6. Reduce Stress

Depression is ultimately a stress disorder: a disease where stress is poorly managed by our bodies. It’s as if many of us with depression and anxiety have a new intern sitting at command central of our nervous system, and she keeps categorizing stress responses incorrectly, sending them to the wrong department in our body. Moreover, she sits right next to the fire alarm and keeps ringing it every time there is a hint of panic. But new research from the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital has found that by eliciting the relaxation response, we can immediately alter our gene expression tied to inflammation, metabolism, and insulin production — all of which impact our mood. We engage the parasympathetic nervous system by practices like meditation, yoga, deep breathing, massage, and prayer. Even a few long, deep breaths when you start to feel panicky can message the intern not to sound the fire alarm.

But I have found that doing a “stress inventory” is also critical to getting well, an exercise where you list on one side of a sheet of paper everything that stresses you out, and list on the other half everything that helps you feel better. Next, you sit with all those things on the left side of the paper (what stresses you out) and have a brutally candid talk with yourself about why you are doing them (people-pleasing hang-ups? ego? confused priorities?), followed by a session where you find creative solutions to cross out as many as you can. I had a stress inventory with myself a few months ago where I finally conceded that my health is not worth my trying to become a blogging superstar and bestselling author like Gretchen Rubin like I’ve always wanted to be, or running a formidable nonprofit like BringChange2Mind. It was an epiphany moment when I realized that I don’t have to be anyone else in order to be OK. By working at my own snail pace, I have enough time to do more of the things on the right side of the paper that make me feel good.

7. Take the Right Supplements

It can be overwhelming trying to figure out which supplements may be helpful, and how to distinguish between quality brands. Consumer Lab lists third-party-tested supplements which should be safe to take. I’ve done a bit of research, too, and found these manufacturers to be reputable: Prothera, Klaire Labs, Pure Encapsulations, Douglas Laboratories, Nature Made, Orthomolecular Products, Metagenics, Vital Nutrients, Truehope, OmegaBrite, and Carlson Laboratories.

In my post 12 Patient-Approved Natural Supplements for Depression, I list various vitamins and minerals that are good to take for your mood. But here are the critical ones that I would start with: an omega-3 supplement, a probiotic, vitamin D, vitamin B-12, and a multivitamin. Because I have low stomach acid (as do many people who have been on medication for years), I find better results when I take a powder or liquid. I get my vitamin D and B-12 as a liquid from Pure Prescriptions. Blogger Lisa Richards has compiled an excellent list of the best commercial probiotics, her favorite being Healthy Origins 30 Billion or Prescript-Assist. I take Ther-Biotic Complete Powder because it contains all of the different strains of bacteria that I need for my unique gut situation (Crohn’s plus significant intestinal bacteria).

A few months ago I started taking a multivitamin called EmpowerPlus Powder from TrueHope after I read through all the research studies using this specific micronutrient to help treat different mood disorders and watching Julia Rucklidge’s inspiring TEDx Talk about nutrition and micronutrients. Finally, I get my omega-3 supplement from OmegaBrite, because their capsules contain 70 percent EPA (eicosapentaenoic acid) in a 7:1 ratio of EPA to DHA (docosahexaenoic acid). New research has confirmed the positive effects of EPA on mood, even more so than DHA, as it provides a natural balance to omega-6 arachidonic acid. Nordic Naturals is also a reliable brand. If you do have a MTHFR gene mutation, it’s a good idea to supplement with l-methylfolate, the bioavailable form of folate.

8. Protect Your Sleep

From all my research on mood disorders over the last ten years, and from conversations with people who can’t get well, I’d say that chronic stress and disrupted sleep cycles are the two biggest factors that prevent a person from climbing out of the depths of depression. Unfortunately, where there is depression, there are usually sleep issues. Volumes of studies have documented the devastating effects of sleep on mental health, like the one by the American Academy of Sleep Medicine that found that the heritability of depressive symptoms in twins with very short sleep was nearly twice the heritability in twins sleeping seven to nine hours per night.

Because I am such a fragile creature, I’ve had to move sleep up on my priority list from about No. 7 to No. 1. I protect it with everything I have. This means I no longer wake up at 5 a.m. to work out. I sleep in, exercise later, and am much less productive during the day (step six). But by sleeping eight hours a night, I am more resilient to mood swings. I’ve had to adopt strict sleep hygiene rules to ensure that I don’t end up with the kind of miserable insomnia I had two years ago: I shut off the computer at 7 p.m., leave my phone downstairs (not next to my bed) and don’t check messages after 8 p.m., and try to be in bed by 10 p.m. every night. I’ve also started to use lavender oil, and take melatonin and a combination of magnesium and calcium at night, which does seem to calm me.

9. Find a Purpose

Nietzsche said, “He who has a why to live for can bear almost any how.” Last summer, when I began to think that I would never be without debilitating death thoughts, I clung on to that logic, and to the inspiring words of Holocaust survivor and famous psychiatrist Viktor Frankl, MD, PhD. If a person has found a purpose in life, he explains in his classic Man’s Search for Meaning, “even the helpless victim of a hopeless situation facing a fate he cannot change, may rise above himself, may grow beyond himself, and by doing so change himself.”

Upon finishing that book, I had no doubt about my purpose in life: to help others who have been battling depression and anxiety for most of their lives…people that, like me, have spent years in the offices of psychiatrists trying so many drugs, and yet dream of a flattened pulse.

So I started my two forums and a nonprofit dedicated to treatment-resistant depression. They haven’t cured me of my symptoms, but I can honestly say that committing to a purpose last summer is what brought me hope in a period of desperation. For the first time, I could see myself living a meaningful life despite the persistent ruminations clogging up my brain. When I began to help other people off the ledge, I often forgot about my own inclination to jump.

I think Nietzsche and Frankl were right. Meaning and purpose can serve as a kind of anesthesia to pain; focusing on your small role to make the world a better place positions your suffering into a larger perspective that leads to peace.

Join ProjectBeyondBlue.com, the new depression community.

Originally posted on Sanity Break at Everyday Health.

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