How Antidepressants Work Part 3: Nonpharmacological Approaches

Last week, in How Antidepressants Work Part II: The Nitty Gritty, we discussed various ways antidepressants impact the brain. This week, we’ll explore nonpharmacological strategies that can also be used to help improve symptoms of depression. These strategies are important because many people have various reservations about antidepressant use and prefer holistic approaches and, of those who do attempt antidepressant treatment, many find that it is only partially successfully, if not totally unsuccessful.

The good news is that there is tremendous research support for the antidepressant effects of various holistic strategies as well! In fact, many of these strategies lead to changes in the brain that are indistinguishable from the benefits associated with antidepressant medication use. For example, remember our friend BDNF (“brain fertilizer”) from Part II? Exercise and talk therapy both lead to similar increases as seen with antidepressant medications! In fact, engaging in these activities while taking antidepressants is thought to have a synergistic effect (in essence, 1 + 1 = 3!).

Express and Explore. Understanding yourself and others is incredibly important for good mental health. The obvious classic opportunity for self-discovery and expression is talk-therapy, but there are numerous approaches that can help inspire personal growth and enhanced coping. Consider attempting any of the following activities in order to encourage expression of difficult thoughts and feelings as well as to develop insight into who we are and what we want out of life. Without this knowledge, we are at the mercy of our immediate responses and are quite limited in terms of our ability to choose and understand our mood and behaviors.

Try it:

1. Contact a local therapist or counseling center (OCLinks and Psychology Today are fantastic resources). If cost or scheduling are prohibitive, consider self-directed approaches such as completing a therapeutic workbook.
   
   
2. Keep a journal. A daily or weekly practice of writing in a stream of consciousness style can provide tremendous insight into the nuances of your thoughts and feelings. Sometimes we are unaware of how much impact a certain experience or a distressing thought is having on our mood; writing helps illuminate these factors and provide us directions in terms of avenues for self-growth.
   
   
3. Make a collage. Looking through magazines or other sources of visual material is another way of accessing our thoughts and feelings and expressing them in such a way as to externalize them from our bodies and minds. Similar to journaling, collages can also provide interesting and informative insights into our personal stories.
   
   
4. Write a letter. To whom and what you do with it afterward depends on your personal journey. Still holding a grudge against your brother for embarrassing you as a child? Write a letter to him expressing all of your thoughts and feelings about it. Don’t want to show it to him? Burn it or save it to review at another time! You might also consider writing a letter to your childhood self, perhaps forgiving him or her for any mistakes made along the way.
   
   
5. Try something new. Engaging in novel activities is another form of exploration that research demonstrates has positive impacts on depression symptoms. Take a new route to work, try a new type of food, consider a different point of view. We never know what we might learn or what might change if we expand our horizons and explore the unknown.

Stay present. Staying present is associated with many positive outcomes. For example, present-minded thinking has been shown to widen our tolerance for uncomfortable thoughts and feelings, which then reduces the need to fight with those thoughts or feelings or do respond to them in an unhealthy manner. When future to-dos and worries invade the present moment, we are robbed of the opportunity to feel calm and peaceful in a moment that is often perfectly ok otherwise! Staying present is also essential for paying attention, a skill that is necessary for making informed personal decisions and engaging successfully in the world. Staying present does not come naturally and often takes a bit of work to accomplish. Try practicing the activities below to develop and benefit from this skill! 

Try it:

1. Mood diary. Notice and make connections about how various factors in your life affect you. Exhausted after a long run? Maybe it’s too much right now. Cranky when you go too many hours between meals? Sounds like you’d benefit from a mid-meal snack. Fight with your spouse every time you drink? When you’re fully aware of the negative consequences associated with certain actions, it can be easier to make choices that support wellness.
   
   
2. Engage in mindfulness exercises. There are numerous approaches to mindfulness and endless resources on this topic. It doesn’t need to be complicated or advanced. Simple exercises can have profound positive effects on wellbeing. Try breathing in for 5 seconds, hold for 3 seconds, and exhale out 7 seconds for a few minutes. Notice how simply paying attention to your breath calms your nervous system and your mind.
   
   
3. Trace a mandalynth. Mandalynths are forms of Celtic art that are often used as mindfulness tools. It’s quite simple. You simply access an image of a mandalynth (there are numerous options available through websites and apps) and then trace it with your finger, stylus, or pen.
   
   
4. Take a mindful walk. It’s just like it sounds, a walk with a particular focus on being present-minded and non-judgmental. The goal is to actively notice your internal thoughts and feelings, while also attending to the external world around you. Notice the roots of the large tree in your neighbor’s yard and the slight variances in colors as you walk along the pavement. When you find yourself distracted, ask yourself to redirect your attention back to your present experience as kindly and gently as possible.
   
   
5. Begin a gratitude practice. One of the best ways to learn to pay attention to the positive aspects of life is to do so consciously and deliberately. Each night before going to bed, write down 1 thing you are grateful for that happened that day. Anything from having a positive interaction with a stranger, to having a bit less traffic than usual on your way home from work is fair game. Consider collecting these or writing them somewhere you see them often (Expo markers work great on glass windows!).

