Depression Tip: Mark Your Calendar

By Dr. Nicole Sundene

Did you take your anti-depressant today?

Did you take it yesterday and the day before that?

Can you even remember?

Depression can create such a fog that we can’t remember what we did yesterday, let alone if we took our anti-depressant.

Oftentimes patients are having unnecessary mood swings because they either:

A. Are so depressed they can’t even take it for whatever reason.

Or

B. “I’m feeling better, so I just take it when I feel like I need it.”

Now both of these scenarios can be improved upon with a little organization. Let’s mark our calenders!

First of all, if you fall in category A, you need to talk to your doctor about a more aggressive treatment plan. If you fall in to category B, you need to remember that regardless if you are taking natural or prescription meds for depression, that overall you will feel better with consistency, and consistency means marking the calendar and taking the prescribed supplements or drugs DAILY.

The problem with this inconsistent paradigm of thinking is that most antidepressants have a half life of several days, so they tend to stay in your system even if you aren’t taking them. If you feel fine one day and decide to skip it, it this choice likely won’t have a significant impact until the drug cycles out of your system several days later, when you are depressed, taking your anti-depressant, and waiting for it to “kick in” again.

If you are feeling better, you can talk to your doctor about decreasing your prescription meds. Maybe you just need a half dose. Or maybe it is time to titrate off them and try some natural medicines for depression as I discussed in my article “The Nine Best Natural Medicines for Depression” to help provide simple depression prevention, aka daily maintenance.

St.John’s Wort was shown to be just as efficacious as standard anti-depressants, yet with fewer side effects (be cautious when combining with MANY prescription drugs though, as the drug metabolizes them at a faster rate…esp birth control pills, be careful unless you want to name your kid John.)

I know you are depressed, so give yourself a sticker for sticking to your regime consistently, everything feels like a chore when depressed.

Mark it on the calendar, or find your own system, but by all means make sure you are taking a second to keep track of your depression meds. The best way to stay out of the hole is to make sure there is not a hole in your preventive plan for depression.

Read More: Depression Category.

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What is Depression?

“If I’m such a legend, why am I so lonely?”  – Judy Garland
By KC Kelly, Ph.D., LMHC

Everyone feels down and sad, probably more often than they would like. The stressors of everyday life in our busy, hectic world make feeling this way very common. If, however, you have feelings of hopelessness and helplessness more often than not, you do not know why you are feeling this way, and can not seem to pull yourself out of it to the point where it affects your everyday life, you may be suffering with clinical depression.

Depression is a serious medical condition that effects both the mind AND the body. Many of the symptoms of depression are mental, but because the mind and body are connected, many physical symptoms appear as well.

Depression can be all encompassing causing great lifestyle changes. A person suffering with depression may have difficulties at work, difficulties at school, difficulties with professional and person relationships, and may not even want to leave his or her bed. They have extremely low self esteem and think the worst of themselves in all aspects. They tend to isolate themselves from everyone and everything around them and may even feel as though there is no hope and no reason to live.

What Depression IS

• The leading cause of substance abuse (either drugs or alcohol) as well as suicide.
• A mental condition that can strike anyone of any age, race, gender, or ethnicity.
• A very treatable condition given the proper therapeutic intervention and/or medication.

What Depression IS NOT

• A condition to be taken lightly.
• A sign of personal weakness.
• The fault of the person suffering.

Symptoms of Depression Include

• Sadness, feeling low or blue, irritability.
• Feelings of hopelessness, helplessness, worthlessness.
• Difficulty concentrating.
• Changes in appetite including overeating or under eating.
• Difficulty sleeping.
• Feelings of fatigue.
• Persistent physical symptoms such as headaches, digestive difficulties, chronic pain.
• Thought of death or suicide.
• Suicidal attempts.

Statistical information reported on this page was obtained from The National Institute of Mental Health

If you think you may be suffering with any of these symptoms, or would just like to talk with a professional in a caring and completely confidential way, you can visit Dr. KC at www.DOCintheBiz.com where you will be able to email her for private and confidential help from your own home! You will never be made to leave your house or comfort zone.

