Depression steals people. So far, despite the colossal investment of resources, there is still no reliably effective treatment. What we know for sure is that antidepressants just aren’t working. According to Dr Stephen Ilardi, respected psychologist, university professor and author of ‘The Depression Cure: The 6-Step Program to Beat Depression Without Drugs’, antidepressants only have about a 50% success rate. Out of the people who do find relief, half of them will relapse, taking the actual recovery rate to 25%. Then there are the side effects, such as emotional blunting, weight gain and sexual dysfunction.
When antidepressants fail to deliver, the hopelessness that lies at the heart of depression becomes even more brutal. If we could immunise ourselves and the people we love against depression, we’d be lining up. There is no immunisation, but a growing body of research is finding that there are ways to protect ourselves from depression and alleviate any existing symptoms, particularly for mild to moderate depression.
It’s about certain lifestyle factors – six of them – and the difference they can make to each of us, depressed or otherwise, is phenomenal. The claims may sound extravagant, but science is proving them over and over. The evidence is too compelling for us not to take notice.
The Depression Epidemic: Our Stone Age Brains
There is an undeniable connection between lifestyle and depression. A modern lifestyle is making us sick. The more modern a society, and the more removed it is from the primitive hunter-gatherer way of life, the higher its rate of depression. Our world has changed phenomenally and our lifestyles have changed along with it, but our brains have hardly changed at all. They remain remarkably similar to the ones that powered people in the Stone Age when sleep was abundant, food was nutritious, and people wandered in groups, constantly on the move in the sunshine.
‘Our Stone Age brains just weren’t designed to handle the sedentary, isolated, indoor, sleep-deprived, fast-food-laden, stressed-out pace of twenty-first-century life.’ -Dr Stephen Ilardi
Our brains are beautifully crafted to support Stone Age bodies that live Stone Age lives. When Stone Age brains are forced to live a modern lifestyle, the effect can be devastating. The brain and the body become depleted of the very things that have been fuelling them for thousands of years before now.
In the parts of the world where hunter-gatherer tribes lead similar lives to their Stone Age ancestors, their levels of depression are almost zero. They get plenty of sleep, physical activity and sunlight. They have plenty of distractions to keep them from being trapped in their heads by endless negative thoughts, they have a diet that is rich in omega-3, and their social connectivity is vast. According to Ilardi, these have a much more powerful effect on the brain than any medication.
How Can We Keep Our Stone Age Brain Happy?
Brains can change, and we have the capacity to change them. The key is finding the most effective ways to do that. Enter neuroscience. The chemistry of our brain is very responsive to what we do – for better or worse. Depending on the choices we make, we can deplete it or enrich it.
In preliminary clinical trials comparing the effect of lifestyle changes against antidepressants, researchers found that lifestyle choices brought about a reduction in depressive symptoms almost three times that experienced by the antidepressant group. There are six primary lifestyle factors that have been proven to protect the brain against depression and reduce depressive symptoms and Ilardi details them in his book, The Depression Cure. Interestingly, these lifestyle factors are remarkably close to the way we would have been doing things had we been living in the Stone Age.
What we eat. Let it be plenty of omega-3.
Omega-3 fatty acids are vital for the construction of brain cells and the insulation of nerve fibers. Many of the fat molecules needed by the brain are made by the body, but there are some that can only be drawn from our diet. Some of the best sources are fish (such as salmon), wild game, grass-fed beef, nuts, seeds, and leafy vegetables. It’s no co-incidence then, that Stone Age people consumed five to ten times more omega-3 fat than we do. It’s also no co-incidence that the lowest rates of depression are found in countries with the highest levels of omega-3 in their diets. Plenty of research has confirmed a link between omega-3 and depression – people with depression have lower levels of omega-3 and consuming omega-3 reduces the symptoms of depression.
Omega-3 does beautiful things to the brain – we know that – but there is something we are eating more and more of, that is hurting it – sugar. (I know. That sort of ruined my day too.) Sugar is so addictive – it lights up the brains reward circuitry in a similar way to cocaine. The problem is that it activates the release of powerful inflammatory hormones that causes all sorts of trouble in the brain. Sugar also suppresses the activity of BDNF, a growth hormone that is vital for the health and happy firing of neurons in the brain. People with depression have critically low levels of BDNF.
What to do:
The greatest benefit is to be found in omega-3 rich in eicosapentaenoic acid (EPA), specifically omega-3 comprised of at least 60% EPA. This type of omega-3 is found in fish and shellfish. Ilardi suggests 1500mg of omega-3 daily (in the form of fish oil capsules), with a multivitamin and an antioxidant, such as 500mg vitamin C. Check with a pharmacist or doctor if you have any doubts or questions.
What we think about.
Thoughts influence the brain. A proven risk factor for depression is rumination – dwelling on negative thoughts over and over. Rumination causes physical changes in the brain. When we keep circling around negative thoughts, the brain’s stress circuitry steps up. Cortisol (the stress hormone) attacks the neurons in the hippocampus, which is where memories and emotions are dealt with. People with depression have been shown to have a smaller hippocampus, one of the effects of ruminative stress on the brain.
What to do:
The greatest risk factor for rumination is spending time alone. Being with people or doing an activity are powerful ways to break up a negative thought cycle. Depression is exhausting though, and sometimes being with people will be the last thing a depressed person feels like. Just know that it makes a difference – a big one. If depression has you in its clutches, it’s likely that you will have trouble finding the joy in anything. If that’s the case, think about what you used to enjoy and force yourself to do it. Think of it like medicine or brushing your teeth – it’s just something you have to do. It will be worth it. Interrupting rumination by ‘doing’ is called behavioural activation. It has been proven to be as effective as antidepressants and more effective than cognitive therapy in alleviating the symptoms of depression. Its healing power doesn’t end there. Behavioural activation has been shown to prevent relapse over a two year period as effectively as antidepressants or cognitive therapy.
