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A Holistic Approach for Treating Depression

Using Meditation, Exercise and Other Alternative Therapies to Combat Depression
  -- By Ellen G. Goldman, Certified Wellness Coach
While talking with my client, Dana, as she walked on the treadmill in my home studio, I couldn't help feeling sad. Her usually upbeat and vibrant demeanor was missing—and had been for several weeks.  "I'm so depressed," she stated. "I am tired of feeling sick and can't stand the thought of going to another doctor!"
 
Who could blame her? Two months earlier, Dana had what appeared to be a bout of food poisoning. Weeks later when the constant stomach aches, irritable bowel, and loss of appetite continued, her baffled doctors recommended another battery of tests.
 
Dana had been poked, prodded, examined and tested, and still had no diagnosis. She had little energy living on bananas, toast and turkey, the only foods she was able to stomach. Complaining of exhaustion, sleeping excessively, and not wanting to do much else, she still dragged herself to my studio twice a week for our personal training sessions.
 
As our hour together continued, we swapped stories of other events in our lives, laughed a little, and Dana left a bit more upbeat than she had been when she arrived. I was unaware that she was on her way to temple, to tell her rabbi she was backing out of the volunteer job she loved. She just couldn't muster the strength to concentrate and fulfill her responsibilities.
 
A few days later, Dana told me that her rabbi had listened carefully, and then stated, "Dana, you sound depressed! I want you to go see a friend of mine who is a psychiatrist. You need some professional help."
 
Desperate to feel better, physically and mentally, Dana did make an appointment. The doctor confirmed the diagnosis of depression, started her on low dose antidepressants, and recommended she come for therapy once a week. Luckily, Dana took an immediate liking to this doctor, and trusted her recommendations. 
 
Dana's experience not only got me thinking, but also led me to do some research on depression. I had worked with clinically depressed clients in the past, and had experience helping my father, who battles depression since being diagnosed with Parkinson's disease. In spite of that, I did not recognize the signs in Dana. I truly believed her mood and lack of energy was related to a diet low in calories and nutrients, and the frustration and fatigue that anyone would have from feeling sick for so long.
 
We all tend to throw the statement—"I'm depressed"—around so easily, usually as a reaction to something that's gone wrong in our lives and has us momentarily upset and down. How can we tell the difference between a bad case of the blues and a true diagnosis of clinical depression?
 
There are many signs of depression: loss of energy and interest in the things that we normally enjoy, inability to concentrate, feeling blue all or most of the day, excessive sleep or insomnia, and loss of appetite are some. The tricky part is most of us experience these symptoms from time to time. However, it is the inability to function daily as we normally do, and feeling that way for an extended period of time, that should make us pay more attention. 
 
Causes of depression range from life stressors, insufficient blood flow and oxygen supply to the brain, an altered blood glucose level, hormonal imbalance, food sensitivity or heavy metal toxicity. The first line of defense should be a visit to your doctor to rule out an underlying health problem.
 
Regardless of the cause, we know that medication and therapy are the most common approaches to dealing with depression. Yet, an increased interest in a more holistic approach to managing depression has emerged over the last several years. Lifestyle modifications have been shown to not only treat depression, but also help prevent or lessen the severity of episodes for those who are prone to it, and, in some cases, allow for a decrease in the dosage of medications. 
 
The following ideas are a sampling of complimentary treatments being explored. Nonetheless, true depression is a medical condition, and it requires medical attention and professional help. Discuss these ideas with your healthcare provider, experiment with what seems appealing to you and see if it helps. But they are not meant to persuade you against seeing a licensed health professional. Working with someone you trust is imperative.
 
Exercise and Movement
Exercise has been shown to boost the feel-good brain chemicals endorphins and serotonin. This increase in brain chemicals is similar to those produced by medicine. Elevated levels of cortisol (a stress hormone) are seen in individuals who are depressed, perhaps due to stress and anxiety, which often go hand in hand with depression. Exercise helps reduce cortisol levels, which, when chronically elevated, can cause other health issues.
 
The good news is that it does not require a visit to the gym or a return to your regular routine, which often can feel overwhelming when struggling with depression. Any continuous movement will increase blood flow and oxygen to the brain and can be beneficial. A walk outside, mowing the lawn, gardening or dancing to music can leave you feeling better, calmer and more relaxed.
 
