8 Holistic Strategies to Help Manage Depression
Using a multi-pronged attack to promote wellness
About one in five people experience depression at some point in their lifetime. While it would be nice if there was a one-size-fits-all treatment strategy that would be both effective and acceptable for everyone, that’s simply not the case.
Medications and psychotherapy have the strongest evidence base to support their use in depression, they aren’t always fully effective and they’re not everyone’s strategy of choice.
As a mental health nurse and former pharmacist, I strongly support the use of medications and psychotherapy, but I believe it’s important to have other options available as well to give those living with depression as many tools as they can get to promote recovery.
My own depression has become treatment-resistant. After many trials of medications, my current 5-drug cocktail is what works the best, but it’s no longer enough to get me into remission. While those medications are the mainstay of my treatment, I incorporate other mind and body-focused strategies to promote greater overall wellbeing.
The more potential options that can be identified, the better people with depression are positioned to make choices to support their mental health. Some alternative therapies may be good enough on their own in some cases of mild depression, while in moderate to severe depression alternative therapies are more likely to play a supporting role.
The harder the illness is to treat, the more it’s worth thinking outside the box and incorporating as many elements as possible that might have some benefits.
Vitamins and other supplements
Vitamins and other nutrients are involved in a variety of processes in the body that impact mental health. While supplementation is not by any means a cure for depression, there are a number of supplements that do have some research evidence to support their use in depression.
Vitamin D is sometimes called the sunshine vitamin since it is produced in the human body when our skin is exposed to the sun’s rays. Studies have shown a correlation between vitamin D deficiency and depression, although the nature of this relationship is not yet fully understood.
Research on vitamin D supplementation for people without a deficiency has shown mixed results, but it may be worth considering during the winter at higher latitudes when the sun’s rays aren’t as strong, which results in lower vitamin D production.
SAM-e and L-methylfolate
The major neurotransmitters that have been implicated in depression are synthesized in the brain using a number of different precursor molecules. Some of these precursors act as donors of single-carbon methyl groups, which are important building blocks in this process.
S-adenosyl methionine (SAMe) and L-methylfolate (an activated form of folic acid) are two such precursor molecules, and studies have shown that taking them in supplement form can improve symptoms of depression. Benefits have been seen at daily doses of 1600 mg of SAMe and 15mg of L-methylfolate.
I previously took methylfolate, which I got in injection form from my naturopath because the only tablets available where I live are 1mg (meaning I’d need to take 15 per day). I found it helpful for my concentration, but I ended up stopping it because I couldn’t justify it financially.
Omega-3 fatty acids
A meta-analysis in the Journal of Clinical Psychiatry concluded that omega-3 fatty acids appear to be beneficial in depression, although there are some weaknesses in the existing evidence base. Lower depression rates have been observed in societies that consume large amounts of fish, which naturally contains omega-3 fatty acids.
Supplementation with omega-3s has been found to be effective in various subtypes of depression, including bipolar and postpartum depression. Omega-3 supplements typically contain two different types of fatty acids: EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid); it’s EPA that appears to be most associated with the positive mental health effects.
I’ve taken omega-3 fatty acids for several years. I really have no idea if they’re helping, but it seems reasonable to continue taking it in case they are.
St. John’s wort
St. John’s wort, known scientifically as Hypericum perforatum, contains multiple substances that are active in the human body. It is often standardized based on its content of hypericin, although it’s not clear whether this is the key active ingredient. Some components have been shown to inhibit the uptake of certain neurotransmitters.
According to a systematic review in the Archives of Internal Medicine, a number of studies have demonstrated effectiveness in mild depression at dosages of 300 mg of 0.3% hypericin three times a day.
Because of its effects on neurotransmitters as well as a major metabolic pathway in the liver, St. John’s wort can potentially interact with a number of prescription medications including many psychiatric medications. A pretty good rule of thumb is that if you’re taking psychiatric meds, you probably shouldn’t be taking St. John’s wort.
A study published in the journal Nutrition found that taking probiotics decreased inflammatory markers in the body and improved scores on a depression rating scale. The probiotics used in the study consisted of Lactobacillus acidophilus, Lactobacillus casei, and Bifidobacterium bifidum, with 2 billion colony-forming units per gram of each.
Dietary sources of probiotics include yogurt and fermented products like kefir.
A formal meditation practice isn’t required to get the mental health benefits from mindfulness and meditative practices. There are plenty of apps, such as Simple Habit and Insight Timer, that have guided meditations of varying lengths that can target specific problem areas related to thoughts and emotions. Short guided meditations are an easy way to dip your toes in as a newcomer to meditation.
Restorative yoga is a peaceful opportunity to connect mind and body in stillness and provides an alternative to more physically active yoga practices. The goal of restorative yoga is to support the body with props in resting positions to activate the parasympathetic nervous system and support the body’s natural recovery state. Often guided meditation work is incorporated into classes.
