Latest research suggests a chemical imbalance is not a cause for depression, therefore current pharmaceutical management may be ineffective. Below are 7 ways you can manage depression symptoms.
“The main areas of serotonin research provide no consistent evidence of there being an association between serotonin and depression and no support for the hypothesis depression is caused by lowered serotonin activity or concentrations1.”
This surprising statement comes from a study, published in July 2022, that examined “The serotonin theory of depression1.” Since the 1960’s it has been thought depression is the result of alterations in the chemical balance in the brain. For six decades this belief has moulded people’s understanding of their moods and how depression is managed.
The answer to the problem has come from a prescription pad. More than 3 million Australians were taking an antidepressant in 20182. We have been led to believe depression must be treated with medication, most commonly selective serotonin reuptake inhibitors (SSRIs). Exercise, sleep, a healthy diet, and a host of other lifestyle factors are known to influence our moods, but people have lost hope of self-regulation strategies having a positive outcome for the management and prevention of depression and anxiety.
That raises the question: If depression is not caused by a chemical imbalance in the brain, are drugs such as SSRIs an effective way of managing the condition?
What should the 1 in 10 Australians living with depression do to help them improve mood3?
A different take on the cause of depression
The results of the systematic umbrella review of the evidence on the long-held theory that depression is a result of chemical imbalances conducted by Moncrief et al1, raises questions about the validity of the research that has been done in this field for the last 60 years. Their assessment of the research has shown a lack of convincing evidence that supports the theory.
It is interesting to note that in the studies that were included in the review, most of them did not show a lower level of serotonin activity in people with depression compared with those who didn’t have this mental health condition. One of the methods used to study the effects of low serotonin levels is to induce a tryptophan deficiency in study participants. Even that does not consistently result in mood alterations.
Healthcare professionals still rely on the assumption that their patients who present with signs of depression have a serotonin deficiency. Since our doctors are the authority we turn to for help when we are not well, the public believes that a chemical imbalance has been proven to be the underlying cause of depression and blindly goes along with their doctor’s treatment suggestions.
Antidepressants may not live up to their promises
The understanding that depression is the result of a chemical imbalance influences how doctors and their patients view their treatment options. Do you take antidepressants or not? If you are already taking medication for depression, is it an option to stop taking it?
Perhaps a more relevant question to ask is: If depression is not caused by a lack of serotonin or serotonin activity, what happens if you continue taking your SSRI? In a systematic review of research that examined the factors that prevent people from discontinuing their antidepressant medication, it was noted that 30% to 50% of people on long-term treatment for depression have no evidenced-based reason to be taking the drugs4.
Research also shows that the acute effects of antidepressant drugs do not persist in long-term treatment. You may feel better when you start taking them, but their effect can wear off. Unfortunately, because medications such as SSRIs result in an improved mood for many people, research has not gone on to evaluate their effectiveness for chronic use. It has been assumed that if your mood improves, and you continue to show reduced signs of depression, you should carry on taking what the doctor has prescribed5.
The problem with that is prolonged use of antidepressants has some negative consequences. When they are taken consistently for more than 6 months you may develop a tolerance for the medication. 9% to 57% of people taking maintenance antidepressants experience a recurrence of the condition. The longer you take the drug, the more likely you are to suffer a depressive episode again. Studies have shown that after 3 years, 45% of people on antidepressants will have a relapse6.
So, if you have been diagnosed with depression, where do you stand? The first thing to do is talk to your doctor, or functional medicine practitioner about your treatment options. While the true cause may be misunderstood, depression is a very real problem for lots of people, with consequences ranging from lack of productivity and self-care to suicide. It cannot be ignored.
Lifestyle can prevent depression
It is well known that how you live has an impact on your mood. What you eat, how often you exercise, taking time to focus on your breathing, getting enough good quality sleep and taking care of your thoughts, all influence how your body and your brain work.
There is a new field in mental healthcare that recognises the benefits of a healthy lifestyle for the prevention and management of mood disorders called Lifestyle Psychiatry.
Compared to people who don’t suffer from depression, those that do have been found to be less active, eat an unhealthy diet and have poor sleep habits. All of these factors are within our control and can be modified to improve overall physical and mental health7.
7 things you can do to manage depression symptoms without SSRIs
1. Move your body
When you are depressed the last thing you feel like doing is getting off the couch and putting on your trainers. But exercise is what your body is craving to make you feel good. Aerobic exercise has been shown to be particularly useful. Walking, jogging, swimming, gardening and dancing are thought to improve depression by altering the body’s physiological response to stress. Other mood-related benefits of exercise include distraction from your daily struggles, the opportunity to connect with other people, and feeling a sense of accomplishment and self-efficiency8.
The great thing about exercise is that you don’t have to do the full 30-minute daily recommendation all at once. You can split it up over the course of the day, giving yourself a mental health boost whenever you need it. We encourage you to choose something you enjoy doing. If you hate the gym, ask a friend to join you for a walk. The more pleasure you get out of the activity, the more likely it is to become a habit.
2. Eat nutritious food
Every part of your body, including your brain, depends on the nutrients you eat to maintain its structure and to function well.