Research on the benefits of exercise is so promising that some therapists are taking their sessions out of the office and combining talk with movement. The combination of walking and being outdoors has shown to be particularly powerful, with patients and doctors reporting more productive sessions.
 
Food and Mood
Nutrition science is exploding with information on how certain foods and nutrients not only affect our health, but our moods as well. When treating depression, a healthy diet that includes whole grains, vegetables and fruits, lean proteins and healthy fats is highly recommended. It is important to keep blood sugar levels steady by eating every few hours, and avoiding processed foods, excessive sugar, alcohol and caffeine for those who are highly sensitive to it.
 
Foods high in Omega 3-fatty acids, folate and vitamin B-12 have shown positive effects for those with depression. Try adding salmon, avocado, walnuts, almonds and enriched breakfast cereals fortified with folic acid to your daily meals.
 
A relatively new field is studying the effect of vitamin deficiencies, food allergies and food sensitivities on depression, mood and brain chemicals. Many dietitians are using elimination diets and blood test screenings to explore how food and mood are related.
 
Supplements
The dietary supplement market is a multi-billion dollar industry, and many claims of alleviating depression may not be backed by scientific research. Even researchers who are unbiased have found results inconsistent and indecisive, although some studies show promise. Anecdotal evidence has shown certain supplements such as fish oil, St. John's Wart, Sam-E and magnesium to be beneficial for treating mild depression. 
 
If you decide you want to investigate the use of supplements as part of your personal treatment plan, do your homework. First and foremost, work with a doctor or naturopath who is knowledgeable. Supplements can interfere with medications, and they are not without side effects. Make an educated decision in conjunction with your physician.
 
Chiropractic Treatments, Acupuncture and Massage Therapy
The research concerning all of these treatments has been inconclusive, but encouraging. Whether or not they can alter the brain chemistry in favor of reducing depressive symptoms is unclear. However, all have been shown to reduce chronic pain due to injury, trauma, muscle tightness, migraines, and back and neck problems. Since living with pain can trigger, accompany or exacerbate depression, it would make sense that anything that reduces pain is worth a try.
 
Chiropractic manipulation, acupuncture and massage have all shown to produce states of relaxation and tension release. This too could be quite helpful for an individual in the throes of depression. Human touch, which occurs with all of these treatments, floods the body with oxytocin, a "bonding hormone" that makes people feel secure and trusting towards each other, lowers cortisol levels and reduces stress. That certainly can help a depressed individual feel less alone and better connected to others.
 
Mindfulness Meditation
A handful of promising research papers are pointing towards mindfulness meditation as an integrative approach to combating depression. Meditation helps regulate attention away from negative thoughts and sensations and rumination, which is a hallmark of depression. Indeed, neuroimaging scans show positive brain chemistry changes in long-term meditators. 
 
Spirituality and Religion
For many, religious affiliation brings security, comfort and peace. If this is a place where you have found joy and serenity in the past, it would be wise to continue to stay connected to your house of worship despite feeling depressed. Prayer can offer moments of tranquility and hopefulness. Most priests and rabbis have schooling in psychology and counseling and make themselves available to parishioners for talk and support. Going to church, temple or synagogue will keep you attached to others and alleviate feelings of isolation.
 
Not all spiritual practices are "religious," so if this is not a direction you lean, there are many other ways to achieve similar feelings of connection. Anything that links you to meaning and purpose in life can be spiritual. For some it is being in nature, or listening to music. If you have a gift such as painting, writing, or playing an instrument, pushing yourself to practice your art for even a few minutes each day can elicit meaningful moments. The practice of meditation, yoga and tai chi can be spiritual for some.
 
Choose Happiness
I know this sounds like a crazy suggestion. When you are depressed, you are anything but happy. And remarks such as, "Think positive. You have so much to be grateful and happy about," although well-meaning, can be outright harmful.
 
That being said, it may help to know that positive psychologists are proving that how happy we are is, to a great degree, within our control. Although 50 percent of our happiness level is related to genetics (and quite often depression runs in families), only 10 percent is related to life circumstances. A whopping 40 percent is within our direct control. There are practices we can do that will increase our happiness and ratio of positive to negative emotions.
 
