Disclaimers

This is a list of all of the possible treatment options that I could find on depression. I am not suggesting, nor recommending any of these options. This list is informational only.

1. I’m not a doctor – Nor do I play a doctor on TV. I’m merely a person who is often visited by the symptoms of depression. Many of these treatments do not meet the standard of care for the medical community in your country. Items that do not meet the standard of care are typically not covered by your healthcare insurer and you will have to pay the full price out of your own pocket. Follow the advice of your doctor, chances are good that they know more of depression than I do.

2. Informational only – I am not recommending, endorsing, or even suggesting you take any of these options. The content here is for informational purposes only. Now that you know all of the options do your own research. Consult your own doctor. Come up with a plan to manage your depression, with the recommendations of your doctor. Having information and choices available to you is a good thing.

3. Everyone is different – News flash: people are different. Treatments that work for one person may not work for another. Some treatments could even make your depression worse as a detrimental side effect. Some of these options may go against some of your beliefs, you are not required to implement any of these options.

4. Don’t eat peanuts if you are allergic to them – If any of these options are detrimental to your health or well being don’t do them. Use your own judgement on what will or will not work for you. An example of this could be you have kidney and bladder problems and increasing your water intake is not advisable. OK, cross that option off of your own personal list of viable options. You know you better than I ever could.

5. There is no panacea or cure-all for depression – Depression is a complex and difficult disease to treat. There is no one single silver bullet that will magically take away depression. You most likely will need to do multiple things to improve your depression and get back to good mental health. Some of you may need to include 10 of these items in your daily practice, others may need to do 20 or more to see an effect. Don’t be discouraged when a single option doesn’t magically cure you.

Rule out other underlying causes

You may have symptoms similar to depression without actually having depression. Rule in or rule out any or all of these conditions.

6. Cancer – A cancer diagnosis can trigger a depression. Cancer treatment and its effects on the body can trigger depression. The cancer needs to be managed effectively as well as the depression. Given the pressing nature of cancer this is typically addressed first, but not at the exclusion of treating depression.

7. Abuse, trauma, PTSD – These can create mental scars that continue to affect us to this day. These issues are typically a major mental stumbling block and may need to be addressed before depression. EMDR is a therapy often used in healing from trauma. See the WikiPedia article Eye Movement Desensitization and Reprocessing for further information. Note that it can be any type of rhythmic bilateral stimulation: blinking lights; alternating tones in headphones; vibrating paddles in the hands; tapping on the shoulders, etc.

8. Conflict, ongoing – Ongoing conflict increases stress and can severely impact depression. Work on reducing intensity of the conflict to ease its impact on your depression.

9. Chronic pain – Pain has a debilitating effect on the body. If you have chronic pain, find a healthy treatment on reducing pain. Rheumatoid arthritis and its constant aches and pains can wear one down mentally. People with RA have a higher incidence of depression.

10. Genetics – Those people who have family members who have or have had depression are much more likely to have depression themselves. There is correlation that a family member with other mental health issues (bipolar, schizophrenia, etc) increase the likelihood of that issue or depression.

11. Chronic deep infections or infectious diseases – AIDS, hepatitis, mononucleosis, Lyme disease can all have a mental toll. Be sure to treat those issues as lack of progress on that front may prevent progress against depression.

11a. Hidden locations for infections – Teeth that had root canals done against them years before can be a hidden source of infection that is not easily detectable. If you have had a root canal then I would suggest the following: find a dentist who follows the tenets of biological dentistry; have a 3D X-ray of the root canal tooth to detect if there is a hidden abscess; if there is an abscess consider the option of having the tooth extracted. Note: a regular X-ray will NOT detect the abscess, it must be a 3D X-ray. For further information watch the documentary Root Cause on NetFlix. Here is the link to the documentary Root Cause on IMDB.com.

12. Chronic disorders that have neurological component – Neurological disorders that can present with the symptoms of depression. Including but not limited to: stroke, multiple sclerosis, Parkinson’s disease, dementia, cystic fibrosis, lupus. The neurological disorder should be addressed as well as depression.

13. Dehydration – According to two studies conducted at the University of Connecticut’s Human Performance Laboratory, even mild dehydration can alter a person’s mood. (See item 80 the Diet section below for further information on water intake.)

14. Hypothyroidism – An underperforming thyroid gland. Greatly reduces activity level. Symptoms similar to depression. Often treated with medication.

15. Low blood sugar – Low blood sugar can have a major effect on mood. We laugh at those outlandish Snicker’s commercials, but there is some truth to them. “Triggered by drops and fluctuations in blood sugar, anxiety and depression can manifest in people who are very sensitive and can become chronic if food intake isn’t consistent. Humans are built like all the other animals – and animals get very unhappy when blood sugar is low.” – Peter Bongiorno

16. Nutritional deficiencies – A lack of certain vitamins, minerals, or nutrients (e.g. deficiency of B12 or B6) can manifest with depression like symptoms.

