Managing Depression the Natural Way

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by

Dawn Ferrara, Psy.D

 

We all have days when we’re feeling a little low, maybe even sad. Days when even the little things just seem monumental and overwhelming. Most of the time, a good sleep, a good cry or maybe some time away from the daily routine is all that’s needed to get your mojo back. Sometimes, though, those little adjustments just aren’t enough. Sometimes that mood hangs over us and just won’t move on. When a couple of off days turns into weeks or months, it’s time to take a closer look at what’s happening.

Is It Depression?

Depression and “being depressed” have become casual descriptions for feeling low, feeling sad or just generally out of sorts. But is it really depression or just one of those days? The difference matters.

Sadness is a normal emotion and we all experience it. It’s that feeling of being down, feeling blah, maybe even feeling regret, remorse or a sense of loss. Sadness is generally associated with a trigger event of some kind. You may feel sad but you are still able to function, sleep, eat and do things you enjoy.

Depression, on the other hand is quite different. It presents with a distinct constellation of symptoms that are far more than just feeling down for a few days. Depression doesn’t need a trigger. It is a more persistent and pervasive disruption in mood that significantly impacts one’s ability to function. The risk of self-harm can also be present.1

Symptoms of depression2 can include:

  • Persistent sad, anxious, or “empty” mood
  • Feelings of helplessness, hopelessness or pessimism
  • Increased irritability
  • Feelings of guilt or worthlessness
  • Loss of interest or pleasure in activities (sometimes referred to as anhedonia)
  • Decreased energy or fatigue
  • Slowed speech or movement
  • Restlessness or fidgeting
  • Poor concentration or indecisiveness or forgetfulness
  • Poor sleep – trouble falling asleep, early-morning awakening or oversleeping
  • Somatic complaints (physical complaints that don’t seem to have a medical cause and/or that don’t respond to treatment)
  • Significant appetite and/or weight changes (generally +/- 5% of normal body weight)
  • Thoughts of death or suicide, or suicide attempts

 

That’s a long list and not every person will experience every symptom or in the same ways. But, if you’re finding symptoms bothersome, a visit with your healthcare provider is probably a great next step. A skilled clinician can help you to determine whether you’re experiencing depression and if so, what options there are for treatment.

Treating Depression – Does It Mean Medicine?

The short answer is, it depends.

There are a number of ways to treat depression. Some are backed by solid research, some by more anecdotal evidence. Options can include medications, procedures such as ECT (electroconvulsive therapy), TMS (transcranial magnetic stimulation) and psychotherapy as well as alternative approaches such as lifestyle management, mind-body practices and herbal remedies to name a few. You’ll sometimes see treatments used in combination.

 

What works best is what works for you. Because depression has many facets, it is important to consult with your healthcare provider so that you can make the best decision for your situation.  This is especially true if your symptoms are especially severe or if you’re experiencing thoughts of self harm. Your provider can help you find the safest way to manage those feelings and symptoms. When making decisions about your mental health, the most important thing is to make an informed, safe choice.

 

Managing Depression the Natural Way

Treating depression in a natural, holistic way means actively taking ownership of your world and how you manage it. Making changes in the way you go about daily life can yield huge benefits. But what works?

If you Google “natural ways to treat depression,” you will literally get 77,200,000 hits and many of them are sites looking to sell you their latest and greatest product, backed by research…that they sponsored. Proceed with caution. You took the time to get an accurate diagnosis. Take the time to choose strategies with sound evidence.

So, let’s talk about strategies.

 

Cognitive Behavioral Therapy (CBT)

CBT is considered the gold standard in psychotherapy. It is a form of “talk therapy” that focuses on helping the person to change unhelpful thoughts, feelings and behaviors, improve emotional regulation and develop more effective coping strategies. CBT is probably the most researched of the various forms of therapy and has one of the most consistent track records of efficacy. When compared to the use of medications for chronic depression, CBT has been found to be as effective as pharmacological interventions in many cases.3

Lifestyle Management

How we live our lives has a tremendous impact on our mood and well-being. Things like getting enough sleep, eating healthy foods, getting exercise and fresh air and managing our stress can significantly reduce depressive symptoms.

