“I’m Going To Die”
I thought as I stared out the window of my lonely hospital room.
I was in disbelief as I stared at the tube in my arm. It reached into my left heart ventricle “because the medicine is too harsh for the smaller veins” the doctor had said.
My heart skipped a beat, a cold sweat broke out and a shock of panic set in. If they think this extreme treatment is necessary, I must be in trouble.
I was about to start a treatment to fight a deadly infection that had a 30% chance of killing me.
Only days before this everything had been fine.
But then it happened, the email that would change my life forever.
It was from my doctor, and it was bad news.
The kind that had a good chance of ending my life, at only 23.
But I’m getting a bit ahead of myself.
Let me first introduce myself.
For those who haven’t read my story. My name is Jono (Australian for Jonathan) and I’m a certified nutritionist, author and medical researcher.
I’m also alive and well despite being told that I probably wouldn’t make it to my 5th birthday.
I have a life-threatening genetic condition that affects the lungs and pancreas. It’s a condition called Cystic Fibrosis, and it’s devastating. It’s incurable and results in death 100% of the time – life expectancy when I was born was less than 10 years.
Cystic Fibrosis means the lungs can’t fight infection, so from day one, the lungs get colonised with deadly bacteria and despite being put on harsh antibiotics permanently, the infection sets in and gradually destroys your lungs. You eventually end up on oxygen permanently and can’t walk to the bathroom without losing your breath. Death follows soon after. I lost a good friend this way recently.
I’m 29 right now and as healthy as a normal person.
I owe my health to my parents who spent the first 10 years of my life reading every book, consulting every doctor and studying every journal article they could find. All to give me a bit more of an edge over my condition.
And what they did worked. I still need to eat well, exercise and inhale medication every day, but apart from that, I’m pretty normal.
So this is the environment I grew up in. I was taught from an early age how anything is possible (hey, I’m proof!), and more importantly, I was instilled with a passion and drive to learn all I could about how the body works, and how to fix things when they go wrong.
So from an early age, I took over from my parents and started researching myself. Finding anything and everything that could not only help me fight my disease, but help other people do the same.
By the age of 25, I had already written 2 books on health and nutrition.
I realise now that all of this research was a way for me to prepare for not if, but when my condition turned on me. When it tried to kill me.
I was arming myself with as much ammunition as I could because when my illness decided to turn on me I wanted to be ready for it.
And my illness did turn on me.
But more on that a bit later.
From a lifetime of fighting a life-threatening condition, and thousands of hours of research, I’ve learned a thing or two about disease.
And this knowledge has served me well a number of times. One of which was when I was diagnosed with severe clinical depression. After 2 years of struggling I managed to successfully find the root cause of my depression and recover in less than 2 weeks.
I know how that sounds, but believe it or not, it’s completely true.
Everything I learned on my journey to recovery is in this article, and I wrote it because I want you or your loved one to beat depression like I did. Depression is the single worst thing I’ve ever had to deal with, and as you can probably tell, I’ve been through quite a bit.
So this article was written for you if a) you suffer from depression yourself, or b) you have a loved one that suffers from depression.
This guide took me almost a year to write, I read dozens of books, interviewed a number of researchers, and I’ve referenced more than 330 scientific journal articles. All to help you beat depression for good. If you give this guide the attention it deserves, and you may just find the answers you’ve been looking for.
This is what we’ll be covering:
- What depression is: all in the head, or a “chemical imbalance”?
- The 5 sources of depression – you’ve probably never heard of most of these.
- The two drivers of depression you need to fix to recover.
- The 21 scientifically-backed ways to beat depression without drugs:
- How “shocking” your body is a “rapid-acting antidepressant treatment with a prolonged therapeutic benefit” according to one study.
- The little-known treatment that can eradicate depression in 60% of people in less than 2 days. It has over 80 studies behind it and yet it’s unheard of.
- The 4 vital micronutrients that your brain is starved for.
- The circadian rhythm hack that has a 68% remission rate in studies.
- How I removed this one “healthy” ingredient and fixed my depression in 2 weeks.
- The 4 herbs that are more effective than antidepressants in studies.
- Why your doctor hasn’t told you about this.
- And much more.
For the sake of brevity I’ve focused mostly on major depression. The other forms of depression have more in common than not so will likely still benefit from these solutions.
But before I get that I need to finish my story. And while it’s hard for me to share, it’s absolutely necessary for you to hear, because it has a lot to do with how you can fix your depression.
I’ll rewind to before I found myself in the hospital.
How I Almost Died
5th March 2012 (1 week before).
“Jonathan, can you call me ASAP?”
My heart skipped a beat. A shock of fear gripped me, pulsing up my body. Like how you feel when you see police lights behind you.
“Something is wrong,” I thought. It was an email from my doctor.
The week before I had flown to London from my home in Australia, I was going to get a job in Europe.
Up until now, my health had been fine, but that email was about to change everything.
“Jonathan, you’ve cultured a very dangerous bacteria”
I had done a routine test before I left, and it came up positive for Burkholderia cepacia. A bacteria that had a 30% chance of killing me in a matter of weeks.
“You’ll have to return to Australia immediately so we can treat you.”
I booked the next available flight and headed home.
So there I was, 36 hours later, all alone and staring out my hospital window.
It was then that it finally hit me.
My worst nightmare was coming true. I had played out my death a million times, and now it was coming true. It had always been a possibility, but now it was very likely.
“I’m going to die,” I thought to myself.
So there I was, convinced I was going to die.
No more fun nights out with friends, no more random road trips, no more surfing. No more time to love, to travel, to experience all that life has to offer.
I wasn’t ready for it all to end, not at 23. It just wasn’t fair.
And so there I was, lonely and deeply sad. I’d hit rock bottom.
The despair that I felt is indescribable. To think that my life was about to be claimed by this horrible disease was always my biggest fear. But I’ve always blown it off, thinking it won’t happen to me.
But there I was, convinced I was going to die.
And so this was my mindset at the time. This is what I thought was going to happen to me. I faced my mortality, and it sucked. Big time.
That was 5 years ago, and thankfully, defying the odds once more, I came out unscathed. I’ll get to what happened a bit later.
So you might be wondering why I’m telling you this story, it doesn’t seem to have anything to do with clinical depression after all.
Well, it will all become clear very soon. But before we get to that I need to rewind even more:
My Experience With Depression
June 2010 (about 2 years before)
‘You’re worthless you know that right? No-one loves you, why don’t you just kill yourself?”
“Life is just pain; there’s no point in living anyway. It would be so easy to end it all. Just do it already. Everyone wants you to do it.”
I heard these things said about me and I’m not going to lie, it hurt. I just wanted to curl up in a ball and cry.
But these things that were being said to me constantly, these things that rocked me to my core weren’t the cruel taunts of a bully or the heartless words of an enemy.
These things that were being said about me were from my biggest ally in this world…
There’s nothing scarier than the thoughts of someone with depression.
It’s a dark and horrible place, where happiness and positivity are drowned out, and only dark and negative thoughts are allowed to exist. The brain simply doesn’t allow anything other than soul-crushing torment directed at your greatest insecurities.
It makes you feel unloved, insecure and hopeless.
You have no idea why you’re talking to yourself like this. You blame yourself though. After all, everything is your fault. You’re just a worthless piece of shit, and you deserve this.
People who have never experienced depression think of depression as deep sadness.
But depression isn’t sadness
Depression is to have your mind turn against you. To lie to you and tell you that you’re not okay, that you’re unwanted and have no value to anyone. That no one loves you and that you’re worthless. These thoughts hurt a million times more than if someone else told you these things.
Because what depression tells you, you believe.
Because depression talks through you. It wears you like a puppet and becomes you, as though it’s you talking to yourself. It penetrates to the very depths of your soul and becomes your reality.
No matter how untrue it is.
What makes you, you has been stolen away by depression. Replaced by someone you don’t recognise. Who thinks and acts the way you never would.
But it’s still you, isn’t it?
But, what you don’t know, and couldn’t possibly know, is that these thoughts and feelings you have, aren’t you. They’re not in your control. They are summoned by a brain in distress.
Depression isn’t caused by your thoughts turning dark. Studies have shown depression causes your thoughts to turn dark.
Depression isn’t sadness.
You keep trying to turn your thoughts happy, “to see the positive side of things” or to “snap out of it”, but your brain won’t let you. It’s as though your thoughts are a needle on a compass, but a magnet has been haphazardly placed next to it. You try as hard as you can, you think positive thoughts, you poke holes in the logic of what you tell yourself.
But each time you try to do this, it holds firm, and you go back to choking darkness.
That magnet is holding strong. Nothing you’ve got inside you is strong enough to swing that compass needle back to even neutral, you can push against it with all your strength, with all your might, but it’ll swing right back, and you’ll be back at square one. But this time exhausted and discouraged.
Until you give up.
Until you start to consider killing yourself. Maybe you even fantasise about the way you’d do it.
So that you can escape the pain.
It would be so easy, just a swerve of your car or swallowing a bottle of sleeping pills. Then it would all be over. You could finally be at peace and free from your constantly tormenting mind.
Sometimes this pain is so bad people actually cut themselves for an endorphin hit and a slight reprieve from their depression.
This is depression. This is darkness where no light can find you.
Normal sadness is a fender bender; depression is a 5 car pile-up.
Depression isn’t sadness.
But my depression wasn’t always this unrelenting darkness.
My depression was strange. It was on a cycle from happy to depressed. I would be going about my day, as happy as I normally am, then all of a sudden I’d feel a bit of sadness. There would be no reason for the sadness. It wouldn’t be triggered by a thought I’d had or something that happened in my life. It wasn’t caused by my health condition, as I was as healthy as I’ve ever been.
The sudden “attack” of sadness would come out of nowhere.
Then I’d feel a bit sadder, then a bit more.
I’d spiral down like this until my world became dark. Like a dark filter was put over the lens of my consciousness.
Then the dark thoughts would come. Engulfing me completely.
But the strange thing was, while this depression episode hit me so suddenly, it would go away just as quickly.
It’s a difficult thing to describe, but I’d actually “feel” it dissipating in my brain.
And just like with the depression “episode”, this recovery would have no reason behind it, no thought or event. I would just start to feel a bit happier. Bit by bit.
Until I was back to normal again; back to being happy and content.
The whole episode would only last 5-6 hours. But it would feel like an eternity.
What’s more, I’d look at my thoughts from only a few hours ago, and the evidence in opposition would stand out clear as daylight.
“I’m not worthless” I’d say to myself. Knowing with every fibre of my being that I wasn’t. “Why did I believe all of this stuff?!” this isn’t me, or the truth.
These are lies.
It’s as though I’d spent the last several hours on a “depression” drug.
Depression isn’t sadness.
I’ve been through a lot in my lifetime, constantly worrying about whether I’ll be dead in the next 5 years, fighting every minute of every day just to stay healthy and stave off death.
Even though I’ve had a lifetime of that, depression is still the worst thing I’ve ever been through.
And that includes that day I thought I was going to die in that lonely hospital room.
And now we get to the reason I’m telling you these two stories…
Because it has since become clear to me that:
A day of depression is far worse than a day of believing you’re going to die.
I’d gladly live 10 days of “knowing” I was going to die, than a single day of depression.
So when I was sitting in that hospital room convinced I was going to die, I was beside myself with grief. But I didn’t lose hope; I didn’t feel unloved, worthless or alone.
I definitely didn’t want to kill myself. In fact, I was sad because I wanted to live. I didn’t wish for my death with all my heart, as I did when I had depression.
I grieved, and that brought relief. It felt good. A beautiful sadness.
A sadness born of love for my life.
And this sadness wasn’t depression.
Depression isn’t sadness.
I’ve always considered myself a strong person, I’ve had a lifetime of training for bad events. But my defences were nothing against depression.
So I wrote this article because I successfully beat my depression, and it pains me to know there are millions of people out there right now still struggling. So the rest of this article deals with how you can fix your depression, much like I did.
IMPORTANT: A Note on the Rest of This Article
To make the rest of this article as easy to read as possible I’ve split it into expandable sections; I’ve done this because of the large amount of information that follows. You’ll see the headline and a summary section with bullet points of what I discuss in that section. If you’re interested you can click on the “Expand section…” and it will expand to provide more information.
I’ve done this so you can digest the whole article as quickly as possible, or if you’re interested, go more in-depth.
Additionally, I’ve provided the below table of contents if you’d like to skip to a particular section.
Table of Contents
What is Depression?
• Depression on the Rise
• The Root Dysfunction of Depression
• Inflammation and Depression
• Micronutrients and Depression
5 Ways Depression is Caused
• Psychological Factors
• Circadian Rhythm
• The Gut
Why Hasn’t My Doctor Told Me About This?
• Drug Money
• Problems in the Doctor’s Office
• Antidepressants Mostly Don’t Work
• Side Effects
20 Ways to Kick Depression in the Balls:
Fix Nutritional Deficiencies
• Omega 3
• Vitamin D
Fix Your Circadian Rhythm
• Light Therapy
• Wake Therapy
• Curcumin, Saffron, St. John’s Wort, Kava, L-Theanine, Folate, Phosphatidylserine
• Curcumin, Saffron, St. John’s Wort, Kava, L-Theanine, Folate, Phosphatidylserine
• Magic Mushrooms
Other Useful Therapies
• Heat Therapy
• General Tips
Using Placebo Power to Treat Yourself
Putting it all Together + Beating Low Motivation
• Helping a Loved One with Depression
• Final Remarks
• What to do now
You are Supposed to be HappyExpand section…
When I was sitting in that hospital room, confronting my mortality, I was deeply sad. I was distraught, and I grieved. My grief consoled me; it helped me to come to terms with my situation. Because grief is a tool that helps us come to terms with bad things like that.
Natural human emotions like sadness, anger, happiness and love, are there to serve a purpose. Fear prepares us for a fight or flight situation when we’re in danger. Anger prepares us for a fight if we need to defend ourselves. Happiness is there to help us seek out things that are good for us as individuals. Love is there to bond us to others.