17. Side effect of certain drugs – Each person’s body chemistry is different. What may be helpful for one person, could be harmful for another. Some medicines that could potentially trigger depression include: Singulair, Accutane, Lariam, Chantix, Ideral, contraceptives, Interferon, certain HIV medications, Vigabatrin. This list is not inclusive. Do NOT stop taking medicine without consulting your doctor. Medical personnel can better ascertain if this issue is applicable to you. If you are having a depression side effect, they will come up with other forms of treatment for you,

18. Situational depression – A recent loss or sad event such as the loss of a job, bereavement, divorce, or social isolation. This is not to belittle your symptoms, or your grief. Situational depression will often pass on its own. Situational depression can benefit from these treatments, but some of the stronger treatments may not be warranted.

19. Hormonal imbalance – Hormones can have a great effect on the mind and the body. Both men and women can be effected by hormonal imbalances, but women are much more likely to experience depression from this cause. Examples include: premenstrual dysphoric disorder (PMDD), perinatal depression (depression during or after pregnancy), perimenopause depression (the transition into menopause). Some of the hormones that could be out of balance include:
estrogen – boosts serotonin (neuro transmitter)
progesterone
cortisol – stress hormone
testosterone – low levels can negatively effect mood

Medical treatments

Under the care of a medical professional. Often covered by insurance. Those treatments not covered by insurance typically are off label uses of medication, or therapy protocols that do not meet the standard of care for the medical profession in your country.

20. Take medication – Many different types of medication. Everyone’s body chemistry is different, it may take several attempts to find the right mix of medicines. Discuss with your doctor and come up with a plan of action. If your symptoms are not relieved, or the side effects are too severe talk to your doctor.
A) SSRI – Selective Serotonin Reuptake Inhibitors. Examples: citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil, Pexeva), fluoxetine (Prozac, Sarafem), and sertraline (Zoloft).
B) SMS – Serotonin Modulators and Stimulators. Examples: vilazodone (Viibryd) and vortioxetine (Brintellix)
C) SNRI – Serotonin and Norepinephrine Reuptake Inhibitors. Examples: venlafaxine (Effexor), desvenlafaxine (Pristiq and Khedezla), duloxetine (Cymbalta), and, levomilnacipran (Fetzima)
D) TCA – Tricyclic antidepressants. Examples: amitriptyline (Elavil), desipramine (Norpramin, Pertofrane), doxepin (Adapin, Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil)
E) MAOI – Monoamine oxidase inhibitors. The MAOIs block an enzyme, monoamine oxidase. Examples: phenelzine (Nardil), tranylcypromine (Parnate) , isocarboxazid (Marplan), and transdermal selegiline (the EMSAM skin patch)
F) NDRI – Norepinephrine and Dopamine Reuptake Inhibitors. Examples: bupropion (Wellbutrin, Aplenzin)
G) Serotonin and norepinephrine medicines Examples: mirtazapine (Remeron), trazodone (Desyrel)
H) Antipsychotics – Don’t get freaked out by the name as a low dosage of an antipsychotic combined with other medicine can have a major positive effect. Examples: aripiprazole (Abilify), quetiapine (Seroquel) and brexpiprazole (Rexulti).
I) Combinations – Symbyax, a combination of the antipsychotic drug olanzapine (Zyprexa) and an SSRI (Prozac, or fluoxetine), is approved for treatment-resistant depression or depression in people with bipolar disorder.

Do NOT stop taking medicine without consulting your doctor. A cold turkey ending of medication can have disastrous results. Typically with antidepressants a protocol of tapering down to lower levels of medication is followed prior to coming off a medication completely.

21. Attend talk therapy – Talk therapy comes in many forms: Freudian, gestalt, behavioral therapy.
Much of current therapy is behavioral based. CBT (Cognitive Behavior Therapy) and DBT (Dialectal Behavior Therapy) are the leading options, but not the only ones.
Talk therapy can be done either individually or in a group.
Most talk therapy is done in an out-patient model, where the client goes about their normal life and meets periodically. If the depression or mental disorder is severe then in-patient care may be warranted. In-patient does not mean that you will be locked up forever, you just need more care than out-patient can provide.

