I'm An Integrative Psychiatrist: Here Are 9 Things I Recommend Before Antidepressants

As a culture, we have a total lack of creative thinking when it comes to treating depression. When we or someone we know is depressed, we often think their only two options are prescription psychiatric medications and therapy. And most likely, medication is front of mind. Well, without going into the pros and cons of psychiatric medications, let’s say this: Medication is not the only option when it comes to treating depression. As a holistic psychiatrist, I know firsthand that there are many avenues that often go unexplored.

If you’re struggling with depression, try some of these diet and lifestyle approaches to healing your depression before you take the first pill. They're a great place to start, and in my clinical practice, I've seen them make a significant enough difference that medication, and the side effects that often come with it, can be avoided.

If you’re serious about wanting to feel better, give yourself the gift of a week where you’re actually asleep by 10 p.m. (which for many of us means you’re in bed reading by 9:30 p.m.).

If you want to treat your depression without meds, this one is nonnegotiable. Changing the way we feed ourselves (and our brains) can be hard, but our mood is based on the health of our brain, and the health of our brain hinges in large part on what we eat. We need to consume several vitamins, minerals, fats, and antioxidants to feel our best, and the only way to authentically do that is with real food.

I won't sugarcoat it: It doesn’t come cheap, and it requires an immense amount of effort. It means swimming upstream in the mainstream food culture of modern life, and it means relinquishing the euphoric hits you get from processed foods. But if you’re looking for the keys to the kingdom of feeling good, they're right in front of you on your plate.

So what does an antidepressant diet look like? It’s a nutrient-dense, anti-inflammatory, real food diet. Essentially, you eat a balance of vegetables; well-sourced meat, fish, and poultry (go to the farmers market or a good butcher and have a conversation about their practices); starchy tubers (translation: sweet potatoes, white potatoes, plantains); fermented foods; nuts and seeds; fruit; and plenty of healthy fats such as ghee, olive oil, avocado, coconut oil, and fatty cuts of meat and fish. What’s not there is what most Americans are eating on the reg—sugar, refined carbs (i.e., bread, crackers, pasta, cookies, even seemingly healthy vegan baked goods and gluten-free replacement foods), and inflammatory oils, such as canola oil.

A controversial and risky suggestion! But let’s talk about this. I have treated ambitious and strung-out New Yorkers (and I’ve been one) for far too long. I’ve realized that the never-ending stress treadmill is often a construct and a choice. So if you’ve exhausted the nutrition, sleep hygiene, and aromatherapy rituals, and you still wake up in a state of dread about your commute and your job—make a change.

Prozac doesn’t hold a candle to community, so start building yours. Begin by thinking about the people you know who are amazing additions to your life. These are the people that are kind and push you to be a better version of yourself while always making you feel worthy and like you belong. You can be flawed and real with them, they share your sense of humor, and as long as you have one of those people in your life, spend time with that person and meet their friends. These qualities are contagious, and there will be more people like that in their orbit.

If you’re reading mindbodygreen, you've probably heard of yoga, and I’m not telling you anything new when I say these ancient traditions pack a powerful antidepressant benefit. If you’ve tried yoga and determined it wasn’t for you, I would recommend trying different studios and a few different styles. Similarly, if you haven't found a meditation approach that pulls you in, keep exploring. One person might feel right at home with mindfulness meditation while another person needs Kundalini yoga or Vedic meditation to hold their attention.

I used to recommend that everyone manage their stress with meditation as their primary tool, but these days I’m pushing my patients to go further than meditation in order to truly manage their stress. If you’re living with chronic, toxic stress, a few minutes a day of meditation is not going to be a sufficient antidote. It’s time to take a major step back and reevaluate the structure of your life. Everything is up for grabs—from career to geography to relationships to how much clutter you’ve accumulated in your home. Take stock and make decisions about what needs to go and what needs to change. Many people are stuck in a loop of staying in a job they hate so they can afford a certain standard of living. But when that standard of living necessitates chronic stress, I question if that’s really a good quality of life. Don’t be afraid to make some rebellious opt-out choices when it comes to career and lifestyle default settings. Take some leaps in order to create the right life for you.

If you’ve been feeling depressed and contemplating the need for medication, I hope you’re able to put some (or all) of these practices into place. In my experience, these can transform depression at the root and obviate the need for medication. I always recommend being in care with a good mental health provider to help you see your blind spots and give you support, but I’m hopeful that most people can heal their depression without medications and the side effects that often come with them.

If you’re experiencing depression and need support, please call the National Depressive/Manic-Depressive Association Hotline at 1-800-826-3632 or the Crisis Call Center’s 24-hour hotline at 1-800-273-8255 (or text “ANSWER” to 839863).