All of these help us navigate our surroundings and help us survive and reproduce. Evolution has instilled these emotions in us for a very good reason.
Sadness is a natural part of life as well; it’s there to help us avoid things that are bad for us and helps us deal with sad events in our lives, like a death of a loved one, or a bad breakup.
But depression isn’t an emotion.
Depression isn’t sadness.
Depression isn’t a natural state.
Each of us has an average level of happiness, a happiness set-point, that we hold throughout each day-to-day. We experience good and bad things but our mind always comes back to this set point of happiness (1). Research has shown that even when faced with extremes of positive or negative (winning the lottery or having a spinal cord injury), happiness levels returned to their original baseline after a short adjustment period.
The mind, therefore, is designed to return us to contentment shortly after a positive or negative event. No matter what euphoric or depressing event happens in our lives.
The reasoning for this in an evolutionary context is clear; a euphoric human is not going to be very interested or motivated to seek things that would increase the chance of survival like food, shelter and sex (they’re euphoric, so don’t want anything else); whereas a depressed human isn’t going to be interested in doing anything at all.
So the healthy human is happy but not euphoric. Content; but with room for improvement.
In depression, this doesn’t happen. The happiness level drops off substantially and never recovers.
Your Reason To Be Depressed
Depression is cruel. Instead of grieving normally, it drives a stake through this process and makes us focus on one thing in particular; often a stressful event that initially led to our depression. So if your depression has an underlying reason then it’s the depression and not the event that is causing you to feel this way.
Fix your depression, and you’ll get back to normal.
• Sadness is a tool that humans use to grieve. However, depression isn’t sadness and is a sign that this function is broken.
• We all have an average level of happiness that we return to after positive and negative events. If we fail to return to this happiness level after a traumatic or stressful event, then this is depression.
• Depression often makes us focus on a particular event or situation, but this isn’t causing your sadness, your depression is.
What is Depression?Expand section…
Depression is a physical disease like cancer or diabetes. It’s the result of a physically altered brain.
We know this for a few reasons:
Depression, the Physically Changed Brain
Reason 1: The brain is different in people with depression. One study found significant differences in white matter (3). A number of other studies have found differences in other areas as well (4, 5, 6, 7). One study showed these changes were less in depressed patients who had recovered than those that still had depression (8).
Reason 2: Depression affects the whole body and not just the mind. Symptoms like (9): indigestion, stomach cramps, impaired cognitive function, headaches, frequent urination, backaches and muscle aches are all common in people with depression.
Reason 3: Having depression increases your risk of a number of other diseases such as stroke (10), coronary artery disease (11), low bone density (12), cancer (13) and several others (14, 15, 16, 17, 18, 19). Indicating a common physical cause.
Reason 4: Scientists can cause depression by depriving the brain of certain micronutrients (20) or inducing inflammation (21, 22). While certain physical compounds can reverse this (23).
Reason 5: Physiological measures such as inflammatory markers (24, 25), vitamin (26), mineral (20), fatty acids levels (27, 28) and gut bacteria (29) are all elevated or abnormal in depressed individuals.
There are many more reasons but let’s leave it at that. Depression is a physical disease like cancer or diabetes.
But while the cancer and diabetes are physical diseases, depression is influenced heavily by psychology, which can often be the cause of this physical change.
Mental illness is the result of a person’s thoughts, feelings and thinking patterns interplaying with the brain’s physical state.
It’s the physical AND the mental interacting. The physical can influence the mental, and the mental can influence the physical. It’s a circular effect.
To give you a better idea of what I mean, when healthy people are infused with an inflammatory agent the result is depression in up to 70% of people (21, 22, 30).
Depression then turns these people’s thoughts negative. This is the physical side directing the mental side.
The physical can also fix the mental. When people fix their depression via a physical compound like antidepressants they inevitably no longer have dark thoughts (31, 32).
The physical side is directing the mental side once again.
On the other hand, the mental side has a tremendous effect on the physical side. As an example, stress, the largest predictor of depression (33), increases inflammation in the brain (34). This leads to depression symptoms by interfering with neurotransmitters (more on that later).
So stress leads to inflammation which leads to depression. The mental side is directing the physical side once again.
So the takeaway here is that your thoughts, feelings and thinking patterns can influence the physical make-up of the brain, and the physical make-up of the brain can influence your thoughts, feelings and thinking patterns.
It’s counterintuitive so reread that line until it makes sense. It’s important for the rest of this article.
• Multiple lines of evidence prove depression is the result of a physically altered brain.
• The mind can influence the brain, and the brain can influence the mind.
• Depression can result from our thoughts directing our physical brain, or depression can direct our thoughts as a result of our physically changed brain.
Depression on the RiseExpand section…
So we now know what depression is.
What’s causing depression though?
According to the CDC 9% of the US population (~29 million people) and 350 million people worldwide have depression and it’s only getting worse (35).
But it wasn’t always like this.
Rates of depression are 5 times higher now compared to just 70 years ago (36).
Why the dramatic increase?
There are two common arguments put forward, one to do with increased awareness and acceptance of depression (people are more likely to seek help and feel less stigmatised), and another to do with more professionals treating and, arguably, over-diagnosing depression. These two arguments are put forward as explaining the increase in depression diagnosis, thereby suggesting that depression isn’t actually more common now than 70 years ago.
And indeed this does make sense, but is this supported by the evidence? Let’s take a further look.
While there have been numerous studies looking into this increase many suffer from significant flaws such as relying on one’s memory of depression earlier in life (which has been shown as inaccurate).
What we need is a study that looked at two groups of people, who did the same psychological test, just at different times in history. This takes care of both the awareness issue and diagnosis issue, as these are objective tests that bypass these two issues.
This is exactly what one study did between 1938 and 2007 (36a). High school and college students completed an intensive 500+ question survey designed to analyse their psychological health. The questions were asked in such a way as to avoid the bias of stigmatisation of their mental state.
This survey was done by students in 1938 and every year until the study was published in 2007. The results show that there has indeed been a more than 5 times increase in depression in the last 70 years. So this proves that depression is indeed on the rise and not merely from increased awareness and diagnosis. Two other studies of similar design have found comparable increases (36b, 36c).
So the obvious question now is if the rapid increase in depression isn’t from an increase in awareness and diagnosis, then what is causing it?
We could look at genetics, but since this rapid increase has happened in the span of 1-2 generations, this can’t be the cause.
We could also look at how much harder life is now than back then, like how the media bombard us about how we should act, feel and look. But I think people tend to forget how hard life was 70 years ago. Even if it is the case that life is harder now, this can’t explain a 5 times increase.
What has changed dramatically in the last 70 years, and what fits in nicely with depression being a physical disease, is our diet, exercise levels, working environments and the artificial lights we’re bombarded with constantly (more on that soon). These are all completely different to 70 years ago.
We will see shortly that it’s these factors that are driving depression, and this is where the secret to treating depression lies. But before we get to them, we need to be reminded of what the underlying cause of depression is.
• Depression is 5 times more common now than 70 years ago, and this rise cannot be explained by an increase in awareness and diagnosis.
• This rise is mirrored by our radically changed diet and lifestyle.
The Root Dysfunction of DepressionExpand section…
Depression is a complex disease, and there’s no consensus on the exact mechanism by which depression works.
We do know that it has something to do with a malfunctioning in our neurotransmitters.
Neurotransmitters are chemical messengers that send information between synapses in the brain. You’ve probably heard of serotonin, which is thought to be responsible for maintaining mood balance, but there are several others like dopamine, norepinephrine, GABA and epinephrine.
Impaired neurotransmitters can lead to depression (38). Serotonin, for instance, is derived from the amino acid tryptophan. Researchers can stimulate a depressive episode by depriving someone of tryptophan (and therefore serotonin) (39). So serotonin in particular is very important for mood levels.
Depression can also be stimulated by inducing inflammation in the brain, which interferes with neurotransmitter function.
Various things like genetics, social stress and environment have a great deal of influence on neurotransmitters, serotonin in particular.
So we know that these neurotransmitters are implicated in depression. Let’s look at what affects these neurotransmitters.
• Depression at its core is a dysfunction in the neurotransmitters in the brain, particularly serotonin, which is responsible for maintaining mood balance.
Inflammation and DepressionExpand section…
Inflammation is one of the key drivers of diseases like heart disease, cancer and diabetes (41) and depression is no exception (42, 43).
Inflammation is a response by the immune system to help us heal when we experience trauma (like breaking an ankle) or fighting an invader, but when the body’s inflammatory reaction happens at inappropriate times, things can get bad, quickly.
Depression and inflammation of the brain are intimately linked. For instance, people with depression are at a greater risk of many other inflammatory diseases like stroke (10), coronary artery disease (11), type 2 diabetes (15) and several others (14, 16, 17, 18).
On the other hand, people with inflammatory diseases are also at a higher risk of depression (44).
In fact, when researchers looked at inflammatory markers and depression, they found that for every standard deviation increase in inflammation they had, there was a 44% increase in risk of depression (45). Inflammatory markers even increase during a depressive episode and drop to normal levels once remission is achieved (46).
When healthy people are injected with inflammatory compounds, it causes depressive symptoms in up to 70% of patients (21, 22, 47). Interestingly, the anti-inflammatory fatty acid EPA (omega 3) has been shown to drastically mitigate the effect of these inflammatory effects and its effects on mood (23). Indeed, several studies have shown that anti-inflammatory therapies led to significant reductions in depression symptoms (48).
Social stress, as we’ll see later, is the number one predictor of depression, and it increases inflammation, which leads to depression (49).
So from the above, there’s very little doubt depression has a very strong inflammatory component to it.
But how does inflammation cause depression?
Firstly, it interferes with neurotransmitter metabolism, such as serotonin, dopamine and glutamate by altering how they are created, released and recycled in the brain (50, 51). Secondly, inflammation depletes tryptophan, making it less available to be converted into serotonin (52). Thirdly, inflammation creates compounds in the brain called neuroactive metabolites that can significantly influence the regulation of dopamine and glutamate (51).
So depression and inflammation are intimately linked. And indeed most of the treatments in this article treat depression by lowering inflammation.
• Inflammation of the brain is a significant driver of depression through its effects on neurotransmitters.
• Inflammation is higher in depressed people and can cause depression in healthy people.
• Anti-inflammatories can reverse depression.
Micronutrients and DepressionExpand section…
Neurotransmitters rely on a whole host of different minerals, vitamins and fatty acids to be produced and used effectively.
The most obvious one is tryptophan, which is converted to serotonin. Magnesium is needed for the synthesis of serotonin in the brain (53) whereas omega 3’s and vitamin D act as controllers of serotonin release (54).
So without these important micronutrients (and more that will be discussed later), the body can’t digest, absorb and use tryptophan. Tryptophan can’t be efficiently converted to serotonin, and once converted it can’t be used by the brain properly.
So you can see what a huge impact being deficient in any of the above would have on the brain.
Interestingly enough, many of these micronutrients are also needed by the body to control inflammation.
An example of this is magnesium. When researchers feed a low-magnesium diet to rats, their inflammation markers sky rocket (55). We see the same in humans where low magnesium is associated with increases in inflammation (56).
This article focuses on diminishing inflammation and improving micronutrient levels to fix the underlying causes of depression (neurotransmitter dysfunction).
• Various micronutrients are needed to produce and use neurotransmitters and these being deficient can lead to depression.
• Certain micronutrients help to keep inflammation down.
5 Ways Depression is Caused
Or: Causes Of Inflammation and Micronutrient Deficiencies
So we know the root cause of depression is impaired neurotransmitters, and that lack of proper micronutrients and inflammation can be behind those. But what causes inflammation and lack of micronutrients?
Cause 1: StressExpand section…
The strongest predictor of depression is by far a stressful or traumatic event (57). A loss of a job, a bad breakup, the death of a loved one, abusive relationships, being bullied, serious trauma like rape, abuse, neglect, or social isolation are all common triggers of depression. It doesn’t matter if it’s a once off event or ongoing, both are equally devastating. These events happening early in life are of particular risk for depression.
So what’s happening to the brain in these stressful events? And how does this lead to depression?
The brain is set up to be able to handle stressful events, and a whole cascade of biological processes are at play when these events happen; all designed to bring us back to normal again. In depression, however, these processes become overwhelmed and stop working the way they should (58, 59).
We see that the brain’s ability to produce neurotransmitters is reduced when stressed. In studies, when rats are exposed to stressful events they exhibit depressive-like behaviours (less social, preferring dark places, giving up easier when physically challenged). When researchers looked at their brains, they found that, even after 3 months, the neurotransmitters dopamine and serotonin were significantly reduced (60).
One of the biggest issues in depression is that the stress response is extremely sensitive and leads to an exaggerated response.
Let’s take a look at our two culprits behind why stress leads to depression. First, we’ll look at inflammation.
Inflammation and The Stress Response
First of all, psychological stress increases inflammation significantly as well as inhibiting the body’s ability to produce anti-inflammatory compounds to settle things down again (61, 62, 63). This leads to depression in some people (64). In studies, stress-induced inflammation has been shown to drive depressive symptoms like poor mood, fatigue and withdrawal from social situations (65).
Interestingly, when depressed people experience a stressful event, their inflammatory markers increase far more than when non-depressed people experience the same event. (66). Same stress, but a higher inflammatory response.
So the stress response is overactive in depression.
One of the biggest predictors of depression is childhood adversity or trauma (like maltreatment, abuse, social isolation). When researchers look at adults who experienced adversity or trauma as children, they discover that they experience a far greater increase in inflammation to a stressful event than healthy controls (67). They are also twice as likely to suffer from chronic inflammation in adulthood (68). It’s this increase that leads to depression (69).
In a study of 1000 New Zealand adults who experienced childhood stress, they found significantly higher levels of inflammation and depression (70).
