NON-MEDICATION INTERVENTIONS FOR DEPRESSION:

            Act as if you are not depressed.  Do the things that you would do if you were not depressed.  I am aware this takes a lot of effort.

            Try to turn off repetitive negative thoughts, negative scenarios, and/or negative memories. It is easier to stop these than you think.  Distract yourself with other thoughts or watch a movie or listen to music (an opera is ideal to follow the libretto as you listen).

If you wake up early, get out of bed and stay out of bed.   In fact, if you cut off the last ½ of your usual 8 hours of sleep, the depression usually remits, though for one day only.

Try to walk outside early in the morning –if it is light out– ½ hour or more. Do this as early as possible and at the same time every morning—as soon as you get out of bed.

            Exercise daily, at the same time if possible.  One hour of vigorous exercise 5 days per week works as well as Prozac.  The minimum effective antidepressant dose is 3 hours per week.

Constantly reframe the way you view things (positive, not negative: For example, “I got a 72 on that exam, and finally passed on the 3rd try.  The extra work was worth it!  Maybe I should have studied a little harder the 1st two times, but at least I am there now”.   Rather than: “I am so embarrassed and humiliated.  If anyone knew what my grade was, they would know I am as stupid as I always believed I was.  Additionally, I am a worthless human being because I couldn’t get myself to study the first two times.” .

Cultivate positive emotions.  Consciously engage in these emotions, which may necessitate creating the right conditions:  joy, gratitude, contentment, interest, hope, pride, amusement, inspiration, awe, love.

A RULE FROM AA:  If you are troubled by something you cannot do anything about, then put it out of your mind until you are able to deal with it.  AA says a similar thing better with the serenity prayer:   Accept the things we cannot change, have the courage to change the things we can, and the wisdom to know the difference.

Eat more omega 3’s, especially fish: epidemiologic studies and one double-blind study demonstrate antidepressant effect of omega 3 fats found in ocean fish—EPA is the relevant omega-3, essential fatty acid.     It is only found in sufficient amounts in the oil of kosher ocean fish (sharks, shellfish, octopus squid are of no benefit ).

Plant omega 3’s maybe slightly helpful: flaxseed oil (in your salad dressing, as it has to stay refrigerated after it is opened), canola oil for cooking, walnuts, and green leaves.  However, plant omega-3’s are only 18 carbons long and the brain needs a skeleton of 20 to 22 carbons.  If we can convert an 18-carbon molecule to 20 or 22 carbons skeleton, we can only do it in a small percentage.

FOODS AND SUPPLEMENTS [High inflammation predisposes both to depression and cardiovascular disease.  Many of the substances below are anti-inflammatory – for example a vegan diet; fish oil; vitamin D—which may be why they are effective.

  • folic acid 1-2mg/day Folic acid may slightly increase the risk of some cancers, but tid definitely can help depression, especially in women.   Folic acid is not found in food, nor is it found in the human body. Vitamin companies make folic acid because it is inexpensive to make and they know that most of us can convert folic acid to the active vitamin: L-methylfolate, which is also called 5-MTHF.
  • THIS IS BETTER THAN FOLIC ACID: L-methylfolate/5-MTHF (Deplin)  15mg/day;  this is active folate vitamin and has much more antidepressant effect than folic acid and may be safer.  When used as an antidepressant, one needs 15 mg per day. When used for general health, 15 mg once per week is sufficient.      It expensive ($100) by prescription—less expensive if from the internet  $60 to $90 for 30 pills of 15 mg.
  • 10 fish oil pills per day (or 3 tablespoons of fish oil twice a week).    Nordic naturals have liquid that tastes OK.  Evidence is very strong from epidemiological studies and many double-blind studies for the antidepressant effect of omega 3 fats found in ocean fish.  Freshwater fish and omega-3’s from land plants (flaxseed oil, canola oil, nuts) are of virtually no benefit, as their carbon skeleton is too short for the brain’s use. .   There are some capsules now that have only EPA in them.   DHA has no antidepressant effect.  Ordinary fish oil pills have both EPA than DHA. There are also other brands with only EPA.
  • 4 grams of NAC (N-acetyl cysteine) per day —8 pills of 600mg capsules; when the depression is gone, you can try less. It is available in the health food store.  This allows us to make 50 to 100% more of the main antioxidant [glutathione] in the body.  Free radicals are waste products of chemical reactions in the body and are poisons that must be neutralized.  Note that Vitamin D itself increases the production of glutathione.  NAC provides a substrate.
  • inositol: 2-3 teaspoons twice a day; a sugar which is a natural transmitter in the brain.  ~$35 for 2 months.  Increase the dose slowly to avoid diarrhea.
  • Take vitamin D3 5000 I.U. per day.    If you weigh ≥ 125 lbs, it might be better to take vitamin D3 50,000  U.: one pill per week. This is a steroid hormone and virtually everyone in the developed world is deficient in it and should take it their entire life.  The skin makes vitamin D exposed to UVB light when the sun is high in the sky.   Take 3 pills per month of the 50K I.U. pills if you weigh 100 to 125 lbs.  The daily dose is about 1000 I.U. for every 25 lbs.  Hence, 100 lbs need 4000 I.U. /day and 200 lbs need about 8000 I.U./day. Vitamin D also reduces breast cancer and colon cancer risk by at least 50% after the first year on it.  It makes babies healthier and children grow taller.   It costs ~$10/year if using 50,000 I.U. (1.25mg) pills.
  • SAM-E 400mg bid; it is endogenous to the body; you need to take B12 and folate with it for maximum benefit, as they all work together.  I rarely use it, as it is expensive.
  • B12 _500mcg/ ½ mg ­-  this mainly helps only if you are deficient in it;  vegetarians are usually deficient, as it is obtained from meat.

