Simple mood boosts to beat Blue Monday
Antidepressants are not the only answer to despondency. Anna Magee looks at a selection of more natural remedies
Today is Blue Monday, officially the most depressing day of the year. Even without a dark January morningg to contend with, Brits are dangerously prone to depression. Around one in five of us shows symptoms, and prescriptions for antidepressants reached an all-time high in 2018, the British Medical Journal reported earlier this year. As more research uncovers new treatments and helpful lifestyle measures, the catalogue of ways to help alleviate depression or generally lift the mood is bigger than ever.
Exercise for three hours a week
Fact: exercising regularly and having high aerobic fitness can help fight depression. In a new study published in November in the journal Depression and Anxiety, researchers at Harvard University looked at the lifestyle habits of 8,000 men and women. They found physically active people had less risk than people who rarely moved. Better still, the type of exercise they did barely mattered as long as they did it. Basically, if someone does a total of three hours a week activity, from running to yoga or brisk walking, they were less likely to be depressed than their sedentary counterparts. Moreover, the more exercise you do, the lower your risk of depression, with risk falling another 17 per cent with each additional 30 minutes or so of daily activity.
Get the right kind of therapy for you
It’s well known that Cognitive Behavioural Therapy (CBT) – where you learn to change or redirect the repetitive thoughts that make you sad in a formal therapy setting – is useful for depression. But it doesn’t work for everyone. David Richards, professor of mental health services research at the University of Exeter, published a study in The Lancet three years ago that found another simpler – but very different – treatment known as Behavioural Activation (BA) had similar success as CBT, but on people the latter didn’t work for.
BA is an “outside-in” treatment that focuses on people’s mood being determined by their interaction with the environment, rather than changing their thoughts, Prof Richards explains. “In practice, we help people restart the meaningful activities they are not doing because they are depressed.” So for example, you used to love playing squash but since your mood changed, you feel tired and more inclined to sit at home and watch Netflix. But playing squash – especially when it is the last thing your depression is telling you to do – is what will help, he hypothesises. Talk to your doctor to get on a course, as BA is offered on the NHS.
Accept your negative thoughts – then get distracted
What if you were to be more accepting of the ebb and flow of your moods and thoughts, including all the negative ones? That’s the promise of a treatment Prof Richards’s team has had success with in treating depression. It’s called Morita therapy, which originated in the Twenties and is regaining popularity. It’s a fourstage treatment that starts with accepting your mood and if you need to, taking a week of bed rest without any stimulation. “Then we get patients to start small tasks, and also look at the natural world and their part in it.”
Over time, the therapy encourages people to do repetitive small tasks such as knitting, walking in the woods or even jigsaw puzzles – as a distraction from their thoughts. Prof Richards explains: “We find that when people have to concentrate on small tasks outside their bodies, they’re much less likely to ruminate on how they’re feeling. Eventually, they move on to bigger nature-based activities such as hiking that are also outward-looking but more strenuous – it works.” In a pilot study published in BMJ Open last year, authors concluded that Morita therapy “showed promise as a distinct alternative to current depression treatments”.
Wake and light therapy
Many of us suffer from Seasonal Affective Disorder (SAD) or its less serious cousin, the winter blues. “There is a type of depression where the body’s circadian rhythms [body clock] have been disrupted because of lack of light in the winter, whose main symptom is waking up in the small hours or not being able to get to sleep, along with low mood,” says Prof David Veale, consultant psychiatrist at the South London and Maudsley NHS Trust and Priory Hospital North London and co-author of Manage Your Mood. If the problem is mild, simply getting a little light in the morning could help reset your sleep/wake cycle, he explains. “This could be opening the curtains while you eat your breakfast – if it’s light outside. Or it could be using a lightbox at your desk.” If your depression is
serious and hasn’t responded to other treatments, a new arm of treatment called chronotherapies (those that manipulate your body clock), specifically known as Wake and Light Therapy, is increasingly being used to help reset depressed patients’ body clocks and can reap results in less than a week. Prof Veale’s team at Priory Hospital North London provides the therapy to suitable patients as part of their Rapid Acting Programme for Depression.