22. IV Ketamine infusions – The anesthetic ketamine could offer hope for people who don’t have other depression treatment options. The most recent research on ketamine, as well as a statement from experts on its use published in April 2018, finds the drug works quickly, makes dramatic improvements in mood, and can work on people who haven’t gotten better with other depression treatments. The evidence is so enticing that the FDA has granted two ketamine-based drugs breakthrough therapy status and fast-tracked them to market. Yet the studies done so far on ketamine have been small, and its availability is so far limited mainly to ketamine clinics and research studies. The FDA has only approved ketamine for use as anesthesia, using it to treat depression is considered off-label by the FDA and as such is typically not covered by insurance. Rates are typically $500-750 per session with a common protocol being 6 sessions in a two week period. Maintenance sessions often are needed in the 4-8 week timeframe and ongoing. There is at least one practitioner of this in the Albany area.

22a. Nasally administered esketamine – The US FDA approved the use of esketamine as a treatment for depression on 3/5/2019. Esketamine is a chemical cousin of ketamine. One brand name that is being marketed in the US is Spravato. Since the FDA has approved the use of esketamine it falls within the standard of care, and most likely will be covered by insurance but there might be a lag in insurance covering it. Spravato has roughly the same cost as a ketamine IV infusion ($500-750), but the anticipated out of pocket costs will most likely be lower. For further information see this article on NPR: FDA Approves Esketamine Nasal Spray for Hard-To-Treat Depression.

23. TMS – Transcranial Magnetic Stimulation. The premise is that a strong magnet outside of the head will induce a current of electicity in the brain inducing change. There are some recent studies that show promise with this method. There doesn’t appear to be as many downsides as ECT, but this is a procedure that must be performed by a medical professional. There have been studies but it has not been fully approved by the FDA and as such is typically not covered by insurance. A common protocol of treatment is a series of sessions over a period of time, and the series cost in the ballpark of $10,000. There is at least one TMS practitioner in the greater Albany area.

24. Vagus nerve stimulation – Vagus nerve stimulation (VNS) is a surgical procedure that can be used to treat those with treatment-resistant depression. A pacemaker-like device, implanted in the body, is attached to a stimulating wire that is threaded along a nerve called the vagus nerve. The vagus nerve travels up the neck to the brain, where it connects to areas believed to be involved in regulating mood. Once implanted, this device delivers regular electrical impulses to the vagus nerve. Since this is a surgical procedure I would try all of the other methods before I selected this option.

25. ECT – Electro Convulsive Therapy sometimes erroneously called electroshock therapy. The premise is that a large electrical charge through the brain will induce change. It’s true that a change is induced, but it can have a major impact on memory and personality. It can create these negative side effects with actually having no impact on the depth of your depression. Given its potential for drastic side effects I believe that it should be a last resort option when all others have been exhausted. ECT is typically performed in a hospital or qualified mental health facility.

Complementary and alternative medicine treatments

Typically outside of the scope of traditional Western science based medicine.

26. Acupuncture – One new study found the traditional Chinese practice to be as effective as antidepressants, and a different study found that acupuncture may help treat the medications’ side effects. In acupuncture, a practitioner inserts needles into the skin at points of the body thought to correspond with specific organs. Western research suggests the needles may activate natural painkillers in the brain; in traditional Chinese medicine, the process is believed to improve functioning by correcting energy blocks or imbalances in the organs. Some studies have shown that acupuncture into the abdomen may have the most positive effect in comparison with other regions of the body. Few acupuncture practitioners provide abdominal acupuncture in the Capital Region however.

27. Chiropractor – Some people with depression may find that imbalances within their body were contributing to their symptoms. If spinal vertebrae are out of place, it can place pressure on the surrounding nerves. Since the nervous system circulates throughout our bodies, a blocked nerve in the lower back can actually affect all sorts of places in the body. Once a chiropractor has identified a problem area, symptoms can be alleviated after one adjustment, or a series of adjustments. The chiropractor will recommend a regimen that will more than likely include regular visits and perhaps other related treatments such as massage.

28. Energy medicine therapists – A branch of alternative medicine. This may or may not involve the laying of hands on or over the injury. The laying on of hands may involve touching, stroking, or tapping certain energy points in the body. Reiki and Qigong, and Reflexology are types of energy healing, but there are energy therapists that don’t fall into the Reiki, Qigong, or Reflexology categories. Considered by many to be a psuedoscience there are no or few peer based studies of energy medicine. Even with that there are many pieces of anectodal evidence that promote this type of healing. See https://en.wikipedia.org/wiki/Energy_medicine Reflexologists believe that the body has the capacity to heal itself. The nerves in the hands and feet are related to various parts of the body. Reflexologists believe that the healing process is stimulated by applying pressure to specific points on the hands and feet. **I couldn’t find any peer reviewed studies of Reflexology and depression.
**Patients dealing with the symptoms of depression may experience benefit from participating in Reiki sessions in conjunction with their professional treatment programs and methods. Reiki therapy can be used deal powerfully with mental stress, feelings of failure, loneliness and very high expectations, which are some of the main causes of depression. Using Reiki for depression will speed up recovery in unimaginable ways. I couldn’t find any peer reviewed studies of Reiki and depression.