Learn from the happiness experts; professionals who conduct scientific, evidenced-based research teach us which daily habits foster an increase in our positivity, optimism and ultimately our happiness. 
 
Many of the things already mentioned such as exercise, meditation and spirituality are recommended.  Other proven techniques are keeping a gratitude journal, volunteering and practicing acts of kindness.  Check out a few of the resources mentioned below and do some reading. If the focus and attention needed for reading books is difficult due to you depression, check out YouTube videos of lectures given by many of the same authors. 
 
Create a Support Team
One of the most important components of fighting depression is to not do it alone! Do not feel embarrassed or ashamed. Depression is not a personality flaw; it is an illness. Like any other illness, you should seek help. 
 
First and foremost, find a healthcare provider you like and trust. After visiting your primary care physician and ruling out any underlying medical reasons for depression, ask for referrals to a mental health professional. Get names from your doctor and friends. Talk to a few until you find someone with whom you feel a connection.
 
A consultation with a dietitian can help you develop a "feel good, stay healthy" meal plan. Join or go to your gym, and sign up for some classes. Ask the instructor if he or she would be willing to call you if you don't show up. If budget allows, consider hiring a personal trainer, even if just for a short time. Reach out to family and friends for support, and as much as possible stay connected to others.
 
 
Dana's therapist was surprised and pleased at how quickly her mood began to improve, despite the 4-6 weeks it normally takes for medication to kick in. I saw an amazing difference once she returned from a brief trip to California to visit her brother's family. It was a welcome change in scenery and a place where she felt secure and accepted, no matter what her mood. Our twice-weekly training sessions continued, and Dana committed to including walks with her dog most mornings. Her rabbi convinced her to cut back her hours, but not quit the volunteer job. She found the other women supportive and began to look forward to chatting with the rabbi more often. For her birthday, Dana asked for and received gift certificates for twice-monthly massages, too.
 
If building a team to help you through your depression seems like an expensive proposition, it need not be. Physicians and therapists are covered by most medical insurance plans. If talk-therapy sessions are limited or not covered by your plan, most spiritual leaders offer no-fee counseling. More and more insurance carriers are reimbursing for dietary consultations when recommended by a physician. Even acupuncture is reimbursable under some plans.
 
Having an appointment with a personal trainer could be the push to get you out the door for a workout, but so will knowing your friend is meeting you at the park for a walk. You don't have to belong to a gym to exercise or take yoga or meditation classes; most community centers offer low or no cost exercise and continuing education classes. Libraries are stocked with books to read or on tape for any topic you want to pursue, or videos for you to borrow. Meditation and relaxation programs can be downloaded to your iPod for free or low-cost. Check out your local hospital, too. Many have integrative medicine programs, offering education and treatment for depression and anxiety.
 
A holistic approach just seems to make sense for many people. Not only will it open the doors to a proactive action plan for those who prefer not to go on medicine or cannot due to other medical issues, but it might also help some stop taking medicine that much sooner. Whether continuing meds or not, an integrative approach seems to reduce the likelihood of relapse and will lead the way to a lifelong path of wellness and peace of mind.
 
 
Sources
Ben-Shahar, Tal, 2007. Happier. New York: McGraw Hill.
 
CNN Health, "Supplements for depression: What works, what doesn't," www.cnn.com, accessed on July 2, 2013.
 
Fredrickson, Barbara, 2009. Positivity. New York: Crown Publishers.
 
Help.org, "Depression Treatment," www.helpguide.org, accessed on July 2, 2013.
 
Lyubomirsky, Sonja, 2008. The How of Happiness. New York: Penguin Books.
 
Psychology Today, "Curing Depression with Mindfulness Meditation," www.psychologytoday.com, accessed on July 2, 2013.  
 
Somer, Elizabeth, 1995, 1999. Food and Mood. New York; Henry Holt & Company.
 
The Guardian, "NHS recognizes that mindfulness meditation is good for depression," www.guardian.co.uk, accessed on July 2, 2013.  
 
WebMD, "A Holistic Approach to Treating Depression," www.webmd.com, accessed on July 2, 2013.
 
WebMD, "Walk and Talk Therapy," www.webmd.com, accessed on July 2, 2013.