Blues or Depression – how do you know?

Is this the ‘blues’ or am I struggling with depression?

Human Services, Inc.

We all have times when we feel blue, are overwhelmed by everyday tasks, have difficulty sleeping, lack joy in life, or find it difficult to concentrate. However, if any or all of these feelings become frequent and persistent, they may be symptoms of depression, and should be taken seriously. Depression is a common and serious medical illness that negatively impacts feelings, thoughts, and actions. It affects men and women of all ages, cultures, races, and income levels.

However, the very word “depression” can be confusing, as it is used both in a general and a clinical sense. We often say that we are “depressed” when we are blue or sad, but these feelings are usually fleeting and pass within a couple of days. When a person has a depressive disorder, however, it interferes with daily life, normal functioning, and causes pain for both the person with the disorder and those who care about him or her.

Depression is a common but serious medical illness that involves changes in the brain. If you are one of the more than 20 million people in the United States who have depression, your feelings of being “down in the dumps” or “blue” do not go away. They persist and interfere with your everyday life. Such symptoms can include sadness, loss of interest or pleasure in activities you used to enjoy, change in weight, difficulty sleeping or oversleeping, energy loss, feelings of worthlessness, and even thoughts of death or suicide.

Depression can run in families, and usually starts between the ages of 15 and 30. It is much more common in women, who can also get postpartum depression after the birth of a baby. Some people suffer “seasonal affective disorder” in the winter, which involves depression. Depression is also one part of bipolar disorder. Depression often co-exists with other illnesses. Such illnesses may precede the depression, cause it, and may be a consequence of it.

Although depression can affect anyone, there are a few groups that are particularly vulnerable. These include the elderly; suicide rates are highest among people aged 65 years and older, with men in that age group having the highest rates of all. The next most vulnerable group is adolescents; suicide is the third leading cause of death for young people aged 15-24 years. When depression is combined with substance abuse, the risk for self-harm goes up dramatically for any age group.

Left untreated, depression wreaks havoc on a person’s quality of life. It may worsen symptoms of other diseases, and even can be fatal. People who have a stroke or heart attack, for example, are more likely to die if they have depression.

The good news is that depression is treatable, even in severe cases. Between 80 percent and 90 percent of people respond well to treatment, and most gain at least some relief from their symptoms. The first step is to visit a doctor. Your family doctor or a health clinic is a good place to start. A doctor can make sure that the symptoms of depression are not being caused by another medical condition. A doctor may refer you to a mental health professional.

Most insurance plans cover treatment for depression. Check with your own insurance company to find out what type of treatment is covered. If you don’t have insurance, local city or county governments may offer treatment at a clinic or health center, where the cost is based on income. Medicaid plans also may pay for depression treatment.

People who are depressed often need those who care about them to lead the way. If you are concerned about depression in yourself or someone else, it is important to seek help. Discuss your concerns with a health care or mental health professional and request a complete evaluation. Remember that depression is treatable, and the proper diagnosis and treatment can restore the sufferer to enjoyment of life.

- HSI, a nonprofit organization with seven offices located throughout Washington County, annually serves more than 8,600 people, offering a variety of services to adults, children, adolescents, and families.

Source: http://www.review-news.com/main.asp?SectionID=60&SubSectionID=126&ArticleID=5341

Is this the ‘blues’ or am I struggling with depression?

From Human Services, Inc.

We all have times when we feel blue, are overwhelmed by everyday tasks, have difficulty sleeping, lack joy in life, or find it difficult to concentrate. However, if any or all of these feelings become frequent and persistent, they may be symptoms of depression, and should be taken seriously. Depression is a common and serious medical illness that negatively impacts feelings, thoughts, and actions. It affects men and women of all ages, cultures, races, and income levels.

However, the very word “depression” can be confusing, as it is used both in a general and a clinical sense. We often say that we are “depressed” when we are blue or sad, but these feelings are usually fleeting and pass within a couple of days. When a person has a depressive disorder, however, it interferes with daily life, normal functioning, and causes pain for both the person with the disorder and those who care about him or her.