29. Hypnosis – Although I’m not sure of its efficacy, hypnosis has produced dramatic change for many people across a broad range of behaviors and could show benefit with depression as well.

30. Life coaching – Focused on the present moment, setting goals, and holding client accountable. Does not focus on the WHY we think or behave in situations, but rather involve an AWARENESS of thoughts and feelings and coming up with alternative METHODS of thinking or behaving. Often times involves specific actions or list of things to do in a particular situation.

31. Massage therapists – Taking time for massage is as important for people dealing with depression as it is for people dealing with arthritis, sports injuries and carpal tunnel syndrome. WebMD reviewed more than a dozen studies that revealed how massage can fight depression by lowering cortisol levels. Cortisol is the body’s response to stress, and massage therapy lowers it by as much as 50%. At the same time, massage provides many benefits and can also increase the levels of serotonin and dopamine, which are both neurotransmitters that help stabilize your mood.

32. NLP – Neuro Linguistic Programming. Our success, or lack of it, is caused in large part what we think about (neuro), what we say to ourselves and others (linguistic), and how we act (programming). By using tools and strategies within NLP a significant change of state can occur. NLP can be used for many different situations and conditions. Some people consider NLP as a psuedoscience. Try it before you discount it.

Personal Practices

Things that you can make a regular part of every day that can help with depression.

33. 30 Second Mindfulness – The present moment is where peace and serenity exist. Many of us seek to check out of the present moment and buffer the negative emotions with food, drugs, alcohol, sex, spending. The key is come back to the here and now. Pick an “anchor action” where just before you do the anchor action you check your spiritual posture.
Checking your spiritual posture: a) Where are my feet?; b) Where is my heart?; c) Where is my mind? d) invite the God of your understanding into the present moment to be with you while you experience the anchor action.
Where are my feet? What am I currently experiencing as it relates to my 5 senses, where do I sense things in my body?
Where is my heart? Which of the 7 emotions am I feeling? (sad, mad, glad, afraid, lonely, embarrassed, guilty) – and if it’s not one of those it most likely is one of those plus a thought.
Where is my head? What thoughts are in my head? Am I caught in stinking thinking or a cognitive distortion?
Ask the God of your understanding to be with you for the next few moments so that you fully experience the next few moments.

34. Affirmations – Repeating positive phrases to yourself. Affirmation should be stated in the present tense, towards a positive action not away from a negative one, a believable stretch statement not one you think is impossible. Preferably spoken aloud, in front of a mirror, with positive emotional affect in your voice.

35. Challenge negative thoughts – Fire your inner critic. Can you find fault with perfection? Buddha’s fat, Gandhi walks around half naked, and Jesus needs a haircut. Ask yourself 4 questions before you speak: Is it TRUE? Is it KIND? Is it NECESSARY? Is it HUMBLE? If the answer is NO to any of these then you need to say nothing. After doing this successfully for several weeks start applying these questions to your THOUGHTS.

36. Declutter for 5-10 minutes – Cleaning a whole mess of a house can be daunting. Take 10 minutes and declutter the room you are in. Or do what I call ADHD decluttering: every time you walk into a room you are to immediately search for 3 things out of place and your job is to put them in their rightful place.

37. Do the dishes – Do something productive. The dishes need to be cleaned regardless whether you want to do them or not.

38. Do the laundry – Pick up the dirty clothes, wash, dry, fold the laundry, iron, put clean clothes away

39. Follow a spiritual practice – Put some spiritual discipline in your life. It doesn’t matter what the origin of the practice is, focusing your attention on certain tasks and thoughts can be extremely helpful. Examples include: 8 fold Noble Path from Buddhism, Spiritual Exercises of St. Ignatius from Catholicism, A Purpose Driven Life from Rick Warren, A Course In Miracles a new age Christian philosophy, or the 12 Steps from Alcoholics Anonymous.

40. Gratitude list, daily – Get in touch with realizing how blessed you already are. Find 5 things that you are grateful for each day. Write them down in your journal. Try not to repeat your entries.

41. Grocery shopping for healthy food – Why not buy the right things and keep them in your house. If you have junk food in your house you are more likely to binge. Don’t go shopping when you are hungry. Eat first, then go shopping. Lean towards organic plant based whole foods and away from non-organic processed foods.

42. Hobby – What lights you up? You don’t have to be good at, you just enjoy doing it. Preference would be towards hobbies that involve other people.

