Overcoming Depression: God, friends and exercise

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You won't find them in a pharmacy, but these eight treatments could help you beat depression.
By Lesley Young

You can count on antidepressants to help battle depression - they're up to 70 per cent effective, combined with therapy - but you may also want to say a prayer or read Plato the next time a dark day strikes. Recent studies suggest that complementary approaches such as exercise, meditation and online therapy can boost the likelihood of recovery. (Not everything works, though. see Use with caution, page 56.)

Experts agree that a depression treatment plan - developed in consultation with your doctor, of course - should address a wide array of potential triggers. (Don't be among the 50 per cent of depression sufferers who never seek treatment.) "Recovery from depression is like recovery from any major illness," explains Dr. Arun Ravindran, head of the mood and anxiety program at the Centre for Addiction and Mental Health in Toronto. In addition to considering medication or talk therapy for immediate symptoms, try changing some of the factors that affect your health in the first place, such as bad relationships and poor food choices, he says. Many of the following ideas can help you do just that. We've reviewed the evidence on some of the most promising options to help you and your doctor choose the right ones for you.

1. Grill up a juicy beef or salmon steak

According to a recent Finnish study, patients being treated for major depressive disorder - more than half of whom were taking antidepressant meds - responded better if they had higher levels of vitamin B12 in their bloodstreams. Red and organ meats, along with clams, trout and salmon, deliver this nutrient.

A recent study in the American Journal of Psychiatry also concludes that populations with low intakes of omega-3 fatty acid - heart-healthy oils found in seafood - have higher rates of bipolar disorder. Dietitians of Canada recommends eating one to two servings of fatty fish (such as salmon, mackerel, trout, herring or sardines) a week. To find out how good eating habits can improve your overall health and state of mind, talk to a registered dietitian. Also, inform your doctor before taking any supplements, especially if you are on antidepressants or other medications.

2. Take a hike

The next time you're feeling low, go for a long walk or hit the gym. A study from Duke University in Durham, N.C., found that depression returned in only nine per cent of people who didn't take antidepressarits and exercised go minutes a -week, compared with 38 per cent relapse rates in those who took antidepressants and didn't exercise. While you cant treat moderate to extreme depression with exercise alone, regular activity can help improve anxiety and depression symptoms, says Dr. Murray Enns, a psychiatry professor at the University of Manitoba in Winnipeg.

3. Schedule lunch with a friend

Positive relationships and spirituality are, together, the "ultimate antidepressant," say psychologist Bob Murray and psychotherapist Alicia Fortinberry in their book, Creating Optimism: A Proven, Seven-Step Program for Overcoming Depression (McGraw-Hill). Solving relationship issues and reconnecting with people can be important steps toward recovering from depression, adds Dr. Enns. If you think personal relationships play a role in your depression, ask your doctor about interpersonal psychotherapy (IPT), a type of talk therapy that teaches assertiveness and balancing strategies to strengthen relationships. The Centre for Addiction and Mental Health has an IPT clinic (416/535-8501, ext. 6925), but you need a referral from your doctor before calling. You can also find out more about IPT at the International Society for Interpersonal Psychotherapy website at www.interpersonalpsychotherapy.org.

4. Connect with your higher power

While the powers of prayer have not been scientifically proven, spirituality seems to improve depression-related coping skills and encourage more complete remissions, says Dr. Ravindran. "What appear to be effective are not the religious rituals themselves but rather spiritual attitudes," he explains. Spirituality can be as simple as believing in a higher purpose or expressing one's faith in daily affirmations, meditation or prayer.

5. Talk it out

Cognitive behavioural therapy (CBT) is the most widely supported talk-therapy treatment for depression, according to Dr. Ravindran. The therapy teaches patients to identify and actively replace self-deprecating, self-critical and pessimistic thoughts with realistic ones. It's an effective, long-term coping tool, especially considering that half of all depression sufferers will relapse. Brief, focal dynamic psychotherapy, another promising short-term treatment, addresses specific emotional triggers. There are many therapy options available and the one that can help you most depends on the type and severity of your illness, says Dr. Ravindran. Talk to your doctor.

6. Breathe deep

Om, a bit skeptical? Don't be. Patients with a history of three or more depressive episodes who participated in CBT-based mindfulness training (also called mindfulness-based cognitive therapy) were half as likely to relapse as those who didn't meditate. The method includes simple breathing meditations, yoga stretches, basic education about depression and several CBT exercises to examine and question negative thoughts. Ask your physician for more information about mindfulness meditation, or learn more about resources in your area by visiting www.umassmed.edu/cfm and clicking on Other MBSR Programs.

