Dr. Joseph M. Ripperger, MD
Serving behavioral healthcare needs throughout the Bow Valley
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Depression: 16 Strategies

Click HERE for a printable version.

The current depression theory is that mood disorders are caused by chronic inflammatory effects in the brain and body. Below is a checklist of things you can do to reduce these inflammatory changes and improve your chances for a complete recovery. They are listed in order of importance. Begin with Tier 1 and work your way down to Tier 4.

Tier 1

1. Normalize your sleep cycle

  • Set a routine wake-up time and get 7-8 hours of sleep each night.
  • Bedtime can vary but prepare with a “bedtime ritual."
  • Ask for complete list of proper sleep hygiene suggestions or consider a hypnotic medication if needed. 

2. Antidepressant Medication

  • Can usually begin noticing positive effects within first 2 weeks.
  • Requires 4-6 weeks to be effective, with maximum effectiveness at 12 weeks.
  • Should be taken for minimum of 6 months. 

3. Psychotherapy

  • Education and counseling to address your identified distressing issues
  • Usually time limited.
  • Medical research has shown this to be as effective as antidepressant medication.
  • May involve specific anti-rumination strategies to reduce negative thinking. 

4.  Increase Physical Activity

  • At least 45 minutes of moderate-intensity activity, 5 days per week: this means“breaking a sweat”, such as fast walking, cycling, or lawn work.
  • At least 30 minutes of vigorous-intensity activity, 4 days per week, such as jogging, stair climbing, or swimming).
  • If you can schedule with a partner who is committed, you are more likely to  be consistent.
  • Medical research has shown that aerobic exercise has the same therapeutic effects on the brain as an antidepressant.
  • Read Spark: The Revolutionary New Science of Exercise and the Brain by John Ratey, M.D. and Eric Hagerman.

Tier 2 

5. Change Your Diet

  • Eat a low glycemic-load, Mediterranean-style diet with adequate protein and plant foods. Avoid highly-processed foods.
  • Eat foods high in antioxidants such flavonoids and carotenes. Examples include colorful foods such as carrots, broccoli, oranges, red grapes, strawberries, blueberries, tea, tomatoes, apples, and dark chocolate (yes, chocolate!).
  • Always eat breakfast.
  • When snacking, eat nutritious combination such as:
    • Whole grain bagel and fruit (blueberries or tomatoes)                     
    • Piece of fruit with crackers and cheese
    • Yogurt or cottage cheese with a piece of fruit.
    • Carrots or celery with peanut butter or cream cheese.
  • If uncertain about what to eat, read: AntiCancer- A New Way of Life by David Servan-Schrieber, MD 

6. Social Support

  • Seek out and surround yourself with positive, happy friends or family.
  • Avoid negative or unhappy people.
  • Avoid spending time alone as this increases negative ruminations and worry. 
    7. Relaxation Techniques (or Meditation)
  • The easiest to use is “The Relaxation Response.”
  • Has been shown to improve sleep and your immune response, reduce anxiety, and prevent relapse of depression.
  • Perform 3-4 times weekly.
  • Ask for handout if interested in this. 

8. Limit Alcohol Intake

  • Maximum limit for healthy MEN up to age 65: no more than 4 drinks per day, and no more than 14 drinks per week.
  • Maximum limit for healthy WOMEN (and healthy men over 65): no more than 3 drinks per day, and no more than 7 drinks per week.
  • Limit yourself to 1-2 drinks per setting.
  • Remember alcohol is a depressant and will exacerbate depression.
  • Alcohol can also disrupt sleep.  

9. Weight Management

  • Obesity causes multiple health problems, including sleep disturbance, depression, and reduced energy.
  • Begin to gradually “trend down” weight toward target Body Mass Index (BMI) 18.5-25. Ask for handout if this interests you. 

Tier 3

      10. Address Marital (or Couple) Problems

  • Studies show a “bad” marriage reduces your chances of recovery by 50%.
  • Consider marital or couple counseling.
  • Read The Seven Principles for Making Marriage Work by John Gottman, Ph.D.  

11.   Balance Work Responsibilities

  • If working more than 50 hours per week, consider reducing work hours to less than 45 hours per week.
  • Take regular vacations (at least 2-4 weeks)
  • Ask for time off from work until feeling better.  

12. Spirituality

  • Studies show that people who believe in a higher power are healthier and happier.
  • Begin a “spiritual practice.”
  • Examples include regular prayer, meditative practice, yoga, gratitude work, drumming, or joining a church.  

13. Over-the-Counter Nutritional Supplements

  • SAMe
    • A salt-like metabolite involved in biosynthesis of norepineprine, serotonin and dopamine.
    • Dosage is 800-1600 mg/day for 6 weeks.
    • Can speed the onset of antidepressants or augment effects of antidepressants.
  •  Omega-3 Fatty Acids (EPA or DHA)
    • Usually from fish oils and may increase CNS serotonin and have anti-inflammatory effects.
    • Dosage is 1 gram daily.
    • Augments effects of antidepressant and EPA is more effective than DHA.
  • N-acetylcysteine (NAC)
    • Enhances production of glutathione (GSH), a powerful antioxidant that protects the brain from stress.
    • Dosage starts at 600 mg twice daily.
    • Augments antidepressant or may even work without an antidepressant.

Tier 4

14. Bright Light Exposure

  • Especially effective for those who notice a seasonal (fall/winter) component of depressed mood.             
  • 10 to 15 minutes per day of full-body direct sun skin exposure.
  • An alternative would be at least 30 minutes per day by using a special light box that  emits 10,000 lux.
  • Light boxes can be ordered on-line at www.northernlighttechnologies.com or www.LightTherapyProducts.com. 

15. Yoga

  • Medical studies have shown this can reduce depressive symptoms, reduce tension, and decrease chronic pain.
  • Twice weekly for 30-60 minutes.
  • Best suited for younger people or those who are relatively fit. 

      16. Education (Bibliotherapy)

  • Reading self-help books will assist you in your recovery.
  • Suggested books include:
    • The Art of Happiness by Howard Cutler, MD and the Dalai Lama.
    • Learned Optimism or Authentic Happiness by Martin Seligman, Ph.D.
    • Feeling Good by David Burns, MD.


  • Support Groups
    • National Alliance for Mentally Ill (NAMI) www.nami.org.
    • Depression and Bipolar Support Alliance (DBSA) www.dbsalliance.org.

Depression: 16 Strategies
Bipolar Mood Scale Printout
Weight Management

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