43. Inspirational readings – This could be scripture, poems, meditation books, or recovery readings. Be inspired.

44. Journal – Keep track of your moods and your life. Focus on yourself, on your inner motivations and how could you better approach the difficulties that life presents you. Write continually without editing what you are writing. Order will eventually come out of the chaos of your rambling writing.

45. Live by the law of cause and effect – Sometimes it’s called karma. Some people refer to it as the Law of Attraction. Others say what goes around comes around. Regardless what you call it, what we put out into the universe comes back to us in some form. If you put out hate and disgust that will come back to you. Put out compassion, kindness, and love and it will return to you.

46. Looking up – I don’t mean having a positive attitude, I don’t mean looking up to heaven to connect with God. Both of those are laudable but I literally mean look upwards. According to NLP when we feel we are using our kinesthetic senses and our eyes typically look downward. Depression can be looked at as having habitual behavior to feel bad. By looking up you are short circuiting the connection to the kinesthetic. Having a positive outlook or looking up to God can be helpful as well but that is not what I’m talking about here.

47. Make your bed – A simple practice, but one that shows discipline and that you are trying to do your best. Don’t underestimate this simple practice.

48. Meditation – Connecting with the present moment. It could be focusing on the breath, it could be a mindfulness meditation, or it could be listening to a guided meditation.

49. Meditation, guided imagery – Guided imagery is a form of focused relaxation that helps create harmony between the mind and body. Guided imagery coaches you in creating calm, peaceful images in your mind-a “mental escape” for therapeutic purposes. It can be a powerful psychological strategy to enhance a person’s coping skills. It can help people cope with-and possibly overcome-stress, anger, pain, depression, and insomnia with or without associated physical illness. There are many low and no cost options online.

50. Personal hygiene – Getting cleaned up can have a dramatic effect on mood. Shower, shave, do your hair, get dressed to at least the level of business casual. You will feel better. Today’s cleanliness can’t rely on yesterday’s shower.

51. Plan for the day – Having a plan prepares you for the day and you are more likely to get things done if you plan for them. Structured time is better for the depressive person. Don’t get overly hung up about following the plan and only the plan. Allow for spontaneity, but have a plan for what you want to accomplish.

52. Practice compassion – The Dalai Lama said it best “If you want others to be happy, practice compassion. If you want to be happy, practice compassion.” Be compassionate with others, but also be compassionate with yourself.

53. Prayer – These do not need to be formal or rooted in any spiritual tradition. Typically prayer comes in 3 forms: Help, Thanks, and Wow.

54. Projects/chores – Make progress on those things you have been on your to do list for a while.

55. Read reputable self help books and websites – Learn from the wisdom of others. Much of what is out there has negligible benefit. Speak to others and get their recommendations on what helped them. Don’t use them as “shelf help” where you learn new wisdom and don’t put it into practice. Put into action what you’ve read.

56. Sleep regimen – Many people are in a perpetual state of being sleep deprived. You should be getting 7-9 hours per night. Have a routine and stick with it. Set a bed time for yourself and set your alarm to wake up and get out of bed at a set time.

57. Stress and relaxation techniques – Relaxation techniques may produce modest short-term reduction of anxiety in people with ongoing health problems. These techniques have also been shown to be useful for older adults with anxiety.

58. Surrender to your Higher Power – Spirituality is not the same as religion. Spirituality typically has 3 characteristics: 1) there exists a power higher than self; 2) we are all connected to that power; 3) there is no US vs. THEM as there is no THEM. Spirituality does not require a belief in the supernatural, but it does require the belief in something that is superhuman. (No not the comic books, just something that is greater than self). It could be nature, love, the end of suffering, enlightment, serenity, Buddha, Jesus, God, Allah but it need not be any of these. Surrender is not the same as giving up. Surrender is fully accepting the reality of the present moment. You don’t have to like the present moment, but you do need to accept it as it is.

59. Simplify your life – Cut back on obligations when possible, and set reasonable goals for yourself. Give yourself permission to do less when you feel down. Get rid of the clutter. Become less materialistic.

60. Track top lines – All of these practices could be called top line behaviors that build up inner resolve and resilience. The more top lines you practice regularly the better you will be.

61. Track your moods – Keeping a history of your mood over time can be helpful. Some options include: BDI (Beck Depression Index), DBT (Dialectal Behavior Therapy) diary card

Personally Administered Therapies

These are simple, relatively low cost, things that you can put into practice.

62. Binaural beats – The premise is that listening to a recording where the left and right audio tracks are slightly out of phase with one another induces certain patterns of brain waves. Requires that you listen with stereo headphones. Considered by many to be quackery. Some anecdotal evidence exists that it could increase the chance of having seizures so those of you with a seizure disorder should avoid this option. There are low cost options available on Amazon and other online resellers, some as little as $0.99 and with such a small investment why not give it a try.

