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Taking Depression Seriously: Why healthy living matters

In the seventh post in the series Taking Depression Seriously, Sophia Xiao and physician Randall Stafford outline how healthy behaviors can lessen symptoms.

Improving health habits is an emerging strategy for treating depression. Shifting to healthier lifestyle behaviors can improve the effectiveness of anti-depressant medications and talk therapy or can even be used alone to treat mild depression.

Let's consider Ms. C., the 55-year-old former salon owner we introduced earlier. When first diagnosed with depression, the medication she was initially prescribed had too many side effects, and she stopped taking it. She also had difficulty finding a talk therapist who fit her needs. So, she turned to exercise, an improved diet, and meditation to cope with her depression. For Ms. C., regaining confidence in her own physical abilities helped her regain confidence in other aspects of her life. Meditation also cleared her mind and reduced her negative thoughts, emotions, and anxiety.

Everyone responds to treatments differently, and optimal therapy usually involves multiple approaches. Some people find talk therapy or medications most effective, while others like Ms. C. respond well to lifestyle changes. Regardless of individual responses, healthy habits can reduce depression symptoms.

Let's review the benefits of different lifestyle changes and ways to start implementing them.

Diet

New evidence suggests that poor dietary choice and metabolic problems are risk factors for depression, though the exact mechanisms are unknown. Eating balanced meals is key -- incorporating vegetables, fruits, whole grains, lean meats, fish, and drinking plenty of water. A great resource for determining ideal serving sizes is available at choosemyplate.gov.

Cutting down on caffeine and alcohol is also useful. Reducing intake of sugary beverages may be especially advantageous. A single serving of soda or fruit juice has more than double the amount of sugar recommended daily. To start: focus on one less healthy food group -- such as sugar-containing beverages -- and gradually reduce intake, while finding healthier -- water or sparkling water -- alternatives.

Physical activity

Physical activity can make a difference in depression, and for milder depression, exercise alone may be a reasonable alternative to medication and/or talk therapy. Regular exercise is associated with improved sleep, and reduced stress and anxiety, resulting in a lower risk of depression, according to Stanford internist Randall Stafford, MD, PhD.

By elevating mood, increasing self-esteem, and enhancing body image, exercise can improve depression symptoms. Finally, exercise and many other healthy habits reduce systemic inflammation in the body, which is associated with depression and many chronic diseases.

Guidelines recommend that adults get at least 150 minutes per week of a moderate-intensity activity (brisk walking) or 75 minutes of vigorous-intensity activity (jogging). Other forms of physical activity that incorporate mindfulness, like yoga and tai chi, are also effective. As with any health habit change, start slow and ramp up gradually.

Meditation, mindfulness, and stress reduction

Meditation and mindfulness-based stress reduction (MBSR) can improve mood. MBSR is generally an eight to 10-week program of training in mindfulness meditation practice, mindful awareness during activities (like yoga or other forms of exercise), and mindfulness during stressful situations and social interaction. Stress can make depression and anxiety worse, so identifying areas that cause high stress and learning strategies to minimize their negative impact can bring more control and calm.

Other aspects of healthy living

Healthy weight loss can be valuable for managing depression because it improves metabolism and can also heighten self-esteem.

Poor sleep has also been shown to affect mood and make depression more likely. Practicing healthy sleep habits, like avoiding screens before bed, making your sleep area dark and quiet, not having caffeine at night, setting a consistent sleep schedule, and getting at least seven hours of sleep per night can be beneficial.

Social support often improves symptoms of depression, and maintaining regular contact with friends and family, taking classes, volunteering, or finding other ways to stay connected with people can reduce isolation.

While medicine and talk therapy are vital to treating depression, cultivating better health habits can help promote and sustain a better mood. Working to improve diet, physical activity, weight, sleep, stress, and social support can make you feel significantly better.

This is the seventh in a series of blog posts, Taking Depression Seriously, that aims to help patients and family members better understand depression as a chronic disease and more successfully navigate the health care system. The next blog will focus on common conditions that co-occur with depression.

Sophia Xiao is a masters degree student in Community Health and Prevention Research at Stanford University. She studies barriers to health care and the role of public health education in improving access to care. Stanford professor and primary care physician Randall Stafford, MD, PhD, studies strategies to improve chronic disease treatment, including increasing the role of patients in their health care.

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