Depression is a common but serious medical illness that involves changes in the brain. If you are one of the more than 20 million people in the United States who have depression, your feelings of being “down in the dumps” or “blue” do not go away. They persist and interfere with your everyday life. Such symptoms can include sadness, loss of interest or pleasure in activities you used to enjoy, change in weight, difficulty sleeping or oversleeping, energy loss, feelings of worthlessness, and even thoughts of death or suicide.

Depression can run in families, and usually starts between the ages of 15 and 30. It is much more common in women, who can also get postpartum depression after the birth of a baby. Some people suffer “seasonal affective disorder” in the winter, which involves depression. Depression is also one part of bipolar disorder. Depression often co-exists with other illnesses. Such illnesses may precede the depression, cause it, and may be a consequence of it.

Although depression can affect anyone, there are a few groups that are particularly vulnerable. These include the elderly; suicide rates are highest among people aged 65 years and older, with men in that age group having the highest rates of all. The next most vulnerable group is adolescents; suicide is the third leading cause of death for young people aged 15-24 years. When depression is combined with substance abuse, the risk for self-harm goes up dramatically for any age group.

Left untreated, depression wreaks havoc on a person’s quality of life. It may worsen symptoms of other diseases, and even can be fatal. People who have a stroke or heart attack, for example, are more likely to die if they have depression.

The good news is that depression is treatable, even in severe cases. Between 80 percent and 90 percent of people respond well to treatment, and most gain at least some relief from their symptoms. The first step is to visit a doctor. Your family doctor or a health clinic is a good place to start. A doctor can make sure that the symptoms of depression are not being caused by another medical condition. A doctor may refer you to a mental health professional.

Most insurance plans cover treatment for depression. Check with your own insurance company to find out what type of treatment is covered. If you don’t have insurance, local city or county governments may offer treatment at a clinic or health center, where the cost is based on income. Medicaid plans also may pay for depression treatment.

People who are depressed often need those who care about them to lead the way. If you are concerned about depression in yourself or someone else, it is important to seek help. Discuss your concerns with a health care or mental health professional and request a complete evaluation. Remember that depression is treatable, and the proper diagnosis and treatment can restore the sufferer to enjoyment of life.

- HSI, a nonprofit organization with seven offices located throughout Washington County, annually serves more than 8,600 people, offering a variety of services to adults, children, adolescents, and families.

Source: http://www.review-news.com/main.asp?SectionID=60&SubSectionID=126&ArticleID=5341

How can stay-at-home moms avoid depression?

Reposting this blog entry:

http://www.momstalknetwork.com/resources/stay-at-home-mom-depression-ways-to-avoid-it/

Written on April 26th, 2007 at 8:28 pm by Kelly

 

Depression can strike anyone at any time in their lives. When we think of depression and mothers, what comes to mind is postpartum depression. But, stay-at-home moms can suffer from depression as well. Learn how to keep depression from becoming an issue in your home.

Most mothers who decide to stay at home with their children will tell you that they have made no greater decision in their lives. Being present for the formative years is a once in a lifetime experience. The children benefit from having a parental presence throughout the day and the family saves money on daycare services.

Still, there are challenges that each mother has to face as a stay-at-home parent. The interaction with other adults is limited now that there is no job outside of the home. At first it may not seem like a big deal, but every woman needs a little girl talk now and again.

Stay-at-home mothers perform a job that never ends. At the end of the day your kids do not leave for elsewhere. They are already home.

Household duties still need to get done. The best times to clean is when the children are asleep and don’t need constant supervision. Then you have to clean, cook, wash clothes, and tidy up before they wake up. Moms can feel like a prisoner in their own homes.

When the days become overwhelming, depression can set in. At first, you may feel like sleeping every time the kids lay down. Then you may get easily irritated with them when they want you to play with them or if they break something. Moms could chalk these symptoms up to fatigue. Then your emotions may begin to have their way with you.

