The Role of Exercise, Nutrition, and Sleep in the Battle Against Depression
Part I: Exercise
Clinical Depression affects an estimated 17 million Americans each year. Depression is one of the most treatable mental disorders. There are many treatment options now available for those suffering with Depression. Over the past 40 years, we have made great advances in developing anti-depressant medications to treat the illness of Depression. Studies have shown that antidepressant medications relieve the symptoms of depression in as many as 80% of those who take them. But, medication alone may not be enough for those who suffer from Depression. Psychotherapy has been another important and effective tool in the treatment of Depression. Psychotherapy has been used in the treatment of Depression long before medications were available, and new and more effective therapy approaches are being developed and utilized all the time. Numerous studies have shown that the best way to treat Depression is with both antidepressant medications and psychotherapy provided simultaneously.
But, as with many other illnesses, there is still more we can do for ourselves to improve our health and wellbeing. For example, somebody with Diabetes would be quick to tell you that managing the symptoms of their illness requires more than just taking their medication or insulin. To best manage the symptoms of Diabetes, one has to follow the appropriate balanced diet, exercise regularly, and get adequate rest. Likewise, nutrition, exercise, and sleep play a vital role in managing and preventing the illness of Depression. The mind and body are connected. If you want to feel your best mentally, take good care of your body. So often people who feel stressed, fatigued, and mentally “down” are under-exercised, undernourished, and under-rested. Often they assume that tending to the body takes too much time or is too difficult. The point is important enough to restate: You can’t ignore your body and expect to feel good. Time invested in physical health is a wise investment. Exercise, proper nutrition, and adequate sleep are very important in overcoming Depression and in preventing Depression. The objective of this bulletin and its sequel in March is to help you set up and execute a simple plan for optimal physical and mental health in three areas: exercise, nutritional practices, and sleep hygiene.
Exercise
Exercise improves self-esteem and general mental health. Research has shown that exercise is an effective, but often underused, treatment for mild to moderate Depression. Regular exercise has been proven to reduce stress and anxiety as well as improve sleep. There’s no evidence that any one kind of exercise choice has a greater impact on Depression than others. It appears that any form of exercise can help Depression. Please check with your healthcare provider before starting any exercise program. This is particularly important for people with a medical condition and people who have not exercised much in the past.
To get the most benefit, you should exercise at least 20 to 30 minutes a day, three days a week.
Current studies suggest that four or five times a week is best. If you are a beginner, exercise for 20 minutes and build up to 30 minutes. But remember, any amount of exercise is better than none. Even a 10 minute “energy walk” has been found to increase energy and lift the mood. Start your exercise gently, and build up gradually. If you can eventually work up to 30 minutes a day, five days a week, great! If not, do what you can to start. Here are some tips for getting started:
Choose an activity you enjoy. Exercising should be fun, not a chore.
Walking is an easy choice to make as you begin your Depression and exercise plan. It carries little potential for injury and requires no special equipment.
Initially, due to the isolation that accompanies your Depression, it may be important to team up with someone, or even a group.
When it’s nice outside consider outdoor activities. Sunshine can be a “pick-me-up”, both psychologically and literally. Twenty minutes of sunshine a day stimulates the natural production of serotonin in the brain.
Schedule regular exercise into your daily routine, write it in your planner, or on your calendar.
Add a variety of exercises so that you don’t get bored.
Look into scheduled exercise classes at your local community center, school, or church. In Alma, for example, foul weather walkers take advantage of HIS Place, the Alma High School hallways after dinner, and the Stone Center track at Alma College.
Exercise does not have to put a strain on your wallet. Avoid buying expensive equipment or health club memberships unless you are certain you will use them regularly.
If you have trouble falling asleep, try exercising before dinner, or earlier.
Stick with it. Set goals for yourself and reward yourself for reaching your goals. If you exercise regularly, it will soon become part of your lifestyle.
Depression is a treatable and manageable illness. Anti-depressant medications and psychotherapy are the foundation of treatment, but there is more we can do to defeat and prevent Depression.