Another study observed 147 females with a high risk of depression from either family history of depression or childhood adversity (71). They tracked who had depressive episodes and who didn’t during the 2.5 years the study took place. They found that those with childhood adversity had an greater inflammatory response than those with a family history of depression.
So it seems that the inflammatory response to stress is much higher in people with childhood adversity and that this makes them more likely to get depression.
Approximately 60% of those that have 1 depressive experience will have a second one, 70% of those will have a 3rd, and 90% of those will have a 4th depressive experience (72). This is because the level of stress needed to elicit an inflammatory response decreases over time when you have depression (73).
But what’s even more interesting is that these stressful events can cause the first or second depressive episode, but after that it’s common for depression to develop without any trigger at all (74, 75). Or even following events that are positive but emotionally intense (like having a baby or getting married).
Micronutrients and The Stress Response
What about micronutrients, what do they have to do with stress?
As well as stress driving inflammation, stress just so happens to increase the nutrient demands on the body (76, 80). If these nutrients aren’t replenished through a nutrient dense diet, then the brain is going to have a hard time keeping mood stable.
It gets worse though.
Because certain nutrients like omega 3’s, B vitamins and some minerals are also needed by the body to properly deal with stress. (77, 78, 79). If these are deficient then the stress response will not work properly and drive inflammation further.
The upshot of all of this is that our nutrient deficient diets lead to us being unable to handle stress properly, and this leads to even more nutrient deficiencies, which leads to a further worsening of mood.
We really need those nutrients when we have depression, the irony, however, is that in depression we so often seek comfort foods that are devoid of nutrients, and this makes the situation much worse.
• The largest predictor of depression is stress, in particular, early life stress.
• Stress drives inflammation and depletes nutrients, which leads to depression.
• Early life stress leads to an over exaggerated response to stress later in life (more inflammation in response to a stressful event).
• Certain nutrients are needed to handle stress properly, but stress also increases the nutrient needs of the body.
If you’ve had depression, you know that it’s often very difficult to get your mind to get off a particular thought. Like a magnet next to a compass, your mind keeps going back to the thought, even when you try to distract it.
This rumination leads to more intense depressed thoughts and mood, which leads to more rumination, which leads to more depression. It’s a horrible cycle.
One study showed that when depressed people were asked to ruminate for 8 minutes about their current emotional state and personal characteristics, they became significantly more depressed compared to when they were told to distract their thoughts. What’s even more interesting however is that this was only true for depressed people. Non-depressed people had no change at all in mood levels (81).
So what’s going on in the brain?
In one study, two groups of people were put through a stressful situation, and their inflammation was measured before and after (82). But there was a catch, one group was told to ruminate on the stressful event that had just happened, and the other group was told to distract their mind.
While both groups experienced an increase in inflammation during and immediately after the stressful event, only the ruminating group sustained their inflammation throughout the 2-hour visit. This indicates that ruminating increases inflammation. Or at the very least stops it subsiding.
The part of the brain responsible for rumination is overactive in depression. This leads to increased rumination (83). Which explains the rumination -> depression cycle we just discussed.
So we see that rumination increases inflammation, and we also see that depression leads to rumination. This explains the all too common spiral in low mood when something happens.
The stressful thought, event or feeling increases inflammation, and then the depressed mind kicks in and leads to more rumination, more inflammation and more severe depression.
It’s an endless cycle and very difficult to stop.
However, there is hope. As we will discuss later on, meditation and exercise have the potential to kick your brain out of this cycle (84). We’ll see how they can help later on in the section “Rumination Breakers”.
• Rumination is the act of repetitive thinking about an event or situation.
• Rumination increases inflammation and leads to more depression.
• The brain of someone with depression is also geared to ruminate, making things worse.
Cause 2: Psychological FactorsExpand section…
Negative thought patterns (85), self-esteem (86), coping skills (87), a person’s ability to understand, use and regulate their emotions (88), certain personality types (89) and other factors all have a significant influence on how likely you are to get depression. These factors have a lot to do with how you were raised or your genes. While they can make you more likely to get depression, they won’t actually pull the trigger on it.
Think of your psychology as the force field on a space ship; it defends against stressful events in our lives. Some have a strong force field, others not so much.
However, as I found in my depression, and what we discussed earlier, these things can equally be changed by depression and not the other way around.
I haven’t spent much time on this cause, either in this section or the rest of this article. For the simple reason that it’s something that is difficult to change on your own, and the best way to go about doing that is to see a psychologist. Since I’m not one of those, I’m leaving that to the experts. However, I will say that psychological therapies can and do help many people with depression, so I recommend seeking help from one.
• A person’s psychological state can make someone more prone to depression but won’t pull the trigger.
• Depression can negatively alter someone’s psychological state.
Cause 3: Circadian RhythmExpand section…
The circadian rhythm is the biological clock that we have that synchronises our body’s different functions to each other and to the time of day. It’s like the conductor of an orchestra, keeping everything working together. The feeling of lethargy, irritability and slight disorientation from jet lag is the result of this clock being out of sync. The brain stays in sync with day time by using cues from our environment like light entering our eyes, exercise and meal timing.
Light, in particular, is the most important cue.
Especially with our sleep cycle. Light entering our eyes shuts down melatonin production in the morning, and dimming light in the evening stimulates melatonin production. Melatonin is a hormone the body uses to get us ready for sleep. Release of melatonin is one way the circadian rhythm is synchronised (90).
The circadian rhythm in depression has been consistently shown to be out of whack. To such an extent that in the scientific community, depression is known as a circadian rhythm disorder. It’s been shown that sleep, temperature, mood and hormone secretion are all altered during a depressive episode (92). Patients with seasonal affective disorder are more susceptible to circadian rhythm disturbances (93). It appears that this is one of the driving factors for depression, and explains why sleep deprivation therapy, ketamine and light therapy are so incredibly effective (more on those later) (94).
Studies done on shift workers show they are far more likely to get depression. One study showed a 263% increase for rotating night shift workers, and a 346% increase in depression for those that worked only at night (96). One study showed that even with the common 1-hour daylight savings change there was an 11% increase in hospitalisations for depression across the country after this change (97). So the circadian rhythm is pretty important for depression.
This disturbance in depression could explain the physical symptoms that so many people with depression feel, like early awakening, excess sleepiness, insomnia, restless sleep, fatigue, irritability, slowness of activity, etc. (95). These are all found in jet lag as well.
Why does the circadian rhythm have such a profound effect on depression?
It appears that disruption of the circadian rhythm alters the inflammatory response in the body, leading to higher than normal levels of inflammation (98, 99, 100). This is backed up by studies showing that shift workers are significantly more susceptible to other inflammatory diseases like diabetes and heart disease (101, 102). And when normal healthy people are put into shift work cycle, their inflammatory markers increase significantly (103).
So an impaired circadian rhythm leads to increased inflammation, which likely leads to depression. However, there’s a circular association, because it seems that inflammation can also alter the circadian rhythm significantly (104). Suggesting that inflammation from other sources (like stress) will shift our circadian rhythm, potentially worsening our depression.
Why is our circadian rhythm out of whack?
So seeing as the circadian rhythm takes its cues primarily from light entering our eyes, I’m sure you can already see why the circadian rhythm is so out of whack in this day and age. The light we have in our lives sends mixed messages to our pre-civilisation brains. When we wake up, we often stay indoors, so we avoid the bright sunlight that’s supposed to shut off melatonin (which resets the circadian rhythm), when the sun goes down we tend to watch TV or play on our phones, which directly stimulates the brain and makes it think it’s still daytime. So this is why our circadian rhythm is so out of whack.
Later on, we will see how treating depression via the circadian rhythm can lead to pretty impressive remissions in depression, and in particular bipolar disorder.
• Our circadian rhythm controls countless biological functions, including those that relate to mood regulation.
• Extensive research has shown the circadian rhythm to be out of whack in depression and is a major risk factor for depression.
• A disrupted circadian rhythm drives inflammation.
• Inflammation can also change the circadian rhythm.
• The circadian rhythm is synchronised by external cues such as meal/exercise timing and light entering our eyes. Our modern hectic lifestyle is why the rhythm is out of sync.
Cause 4: DietExpand section…
Even though diet has a profound impact on our mental health, it’s often completely ignored.
Why is diet so important in depression?
There are 3 reasons for this. The first reason is that, except for vitamin D, every nutrient our body needs can only come from our food. The modern diet is so deficient that it’s little wonder why diet is so heavily associated with depression. As an example, 95% of adults don’t get enough Vitamin D, 94% don’t get enough Vitamin E, 61% don’t get enough Magnesium and 51% don’t get enough Vitamin A (106). So the vital nutrients the brain needs to maintain mood just aren’t being provided.
The second is that our diet provides our microbiome food to live (more on that next).
The third reason is that our diet is a significant source of inflammation (107). One study, for instance, looked at the diet of 2594 patients with depression and compared them against a similar group without depression. They found that those with a more inflammatory diet were 41% more likely to be depressed than the control group (108). The inflammatory foods they tracked were things like sugar-sweetened and diet soft drinks, refined grains and margarine.
Another study looked at depression and the Western diet compared to a traditional diet. The traditional diet group had significantly lower levels of depression than the Western diet group (109). This was backed up by another study that found a 23% lower incidence of depression in the traditional diet group (110). They considered a traditional diet as one including vegetables, salads, fruits, rice, fish, wine, non-processed meats, etc. The Western diet included processed meats, pizza, salty snacks, chocolates, sugar, soft drinks margarine, etc.
Another study found a 58% increase in depression from a processed food dietary pattern compared to a whole food dietary pattern (111). Another study found a 36% increase in depression from those who ate the most fast food, relative to those who ate the least (112).
A 2009 study of 10,094 initially healthy Spanish people looked at the association between the Mediterranean diet and incidence of depression. Much like the above studies, the Mediterranean diet saw significantly fewer depressed people than the standard diet (113). A meta-analysis looking at 9 studies on depression and the Mediterranean diet found a 32% reduction in depression risk from the Mediterranean diet (114). The Mediterranean diet is known to be anti-inflammatory.
A 2014 meta-analysis took 21 studies on diet and depression and found a reduction in depression of 16% when comparing a “healthy” diet pattern to an “unhealthy” one (115). A further meta-analysis looked at depression and dietary patterns in children and adolescents, found similar results to the above (116).
And these are only the ones that looked at a dietary pattern versus depression.
There have been a few other studies looking at individual foods and depression:
In a study of over 5800 patients from the Centre for Celiac Research, 22% of those with gluten sensitivity were also symptomatic for depression; much higher than the general population. (117). This is probably due to its effects on the gut (which we will discuss soon).
In a study of over 12,000 people in Spain, those with the highest intake of trans fatty acids were 48% more likely to have depression than those with the lowest intake (118). What’s alarming about this is that in Spain, trans fatty acid intake is relatively low compared to that in the West. Spain’s intake was 0.4% of their daily calories whereas in the USA it’s as high as 2.5%!
Trans fats are highly inflammatory, so this provides a good explanation as to the reason for this increase in depression (119).
In a study looking at the habits of over 260,000 people, they looked at soft drink consumption and found a 30% increase in depression risk for soft drinks (4+ cans/cups per day vs 0) and a 51% increase for diet soft drinks (120).
A study done in my country (Australia) saw a 60% increase in depression from intakes of as little as 1.5 cans/day (121). Similar results have been shown in 2 other studies (122), including one which found a 250% increase in suicide attempts with increases in soft drink consumption (123).
This finding can be paired nicely to a study that took healthy adults and gave them different amounts of a sugar-sweetened drink over the course of 3 weeks (124). They found that inflammatory markers increased a massive 60-109%! Depending on how much they consumed.
So this explains the sugar leading to depression phenomenon. Sugar leads to inflammation, which leads to depression. We’ll see a bit later on how this happens. We’ll also see how improving the diet led to a 32% remission rate in depression!
Sugar consumption is more than 17 times higher now than it was just 100 years ago. So this is extremely likely to be a significant driver of the increase in depression in the last century.
• Extensive research shows a very strong link between diet and depression. In particular, to processed food, sugar, bad fats and inflammatory foods.
• Poor diet leads to depression in a number of ways:
o Increases inflammation
o Leads to nutrient deficiencies
o Poisons our gut bacteria
• A proper diet will:
o Be anti-inflammatory
o Provide enough nutrients for proper neurotransmitter function.
o Nourish the gut
Cause 5: The GutExpand section…
In 2016, scientists at Chongqing Medical University, in China did an interesting experiment. They decided to look at the make-up of the gut bacteria of depressed people, and compare these to non-depressed people (126). They discovered that there was a distinct make-up (strains of bacteria and proportions) that the depressed people had relative to the non-depressed. They had a “depression microbiota”.
This experiment wasn’t all that ground-breaking, after all, in depression, much like other diseases, the gut bacteria had been studied before and was found to be noticeably different from healthy people’s. What they did next was ground-breaking, however.
They took the gut bacteria from the depressed people and transplanted it into mice who had no microbiome of their own. These mice were therefore colonised with the “depression microbiota”.
It was then that something interesting happened, almost immediately the mice started to exhibit depression-like behaviour (they became less sociable, had less interest in food, preferring dark places and gave up more easily when challenged physically). These mice were given a bacterial transplant from their gut, and now they appeared to be depressed. They tried this with the microbiome of healthy humans and the resulting mice didn’t show any signs of depression at all.
This is the power of your gut microbiome.
Your Gut Microbiome and Depression
“All disease begins in the gut” – Hippocrates.
Your gut microbiome is the community of bacteria in the gut which live in a symbiotic relationship with us. We provide food and shelter, and in return, they assist us to perform a number of crucial functions like protecting us from germs, breaking down food and producing vitamins. This community is made up of more than 100 trillion bacteria divided up among 40,000 species (127, 128), this is in contrast to the 37.2 trillion cells in the human body (129). So technically we are only about a third human! These bacteria are found in the gut in such number that they weigh about as much as your brain. It’s no wonder this community has been called a “forgotten organ”.
