Because there are many fronts on which to wage the battle against depression, there is a risk of getting confused about where to start getting leverage. Dr. Allen recommends that patients prioritize. "Think in terms of a hierarchy moving from the physical to the mental to the interpersonal. Start with sleeping and eating. Then add activity; start with a 10-minute walk. Tackle the cognitive and interpersonal stuff later."
He concedes that the physical aspects of depression—eating, sleeping, exercise—are commonly neglected in treatment. But he regards physical well-being as the third pillar of recovery, along with medicine and psychotherapy, and in fact a precondition for it. Sleep, for example, is basic to energy and thinking straight. Improving sleep may take a combination of medication and attention to schedules and routines.