Many mindfulness practices are directed primarily inward, but depression can make this more challenging than usual. Inside may feel like an unpleasant place to be, and it may be difficult to maintain concentration on the breath or other physical sensations.
It’s equally valid to direct mindfulness outward, being present in the moment with what is perceived through the senses. The natural world provides many delightful places to focus attention. Birds, the rustling of leaves in the wind, and the movement of clouds overhead can all serve as sources of wonderment that can anchor you in the moment. I greatly prefer outwardly directed mindfulness practice to inwardly directed.
Looking through the lens of depression, staying in bed has a magnetic attraction. The problem is, spending all day every day in bed only makes depression worse. To combat this, it’s important to set achievable goals and schedule healthy activities into your day. SMART goals are:
It’s important that SMART goals take into account the very real limits depression can impose on overall functioning. Showering daily may not warrant a second thought normally, but with depression, it may become a meaningful and challenging SMART goal. In my opinion, it’s better to aim low-ish (but still above what you’re currently doing) and succeed than to aim high and fail.
Getting moving is also important and has the added benefit of reducing inflammation. This doesn’t need to be strenuous exercise; walking works just fine, plus it’s easy to pair with mindfulness practice.
Some people will report significant benefits from exercise, while others will not. I fall into the latter category, so for myself, I tend to view exercise as a general health promotion strategy rather than something that specifically targets my mental illness.
Depression tends to narrow perspective of the world, making it difficult to see important patterns. Even without depression, it’s hard to remember day to day variations.
Bullet journaling is an excellent way to keep track of what’s happening in your mind, body, and environment. This doesn’t require artistic talent, despite the intimidating designs splashed all over Pinterest; the key here is the function rather than the form.
Surprising patterns may emerge, which can serve as a starting point to make some positive changes. Some ideas of factors to track are:
- menstrual periods
- stressful events
- physical activity
- use of wellness activities
- alcohol or other substance use
- physical symptoms such as headaches and effects of inflammatory conditions
This can be a great way to track how you’re responding to changes in your treatment plan and give insight into how external and internal factors are affecting your wellbeing.
Bullet journalling can also provide a structured way to practice gratitude, which promotes improved mood and increased compassion and resilience. Try to do a gratitude entry every single day, and as a bit of a challenge try doing it with no repeats.
Depression often feels like mental pain, and it can be helpful to release some of that through some form of self-expression. That can be through private writing just for yourself, writing on a platform like Medium, drawing, painting, coloring, music, or anything else you can come up with.
Art therapy and music therapy are ways to explore more deeply the healing power of self-expression.
A vision board can be a way to combine artistic expression and goal-setting. This can be done on paper, but there are also online options, including the site www.dreamitalive.com, which lets you set intentions in ten different life areas, including health/wellness and mind/soul.
It may feel like there are strings attached when it comes to the people in your life, but animals offer unconditional acceptance. Having the responsibility of taking care of a pet can help activate you when depression is beckoning you to your bed, and having responsibility for a furbaby is a protective factor that helps to decrease suicide risk.
Research supports the therapeutic value of animals; one study in Psychogeriatrics found that pet therapy improved symptoms of depression in a study of elderly care home residents.
If you don’t have pets of your own, volunteering at a local animal shelter could be a good way to combine time with animals, social contact, and possibly physical activity if you’re doing dog-walking. Some cities have cat cafés, which allow you to have a coffee while having some quality feline time.
Massage therapy can be beneficial for mental health as well; as physical. Massage therapy for depression is typically aimed at full-body relaxation, with extra focus as needed on specific areas that may be carrying increased tension.
Research has shown that massage can decrease levels of the stress hormone cortisol and boost levels of the feel-good neurotransmitters serotonin and dopamine. Receiving physical touch in this manner is especially important for people who become very isolated because of their depression. For me, it’s been a great opportunity to access human touch in a way that feels very safe.
Light therapy boxes can be effective even for non-seasonal depression, according to a paper in the Journal of Affective Disorders. Light therapy can also help to boost the response to antidepressant medication. It’s recommended that you use a 10,000 lux box for 30 minutes daily or a 5,000 lux box for an hour daily.
The more wellness tools in your arsenal, the greater the likelihood that you will derive benefit from them. Some tools may be easier to incorporate into your lifestyle than others, and there is no right or wrong way to wellness. I tend to take an everything-but-the-kitchen-sink kind of approach to my own treatment-resistant depression.
What’s most important is to keep an open mind, and pay attention to what your mind and body are telling you is working or not working. Try to resist being pulled only in the direction of medication or only in the direction of alternative remedies just because of what others might be telling you. Take what works for you and leave the rest, and try not to become so focused on illness that wellness falls by the wayside.