Depression

Lesson 4: Alternative Therapies

In this lesson, we will explore scientifically validated alternative therapies for depression such as acupuncture and supplements as well as smart lifestyle choices, including diet, exercise, and sleep.

Introduction and Lifestyle Choices

For some people, an antidepressant may be all that is required to get one back on one's feet, but for the vast majority of us medications are only part of the answer. Some people look at natural treatments to complement or replace medications, but one needs to bear in mind that any substance that can alter the course of something as monumental as depression - whether it grows by the side of the road or is to be found in the ocean - should not be regarded as strictly natural.

What IS natural is maintaining a lifestyle that pays respect to the destructive potential of our illness, from diet to exercise and meditation to sleep.

Diet

There are some 100 different kinds of neurotransmitters in the brain, all working - or supposed to be working - in close harmony. It doesn't take much to throw the brain out of whack. The average American eats more than 125 pounds of white sugar a year, comprising 25 percent of our daily calorie intake. Studies by Richard Wurtman MD and Judith Wurtman MD of MIT have found that sugar and starch in carbohydrates boosted serotonin levels, and that people who excessively craved carbohydrates were also prone to depression. Additionally, depressed people are drawn to sugar and fat combinations such as those found in cookies and chocolate.

Dr Robert Hedaya, professor of psychiatry at Georgetown, in "The Antidepressant Survival Program" says the quick energy rush of sugar and carbohydrates is followed by an inevitable crash, leaving one sluggish, drained of energy. He recommends a diet balanced between carbohydrates and protein. Others advocate high carb regimens, but the bottom line is healthy foods low in empty calories.

Crash diets or starvation diets can be as bad as carbohydrate binges, and play similar havoc with the brain's neurotransmitters, albeit in different fashion. Rita Elkins in "Solving the Depression Puzzle" recommends: avoid eating when you are anxious, bored, depressed, lonely or frustrated; avoid nibbling when the meal is over; don't use food as a reward; drink when you have the urge to eat (and then eat if you are still hungry); and join a support group.

Exercise

A recent Duke study divided 150 participants with depression age 50 or more into three groups. One was put on an exercise regimen, another administered Zoloft, and a third given a combination of the two. Those in the exercise group worked out on a treadmill or stationary bicycle at 70 to 85 percent of their maximum heart rate for 30 minutes, three times a week.

At the end of four months, all three groups showed significantly lower rates of depression. The big surprise came from a follow-up conducted six months later when it was discovered that those in the exercise group experienced significantly less relapse than those in the Zoloft or combination groups. Only eight percent of the exercise group had their depression return compared to 38 percent of the Zoloft group and 31 percent of the combination group.

As to why the combination group should fare worse than the exercise alone group, lead researcher James Blumenthal PhD speculated that: "The concurrent use of medication may undermine the psychological benefits of exercise ..." He goes on to say: "The important conclusion is that the effectiveness of exercise seems to persist over time, and that patients who respond well to exercise and maintain their exercise have a much smaller risk of relapsing." Other studies corroborate the Duke findings.

Exercise works against depression in a number of ways:

By reducing the stress hormone cortisol, which is linked to depression.
By restoring one's sleep and eating patterns, and raising energy levels, all critically important to feeling alive.
By releasing endorphins, which are associated with good mood.
By raising serotonin levels, according to one study.
Finally, getting in shape improves self-esteem.

When considering an exercise regime, it pays to keep realistic goals in mind. If the body is not accustomed to activity, it is going to fight back and enlist your mind in the cause. Don't expect to run a marathon your first week. Walking for 30 minutes is perfectly acceptable, and represents a giant step forward for those who have been inactive. Don't expect your depression to begin lifting until at least a few weeks, and don't look forward to slacking off when you start feeling better. Working out should be a life-long commitment.

Meditation and Yoga

Stress and depression go together like beans and cornbread. Both meditation and yoga are proven stress-busters. A study just published in the British Medical Journal found that chanting either the Ave Maria or the Hindu mantra Om mani padme om slows respiration to the same timing as circulatory rhythms, creating a sense of well-being. Fortunately, yoga and mediation are atheist-friendly, as well. Instead of reciting a mantra, you can simply chant peace or you can follow your breath in and out. Even a few minutes a day can yield results. There are routines that can be performed at your desk, during lulls in your work. The important thing is to find a practice that works for you and stick to it.

Sleep

Depression and sleeping disorders are virtually joined at the hip. According to an article in Medscape, 85 percent of depressed patients complain of insomnia, and ten to fifteen percent complain of hypersomnia. Research has linked persistent insomnia with the onset of another major depressive episode within one year, and sleep complaints are a reliable predictor of future relapses.

Modern times work against us. Back before electric lights, most people slept about ten hours. Now it's down to seven, with one third of us below six. Throw in shift work, jet travel, and the demands of having to be in two places at once, and one can see why many more of us - children included - fall victim to depression and related disorders. Following are some recommended guidelines, based on the same Medscape article cited above:

Maintain a regular waking time.
Avoid excessive time in bed.
Avoid naps, except if you are a shift worker.
Use the bed only for sleeping and sex.
Avoid nicotine, caffeine, and alcohol. Note that caffeine is often loaded in other foods and medicines. Two tablets of Excedrin contain 130 mgs of caffein, about the same as a cup of brewed coffee, while twelve ounces of Sunkist orange soda contain 41.
Exercise regularly, early in the day.
Do something relaxing before bedtime.
Don't watch the clock.
Eat a light snack before bed if hungry.

In addition, according to the same article, it also pays to practice relaxing meditation, consider sleeping pills or sedating or activating antidepressants, and employing a form of behavioral therapy that conditions one to establishing regular sleeping schedules. Some of these behavioral techniques include:

Going to bed only when sleepy.
If unable to fall asleep within 15-20 minutes, moving to another room.
Returning to bed only when sleepy.
Adhering to a regular awakening time.
Avoiding napping.

Also bear in mind that light at night is the enemy. A flick of the switch does more than turn on the lights. It throws out your body's biological rhythms, as well. If you must go to the bathroom in the middle of the night, learn how to negotiate your mission with the lights out, and with the toilet seat down.