We are in a mental health crisis. More people are suffering from anxiety and depression than ever before and doctors are churning out prescriptions at an unprecedented rate. In 2016, antidepressants (e.g; Prozac) were the most common prescription medication taken by adults, ages 20 to 59. (1) In early 2020, prescriptions for antidepressants rose 18% while those for anti-anxiety medications (e.g; Xanax) rose 34%. (2) Years of taking care of patients with psychiatric emergencies taught me how devastating these illnesses are on a clinical level. Watching some of my own loved ones struggle has done the same in a personal way. Thankfully, we seem to realize the importance of removing stigma and improving access to care. But I don’t believe we are looking closely enough at the connection between lifestyle and mental health. As doctors, we do our patients a huge disservice when we fail to teach them ways that they can improve any disease through the simple habits of their daily lives.
Mental health diagnoses are no exception. Here are five simple interventions that have been shown to improve anxiety and depression. Start moving. Taking a walk or bike ride floods our brains with a variety of mood-boosting hormones, the “natural” versions of many substances people take to feel better. We raise our serotonin levels (the “happy hormone” targeted by SSRI antidepressants), our endorphins (homemade opioids), and our endocannabinoids (that activate the same brain receptors as marijuana), to name a few. We also shift the flow of blood away from our amygdala (the fear-center of the brain) and toward the prefrontal cortex (the center for critical thinking), giving us a chance to consider our problems in a new light.
Sleep more. When we constantly skimp on the seven to nine hours needed for nightly sleep, we put our bodies in a state of chronic stress. Our cortisol and norepinephrine levels are elevated and our minds process the resulting “fight or flight” feeling as anxiety. We also miss out on the array of benefits that sleep and dreaming have for mental health. Leading sleep researcher Matthew Walker PhD refers to dreaming as “overnight therapy”, allowing us to process the difficult experiences of our lives so that we can later recall them without a severe emotional reaction. (3)
Eat better. Diets that consist of highly processed and sugary food shift our bodies into a state of inflammation. Just as an inflamed ankle results in ankle pain, an inflamed brain contributes to anxiety and depression. In a landmark study, researchers showed that 32% of depressed patients who received nutritional training (in addition to their other psychiatric care) had improved symptoms compared with only 8% of those receiving social support.(4) They were taught a Mediterranean diet, focused on eating more whole foods such as fruits, vegetables, nuts, and beans.
Get grateful. Research tells us that, left to our own devices, we tend to have at least four negative thoughts for each positive one. In other words, we are experts at looking for the bad in any situation. A gratitude practice is our simplest tool to dismantle default negativity and take ownership of our thought patterns. By writing down three things that are going well in our lives every day, we teach our brains to look for the good in other areas of our life. This practice not only alleviates symptoms of anxiety and depression but it very really shifts the way we experience our lives.
Live intentionally. We must remember that this is not a dress rehearsal. We have one crack at this life and we get to choose how we spend our time. Perhaps we decide to put down our phones for an afternoon and connect with a friend for a hike. While scrolling social media is associated with increased risk of anxiety and depression, face-to-face connection with friends and spending time in nature are both shown to boost mood. Perhaps we say yes to a volunteer opportunity or call someone that we know is struggling. By helping others, we not only feel better, but we gain a sense of purpose in our lives.
Whenever I share suggestions, I like to highlight the one tip that has helped me the most. In this case, it’s difficult to say because all of these tools are critical to my happiness. My default mindset is one of worry (the kind of person who assumes you were in a car accident if you are five minutes late.) At times this can be just part of my quirky energy and at others it can be debilitating. I try to do all of the things on the list every day because I don’t know which one is the most important, but together they work. Whether you struggle with a severe mental health diagnosis or just the ups and downs that are common to the human experience, I hope you find one thing on this list that helps you!
References:
1. Martin CB, Hales CM, Gu Q, Ogden CL. Prescription Drug Use in the United States, 2015-2016. NCHS Data Brief. 2019 May;(334):1-8. PMID: 31112126.
2. “America’s State of Mind Report.” (2020). Express Scripts, April 16. https://www.express-scripts.com/corporate/americas-state-of-mind-report .
3. Walker, M. P. (2017). Why we sleep: Unlocking the power of sleep and dreams (First Scribner hardcover edition). Scribner, an imprint of Simon & Schuster, Inc.
4. Jacka, F. N., O’Neil, A., Opie, R., Itsiopoulos, C., Cotton, S., Mohebbi, M., Castle, D., Dash, S., Mihalopoulos, C., Chatterton, M. L., Brazionis, L., Dean, O. M., Hodge, A. M., & Berk, M. (2017). A randomised controlled trial of dietary improvement for adults with major depression (The ‘smiles’ trial). BMC Medicine, 15(1), 23. https://doi.org/10.1186/s12916-017-0791-y