People time. Spend it with the ones who matter.
According to Ilardi, when someone is depressed the brain mistakenly interprets that pain as an infection. It then tries to protect the person by sending a message for them to isolate themselves until the pain goes away. The effects of this can be catastrophic because isolation encourages toxic rumination. Human contact is powerful. It can ease the symptoms of depression, and protect against them.
What to do.
Spend regular time with people who care about you. If your tribe is looking a bit sparse, force yourself to join a group – anything where there are people – a book club, an art group, an exercise group, a drama group … anything. You might not feel like it but it will make a difference. People were meant to be with people. Just make sure they are people who deserve you.
What we do. Exercise.
Exercise changes the brain and is one of the most under-utilised anti-depressants. Our brains were never meant for sedentary lifestyles. Whenever we are active, key neurochemicals (including serotonin, the neurochemical targeted by antidepressants) set to work throughout the brain, elevating mood, motivation and energy levels. Exercise also elevates the brain’s production of BDNF, the key growth hormone we talked about earlier. During depression levels of BDNF plummet and cause the brain to shrink over time, making learning and memory more difficult. Exercise reverses this. Research that compared the effect of a popular anti-depressant (Zoloft) with the effect of exercise on depression found that 30 minutes of brisk walking 3 times per week was every bit as effective as the medication. Exercise also seemed to have a protective function that the antidepressants seemed to lack. Twelve months after the study, the participants who kept exercising were more likely to have kept their depression at bay. Medication didn’t seem to show this effect.
‘Exercise is medicine … It enhances brain function as powerfully as any medication.‘ –Dr Stephen Ilardi
What to do.
Try for at least 30 minutes of brisk exercise three times a week, but of course, if you can do more, go for it. Anything that gets your heart beating is perfect – a hurried walk, running, dancing, bike-riding, swimming – anything. It doesn’t have to be graceful or strong or beautiful to watch – it just has to be active.
Get plenty of safe sunlight
Sunlight sets off an avalanche of activity in our brain. It does this through receptors in the retina that are connected to the circuitry deep inside the brain that takes care of our body-clock. These are circuits that look after sleep, appetite and arousal. For millions of people, when the days become short the lack of sunlight unleashes chaos in our sunlight-loving brains. This can cause seasonal affective disorder (‘SAD’) which is debilitating and painful, and remarkably, up to 30% of us can show symptoms. SAD can happen to anyone who is chronically deprived of sunlight, because of the impact on serotonin. The power of sunlight isn’t only protective. It also has a remarkable capacity to heal the symptoms of depression. Research has found that light therapy is an effective, stand-alone treatment for depression, having an effect similar to most antidepressant medications.
What to do.
Try for 15-30 minutes of safe sunlight each morning. If it’s not easy to get some rays, try a lightbox, which is able to simulate the effect of sunlight on the brain and create the same protection against depression.
Pillow time. Blissful, restful abundant pillow time.
Yes. I know you know this one, but despite knowing how important sleep is, so many of us remain chronically sleep-starved. We need at least eight hours – as eight hours every single day. Sleep is like a superpower. It really is that good and that important to mood and mental health.
‘Disrupted sleep is one of the most potent triggers of depression, and there’s evidence that most episodes of mood disorder are preceded by at least several weeks of sub-par slumber.‘ -Dr Stephen Ilardi
What to do.
Aim for at least eight hours every night. Set your bedroom up so it’s conducive to restful sleep. Make sure it’s dark, minimise the light from appliances and iThings as much as you can. If you struggle to fall asleep, try a warm shower before bed and spray lavender into the room before you settle.
But remember …
If you are already on medication, it is critical that you don’t stop it suddenly. Coming off anti-depressants should always be done in close consultation with a doctor to avoid withdrawal symptoms (such as a worsening of depression) that can happen when medication is stopped too quickly. Sometimes, particularly for more severe depression, medication is important to bring relief to symptoms but again, they won’t work for everyone. When medication does bring relief, using the lifestyle factors in conjunction with medication is a way to potentially strengthen mental and physical health even further.
Depression doesn’t always happen in isolation and can sometimes be triggered by medical conditions such as diabetes, sleep apnea, thyroid disorder, heart disease, chronic infection and hormonal imbalance – to name a few. In these cases, it will be hard to shift the depression until the underlying medical issues are dealt with.
Depression can also come about in response to other medication, but your doctor will be able to support you on this.
And finally ….
The six lifestyle choices are something that will make a difference for all of us, not just those with depression. We were born to thrive and for that, we need to take our cue from our Stone Age relatives. They were the pioneers of the human brain and their lifestyle was perfect for making it thrive. Our circumstances have changed – a lot. We no longer need to wander the sunny plains in search of food, and we don’t snuggle up with a tribe of relatives in front of a campfire every night, but our brains have stayed remarkably unchanged.
The human brain still craves the things that were ‘everyday’ in the Stone Age. We don’t want to go back to scouring the land for food, fighting wild animals and living with a tribe of relatives, and we don’t have to. Careful and consistent research has isolated the parts we need to keep, and the parts we can leave thousands of years behind us. If we tweak the way we live, we will see a profound difference – on our quality of life, our mood, our physical and mental health, our relationships and our lives.