If this happens, stop and take a deep breath. Depression is a serious issue that needs to be dealt with. If your kids are getting to you, be honest about it and don’t feel guilty. We all have our breaking point without an outlet. The solution may be as simple as a bit of “mommy time”.

Resolve to make time for yourself everyday. On a beautiful day, take the kids to the park, where you can relax and they can have some free time. Invite a girlfriend you haven’t seen in a while and use the time to catch up. If she works, offer to bring a picnic lunch to accommodate her lunch hour.

Regardless of what you do, time apart for one’s self is important for everybody. Rising early in the morning for a period of meditation can change the perspective of your whole day. Paying attention to your own needs can keep the specter of depression at bay.

 

Well done, Kim Clijsters

Kim Clijsters became the first mom to win a major since 1980, defeating Caroline Wozniacki 7-5, 6-3 in the U.S. Open final on Sunday.

Julian Finney/Getty Images

The mother of all comebacks: Kim Clijsters celebrates unlikely U.S. Open triumph with daughter Jada

By NICOLA BODEN

Last updated at 12:18 PM on 15th September 2009

Appearing in her first grand slam tournament since retiring more than two years ago, Kim Clijsters would probably have been quite happy to make it into the second week.

Instead, she stormed all the way through to the final and took the title – repeating her success at Flushing Meadows four years ago.

The delighted 26-year-old was able to celebrate with her young daughter, Jada – who was the very reason she gave up tennis in the first place.

The toddler, who at 18 months is the spitting image of her Belgian mother, lapped up the limelight at the Arthur Ashe stadium as her mother showed off her trophy.

‘We tried to plan her naptime a little bit later so she could be here today. It’s the greatest feeling in the world, being a mother,’ an over-whelmed Clijsters told the cheering crowds.

Family affair: Kim Clijsters with daughter Jada after winning the U.S. Open in New York

Delight: Clijsters kisses husband Brian Lynch in the stands and, right, celebrates with him and Jada

Clijsters is the first mother in 29 years to take a grand slam crown after Evonne Goolagon won Wimbledon in 1980. She is also the first ever wild card entrant to win the U.S. Open.

Her triumph against Caroline Wozniacki was all the more remarkable because she gave up tennis in 2007 to start a family with husband Brian Lynch, a basketball player.

More…

• ‘If I could, I’d take this ******* ball and shove it down your ******* throat’: What Serena Williams REALLY told line judge
• Click here for all the Mail’s tennis coverage

The U.S. Open was only her third tournament since she announced her return to the courts in March this year. As Clijsters said herself this morning: ‘Winning was not really our plan’.

A hugely popular player, the Belgian was welcomed back onto the tour with open arms and swept aside both Venus and Serena Williams on her journey to the U.S. title.

Serena handed her a place in the final on Saturday night after arguing with a line judge who called a foot fault as she was 15-30 and serving to stay in the match.

I can’t look Mummy: Clijsters and her 18-month-old daughter lap up the limelight at the Arthur Ashe Stadium

Historic: Clijsters is the first mother to win a grand slam in almost 30 years

After a warning earlier in the game when she smashed her racket, Serena was given an automatic point penalty for a second violation and the match was over.

In truth, Clijsters had already been comfortable and took it 6-4, 7-5 but a message she posted on Twitter later revealed she was still struggling to absorb quite how far she had already come.

‘The fairy tale goes on – some how, I’m in the US Open final on Sunday beating both Venus and Serena along the way… am i dreaming???,’ she wrote.

Less than 24 hours later, when a final delayed by rain eventually took place, she duly overcame ninth seed Wozniacki of Denmark 7-5 6-3 to complete the fairy story.

Clijsters clinched the 93-minute match – and its $1.6m pay cheque – with a forehand winner and sank to her knees in celebration, visibly sobbing.

She immediately climbed up to her family’s box to give Brian – her husband of two years – a kiss and to hug her friends.