The different strains of bacteria in our gut and the proportion of these strains depends highly on things like the food we eat, antibiotic use (especially early in life), infections and even our stress levels. This make-up of bacteria, in turn, influences our health. For better or worse.
When studies have analysed the gut microbiome in different diseases, they find significant differences compared to healthy humans; IBD (130), asthma (131), allergies (132) and eczema (133) are examples. And we saw above that depression is no exception (126).
In fact, these bacteria have so much influence on us that specific populations of bacteria can actually drive our food seeking behaviour, by stimulating food cravings for foods that they prefer (134). For instance, bacteria that thrive on sugar are actually able to stimulate sugar cravings. So the bacteria in your gut may be doing the ordering when you’re at a restaurant. Those cheeky bastards!
Stress, Depression and Your Gut
So we know that the gut in human health is very important, but what does this have to do with depression?
We know from above that the gut microbiome is significantly altered in depression (135) and when you take the gut microbiota from a depressed human, and transplant it into a germ-free mouse, the mouse exhibits depressive-like behaviours (126). The same has been found with anxiety (136).
So it seems that the species and proportions of bacteria in our gut can be shaped by our environment to a point where they resemble an “anxiety” microbiome or a “depression” microbiome.
We also know the microbiome can partially control inflammation (137). Mice with impaired gut microbiome have an increased stress response (and higher inflammation) to normal controls. This can be reversed by repopulating the gut with healthy bacteria (138).
Early life stress, as we’ve saw before, has a huge impact on risk for depression later in life. It’s been shown in mice that when they are stressed early in their life that their gut microbiome changes significantly, and that this leads to stronger reactions to stress (and increased inflammation) (139). As we saw before, early life stress very often leads to an impaired stress response later in life; this could be one of the reasons why this happens.
Stress in older animals leads to alterations in the gut microbiome as well (140) but this can actually be reversed with probiotics (141).
So we see that the gut is an important factor in how we handle stress. A healthy gut bacteria will reduce the stress response, and unhealthy gut bacteria will increase the stress response. And as you’ll remember, stress is a big driver of depression through inflammation.
Now, on to inflammation.
Your Gut and Inflammation
One of the roles of the gut microbiome is to provide a barrier in the gut to the blood stream. Without it, foreign invaders can penetrate the gut wall and get into the blood stream. This is known as “leaky gut” and the result is the body mounts an immune response (inflammation) against the invader (142). It has been shown that stress leads to this barrier becoming more permeable (143). Explaining the 35% prevalence of leaky gut in people with depression (144). The permeated gut drives inflammation. Different foods and nutrients have also been shown to increase intestinal permeability (144b), interestingly, zinc can actually help maintain it (224).
One study found that 37% of people with irritable bowel disorder had depression, representing an increase in depression of 530% compared to healthy people (145). Inflammatory markers were shown to be more than 4 times higher in those with IBS in one study (146). Studies have shown that anywhere between 10-15 % of the US population has IBS (147).
Gut and Micronutrients
When scientists artificially increase inflammation in the gut, they find anxiety-like behaviours follow. But what’s more interesting is that tryptophan metabolism was impaired as well, potentially leading to lower serotonin levels in the brain. Administering a probiotic reversed this (148). This, in addition to higher levels of inflammation, explains why IBS is so highly related to depression. And considering that 95% of your body’s serotonin is located in the gut, it further highlights why gut health is so important (149).
Why is My Gut Microbiome Impaired?
There are several reasons why the gut is impaired in this day and age. One that we have discussed before is our radically changed diet. One study showed that continuous exposure to fructose and sugar substitutes lead to an impaired microbiome and a shift towards a “Western-type” gut microbiome (150).
Another study looked at the gut microbiome of African rural children and compared them to Italian city children and found radical differences in their microbiomes (151). The implication is that industrialisation has changed our diet and this has had profound effects on our gut microbiome. What’s interesting is that the increase in depression incidence also follows the changes in our food choices in the last 100 years. From mostly home-cooked, to more processed and fast food.
Antibiotics and Depression
One of the greatest influences on our gut microbiome is antibiotics. Antibiotics are lifesaving compounds designed to kill bacteria that are harmful to us. However, they have the undesirable effect of killing other bacteria as well. And when these antibiotics hit the gut, it’s carnage. In fact, one study of 1,000,000 people found that even one course of antibiotics was enough to increase the odds of getting depression by 25%. Multiple courses increased this as high as 56% (152). On top of this, one study showed that after just one short course of antibiotics, some bacterial strains were still recovering 6 months later (153). So antibiotics are pretty devastating to the gut and appear to increase the likelihood of depression.
Having said that, antibiotics are pretty important in a lot of cases. So don’t stop using them based on this, it’s better to have an impaired gut microbiome than an uncontrolled bacterial infection (trust me, I know).
So we see that our environmental factors shape our gut bacteria, and this gut bacteria, in turn, shapes our behaviour, pointing to a root cause of depression that shouldn’t be ignored.
• Our gut microbiome helps to maintain our mood.
• The microbiome is significantly altered in depression, and when transplanted into mice it causes depression in them.
• The microbiome helps the body to deal with stress.
• Stress can negatively change the microbiome, especially early life stress.
• An unhealthy gut will drive inflammation and lower micronutrients, which can lead to depression.
• Our completely changed diet and increased antibiotic use have radically changed our microbiome pointing to why depression is more prevalent today.
Why Hasn’t My Doctor Told Me About This?Expand section…
You may be wondering why you had to come to my website to discover this information and why your doctor hasn’t told you themselves.
Well, there’s no other way to put it, but the system is broken.
The way we deal with our health in this day and age is seriously messed up.
According to the CDC, 117 million people in the USA have more than one chronic health condition. Heart disease, cancer, stroke, diabetes, obesity are all at epidemic levels.
This is in spite of the fact that spending on health care is at record highs (154). In the USA this equates to more than $8,000 per year, per person. What are we spending this money for? It’s clearly not helping.
Why isn’t this working? Because a drug solution 9 times out of 10 is a band-aid solution, designed to treat a symptom of a disease and not the disease itself. So you’ll still continue to suffer on the inside, you just won’t notice it.
The system is set up to keep big pharma’s “solutions” at the forefront.
Just the top 10 drug companies spent an eye-watering $98.3 billion in 2013 on marketing – much higher than R&D I might add (155). Furthermore, marketing towards doctors (the ones prescribing the drugs to you) was 8 times higher than to you, the end consumer. In the last few years almost $6.25 billion was given to over 810,000 doctors in the US (156). Research shows that even a free meal was enough to sway a doctor’s prescribing habits (157). So any medication that you are on right now might not be because it’s the best for your condition, and might instead be because of big pharma’s influence.
As a well-known depression researcher put it “the inundation of marketing [by the giant pharmaceutical companies] drowns out ideas that don’t have that kind of massive advertising” (158). Ideas like those that are found in this article.
Now I know for a fact that the vast majority of doctors are truly trying to help people. I’ve known many doctors both socially and been cared for by them, and they are amazing people. They are there to help, but doctors are people, and people are susceptible to advertising, whether we like it or not. Would big pharma spend $98 billion on it if it didn’t work?
Problems in the Doctor’s Office
The problems get even worse for doctors trying to do the right thing. 2 studies have shown that it takes an average of 17 years for new evidence-based research to find its way into clinical practice (159, 160). Meaning that most of what your doctor knows about depression or any other illness is back-dated to 2000. This is the same year that the Nokia 3210 came out.
Yeah, that thing^^^.
If your doc took a call from that phone while you were in the office, you’d probably make a bee-line for the door. And that’s just a phone! Not the information that your life potentially depends on.
Additionally, doctors typically get almost no training in nutrition. A study showed that the typical doctor gets only 19.6 hours of nutrition instruction in their entire medical degree (161). Only 1 in 4 universities actually required a dedicated nutrition course. Thankfully it’s getting less common, but some universities don’t even offer nutritional training, so it’s entirely possible for your mechanic to have just as much nutritional training as your doctor.
Something is seriously wrong with the health care system when the people we rely on to keep us healthy aren’t trained in one of the most important aspects of health.
• I’m a big fan of doctors, but they are stuck in a system that has more to do with money and politics than evidence-base.
• It takes 17 years for information to get to the doctor’s office
• Doctors aren’t trained in nutrition.
• A drug solution is vital in many cases, but in many more cases, it’s just a band-aid solution that ignores the underlying cause of the problem.
• It’s important to fix the underlying cause then look to drugs (if still needed).
Antidepressants Mostly Don’t WorkExpand section…
Now I’m about to talk about the conventional treatment for depression: antidepressants.
But before we dive into that subject, I’ll just say a few things first, while I’m about to show you that they are ineffective in many people, they do help some people and if you are on antidepressants and they are helping you, then great! Stay on them. They are helping you and you should keep using them. Any discussion of antidepressant use should be done with your doctor.
So here we go:
According to the CDC, almost 11% of the US population are taking an antidepressant (162). Fuelling the $14 billion per year worldwide industry (163).
In a 2010 study, researchers compiled the results of 30 years of studies on the use of antidepressants in depression (164). They wanted to see how effective antidepressants were, and how many people benefited from their use.
The results were surprising and rather scary.
I’ll let the authors tell you the bad news: “True drug effects were non-existent to negligible among depressed patients with mild, moderate, and even severe baseline symptoms”. The only significant effects were seen in those with very severe depression.
Being classified as “very severely depressed” meant that the patient scored a rating of 25 or more on the commonly used Hamilton Depression Scale. What proportion of the depression population has a score of 25 or more? Well, a 2013 paper showed that in their study population, only 18.5% were classified as having a rating of 24 or more (there doesn’t appear to be data on scores of exactly 25+) (165).
So this means that more than 81.5% of people with depression see no benefit from antidepressants at all. Add in the fact that these people would still experience side effects, and they were actually far worse off than just being on a placebo. Not to mention wasting their money.
So why are doctors prescribing a drug to all depressed people when we know that the drug will do nothing for 81+%?
To answer this question, we can look at a study published in The New England Journal of Medicine. It found that drug companies publish positive but not negative studies on antidepressants (166). A positive study was 12 times more likely to be published than a negative or neutral one. The study concluded that this selective publication meant the drugs in the published trials appeared 32% more effective than they really were.
It’s perfectly legal for a drug company to perform 10 different clinical trials, all with the same design, and only publish the most promising one. Even though, just by pure chance, at least one of these studies will show a positive outcome (167).
This happened with a drug called reboxetine where one study found that only 26% of the studies done on the drug were published (168). Leaving out the results from over 3,000 people who used the drug. Without these people, the drug was presented to be just as good as other antidepressants.
When these unpublished results were added to the rest of the data a very different story unfolded. Reboxetine was in fact far less effective than other drugs on the market and its performance wasn’t even better than placebo (even in the very severely depressed).
How many other antidepressants – or indeed any other drug – were brought to market this way? Could the drug that your doctor wants to prescribe you be like this one? Unfortunately, it’s difficult to find out.
One final nail in the coffin is the fact that a drug company funded study is 5.3 times more likely to support the sponsor’s products than a non-commercially funded study (169). Every study that shows a drug is beneficial is funded by a drug company, so this muddies the water even more as far as knowing if a drug is helpful or not.
So it’s not a good situation we’re in.
Antidepressants being ineffective for the vast majority of people wouldn’t be such a big deal if not for the dangerous side effects that come along with them. Many are so dangerous they’ve even attracted the FDA’s black box warning.
Strangely enough, suicide is a big issue when people first start antidepressants (170), while other side effects like fatigue, nausea, headaches, agitation, decreased sexual desire and erectile dysfunction are all common as well (171). The CDC even found a link between antidepressants and obesity (172). Birth defects are more common as well, explaining the more than $1 billion in payouts to victims in 2010 (173).
But the biggest issue with antidepressants is they do nothing to fix the underlying cause of depression. A cause that, if not corrected, leads to other diseases and even a worsening of depression.
Next, we’re going to see how we can attack depression from its root cause.
• Studies have shown that traditional antidepressants do nothing for more than 81.5% of people with depression. However, if you are on antidepressants and you feel they are helping, you are in the 18.5% that benefits, and you should stay on.
• Anti-depressant studies are far more likely to be published when they have positive results, relative to negative ones, which skews the results even more.
• Industry-funded studies are 5 times more likely to support the sponsor’s product than non-industry-funded studies.
• Antidepressants can lead to dangerous side effects like suicide.
• They do nothing to fix the underlying cause of depression.
20 Ways to Kick Depression in the Balls
Disclaimer: Although I’m trained in nutrition, I am not your doctor. I provide this information so you can have a discussion with them. While the typical doctor doesn’t get much training in nutrition, there certainly are ones out there that are knowledgeable, and so it would be worth seeking one out to discuss these options. It is never a good idea to treat yourself without the supervision of a qualified medical professional. Especially when dealing with such fragile things like your brain chemistry. There is the propensity for antidepressant treatments – whether pharmaceutical or not – to worsen symptoms briefly before they get better. There is a chance that this is true for the below interventions. Additionally, supplement amounts are provided as a guide only, and you should check with your doctor or naturopath about what is right for you before using them.
Traditional methods of dealing with depression involve the use of drugs that as we’ve seen don’t fix the underlying cause, and aren’t really effective at all. We’ve identified the root causes of depression above, and now we’re going to look at all of the scientifically proven ways to correct these causes and fix your depression.
Having 20 options to help your depression will seem very overwhelming, but it’s important not to allow this enormous amount of information to do that. My goal is to outline every scientifically based option you have at your disposal to recover from depression.
The goal for you is NOT to try every single one at the same time, or even more than 2 or 3. The goal is to read through everything, then try them as per how you feel they will help you.
1. Fix the Gut, Fix the BrainExpand section…
A few years ago, at the height of my depression, I did something that I had tried to do for years.
I quit sugar.
No table sugar. No high fructose corn syrup. No honey. Not even fruit.