7. Dial away depression

Patients who were taking antidepressant medications were significantly more likely to improve when they also received several 30-to 4o-minute counselling sessions over the phone, according to a report published last year in the Journal of the American Medical Association. As well, a recent Australian study of 525 people who visited a website designed to reduce anxiety and increase coping skills (www.rnoodgym.anu.edu.au) demonstrated that web-based therapy can reduce symptoms of depression.

Why does virtual therapy work? In part, because the approach requires patients to be proactive about depression, says Dr. Enns. "People learning about their illness might be less inclined to be self-blaming about it," he adds. Talk to your doctor or visit the Canadian Network for Mood and Anxiety Treatments at www.canmat.org for a list of provincial organizations that offer support.

8. Consult Plato

If your depression stems from the feeling that life is meaningless, philosophical counselling may complement your treatment plan. Lou Marinoff, a professor at the City College of New York, has spent years promoting this controversial talk therapy based on the theory that depression springs from faulty logic and uncertainties about the meaning of life. Philosophical counselling is not an effective depression treatment on its own, though, because loss of meaning is seldom the only issue for depression sufferers, says Vancouver psychologist Randy Paterson, author of Your Depression Map: Find the Sources of Your Depression and Chart Your Own Recovery (New Harbinger). Discuss this approach with your doctor first.

antidepressant ABCs

Learn about the time it takes to find the right depression-fighting drug for you, what kind of side effects to expect, why you shouldn't quit or change dosage without the help of your doctor and more atwww.chatelaine.com/antidepressant.

Positive relationships and spirituality are, together, the "ultimate antidepressant," say some mental health experts

"exercise and therapy have been pivotal in my recovery"

Five years ago, Jennifer Guitard experienced her first panic attack for no apparent reason during a visit to a friend's house in Halifax. For the next six months, she treated her cycles of depression and anxiety with cognitive behavioural therapy (CBT) and physical exercise. Guitard was so eager to try anything but medication that when a new therapist told her to try an hour of intensive exercise for five days in a row, she bought a YMCA pass card and started exercising that day. "I have never felt better in my life," she says. "I was so focused."

What works for her Guitard integrates physical activity in her life to give her spirits a lift. She also applies CBT coping skills, such as taking more time to work through decisions and organizing herself better, to help prevent anxiety.

Use with caution

Not all depression treatments are created equal, according to Dr. Arun Ravindran, head of the mood and anxiety program at the Centre for Addiction and Mental Health in Toronto, and Dr. Lakshmi Yatham, a psychiatry professor at the University of British Columbia in Vancouver.

Herbs and supplements

The evidence for many of these products is limited, the quality of herbal remedies varies and the amounts of active substances vary widely. Consult your physician before taking any over-the-counter cures, as some also conflict with antidepressants and other meds. One of the only supplements shown to reduce depression is St. John's wort. An unproven amino acid called SAM-e (S-Adenosylmethionine) also shows promise but can trigger gastrointestinal and cardiovascular side effects.

Hormone therapy

In rare cases, a hormone treatment may complement antidepressant medications, says Dr. Yatham, adding: "It is not something you should do ahead of other well-known strategies." The reason? There are potential dangers to using hormones that should be discussed with your physician, including an increased risk of certain cancers.

Hypnotherapy

"You are becoming very happy...." If only it were that simple. While some experts say that patients can benefit from hypnotherapy as part of a depression treatment plan, there is no evidence to support its effects, according to Dr. Yatham.

Transcranial magnetic stimulation

This therapy alters brain chemistry with pulsed magnetic fields, effectively treating depression about 20 per cent of the time. Until more research is conducted, it's a last-resort option recommended only when standard treatments fail. It rings in at $3,000 for a minimum of 15 treatments at MindCare Centres in Vancouver and Toronto and is covered only on a case-by-case basis under most insurance plans

Vagus nerve stimulation (VNS)

In this invasive treatment, a small generator-like device is placed under the collarbone and wired to send electrical impulses to the left vagus nerve. This nerve originates in the brain area thought to help regulate mood, sleep, appetite and alertness. VNS can be effective in relieving hard-to-treat depression, but it's not understood why. It's currently approved to treat seizures in patients with epilepsy.

Patients taking antidepressants were significantly more likely to improve when they also received 30- to 40-minute counselling sessions over the phone

"depression requires treatment of the body, mind and soul

Actor and mental health advocate Victoria Maxwell suffered from a mysterious mental illness for eight years before being diagnosed with bipolar disorder and finding an effective treatment: a combination of antidepressants, mood stabilizers, therapy and mindfulness meditation that she learned on her own through books. Today, the sechelt, B.C., resident uses humour to help raise awareness about mental illness in her one-woman show, Crazy for Life.
What works for her "Mindfulness meditation gives me a place of neutrality where I can watch my mean-spirited and negative thoughts. I can be aware of them instead of getting caught up in them and, that way, keep them at bay."