Lifestyle Interventions for Depression
The good habits that can make you more resilient to stress
Posted Feb 15, 2015
Clinical depression, where sad mood and/or lack of interest in usual activities persists among other symptoms to lead to inability to function in normal life, substance abuse, and even suicidal thoughts, is a complicated condition. Stress of course is known and easily accepted to be the main cause, but two people may endure the same stress with only one developing depression, while the other is resilient. What are the differences in these two people? What can we learn from the physiology of clinical depression that might help us become more resilient, preventing depression? For those who already have depression, what lifestyle and other changes should we promote to help the person feel better and stay better?
A recent article from BMC Medicine focuses on the inflammation that occurs in depression, and what the environmental causes are. Inflammation is a word for the sort of immune response we make, and inflammation in the course of normal life helps us stay healthy, for example, when our ankle hurts and swells after a sprain, keeping us off of it so it will heal. However, inflammation often gets chronic and out of hand, leading to residual problems and illnesses.
Cytokines and other inflammatory particles are both present in high levels in people who are depressed, but they can also induce depression all on their own. Acute stressors, such as deaths in the family or losing one’s job cause high levels of inflammatory particles that are measurable in the blood. In most people, however, the inflammatory particles eventually induce an anti-inflammatory response, the body’s off switch, if you will. Most physical processes work this way, with automatic regulation. A clinical depression seems to happen when that off switch isn’t working properly, and the inflammation perpetuates itself. Lifestyle changes like exercise and getting out in the sunshine on a regular basis are known to be helpful for depression and decrease inflammation, but depression saps the very motivation and energy it takes to do these things. Worse still, early childhood trauma seems to be a set up for an impaired immune response to stress for the rest of the life.
We’ve already mentioned a few lifestyle modifications one can use to help keep depression at bay (and help an ongoing depression, as long as it is not too severe to interfere with changing lifestyle…professional help may be required to get started on some of these lifestyle changes, and sometimes situations make them impossible). Regular exercise is one, known to improve brain function and resiliency, even helping the brain remember better after studying. Light therapy and sunshine is another. Diet is another, with people eating diets rich in whole foods, vitamins, minerals, omega 3s, and low in highly processed foods being less likely to experience clinical depression than those who eat a Western Diet. People eating a “prudent” diet of lots of fish, vegetables, fruits along with people consuming a Mediterranean diet pattern have lower levels of inflammatory cytokines in the blood. Fibers present in whole foods, while not associated with weight loss, is associated with better immune function and may influence inflammation by making the gut microbiota happy.
Smoking of course is associated with high levels of inflammation, and smokers tend to be more depressed than non-smokers (it seems to be a two-way street, too, with depressed people more likely to smoke as a way of self-medicating). Smoking has very aging effects that one can see on the face of a long-term smoker, and the cell aging that’s visible also occurs all over the body, leading to a sicker and less resilient person overall. Patients who quit smoking, like those who quit caffeine, experience an acute change in mood, alertness, and sleep, but for smoking, the long term benefits of quitting are profound. The evidence is not so clear on caffeine.
Other environmental and medical problems you might not expect to be associated with depression, and are somewhat modifiable by appropriate care and good habits, are allergic disorders (like asthma and hay fever) and cavities. Asthma is associated with suicide, and those folks who fill prescriptions for overall anti-inflammatory medicines have lower rates of suicide than those who only get an anti-histamine. Cavities and gum disease are also associated with depression, though data is more sparse than that connecting asthma and suicide. Periodontal disease is associated with a high amount of systemic inflammation, including Il-6 and Il-8 which are also markers of depression.
Since depression, via decreasing motivation and energy, can decrease good oral hygiene practices while poor oral health can lead to shame and social avoidance, like many lifestyle factors, the connection to depression with dental disease can be a two-way street and a self-perpetuating problem.
Poor sleep is one sure-fire way to ramp up the stress and inflammation in the body very quickly, while lifestyle stressors are the most obvious causes of poor sleep. In the (very) short term, acute sleep deprivation can improve depression symptoms, but it is not a sustainable practice. Humans need our sleep to help our brains work well.
One final anti-inflammatory hormone is good old vitamin D, derived in the skin from sunshine. Where I live in Boston, fully a third of adults are frankly vitamin D deficient. You can get your vitamin D levels measured via http://www.grassrootshealth.net. I think a level of 30-50 ng/ml is fine for most people, but reaching and maintaining that level will require regular brief sun exposure in the summer and, for those of us who live in high latitudes, vitamin D supplementation over the winter. Low levels of vitamin D are associated with inflammation and/or depression in large studies. Cause and effect are unclear, but very low vitamin D levels cause problems in immune functioning and bone health, so its best to keep levels normal.
In summary, do what you can to sleep well, eat well, exercise, get sunshine, and keep flossing those teeth. These habits will have an anti-inflammatory effect on your body, making you more resilient to the depression that unchangeable factors, like a history of childhood trauma, sudden death in the family or a genetic predisposition to depression may cause.
copyright Emily Deans MD