We have discussed the role of exercise as a technique to help in the battle against
Depression. The next “Mental Health Matters” will explore the role of nutrition and sleep. Start now with a simple, written plan for optimal physical and mental health. It’s not always easy, but you can do it if you put your mind to it.
Part II: Nutrition and Sleep
Clinical depression affects an estimated 17 million Americans each year. Depression is one of the most treatable mental disorders with many treatment options now available for those suffering. Over the past 40 years we have made great advances in developing anti-depressant medications to treat the illness of depression. Studies have shown that anti-depressant medications relieve the symptoms of depression in as many as 80% of those who take them. But, medication alone may not be enough for those who suffer from depression. Psychotherapy has been another important and effective tool in the treatment of depression. Psychotherapy has been used in the treatment of depression long before medications were available, and new and more effective therapy approaches are being developed and utilized all the time. Numerous studies have shown that the best way to treat depression is with both antidepressant medications and psychotherapy provided simultaneously.
But, as with many other illnesses, there is still more we can do for ourselves to improve our health and well-being. For example, somebody with diabetes would be quick to tell you that managing the symptoms of their illness requires more than just taking their medication or insulin. To best manage the symptoms of diabetes, one has to follow the appropriate balanced diet, exercise regularly, and get adequate rest. Likewise, nutrition, exercise, and sleep play a vital role in managing and preventing the illness of depression. The mind and body are connected. If you want to feel your best mentally, take good care of your body. This only stands to reason. So often people who feel stressed, fatigued, and mentally “down” are under-exercised,
Undernourished, and under-rested. Often they assume that tending the body takes too much time or is too difficult. The point is important enough to restate: You can’t ignore your body and expect to feel good. Time invested in physical health is a wise investment, indeed. Exercise, proper nutrition, and adequate sleep are very important in overcoming depression and in preventing depression. The object of this bulletin and its previous issue in February is to help you set up and execute a simple plan for optimal physical and mental health in three areas: exercise, nutritional practices, and sleep hygiene.
Nutrition
While many people understand the connection between nutrition and a physical disease state, fewer people are aware of the connection between nutrition and depression. Depression is more typically thought of as strictly emotional or biochemical. Nutrition, however, can play a key role in the onset, severity, and duration of depression, including daily mood swings. Many of the same food patterns that precede depression are the same food patterns that occur during depression. These patterns may include skipping meals, poor appetite, and a desire for sweets. People who follow extremely low carbohydrate diets also run the risk of feeling depressed or blue, because the brain chemicals that promote a feeling of well-being, tryptophan and serotonin, are triggered by carbohydrate rich foods.
A number of studies have found that vitamin deficiencies are more prevalent among subjects with depression compared to normal individuals. Vitamin deficiencies that have been found include vitamin B1, vitamin B6, vitamin B12, and folate deficiency. Beside some of the other functions of these vitamins, they also play important roles in neurotransmitter metabolism. Folic acid deficiency can cause personality change and depression. Vitamin B12, at just marginally low levels, can contribute to depression and memory problems. Folic acid deficiency is one of the most common vitamin deficiencies in the United States. Not only is it easily destroyed by cooking, but is most abundant in leafy green vegetables – an often under consumed food group. As we age, Vitamin B12 may not be absorbed as readily, even if the recommended daily requirement is met through the diet. Minerals that play a role in the development or prevention of depression, irritability, and mood swings include calcium, iron, magnesium, selenium, and zinc.
The bottom line is that proper nutrition plays a key role in maintaining mental health:
Foods to eliminate or eat in moderation include sugar and sugary foods, and caffeine.
Get into the habit of eating at least three meals a day, including breakfast.
Replace sweets with fruit and whole grain carbohydrates.
Eat lean sources of protein several times a day.
Drink plenty of water (at least six 8 oz glasses per day).
Focus on a well-balanced diet, including various foods from each section of the food guide
Eat plenty of leafy greens for folic acid.
