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.
Disclaimer: I recommend that you be in treatment with a good mental health provider who can help you navigate these choices, balancing them with the need for other intervention.
1. Go to bed by 10 p.m. (Yes, I said 10 p.m.)
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.).
As much as modern life tries to move us away from our evolutionary roots, we can’t change the fact that the human body works best when we fall asleep approximately three hours after sunset and wake with the sunrise. Modern life has us wired, awake, and plugged into our screens much later than we should be, and I think we have epidemic rates of insomnia, anxiety, and depression to show for it.
2. Eat an antidepressant diet.
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.
Switching up your diet is no small task. Ask for the help you need (enlist help from roommates, partners, family). Ask them to join you for a month of Whole30, or to commit to more home cooking, or just ask them to help hold you accountable in a kind and supportive way. If you can manage it, kick things off with a meal delivery service to gather some momentum eating real foods. Remember, you WILL go through processed food withdrawal, and it'll be really hard to pass a pizzeria those first few weeks. Stay strong and remind yourself this is an act of radical self-love.
3. Avoid foods that make you sad.
When we talk about eating real food, we often overlook the flip side, which is avoiding the foods that contribute to depression. This includes anything that takes our mood for a roller-coaster ride (sugar, alcohol, and caffeine are the primary players), anything that inflames us (gluten, industrially processed vegetable oils, all processed foods, and dairy for some people), and anything that serves as a waste of space on your plate. In other words: Ditch the rice cake for a meal that can actually get you the nutrition you need.
4. Get into nature as much as possible; your nervous system will thank you.
A critical dimension of healing depression is ensuring that your life is full of connection with nature. Be in nature weekly, daily, constantly—whatever it takes for your soul to wash away the residue of that air-conditioned, fluorescent cubicle. After 15 continuous years in NYC, I’m currently living around the world for six months, often deeply intertwined with nature. Man, can I feel my nervous system uncoiling from years of sirens and concrete! Our cells need to see the sun and the moon, swim in salty water or a crisp lake, hear birds in the morning, and feel surrounded by trees and breezes. If you’re depressed and struggling to feel well, pack your gear and take the drive or train ride or plane ride to make this one actually happen.
5. Get honest about your daily schedule: Can you live like this?
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.
You don’t have to expatriate to Costa Rica to do this right (though that would be a sound choice). You can make small, unsexy but profound changes in your work life in order to craft a daily life that feels manageable and satisfying. It might be as simple as working one fewer day per week, creating healthy boundaries with your email account, turning down a promotion, building in more time in nature, or downsizing your home to free up some cash flow. Ask yourself tough questions about how much space and stuff you really need, how much money you really need to make, and what quality of life that money really affords you (and at what cost).
6. Start finding your tribe by doing activities YOU enjoy.
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 loathe the way people socialize, and you have no interest in the bar scene, then craft a social situation that you would enjoy (maybe bowling, hiking, book club, art gallery hopping, baking healthy muffins, or watching Dawson’s Creek?). Whatever floats your boat. The people who would show up to this will be people who enjoy doing similar things to you, and therein lies the beginning of your tribe.
7. Lower your standards on exercise.
When you’re depressed, the last thing you want to do is haul yourself to the gym for a spin class. My advice is to lower your standards, a lot. Commit to doing something quick, free, easy, convenient, and pleasant in your living room for a few minutes most days of the week. I suggest anything from Pilates to calisthenics to yoga to dancing along to a Beyoncé music video on YouTube. If you do anything at all, you’ll begin to get the antidepressant benefits, and I assure you doing something—no matter how small—is so much better than nothing.
8. Don't give up on yoga and meditation.
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.
It’s also worth exploring other forms of reflective practices like journaling, painting, making music, dancing, or even coloring in mandalas. Yoga and meditation are such effective antidepressants that it would be a shame to rule them out based on a few subpar vinyasa classes or adherence to a meditation practice that isn’t your cup of tea. Keep seeking until you find a practice that resonates with you.
9. Opt out, say "no," and make rebellious lifestyle choices.
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).
Not convinced that nature can save your health? This study showed that teens who live near nature are less depressed.
Dr. Ellen Vora is a holistic psychiatrist practicing in NYC. She graduated from Columbia University Medical School, received her B.A. in English from Yale University, is boarded in psychiatry and integrative and holistic medicine, and she's also a licensed medical acupuncturist and certified yoga teacher. Vora takes a functional medicine approach to mental health–considering the whole person and addressing the problem at the root, rather than reflexively prescribing medication to suppress symptoms. She specializes in depression, anxiety, insomnia, adult ADHD, bipolar and digestive issues. In addition to seeing patients, Vora also writes, blogs, contributes to two healthcare startups, and does corporate wellness presentations.