these SUPPLEMENTS probably  SOMETIMES help depression:

  • One multivitamin (MVI) per day– proven to ¯ heart attacks by 30%, and it ¯’s colon cancer by 30 % (it is the folate/ folic acid  in the MVI  that does it). Any generic MVI is OK.  If low on some vitamins you can become depressed–but it is too expensive to measure them all.  If you forget it, take 2 the next day, as it is only the minimum daily requirement.   There is a DBS (double blind study) proving people in general feel better on a multivitamin vs a placebo.
  • B12: 500mcg/day –especially if you are low in B12; you get it from meat; vegetarians should definitely always take B12 supplements.
  • Vitamin B Complex [e.g., “100” or “150”]: 2 pills/day a little evidence that B complex vitamins may help depression—especially folic acid and B12.
  • Zinc 25mg [here was a DBS (double blind study) in Poland in 12/2003 showing that adding this to antidepressant helped depression]
  • take magnesium 400mg twice a day [Eby and Eby,  Magnesium for treatment-resistant depression: A review and hypothesis;  Medical Hypotheses 74 (2010) 649–660]   — maximum of 400mg 3 times a day  .  I have only rarely had this help anyone.
  • sarcosine 1000mg twice a day. Hard to obtain and expensive.  I have had one enormous success with it—in someone with agitated depression and severe OCD.

 

 

 

 

BEHAVIOR TO LIFT DEPRESSION:

  • SOUND IS AN ANTIDEPRESSANT: Always have sound on—e.g., music at 65 decibels (the volume of normal conversation)[i]  [Or is it that silence causes more depression?—-RDM.]
  • BUY A TIMER, ATTACH TO A LIGHT NEXT TO YOUR BED, to go off 30-45 minutes prior to alarm.  The brighter the better.
  • FORCE yourself out of bed as early as possible every day, at about the same time
  • And, if possible, yourself to ½ hr of bright light in the early am [especially if seasonal and/or difficulty getting out of bed in the morning]—you need 10,000 Lux, and hence will need a light box [$300] or will have to walk outside in bright light. It is hard to induce people to do this proven treatment, unfortunately.
  • One hour of VIGOROUS EXERCISE 5 hours per week—split up. [approximately equal if effect to an antidepressant]  Minimum effective antidepressant dose is 3 hours/ week
  • An extremely REGULAR SLEEP SCHEDULE (bedtime and waking at exact same time every day)—a very conservative lifestyle.
  • DO NOT SLEEP MORE THAN 8 HOURS. [Note: if you get up 4 hours earlier than usual one morning, and stay out of bed, 50% of the time you will have no depression that day—but  good benefit only lasts one day.]
  • NO NAPS.  If necessary, ≤ 1½ hours in afternoon.
  • A real project: Do not sleep at all every other night for 3 nights.  Then change your time of nightly sleep to 9PM to 5AM, to try to maintain the antidepressant effect.  This is complicated and takes an enormous amount of effort—I don’t encourage it without supervision.
  • No alcohol till depression is gone. Even one drink per day [7 per week] inhibits remission. Alcohol can actually cause depression.
  • Avoid substances that cause depression: cigarettes, marijuana, cocaine, Ecstasy, et al. The cigarettes and marijuana are insidious:  they make the depressions more common and worse as the years go on.  Cocaine and Ecstasy often are more immediately causative of depression.

THE BEST DIET FOR IS VEGAN—no animal products;  even better: add fish; avoid five evil white things: sugar, pasta, rice, bread, and white potatoes.

A MEDITERRANEAN DIET is also effective for depression:

Arch Gen Psychiatry. 2009;66(10):1090-1098.

Context  Adherence to the Mediterranean dietary pattern (MDP) is thought to reduce inflammatory, vascular, and metabolic processes that may be involved in the risk of clinical depression.  Objective  To assess the association between adherence to the MDP and the incidence of clinical depression.  Design  Prospective study that uses a validated 136-item food frequency questionnaire to assess adherence to the MDP.