Read more articles on depression

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Seasonal Affective Disorder (SAD) Self Help

“Hi Dr. Nicole, my depression is much worse this time of year.  What do you recommend?”

Immediately after the holidays is a great time to have a nervous breakdown…er…”nervous breakthrough.”

We tend to feel even more agitated and moody this time of year especially now that all the excitement of the holidays have died down and there isn’t much to distract us from the winter blahs.

We are also all feeling about ten pounds over weight after likely losing the battle of the holiday bulge.

Whether you just have depression during the winter months, or whether you struggle with depression all year round that is exacerbated by the low light conditions of winter; having a plan in place to better cope with the realities of winter depression is an important preventative measure.

My last name serves as a convenient mnemonic to help remember how to take care of yourself throughout the winter months…

The Sundene Protocol for Seasonal Affective Disorder

• Sun- for Sunshine or Sun Equivalent
• D- for vitamin D
• E- for Exercise
• N- for Nutrition
• E- for Everything else. SAD can have debilitating consequences. If you struggle with depression, be sure to share this plan with the family and friends on your “support team” so that if you find yourself in an excessively dark and gloomy place this winter you can easily get some help to pull you out of the “hole”.  Consult with a physician before self treating with natural anti-depressants or natural anxiety aids.

Although severe depression should also improve with this protocol, those experiencing moderate to severe depression should ALWAYS be working with their health care provider. Anyone experiencing thoughts of suicide should be under the supervision of a physician.

The following are the basics for my protocol for seasonal depression.

“Sun” – We need 10,000 lux of light every day in order to produce enough serotonin to feel happy. This can be achieved by 15 minutes outside on a bright blue sky sunny day, or 1 hour outside when it is overcast. You may wonder “What in the world is a lux?” A lux is the light equivalent put off by one candle. So you can light 10,000 candles in your home to cheer yourself up (a bit of a fire hazard!) or you can just invest in a light box.

A light box is an excellent idea for those with seasonal depression and is best used for twenty to forty minutes in the morning depending on the manufacturer’s recommendations to achieve the 10,000 lux equivalent.If you are unable to afford a light box you can simply try full spectrum light bulbs as these often provide enough light for those with mild to moderate seasonal depression.

Keep in mind also that outdoor places near water or snow are great to visit during the gloomy months of winter as the light is intensified as it is reflected back up to our eyes. If you are concerned about protecting your eyes from UV radiation, you can buy sunglasses with a clear lens, but that still provide UV filtration as it is the actual photons of light that our brains use and not the UV radiation to produce serotonin.

Those struggling with seasonal depression need to make an appointment with the sun or the sun’s substitute every single day. Topping off your serotonin levels by day means that more of this neurotransmitter will be available for conversion to melatonin (the hormone that keeps us asleep at night). Using light as a medicine should easily improve your sleep, leaving you more energetic for the following day.

“D” -Vitamin D is no longer considered a vitamin, but a “pro-hormone”. Exciting research about vitamin D is on the horizon, and some evidence supports a link to depression, although some studies do not support this link. Just about every patient I have ever checked in Seattle has been vitamin D deficient.

Vitamin D is produced in our bodies when UV light touches our skin. Most people living in the northern latitudes are easily vitamin D deficient if they do not spend 20 minutes outside each day. Elderly people have thinner skin, and thus produce less vitamin D, they also absorb less dietarily. Until further evidence supports this theory linking depression with low vitamin D levels, it only makes sense to be sure that you are at least not deficient in vitamin D.

The RDA for adults ranges between 200 IU and 600 IU. Food sources of vitamin D are milk, fish, and yeast. I typically recommend 1000 IU of vitamin D for my patients struggling with depression as a cheap and easy insurance policy that they are not deficient in vitamin D.

If you would like to have your levels checked be sure that your physician orders the “25-OH-D” as that is the most reliable indicator of vitamin D stores. Do not ever exceed 1000 IU of vitamin D unless under the care of your naturopathic physician. Dangerous side effects such as hypercalcemia can occur.

