At various times in my life I’ve been diagnosed with mild clinical depression, moderate-to-severe clinical depression, situational depression, and seasonal affective disorder (SAD). I’ve been on and off various medications for it, and while I’ve been lucky that it’s almost never made me completely unable to function, it does seriously impact my life, particularly this time of year when the SAD (most apt acronym ever) compounds whatever else is going on. Right now, I’m managing it without prescription medication and am doing OK, but before I talk about how, I want to stress that you should always consult a doctor before making any big changes to how you manage your depression, especially before going on or off any medications. I am not a doctor and am not providing medical advice or treatment. Got it? Fantastic.
I also want to stress that the fact that I am managing without prescription medication is not a testament to my willpower or strength of character, and it isn’t objectively “better” than being on meds. The best thing is what works for you and your condition. I don’t want to hold up managing without meds as some kind of a universal (or even a personal) goal, because there are times when meds have been hands down the best thing for me. These are simply some measures that I have found to work for me, at this time. They haven’t always worked in the past and they may not work in the future. The science on how well these work for the general population varies, so do your own research and consult your doctor or therapist before trying anything major.
On my good weeks, I do all of these and feel pretty well (depending on how much sleep I’m getting, which is another story). Unfortunately, part of depression’s effects is making it hard to put in the effort to take care of yourself, so it’s easy to stop doing the things I know are good for me and spiral downward. A good scheduling app with reminders helps me keep things up, but I’m capable of ignoring even that if I’m having a bad day.
1) Exercise. There’s really good evidence for this one as a primary or supportive treatment for depression, and very little downside to trying it (assuming you are healthy enough otherwise to exercise). Regularly exercising is probably the hardest for me, particular in winter when it’s cold and dark out, but it definitely has the biggest positive impact on my mood day-to-day. Walking an hour most days makes a huge difference in how I look at the world and myself. Endorphins are powerful, and honestly so is just getting out of the house/office and having a change of scenery. I’m fortunate enough to live in a safe, walkable neighborhood with many hiking trails nearby and a pretty decent climate, but if you don’t have access to the outdoors in the same way (or just don’t like it), a good indoor exercise program can still make a big difference. Join a gym (I like swimming and hot yoga in the winter) if that works for you, but even if you hate gyms, won’t go, or can’t afford one, there are options. Thanks to the internet, there are tons of free, high quality fitness programs no further away than YouTube!
2) Having a dog. Okay, let’s get this out of the way: do not get a dog just because you are depressed. Right. That said, having a dog has really been a positive for me in managing my depression. One of the reason ties into strategy #1 – he needs walkies. I have an adolescent black German Shepherd (see right), and he needs all the exercise in the world. Even when my husband is home and walking him several miles, he still needs at least one good walk from me as well. I have to exercise, at least some. I cannot lie in bed all day or refuse to go outside. He will eat my house if I don’t exercise him and spend time training him. There’s lots of great evidence that pets (and dogs specifically) lower stress, increase health, and improve mood and I’ve found that to be true. I’m not one of those super sentimental “everything I know I learned from my dog” magical thinkers, but there’s just something about having someone who’s always really excited to see you that makes life seem just a little bit better. But seriously, don’t get a dog if you don’t a) really want one because you love dogs, b) have the time, space, money, etc to care for one, and c) are prepared to invest that time, space, money in the dog (including training) for 8-16 years. Also, if your depression is so severe that it would preclude you from giving the the dog what she needs, as opposed to the dog encouraging you to take care of you both, it is not the right time for a high maintenance pet. Get a plant. And if you are getting a dog, please please please adopt and never buy one from a store or shady craigslist breeder.
3) Diet. Diet is tricky, because everyone responds differently to what they eat, but when I realized my depression was hitting me hard this fall, I decided to try and see if changing my diet could help. It really seems to, although sticking to the mood-improving diet is hard because depression makes me want to eat all the takeout in the world and wash it down with gin. But when I do manage to stick to it, I notice an improvement almost immediately. The best thing for me seems to be cutting out alcohol, most caffeine, processed carbs, starches, and most added sugar and eating a lot of fish (particularly salmon), avocado, aged cheeses (brie and blue are the best), leafy greens, legumes, nuts and seeds (chia in particular), and whole grains (not whole grain baked good, but actual grains like steel cut oats or barley). Grassfed beef or lamb, spicy foods, and eggs from free range, foraging chickens also are great, as are small amounts of super-dark chocolate. Again, this diet may not work for everyone, but there is some scientific backing for it and personally, it helps a ton.
4) Light therapy. This one is huge. I got a lightbox, which is just a panel of LED lights at a wavelength that mimics the sun’s, after I was diagnosed with SAD and my doctor suggested it. I spent $50 on it seven years ago, and it’s made a huge difference in how I experience winter in particular. You’re only really supposed to use it for a little bit of time early in the day, and I did that for awhile (an hour in the morning and then 15 mins right after lunch if I felt sleepy) but ever since I moved to a cubicle with no windows I’ve actually started leaving it on for most of the work day year round, as the low lighting there really worsens the seasonal depression and can make me have it even in summer. But be careful with that, for some people too much light therapy can have really negative effects, including anxiety. I always turn mine off by 2pm as well, to avoid making my sleep any worse than it already is. I can tell it’s working because I keep it on my desk and usually don’t remember to bring it home on the weekend. By Monday I often feel a lot more down until later in the day when I’ve had my dose of light. I should probably just face up to the fact that I will never remember to bring my lightbox home on Friday and buy a second one.
5) Supplements. I am very ambivalent about supplements, having worked in a related industry for many years. On the one hand, there are many herbal or “natural” treatments that have scientific or strong anecdotal evidence of working very well for a variety of conditions. On the other hand, the industry is virtually unregulated, there are tons of supplements out there that do nothing or, worse, are actively dangerous if you don’t know how to use them or combine them wrong, and there’s no guarantee you are getting the ingredients you think or in the right dosage. The FDA doesn’t regulate supplements at all. That said, if you do your research into reliable brands that have third party verification of their quality, you know what the potential interactions with other supplements and prescription medications are, and you’ve talked to your doctor, supplements can be hugely beneficial. Right now I am taking Sam-E in the morning (which is actual a prescription medication for depression in other countries) and 5-HTP at night (which boosts serotonin but should never be combined with prescription antidepressants). Additionally, I’ve started taking fish oil (which may or may not be doing anything), magnesium, and a B complex vitamin. This combo seems to help, particularly the first two. The other supplements it’s better to get from your diet, and I definitely try but since I’m not great at sticking to it, I feel better giving myself a little boost. The downside of these is that they are expensive, particularly Sam-e, and not covered by insurance so it can be prohibitive for some.
It’s important to remember when treating your depression that everyone is different. Our brains are different and what causes – or helps – our depression is different. Measures like these may work well for some people, others need to combine with prescription methods. Some people find improvement through socializing, talk therapy, hobbies, or religion. Others have difficulty improving even with very strong prescriptions. Depression still isn’t fully understood as a disease, although we know a lot more than we used to, and the symptoms, degree, and treatment needs can change over time. It’s very important to not compare your depression or your treatment to others, but focus on what you personally need. Don’t lose hope or feel like you’re doing something wrong if what you try doesn’t work. Talk to your doctor, your therapist, your significant other, your friends about what you are going through and be honest about it. Depression doesn’t have a quick fix, but there are lots of options out there and it can get better.
Coming soon – How I monitor my depression.