THE GOOD:  The MDP score positively weighted the consumption of vegetables, fruit and nuts, cereal, legumes, and fish; the monounsaturated- to saturated-fatty-acids ratio; and moderate alcohol consumption,

THE BAD:  whereas meat or meat products [chicken, steak, sausage, etc]   and whole-fat dairy [avoid regular milk and cheese; skim milk is OK]   were negativelyweighted.

Setting  A dynamic cohort of university graduates (SeguimientoUniversidad de Navarra/University of Navarra Follow-up [SUN]Project).

Participants  A total of 10 094 initially healthy Spanish participants from the SUN Project participated in the study. Recruitment began on December 21, 1999 and is ongoing.   Main Outcome Measure  Participants were classified as having incident depression if they were free of depression and antidepressant medication at baseline and reported a physician-made diagnosis of clinical depression and/or antidepressant medication use during follow-up.  Results  After a median follow-up of 4.4 years, 480 new cases of depression were identified. The multiple adjusted hazard ratios (95% confidence intervals) of depression for the 4 upper successive categories of adherence to the MDP (taking the category of lowest adherence as reference) were 0.74 (0.57-0.98), 0.66 (0.50-0.86), 0.49 (0.36-0.67), and 0.58 (0.44-0.77) (P for trend<.001). Inverse dose-response relationships were found forfruit and nuts, the monounsaturated- to saturated-fatty-acidsratio, and legumes.

Monounsaturated fats are found in natural foods such as nuts and avocados, and are the main component of tea seed oil and olive oil (oleic acid). Canola oil is 57%–60% monounsaturated fat, olive oil is about 75% monounsaturated fat while tea seed oil is commonly over 80% monounsaturated fat. Other sources include macadamia nut oil, grapeseed oil, groundnut oil (peanut oil), sesame oil, corn oil, popcorn, whole grain wheat, cereal, oatmeal, safflower oil, sunflower oil, tea-oil Camellia, avocado oil.

Extra Virgin Olive oil is better than regular olive oil –for the heart and probably for inflammation (and, thus, depression).

FRUITS ARE GOOD maybe because they contain essential sugars used in glycoconjugate synthesis—mannose, galactose, xylose, fucose, n-acetylglucosamine, sialic acid, n-acetylglucosamine, and n-acetyl galactosamine.

“ELECTRICAL” INTERVENTIONS:

  • the MOST effective is rTMS (repetitive Transcranial Magnetic Stimulation), 40 minutes/day of powerful magnetic impulses to the left forehead.  It brings an astonishing 80% of patients to euthymia in 6 weeks (30 treatments).  The effect is long lasting.  When there is relapse, only a few treatments are necessary to effect remission—not 30.   The first course of treatment is one hour per day, 5 days/week, for 4 to 6 weeks.  Insurance is beginning to help pay for it.  It is FDA approved. Double blind studies indicate that it works even better than medication. ~$10,000 for 6 weeks of treatment.
  • tDCS (transcranial direct current stimulation): Treatment is with 1 mAMP 45 minutes/day for 4-6 weeks, at home.  Anode at F3 on left forehead and cathode on right shoulder or right upper arm. You need a doctor’s prescription for it.  It is a one-time cost for the device (e.g., Oasis Pro with tDCS kit  for $550 total from mindalive.com ).
  • CES (Cranial Electrotherapy Stimulation)— similar to tDCS, but less specific and apparently less effective. It is easy to do, as it is merely the attachment of electrodes to the earlobes for 45 minutes/day, passing a 1 mAMP current at 100 hz.
  • negative ions; water splashing, and lightning make negative ions, which lift depression. Michael Terman, PhD at Columbia discovered this.   There are at least 2 double blind studies supporting it.  The best device is at:  https://cet.org/product/naturair-ionizer/
  • ECT (electroconvulsive therapy)— not for the average depression.

5 simple things you can do, to stay healthy.
1. Avoid smoking and smokers
2. Eat right and Keep BMI  at 18 to 24

  1. avoid drinking Alcohol.
    4. Exercise Daily—or vigorously 3 times a week
  2. Sleep Right—7 to 8 hours
    These are rather effective for good health, but you should do all 5.

For the elderly to have more resiliency and more sense of well-being:

#1: volunteering has the enormous benefit (even more so in the physically impaired and people with low income)  

#2: concentrate on positive emotions.

#3. regular exercise.

#4 higher religiousness and spirituality.

#5. Stress reduction.

#6 maintenance of secure family and social relationships.

#7: positive retraining

[i] Front. Psychol., 08 May 2019 A Pilot Study Investigating the Effect of Music-Based Intervention on Depression and Anhedonia     Treatment response was determined by a minimum of 50% change in the MADRS total scores from baseline to post-intervention. Based on this criterion, 37% of participants (n = 7) presented a clinically relevant reduction of symptoms and were classified as responders (Table 2). The average improvement of depression symptoms for treatment responders was 62% (ranging from 50 to 86%), with mean MADRS score changing from 30.71 (SD = 4.88) at baseline to 11.71 (SD = 4.66) at post-intervention.