I still ate plenty of carbohydrates like rice and potatoes. They were fine.
But sugar was not.
In particular, I wanted to get rid of fructose from my diet. The so-called “natural” sugar.
Table sugar, honey, high fructose corn syrup, etc. are all made up of roughly 50% glucose (the energy source our bodies have lived on forever) and 50% fructose (a recent addition in the quantities we eat today).
Giving up sugar was one of the hardest things I’ve ever done.
But strangely enough, it was also the best thing I’ve ever done for my health. Because within 2 weeks my depression had completely vanished. Gone.
I was elated by my cured depression but also very curious. Why did giving up sugar have such a profound effect on my mood?
Well, it starts with the gut…
The Gut and Sugar
We’ve already seen how the gut has a tremendous impact on the health of our brain. But now I want to introduce you to something called carbohydrate malabsorption, or CM for short.
CM is unheard of yet up to 40% of people suffer from it in one form or another (174, 175, 176, 177). Carbohydrate malabsorption is a blanket term that refers to the malabsorption of normal amounts of fructose (and fructans), lactose and sorbitol. The problem is that many of these sugars are either completely new to us, or are consumed in such quantities that we are unable to fully break them down (175). Fructose intake is so high now that up to 80% of people don’t digest it fully at these levels (187).
When these undigested sugars hit the colon, they interfere with the metabolism and absorption of a number of nutrients, tryptophan being one of these (181). Studies have shown lower levels of tryptophan, folic acid and zinc in carbohydrate malabsorption. All are important in depression (181, 182, 183, 184, 185).
Symptoms usually are bloating, abdominal discomfort and sometimes osmotic diarrhoea (watery stools), however, 50% of sufferers don’t have any symptoms at all (178).
A small trial found that 28.5% of people with CM had depression. 10 times higher than the general population (174). Depressed people are also 4.5 times more likely to have CM according to 2 other small studies(179, 180).
To see if removing these sugars from the diet would help sufferers of depression, 53 people with depression were put on a low fructose and sorbitol diet for 4 weeks (179). The results were a 65.2% reduction in depressive scores by the end of the trial!
As we saw, the gut is important in depression. Our gut bacteria help to digest food, and these foreign sugars wipe out certain species in the gut (188). This explains why this is happening at higher rates now than ever before.
How do you know if you have carbohydrate malabsorption? If you have symptoms like bloating, abdominal discomfort and sometimes osmotic diarrhoea and they go away after you remove these sugars, then you probably have it. If you don’t have any symptoms, like 50% of sufferers, then you can take a non-invasive hydrogen breath test, or just remove those sugars and see how you feel.
Interestingly enough, after removing fructose cured my depression, I went a further 16 months without so much as a piece of fruit. I was terrified that I would relapse and I didn’t want to risk it. But eventually, I reincorporated sugar in small amounts (fruit was fine), and even have a sugar binge now and then. Surprisingly, sugar doesn’t have any effect at all now, suggesting that avoiding sugar for long enough shifted my gut bacteria to normal and allowed me to handle sugar again (but if I returned to my normal ways I don’t think this would last).
• I gave up sugar. It sucked. It also cured my depression in less than 2 weeks.
• Many of the sugars in our modern diets are either completely new or in amounts we aren’t used to.
• 40% of people can’t digest these sugars.
• Depression is 10X higher in these people.
• Malabsorption states result from undigested sugars, which leads to changes in gut bacteria and deficiencies. This leads to depression.
• Significantly lower fructose (don’t forget table sugar and honey), fructans, sorbitol and lactose from the diet for 3-4 weeks and see how your mood reacts.
• The ratio of glucose to fructose is important for absorption. Consuming glucose along with fructose will help absorption.
• Heal the gut by doing the following:
o Avoid processed foods, artificial sweeteners and unnecessary antibiotics.
o Get a good probiotic: one trial saw a 50% reduction in depression and anxiety symptoms from a 1-month probiotic supplement (189).
o Eat more leafy green vegetables and starchy vegetables for fibre (what your gut bacteria lives on).
o Eat more fermented foods like sauerkraut, kefir and kimchi.
2. Beat Depression through DietExpand section…
As we saw before, diet and depression are strongly linked in observational studies. But these studies can’t prove poor diet leads to depression, just that they are linked.
To see if poor diet leads to depression and that if changing diet can lead to significant improvements, we need to look at a recent clinical trial on depression and diet.
In this study 67 people with depression were randomised to two groups (190). Group one would receive 7 individual nutritional consultations over the 12 weeks of the study. Group two would receive a social support appointment of the same duration and schedule. The intervention group were counselled to reduce foods like sweets, refined cereals, fried foods, processed meats and sugary drinks (all inflammatory foods). They were told to eat more foods like fish, vegetables, fruit, legumes, lean red meat and eggs.
The results were impressive.
After 12 weeks, the group that received the dietary counselling saw their depression drop like a stone with 32% seeing their depression go into remission (vs. 8% in the control group).
This proves that diet is pretty important to our mood levels. A good diet will be anti-inflammatory, nourish our gut bacteria, and provide ample nutrients that the brain needs to keep mood levels stable, whereas an unhealthy diet will be highly inflammatory, lead to nutrient deficiencies and poison your gut bacteria.
• A 32% remission rate was found in a recent clinical trial that changed people’s diet.
• A good diet will lower inflammation, increase micronutrients and provide good food for your gut.
• In addition to the recommendations for healing the gut, try to lower fried foods, processed foods, sugary drinks and refined cereals.
• Consume more fish, good quality meats and eggs, low-sugar fruits and vegetables.
Fix Nutritional Deficiencies
As we discussed earlier, nutrient deficiencies are one of the root causes of depression. We will discuss several nutrients here that the body needs to maintain proper mood, all of which have been shown to be lower in depression and lead to improvements when replenished.
Before we get to individual nutrients let’s look at a study of a broad vitamin/mineral supplement in depressed patients (191). They took 225 elderly people who were in hospital and separated them into two groups; one received placebo plus hospital food and the other a supplement plus hospital food. The supplement provided 100% of their daily needs of vitamins and minerals. After 6 months the supplement group saw a 14% reduction in depressive symptoms compared to an increase in the placebo group (probably the terrible hospital food).
Now, on to specific nutrients.
3. Omega-3Expand section…
Essential fatty acids omega-3 and omega-6 are crucial in the regulation of mood. Compared to healthy controls, depressed patients have lower levels of omega-3 and a higher ratio of omega 6:3 (28, 192, 193). Additionally, the more severe the depression, the worse the ratio of omega 6:3 (192, 194).
The ratio between omega-3 and omega-6 is very important (195). The reason for this is that many nutrients in the body work on a seesaw, meaning too much of one will interfere with the other. Omega-3 and 6 are two such nutrients.
The historic ratio of omega 6:3 is estimated to be no higher than 4:1 (and probably closer to 1:1) (196). The Western diet contains far more omega-6 now than back then and so today this ratio has jumped to more than 15:1 (196). Diet is the only source of these fatty acids and so the ratio in our diet will dictate the ratio in our bodies (197).
In general, omega-6 is considered to promote inflammation, and omega-3 is considered to reduce inflammation (42). So you can see why having too much omega-6 and not enough 3 will be a problem. It drives inflammation crazy, and this imbalance of essential fatty acids fuels depression (198).
But while an imbalance in the omega-6:3 ratio can lead to increased inflammation, returning this ratio to favour omega-3 has significant anti-inflammatory effects (199). As we saw before, researchers can stimulate a depressive episode by increasing inflammation in the brain. When omega-3s are administered beforehand, this doesn’t happen (23). Highlighting how effective omega-3 fatty acids can be in depression.
So how does omega-3 fair in depression?
In a recent meta-analysis of 15 trials with 915 people, researchers found a positive and significant effect from omega-3 supplementation (200). From the authors: “At present, our knowledge base supports the use in acute depression of omega-3 supplements.”
In one of the studies included in the meta-analysis, participants were given 1 gram of EPA per day. After 12 weeks their depressive scores dropped 56% whereas the control only improved by 23% (201).
In addition to omega-3’s impacts on inflammation, it also up-regulates the serotonin receptors thereby making serotonin more available to the brain (202).
• Essential fatty acids are crucial to the maintenance of healthy mood and inflammation regulation.
• They are out of balance in depression.
• The ratio of omega 3 and 6 is as important as absolute amounts.
• They’re proven in clinical trials to significantly improve depression.
• Reducing omega-6 from the diet is equally as important as adding omega-3:
o Reducing intake of fried foods
o Replace vegetable oils with coconut/palm oil or animal fats like lard or tallow.
• Add omega-3 fatty acids by supplementing or eating more fatty fish.
• Supplemental omega-3’s must be at least 60% EPA e.g. 300mg EPA to 200mg DHA.
4. MagnesiumExpand section…
Magnesium has had a long history of treating poor mood, with reports dating back as early as 1921 (206). In animal studies, zinc and magnesium lead to significant antidepressant-like effects (207). Zinc has also been shown to enhance the activity of conventional antidepressants in studies (208).
A 2008 study took 23 depressed patients who were also magnesium deficient and put them on either a traditional antidepressant or 450mg of magnesium per day (209). 12 weeks later the group taking the magnesium did equally as well as the group taking the antidepressant, with each seeing a 38% drop in depressive symptoms. This shows that a simple magnesium supplement was just as effective as a pharmaceutical antidepressant. The authors concluded that magnesium supplementation was an effective and safe way of treating depression in those with a magnesium deficiency.
A second study put 44 female patients with PMS on a b6/magnesium complex for a month to see if it would have any effect on their anxiety and depression (210). A modest reduction in depression was found and an almost halving of anxiety symptoms. These results have been duplicated in another study done with only magnesium (211). And two more in epilepsy and chronic fatigue syndrome (212, 213).
Of particular interest is a paper reporting on 4 separate case studies of severe depression and magnesium supplementation. What’s interesting about these case studies is that all 4 of them recovered completely in less than 7 days (20).
One of these cases was a 59-year-old man who normally had mild depression but after a year of extreme personal stress became suicidally depressed. He was given 300mg of magnesium 4 times a day. His results were rather astounding. From the authors: “the man experiences life-saving benefit from magnesium”. Within the first day his sleep improved significantly (magnesium is known to be great for sleep quality) and within 4 days his mood returned to normal.
That’s right, severe depression normalised in less than 4 days from a simple magnesium supplement. Another case study reported reversal of severe depression after just 2 days (214).
What’s even more interesting is the 59-year-old man from the first case study discovered that a depressive episode would occur within an hour of taking a calcium supplement. The depressive episode could then be completely stopped by taking a magnesium tablet. He was so sensitive to calcium he had to be taken off calcium supplements and dairy.
Why would this be?
As discussed earlier, much like omega-3/6, some nutrients work on a seesaw; the ratio between two nutrients is often just as important as the amounts we get. Calcium and magnesium are two of these minerals (20). So ingestion of too much of one will lead to lower blood levels of the other.
How many people take a calcium tablet for their bones but forget about magnesium? And how many of these people have resulting depression and are completely unaware of it? There’s no research on this, but it’s an intriguing question.
So how does magnesium work for depression?
It works in a few ways. One is that it’s crucial for serotonin metabolism (215). Another is that magnesium deficiency increases inflammation (215). We also know that chronic stress decreases magnesium levels, potentially indicating one of the ways in which chronic stress can influence depression (216). In mice, a magnesium-deficient diet leads to depression-like behaviour from changes in gut microbes and higher inflammation in the gut (217, 218).
• Magnesium is important for the production of neurotransmitters and calming inflammation.
• Magnesium is lower in people with depression.
• Supplementation has been shown to lead to rapid recovery (less than a week) in some people.
• Excess calcium can interfere with magnesium.
• Eat more magnesium-rich foods like leafy greens, nuts, seeds, fish, beans and avocado.
• Magnesium supplementation must be done carefully to avoid toxicity so consult a healthcare professional before you do anything.
• Chloride, sulphate, citrate, lactate, malate, glycinate and taurinate are the best sources of magnesium, while magnesium oxide is essentially useless.
• Avoiding calcium supplements temporarily to see if this helps.
5. ZincExpand section…
Another interesting finding is that those who do not respond to treatment – treatment resistant depression – have lower levels of zinc than those who do respond (219). This suggests that zinc levels have something to do with resistance to treatment. Depressed patients have been shown to have significantly lower levels of serum zinc and the lower the zinc levels, the worse the depression.
In one such study researchers assigned 20 patients with major depression to two groups (222). Both received antidepressants, but one group would receive a placebo and the other a zinc supplement. By the end of the 12-week study, the placebo group saw an improvement in depressive scores of 50% whereas the zinc supplementation group experienced an improvement of 79%. Very similar results were seen in a second study using similar methods (223).
Zinc seems to help through its ability to influence inflammation and indeed low serum zinc is associated with higher inflammatory markers/inflammation (219). Zinc also helps to maintain intestinal integrity (224).
• Zinc is needed to calm inflammation.
• It’s lower in depressed people and increases when people recover.
• A zinc deficiency is related to treatment-resistant depression.
• Take a zinc supplement or eat more zinc rich foods like lamb, beef, chicken, pumpkin seeds, cashews and spinach.
6. Vitamin DExpand section…
Vitamin D plays myriad roles in the human body including in mineral absorption, bone health, the immune system, and cardiovascular processes etc (225, 226). Deficiencies in vitamin D have been consistently associated with diabetes, cancer, heart disease, autoimmune diseases, high infection rates, as well as depression (227, 228).
We get vitamin D primarily from the sun, but also from fats in our diet (vitamin D is fat soluble).
Unfortunately, deficiency rates in the Western world are between 40 and 70%, depending on where you live (229, 230).
A recent meta-analysis found that vitamin D lead to significant anti-depressant effects in depression and that this effect was similar to that of antidepressant medication (231).
Vitamin D is vitally important for immune function and influencing inflammation, which is why it helps in depression (225).
• Vitamin D is needed for immune function and calming inflammation.
