Many singers suffer from depression. In this issue’s column, we explore ways to approach managing depression as a performer.
The Mental Highs and Lows of a Career as a Singer
Making a career out of singing professionally is a difficult proposition, without a doubt. It comes with the highs of putting your heart and soul into the thing you love and being celebrated for the talents you possess. Conversely, the stress from both personal and public expectations of singers is significant. Let’s face it: you are expected to perform perfectly on stage or in competitions every time, you feel the urgency of finding steady income in a tough market, and then you are bombarded with constant online feedback (negative or positive). Living in such a stressful, cortisol-saturated environment where the status quo is an activated fight-or-flight response can lead to illness and, especially, depression.
In the U.S., depression is already one of the most common mental illnesses, but professional performers are twice as likely to report depression than the general public (Catherine Loveday, et. al., “Predicting Anxiety, Depression, and Wellbeing in Professional and Nonprofessional Musicians,” Psychology of Music, 2023). So, yes, you are not alone if you feel down—your colleagues are also probably depressed too. But that does not bring much comfort, does it?
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Many times, when it comes to our mental health, there are more questions than answers. How do you know when you should see a physician or other professional for treatment? When you do ask for help, what are the treatment options (medication or otherwise?) And, finally, when your physician prescribes a medication, will it get in the way of your performance?
Recognizing Depression
First off, how do you tell if you’re simply having a terrible, no good, very bad day/week or if you’re depressed? Although there are some very important questions that will help guide that assessment, episode duration and frequency help us figure out whether or not to ask the questions at all. If this is the first time you feel this way, it could be nothing more than a bad day. On the other hand, if episodes come frequently, or last for weeks on end, you may be suffering from depression.
What Does Depression Look Like?
Have you noticed you do not enjoy activities like you used to, and that you always feel down? Or, do you feel overwhelmingly tired but are becoming frustrated because no matter how early you go to bed, you do not get very much sleep? Perhaps you are finding that you have no appetite whatsoever or, conversely, you cannot stop eating foods like potato chips or ice cream. Has learning music become more difficult because you cannot concentrate like you used to? Do you struggle with performing because you cannot feel the music? Are you moving more slowly? And, finally, have you ever thought you’d be better off dead? If you answered yes to any of these questions, you may be suffering from depression—but to get a clearer view of your situation, you should visit with your primary care physician.
When you go to your physician’s office, they will probably use a questionnaire called the PHQ-9 (Patient Health Questionnaire) to gauge the severity of your symptoms. Recognizing the signs and symptoms of depression is important, and many resources exist that discuss that topic. But understanding the treatments available (pharmacologic, psychologic, and others) that can help and, perhaps more importantly, their adverse reactions, is helpful when working with your physician to determine which treatment is right for you.
What Treatments Are Available?
According to the American Psychiatric Association’s Clinical Practice Guidelines for the Treatment of Depression in Adults, the foundational treatment approach is rooted in behavioral, cognitive, and supportive therapies. These therapies include the following:
- Cognitive-Behavioral Therapy (CBT): An approach that helps change the way you process negative self-beliefs, which usually takes 10–20 sessions. (Stuart Rupke, et. al., “Cognitive Therapy for Depression,” AAFP, 2006)
- Interpersonal Psychotherapy: Therapy that emphasizes the link between mood and interpersonal relationships. (John C Markowitz, et. al., “Interpersonal psychotherapy: principles and applications,” World Psychiatry, 2004)
- Mindfulness-Based Cognitive Therapy: Adds the benefits of meditation to CBT. (Walter E B Sipe, et. al., “Mindfulness-based cognitive therapy: theory and practice,” Canadian Journal of Psychiatry, 2012)
- Psychodynamic Therapy: Helps you understand how your past affects your present mood. (Rockville [MD]: Substance Abuse and Mental Health Services Administration, 1999, chapter 7)
- Supportive Therapy: An approach for complex depression that develops a strong team between the patient and therapist and emphasizes working on present problems rather than long-term ones. (“Psychotherapy for Major Depressive Disorder and Generalized Anxiety Disorder,” Ontario Health Technology Assessment Series, 2017)
Interestingly, nutrition can play an important role in mental health, and various nutrition plans, including consuming high protein and low carbohydrates, have shown some promise for helping with depression as well (Daniel M Dietch, et. al., “Efficacy of low carbohydrate and ketogenic diets in treating mood and anxiety disorders,” BJPsych, 2023).
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All of these approaches work synergistically with medications to help you feel more grounded. As a performer, there are a lot of considerations you and your medical provider will need to account for when selecting an antidepressant medication, including your past medical history, medication allergies, what has worked for you in the past, how often you take the medication, and potential adverse reactions. For singers in particular, it is important to understand how medications may affect your prized possession: your voice! Dry mouth is a common adverse reaction of many medications for depression including the most commonly used ones, the Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs).
Another important adverse reaction to watch out for may include drowsiness, which could affect the alertness and stamina needed to perform. Additionally, other adverse reactions can include nausea, headache, diarrhea, and reversible sexual dysfunction. Many adverse reactions can be dose dependent, meaning the higher the doses, the higher the risk of experiencing adverse reactions. This is why it is important to work with a medical provider to find the most effective dose for you while limiting the risk of potential adverse reactions. There are also simple genetic tests available that can guide you and your provider in understanding which medications may be most effective and which ones may cause adverse reactions.
Getting Support
- Call 988, The Suicide and Crisis Lifeline, for 24/7 free and confidential support when you are facing any mental health or emotional challenge and need someone to talk to.
- Schedule an appointment with your local primary care provider, counselor/therapist, or community support groups.
- Music Industry Therapist Collective provides music industry psychotherapists, counselors, psychoanalysts, and psychologist.
- Backline provides free programs such as case management, communities, wellness activities, and educational resources to those in the music industry.
Janet Feels Tired
Janet finds her energy levels tend to mellow out as the winter months approach and as her exposure to the sun and the outdoors lessen. This year, she has struggled with finding the motivation to make it to her mid-day rehearsals, a part of her day she used to look forward to. Initially, she chalked her symptoms up to the weather, but now it has been two months and she has stopped writing new lyrics, going to after-parties, or participating in her monthly family Facetimes. Which of the following would be good steps for Janet to receive the appropriate treatment for her symptoms?
A. Call a trusted friend or family member to talk through what she is feeling.
B. Search for dietary supplements on the Internet marketed to treat fatigue.
C. Schedule an appointment with her medical provider for a comprehensive assessment of her symptoms.
Note that it is important to remember there is no blog, quiz, or AI-generated algorithm that can determine the best treatment for your specific symptoms of depression or anxiety.
Answer: A and C are correct!
