A Personal Look at Depression

First I noticed fatigue and a general lack of physical and emotional energy this summer. Most days by dinnertime I hardly had the energy to stand, and the only thing my brain could handle doing after dinner was vegging out in front of the TV. But I dismissed it as seasonal allergies, because last year in July and August, the doctor told me allergies caused the horrendous cough and lethargy that lasted for six or eight weeks.

Then I started feeling stressed and anxious. But that started about the time I made our first married-couple budget, so I attributed the stress and anxiety to the fact that, while we have plenty of income to pay our bills, I need to bring in significantly more income if we’re going to get ahead and reach our financial goals. This reality just left me feeling a lot of pressure.

Meanwhile, I also felt scattered, like I couldn’t sit down and concentrate on anything. But, I reasoned, there are a lot of things going on in my life right now. I’m adjusting to married life (love it—about to celebrate six months); settling a new house (also love it—but the garage is still about one-quarter full of unpacked boxes, and the list of things yet to do inside the house is still long); doing all the housewife-ly duties like cooking, cleaning, laundry and sometimes yard work (believe it or not, love these things too); managing our finances—doing the budget, etc. (also love this); maintaining my massage business (I see about 2 or 3 clients a week right now, all of whom have come to me for four years or longer, so I genuinely enjoy seeing them each visit); starting a new blog and trying to get publicity for it (enjoying this); we traveled quite a bit over the summer; and then of course there are the usual things like trying to maintain a social life and keep up with my health and fitness goals.

Which I’m obviously not doing, because I gained 12 pounds in four months. But, before my wedding in April I ate more sparsely, so I figured the pendulum was just swinging the other direction. And of course, being a diligent, eager new wife, I make a sit-down dinner about five nights a week. Yeah, I cook healthy, but we rarely eat earlier than 6:30pm, often more like 7 or 7:30. Eating late has always made a difference in my weight. Then I started to notice myself “binge-eating”, which, for me, isn’t usually as bad as it sounds, but half a box of Kashi brand TLC crackers is still half a box of crackers! I craved carbs and sweets.

Two of my girl friends who also have “unstructured” work time—one is looking for a job and the other is a new stay-at-home mom/freelancer—have at different times been my morning walking/running partners. I love and appreciate both of them. For some reason, about halfway through the summer, the commitment to walk every morning felt overwhelming. I thought maybe I just needed to adjust to this new phase of life. Besides, I felt pressure to work more and felt unjustified spending the time with them.

Then came the guilt. I felt guilty for not working enough, I felt guilty for not spending as much time with my girl friends, I felt guilty for giving into my cravings, for not eating enough vegetables, and for gaining weight. Thoughts of stupid things I’ve done in the past began to pop into my brain, much like unwanted pop-up windows in your web browser: People I’ve let down or hurt, times I didn’t follow through on a commitment, careless things I’ve said or done; I felt guilty about all of them. I didn’t know what to make of the guilt. I thought about calling a counselor.

Then one day, I happened to click through to my article on depression, written several years ago, which I’d posted recently. In the seconds between landing on that page and proceeding to another, a glimpse of the list of depression’s nine major symptoms near the top of the article turned on the lightbulb.

Well that explains it, I thought. The fatigue, the anxiety, the difficulty concentrating, the weight gain, the withdrawal from social interaction, the guilt… It was back.

I’ve battled depression off and on for the last nine years or more. I say “or more” because I never labeled it until nine years ago. But as early as junior high, and at different times throughout high school and college, I can recall crying for little or no reason, withdrawing from social interaction, or feeling apathetic, but I never talked to anyone about it.

At its most severe, when I did label it nine years ago, I cried all the way to work and all the way home, got straight into bed, cried myself to sleep, and slept until I had to get up and go to work the next morning. Wash, rinse, repeat… I can’t remember exactly how long that lasted, maybe only a week. That time I talked briefly to a physician colleague about it, who dismissed it as ambiguity: Around that time I was considering quitting my job, moving to another state and going back to college. I didn’t tell him how bad it really was, or that the deep sadness started soon after an event which proved to be my biggest heartbreak and most faith-shaking experience to date. It seemed no coincidence to me, though.

Whatever the cause, by the time I got settled in my new environment and started school, the depression dissipated. Change always puts the blues on the back burner for me.

Still, my depression has continued to come and go over the last nine years. Once, reluctantly, I took medication (Wellbutrin). My doctor “reassured” me that my body might just need the antidepressant for the rest of my life, just like it needs thyroid medication. Small comfort. After about eight months I weaned myself off. Oh, the blues still came and went, but mostly I felt okay.