63. Aromatherapy – Aromatherapy is said to be effective for many disorders. Some examples of essential oils that help with depression are: jasmine; sandalwood; ylang ylang; clary sage; basil; bergamot; rose; geranium; neroli; petitgrain; lavender; chamomile; yuzu; rosemary; mandarin orange; frankincense; lemon; eucalyptus. Here is an article for you to read about using essential oils and aromatherapy for depression: Using Aromatherapy for Mental and Emotional Health (https://psychcentral.com/blog/using-aromatherapy-for-mental-and-emotional-health/)

64. Heat therapy – Research I’ve read indicates that the best form is deep infrared based heat, but there is anecdotal evidence that both saunas and steam rooms can bring about a benefit (with more evidence pointing towards saunas). A DIY home based solution can be built from products available from your favorite big box home retailer for under $200.

64a. Cold water immersion – There have been a number of studies performed looking at the effect cold water immersion has on depression and mood. Not many of us live near a cold water lake, nor would I suggest that swim in a cold water lake as you run the risk of drowning. What I’m suggesting is that you finish your shower with 1 minute of the coldest water you can stand for one minute. Work your way towards colder water over time. I know that we all want comfort and to not be in frigid water, but give it a try before you scoff at the idea. You’ll be amazed at how alive you feel after doing it.

65. Inversion therapy – Getting the head below the heart increases blood flow to the brain. It is rumored to affect the brain in many other positive ways. Inversion could be done with various yoga poses including downward facing dog, handstands, or even using an inversion table.

66. Light therapy – A light source more closely mimicking the full spectrum of light from the sun can affect positive change in those people whose depression has a seasonal component to it. Inexpensive light boxes can be found online in the $50-200 price range. More expensive options exist as well.

67. Personal energy medicine / Personal Reiki – Similar to those done by an energy practictioner, but self administered. Typically not as effective as done by a practitioner, but you can do this several times each day which can more than make up for the diminished effectiveness per treatment. Some studies have been done testing the validity of reiki, but there is no conclusive scientific evidence. Many people do swear by it though. See the article Reiki Healing and Mental Health: What the Research Shows on Psych Central. (https://psychcentral.com/lib/reiki-healing-and-mental-health-what-the-research-shows/)

68. Tapping / EFT / pressure points – Tapping certain pressure points in the body can have a positive effect on your thoughts and moods. The movement is called Emotional Freedom Technique. See videos on YouTube (sample YouTube search) or the article Emotional Freedom Techniques on WikiPedia (https://en.wikipedia.org/wiki/Emotional_Freedom_Techniques)
Pressure points is also sometimes called acupressure, think of it like acupuncture but with pressure not needles.

69. TDCS – Transcranial Direct Current Stimulation. The premise is that low voltage, low amperage direct current stimulation on the exterior of the head can produce a small electrical current within the brain and induce change. There are several montages or “constellations” of where to place the electrodes to produce a specific change. Some peer reviewed studies exist but they are not super compelling. There are several low cost alternatives online in the $100-200 range.

Activities

These physical activities can help dramatically with lifting depression. Try to do 3-7 of these each week to boost your mood. Start out small and build up strength and duration over time. Don’t overdo it at the beginning.

70. Calisthenics – You don’t need to belong to a gym to get in shape. There are many exercises that use your own body weight to get you into shape. Planks, squats, lunges, jumping jacks all use your body to get your body into shape.

71. Exercise 20-30 minutes – Get in motion. Find an activity you like and just do it. Go for a bike ride, walk the dog, heck walk the neighbor’s dog, just get into motion.

72. Get 30 minutes of sun – Get out and soak up the sun rays, your body’s way of making vitamin D. I’m not suggesting you sunbathe, but rather do something that requires you to be outside in the sun. Do some yard work, sweep the driveway, go for a walk or a bike ride. Don’t forget the sunscreen though.

73. Good posture – People who are down and depressed tend to slouch. The physical state is an outcome of the mental state, but the two are linked. Having better posture will have an impact on mood even if it is slight. The article Good Posture May Ease Symptoms of Depression on Psychology Today may be of interest to you. (https://www.psychologytoday.com/us/blog/minding-the-body/201701/good-posture-may-ease-symptoms-depression)

74. Power poses – These physical activities can help dramatically with lifting depression. See the Amy Cuddy TED Talk on YouTube (https://www.youtube.com/watch?v=Ks-_Mh1QhMc&t=6s)
Think of the Wonder Woman pose, standing forward, open with hands on the hips.

75. Stretching – Depression is often accompanied with body aches. Stretching can lessen those aches and pains and can make it easier to get into motion.

