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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.
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.
- 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.
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.
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.
- 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
- 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.
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.
- 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.