According to the Center for Disease Control (CDC), 7.6% of Americans aged 12 and up are depressed. This number was much higher for females and those between the ages of 40 and 59 years of age. In fact, 12.3% of females between the ages of 40 and 59 are depressed. Of course, this is likely to be smaller than the actual number as this only reflects those who participated in the National Health and Nutrition Examination Survey from 2009 – 2012.
An earlier study from the CDC showed us that of all prescription medications, antidepressants were the third most commonly used by Americans. Even more astonishing is that the rate of antidepressant use in the United States has increased 400% from 1988 – 1994 through the 2005 – 2008 period. Interestingly, a whopping 11 percent of Americans above the age of 12 are taking antidepressants. Curiously, this is more than the number of individuals considered to be depressed. More than half of these individuals (60%) will take antidepressants for more than two years and 14% will have taken it for more than 10 years. Even more concerning is that the rate of depression appears to be on the rise. In fact, depression rates increased from 3.33% from 1991 – 1992 to 7.06% in 2001 – 2002.
So what has changed? Several studies point to the fact that depression rates have increased because we no longer live as hunter-gathers. This is evidenced by the fact that those who live in modern cities are more likely to be depressed than those living in more rural areas. While we are unlikely to all be able to move to rural areas and become hunter-gathers again, there are many lessons that we can learn from this.
A very important change that has occurred in modern times is the increased rate of obesity. We know that those who are obese are far more likely to be depressed than those who are of normal weight. Diet too, has suffered with the convenience of modern life. The Standard American Diet (SAD diet) is laden with sugar, saturated and trans fats, excessive calories, inadequate vitamins and minerals, too much sodium, and too little fiber. Add in the questionable effects of genetically modified foods (GMOs), herbicides, and pesticides and you cannot help but to wonder how this could not affect the rate of depression. Decreased folate content in greens alone could account for depression. The vitamin is essential for the formation of serotonin, a brain chemical that is decreased in those who are depressed.
Another change in modern life has been severely decreased physical activity. We were designed to be active. Life until the modern era was quite strenuous. Walking, running, hunting, gathering, farming, building, and many other activities would have filled our days. There was no need for exercise in the modern sense because life would keep us fit. Now, the vast majority of us get up, drive to work, sit at a desk for eight or more hours, drive home, and sit on the couch until bedtime. No wonder why we are so out of shape as a nation! Research has shown that regular aerobic exercise is a treatment as effective as antidepressants. Just 20 minutes of regular activity on most days of the week can improve mood and decrease anxiety.
Pronounced changes to our wake-sleep patterns have also occurred over time. Since we spend so much time inside as opposed to outside, we have decreased exposure to the sun, particularly in the winter months. This can substantially decrease our vitamin D levels. Exposure of the skin to the UV radiation of the sun generates the synthesis of this essential vitamin. Deficiency of vitamin D is well documented. More often than not, when I see tests for clients not currently taking supplemental vitamin D, their levels are lab low. Even for some taking a multivitamin containing the RDA for vitamin D (400 IUs), the levels are still low. Decreased vitamin D is associated with cancer, autoimmune disease, chronic diseases (i.e. metabolic syndrome and type 2 diabetes), and depression. The winter months can also lead to seasonal affective disorder (SAD), a type of depression often benefited by light therapy. This form of therapy appears to increase the neurotransmitters dopamine and serotonin, reversing the depression. Sleep has suffered in modern times as well. A third of the population in the United States has at least one symptom of insomnia. Less sleep, or even decreased quality of sleep can lead to depression or be considered a symptom of depression.
Antidepressants are considered the main medical intervention for depression. Despite the fact that the numbers clearly indicate that depression is a substantial issue in this country, many experience only temporary or no relief from prescription antidepressants. Most of the antidepressants commonly used are Selective Serotonin Reuptake Inhibitors (SSRIs). These medications do not actually increase serotonin levels, but simply hold the serotonin on the nerve cell longer. So for individuals who have very low brain levels of serotonin, these medications can be ineffective. Unfortunately, they also come with various side effects including constipation, decreased libido, weight gain, diarrhea, dry mouth, ejaculation delay, gas, heartburn, the inability to have or keep an erection, drowsiness, and trouble sleeping. From a more natural perspective, the herb St. John’s wort (Hypericum perforatum), has a similar mechanism to SSRIs. Again, sometimes it works and sometimes it does not.
In my experience, I have found that lifestyle interventions are often sufficient for many individuals to recover from mild to moderate depression. While programs are customized to meet the needs of clients, there are certainly some common core suggestions that I give to most.
First Intervention: Exercise
My first suggestion is to begin an exercise program. This must absolutely include aerobic exercise at a moderate level for at least 20 minutes, three to five days per week. The idea is to do a large repetitive motion frequently. The type you choose is not all that important. You can try walking, jogging, hiking, biking, swimming, roller blading, elliptical, or aerobics. The exercise does not have to be incredibly intense to have mood lifting benefits. It simply needs to get your heart rate up enough to be slightly out of breath.
For many, adding in some mind-body exercise such as Pilates, yoga, Tai Chi, or Chi Gong can also be extraordinarily beneficial. The meditative nature of these types of exercises can be quite stress relieving. Doing this two to three times per week can be excellent for decreasing stress levels and improving mood. If you are not interested in trying any of these types of mind-body programs, consider implementing a meditation program (see below).