Eat bananas, avocado, chicken, greens, and whole grains for Vitamin B6.
If you’re concerned about getting enough of some of the key nutrients, consult your physician or dietitian before supplementing.
Sleep
For optimal physical and mental health, most people need about 6-9 hours of sleep per day, at regular times. But many people have difficulties with sleep. There is definitely a connection between sleep problems, particularly insomnia, and depression. We frequently find insomnia in patients diagnosed with clinical depression; in fact, sleep disturbance is one of the core Symptoms of clinical depression. More than 80% of those suffering from depression experience insomnia or some type of sleep disturbance. But this is truly a two-way street because sleep deprivation and insomnia can also increase a person’s risk of developing depression or experiencing a recurrence of depression.
The psychological symptoms of sleep deprivation include: mood swings, irritability, impatience, anxiety, depression, fatigue, decreased alertness and concentration, impaired memory, and impaired judgment. Many people feel that there is little we can do to improve our sleep…we are either going to sleep or we’re not. However, this is not the case. There are many things we can do to improve our chances of getting good sleep by learning to practice more effective sleep hygiene techniques. Here are some good sleep hygiene techniques:
Go to bed at the same time every night and get up at the same time every day. Plan to allow for 8 hours of sleep per night. For example, go to bed at 11 p.m. and wake up at 7 a.m.
Decrease the stimulus in your home at least one hour before going to bed; turn down the lights, turn down the volume, turn down the activities, etc.
If you take medication to help you sleep, take your medication about 1 hour before bed. For most people, these medications take about 30 minutes to 1 hour to start working.
Find an activity that is relaxing to you and do that activity in the hour before bed. Some examples include; reading, listening to relaxing music or nature sounds, knitting, working on a hobby, writing in a journal, taking a warm bath, etc.
Make a mental list of all the things you have to be thankful for.
Write about your worries in a journal, or mentally set them aside. Plan to think about them another time.
Avoid caffeine 4-6 hours before bedtime.
Avoid alcohol, a depressant which may induce sleep but which will disrupt it later.
Avoid consuming a heavy meal just before bedtime. A light carbohydrate snack is fine. Don’t go to bed too full or too hungry.
Regular exercise during the day has been proven to improve your ability to fall asleep faster, stay asleep longer, and have better quality sleep. But, avoid exercising too close to bedtime (within three hours).
Select a comfortable mattress, pillow, sheets, and clothing.
Keep the room temperature moderate.
Keep the bedroom quiet; wear ear plugs. Use a white noise machine, like a fan, to block other Unplug the telephone.
Remove the clock from your view.
Depression is a treatable and manageable illness. Anti-depressant medications and psychotherapy are the foundation of treatment, but there is more we can do to defeat depression. We have discussed many healthy techniques to help in the battle against depression, not all of them may be right for you. Your job now is to find those that work for you and stick with them. Develop a simple, written plan for optimal physical and mental health. Individuals suffering from depression need to eat a balanced diet of healthy and nutritious food, exercise regularly, and get enough rest and sleep to overcome depression. It’s not always easy, but you can do it if you put your mind to it.
Written by: Jerry Masley, RNC
Edited by: Sue Malone
Reference: Masley, J. (February, March 2005). The role of exercise, nutrition, and sleep in the battle against depression.
Mental Health Matters. 2(5,6). Gratiot Medical Center: An Affiliate of MidMichigan Health.
Social Anxiety Disorder
Most people experience some form of social anxiety at some time in their lives, such as performance anxiety, shyness or stage fright. Some studies have indicated that the most common fear that people have is not spiders or snakes, but is the fear of public speaking. And while most people have anxiety in social situations at times, for some people the anxiety can become debilitating, and be classified as a Social Anxiety Disorder.