“E” -Exercise- is the drug of choice for anyone that is depressed. It is a tough medication to take though when depressed because as best summed up by Newton’s laws of motion: “An object at rest stays at rest until acted upon by another force.”

When you are down in the depressed hole it is tough to get exercising, but stagnation is just going to perpetuate your problem.

Countless studies support the efficacy of exercise for depression. If you struggle with seasonal depression be sure to try to exercise outside EVERY SINGLE TIME the sun is out! Find a walking, running, or cycling buddy and take turns pushing each other out there. Whatever you do…just keep moving! Being cramped up in doors during the winter months is the problem and not the solution.

“N” –Nutrition is fundamental for anyone struggling with depression. When the body does not feel good the mind is soon to follow.Depressed thinking often results in poor dietary choices.

When we are depressed and in a low light setting we crave carbohydrates so that the body can produce more serotonin. However, sugar is exactly what the body does not need in the long term for healing from depression. The best diet for those with depression, anxiety, and bi-polar to follow is the LOW GLYCEMIC INDEX DIET.

Balancing out the blood sugar will help keep the mood at an even keel throughout the day. Be sure to eat protein with every meal and especially foods high in tryptophan such as turkey, cottage cheese, peanuts, fish, eggs, oatmeal, avocados, and bananas.

A high quality multi-vitamin will cover all the bases and ensure that you are not deficient in any of the B vitamins that are coenzymes for producing the neurotransmitters that make us feel happy.

“E” -For Everything Else, such as “Herbal Sedatives.” There are many treatment options for depression. Please do not give up hope.

Counseling, herbs, amino acids, and of course anti-depressants when need be will help keep you out of the “hole”. Naturopathic treatments for depression often take time as they are addressing the whole person and the long term.

As a physician, I give every treatment plan three to six months to determine it’s efficacy. If you are not experiencing improvement you may want to consider other treatment options. Various counseling and therapy techniques are also available, if you find you are not making progress with your therapist, consider a new referral for a different type of therapy.

Remember that aside from physical and mental components, there is also a social component to seasonal depression. Much time spent inside, or repeatedly with the same people inside can contribute to a poor mood.

Schedule weekly activities to get you out of the house and interacting with others. If you live alone, the winter months can feel especially isolating. Find an elderly person that also lives alone to check in on, it will do you both a world of good.

If you enjoyed this post please feel free to leave a comment, share this information with those that might benefit and subscribe to future articles. Thanks for stopping by my “kitchen table!”

~Dr. Nicole Sundene
Naturopathic Physician

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The Best Diet for Those with Depression

The term depression has several meanings:

(1) As a human affect, it arises from the disruption of life’s normal balance, usually following a loss, conflict or trauma

(2) It can be a symptom of an underlying medical condition or the side effect of a medication

(3) It’s also a clinical syndrome of varying severity, based on brain chemical (neurotransmitter) disturbances and

(4) Finally, depression can result from any combination of all three processes. The causes are not fully understood, but are many and varied.

Depression affects the entire body. In addition to the more noticeable affects on the nervous system, moods, thoughts and behavior, numerous studies in a field of research known as psychoneuroimmunology have shown that depression affects the functioning of every type of body cell. Immune functioning, allergies, bone density, cardiac and vascular functioning, endocrine balance, digestion, fertility, ageing and longevity—any and all aspects of our physiology are inextricably tied to our mental, emotional and spiritual health (or lack of).

People from all walks of life and of all ages suffer from depression and its prevalence seems to be increasing. It’s estimated that 5-12% of men and 10-20% of women in the U.S. will suffer from a major depressive episode at some time in their life. The percentage of teenagers diagnosed with clinical depression has increased five-fold over the past forty years.

Symptoms of depression typically include chronic fatigue, sleep disturbances, changes in appetite, headaches, backaches, digestive problems, irritability, loss of interest or pleasure in everything in general and feelings of worthlessness or inadequacy. Commonly there can be a preoccupation with death that sometimes results in suicidal ideation and/or attempts. Treatment options vary widely, though any given treatment does not necessarily work for everyone.

