We often hear of depression as treated by medication, usually an SSRI, and that's unfortunate. Because although medication has been proven effective, particularly for more severe forms of depression, there are plenty of other treatment alternatives. I take this information pretty exclusively from Dr. Ilardi's The Depression Cure, but also Jeffrey Young and other authors below. Of course, it goes without speaking that the below is just a reproduction of the published ideas of researchers and authors, which are supported by research, and not at all recommendations for treatment for any individual person here.
Good luck, friends.
- Consumption of omega-3 in proportion to omega-6 fatty acids is a huge, and still growing, realization for the treatment of depression and even bipolar disorder. According to Dr. Ilardi, the average American diet has a 1:16 ratio of 3 to 6, and the ratio is supposed to ideally be 1:1. So starting with fish oil supplements, which importantly are high in EPA and DHA (being pharmaceutical grade or molecularly distilled is also important), is good, but Ilardi also recommends minimizing omega-6 rich foods as well. Google the different foods for each to find out more. The easiest recommendations are to eat more fish, eat more greens, eat less Western diet foods.
- Exercise has also been found to be moderately effective with depression, the magic number of therapists being "3 times a week, 30 minutes each time," with your heart rate at at least 60% of its maximum rate, which you can calculate by subtracting your age from 220.
- Another is exposure to light, or phototherapy. Lots of people hear about this with Seasonal Affective Disorder, but this is also a viable treatment for anyone with depression. The idea is to get exposed to light outside when it's brightest, ideally in the morning, or get a 10,000 lux light box, which can be reasonably priced. Serotonin levels are triggered when your eyes perceive light of a certain intensity, hence the 10,000 lux number. Ilardi speaks in some detail how we've naturally become a society that has disengaged itself from outside activities and light exposure, so it's not just depressives who have light deficiencies, but generally the whole society. (It's also interesting how light exposure can be very helpful in resetting circadian rhythms for people with sleep difficulties, including insomnia.)
- Another is interacting with other people, usually a challenging thing given the "sick cycle of depression," wherein people want to be more alone with depression, which exacerbates symptoms (probably because a person who is alone is more free to ruminate, or think about things which trigger depressive feelings). But social interaction is huge.
- Another is sleep. Although to my studies there have only been correlational studies on sleep and mood, the idea is that because depression is a stress disease, and lack of sleep causes higher sensitivity to stress, losing sleep often makes depression worse. This also has a negative cycle with it, especially for people who have anxiety concerns alongside their depression, because just depression itself brings with it rumination, which can make sleep difficult, and the less sleep a person has, the stronger the depression can be, leading to less sleep, and so on. I remember a friend who told me about a friend of hers, who was doing through a depressive episode, and the way out for her was getting a prescription for Ambien so that she could finally sleep, which made dealing with stress easier, which minimized her depression (this person was in an extremely stressful environment, as often isn't the case with depressives).
- There's other approaches that Ilardi doesn't talk about but which can be very powerful. One is Schema Therapy, a form of therapy with its roots in old-school Cognitive Behavioral Therapy but more newly created by Jeffrey Young, who holds that there are 18 different schemas, which he calls "life traps" and more broadly defines as "broad interpretations" a person might have about themselves, other people/society, or their futures. Popular schemas for depression are inadequacy (this also a good fit for anxiety), but especially defectiveness (usually involves feelings of shame, and not uncommonly prior sexual, emotional, or physical abuse) and failure. You can find a good summary of Schema Therapy here, and consider checking out Young and Klosko's phenomenal book on schema therapy called Reinventing Your Life -- the best "self-help" book I've ever read.
- Of course, Schema Therapy is what I call "advanced CBT," and although it was created historically for people with personality disorders or chronic psychological problems, many therapists use it for all their clients. That said, you shouldn't discount the power of "regular" Cognitive Behavioral Therapy, which focuses how our thoughts or beliefs influence our feelings or moods (of which depression is one) and our behaviors, of which this is a great (and totally free) package of CBT stuff for depression. People with depression often have negative views of 1) themselves ("I'm a failure," "I'm no good," "I'll never amount to anything," etc.), other people or society ("people don't care," "the world is a terrible place," etc.), and their futures ("there's nothing out there for me," "this is completely hopeless," etc.). A good therapist will focus on this triad of possible problems, and there's a lot of material that can take place in these three areas.
- I'd lastly add a not-too-commented-upon approach that's still utilized by CBT practitioners, which focuses on meaning, and is often called behavioral activation. Aaron Beck, one of the founders of cognitive therapy, has a great approach still widely used by CBT-educated therapists, where people write their daily activities down on a time sheet by hour ideally for 5-7 days and then rate on a scale how much pleasure and mastery these activities brought them; then they fill out another sheet for 5-7 days on the activities they could do instead and fill out how much they think these activities will bring them pleasure and mastery on a scale, then do these things and write out their actual level of pleasure and mastery. The idea is that people with depression often get caught up in activities that aren't pleasurable or don't bring about a sense of mastery to them -- which the existential therapists would equate with meaning or meaningful activities. The behavioral activation approach can also be summarized with, "when feeling depressed, get moving," or something like that. What tends to happen with depression is people don't want to do anything, which makes them stay with their thoughts and remain depressed, which keeps them from wanting to do anything; to remind oneself to "get moving" when depressed breaks this cycle. Using rules like the "15 minute rule" can also be incredibly helpful; this rule states that "I'll just try X for 15 minutes, and then see what happens," whether this means the person can stop doing the thing she tried doing or continue doing it. Most people find that after starting anything and sticking with it for a few minutes, things take on their own inertia and become easier. That's also the idea with behavioral activation. A briefer version of the Beck approach can be found here.
Good luck, friends.
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