Sleep

Disrupted sleep and depression often go hand-in-hand. Could improving your quality of sleep improve depressive symptoms? Research says, maybe so. Recent studies have found that poor sleep quality seems to disrupt the center of the brain responsible for the regulation of negative emotions.4 Improving your quality of sleep may help you manage anxiety and depression better.

Improving quality of sleep can be as simple as practicing good sleep hygiene. Things like limiting caffeine, limiting evening screen time, darkening the room, making the sleeping space comfortable and aiming for your 8 hours can do much to improve your quality of sleep.5

Nutrition

Good nutrition is the cornerstone of good health so it makes sense that we would include mental health. The evidence of connection is so strong that there is even an emerging field known as nutritional psychiatry.

Study after study is demonstrating a link between nutrition and mental health and more specifically, depression. Of particular concern are diets high in refined sugar and processed foods.6,7 Typical western diets or those lower in nutrient-dense foods have been associated with differences in the brain that may contribute to emotional regulation. Diets rich in fruits, vegetables, healthy fats and lean proteins (like the Mediterranean Diet) have been linked to improved health biomarkers and lower levels of depression.7,9

Exercise

Regular exercise has been linked to improved feelings of well-being and a positive impact on levels of depression.10, 11 Exercise stimulates the release of powerful neurochemicals that improve feelings of well-being and improves blood flow to the brain. The good news is that you don’t have to spend hours sweating in the gym. You can choose activities that incorporate intentional movement and that you will do on most days. Things like walking, swimming or biking are great choices.

Manage Stress

When we’re chronically stressed, our bodies are in a constant “fight or flight” mode. Cortisol, the “stress hormone,” surges and levels of mood-regulating neurochemicals like serotonin and dopamine plummet. This can create a cascade of physical, psychological and interpersonal changes that over time can contribute to or exacerbate mood changes.12  Take time to relax, unplug and recharge in the ways that work for you. . Your body and your mood will thank you.

Mind-body Approaches

Mind-body practices such as yoga and mindfulness meditation have come front and center in the non-pharmacologic treatment of depression. While yoga has long been known to improve flexibility, improve balance, lower blood pressure and reduce stress and anxiety, it has gained attention as a possible tool for improving mood. Studies have found that regular yoga practice seems to have a positive effect on levels of depression for some people.13 Most studies have looked at the vinyasa style of yoga but other practices seem to have similar effects

Mindfulness meditation has also received quite a bit of attention in recent years. Practicing mindfulness has been shown to reduce anxiety, improve physical and psychological health and feelings of well-being. Studies have demonstrated a direct effect of practicing mindfulness with the reduction in levels of depression.14,15

The power of mindfulness has also been incorporated into a form of psychotherapy called Mindfulness Based Cognitive Therapy (MBCT). This approach, developed specifically for the treatment of depression, combines two highly effective methods for coping with emotional health – mindfulness meditation and cognitive behavioral therapy.15

 

Herbal Remedies

St. John’s Wort has been the go-to herbal remedy for 2000+ years and has a long record of anecdotal support. Research has been somewhat mixed. Studies have generally found that St. John’s Wort is more effective than placebo and as effective as antidepressant medication for mild to moderate levels of depression.16 It has not been found to be particularly effective in cases of severe depression.17

CBD Oil is the new kid on the block and getting lots of attention. It is proving to be effective with a number of psychiatric and medical issues. The research with CBD oil and depression, though, is not so clear. A 2017 review of studies involving CBD oil and psychiatric disorders found that the evidence was insufficient to conclude that CBD oil is an effective option for depression.18 More research is needed to determine how or if CBD oil can offer symptom relief.

The Takeaway

Depression, whether mild or severe, is a multi-faceted mental health issue that does not lend itself to a one-size-fits-all approach. No one single strategy is likely to be “it”. More likely, you will adopt a set of strategies that work for you and give you the greatest relief. Remember, it is important to understand your depression, fully vet your options and find what works for you. And it is always ok to ask for help. Your mental health provider can help you choose the tools that are safe and most appropriate for you.