Eat a Mediterranean diet
The Mediterranean diet, with its high levels of oily fish, vegetables, fruits, olive oils and wholegrains is associated with a lower risk of heart disease, stroke and cancer, but it can also boost your mood. “The data also shows it is associated with a lower risk of depression,” says Ed Watkins, professor of applied clinical psychology at the University of Exeter, who has been researching the effects of food on mood.
“If you eat crap, you will feel crap,” says Prof Veale. “Refined sugars and processed foods are not conducive to better mood and will make you feel dreadful.” In fact, a study published in 2017 in Scientific Reports examined the diets of 8,000 men and found that those
‘Those who consumed 67g of sugar per day were 23 per cent more likely to be diagnosed with depression’
who consumed 67g of sugar per day – a Mars Bar contains 20g, a glass of orange juice about 21g and one processed meal can contain over 20g – were 23 per cent more likely to be diagnosed with depression compared with men who ate 40g or less.
…and more fermented food
Gut bacteria play a crucial role in physical health, with studies linking the microbes in our large intestines to everything from allergies to immunity to weight. Now, it’s becoming increasingly acceptable in medical and psychiatric thinking that our gut flora can influence our moods too, thanks to animal research linking gut bacteria to depression.
Says Prof Veale: “Early research in this field has taken the faeces of depressed and non-depressed patients – which carry their gut bacteria – and transplanted them into the guts of germfree mice, and the animals that received the poo from depressed patients became more withdrawn, inactive and showed signs of depression.” Fascinating.
But while there has been no research showing a specific probiotic pill can help lift mood, what we do know is having a diverse healthy diet can help our guts. “That means eating a diet rich in foods which contain probiotic gut bacteria such as fermented kefir (milk drink), blue cheese, kombucha, kimchi and sauerkraut as well as a wide variety of vegetables and fruits which contain probiotics that help feed that gut bacteria like a fertiliser so it grows.” Bananas, artichokes, asparagus, chicory, onions, garlic, chickpeas, beans and lentils all help.
Listen to music daily
According to new research conducted by the British Academy of Sound Therapy, we need to listen to just five minutes of music to feel happier. Listening to 78 minutes a day can help improve emotional wellbeing, the study found.
The study looked at 7,500 participants across the globe and revealed that a daily music diet should include 14 minutes of uplifting tunes, 16 minutes of calmer music and 15 minutes of motivating beats. Pop music was found to have the strongest ability to initiate feelings of happiness and classical music was most relaxing. But perhaps the biggest surprise was the finding that heavy rock music has strong calming benefits, with the scientists suggesting its effect on increasing heart rate and blood pressure could help us process anger.
Just get outside
A walk in the park is the most natural antidepressant there is. A growing scientific area called ecotherapy is showing strong links between time spent in nature and reduced anxiety, stress and depression, a study in April last year published in the journal Frontiers in Psychology quantified how much we need for an effect. Just 20-30 minutes spent in nature will significantly lower levels of stress hormones such as cortisol (which, left to build up, can lead to depression). It’s prompted the researchers at the University of Michigan to suggest doctors prescribe “nature pills” to depressed patients. Interestingly, the study participants either walked or sat – it didn’t matter, as long as they were outside.
Cold water swimming
Those people addicted to swimming in the sea in January always seem so annoyingly happy to the rest of us in our midwinter misery. They’re on to something. A case report published in BMJ Case Reports in April 2018 followed one woman with major depressive disorder whose symptoms were resistant to treatment with fluoxetine (the generic name for the antidepressant, Prozac). “Following the birth of her daughter, she wanted to be medication-free and symptom-free,” said the BMJ report, conducted by TV doctor Chris van Tulleken of University College London. After a programme of weekly open coldwater swimming, she had an immediate improvement in her mood after each swim and a sustained, gradual reduction in depression symptoms eventually coming off her medication. But make sure you start off slow and warm and build up. For information on getting started try the website for the British Outdoor Swimming Society.