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Depression

8 Keys to Warding Off Depression

8. Get 15 minutes of morning sunlight every day.

Key points

  • Health psychologists treat depression as well as medical conditions.
  • Although most people consider diet, sleep, and exercise important for health, they may underestimate the benefits on mood.
  • A health psychology approach to depression is increasingly recognized by science and treatment guidelines as efficacious.

Health psychology is a branch of psychology (Division 38, specifically, of the American Psychological Association) that “seeks to advance contributions of psychology to the understanding of health and illness through basic and clinical research, education and service activities.”

In practice, health psychologists engage in patient care, research, and system-level activities to advance the treatment and management of major medical conditions. Health psychologists are increasingly specialized these days practicing in areas such as pain psychology, bariatric and weight management psychology, psycho-oncology, diabetes psychology, cardiac psychology, and smoking cessation, among many others.

Few people know that health psychologists also commonly treat common mental health conditions such as depression. Further, how health psychologists assist people with depression is fundamentally different from the conventional psychotherapy and psychotropic offerings available in most mental health treatment settings. As you’ll learn here, the health psychology intervention model for depression is no less evidence-based than conventional treatments and has at least three unique advantages in the form of a) carrying less treatment stigma; b) the ability to implement the treatment more independently; and c) conferring health benefits beyond improving depressive symptoms.

People who have either: 1) not benefited from psychotherapy or psychotropic treatments; 2) have physical or financial barriers to participating in conventional depression treatments; or 3) experience job or personal concerns related to receiving mental health treatment may consider the health psychology approach as an alternative option to explore.

In the paragraphs below, I outline some of the recent science supporting the specific approaches used by health psychologists for treating depression. However, in a simple checklist form, here is the evidence-based formula I use with my own patients (tailored, of course, to individual circumstances):

  1. 7-8 hours of sleep, practiced on a regular schedule
  2. Exercise at least 3-5 days/week (including both aerobic and resistance training)
  3. 1.75-2.5 grams of omega-3 fatty acids/day through diet or quality supplements
  4. Reduction in added sugar (maximum of 6/9 grams/day for women/men)
  5. Reduction in processed food (replacing with whole foods)
  6. 2+ servings of fermented foods/day
  7. 25+ grams of dietary fiber/day
  8. At least 15 minutes of morning sunlight

In practice, I ask people to assess each of these factors for themselves—sometimes supplemented with a week or two of self-report diaries to obtain more accurate information—to create an individual rank ordering. It is usually counterproductive to try to change multiple health behaviors at once. Instead, it is more practical to begin with the area(s) farthest away from the recommended standards. This is usually also the behavior most likely to yield mood benefits for the person.

As noted above, none of these health interventions require psychotherapy or prescription medicines. This allows, for example, some of my treatments to consist of just one or two meetings with a person to describe the approach and discuss the logistics of implementation in their individual circumstances. After that, many can execute the program independently or with periodic follow-up visits. This does not mean that there is no benefit to working regularly with a health psychologist; as with most other depression treatments, people usually obtain better results with the assistance of a professional.

With my own students and colleagues, I enjoy discussing the rapidly advancing science supporting health psychology treatments for depression. Although this body of research is far too large to summarize in a short post, here are the highlights and some recent clinical trial evidence:

  • Sleep. A healthy sleep schedule is essential to emotional well-being (1). Multiple clinical trials and systematic reviews have demonstrated that cognitive behavior therapy for insomnia (CBT-I) improves depressive symptoms (including symptoms ranging from fatigue to suicidal ideation).
  • Exercise is known to most people to enhance muscular and cardiovascular function. However, fewer realize that the benefits of regular exercise on cognitive function are equally if not more profound. The good news is that both aerobic and resistance training appears to confer these benefits (2).
  • Omega-3 fatty acids, perhaps particularly EPA, have been repeatedly shown in clinical trials to improve depressive symptoms. It is possible for some to obtain sufficient amounts of EPA and other omega-3 fatty acids from diet; others will benefit from supplementation (3).
  • Sugar reduction improves both metabolic health and cognitive function, often in surprisingly short time frames. Reduced mood and anxiety symptoms are among the latter cognitive benefits (4).
  • Processed food. Food has medicinal effects, including on our physical and emotional health. As westernized societies drift increasingly towards diets consisting primarily of ultra-processed foods, the harmful consequences increasingly appear to include higher rates of depression (5).
  • Fermented foods. The gut microbiome—comprising trillions of bacteria inhabiting the stomach, small intestine, and colon—is a topic of intense research interest recently and shows increasingly strong evidence for influencing mental health (6).
  • Dietary fiber. Through mechanisms such as improving gut microbiota and reducing systemic inflammation, high fiber intake is yet another dietary route to improved physical and mental health (7).
  • Daily sunlight. The absence of sunlight has long been linked to seasonal affective disorder. However, more recent evidence suggests that the emotional benefits of regular sunlight exposure extend to all forms of depression (8).