So why would it come back now, when I finally have the life I’ve always dreamed of? I have the most wonderful husband. We bought a lovely home which, thanks to our generous wedding guests, actually looks put together rather than being furnished with the collection of mis-matched leftovers and yard sale pieces we had in our apartments! Moreover, I get to work my own hours at my own pace in my own space, doing something I enjoy, all while being as domestic as I want to be in our little house. I attend, and am sometimes involved in, a church I love and receive a blessing from every week. Granted, I’m still in Tennessee when a big part of me holds onto the hope of moving back to California, but eight years in one place means I finally have a fulfilling social circle and feel like I’m part of a community.

I can’t explain it, other than that according to the book Depression: The Way Out by Dr. Neil Nedley, I did almost everything wrong this summer…

Last year, in the midst of another bout of the blues, I attended Nedley’s Depression Recovery seminar and read his book cover to cover. (I highly recommend it if you battle depression.) I think a few of the things he says are his opinion (I used to attend church with this man and his family about ten years ago), but scientific research backs the vast majority of the information in his book. Determined to avoid medication if at all possible, I decided to put it to the test. (I’m not against medication in its place, but I believe that when lifestyle changes have been proven to positively impact a disease or condition, medication’s “place” is as a last resort. I want to treat the root cause, not just slap on a band-aid. Besides, medication gets expensive!)

Nedley explains that the causes of depression can be grouped into ten general “categories”:

1. Genetic: having a family history of depression
2. Developmental: a history of depression in adolescence, not being raised by both biological parents, suffering severe sexual abuse, and, for girls, starting puberty early (menstruation at age 11 or younger)
3. Nutritional: consuming a diet low in tryptophan, omega-3 fatty acids, folic acid or vitamin B12, or high in cholesterol, saturated fat and refined sugar. Also, anorexia and weight loss.
4. Social: having a lack of social support; experiencing negative, stressful life events; being in a low social class; grandparents who raise grandchildren; having an immediate family member who is an alcoholic or drug addict
5. Toxicities: lead, mercury, arsenic, bismuth or other toxins
6. Disruption of circadian rhythms: having regular insomnia; routinely sleeping more than nine hours or less than six hours per day; sleeping and eating irregularly—not being on a consistent schedule
7. Addictions: alcohol, smoking or tobacco, caffeine and illicit drugs
8. Lifestyle: lack of exercise, sunlight or fresh air
9. Medical conditions: hepatitis C, recent head injury, stroke, heart disease, terminal cancer, Parkinson’s disease, severe postpartum stress, premenstrual tension syndrome, lupus, and inadequately treated diabetes, thyroid or adrenal gland disease
10. Frontal lobe impairment: a diet low in carbohydrates or high in meat, cheese and other rich foods; regularly watching entertainment TV or movies; an addiction to “entertainment Internet” or chat rooms; undergoing hypnosis or practicing Eastern-style meditation; not enough abstract thinking; going against your conscience

Note that only two of these categories are out of our control—genetic and developmental factors; the remaining eight can largely be impacted by personal choices.
Based on Nedley’s recommendations, I developed some goals (roughly following the “Twenty-Week Cure” program outlined in Nedley’s seminar) and re-hired the life coach I’d worked with previously to keep me accountable to these new personal goals.

It worked. Within a few weeks I felt better. Normal, even. Then I got engaged and of course felt wonderful, and wedding plans consumed my life for the next seven months, pretty much crowding out all other concerns!

But this summer, the wedding receding into the past, basking in the glow of the honeymoon phase, I got careless. I stopped eating the “right” foods, and ate many of the “wrong” ones. My morning walk in the sunshine was hit or miss (partly because of a lot of rainy days). I ran out of my vitamins and supplements. Having a TV in the house for the first time in several years, I binged on it. I made my husband coffee almost every morning and had a cup or two myself.

All the wrong things, according to Nedley.

So I revisited my goals, pulled out the nerdy worksheet I put together last year, and started keeping track. I taped the worksheet to the inside of a kitchen cupboard and keep a pen handy so I can check things off as I do them each day. I know, it’s unbelievably nerdy, but it helps me stay on track.

Since the possible causes of depression are many and varied, Nedley stresses that treatment for depression must be individualized. He discusses numerous herbs, medications and lifestyle approaches in his book; those that I’ve listed below are the ones I identified as possible causes of my depression. I also have a strong family history of depression, was probably depressed in my adolescence, and started puberty on the early side—both uncontrollable factors. So while caffeine or watching lots of TV, for example, may pose no increase in the likelihood of your developing depression, they may be strong triggers for me.