Social Phobia and Avoidant Personality Disorder
Social anxiety becomes Social Anxiety Disorder when the symptoms become more severe and lead to more impairment in functioning. The DSM-IV identifies two main diagnoses related to social anxiety. One, Social Phobia, has been shown to affect as many as 13 percent of the population. The defning characteristic of Social Phobia is that sufferers have a persistent fear in one or more social or performance situations. People with Social Phobia fear they will act in a way that will be embarrassing or humiliating. They worry excessively about what others think of them, and assume that others are constantly judging them in a negative way leading to fear of interacting with others or of being observed performing any task. Being in such a situation almost always leads to severe anxiety that can include panic attacks. People with Social Phobia know their fears are exaggerated and unreasonable, so often are very hard on themselves for having these fears. They frequently worry that they will be judged negatively for even having the anxiety, and worry that others will see their symptoms such as blushing, shaking, sweating or stuttering. They, in effect, develop anxiety about their anxiety. People with Social Phobia typically will avoid the feared situation. This can lead to serious interference with normal functioning such as holding jobs or being in school, and relationships are often very difficult to develop and maintain.
Another diagnostic category related to social anxiety is Avoidant Personality Disorder (APD). There is a great deal of overlap between Social Phobia and APD. The DSM-IV even says that they may be alternate conceptualizations of the same condition. APD is a pervasive pattern of social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation. People with APD often avoid occupational activities that involve much interaction with others, avoid new activities and risks, want assurance that they will be liked before getting involved with other people, tend to hold back in relationships and view themselves as inept and inferior. People with APD also fear criticism, disapproval and rejection. This disorder also leads to interference with normal functioning occupationally, educationally and interpersonally.
Treatment
The most common treatment for Social Anxiety Disorder is a combination of medication and cognitive-behavioral therapy. In cognitive-behavioral therapy the focus is on identifying selfdefeating thoughts and behaviors and replacing them with healthier ones. This form of therapy helps the sufferers identify the speci?c thoughts that are leading to the social anxiety and to logically examine them and replace them with more realistic and positive thoughts. For example, a man with social anxiety disorder may fear going to a public place where there will be crowds such as a store or mall because he has the belief that everyone will be looking at him and thinking bad thoughts about him. He can be helped to look at the thinking errors in these beliefs. One thinking error at work in this example is “mind reading”: the belief that “I know what others are thinking.” This belief can be reframed as “most people aren’t going to be thinking about me or even paying much attention to me at all, and I have no way of knowing what they might be thinking. It’s possible some may even have positive thoughts about me.”
People with Social Anxiety Disorder are encouraged to identify their thinking errors and to challenge and replace them with more functional ways of thinking. Sufferers are also encouraged to replace their negative self-evaluations. Instead of continually criticizing themselves for their perceived inadequacies, including criticizing themselves for being anxious, they are encouraged to be more accepting of themselves as imperfect humans, just like everyone else. They are also encouraged to accept themselves Social Anxiety Disorder with their anxiety. Changing such entrenched beliefs does not happen overnight and requires much practice. People with Social Anxiety Disorder are also encouraged to step out of their comfort zones and to try new behaviors. When they do this they usually find that their fears did materialize. A person may be encouraged to initiate a conversation with someone they don’t know well, or to try an activity they have been avoiding. They are instructed to pay attention to the outcome to see if their
fears were realized. If their fears did actually come true, the person is encouraged to evaluate whether it truly affected his or her life. For example, a woman may fear walking down a crowded street as she has the belief that she may stumble while walking and everyone will laugh at her. If, in fact, she does stumble and someone laughs, she can be encouraged to see that this had no real impact on her life and was not a catastrophe. If people with Social Anxiety Disorder can be helped to worry less about what others are thinking, much of their anxiety will diminish.
Social Anxiety Disorder is a very treatable disorder. When people combine the proper medications with treatment to help modify dysfunctional thoughts and behaviors, change and relief from debilitating symptoms can be rapid and lasting.
Written by: Will Thomas, M.A., L.P.C.
Reference: Thomas, W. (July 2007). Social Anxiety Disorder. Mental Health Matters. 4(9).
Gratiot Medical Center: An Affiliate of MidMichigan Health.