76. Take the stairs – Let others take the elevator. Get into motion and take the stairs. Be sure to walk both upstairs and downstairs, going in one direction only will not build balanced muscles.

77. Walk 5,000 – 10,000 steps – Walking is the easiest and safest form of exercise. Get yourself a pedometer or use an app on your smart phone. Get moving, you will feel better. I suggest you don’t always walk in the same direction, sidewalks are built to slope away from buildings and into the road, walking in the same direction every day can put uneven pressure on your joints. Go clockwise one day, and counter-clockwise the next, your joints will thank you.

78. Weight training – Weight training is the fastest way to build lean muscle mass. You don’t need to be a professional body builder. Try not to overtrain a specific part of the body, mix it up and build all of your muscles.

79. Yoga – There is a mind body connection that yoga can help explore. There are various poses that you undertake that are used to strenghten the body and increase flexibility.

Diet

You are what you eat.

80. Adequate water intake – The guideline of 8 cups of water is far too little for most people. A better rule of thumb is to take your body weight in pounds, divide that number by 2 and the resulting number is how many fluid ounces of water you should be drinking. So a 200 pound man should be drinking 100 fluid ounces of water. Spread the water drinking throughout the day. You can drink too much water too quickly which can result in death (caused by an electrolyte imbalance). Don’t drink more than 20 ounces of water in an hour.

81. Anti-inflammation diet – A recent Harvard study found that a diet full of foods that inhibit inflammation in the body (like vegetables, olive oil, wine, and coffee) can cut depression risk by 41 percent, compared to eating foods that tend to trigger it, such as refined grains and red meat.

82. Avoid alcohol – Alcohol is a depressant and can make your depression worse. It can temporarily take away your pain, but there is a price to pay. Also alcohol is addictive.

83. Avoid artificial sweeteners – A recent article from Harvard Medical School describes the negatives of artificial sweeteners as it relates to mental health. See https://www.health.harvard.edu/blog/could-artificial-sweeteners-be-bad-for-your-brain-2017060711849

84. Avoid caffeine – Caffeine is a drug and does effect the brain. To what level is a deep topic. See the following article: https://www.livescience.com/34765-coffee-drinking-is-mental-disorder-dsm.html

85. Avoid dairy – Many people have an intolerance to lactose (milk sugar) and to dairy products in general. You don’t need to give it up forever. Try 1 week without dairy products and see what the impact is. If you exercise this option contemplate taking a calcium supplement.

86. Avoid gluten – Gluten intolerance can effect many aspects of your health, not just your digestive health. Even if you test negative for celiac, you could still have a low level gluten intolerance that manifests in many different ways. Gluten is predominantly found in wheat, but it is also found in rye, barley and other grains. Although oats themselves don’t contain gluten they are often processed in the same plant as wheat, and as such are cross-contaminated. Unless it says gluten free there could be low levels of gluten in it. Eliminate it from your diet for 1 to 2 weeks to see the effects on your body and your mood.

87. Avoid sugar and highly processed food – An article in Psychology Today discusses the impact of sugar on your mental health. See: https://www.psychologytoday.com/us/blog/where-science-meets-the-steps/201309/4-ways-sugar-could-be-harming-your-mental-health

88. Follow a ketogenic diet – A number of studies have been undertaken showing the effect on following a ketogenic diet. What type of diet is it? Think low carbohydrate, healthy fats, protein. Lots of green leafy vegetables, nuts, fruits sparingly (given higher sugar content in fruit). This is not an excuse to fill up on bad fats, lard fried bacon or anything like that. A more structured and less fad orientation than Atkins or Paleo diets. See https://medium.com/@drstephanie/how-the-ketogenic-diet-helps-with-depression-d888e96b43a3

89. Whole food, predominantly plant based – Eating a whole food predominantly plant based diet can help dramatically. Try to eat organic foods if you can afford them. If you choose to eat animal based products go for minimally processed, organic, and the animal should eat what it was evolved to eat (e.g. cows being grass fed and not grain fed)

Vitamins and supplements

Sometimes you need more than what you eat.

90. 5-HTP – 5-HTP (5-Hydroxytryptophan) is a chemical by-product of the protein building block L-tryptophan. It is also produced commercially from the seeds of an African plant known as Griffonia simplicifolia 5-HTP is used for sleep disorders such as insomnia, depression, anxiety, migraine and tension-type headaches, fibromyalgia, obesity, premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), attention deficit-hyperactivity disorder (ADHD), seizure disorder, and Parkinson’s disease. Dosage 50-300 mg up to 3x per day.
How does it work? 5-HTP works in the brain and central nervous system by increasing the production of the chemical serotonin. Serotonin can affect sleep, appetite, temperature, sexual behavior, and pain sensation. Since 5-HTP increases the synthesis of serotonin, it is used for several diseases where serotonin is believed to play an important role including depression, insomnia, obesity, and many other conditions. This supplement can interact with medications so don’t take this without talking to your doctor.