 

 

 

 

References

  1. American Psychiatric Association. (2017, January). What Is Depression?. Retrieved from https://www.psychiatry.org/patients-families/depression/what-is-depression
  2. American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Fifth edition.
  3. Vos T, Haby MM, Barendregt JJ, Kruijshaar M, Corry J, Andrews G. (2004). Archives of General Psychiatry, 61(11), 1097-1103.
  4. Klumpp, H., Roberts, J., Kapella, M. C., Kennedy, A. E., Kumar, A., & Phan, K. L. (2017). Subjective and objective sleep quality modulate emotion regulatory brain function in anxiety and depression. Depression and Anxiety, 34(7), 651-660.
  5. What is Sleep Hygiene?. (n.d.). Retrieved from https://www.sleepfoundation.org/articles/sleep-hygiene
  6. Lai, J. S., Hiles, S., Bisquera, A., Hure, A. J., McEvoy, M., & Attia, J. (2013). A systematic review and meta-analysis of dietary patterns and depression in community-dwelling adults. The American Journal of Clinical Nutrition, 99(1), 181-197.
  7. Sánchez-Villegas, A., Martínez-González, M. A., Estruch, R., Salas-Salvadó, J., Corella, D., Covas, M. I., Serra-Majem, L. (2013). Mediterranean dietary pattern and depression: the PREDIMED randomized trial. BMC medicine, 11, 208.
  8. Jacka, F. N., Cherbuin, N., Anstey, K. J., Sachdev, P., & Butterworth, P. (2015). Western diet is associated with a smaller hippocampus: a longitudinal investigation. BMC medicine, 13, 215.
  9. O’Neil, A., Berk, M., Itsiopoulos, C., Castle, D., Opie, R., Pizzinga, J., … Jacka, F. N. (2013). A randomised, controlled trial of a dietary intervention for adults with major depression (the “SMILES” trial): study protocol. BMC psychiatry, 13, 114.
  10. Cooney GM, Dwan K, Greig  CA, Lawlor  DA, Rimer  J, Waugh  FR, McMurdo  M, Mead  GE. (2013). Exercise for depression. Cochrane Database of Systematic Reviews, Issue 9. Art. No.: CD004366.
  11. Mandolesi, L., Polverino, A., Montuori, S., Foti, F., Ferraioli, G., Sorrentino, P., & Sorrentino, G. (2018). Effects of Physical Exercise on Cognitive Functioning and Wellbeing: Biological and Psychological Benefits. Frontiers in psychology, 9, 509.
  12. Schneiderman, N., Ironson, G., & Siegel, S. D. (2005). Stress and health: psychological, behavioral, and biological determinants. Annual review of clinical psychology, 1, 607–628.
  13. Bridges, L., & Sharma, M. (2017). The Efficacy of Yoga as a Form of Treatment for Depression. Journal of evidence-based complementary & alternative medicine, 22(4), 1017–1028.
  14. Edenfield, T. M., & Saeed, S. A. (). An update on mindfulness meditation as a self-help treatment for anxiety and depression. Psychology research and behavior management, 5, 131–141.
  15. MacKenzie, M. B., & Kocovski, N. L. (2016). Mindfulness-based cognitive therapy for depression: trends and developments. Psychology research and behavior management, 9, 125–132.
  16. Linde, K., Berner, M. M., & Kriston, L. (2008). St John’s wort for major depression. Cochrane Database of Systematic Reviews.
  17. Shelton, R. C., Keller, M. B., Gelenberg, A., Dunner, D. L., Hirschfeld, R., Thase, M. E., … Halbreich, U. (2001). Effectiveness of St John’s Wort in Major Depression. JAMA, 285 (15), 1978.
  18. Khoury, J. M., De Castro Lourenço das Neves, M., Valente Roque, M.A., Alves de Brito Queiroz, A., Corrêa de Freitas, A. A., de Fátima, A., Moreira, F. A., & Garcia, F. D. (2019) Is there a role for cannabidiol in psychiatry?. The World Journal of Biological Psychiatry, 20(2), 101-116.

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