 Move your body (outdoors, if possible). Exercise is so important to overall health and for fighting depression that it gets its own category! Every single day, challenge yourself to move in some way. Each of us is different in terms of what our bodies want or what we enjoy in terms of exercise. Depending on your location, spending time outside may provide additional benefits associated with exposure to daylight and fresh air. The most important thing is that you’re moving, even if it’s just out of bed for a walk around the living room. Do your best and give yourself credit for your efforts!

Try it:

1. Need help unwinding? Consider a restorative or yin yoga class at a local studio.
   
   
2. Used to love dancing? Try a Zumba class.
   
   
3. Nice weather? Join a hiking meet-up group or set time aside for a hike alone or with a friend.
   
   
4. Short on time? Take a 20-minute walk during your lunch break.
   
   
5. Tight budget? Get creative! Even with limited funds in the middle of a freezing winter, exercise is possible. The internet is full of ideas for various ways to stretch and workout with basic supplies at home. Don’t let excuses get the best of your ability to feel better!

Address your overall wellness. Exercise is awesome, but it’s only one component of overall health and wellness. Factors such as diet, water intake, stress management, interpersonal connections, sleep, substance use, and many, many others also impact our health and therefore our mood. Treat yourself the way you want to feel, even if that feels distant or unattainable for now. You may find that your physical body needs more attention than your mind or vice versa; use that insight to direct yourself to the most needed or desired activity for you!

Try it:

1. Aim for a Healthy Mind Platter (thanks, Dan Siegel!). This involves setting time aside each day to engage in activities related to a variety of factors that underlie wellness (exercise, sleep, rest, play, connection, play, and tuning-in). Difficult to find time because of childcare responsibilities? Check out our self-care post for activities you can try with your children to help save time!
   
   
2. Meal plan/prep. Thinking ahead about dietary choices can make a huge difference in terms of the choices we make throughout the week. While it may feel tempting to engage in every craving, people with depression disproportionately crave carbohydrates as an unhealthy and ineffective way of improving mood. Use your best judgment in determining what healthy means for you and your diet. Consider enlisting help from a professional, if needed.
   
   
3. Social support is deeply connected to the experience of wellness and contentment in life. Depending on your personal needs, increasing social support may involve developing new friendships or it may involve deepening relationships with people currently in your life (if so, see our intimacy post for ideas). Reflect on what is missing or could be improved about your social connections and then take active steps to address these factors.
   
   
4. Improve sleep hygiene. You may be in the minority of people and sleep quite well at night, but let’s be honest, most of us struggle in this category. This is a big deal because good quality sleep is absolutely required for long-term wellness! If you aren’t sleeping well, consider doing some independent research or working with a professional to improve this aspect of your quality of life. You might be surprised at how big of a difference good quality sleep can make!
   
   
5. Be honest with yourself about self-destructive activities and consider what steps are necessary to reduce these behaviors and their impact on your life. If needed, reach out for help from a family member, friend, or therapist.

Manage your energy wisely. Your energy is limited, even more so when you’re feeling depressed. It can be really hard to find time for, much less find balance between, self-care and engagement in productive, meaningful pursuits (family, work, hobbies, friends, religion, etc.). The following strategies can help determine how best to allocate your time and manage your energy based on what’s important to you and what is most likely to support your overall wellness and contentment.

Try it:

1. Identify goals and values. These are the two most important factors in your decision-making arsenal. Don’t feel like going to an event? Ask yourself if that event is aligned with your goals (what you want out of life) or your values (what matters to you). If it is, you are taking a big risk in skipping out; if not, consider allowing yourself the option of prioritizing self-care or another more desired activity.
   
   
2. Assess your battery. What types of activities or experiences tend to deplete your energy, and which make you feel recharged? Use this information to provide additional insight into how best to use your time and energy.
   
   
3. Set limits and boundaries. Once you know what matters to you and how various activities affect your energy, it may be time to set limits or boundaries. Don’t sign up for activities that are not linked to your goals or values or that take significantly more energy than you feel it’s worth.
   
   
4. Take it one step at a time. Once you’ve identified goals, it’s important to break them up into bite-size chunks and then decide on an action plan to begin accomplishing the first step. Instead of feeling overwhelmed and paralyzed by the enormity of the tasks involved, little steps are much more manageable and help to maintain focus, motivation, and success. Be gentle with yourself if you fall behind. Tomorrow is a new day; begin again then and leave the past behind you.
   
   
5. Look for inspiration. Feeling like doing nothing but watching TV? Finding it difficult to get yourself moving even though you know it’d be good for you? Consider watching an inspirational TedTalk, reading or listening to a biography of someone you look up to or printing a meaningful quote somewhere you’re likely to see it. Or perhaps there’s someone in your life that you admire or feel encouraged by. Set up a time for lunch or a quick chat over the phone. Sometimes we just need a reminder that hope is possible and that our actions do pay off. Remember, the only way to ensure failure is to give up!