Finally, for those who may still not be persuaded by the evolving evidence in support of behavioral health treatments for depression, consider that these recommendations are already part of the national depression treatment guidelines in some countries. For example, the 2020 version of the Royal Australian and New Zealand College of Psychiatry includes many of the health interventions summarized here among their first tier of recommended treatments for depression (9).

To find a therapist, visit the Psychology Today Therapy Directory.

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References

1. Cunningham JEA, Shapiro CM. Cognitive Behavioural Therapy for Insomnia (CBT-I) to treat depression: A systematic review. J Psychosom Res. 2018 Mar;106:1-12. doi: 10.1016/j.jpsychores.2017.12.012. Epub 2017 Dec 24. PMID: 29455893.

2. Gordon BR, McDowell CP, Hallgren M, Meyer JD, Lyons M, Herring MP. Association of Efficacy of Resistance Exercise Training With Depressive Symptoms: Meta-analysis and Meta-regression Analysis of Randomized Clinical Trials. JAMA Psychiatry. 2018;75(6):566–576. doi:10.1001/jamapsychiatry.2018.0572

3. Martins JG. EPA but not DHA appears to be responsible for the efficacy of omega-3 long chain polyunsaturated fatty acid supplementation in depression: evidence from a meta-analysis of randomized controlled trials. J Am Coll Nutr. 2009 Oct;28(5):525-42. doi: 10.1080/07315724.2009.10719785. PMID: 20439549.

4. Knüppel A, Shipley MJ, Llewellyn CH, Brunner EJ. Sugar intake from sweet food and beverages, common mental disorder and depression: prospective findings from the Whitehall II study. Sci Rep. 2017;7(1):6287. Published 2017 Jul 27. doi:10.1038/s41598-017-05649-7.

5. Zheng L, Sun J, Yu X, Zhang D. Ultra-Processed Food Is Positively Associated With Depressive Symptoms Among United States Adults. Front Nutr. 2020;7:600449. Published 2020 Dec 15. doi:10.3389/fnut.2020.600449

6. Aslam H, Green J, Jacka FN, Collier F, Berk M, Pasco J, Dawson SL. Fermented foods, the gut and mental health: a mechanistic overview with implications for depression and anxiety. Nutr Neurosci. 2020 Sep;23(9):659-671. doi: 10.1080/1028415X.2018.1544332. Epub 2018 Nov 11. PMID: 30415609.

7. Swann OG, Kilpatrick M, Breslin M, Oddy WH. Dietary fiber and its associations with depression and inflammation. Nutr Rev. 2020 May 1;78(5):394-411. doi: 10.1093/nutrit/nuz072. PMID: 31750916.

8. Campbell PD, Miller AM, Woesner ME. Bright Light Therapy: Seasonal Affective Disorder and Beyond. Einstein J Biol Med. 2017;32:E13-E25.

9. Malhi GS, Bell E, Singh AB, Bassett D, Berk M, Boyce P, Bryant R, Gitlin M, Hamilton A, Hazell P, Hopwood M, Lyndon B, McIntyre RS, Morris G, Mulder R, Porter R, Yatham LN, Young A, Murray G. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders: Major depression summary. Bipolar Disord. 2020 Dec;22(8):788-804. doi: 10.1111/bdi.13035. PMID: 33320412.

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