Isn’t Mummy clever? Jada was fascinated by the silver trophy, which comes with a $1.6m pay cheque

Playful: Jada, who is the spitting image of her mother, runs around the court at Flushing Meadows

‘I don’t have words for this,’ she said during the trophy presentation ceremony. ‘I’m just glad I got to come back and defend my title from 2005. It’s so exciting for me.’

Clijsters, who was unranked because of her time out from the game, was offered a wild card for the tournament earlier this year.

She had not competed in the event since her first grand slam triumph there in 2005 – missing out in 2006 because of injury and then because she had already retired.

‘I just wanted to start these three tournaments to get back into the rhythm of playing tennis and get used to the surroundings again. So I have to thank the USTA for giving me the wild card to come back here,’ she said.

It took a while for Clijsters to find the range with her groundstrokes against Wozniacki, who was appearing in her first grand slam championship match.

But by the end of the final at a windy Arthur Ashe Stadium, she was cracking winners from both sides and registered 36 in all compared to her opponent’s 10.

Wozniacki had been a break up in the first set at 5-4 but Clijsters closed it out by winning the last three games and then dominated in the second set to win.

Champion: Clijsters, husband Brian and daughter Jada posing for pictures in Times Square

The Dane was magnanimous in defeat, saying: ’She’s such a great girl. Unfortunately she beat me today. She played a great match and deserved this trophy.’

Clijsters’ victory will spur on Roger Federer, who will be out to prove tonight that new fathers can also win grand slams.

Now the father of twins, the World Number One takes on an in-form Juan Martin del Potro in the men’s final and is aiming to win a record 16th grand slam title.

Of Clijsters’ win, he said: ‘Amazing. For her to have this incredible run is fantastic. This is a great story for women’s tennis, that’s for sure.’

The Belgian was previously engaged to Australian tennis star Lleyton Hewitt.

She is not now expected to make a full return to the tour but is likely to play in major competitions, including Wimbledon.

Hard-fought: Clijsters overcame ninth seed Caroline Wozniacki in two sets to clinch the grand slam title

Winner: Evonne Goolagong with her daughter Kelly in 1978, two years prior to her second Wimbledon triumph

Read more: http://www.dailymail.co.uk/news/article-1213326/Kim-Clijsters-celebrates-U-S-Open-win-daughter-Jada.html#ixzz1TWkgmhyp

The Anatomy of Depression

Here is some interesting information from Robert J. Hedaya, author of the book “The Antidepressant Survival Guide: The Clinically Proven Program to Enhance the Benefits and Beat the Side Effects of Your Medication”

Posted by By Robert J. Hedaya, M.D., D.F.A.P.A. on January 28, 2009 – 12:00pm

The Anatomy of Depression: Part I

GOAL: The person with depression is in a complex homeostatic state, albeit a disturbed, negative, painful one. The task of the clinician is to develop an understanding of the homeostatic processes (social, biological, etc) involved, and the nodal points that require intervention. The clinician must then intervene at as many of these points as possible, at the same time, to re-establish a new more functional equilibrium.

THE PARADIGM: Neurotransmitters are built from a number of essential nutrients. The process, not too different from making a ‘big mac with special sauce’, requires that certain ingredients (e.g., tryptophan, tyrosine, B vitamins, folic acid, B12, magnesium, etc.) be available in adequate supply. High demand (i.e., stress, certain medications such as stimulants and prilosec) requires a greater supply of the essential ingredients. If any of these is in short supply production and maintenance of a steady state is impaired. In addition, the breakdown and or recirculating of the neurotransmitters requires other nutrient dependent processes (e.g.folic acid, methionine). The task of the clinician is to assess the adequacy of diet, nutritional value of the food sources, digestion, and absorption of the key ingredients used to make the neurotransmitters.

