- Anti-depressant medication by itself is less effective than medication plus therapy. Therapy is more effective with lifestyle changes.
- Getting regular exercise leads to measurable changes in body chemistry, which have an uplifting effect on mood.
- Quality sleep allows for stable moods, better focus, and memory, while meditation decreases the tendency to ruminate on discouraging thoughts.
Roughly 20 million adults in the U.S. suffer from depression each year. Those at greatest risk are women, single adults, and those living on low incomes. Among Americans aged 12 and older, the incidence of depression is 9 percent. Among teens and young adults, the rates are even more concerning, reaching 17 percent.
Use of Antidepressant Medications
A significant step forward in treating depression came with the release of Prozac in 1988, followed by the release of a group of antidepressants, called SNRIs, in the early 1990s. Medication has been extremely beneficial for those who are so depressed they cannot get out of bed in the morning, function during the day, or get to sleep at night. It’s clearly superior to becoming addicted to another substance, such as sleeping pills or alcohol, to allow relief from intensely low mood and low energy, as well as to minimize the risk of self-harm.
As a society, we have come to rely on psychiatric medications for a whole range of emotional and behavioral problems, with varying consequences from life-saving to life-numbing. As psychiatrist Bessel Van Der Kolk pointed out in The Body Keeps the Score, “even as antidepressant use continues to increase, it has not made a dent in hospital admissions for depression.” Medication alone is not enough to treat depression or prevent relapse after treatment.
The Role of Therapy and Its Limit
Most mental health professionals emphasize the importance of therapy and medication (as needed) when treating mental health problems. Various models of therapy, particularly cognitive-behavioral therapies (CBT, DBT, ACT, etc.), are effective in relieving mild and severe symptoms of depression. The combination of medication and therapy has repeatedly been shown to be more effective than medication alone.
If you are opposed to using a psychoactive medication or have had no success with antidepressants, therapy may be your primary course of action. Particularly for those whose symptoms are mild to moderate, therapy is an excellent way to get short-term relief of symptoms.
However, as is true for medication alone, therapy alone cannot produce lasting positive change unless something else changes. If lifestyle habits continue to be self-defeating, such as misuse of substances, ongoing sleep deprivation, or a diet lacking nutrition, no amount of therapy can overcome the detrimental effects of those lifestyle factors.
Your physician has probably advised you to exercise daily, get eight hours of sleep, and eat a healthy, nutritious diet. This common-sense lifestyle advice is based on the wisdom of generations and there is scientific evidence of the benefits for your emotional and physical well-being. Four possible lifestyle habits have been well-studied for their specific benefits.
Regular daily exercise:
- Increases levels of the neurotransmitter serotonin, known to be low in depressed persons.
- Releases endorphins, the natural feel-good neurotransmitters.
- Activates the release of dopamine, the neurotransmitter associated with feeling motivated.
- Builds confidence as you meet your exercise goals.
- Takes your mind off worries and self-critical thoughts.
- Activates the release of the neurotransmitter GABA, which has a natural calming effect after as little as 10 minutes of movement.
- Foods high in omega-3s act as natural antidepressants by boosting serotonin production in the brain (salmon, sardines, and walnuts are a few examples).
- Vitamin D supplements have been associated with improved mood, while low levels of Vitamin D are associated with depressed mood.
- B Vitamins (B-1, B-3, B-6, and B-9) help to produce serotonin.
Good quality and optimal quantity of sleep:
- Deep sleep and REM sleep are critical for memory, focus, awareness, and stable mood.
- Regular sleep schedules work with the body’s natural sleep-wake cycles (circadian rhythms) to maximize our alertness during daylight and restfulness at night.
- Lack of sleep makes us more vulnerable to depression, possibly by disrupting the production of serotonin.
- Too little sleep (insomnia) and too much sleep (hypersomnia) are signs of possible depression.
Mindfulness meditation or transcendental meditation:
- Is associated with increased grey matter in the pre-frontal cortex, the part of the brain that guides us to use self-control (The Body Keeps the Score, Van der Kolk, 2014).
- Stimulates the vagus nerve, improving our emotional regulation.
- Directs brain activity away from the amygdala, the brain’s fear/alarm center (Van der Kolk, 2014).
- Improves our focus, concentration, and awareness of the present moment.
- Decreases our tendency to ruminate on worrisome or discouraging thoughts.
The impact of lifestyle factors on mental health has been well-established through research. Of course, checking with your physician before adding any exercise program, vitamins, or other dietary supplements to your normal routines is important. In addition to starting new and better habits, there are obviously benefits to giving up or limiting unhealthy habits, such as the use of substances to alter moods.
Changing our daily routine is not a simple step; most of us have at least one not-so-healthy habit. I suggest you consider choosing one lifestyle change as a start, following up with a second change when the first has become routine for you. It’s never too soon or too late to improve the quality of your life. To quote T.S. Eliot, “Every moment is a fresh beginning.”
To find a therapist, visit the Psychology Today Therapy Directory.