I've written and spoken about my experience with depression for years, ever since I went through an intense depression as an Emergency Medicine resident over a decade ago. That experience changed my life forever.  It forced me to re-examine the way I was living my life and why it was literally making me miserable.

I discovered that I had spent most of my life trying to please other people and fit society's model for success. I'd dedicated my life to academic success and had neglected the things that had brought me joy at a young age (and had been squelched), such as dancing and writing.

I quit my residency and started to pursue those passions in earnest, working part time as a GP. I felt much better surprisingly soon, and eventually got off my medication. The experience was so transformative (and such a revelation to a physician who'd been told depression was usually a permanent condition), that I began writing and speaking about evidence-based ways to boost your emotional well-being and inoculate yourself (to a degree) against depression and low moods.

This year everything I learned was put to the test. I went through a record number of transitions, some wonderful and some really difficult. As psychologists know (see the Holmes- Rahe Stress Scale), the more new life events you experience in a season, the more likely you'll experience physical or mental health problems. It's hard to cope with lots of change, good or bad.

As the months went by and new changes and adjustments mounted, my mood started to spiral down. I was also having a tough time sleeping in a new environment I had moved to;  lack of sleep has a profoundly negative effect on mood and the ability to handle stress.

It was time to draw on everything I'd learned since those dark days in the ER. Here are some of the tools I used:

1) Exercise

I usually walk my dog daily and was temporarily without her because of issues with the strata in my new building. I didn't realize what an anchor these walks (and my dog) had been until they were gone. Petting a dog boosts levels of the feel-good "love" hormone oxytocin and decreases levels of stress hormones - I'll attest to that!

Exercise boosts levels of serotonin and dopamine in the brain, and has been shown to be as effective as antidepressants. I began working out for at least 30 minutes a day to great music (another mood-booster) in the gym downstairs and started dancing flamenco again. I also eventually found a way to be reunited with my little Tina, hallelujah.

2) Friends and Family

My move had made it hard to visit cherished friends who now lived up to an hour away, and relationships are so important for well-being. I focused on building friendships with people I met in my new area (church turned out to be a great place to connect with people) and found ways to stay connected to old friends, such as calling someone every time I was in my car. During one particularly rough month I accepted an invitation from my sister to go on a long weekend vacation with her family to the beach. I discovered that few things make me feel better than being with loving family and building sandcastles with my 3 year old godson, so good.

3) Brain-Boosting Foods

I have a degree in Dietetics (Human Nutrition) and am hyper-aware of the impact of food on the brain. I started making "green smoothies" every day, reduced sugary treats, and upped my intake of fruits, vegetables and fiber. I ate lots of wild salmon - omega-3 fatty acids are so good for brain - and other healthy proteins. I also took my usual fish oil supplements and increased my daily dose of Vitamin D3, as there is a link between Vitamin D and mood.

4) "What Went Well"

I am a huge fan of Dr. Martin Seligman, the founder of positive psychology. One of his favorite tools, which his research has found to have a profound effect on well-being, is the exercise "What Went Well". At the end of your day, look back and find three things that went well. Reflect on them, and even replay them in your mind, revisiting those good feelings. Say a prayer of gratitude, thanking God for all that is good in your life. I started doing this more actively - it's quite incredible how powerful this small exercise is (as are other gratitude practices).

5) Limit Alcohol

I had started cooking more, which I was really enjoying, but got into the new habit of nursing a glass of wine while doing my best chef imitation. Though I never drink to get drunk, I was drinking much more often than usual and finally made a connection between wine the night before and a particularly grumpy or moody next day. Alcohol is a depressant (I've written about the impact of alcohol before), but this was the most acutely I've ever noticed it. I went back to my usual single glass of wine every week or two and quickly noticed a difference.

6) Prayer

Studies have shown a positive effect of prayer on mental health. In this new version of my life, my altered routine had pushed aside one of my usual practices: time spent in prayer and contemplation every morning. I got back to that religiously (pun intended), and my days felt much more anchored and stable.

Almost immediately I noticed these tactics take effect. It was quite dramatic how quickly my mood would turn from moody to upbeat after a round of treadmilling to great tunes in the gym. I feel very grateful that I happened to have the knowledge to be able to turn things around as I did.

If you've been feeling down, it's still important to see your doctor. Some cases of depression still need medication, but these tools would still make a significant difference to the way you feel and your recovery. There is so much you can do to feel better. Notice that many of the things I listed are easily available and either free or relatively inexpensive (eliminating alcohol will actually save you money!).

Dr. Susan Biali, M.D. is a medical doctor, health and wellness expert, life and health coach, professional speaker, flamenco dancer, and author. She is dedicated to helping people get healthy, reduce stress and enjoy more meaningful lives. Dr. Biali is available for keynote presentations, workshops/retreats, media commentary, and private life and health coaching—visit www.susanbiali.com for more details.

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Copyright Dr. Susan Biali, M.D. 2013

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