The Role of Diet in Depression
Diet greatly influences the brain’s behavior. The levels of brain chemicals known as neurotransmitters, which regulate our behavior and are closely linked to mood, are controlled by what we eat. The neurotransmitters most commonly associated with mood are dopamine, serotonin and norepinephrine. Deficiencies, excesses or imbalances of these cause mental and emotional disturbances and affect our perception of pain and pleasure. Neurotransmitters carry electrochemical impulses between cells. Serotonin plays a role in mood, sleep, relaxation and appetite. Dopamine and norepinephrine play a role in hunger, thirst, digestion, blood pressure regulation, heart rate, respiration, thermoregulation, aggression and sexuality.

Adequate protein consumption and absorption (requiring proper digestion) is essential in order to have enough precursor amino acid building blocks in order to synthesize any neurotransmitters. Their production also requires nutrients such as fatty acids, Vitamin B3, iron, folate, Vitamin B6, copper, calcium, magnesium and lecithin, among others. The absorption of precursor amino acids depends on the consumption of adequate complex carbohydrates.

Note: The dietary recommendations and guidelines below include foods to which some individuals may have allergies, intolerances and sensitivities. In those cases, those foods should be avoided. Persons taking medications should not consume any of the herbal teas described without first consulting your physician/clinician regarding potential interactions. Dietary choices should be modified to meet your personal dietary needs. Consult your physician/clinician for further information regarding nutrition and your individual medical condition.

Dietary Recommendations and Guidelines

• Avoid sugar and both artificial and natural sweeteners of all types, even honey, molasses and fruit juice. Stevia is an acceptable “sweetener”.
• Avoid alcohol, caffeine and soft drinks.
• Avoid junk food, processed and refined foods, foods high in saturated fats or hydrogenated (trans) fats. Healthy fat choices include polyunsaturated and monounsaturated fats and oils that are organic and cold-pressed.
• Identify and eliminate food allergies, intolerances and sensitivities. Gluten found in some grains has been linked to depressive disorders. Gluten-containing grains include wheat, spelt, rye, triticale, oats, barley and kamut.
• Eat adequate lean sources of protein (0.8 g/kg body weight daily). Emphasize wild, cold-water fish (salmon, halibut, mackerel, etc.), legumes, nuts and seeds. Organically raised poultry and eggs are also good protein sources. Fermented dairy products are also acceptable (yogurt, kefir, cheeses, etc.)
• Every meal and snack should be balanced, containing some protein, fat and complex carbohydrates.
• Food choices should be whole foods (unprocessed and unrefined), organic whenever possible, including at least five servings daily of vegetables and fruits. Grains should be whole and unrefined, especially rice, corn, quinoa, millet and amaranth. Fresh food is always preferable to frozen and frozen is always preferable to canned.

Note: In addition to dietary interventions, adequate daily exercise, sleep, full-spectrum lighting and counseling or other mental/emotional support are important factors in reversing depression and are prescribed in conjunction with supplements, botanicals and homeopathy.

Work on things gradually one at a time. Pick the improvements that you can easily make and start with those first. Inform your friends and family that you are trying to eat differently so that you will feel better. Ask for their support while making these changes. Depression is a serious condition that requires support from a physician, counselor, or other qualified therapist. Be sure to check with your health care provider before making any changes to your health care routine to ensure that you get the best care possible.

Resources
Balch, Phyllis and James. Prescriptions for Nutritional Healing, 3rd edition. 2000. Avery.
Brown, Kathleen. Herbal Teas: 101 Nourishing Blends for Daily Health and Vitality. 1999. Storey Books.
Hafen, Brent, et al. Mind/Body Health. 1996. Simon and Schuster.
McIntyre, Anne. Drink To Your Health: Delicious Juices, Teas, Soups and Smoothies That Help You Look and Feel Great. 2000. Gaia Books.

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