• Low levels associated with depression.
• Shown in studies to significantly help depression.
• Spend more time outdoors without sun cream (but don’t get burned).
• Or take a vitamin D supplement.
Fix Your Circadian Rhythm
7. Light TherapyExpand section…
In the 1960’s, a research scientist by the name of Herbert Kern noticed that his depression would get worse in winter, and get better in summer. He tracked his mood over the months, and it appeared that the reason for this was the changes in sunlight intensity and day length (232). He had stumbled upon what would ultimately be called Seasonal Affective Disorder, or SAD.
It was later discovered that light entering the eyes was crucial for the body to do a number of things, like produce (and use) serotonin as well as reset the circadian rhythm (233, 234). We’ve already seen how important the circadian rhythm is for depression, and so while it was a bizarre discovery back then, it makes perfect sense today.
There have been a couple of studies which have reviewed the attendance duration of depressed people in hospital (total of 776 patients), and whether they were in a “bright and sunny” room or a “dark” room. Both studies found much shorter stays (presumably meaning quicker improvements) for the patients who stayed in the bright rooms, relative to the dark rooms (235, 236).
Light therapy was born from the discovery that light has this effect on the body, and it’s used to treat a whole host of different conditions (237). Light therapy involves sitting in front of a bright light for a period of time.
Light therapy in SAD has been extensively studied and is, in fact, one of the conventionally recommended treatments (237). One study in SAD patients saw an almost 60% reduction in depressive symptoms after just 2 weeks of light therapy (238). Another study found a 21% reduction in depressive symptoms after just 1 week (239). Noticeable improvements were seen after only 4 days.
It was always assumed that other types of depression were different from SAD, and would therefore not benefit from light therapy as much. As it turns out this may not be the case.
A 2011 study put 27 pregnant women with major depression into two groups, one with standard light therapy and another with a lower intensity light designed to be a placebo treatment. After 5 weeks a massive 81.3% of the participants in the bright light group saw a 50% reduction in their symptoms (vs. 45.5% in the control group). An incredible 68.6% of patients no longer were classified as depressed at the end of the study.
These results were backed up by a recent meta-analysis which found significant effects from light therapy in major depression (240).
So we know light therapy works, but why does it work?
As I said earlier light therapy resets the circadian rhythm and stimulates serotonin production. We know this because when we look at serotonin availability at different times of the year, we find much more in the summer than winter time (233). We also see that when participants are put on a low-tryptophan diet (to lower serotonin levels) any effect they would have received from light therapy is cancelled out (241, 242, 243).
It appears that the brightness of the light entering our eyes is the determining factor in how much serotonin will be available to the brain, and how effective light therapy is (234). This makes sense if you think about it. Today we spend most of our lives in our houses or in an office, where the brightness is rated at 350-500 lux (lux is a measurement of brightness) (244). The bulbs in the light therapy studies emit between 7,000-10,000 lux. If you were to go outside during the day, you’d be exposed to between 10,000-25,000 lux. But, what do most people do when they go outside on a sunny day? They put their sunglasses on! Immediately cancelling out the effects of the bright light.
So it’s obvious that we aren’t getting enough light into our eyes to make enough serotonin available. This is another thing that has changed drastically in the last 100 years.
Now on to the circadian rhythm. As we already discussed, the brain uses light entering the eyes to sync us to the time of day, and so not getting enough sunlight early in the day effectively means we don’t do this properly. To back this up, studies have shown that light therapy was up to twice as effective in the morning than the evening (245, 246).
While there haven’t been any placebo-controlled trials to see if sunlight is as effective as light therapy in treating depression, when taking the above evidence, it very much points to sunlight having the same effect. In fact, because natural sunlight is exactly that: natural, it would be no surprise if sunlight elicited better effects than artificial light therapy due to our body being evolutionarily designed to react and indeed rely on sunlight.
• The circadian rhythm is out of whack in people with depression.
• The brain uses light to reset this rhythm and without sufficient levels the circadian rhythm de-synchronises.
• Light stimulates serotonin availability.
• Light therapy is highly effective at treating depression by re-synchronising the circadian rhythm.
• See the article I wrote called Reset Your Rhythm.
8. Wake TherapyExpand section…
In the 1960’s a German physician at a local hospital became intrigued by one of their acutely depressed patients who claimed the less sleep she got, the better she felt. This claim was in direct contradiction to what seemed to be needed for depression, as many depressed patients usually struggle with insomnia and try desperately to get more sleep because of this.
In 1968 the physician decided to test out this woman’s strange claims in an attempt to see if it would help others with their depression. Amazingly it led to remission in the majority of people. Fast forward 50 years and more than 80 studies with thousands of participants have been published all confirming one thing: that after just one night of no sleep, around 60% of patients have their depression completely vanish (247). They called this “wake therapy” and it’s one of the most rapid and effective antidepressant therapies ever discovered; and yet it’s completely unheard of.
It has such a profound effect on depression because it resets the circadian rhythm (248).
In the wake therapy studies, mood would slowly improve from 11 pm the night of the sleep deprivation until 5 pm the next day, with significant effects being felt around 7 am. There’s a problem, however, and probably the reason that you’ve never heard about this therapy.
Once the patients went back to sleep their depressive symptoms came back. On average 83% of patients relapsed after the first night of sleep. It appears that the night of sleep deprivation resets the circadian rhythm, which leads to better mood, but if the patient goes to bed at the same time they always do, then it resets back to how it was before.
So while this may seem like a miracle cure for depression, it’s not much good if it only works for 1 day at a time.
But don’t lose hope just yet! Because it gets better.
The discovery of how effective a shift in the circadian rhythm is, led to many other ways to try to sustain the effects of wake therapy for more than one day.
Researchers decided to look at what would happen if patients were told to sleep earlier than they normally do, after the night of sleep deprivation. Then shift this forward by one hour each night. So basically going a full night without sleep, then getting a good 7 hours of sleep at 5 pm, then the next night 6 pm and so on until normal sleep time was achieved. They called this sleep “advancement”.
One study looking at sleep advancement found that 75% of patients after 7 days still retained the benefits of the initial night of sleep deprivation (249). Another study found a 61% maintenance rate (250). One study used this method in bipolar disorder and saw a 30% drop in depressive symptoms after the first night with patients continuing to improve for the following 6 days of the study (251).
So 60-75% maintenance is good, but we can do better.
It turns out that adding bright light therapy to wake therapy and sleep advancement led to even more impressive results.
One such study divided 49 patients with bipolar disorder into either a medication only group or a wake therapy group + light therapy + sleep advancement (252). The wake therapy group were kept awake from 9 am the day of the experiment until 6 pm the day after (33hrs awake). Once they awoke from their sleep they were exposed to bright light therapy for 2 hours. This happened for 3 days.
They also were told to advance their sleeping times by 2 hours each night. So the first night they slept 6pm-1am, second 8pm-3am and third 10pm-5am. After the 4 days of wake therapy, bright light therapy and sleep advancement, they were not told to do anything more for their depression.
The sleep deprivation group saw an almost halving of their depression scores which were maintained for the full 7 days of the study, whereas the medication group only managed half this. After 7 weeks, the results remained. They had maintained the effects of wake therapy for a massive 7 weeks. Another study in treatment-resistant depression found a 61% maintenance after 3 weeks of this protocol (253), and another saw a 62% drop in depressive symptoms after only 5 days (254).
While most of the research was done on bipolar depression, wake therapy has also been shown to be highly effective in major depression (255).
So does this mean that you need to go an entire night without sleep to see the benefits from this? Well not so fast, I have included this section only to show how impressive resetting your circadian rhythm can be with depression. There are several things you can do to reset your circadian rhythm without going to such radical lengths. See the recommendations just below for more information.
• Keeping people up for 36 hours + is called wake therapy.
• Wake therapy has been studied in more than 80 studies and thousands of people.
• It resets the circadian rhythm and leads to rapid and impressive recovery in 60% of depressed people literally overnight.
• Relapse after a night of sleep is common.
• Pairing this with light therapy and sleep phase advancement will prevent relapse in most people.
• This section is provided only to show how important the circadian rhythm is in depression, and how impressive the results can be if it is reset. There are better, less radical ways to reset your circadian rhythm which will likely lead to equally impressive results. See the recommendations below.
• See the article I wrote called Reset Your Rhythm.
9 – 15. Curcumin, Saffron, St. John’s Wort, Kava, L-Theanine, Folate, PhosphatidylserineExpand section…
Curcumin, derived from the Indian spice turmeric, is a potent anti-inflammatory and has been studied with promising results in a number of inflammatory diseases like cancer, arthritis, diabetes, atherosclerosis and ulcerative colitis, to name a few (257).
Depression is no exception. There have been a number of trials showing that curcumin can help to treat depression (258, 259). And one that used curcumin with antidepressants to good effect as well (260), researchers found that curcumin significantly decreased inflammatory markers and also played a role in the serotonin system (261).
The most recent study found that curcumin supplementation led to a 50% reduction in depressive symptoms in 28% of the people taking it. A 65% response was found in those with atypical depression (262).
Saffron is a spice that’s been used in traditional Persian medicine to treat depression for centuries. It’s been shown to have anti-depressant effects in multiple studies. In one study, participants were given either 30mg/day or saffron or placebo. After 6 weeks depressive ratings had dropped by 46% in the saffron group (263). Saffron had similar effects in 5 other studies (264). Saffron appears to be anti-inflammatory as well as help with the serotonin system.
11. St. John’s Wort
St. John’s Wort (hypericum) is a herbal extract which has had a long history of treating depression.
In a randomised, placebo-controlled study, 135 patients with major depression received one of 3 preparations: 1) a placebo, 2) 900mg/day hypericum extract or 3) a traditional antidepressant (265).
By the end of the 12-week study, the patients receiving hypericum extract saw an average improvement in depressive scores of 48% with 38% going into remission. Antidepressants performed no better than placebo.
A recent meta-analysis looked at 29 studies with 5,489 people on the use of hypericum for depression (266). Hypericum was just as effective as antidepressants, with fewer side effects.
Hypericum seems to work by a few different mechanisms. We know it’s an anti-inflammatory (267), as well having effects on the serotonin system (268).
Kava, a common Fijian ceremony drink, has been studied in anxiety and depression in a recent study. For 3 weeks, people were given 250mg/day of kavalactones and their anxiety and depression levels were measured before and after. The kava led to significant lowering of both anxiety and depression (269).
L-Theanine is an amino acid found exclusively in green tea. It’s been studied in an open-label trial (no placebo group) with the use of antidepressants (270). It managed to have pretty impressive effects on both anxiety and depression levels. The authors concluded: “l-theanine administration is safe and has multiple beneficial effects on depressive symptoms, anxiety, sleep disturbance and cognitive impairments”.
L-theanine has effects on neurotransmitter function (271).
14. Folate – Methylfolate/Folinic Acid
Folate, or vitamin B9, is needed for the production of neurotransmitters. It’s also a nutrient that is often inefficiently metabolised due to a very common gene depressed people often have (272). Low folate levels have been consistently found in people with depression (273).
Folate comes in a number of forms, but folinic acid and methylfolate are the most common. One study with methylfolate found a 58% reduction in symptoms after 3 months on the supplement, although this was with an antidepressant (274). 45% of this group went into remission.
There were a number of patients in the trial not on antidepressants, and they achieved a 52% remission rate. Though there wasn’t as much data available so this should be interpreted with care.
A number of other studies have found beneficial results in methylfolate as well as folinic acid (275).
Phosphatidylserine (PS), apart from being really hard to say, is a type of fat found in every cell in your body, but the highest concentration is found in the brain. It facilitates the brain’s use of glucose as a fuel, as well as regulating cortisol levels. A decrease in PS occurs with age, and this has been theorised as one of the reasons for cognitive decline as we get older (276).
In a small trial of 10 elderly people 300mg/day of PS was compared to placebo for 15 days. The PS showed consistent improvement in depressive symptoms and memory (277).
Similar results were found in another study with a higher dose of 600mg/day (278).
A more recent study of 18 elderly people paired PS with omega-3 fatty acids over the course of 12 weeks (279). Depressive scores on average dropped 41%. What’s interesting is that those who saw the most improvement had their circadian rhythm restored to normal, as well as their cortisol levels (stress hormones).
• Curcumin, saffron, St. John’s Wort and kava are potent anti-inflammatories.
• Curcumin, saffron and L-theanine facilitate neurotransmitter use or production.
• Phosphatidylserine is thought to help the circadian rhythm reset.
• All of these have been shown to be effective in treating depression in small to medium studies.
• Curcumin: 250mg twice daily
• Saffron: 30mg/day
• St. John’s Wort: 900mg/day
• Kava: 250mg/day of kavalactones
• L-theanine: 250mg/day
• Methylfolate: 15mg/day
• Phosphatidylserine: 3-600mg/day
All of the above are available as supplements.
16. SulforaphaneExpand section…
Sulforaphane is perhaps the most scientifically studied organic compound and is commonly found in cruciferous vegetables like broccoli, cabbage, cauliflower and kale (280).
It’s potently anti-inflammatory and has been studied in dozens of different diseases (280).
One study showed that only 14 days of increased intake of sulforaphane-containing vegetables was enough to reduce a marker of inflammation by up to 20% (281).
A study in mice (poor little guys), found that sulforaphane stopped the increase in inflammation when the mice were stressed. As we saw before, stress is a big driver of inflammation, and therefore depression. So it’s pretty impressive that sulforaphane actually blocks this increase in inflammation following a stressful event (282). In mice, much like humans, it’s common for them to avoid social interactions when depressed. Administration of sulforaphane actually reverses this compared to untreated mice. Meaning that sulforaphane again makes mice (and likely humans) more resilient to stress (283).
When mice are treated with sulforaphane before being injected with an inflammatory compound designed to induce depressive symptoms (avoidance of socialisation, no interest in food, preference for dark places), the mice show significantly increased resistance to this depressive episode (284).
