I have worked with people who have depression for over 20 years. There are a few essential things to know about Major Depressive illness. It is a neurologically-based brain disease. There is an overwhelming amount of scientific research backing that. Nevertheless, non-biological things like kindness have the potential to make it better. Biological interventions like brain-friendly food, adequate sleep and exercise can make it better. Setting achievable goals during a depressive episode is essential. Depression affects energy and concentration, so, in the words of one patient, “Talking to a stranger for five minutes can feel like an hour of high intensity interval training.”
Accomplishing small goals can be very helpful, while setting goals too high can worsen the sense of discouragement most depressed people already have. That being said, some things are worth trying. When a person can do some of the following, mood often improves, but it is essential that reasonable goals be set.
Depression symptoms are in three realms: problems with thinking, problems with mood and problems with biological processes. It differs from normal sadness that occurs in everyone’s life. Depression is overwhelming and pervades almost all activities. Mood symptoms: feeling intense sadness but sometimes people don’t describe this. They can feel numb, lifeless or angry. Very frequently, people feel hopeless, worthless and guilty for no reason. These feelings sometimes feel unbearable and lead to suicidality. Cognitive symptoms: difficulty concentrating, problems making decisions and feeling mentally slow or foggy. Biological symptoms come in opposites: sleeping much longer than usual or having difficulty getting enough sleep. Either way, people’s energy always seems to be absent. Appetite can be increased or decreased and weight gain or loss may occur. Often, unexplained aches and pains arise due to depression.
People may end up self-medicating with various drugs, especially alcohol and marijuana, but also opiates and stimulants. Of course, this most often further negatively impacts the person’s life. Alcohol is actually a depressant, so it can often exacerbate depression.
Here are some significant ways to improve mood besides medications and therapy:
- Have compassion for yourself or the depressed person you love. If you are depressed, practice compassion toward yourself. Realize that depression is a very painful illness that affects your life deeply. Let’s face it: struggling with having the energy to get out of bed or do normal things like work or even answering the phone is hard! Many depressed people know that if a friend were feeling this bad it would be easy to have compassion for them. Anyone deserves this compassion and it is important for depressed people to have that for themselves. In the words of Pema Chodron, “Have unconditional friendliness toward everything you feel.” If someone you love has depression, be aware that you may never have approached this level of sadness in your life, so your experience dealing with sadness may not help the person with depression. When patients lament about how someone advised them this way or that, I often say, “Well, I imagine if that were going to help, you would be better by now.” Advice from others often just exacerbates the person’s sense of helplessness and disconnection from others. They often already tried whatever you thought they should try or could not get themselves to ……..fill in the blank. And often I find that a person with moderate to severe depression will not be able to engage in helpful activities until the depression improves.
- Overwhelming scientific evidence shows that depression is improved by exercise. In several studies it has been shown to be as effective as medication in treating depression. Most antidepressant medications increase serotonin and so does exercise. Exercise increases brain-derived neurotropic factor (BDNF), which increases the connections of neurons in the brain. Most forms of treatment for depression have been shown to increase BDNF. As importantly, in the psychological realm, exercise gives people a sense of self-efficacy and control. Decrease in feelings of distress are immediate and can last longer for depressed people than “normal controls” in studies.
- Practice mindfulness meditation. The work of Jon Kabat-Zinn and others has shown the great benefit of Mindfulness Based Stress Reduction on depression. There are multiple places to learn this, including meditation centers in Flagstaff: therapists who specialize in MBSR, online courses and various CDs and DVDs available. MBSR is essentially derived from Vipassana meditation with the religious effects removed.
- Eat a brain-friendly diet and some select supplements. Take a B-complex vitamin. Occasionally, B-vitamin deficiencies can contribute to depression. Fish oil supplementation is known to improve depression in some people. Take 1000 mg at least, and 2000 mg is probably better. Eating deep sea fish seems to be as good, which should be at least once per week. Having healthy gut bacteria is important to mood. Eating probiotic foods, especially fermented foods like sauerkraut, kimchi, kombucha, miso and kefir or yogurt is important to gut health. Good bacteria seal the gut and prevent leakage of toxins from the gut into the blood stream and probably brain. Inflammation is also implicated in mood disorders, so eating an anti-inflammatory diet is important. As a general rule, anti-inflammatory foods include vegetables, nuts, fish and certain oils such as coconut and olive oil, among others.
There is no question that medical interventions improve depression, but depression is often a chronic illness that benefits greatly from lifestyle tweaks and awareness of thoughts that contribute to depression. The above approaches can complement treatment or be the backbone of an overall approach to depression that can give the greatest functional improvement. FBN
By Abigail Isakson