BEN’S STORY: In June of 1985, Benjamin sat in the corner seat of my waiting room, feeling distraught and humiliated. Recently released after three weeks on “the psych ward” at McLean Hospital, this rejection-sensitive young man was still highly anxious, experiencing panic, hopelessness and suicidal ideation. His pain was poorly disguised by a thin veneer of quick humor. Using a combination of individual and group therapies, and phenelzine (an MAO inhibitor), gradually, over 5 years, he came to live a full life, and his visits to me were reduced to a biannual event, when I would catch up with his life, and enjoy some of his excellent sense of humor. In 1989, I switched Benjamin over to fluoxetine (Prozac) which lacked the risk of a hypertensive crisis. Benjamin did quite well, and eventually, he married and had three children. His wife, stressed by the maternal role which her own mother had abdicated, developed fibromyalgia. Benjamin’s parent’s health and finances deteriorated. As the breadwinner of his own family, and only child to his parents, his stress level rose significantly. In August of 1999, Benjamin came for an early visit. Fourteen years after his first panic and depression, he was now having a recurrence of the panic attacks. He was terrified that he would end up back in the hospital. He was convinced that he needed to change his medication to Zoloft. “I think it’s ‘Prozac Poop out’, he said.

THE PARADIGM: In general, when one is depressed regardless of the causes (i.e. metabolic, nutritional, social) distortions in one’s thinking become part and parcel of the depression. Selective attention to these distorted thoughts (usually catastrophic thinking, all or nothing, etc-for a full description of this read Aaron Beck’s Cognitive Therapy of Depression or “Feeling Good” by David Burns) is the norm for depressed patients. One aspect of the treatment of the depressed person is identifying these thoughts, the nature of the distortion, testing the logic behind the ‘automatic assumption’.

BEN’S STORY: I asked Benjamin what basis he had for thinking this, and explored his logic. I asked him if there were any other ways of looking at the situation. Finally I reassured him that hospitalization would not happen, and explained the reasons why (e.g., panic could easily be treated with a short acting benzodiazepine while we were searching for the cause, we could increase the frequency of contact as needed rather than use the hospital, he had a relationship with a psychiatrist he trusted, and who cared about him, whereas that was not the case 15 years earlier), knowing that it was important to deal directly with this negative thought and preoccupation.

THE PARADIGM: Untended, this “catastrophic fear” was causing anticipatory anxiety (activating his dorsal raphe nucleus), priming his limbic system for panic (locus coeruleus), and feeding-forward via the amygdala and locus coeruleus into full fledged panic, and the ‘hypothalamic-pituitary-adrenal gland (HPA) axis-activation-positive-feedback’ loop. It would become a self-fulfilling prophecy.
Having addressed this thought, I explained to Benjamin that ‘Prozac poop-out’, (the commonly held idea that the antidepressants often stop working after a while) was not a concept that makes sense. If a person with unipolar depression is fully responding to an antidepressant in an essentially stable manner for several months or more, and then relapses, it is incumbent on the practitioner to search for other factors that are now over-riding the medication (assuming adherence to the medication), such as psychosocial changes and stressors, as well as any aspect of metabolism.

At this point I decided that in order to approach the situation with ‘fresh eyes’, I would evaluate Benjamin as if he were a new patient. I would do my best to leave no stone unturned, no assumption of mine unchallenged.

Tomorrow, I will detail the surprising domino-like events that nearly brought Ben to his knees.

By Robert J. Hedaya, M.D., D.F.A.P.A. on January 29, 2009 – 9:12am

BEN’S STORY (Continued): I decided to start with the psychosocial stressors – (being a parent, having an ill wife and parents) and delve into the nature of how these stressors changed his life, and how he adapted to them. Apparently, Benjamin had to take a detour from his own career in order to manage his parents finances, control his mothers spending, and deal with his fathers business. When the day was done, he would come home to his ill wife and do most of the house work. Having little support, Benjamin began to cope by stress-eating. He gained weight, began to experience indigestion, and excessive belching. His family doctor, concerned about gastro-esophageal reflux, placed him on Prilosec. Benjamin noticed a significant improvement in his indigestion and remained on the drug for three years before his present panic attacks and depression recurred. However, now the recurrence of panic shook his confidence and he felt that he was losing control of his life and his mind, once again.

