Since World War II, the rate of clinical depression, also called major depressive disorder, has risen tenfold. It’s not surprising, then, that about one in eight Americans takes a daily antidepressant.
For many of those people, though, antidepressants just aren’t effective enough. In the largest “real-world” study of antidepressants—one that looked at more than 4,000 patients—fewer than 10 percent of those taking an antidepressant experienced complete remission that lasted longer than a year. Antidepressants can also deliver a slew of common side effects, like headaches, dry mouth, insomnia, digestive upset, sexual problems, weight gain, and fatigue.
Healing depression typically requires combating the disease from several different angles at once—and the following non-drug methods have particularly strong scientific support.
Exercise
This is the single most powerful tool we have for overcoming depression, probably because it affects so many systems in the body: It regulates neurotransmitters, improves sleep, and decreases brain inflammation, to name just a few. It’s not an exaggeration to say that if all of the benefits of exercise could be packaged in one pill, it would instantly become the most useful overall medication in our psychiatric armamentarium.
Based on the best research, just 30 minutes of brisk, aerobic walking three times a week is usually effective. There is some evidence that boosting the exercise “dose” may carry even greater antidepressant benefits. If your depression makes it hard to exercise, a personal trainer, friend, or loved one who can walk with you regularly can help you start and keep up with this depression-busting habit.
Diet, fish oil, and fiber
The Mediterranean diet, which emphasizes fish, vegetables, fruits, beans, whole grains, nuts, seeds, and olive oil, fights depression, likely because it controls inflammation. (The inflamed brain is usually a depressed brain.) You can also fight inflammation— and depression—with 1,000 to 2,000 daily milligrams of eicosapentaenoic acid (EPA), a powerful omega-3 molecule derived from fish oil. To avoid the dreaded “fishy burps,” buy pharmaceutical grade, enteric-coated fish oil and store it in the freezer. Take your pill with a meal.
The Mediterranean diet also delivers high levels of plant fiber, which encourages the growth of healthy microbes in the gut, preventing or reversing dysbiosis, an imbalance of good and bad gut bacteria that has been linked to both depression and anxiety. To get even more fiber, take a soluble fiber supplement, such as psyllium husk or chicory root, at a dose of 5 to 7 grams each day. Cutting-edge research suggests we can also boost beneficial, depression-fighting gut microbes with probiotic supplements, especially those that feature lacto and bifido bacterial strains. Caution: If you have a gastrointestinal problem such as irritable bowel syndrome or ulcerative colitis, talk to a gastroenterologist before taking fiber or a probiotic.
Acetyl-L-carnitine (ALC)
This brain-produced nutritional compound supplies energy to brain cells (neurons). ALC levels are often low in people with depression, particularly those over age 40. Several studies show that supplementing the diet with 2,000 mg of ALC can produce anti-depressive results comparable to medication, but with effects that kick in faster (about a week, as compared to four to six weeks for medications) and with minimal adverse side effects.
Bright light
If your depression starts in the fall or winter, when the days are shorter, you may have seasonal affective disorder, which is best treated with bright light therapy. The eye is an outpost of the brain, and light works like a drug, resetting your body clock and normalizing the natural sleep-wake cycle (the circadian rhythm) for better mood, sleep, and appetite. Research also shows that light boxes are beneficial for anyone with depression, at any time of year.
To get the benefits of light therapy for depression, you need about 30 minutes of exposure to 10,000 lux, a unit of illumination, within an hour of waking up. It’s important to read the manufacturer’s instructions and use a measuring tape to make sure you’re sitting at the correct distance to get the full brightness. Sitting too far away can reduce or eliminate the benefits of light therapy.
Spend time with people
Social connection is a key component of overcoming depression, but when you’re depressed, your brain tells you to stay away from people. It also says they don’t want to be around you, anyway. That’s the disease talking: Disregard the message and spend time with friends and family members in shared activities that you enjoy. For the 25 to 30 percent of depressed people who don’t have supportive friends or family, a psychotherapist or therapy group can provide that type of support. You can also build connections by taking classes or participating in organized or informal group activities. Try www.Meetup.com to find groups of people who are interested in things that you are.
Stop ruminating
Nonstop negative, anxious thinking about the past or the future creates a runaway stress response that worsens depression. To stop ruminating, you need to first notice that you are doing it, and then focus your attention elsewhere.
Cognitive-behavioral therapy and mindfulness-based stress reduction are excellent tools in this process.
A rumination log can help, too. Every hour or so, note whether or not you’ve been ruminating. Over time, you’ll develop a spontaneous “mental alarm” that will alert you any time your thoughts take a ruminative turn—and stop them.