You won’t actually turn into a burger if you eat a lot of them, but your body will change as a result of the lack of vegetables and fibre, and high levels of unhealthy fats and refined carbohydrates in them. Avoiding ultra processed foods is a great starting point before considering other changes.
Your brain needs you to eat good quality food that provides plenty of vitamins, minerals and antioxidants to protect it from damage. The relationship between diet and depression is complex, involving numerous body systems that interact with each other. Research shows the factors affected by diet that contribute to mental illness include inflammation, oxidative stress, mitochondrial dysfunction, gene expression, the health of the gut microbiome, and nutrient metabolism9.
3. Develop a good sleep routine
When did you last get a good night’s sleep? Modern life has a significant impact on the quantity and quality of our sleep. We are constantly busy and on the run, and then zone out in front of our screens when we finally get a chance to sit down and relax. It is no wonder so many of us are sleep-deprived and battling conditions such as depression.
Sleep and depression have a bidirectional relationship; lack of quality sleep causes depression and depression affects the quality of our sleep10. Developing a good sleep routine can help you get a better night’s sleep which can help you manage depression. A routine that works with your circadian rhythm is important. Go to bed and wake up at the same time every day, switch off your screens an hour before going to bed and make sure your bedroom is dark and comfortably cool. Even if you don’t battle with depression, getting a good night’s sleep can make you feel better.
4. Take time out to meditate
Meditation has been practised for thousands of years as part of various spiritual practices. You don’t have to be Christian, Hindu, Buddhist, Jewish or Islamic to benefit from taking time to sit quietly and meditate. It is something everyone can, and should do on a regular basis. With so many different styles of meditation to choose one, you can find one that suits your purposes and preferences.
When you think of someone meditating you probably get an image in your mind of someone sitting serenely with their eyes closed and legs crossed. If that is not for you, you could try lying down, walking, or using a guided meditation. It doesn’t matter which one you choose. They all offer mental health benefits.
Stress and anxiety are both common triggers for depression. Meditation can help you cope better with the emotions that arise when you are feeling under pressure and worried about something. When you meditate you are training your brain to shift your focus away from negative thoughts and emotions so that when you are faced with a stressful situation, you can bring your mind back into focus to help you feel calm.
The practice has an impact on two parts of the brain known to be associated with depression: the medial prefrontal cortex (the part of your brain that worries) and the amygdala (your brain’s fear centre). They normally egg each other on, but meditation has been shown to break the connection between these two brain regions, making it easier to ignore the negative emotions and physiological reactions in response to life events11.
5. Practice gratitude
Drawing your attention to the good things in your life has enormous benefits for enhancing your mood and dealing with stress. Gratitude is something you can cultivate and develop by learning how to habitually focus on the kindness of others and what is going well in your life. In one study participants were split into three groups. One group was asked to keep a journal of the things they were grateful for; another had to write down their daily struggles, and the third wrote about neutral topics. The researchers found that those who focused on the positive aspects of their day-to-day life had better mental health12.
A meta-analysis that examined “The Association Between Gratitude and Depression” concluded: “The association provides a reason to explore further the effects of gratitude-focused interventions as a method to alleviate depression and to prevent the development of depression13.” Avoid getting caught up in the hassles that are part and parcel of living in society, and focus instead on the birds chirping in the trees, your children, or the smile you got from a colleague.
6. Get outside in the sunshine
Have you spent any time outside recently? Living in a city can make keeping in touch with nature difficult. We live in our houses and work in our offices, and a lot of our entertainment takes place indoors too. We have to make a concerted effort to get out into the fresh air and sunshine. It is an effort worth making, though.
More than 50% of people living in the world today live in urban areas; and living in built-up areas has been linked with a greater incidence of mental illness, including depression. A research article that examined the effect spending time outdoors has on the brain and negative thoughts found that participants who took a 90-minute walk through a natural area were happier than those that didn’t. They also discovered that they had reduced neural activity in the part of the brain associated with depression14.
7. Connect with the people you love
Spending time with friends and family is extremely important for mental health. In fact, the researchers of a study published in August 2020, in The American Journal of Psychiatry, stated that social connection is the number one way to prevent depression15.
Social withdrawal is a common effect of depression. You don’t feel like socialising much when you are feeling down so you decline invitations from friends and family. But you know deep down that if you go and share a meal with someone, or take a walk around the park, or celebrate a birthday, you will feel better. The lockdowns we were subjected to during the last two years of the Covid-19 pandemic have shown that social isolation can be a trigger for depression and anxiety and that people need other people to be healthy.
A healthy lifestyle can keep depression away
The research on the causes of depression that health professionals have been using for the last 60 years to determine their treatment of patients with depression is flawed.
As many as 50% of people taking long-term treatment for depression have no clinical reason for doing so. It made them feel better, so they didn’t stop taking it. Chronic use of antidepressants has a variety of negative consequences including developing a tolerance for the medication and relapse of depression.
Lifestyle has proven benefits for preventing and treating depression. You might strain a muscle if you go overboard with your exercise, but otherwise, changes to the way you live don’t have any negative side effects.