Like last year, my goals, in no particular order, are to:

• Get at least 45 minutes of aerobic exercise 6 times per week. Exercise causes the brain to produce more serotonin and norepinephrine, both important neurotransmitters in the brain for alleviating depression. Duke University researchers discovered that as little as 30 minutes of aerobic exercise three times per week decreased depression as well as antidepressant medication, and better than counseling, though the results from exercise may take slightly longer to manifest than from medication. For most people, it takes a week or more of daily exercise before the depression lifts. Though results have been shown with as little as 30 minutes 3 times per week, I’ve set my goal for 45 minutes six times a week because 1) I want to get the maximum benefit, and 2) I want to improve, not just maintain, my physical fitness. Exercise also fosters deep breathing, another treatment proven to improve mental performance and mood by increasing oxygen levels in the blood.
• Take SAMe, 200-1600 mg/day. S-adenosyl-methionine is a brain chemical that occurs naturally and works to improve mood, probably by increasing the brain’s production of serotonin and norephinephrine. Studies in which SAMe was administered by injection have shown it to be very effective, though studies using oral doses have been inconclusive. Some side effects may occur, though fewer than most antidepressant medications. People with a history of mania or bipolar disorder are not advised to use SAMe.
• Take St. John’s Wort, 900 mg two to three times a day. Studies have shown that this herb, a top anti-depressant in Germany, can improve depression symptoms as much as 40-55 percent and has few side effects. It appears to work like an MAO inhibitor. It may interfere with the effectiveness of some other medications and shouldn’t be taken with antidepressants.
• Take Vitamin B12 every day. B12 deficiency is common in vegetarians, especially strict vegetarians, because unfortified plant foods don’t have B12 in them unless they are grown in soils with organic fertilizers that are very rich in B12. Nedley recommends fortified plant sources, such as dry cereals like Total, but I take a B12 supplement.
• Take Vitamin D-3, 4000 to 5000 IU per day. Nedley doesn’t discuss D-3 in his book, but I’ve heard from other sources that it is helpful to improve mood.
• Get 2 tbsp of flaxseed every day. Flaxseed is high in omega-3 fatty acids, a relatively scarce essential fat. Even a high-fat diet can be too low in omega-3 fats. The amount of omega-3 in the blood, especially in relation to omega-6, has a direct relationship with rates of depression. A low omega-3 to omega-6 ratio makes depression more likely. Fish are common sources of omega-3 fats, but because of the high rates of contamination in both fish and the water they swim in, I choose to get my omega-3s from plant sources. (Anyway, the fish get theirs from plants—seaweed!) The best plant sources of omega-3s, in order highest to lowest, are flaxseed oil, English walnuts, canola oil, black walnuts, wheat germ oil, soybean oil and soybeans. I prefer to eat flaxseed (ground, because the body digests it better than whole) or soybeans rather than the oils because of the high concentration of calories in any kind of oil.
• Eat 1-2 servings per day of foods high in tryptophan. Tryptophan must be present in order for the brain to make serotonin. For maximum serotonin production, it’s also important to avoid foods (such as meat and dairy products) that are high in certain amino acids which block the flow of tryptophan to the brain. The best sources of tryptophan, in order highest to lowest are tofu, pumpkin seeds, gluten flour, sesame seeds, almonds, black walnuts and black-eyed peas. (Based on some research and personal experience, I recommend tofu in moderation because of the phytoestrogens it contains.)
• Eat 1 serving per day of foods high in folic acid. A folic acid deficiency has been shown to be a direct cause of depression, though this deficiency is much more common in people who eat meat than in vegetarians. People whose depression is caused by a folate deficiency don’t usually respond at all to antidepressants. The best sources of folic acid, in order highest to lowest, are chickpeas (garbanzo beans), black-eyed peas, lentils and red kidney beans.
• Limit my refined sugar intake to once or twice a week. Large amounts of refined carbohydrates appear to impair frontal lobe function. On the other hand, a low-protein, high-complex carbohydrate diet intake can increase serotonin production—in other words, a plant-based diet high in vegetables, fruits and whole grains as close to their most natural state as possible. (Funny, that sounds familiar… Isn’t that the eating style also proven to promote weight loss, reverse heart disease and type 2 diabetes and reduce the risk of cancer??)
• Limit my intake of foods high in saturated fat to once or twice a week. Certain amino acids found in meat and dairy products block the flow of tryptophan to the brain.
• Limit my caffeine intake to once or twice a week. Caffeine elevates stress hormones, and a strong correlation exists between stress/anxiety and depression. Also, caffeine decreases blood flow to the frontal lobe of the brain. Women appear to have a higher risk than men of developing depression as a result of heavy caffeine use. Another reason to limit caffeine intake is its addictive properties. I love coffee, but I never want to get to a point that I feel like I have to have caffeine in order to function. Nedley, of course, strongly recommends eliminating caffeine entirely; I’ve chosen to allow for a small amount because I enjoy the taste of coffee and the morning ritual of making and drinking a cup with my husband.
• Get up at the same time every weekday, and no more than an hour later on the weekends. The disruption of circadian rhythms has a direct impact on depression. Getting plenty of restful sleep is essential for combating depression, yet sometimes the depression itself can lead to sleep disturbances. Thankfully, some of the other lifestyle treatments for depression can also impact insomnia—regular exercise; daily exposure to sunlight, especially in the morning; even dietary changes.
• Get 30 minutes per day of sunlight, preferably within the first hour of sunrise. Sunlight increases serotonin production during the day, treating depression and fatigue, and melatonin levels at night, allowing for more restful sleep. Exposure to bright light for 30 minutes per day has been used to successfully treat Seasonal Affective Disorder (SAD), a condition with identical symptoms to depression which commonly affects people who live in places like Scandinavia and Alaska where the winters are long and dark. For depression, the best light therapy is outdoors in the morning within 30 minutes of sunrise, but afternoon or evening sunlight is better than none at all. Another alternative is a therapeutic light box that can be used indoors. In any method, only the eyes must be exposed to the light.
• Spend 30 minutes per week, or one hour every other week, just listening to classical music, keeping my imagination active, and thinking about an area of concern in my life. In one study, individuals who listened to the music of classical composers such as Bach and Brahms while thinking of one to three areas of concern in their lives, discussed with a therapist the images that came to their minds while listening to the music. They subsequently experienced a significant drop in their stress hormone levels, improvement in mood and energy, and decreased depression. Interestingly, only traditional classical music has been shown to improve mental health both subjectively and objectively. I’ve read somewhere else that classical music stimulates creativity, so I’ve developed a personal, un-tested theory that this exercise can help you solve some of your most troubling problems by stimulating your creativity while you’re pondering the problem!
• Spend time in prayer and Bible reading every day. Unfortunately, being “religious” or “spiritual” does not immunize an individual from depression. If you are a Christian experiencing major depression, don’t let anyone make you feel guilty by implying you’re not a good enough Christian. (Consider the lives of some of the Bible’s major characters such as Job, David, Solomon or Jeremiah, all of whom struggled with depression!) Still, studies have shown that strong religious faith can help to both treat and prevent depression. Duke University researchers demonstrated that people with an intrinsic religious experience tend to recover from depression more quickly than those without a religious experience. Going to church is a good start, but the experience must be deeper and more personal than simply outward behaviors. If you are new to prayer and Bible study, try reading and contemplating one of Proverbs’ 31 chapters each day of the month.
• And finally, track how much time I spend watching TV/movies. This is something I’d like to do more research on (or maybe I don’t…). Nedley references some studies which show that the rapid scene changes typical of entertainment TV and movies suppress frontal lobe function, which in turn could enhance susceptibility to depression. I’d just as soon not have a TV, but since we do, and I do enjoy watching movies and certain shows, and they’re mostly available online anyway, I’ve chosen for now simply to track how much I’m watching and see if I notice a correlation in how I feel.