Another study found that an increased intake of cruciferous vegetables and leafy greens was associated with a significant reduction in depression risk in humans (285).
While there haven’t been any placebo-controlled trials done in depressed humans (they’re on their way), as we’ve seen from the above it has potent anti-inflammatory effects in humans and significant depression mitigating effects in mice. So there’s good evidence that sulforaphane will help with depression in humans.
• Sulforaphane is a potent anti-inflammatory and has been shown to significantly lower depressive symptoms in mice.
• Sulforaphane intake is associated with lower depression symptoms in humans.
• The best source of sulforaphane by far is broccoli sprouts. Search youtube to find a video on how to sprout them.
• You can increase the quantity of sulforaphane in broccoli sprouts through heat – look at her other stuff, it’s awesome.
• Eat the equivalent of 1 tablespoon of sprouted seeds per day.
• Supplements are generally not recommended as bioavailability is low.
• Eat more cruciferous vegetables (broccoli, cabbage, kale, brussel sprouts, cauliflower etc.).
17. Magic MushroomsExpand section…
Magic mushrooms recently have been getting a lot of attention for their effects on depression.
And I know what you’re thinking drugs are bad right. You shouldn’t take them because they’re dangerous.
And it’s a good point, but you know what else is dangerous? Depression!
In fact, over 1 million people per year die of suicide (289). So yeah depression is pretty dangerous.
But what about mushrooms?
Well, a review article published in 2011 on the dangers of magic mushrooms concluded: “the use of magic mushrooms is relatively safe as only few and relatively mild adverse effects have been reported” (287). In fact, there has never been any conclusive evidence of any fatalities despite ingestion of dosages vastly exceeding the effective amounts. They are also non-addictive.
That said, there is a risk of taking too much, and this can lead to a very disturbing “bad trip”. A recent survey of 2,000 people who had had bad trips before revealed that 39% rated this particular experience as being in the top 5 most challenging experiences in their lifetime (288). But despite this 84% of the people responding to this survey reported benefiting from the experience. With 76% reporting increased well-being and life satisfaction. Of those that had this experience within 1 year, 7.6% sought treatment for enduring psychological symptoms.
Now there are a few caveats here; this survey wasn’t about a user’s best experience or even an average experience; this was their worst experience using magic mushrooms. So it’s impressive that 84% still felt it was a beneficial experience.
This survey highlights a worst case scenario for magic mushrooms. Respondents reported that taking too much, lack of social support and lack of physical comfort were all factors that increased the likelihood of having a bad trip.
So while mushrooms aren’t without risks, they’re far safer than depression. If they can help, then it’s worth looking at.
So let’s look at what studies have shown in depression.
One study showed that those that have used mushrooms in the past were significantly less likely to have experienced psychological distress in the past month or suicidal thinking in the past year (290). Another recent study looked at cancer patients with symptoms of depression and anxiety. Each of the 51 patients was given 2 dosages of psilocybin (the active ingredient in magic mushrooms) (291). They were split into two groups, one received a low amount of psilocybin and then 5 weeks later a high dose. The other group received the high dosage and then 5 weeks later the low dosage.
In both groups, 80% showed a clinically significant decrease in depressed mood and anxiety after 6 months. Quality of life, life meaning and optimism were all improved. There were no serious adverse events recorded.
What’s more, each patient was given a depression test 5 weeks after the first dosage, then again 6 months later. The most impressive results were seen from the high dose first group, where 92% saw their depression scores drop more than 50% after the first dosage. By the 6 month mark, 71% were still in remission. They were no longer classed as having depression!
So just 2 dosages of magic mushrooms were enough to have this profound effect! Anxiety levels reacted in similar ways.
Similar results have been shown in a number of other smaller trials in depression (292, 293).
Mushrooms are thought to be effective because psilocybin targets the serotonin receptors in the brain. They probably act as psychological facilitators as well (294).
My Experience With Magic Mushrooms
I’ve taken a small amount of magic mushrooms when I have felt my depression creeping back. When I felt my mood lowering day after day, I took some mushrooms and waited to see what would happen.
The very next day this slow creep into depression wasn’t only halted, it was completely reversed, and I was back to being my happy self again. The effects seem to last several months, and I have since done this another 3 times with pretty extraordinary results. Each time my depression vanishes.
• While not completely free of risk, mushrooms are relatively safe and shouldn’t be disregarded for safety fears.
• One dose of magic mushrooms (psilocybin) has been shown to rapidly reduce depressive symptoms. These reductions are maintained long-term.
• It stimulates the serotonin receptors as well as probably providing positive psychological effects.
• I’ve used mushrooms as a “top up” when I feel my depression coming back. It’s worked extremely well.
• I don’t condone drugs as they can be unpredictable and unless you are experienced, they can be a bit of an unknown. Unfortunately there currently is nowhere official you can go to get treated. And until drug laws are relaxed, there won’t be. So it could be a long wait to do this legitimately.
• This is by no means a recommendation, however, if you do decide to, take a small amount first and wait 2 hours before taking any more and only with a group of experienced friends that you are comfortable with and trust (that is very important).
18. KetamineExpand section…
Ketamine, primarily an anaesthetic and sedative and known for its party drug status, has received a lot of interest as of late for its profound effects as an antidepressant. A recent large-scale study looked into ketamine use and depression. The researchers looked at the statistics in a US government database of over 8 million patients and narrowed down the data to those that used ketamine for pain relief. The goal was to see if mood levels improved from ketamine use (295). 41,000 patient records were found and these were compared to a group that used pain medication other than ketamine. They did this to rule out the fact that pain relief would, by itself, lead to lower depression levels.
After running the numbers they found that the incidence of depression was about 50% less for those using ketamine compared to the group using other pain medications. This is a significant difference.
This study is far from isolated, as there have been upwards of 20 clinical trials on the use of ketamine and depression, all with consistent results (295b, 296, 297, 298). In fact, a review article that looked at all of these studies concluded: “Ketamine has been demonstrated to be rapidly effective and was associated with a significant clinical improvement in depressive symptoms within hours after administration” (299).
The review pointed out that although ketamine produces a rapid and substantial effect (within hours compared to a number of weeks for antidepressants), this seems to taper off quickly, with about two-thirds relapsing within a week.
Ketamine is often very effective in patients who have resisted traditional treatments (so-called, treatment-resistant depression).
In one of these studies, ketamine was given by IV 2 times a week for 2 weeks (300). 69% of participants saw a 50% reduction in symptoms by day 15, and this was sustained for a further 14 days.
Ketamine is thought to work in depression by altering the circadian rhythm (301).
So ketamine seems to be a good way to boost mood levels temporarily, but it seems that this isn’t a long-term solution. It may be a good way to get out of a funk, then to use this grace period of good mood to do other things that would lead to a longer term (and more sustainable) improvement in depression.
It should be noted that although risks of using ketamine are low, prolonged use can lead to significant negative effects in the bladder and kidneys, so further research should be done on the negative effects if you are considering trying it. The risk of addiction to ketamine is low but is always a concern if you are considering trying it. Risks increase considerably if it’s used long term and/or at high doses (neither of which are recommended).
• Ketamine is a well-studied, highly effective and rapid anti-depressant.
• As effects are short lived, it’s probably best used temporarily to give a window of good mood and motivation to try other more sustainable anti-depressant strategies.
• It’s thought to help by altering the circadian rhythm.
• Ketamine can be prescribed off-label in the USA, and there are even ketamine clinics that people can go to. Google to find one near you.
• If that doesn’t work, find a dark alley and ask for Joe.
• That last one was a joke.
19. Let’s Heat Things up a BitExpand section…
If you’ve ever had a long hot sauna, you’re probably familiar with the exhilarating feeling after you get out. You feel euphoric, have more energy and just, well, glow. As it turns out, heating the whole body has been shown in a number of studies to improve mood.
The earliest study was done on cancer patients with poor mood in 1991 (302). They recruited 10 people and heated their bodies for 60 minutes.
Their mood states were in line with those with depression at the beginning of the study. When surveyed again several hours after the heat treatment, their mood levels had improved by about 75%. They were surveyed every day for 3 days after and while depression levels did increase slightly in the 2 days following, by the third day it was back to 75% improvement. The participants also felt significantly less angry and tense at the end of the study.
Not bad for only an hour of heat treatment.
A second study published in 2013 looked at heat therapy on 16 patients with major depression (303). After just a single session, the researchers noticed that it “induced a rapid, robust and sustained reduction in depressive symptoms”. This lasted 5 days after the treatment. Depressive scores dropped 35%.
A final study in 2016 took 29 people with major depression and split them into two groups (304). The first received whole body heating, and the second were given a “sham” treatment designed to make them think they were being treated even though they weren’t.
After the first week, depressive scores dropped by 29% in the heat treated group, versus only 8% in the sham group. For the heat-treated group, scores continued to improve for the first 2 weeks, then held steady until week 6 where they ended up 40% lower than when they started. The sham group also improved, but not nearly as much (24%). Remember, this was after just one session of whole body heating.
The authors concluded: “[Whole-body heating] holds promise as a safe, rapid-acting, antidepressant modality with a prolonged therapeutic benefit.” Translation: hitting up a sauna can improve your mood quickly, safely and for an extended length of time.
• Heat therapy is a safe, highly effective and long-lasting treatment for depression.
• Purchase a body thermometer.
• Jump in a sauna and get your body temp to 38.5 degrees.
• For safety, take a friend.
19. ExerciseExpand section…
A number of different trials have shown that exercise is an effective treatment for depression. One study took 156 people and separated them into 3 groups: (i) exercise alone, (ii) exercise and an antidepressant and (iii) antidepressants alone (305).
After 4 months, 60% in the exercise group and 68.8% in the exercise + medication group went into remission. After another 6 months, an impressive 92% of those who went into remission were still going strong in the exercise only group. While only 62% of the medication only group, and 69% in the combination group maintained their improvement. So after 10 months, exercise was far and away superior to even exercise + antidepressants; indicating that antidepressants may have negatively affected their recovery.
For every 50 minute increase in exercise per week, there was a 50% reduction in depressive scores.
Another (small) study published in 2007 reported an astounding 87.5% remission rate from their 8-week exercise study with high-frequency aerobic exercise (306).
These two studies have been backed up by a 2016 meta-analysis that looked at all of the previous studies (25 trials) (307). They concluded: “Exercise has a large and significant antidepressant effect in people with depression” and “our data strongly support the claim that exercise is an evidence-based treatment for depression.”
So exercise works great. It’s also been shown that the worse the depression, the better the response to exercise (308, 309, 310), the more exercise the more benefit (305, 309) and that exercise can produce significant and sustained anti-depressant effects immediately and up to 24 hours after the exercise (310, 311).
Exercise seems to work in a number of ways in depression:
● Exercise has proven anti-inflammatory effects (312, 313).
● Exercise tends to provide a sense of empowerment, achievement and self-esteem.
● It protects against stressful events and may protect against circadian rhythm disruption (314, 315).
Exercise is also a potent rumination breaker, along with meditation, which just so happens to be our next topic.
• Exercise has been proven as a very effective anti-depressant therapy in multiple studies.
• It lowers inflammation, increases resilience to stress, provide psychological benefits and may protect against circadian rhythm disruption.
• Build up to 3x 30-minute session of anaerobic exercise a week. Examples of anaerobic exercise are swimming, cardio machines, running, brisk walking, hiking, dancing, etc.
• Try to keep your exertion moderate in intensity.
• Add a social component like a team sport to increase compliance and social interaction.
• Exercise in the mornings, and you’ve got a triple threat of exercise, socialisation and light from the sun. Win!
20. MeditationExpand section…
11 PM on a Monday night.
I was deep in a depressive episode. It was engulfing me completely. Making me feel helpless, unloved, and worthless. I just wanted to cry. But I couldn’t manage even that. Depression had taken even that from me.
I was in my room on this particular night. My mood was as low as it got. All I wanted to do was hide from the world, and that’s what I was trying to do. Thinking back on that night is interesting actually. I only remember it in black and white. No colour.
This night was all too familiar to me, unfortunately, as I’d gone through it countless times before.
But tonight was different. I don’t know why but I suddenly had the urge to move, to get away from where I was. Away from the bad energy.
I got in my car and drove to my favourite place, my local beach. It’s there that I did something I had only done once before. I sat with my legs crossed, I closed my eyes and started to study the different physical feelings that were affecting my body then and there.
The cool breeze that was hitting my face, the sound of the waves crashing not far from me, the feeling of my feet on the sand, and my hands on my knees.
I slowly cycled through everything that I could feel and hear. After just 10-minutes, like a spell had been broken, my mind cleared and my depression vanished completely. It had never done that before.
That night I learnt the power of meditation. 10 minutes is all it had taken me to divert my brain’s course away from depression and back to happiness. It was incredible.
So what’s it all about?
Well when you hear the word meditation, you’d be forgiven for conjuring up an image of a long-haired hippy sitting on a hemp blanket, strumming his free range guitar and wearing tofu pants (no that’s not an actually thing).
And indeed it does a have a slight whiff of that, but at the same time it’s a pretty powerful tool with a lot of scientific research behind it, and its used in depression to great effect.
In one study, 10 weeks of meditation saw an almost 50% reduction in depressive symptoms from those classified as severely depressed. Those classified as moderately depressed saw their ratings go down by 30.5% (316).
Another study showed that a mindfulness-based cognitive therapy over 8 weeks dropped depression levels by 37% on average and 29% went into remission (317). This was backed up by a meta-analysis that looked at 39 studies with 1,140 participants. They concluded that mindfulness-based therapy is a promising treatment for anxiety and depression (318).
This same therapy was used in recovered depressed people to see if relapse could be avoided for longer periods than normal. The results show that it significantly increased the time before the average person relapsed, and decreased the number that did (319). This was backed up by a meta-analysis of 6 studies with 593 patients. They found that mindfulness-based cognitive therapy led to a 34% reduction in relapse (320).
