Sleep, exercise, diet, and meditation are the foundations of health and can help anyone, depressed or not, feel better. The aim of this post is to provide guidance to anyone suffering from fatigue, insomnia, depression, anxiety, stress, burnout, or problems with attention and focus, with part one discussing behavioral interventions, and part two focusing more on supplements and over-the-counter treatments.
Please always speak to your doctor if you feel unsafe or have had suicidal thoughts and certainly do not stop your medication or make changes on your own. If your symptoms are sufficient to impair your ability to work, sleep, or relax, consider getting professional help.
Before we dive into alternatives to taking prescription meds, I would like to emphasize the importance of taking things seriously and sticking to a regimen. Too many people promise they will do something regularly, like exercise or meditation, and then their intentions fall to the wayside.
Be consistent and patient. Whatever you try, do it daily and stick to the course for at least a month. Treat these interventions as you would medicine—do not miss doses. A fair number of people end up on meds because they are easier than adhering to a more natural, behavioral plan, which can be equally helpful.
Our moods tend to bleed into the time surrounding the present. If you feel terrible today, you are more likely to think it has always been this way. The opposite is true as well. Even patients who improved through medications can tend to believe they have always felt as they do.
I often ask my patients—at least at the onset of any treatment—to journal how they feel, what bothers them, and how they react to things. The goal is to compare before and after—in their own words.
If you plan to pursue any intervention, from medication to meditation, take time to journal so you can track your progress and see, in your own writing, the before and after results. Tracking moods and/or journaling is a healthy practice for anyone and makes the process of self-improvement more systematic and less subjective. Writing really helps process feelings, too.
Sleep is the most restorative activity for the brain. Evolution has kept sleep around in all plants and animals forever because it is so important. Our brains store information, recharge neurotransmitters (like serotonin and dopamine), process emotions, and experiment with creative solutions while we sleep. Good sleep leads to better impulse control, which makes it easier to stop thinking in loops, falling off emotional cliffs, eating too many potato chips, or doom scrolling until the wee hours of the night.
Nothing, including prescription medication, works as well if you are not getting the proper sleep. I often tell my patients, "If there is no gas in the tank, you cannot push the accelerator." Fatigue also can mimic depression, worsen anxiety, affect memory, and reduce impulse control.
Regular bed and wake times are essential. Besides sleeping in a cool, dark bedroom, turn off screens and anything else interactive (or too stimulating) at least an hour or two before sleep. I advise my patients to "tech off at 10," meaning no screens, computers, text messaging, emails, or any other electronics before bed. If you cannot sleep, take to reading, ideally on paper in a dimly lit room or on a Kindle, but, on the Kindle, try to invert the colors for white text on a dark background. You want to reduce the amount of light that your screen produces as much as possible.
If you wake in the middle of the night, make sure the bedroom is cold(ish), and you are not too warm. Colder is better for sleep. Try to meditate if you can or relax and visualize your favorite places for 20 minutes. If you cannot fall back asleep by that time, get out of bed, and do something relaxing like reading in dim light. Return to bed when sleepy. Do not allow yourself to get stressed, tossing and turning in bed. Also, do not "reward" insomnia by doing productive things at night, such as work or emails.
Should you awake too early, make sure you do not suffer from sleep apnea, often diagnosed in people who are overweight or who wore braces as children. Sleep apnea patients oftentimes wake several times per night and feel quite sleepy during the day, despite adequate sleep. Loud, extensive snoring and pauses in breathing are signs of sleep apnea. A variety of smartphone apps are available to record sleep at night and let you listen to your own breathing, so you do not have to rely on your bed partner.
Our basic human functions not only require good sleep at night but ample activity by day. We simply were not designed to sit behind a desk or on a couch all day.
"Vertical time" spent upright and moving about, ideally exercising on most days of the week, helps blow off steam and has been shown to improve neurogenesis, as described by authors of a 2018 article in Neural Regeneration Research. Neurogenesis involves the needed growth of new neurons and connections in the brain. Research indicates that exercise can improve mood, reduce anxiety, and enhance sleep quality at night.
I advise about 30 minutes of exercise daily, four to five times per week if possible. If you cannot speak easily while exercising, you know you are pushing the intensity enough.
Of course, exercise is as good for the mind as it is for the body. In a study published in Frontiers in Psychology, scientists conclude physical exercise “determines positive biological and psychological effects that affect the brain and cognitive functioning and promote a condition of well-being. [Physical exercise] plays an important role in counteracting normal and pathological aging.”
Other investigators concur. A study being published this year (2022) in the journal Psychology of Sport and Exercise suggests “short bouts” of moderate-intensity exercise are seemingly effective in improving mood and managing symptoms of major depressive disorder.
“You are what you eat.” If you want to be healthy, you must consume healthy foods. Indeed, experts long have known that, unlike high-fat Western diets, eating plans emphasizing the consumption of fish, vegetables, and fruits—like the Mediterranean diet—are associated with a lower risk of depression and depressive symptoms.
Many of these healthy foods contain antioxidants, natural chemicals with antidepressant properties. In fact, authors of an article in Antioxidants (Basel) propose that future studies consider how “diet and nutrition can be used as a part of a comprehensive strategy for the prevention of depressive problems. Moreover, patients with depression who are not suitable for drug therapy or psychotherapy can [potentially] use diet and nutrition adjustments as an alternative treatment.”
A variety of effective nutritional diets are available to follow, but the Mediterranean diet is again rated the best overall healthy food plan, according to the U.S. News & World Report’s annual ranking for 2022. This is the fifth time in a row the Mediterranean diet has taken the number-one position. The plan is based on eating vegetables, fruits, nuts, legumes, and other foods typical to Mediterranean regions and replacing high-fat meats and condiments like butter with low-fat oils, herbs, fish, and chicken.
Scientists have tied mindful meditation to improved sleep quality (Annals of the New York Academy of Sciences); a reduction in anxiety and positive alterations in the way the brain processes fear memories; and improvements in learning and memory processes, emotion regulation, self-referential processing, and perspective-taking” (Psychiatry Research: Neuroimaging).
But what is mindful meditation? Cognitive restructuring specialist Donalee Markus perhaps defines it best as a “state of being ‘present in the moment’ and controlling the inner dialogue that prompts one’s thoughts to wander.” The research director of the Benson-Henry Institute for Mind Body Medicine at the Harvard-affiliated Massachusetts General Hospital says, “Meditation trains the brain to achieve sustained focus and to return to that focus when negative thinking, emotions, and physical sensations intrude.” By so doing, meditation decreases the risks of depression.
Of course, harnessing that inner voice in us requires practice. Like driving a car, meditation is difficult for everyone in the beginning. In his book 10% Happier, Dan Harris acknowledges everyone has a monkey mind, which constantly distracts you as you try to meditate. This is normal. You are literally strengthening the "muscle" that returns wandering thoughts back to silence.
Mindfulness is no longer considered a practice limited to spiritual enlightenment. An increasing number of people now equate it to achieving general good health and well-being. Mindful meditation helps us process and reconnect with the world around us. It is another useful tool in our efforts to stay physically, mentally, and emotionally healthy.