While I absolutely love weight training for improving health overall, it is less effective for improving mood. This certainly can be included in your overall exercise program, but it is better to concentrate on aerobic and mind-body exercise to lift your mood.
Second Intervention: Diet
My second suggestion for enhancing mood is to eat a healthy diet. This includes adding in a lot of fruits and vegetables. I generally recommend 7-11 servings per day with just 1-3 servings of fruit. Emphasize on the dark, leafy greens, which are very high in folate. Folate is essential for proper serotonin and dopamine production. This will do wonders for increasing your vitamin and mineral levels, helping to support countless metabolic functions including the synthesis of mood boosting neurotransmitters.
Eliminate or significantly decrease the amount of processed foods in your diet. Not only do these foods lack fiber, vitamins, and minerals, but they contain chemicals, sugars, artificial sweeteners, sodium, trans fats, and other harmful ingredients. They also crowd out healthier foods and change the way we think about healthy foods, which cannot keep up with the intense sweetness or saltiness provided in processed foods.
Adding in sources of omega-3 fatty acids can also be helpful. Consuming fish, walnuts, flax seeds, and chia seeds are all good ways to increase your omega-3 intake. Choose oily, wild-caught fish like salmon, sardines, and mackerel for more omega-3 content. Limit or avoid larger fish such as swordfish and tuna, which contain more mercury. It is also helpful to choose free-range poultry, free-range/cage-free eggs, and grass-fed meats. Conventional animal products contain minimal omega-3 fatty acids and plenty of inflammatory omega-6 fatty acids. By choosing the free-range/grass-fed versions, you allow the animal to eat its natural diet and it therefore produces more omega-3s. While it will still contain some omega-6 fatty acids, it is more about having an appropriate balance of these two essential fatty acids than trying to eliminate omega-6s. If you are not consuming sufficient amounts of these omega-3 foods, consider adding in two to four grams of fish oil per day. Decreased levels of omega-3 fatty acids can not only increase your risk for depression, but can also cause inflammation.
Make sure that you are also eating a reasonable amount of healthy, complex carbohydrates including whole grains, sweet potatoes, winter squashes, fruits, and other vegetables. While carbs have gotten a bad reputation in the last few years, they promote serotonin production in the brain.
Third Intervention: Better Sleep Hygiene
Many people underestimate their need for sleep. I have heard frequently from individuals that they only need around six to seven hours per night. While we can function this way, it is not optimal. Getting at least seven to eight hours of sleep per night is essential for health. Unfortunately, we are so scheduled that many of us are working right up until bedtime. Creating some space in your schedule for a relaxing bedtime routine can be quite beneficial. About an hour before, it is best to be in a dimly lit environment. To produce melatonin, the hormone that helps regulate our circadian rhythm, the pineal gland needs a dark environment. So turning off overhead lights in favor of a smaller lamp is helpful. Additionally, turning off electronic devices including cell phones, tablets, computers, video games, and television is also important. You may think that they are relaxing you, but often they are over stimulating you. Try listening to relaxing music, taking a bath, or even reading a novel to help de-stress at the end of your day.
Fourth Intervention: Meditation
Not only helpful for decreasing stress, meditation is great for alleviating both depression and anxiety. We rarely get an opportunity to just breathe and be quiet in our hectic lives. Finding some space to meditate for even five minutes can be so revitalizing. If you are not comfortable with the idea of actually meditating, try simply doing a breathing exercise. Try taking a slow breath in for a count of four and then exhaling over a count of seven. Some also find that alternative activities like coloring or knitting work well. Regardless of your chosen activity, try to find a bit of time each day to spend doing a quiet, relaxing activity.
Interventions for More Severe Depression
For more severe depression, a successful intervention in my practice has been the use of 5-HTP, a metabolized version of the amino acid tryptophan. Tryptophan is the amino acid precursor to serotonin. Supplementation with adequate vitamin B6 is also helpful as this important vitamin is required as a cofactor to synthesize serotonin. Supplementation with niacin is often suggested as well. If one’s diet does not provide sufficient niacin, then the majority of dietary tryptophan will be used to synthesize niacin rather than serotonin.
Remember, if you or someone you know is severely depressed, it is essential to seek help. In addition to working with a psychiatrist and/or a functional practitioner, it may be very helpful to work with a licensed therapist. We often bottle up our emotions. Having someone to talk with about thoughts and feelings is truly helpful.
Jessica Pizano is the owner of Fit to You, LLC, which offers personalized training programs and nutrition/health counseling. Her concentrations include genetics and nutrigenomics, general health and fitness, weight loss, food allergies/sensitivities, autoimmune disease, post-rehabilitative work, training/nutrition for medical conditions, obesity intervention, pre- and post-natal exercise and nutrition, and Pilates. She earned a master’s degree in human nutrition, emphasizing functional medicine at the University of Bridgeport. Currently, she is completing a doctorate of clinical nutrition at Maryland University of Integrative Health. She is also a certified personal trainer and a corrective exercise specialist through the National Academy of Sports Medicine and certified in mat Pilates through PHI Pilates. Pizano has earned her Clinical Exercise Specialist and Longevity Wellness Specialist through the American Council on Exercise. She completed her training to practice Health Coaching at the Institute for Integrative Nutrition and is certified as a holistic health practitioner through the American Association of Drugless Practitioners. Currently, Jessica practices personal training, nutrition counseling, and nutrigenomics in her studio in Avon. She may be contacted at (860)-321-7234 or online at www.fittoyouct.com.