Meditation has been shown to be a potent rumination breaker. As we saw before, rumination often initiates a cruel depressive cycle where a little bit of rumination leads to a lowered mood, which leads to more rumination which leads to more depressed mood. And so on until you’re at rock bottom. The great thing about meditation is that it can halt this cycle and potentially help you to avoid a depressive episode completely.
Meditation’s ability to act in this way has been shown in 2 different studies (321, 322), and a final one where meditation was paired with exercise (323). All three studies showed significantly lower levels of rumination.
So we know meditation works. But how does it work?
Apart from being a great rumination breaker, meditation surprisingly enough has been shown to lower inflammatory markers. This has been shown in a recent study that measured inflammatory levels before and after a mindfulness meditation program (324).
There is also evidence that meditation influences different areas of the brain that are abnormal in depression, and that these regions may influence neurotransmitter synthesis. Meditation also provides a number of psychological benefits.
• Meditation is an effective way to calm the mind and override negative thoughts.
• It can be used to shorten or prevent a depressive episode.
• Meditation has short and long term effects.
• It’s a great rumination breaker.
• Try to meditate once per day. Ideally you want to get into a routine and do it at the same time every day.
• Download the app Headspace and give their 10-day free trial a go. Or search Youtube for guided meditations.
• Meditate in the morning in the sun for the added benefit of light therapy and vitamin D.
• Seek out a mindfulness-based cognitive practitioner near you (Google).
• If you feel a depressive episode coming on, then do a 10-minute meditation and see if you can bring yourself out before it starts.
22. BotoxExpand section…
This one is going to sound strange, but there have been a few studies which looked at Botox (yep the same stuff used to treat wrinkles) and depression. This discovery was based on anecdotes that doctors were hearing from depressed patients who felt better after they had their wrinkles treated with the cosmetic drug.
In a study looking at over 8 million patient files in the USA (same study done on ketamine from above), it was found that those that had been treated with Botox were far less likely to report depressive symptoms (295).
Another study took 30 patients and split them into 2 groups (325). One received Botox on their forehead, and the other received saline. The results were pretty interesting. The depression ratings in the Botox group were an astonishing 47% lower 6 weeks after the treatment.
The idea behind this phenomenon is called facial feedback, wherein our facial expressions don’t only display our emotions but also influence them. In other words, if you’re feeling sad, just the act of forcing a smile will actually lead you to feeling a bit happier.
You can experience the same thing by simply putting a pencil or pen horizontally between your teeth. Multiple studies have shown that this leads to a little boost in mood.
So rather strange, but hey worth a try right? Worst case scenario you smooth out your wrinkles and look younger.
Note: one of the authors of the above study received funding from Allegra, the producer of Botox.
• Botox has impressive anti-depressant effects in a few small trials.
• Seems to work by overriding facial feedback – making you happier because you can’t frown.
• I’m not going to tell you to get botox, but this is an option if you’ve tried all the rest.
• The location of the botox matters a great deal. Trials used botox in the glabellar region.
General Tips to Get You Through Depression
How To Beat Rumination
If we can stop the rumination cycle, then we can pull ourselves out of a dive into depression. Fixing the problem before it happens. Here are some simple steps to take:
1. Keep an eye on what events, thoughts or environments lead to a rumination or depressive episode, journal these if possible. Either remove these triggers or be extra vigilant when they appear.
2. When something happens and you think it might lead to a depressive episode, or you can feel that you are starting to ruminate, then meditate or exercise (or both). This will kick your brain out of the cycle.
Find purpose in your life. Find a project to work on. Something to throw yourself into and keep busy. A distracted mind is more resistant to depression.
When you have a mission in life, something that you can give to the world then everything makes more sense. Mine is to translate and communicate the latest research in health and nutrition to people, so they can take control of their lives, and not rely on a broken system. Mark Manson has some epic advice as far as this stuff goes: https://markmanson.net/life-purpose.
Depression pushes us away from people. We even saw this in the mice with the sulforaphane study. It’s something that depression does to us. It’s just another way this cruel disease works. But if we fight it, we can gain an edge over depression.
And I know that this is something that I couldn’t do at the height of my depression, but if you’re stronger than me then actively seek out social situations with friends and family. Research has shown this can help your symptoms (326). If your depression waxes and wanes like mine did, then try to make future plans to socialise when you feel good. You’ll force yourself to get out there more often.
Do something nice for someone else
While not specifically studied in depression, time and time again altruism is associated with happiness (327). So do something nice for someone else and see how you feel. It’s not going to cure you, but it may make you feel better.
Minimise News and Social Media Exposure
Listen to the news and you’d be forgiven for thinking that the world is falling apart but overall the world is becoming a safer, better place. The news is there to entertain you as much as inform you (maybe more), and what grabs attention more than anything? Bad news.
Have a think about it, when was the last time you watched the news and were actually presented with anything actionable? Chances are it’s been a very long time. If it’s important, people will tell you about it. Otherwise, it’s just an endless stream of negativity getting you down (328).
Social media is similar, but for different reasons. Because of the way the algorithms work on social media, we see the most popular posts from all of our “friends”; which invariably end up being a highlight of that person’s life. Say you have 500 friends on Facebook, each one of those friends only posts the highlights of their life, and it seems your life really sucks compared to all the awesome stuff they’ve got on.
But we don’t sit down and think about this logically, and so it makes us depressed instead. One study showed that those who checked their social media the most, compared to the least, were on average 270% more likely to be depressed (329).
So try to avoid social media and the news for a week and see how you feel.
If carbohydrate intake is too low (less than 100gm/day) then mood may suffer (330). So if you are on a low carb diet and find your mood suffering, then this could be why.
Fat intake, if too low, can also lead to depression. This was highlighted in a study that showed mood levels dropped after people were put on a low-fat diet (331). Low-fat, in this case, meant lower than 25% of calories. Don’t go too low.
Smoking is highly associated with depression (more than twice the risk) (332), likely because of its effects on inflammation. Try to quit if possible. Use the staggered commitment technique where you slowly decrease the amount you smoke every week. So if you smoke 10 cigarettes a day, go for 9 until this becomes normal for you. Then move to 8, then 7 and so on. Each time only dropping down after you get used to the new level. This strategy can be used with nicotine patches as well.
If you really don’t want to give up smoking e-cigarettes are far less harmful than normal cigarettes (333). Still not good for you, but best to use the better alternative if you are going to smoke.
Research has shown an association between contraceptive use and depression. One study found a 170% increase in depression likelihood for those using combined oral contraceptives relative to those who never use contraceptives (334). Consider seeking other methods of contraceptives and see if this helps.
Certain genes can make you more prone to depression (and other diseases). You need to get a gene test to find out. I’ve used 23andme.com before and it’s very reasonably priced. I found out I’m an MTHFR carrier which means my needs for folate are increased. It also means I’m at a greater risk of depression. But because I found this out, it means that I can increase the folate in my diet and cancel out any negative effects that may have otherwise arisen later in life.
If you have your genes sequenced then you can make decisions like this. I recommend anyone interested to do this.
Using Placebo Power to Treat YourselfExpand section…
And while I’m going to leave that discussion to them, I will put forward an idea of my own.
If you take something and you feel better, then it really doesn’t matter if it was the actual compound or your brain’s expectation that led to your improvement in mood. This is depression; if you feel better, then you are better. End of story.
Whatever you tried EITHER changed your brain physically OR your brain did it for you via the placebo effect. Win-win really.
This is what I’ve done with my condition for years, I try everything one at a time and see what effect it has on me. I use myself as a 1 person clinical trial, if I notice a difference, then it works for me and I’ll keep doing/taking it. If not I ditch it and go to the next thing.
So here are the rules:
- Do yourself no harm. This is the more important rule.
- Choose interventions based on which has the most evidence behind it: don’t try a low evidence intervention in favour of one with good evidence, even if it’s a pharmaceutical.
- Don’t spend a fortune on it.
That’s it. That’s how you take advantage of one of the most powerful phenomena in the human body.
• The placebo effect is incredibly powerful and should be harnessed in your fight against depression.
• If a placebo works and your mood improves, it doesn’t matter if it was an active ingredient or not.
• Try everything that you think will help your depression (or even if you’re doubtful).
• Don’t do yourself harm, don’t use a low evidence intervention in favour of a high evidence one, and don’t spend an arm and a leg.
• Homeopathics are a great way to do this (but try the other things in this article first).
Adjunctive therapies refer to therapies that have been studied and add benefit to conventional antidepressants. This isn’t to say that what we have already looked at won’t work in conjunction with antidepressants, but the following have been specifically studied and found to provide a significant additive benefit (335):
- Omega 3’s
- Vitamin D
- Folinic acid
So if you’re on antidepressants, these are your go-to treatments to enhance the effectiveness of them.
Putting It All Together + Beating Low Motivation
The most sinister side of depression by far isn’t the poor mood but the lack of motivation. You feel completely helpless, you feel alone and you can’t even sum up the motivation to take a walk, let alone something that would help more.
Many of the above treatments help depression via the same biological pathway, inflammation for instance, and so you don’t have to do all of them to see benefit. There’s more than one way to skin a cat.
So what I outlined above may seem overwhelming, but the goal is to make some of these changes eventually. Not overnight.
The best way to climb a mountain isn’t by climbing up the cliff face; it’s by walking around to the other side and focusing on taking one step at a time until you reach the top.
So here are a few tips on how to deal with low motivation.
As one of my favourite authors puts it: action isn’t just the effect of motivation, it’s also the cause of it. In other words, when you take a little bit of action, this leads to more motivation to keep going, and take even more action.
So the key is to take a little tiny step in the right direction every day/week. And this is the important part: aim to do much less than you think you can stick to.
The aim is to spur yourself on with successes early on, which will lead to increased motivation, which will lead to more action, which will eventually lead to big changes in your life.
Another tip is to give self-control to someone else. Make yourself accountable to someone else – giving someone $200 and telling them if you don’t do “X” then they can keep it. Or just tell someone that this is what you want to do. This accountability can help give you motivation.
If your depression ebbs and flows like mine did. Then try to utilise the times/days that you feel better than normal and do some of the recommendations I put forward.
The idea is to just take the first step. Just one. If you can’t find the motivation for the more intense changes (fructose avoidance, exercising regularly, etc.) then start with the changes that require much less energy: omega 3’s, Vitamin D, taking a sauna (probably best bang for your buck treatment), meditation, zinc and magnesium supplements. Once you implement these, it’s only a matter of time until you find some relief. The vicious cycle of depression can be reversed. And so this little bit of improvement will make you feel better, giving you more motivation, and with this motivation, you should be able to make a bigger change, and so it will continue until you bring yourself out of your depression.
Exercising outdoors is one of the best things that you can do. If you can’t face big crowds, then grab a friend and ask them to take a walk with you every couple of days. You will be much more likely to do it if they are there doing it with you. They could probably use the exercise anyway.
Low motivation is one the cruellest parts of depression. It makes us feel hopeless, alone and helpless. Even if you can logically see that something will work (like the things in this article), your mind still adopts a pessimistic attitude and convinces you it won’t work. It’s difficult, but if you take little tiny steps in the right direction, you will see large improvements in no time. The science proves this.
Choose a treatment from what I have discussed that won’t take much time or motivation to do. Like taking a sauna, doing light therapy or buying some magnesium, zinc or omega-3s. Do this for a few days and see how you feel. Each time you adopt something you should feel a bit better and this will give you more motivation to keep going with the more time/effort-intensive treatments. If the treatment you chose didn’t work, then try another one. There’s plenty to choose from.
Helping a Loved One With Depression
If you’re here to help a loved one with their depression, I’ve written a little guide to help you approach it in the best way possible: Helping a Loved One With Depression.
You made it to the end! Congrats!
You’re probably wondering what happened to me after I faced my mortality in that dark and lonely hospital room.
Well, the protocol for this particular deadly infection is to do one hospital admission of IV antibiotics, retest and then readmit the patient if they still test positive for the bacteria. This is done three times. If the bacteria is still present, it’s too late. The treatment shifts to dealing with the bacteria rather than trying to eradicate it.
So after my first 2-week stay in hospital, I had a break and a month later a sputum test was done (tests the bacteria in the lungs). To my dismay, I hadn’t gotten rid of it. I was readmitted to the hospital for another course of harsh IV antibiotics, another 2 weeks. One month after that and I was retested for the bacteria. I tested negative. With cautious optimism, I breathed a sigh of relief.
However, I wasn’t out of the woods just yet. Each time a sample is produced as part of a sputum test, the sample could be from a different part of the lungs, so one test could show negative results while the bacteria is hiding somewhere else.
3 clear tests and they conclude that you’re free.
I had to wait a few weeks between these tests. Agonising weeks.
Test 2 came up negative.
Another few weeks of waiting.
Then finally… Test 3: negative.
I had managed to beat my fate once more.
Today, several years later, I’m still kicking CF’s ass! My lung function (what they use to determine how the disease is progressing) is 103% of a person without my condition. To be able to say that at my age is nothing short of amazing. Read my full story. It’s no guarantee that it will stay that way but I’m living life to the fullest in the meantime
What To Do Now:
If you’ve found this article helpful at all, then please share it on facebook or twitter. 1 in 5 people will suffer from depression in their life. That’s one in 5 people you love. Many suffer in complete silence. I recently shared my experiences with depression and was surprised by the people who reached out and told me of their struggles as well. People who appeared happy and content were secretly hiding their struggle. Because that’s what depression does to people.
So please click on the share button below to spread the word. You never know, it could save someone’s life.
Additionally, if you are in a position to help behind-the-scenes (perhaps you have a blog/magazine, or contacts in the health and wellness industry) and can help spread the word about this article or my mission to help as many people with depression as possible, then please get in touch via my email Jono (at) JonoJames.com (subject: Depression Cause). Depression will take a collective effort to beat and I’m so grateful to anyone who joins my cause.
Did I miss anything? Has something helped you in your fight against depression? Leave a comment below.
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