THE PARADIGM: Knowing that Prilosec could inhibit B12 absorption, (it inhibits the very cells that produce intrinsic factor, which is necessary for B12 absorption), I eventually convinced Benjamin that he should be worked up for a B12 deficiency secondary to the Prilosec. Despite his distress, he was quite resistant to this idea. The detection of B12 deficiency is difficult. One can look for a macrocytic anemia (large red blood cells also called high MCV), low serum B12 levels, or high levels of methylmalonic acid. However, a number of studies indicate that these tests are often falsely normal when tested against the gold standard Schillings test (no longer available).

Martin Seligman’s learned helplessness model of depression demonstrates that despite their pain, some depressed individuals actively resist help. The neurophysiology of mood disorders suggests that a certain part of the prefrontal cortex (the ventromedial prefrontal cortex) whose function is to accurately predict or anticipate rewarding experiences and pleasure, or painful consequences, has reduced activity.

Because Benjamin complained of indigestion, bloating, constipation, and gassiness, I also evaluated him for bacterial overgrowth of the small intestine which can impair nutrient absorption. An IgG panel for delayed food sensitivities, a comprehensive digestive stool analysis, and an adrenal saliva test rounded out the work up.

BEN’S STORY: When he finally agreed to the workup (one year later), he indeed turned out to have a B12 deficiency. His methylmalonic acid and CBC were within normal limits, although his MCV was trending to the upper limit of normal, and his red blood cell count was trending toward anemia. These trends indicated that a macrocytic anemia was developing, but that the effects of the B12 deficiency manifested themselves first in Benjamin’s weakest system-his nervous system. The only test that was abnormal was a functional intracellular assay of B12 function. With the introduction of B12 injections Benjamin’s panic and depression cleared completely.

The next two tasks were to help Benjamin address the stressors in his life, and his stress-eating response. Based on the test results a number of dietary changes, a program to rebalnce his gastrointestinal milieu, nutritional support, as well as meditation and a regular exercise program were instituted. Benjamin lost weight, discontinued the Prilosec, and felt more in control of his life. He has been without panic or depression since then (8+ year follow up).

I saw Ben last week, and he told me “I am at a high point in my life.” Many of his career aspirations were coming to fruition, and family stresses were becoming more manageable as his attitude was maturing. Is this just a nice, sugar coated story with a happy ending, or are there lessons to be learned from Ben’s difficult passage? You decide.

(Adapted with modification from: Depression: Advancing the Treatment Paradigm, Robert J. Hedaya, MD, FAPA, 2008. IFM.ORG)

Advice for New Parents

I am reposting a recent blog by Lisa Belkin of the NY Times parenting blog, Motherlode, entitled Advice for Brand New Parents. Enjoy!

September 9, 2009, 12:16 pm

Advice for Brand New Parents?

 

By Lisa Belkin

 

Kristina and her husband, Evan, have just moved into a new house in a new city (Cambridge, Mass.) where Evan is just starting business school and Kristina is putting her law career on hold for a year. Their first child is due any day now, and in an e-mail Kristina asks me to ask Motherlode readers for advice. I know you will have plenty. She writes:

We’re SO excited for the baby to arrive, but we’re also a little nervous. So my question is: is there anything you wish you knew before you gave birth the first time? Any wisdom for those first few weeks?

I’ll start with mine:

Do not have expectations. Some mothers bond instantly with their newborns; others take time to fall in love. Some mothers breast-feed easily; others are sure they will never get the hang of it. There are euphoric new mothers, and overwhelmed new mothers, Babies who take to “schedules” and those who don’t. Relatives whose visits are a godsend, and relatives who just get in the way. Days you won’t take a shower, and days when everything will click into place.

The only thing certain about life with a newborn is that if you have a vision of how it should be, you leave yourself open to feeling that you have failed. And there is no such thing as failure, just adaptation and adjustment.