Luckily, I already make exercise and healthy eating a priority; some of those high-tryptophan and high-folic acid foods are among my favorites; I developed an appreciation for classical music a long time ago; and I already have a personal spiritual experience, so these goals require a relatively subtle lifestyle change for me. But others are harder—I love coffee, sweets, and cheese; it’s hard to rationalize 30 minutes a week to sit and “do nothing” while listening to classical music; it’s a challenge to go to bed and get up at the same time every day. And despite my personal connection with God, it even takes discipline to spend time praying and studying the Bible on a regular basis.

I know for other people these kinds of goals would mean a drastic lifestyle change. The toughest part about depression is that while you must take action to feel better, you have very little energy to do so! I know, I’ve been there. But in my experience, taking even a small step towards recovery, whether it be going to talk to a counselor, getting out there and exercising, or checking things off on my nerdy tracking worksheet, has always made me feel better. If this list of “lifestyle remedies” seems daunting, pick one and work on it for a week or two. Then pick another one or two and work on those. Start with what feels doable. As the saying goes, you can eat a whole elephant if you do it just one bite at a time.

Do I follow my self-prescribed depression recovery program perfectly? No. And yet within 4 or 5 weeks this fall, I felt noticeably better again. Normal again. I still have down days, or more often just down parts-of-days, but the trend now is normal rather than depressed.

When I realized a couple of months ago that my depression had come back and decided I needed to resume my “program,” I resigned myself to the fact that this is just going to have to be a way of life for me. Perhaps I’ll have more “acute” phases and have to follow these recommendations to the letter, but likely there will be less acute phases during which I can slack off a bit. And I’m sure I will. Because I’m human. And I like cheese, and sugar, and coffee, and TV, and movies, and music other than classical, and staying up late and sleeping in…

I hope reading about my journey helps you in some small way. My point is, if you struggle with depression, you can feel normal again too. I hope you do, soon.

This article and the “remedies” described herein are not intended to replace medical treatment. If you suffer from major depression, consult with your physician immediately and get on a treatment program that’s right for you.