of collaborative music making and open discussions. These discussions focused on the patient’s moods, thoughts, or current feelings. The study employed a variety of instruments that are easy for non-musicians to play, including a marimba, an African djembe, and an electronic drum. Each patient participated in a total of twenty sessions, scheduled twice a week. Notably, compared to the standard treatment group, those engaged in music therapy experienced a significantly greater reduction in depression and anxiety.
While these findings offer cause for optimism, an important limitation must be acknowledged: thus far, no study has included a placebo-controlled group. This absence significantly limits the findings, particularly given the well-documented impact of placebo effects in treating depression. For instance, the mere act of leaving one’s home twice-weekly to participate in a structured activity can itself yield tangible psychological improvements. As it stands, the absence of placebo-controlled studies leaves a gap in our definitive understanding of music therapy’s efficacy in treating depression. Nevertheless, several studies such as the one by Jaakko Erkkilä indicate that music therapy reduces depressive symptoms when added to standard treatment.Footnote 5 Moreover, I firmly believe that the therapeutic effects of music therapy extend far beyond mere placebo effects; here are several compelling reasons to support this assertion:
Emotional awakening. Music therapists frequently report instances where patients reveal that music therapy has helped them feel, understand, and articulate emotions they had long been unable to confront. For example, Jaako Erkkilä shared a moving account of a patient who remarked, ‘Today, for the first time in years, I was able to permit, articulate, and comprehend my emotions.’ Another patient, initially hesitant to participate, experienced a profound breakthrough during an intense drumming session, later exclaiming, ‘For the first time in my life, I could let it all out.’ Remarkably, this patient displayed no symptoms of depression after completing the music therapy sessions.
Non-verbal emotional expression. For individuals who find it difficult to verbalize their emotions, particularly when dealing with traumatic experiences, conventional psychotherapy might fall short. Music therapy can provide an alternative by offering a non-verbal medium for emotional expression, thereby creating a safe space for emotional exploration and healing.
Strong patient engagement. Many patients demonstrate remarkable motivation to participate in music therapy. Jaako’s study revealed not only exceedingly low dropout rates but also indicated that the majority of patients were keen to continue music therapy post-study.
Physical activation. The physical act of engaging in music making offers therapeutic benefits, analogous to the positive effects attributed to physical activity in treating depression.
Experience of meaning. For music to emerge, movements need to be synchronized to an underlying pulse. Therefore, music as the result of synchronized movements makes sense. This experience of meaning is crucial for individuals with depression, who often grapple with thoughts of meaninglessness, such as the belief that their existence lacks purpose or value.
Emotional activation. Engaging in synchronized movements during musical activities triggers pleasure and stimulates dopamine release in the reward system. This is an important brain mechanism mitigating anhedonia – a restricted ability to feel pleasure or joy, and a common symptom in depression.
Human connection and social reintegration. The formation of a personal bond with the therapist not only satisfies the human need for connection but also offers a foundation for patients to establish and maintain social bonds in their everyday lives.
Neurological activation of the hippocampus. In many psychological disorders, including depression, the activity of the hippocampus – the brain’s happiness centre – is compromised. Music has an extraordinary ability to mobilize this brain region, offering hope for those with mood disorders. Furthermore, given that depression is associated with reduced hippocampal volume, one might hypothesize that music therapy could contribute to increasing hippocampal volume through emotional stimulation of neurogenesis in the hippocampal formation (also see Chapter 12). This hypothesis warrants further investigation in future research.
Music Therapy across Depression Types
The diverse therapeutic advantages of music therapy underscore its role as a comprehensive and deeply impactful therapeutic approach. Those grappling with depression, as well as relatives concerned about a loved one’s mood disorder, may be curious about the specific forms of depression most frequently addressed by music therapy. The following list provides answers on this matter.
Major depressive disorder. Also known as clinical depression, this disorder’s hallmarks include sustained feelings of sadness, worthlessness or excessive guilt, loss of energy, and diminished interest in previously enjoyed activities. As outlined in the previous section, many music therapists treat major depressive disorder.
Postpartum depression. Postpartum depression is a prevalent psychological condition, affecting millions of parents after childbirth worldwide each year. It primarily impacts mothers but can also affect fathers. Postpartum depression has severe psychological repercussions on the infant. Infants of depressed parents display behavioural abnormalities just days or weeks after birth, such as avoiding faces and voices, which can persist over the long term and affect other developmental aspects, such as language development.Footnote 6 Music therapy interventions often begin with the therapist taking the lead, singing or humming lullabies to the newborn. Parents are gently encouraged to join in, either following the therapist’s lead or singing on their own, all while rocking their baby to the rhythm. The musical interaction not only fosters positive bonding with the baby but also enhances the parent’s sense of competence, self-worth, and overall well-being.Footnote 7
Depression in older adults. In the elderly population, depression is one of the most common ailments, often spurred by factors such as loneliness, limited interaction with younger generations, diminishing abilities due to age, or severe medical conditions. Group singing, music making, and improvisation-based music therapy have shown promise for seniors, including individuals with mild to moderate dementia.Footnote 8
Stroke patients. A significant number of individuals recovering from a stroke also suffer from depression. Therefore, hospitals and rehabilitation clinics should consider integrating music therapy techniques that aim to alleviate depressive symptoms, in tandem with the neurological treatments detailed in Chapter 11.
Cancer patients. The gravity of a cancer diagnosis often leads to significant emotional distress. In addition, the disease itself and its treatments are often accompanied by severe physical pain. Music-based interventions can alleviate symptoms of anxiety, depression, pain, and fatigue in both adult and paediatric cancer patients.Footnote 9 Patients can utilize music listening to reduce anxiety and worries, as well as to manage pain; if possible, active participation in music therapy is likely to offer even greater benefits.
Sleep disorders and substance abuse. Both of these conditions often coexist with depression and can benefit from music therapy. (Refer to Chapters 16 and 17.)
Empowering Your Resilience against Depression
We have seen the diverse benefits that make music therapy a comprehensive and impactful approach to treating depression. In addition to its therapeutic role, music can also help mitigate the risk of depression. The most effective safeguard against depression is building resilience – our ability to cope with traumatic events without enduring lasting negative impacts. Much of the guidance in this book is designed to strengthen resilience (see Chapter 7 for a focused approach). For those who have experienced a depressive episode before, regularly practising meditation exercises with music can be particularly helpful (refer to Chapter 20). Recognizing the early signs of a depressive episode is crucial, including early awakenings, persistent low moods, negative thought loops, or diminished pleasure in activities. When these signs appear, creating and following a personalized action plan can be invaluable. The earlier you identify a depressive downward spiral, the easier it is to interrupt it.
Resilience training for those managing depression begins with maintaining a balanced diet and a consistent exercise routine – even if it is as simple as taking regular walks. Avoiding refined sugar is crucial, as it can exacerbate depressive symptoms. Instead, opt for whole fruits (but avoid fruit juices and smoothies) and incorporate a variety of fresh vegetables such as tomatoes, bell peppers, and avocados. Legumes, seeds, and nuts are also excellent additions to your diet. For vitamin D, consider fish like salmon, herring, sardines, oysters, or shrimp. Foods rich in antioxidants – such as strawberries, raspberries, and walnuts – help the immune system combat inflammation. For your next mood-boosting experience, why not pair uplifting music with a nourishing mix of strawberries, raspberries, and walnuts? Remember, resilience is a potent capacity for protecting against depression. Embracing a healthy lifestyle with music as your companion can significantly empower your journey toward mental well-being.