On a more practical note, make a list of everything you do as you go through the day. “Picked piece of wrapping paper off bedroom floor,” “wrote two thank you notes,” “brushed teeth.” Then put a big check mark next to each. It will give you tangible evidence of real accomplishment when the day ends and you don’t remember where it went. And if you save the lists, you can pass them on to your children when they are new parents, as reassuring proof that their own parents went through some messy days, too.

And on a very practical note, get one of those “donuts” they sell in medical supply stores. Sit on it until things heal. Much more comfortable.

Minimizing antidepressant side-effects

On the bookshelf in my consulting room is a gem of a book entitled: The Antidepressant Survival Guide: The Clinically Proven Program to Enhance the Benefits and Beat the Side Effects of Your Medication by  Robert J. Hedaya

The Antidepressant Survival Program

As time went on I began to realize that these two intertwined issues – alleviating the side effects of antidepressants and uncovering hidden medical disorders – required more than medical tests and drug treatments. During the early 1990s it became clear to me that nutrition, exercise, and other lifestyle factors all played roles in combating the side effects of antidepressants while bolstering the medications’ benefits. (As is often the case in medicine, clinicians on the front lines were finding out what worked ahead of the researchers. Over the past three or four years, research studies have been confirming what I discovered in my practice.) I formulated nutrition, exercise, and stress management plans that became the foundation of my program – what I call the Fundamentals. The Fundamentals are based on sound, tested medical principles that will improve your overall health and alleviate antidepressant side effects while amplifying the therapeutic value of the antidepressants. I then combined the Fundamentals with my diagnostic tests, which I call the Medical Prescription, to create the Antidepressant Survival Program.The Antidepressant Survival Program has one overriding goal:To create healthy, balanced functioning in both your body and your mind, which will enable you to live your life as you were meant to live it: with energy, excitement, pleasure, and vitality. A balanced body and mind are the keys to recapturing the joys and freedoms that make life worth living: the ability to create and experience the simple but profound pleasures of love, work and play. The Fundamentals Nutrition Exercise Spiritual Renewal NUTRITION Good nutrition, exercise, and a renewed spirit are the keys to a fulfilling and healthy life. They are also fundamental to maximizing the benefits of antidepressant medications and reducing their side effects. Think of nutrition, exercise, and spiritual renewal as the three legs of the stool that supports and sustains your wellness. If any one leg is unstable, the stool is likely to collapse. Working together, they create an efficient metabolism and a mind and body in balance. The more balanced you are, the better you’ll feel – and the better you’ll be able to absorb the destabilizing effects of antidepressants on your weight, your vitality, and your sexuality. Antidepressants require the right nutrients to enable them to do their job in your brain and body. Meanwhile, antidepressants can create unhealthy food cravings that lead to mood swings, energy depletion, and weight gain. EXERCISE In concert with good nutrition, exercise will normalize your brainbody functions in a myriad of ways. Exercise releases mood-elevating neurochemicals and circulates more oxygen to your brain, supporting the therapeutic action of antidepressants. When you’re exercising regularly, you’ll have more energy and your body can reclaim its youthful proportions. And by building your physical strength, you’ll feel stronger and less vulnerable in both body and mind. SPIRITUAL RENEWAL Anyone who’s recovering from depression or any other chronic ailment needs to take special care to nurture the spirit as well as the body. My prescription for spiritual renewal offers creative ways to restore your ability to experience pleasure by introducing stress relief, play, and spirituality into your life. If you’re too stressed to enjoy yourself, you will never truly recover from depression. Play is an important ingredient in spiritual renewal because it increases access to pleasure by reinforcing dopamine pathways that may have become underactive during depression. And countless studies have affirmed the medical and psychological benefits of making some kind of spiritual practice – whether secular or religious – part of your daily routine. The Fundamentals are the do-it-yourself part of my program, but please take note of places where I encourage you to enlist a coach or support person. Nutrition and exercise are areas you may want to explore in consultation with your physician, and a trainer or workout buddy can be an invaluable ally when you’re trying to build exercise into your life. Spiritual pursuits are highly personal, but, again, the support of a community of people who share your beliefs or values can only increase the strength you draw from those wells.