What to Do if You Are Depressed: Healthy Lifestyles

A blog series guiding folks who are depressed.

Posted Jun 26, 2019

Welcome to Part X in our “What to Do If You Are Depressed” blog series. Today’s entry builds on the previous entry’s focus on behavioral activation with a focus on cultivating healthier and more “depressive resistant” lifestyles (Part IX is found here; to go to the start of the series, go here). Our primary guide for today’s entry is the work by Dr. Steve Iliardi and his excellent book called The Depression Cure (here is a pdf). It starts with the argument that there is a depression epidemic that is spreading, and the likely reason is because our lifestyles. He reviews research findings that suggest that people who life more traditional indigenous hunter-gatherer type lifestyles are much less likely to get depressed. He writes:

Modern-day hunter-gatherer bands—such as the Kaluli people of the New Guinea highlands—have been assessed by Western researchers for the presence of mental illness. Remarkably, clinical depression is almost completely nonexistent among such groups, whose way of life is similar to that of our remote ancestors. Despite living very hard lives—with none of the material comforts or medical advances we take for granted—they’re largely immune to the plague of depressive illness that we see ruining lives all around us. In perhaps the most telling  example, anthropologist Edward Schieffelin lived among the Kaluli for nearly a decade and carefully interviewed over two thousand men, women, and children regarding their experience of grief  and  depression; he found only one person who came close to meeting our full diagnostic criteria for depressive illness.

What is going on here? One strong line of thinking is called the “evolutionary mismatch” argument. It refers to the fact that there is a contrast between our current lifestyles and the environment our minds and bodies evolved to live in. Consider, for example, a likely reason we experience tooth decay is that we eat very different kinds of foods than our ancestors. The same may apply to depression. The lives of our ancestors were, like the Kaluli peoples, close knit hunter-gather tribes that would live and work together to meet the challenges of survival and reproduction in natural environments. In contrast, we live in a highly fractured, complicated, stressful, high paced life. Moreover, we can become easily socially isolated in ways that our ancestors would not. This huge difference likely creates lots of problems with our biological and mental health and it provides a good way to understand the modern epidemic of depression. 

Dr. Ilardi's book details a Therapeutic Lifestyle Change (TLC) program that systematically reviews key domains of living and guides the reader in developing healthy, “anti-depressant” habits in each. This is a well-researched program found the following: “Patients were randomly assigned to receive either TLC or treatment-as-usual in the community (mostly medication), and fewer than 25% of those in community-based treatment got better. But the response rate among TLC patients was over three times higher. In fact, every single patient who put the full program into practice got better, even though most had already failed to get well on antidepressant medications.” The reviews the book receives are generally outstanding. As such, it serves as our guide for today's key adaptive principle, which is cultivating an adaptive lifestyle. 

Six Key Lifestyle Domains

The TLC program identifies six key lifestyle domains, each of which represent areas that our ancestors engaged in dramatically different ways of being than we do.

1.  The first domain he identifies is dietary, specifically the consumption of omega 3 fatty acids. He notes how crucial such fatty acids are for brain function and that hunter gatherers ate much more fatty acid rich foods than we tend to do. He offers a systematic way to monitor and change one’s diet to increase fatty acid consumption

2.  The second domain is exercise. Noting that hunter gatherers were in much better shape than we are, he encourages physical exercise. I would especially encourage folks to consider walking. Walking with a friend or walking in nature or walking while you listen to music or a podcast on a topic you are fascinated by is a great way to get exercise and also make connections and be outside and learn new things.

3.  Much as our previous blog, Dr. Ilardi emphasizes the need for productive engagement with various activities and explores ways to foster such engagement in one's life.

4.  We spend much of our time indoors and are exposed to natural sunlight much less than our ancestors. We know that light therapy is important for bipolar conditions and Dr. Ilardi argues that sunlight exposure is helpful for our bodies and minds to feel alive and engaged. The book recommends increasing sunlight exposure and provides clever ways to accomplish that.

5.  Social support and connection is the fifth lifestyle. In a future blog entry, I will be discussing the importance of relationships and feeling secure and known and valued by others. Here we can note the importance of human connection and the book examines ways one might increase connection with others. For example, one might join a club or a church or invite a friend to become a regular walking partner.

6.  Sleep is one of our most important habits and a regular and fulfilling sleep pattern is crucial for our health. The book explores good sleep hygiene and offers suggestions for getting a good night’s sleep.

Dr. Ilardi’s Depression Cure is an excellent resource to foster an “anti-depressant” lifestyle and I highly recommend it. Whereas behavioral activation serves as the basic adaptive principle, the lifestyle approach provides a systematic guide toward constructing a life that is more robust and resistant to depressive cycles and shutdowns.

Let me conclude this blog with two other books are work considering. Spark is a book on the benefits of exercise and getting more physically active and Go Wild is a more recent book by the same author on living a more natural lifestyle can foster well-being. In the next blog, we turn our attention to the biology of depression.