Our pillars of health method is a great starting point for helping you take charge of your physical and mental health. Diet, exercise, breathing, meditation, and quality sleep can all prevent depression and help you overcome it if you are already in the grips of the condition.
Checkout our Unstress membership options to discover simple interventions across the pillars of health to fulfil your health potential.
- Moncrieff J, Cooper RE, Stockmann T, Amendola S, Hengartner MP, Horowitz MA. The serotonin theory of depression: a systematic umbrella review of the evidence. Molecular Psychiatry [Internet]. 2022 Jul 20 [cited 2022 Aug 11]; Available from: http://dx.doi.org/10.1038/s41380-022-01661-0
- Whitely M. 1 in 8 (over 3 million) Australians are on antidepressants – Why is the Lucky Country so miserable? [Internet]. PsychWatch Australia. PsychWatch Australia; 2019 [cited 2022 Aug 11]. Available from: https://www.psychwatchaustralia.com/post/1-in-8-over-3-million-australians-are-on-antidepressants-why-is-the-lucky-country-so-miserable
- Mental health, 2017-18 financial year | Australian Bureau of Statistics [Internet]. Australian Bureau of Statistics. [cited 2022 Aug 11]. Available from: https://www.abs.gov.au/statistics/health/mental-health/mental-health/latest-release
- Maund E, Dewar-Haggart R, Williams S, Bowers H, Geraghty AWA, Leydon G, et al. Barriers and facilitators to discontinuing antidepressant use: A systematic review and thematic synthesis. Journal of Affective Disorders [Internet]. 2019 Feb [cited 2022 Aug 12];38–62. Available from: http://dx.doi.org/10.1016/j.jad.2018.10.107
- Fava GA. May antidepressant drugs worsen the conditions they are supposed to treat? The clinical foundations of the oppositional model of tolerance. Therapeutic Advances in Psychopharmacology [Internet]. 2020 Jan [cited 2022 Aug 12];204512532097032. Available from: http://dx.doi.org/10.1177/2045125320970325
- Fava GA. Rational Use of Antidepressant Drugs. Psychotherapy and Psychosomatics [Internet]. 2014 [cited 2022 Aug 12];(4):197–204. Available from: http://dx.doi.org/10.1159/000362803
- Balanzá-Martínez V, Cervera-Martínez J. Lifestyle Prescription for Depression with a Focus on Nature Exposure and Screen Time: A Narrative Review. International Journal of Environmental Research and Public Health [Internet]. 2022 Apr 22 [cited 2022 Aug 12];(9):5094. Available from: http://dx.doi.org/10.3390/ijerph19095094
- Sharma A, Madaan V, Petty FD. Exercise for Mental Health. The Primary Care Companion to The Journal of Clinical Psychiatry [Internet]. 2006 Apr 15 [cited 2022 Aug 12];(02):106. Available from: http://dx.doi.org/10.4088/pcc.v08n0208a
- Marx W, Lane M, Hockey M, Aslam H, Berk M, Walder K, et al. Diet and depression: exploring the biological mechanisms of action. Molecular Psychiatry [Internet]. 2020 Nov 3 [cited 2022 Aug 12];(1):134–50. Available from: http://dx.doi.org/10.1038/s41380-020-00925-x
- Dinis J, Bragança M. Quality of Sleep and Depression in College Students: A Systematic Review. Sleep Science [Internet]. 2018 [cited 2022 Aug 12];(4):290–301. Available from: http://dx.doi.org/10.5935/1984-0063.20180045
- How meditation helps with depression – Harvard Health [Internet]. Harvard Health. 2018 [cited 2022 Aug 12]. Available from: https://www.health.harvard.edu/mind-and-mood/how-meditation-helps-with-depression
- Emmons RA, McCullough ME. Counting blessings versus burdens: An experimental investigation of gratitude and subjective well-being in daily life. Journal of Personality and Social Psychology [Internet]. 2003 [cited 2022 Aug 12];(2):377–89. Available from: http://dx.doi.org/10.1037/0022-3518.104.22.1687
- Jo A I, John M M, Nicola S S. The Association between Gratitude and Depression: A Meta-Analysis. International Journal of Depression and Anxiety [Internet]. 2021 Jun 23 [cited 2022 Aug 12];(1). Available from: http://dx.doi.org/10.23937/2643-4059/1710024
- Bratman GN, Hamilton JP, Hahn KS, Daily GC, Gross JJ. Nature experience reduces rumination and subgenual prefrontal cortex activation. Proceedings of the National Academy of Sciences [Internet]. 2015 Jun 29 [cited 2022 Aug 12];(28):8567–72. Available from: http://dx.doi.org/10.1073/pnas.1510459112
- Choi KW, Stein MB, Nishimi KM, Ge T, Coleman JRI, Chen C-Y, et al. An Exposure-Wide and Mendelian Randomization Approach to Identifying Modifiable Factors for the Prevention of Depression. American Journal of Psychiatry [Internet]. 2020 Oct 1 [cited 2022 Aug 12];(10):944–54. Available from: http://dx.doi.org/10.1176/appi.ajp.2020.19111158