91. Amino acids – Amino acids are the special building blocks of protein, some of which gets transformed in our bodies into neurotransmitters. Author Mark Hyman, MD explains, “ALL of the thousands of molecules in your body are built from only eight essential amino acids that we must get from our diet.” Without adequate amino acids, your brain can’t work and you get sluggish, foggy, unfocused, and depressed.

92. DHEA – DHEA is a hormone that is naturally made by the human body. DHEA levels seem to go down as people get older. DHEA levels also seem to be lower in people with certain conditions like depression. Some researchers think that replacing DHEA with supplements might prevent some diseases and conditions. This supplement can interact with medications so don’t take this without talking to your doctor.

93. GABA – Gamma-aminobutyric acid (GABA), a neurotransmitter involved in inhibition and stress relief. GABA is sold as a capsule, pill, or powder.
The evidence: Low GABA levels have been linked to depression and anxiety. Although supplement makers claim on their labels that GABA provides “Positive Mood Support” and “Supports a Calm Mood,” there is no evidence that GABA supplements have an effect on depressive symptoms; no studies have been conducted in humans to date. This supplement can interact with medications so don’t take this without talking to your doctor.

94. Ginkgo Biloba – Ginkgo biloba is an herb sometimes used as an alternative treatment for depression, but there is a lack of conclusive evidence to support a role for this herb in the treatment of depression. This supplement can interact with medications so don’t take this without talking to your doctor.

95. Inositil – An organic, glucose-like compound that facilitates the transmission of serotonin and other neurotransmitters. People ingest about 1 gram of inositol a day from fruits and vegetables, whole grains, meat, and other foods, and it is also sold as a capsule and powder. The evidence: The brains of people with depression and bipolar disorder have been shown to have below-average levels of inositol, which prompted researchers to investigate whether inositol supplements could help treat depression. This supplement can interact with medications so don’t take this without talking to your doctor.

96. Magnesium – According to review published in “Medical Hypotheses” in 2006 and 2010, magnesium deficiency is a major cause of depression. Magnesium supplementation may thus function as an effective treatment for depression. A 2008 clinical trial referenced in the review showed that magnesium was as effective as a tricyclic antidepressant in treating depression in diabetics, and animal studies also show orally-administered magnesium produced strong antidepressant effects. Dosage 400-1200 mg daily spread throughout the day. Taper up from base dosage. Small chance of loose stool at the higher doses. If so, go down to next acceptable dose.

97. Melatonin – If your depression manifests in insomnia and difficulty in getting to sleep this may be the supplement for you.
Anyone who has ever experienced insomnia knows about melatonin. It helps us get to sleep and regulates the sleep-wake cycle.

98. Multivitamin – In our fast paced fast food world many of us do not get the recommended minimum values for many nutrients. Be proactive and cover yourself.

99. Omega 3 fatty acids – The brain is made up of mostly water and fat. People need to take in an adequate amount of omega 3 fatty acids as a highly processed diet will have too many omega 6 fatty acids relative to omega 3. Most often as fish oil, but could be alternatives such as flaxseed oil, or others. I take a mix of fish oil and flaxseed oil.
The polyunsaturated fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which are essential to brain function and cardiovascular health. Combined in roughly equal amounts, EPA and DHA are the main ingredients in fish oil, but they are also sold in formulas that include more of one than the other. The evidence: A link between omega-3 consumption and mood is supported by two main sources of evidence: People with depression have been shown to have lower levels of omega-3 fatty acids, and countries that eat a lot of fish per capita (such as Japan) have lower rates of depression. Dosage 1-3 grams per day with food.

100. Probiotics – It is crucial to keep your intestines in good shape because your brain is only as healthy as your gut. The nerve cells in our gut manufacture 80 to 90 percent of our body’s serotonin, the neurotransmitter we need to stay sane. That’s more than our brain makes. And the gut is in constant communication with the brain, sending it information that most definitely affects your mood, even as the messages never come to consciousness. There are many different probiotic blends on the market today. At a minimum I would recommend at least 8 strains with at least 8 billion CFUs (colony forming units). If you can afford it I would up this to 15 strains and up to 50 billion CFUs daily. Probiotics are one weapon in the fight against leaky gut syndrome.

101. Saffron – A spice, made from the dried stigmas of crocus plants, that is used in cooking and also in traditional Persian medicine to treat symptoms of depression (among other conditions). Although they can be found online, saffron supplements are not widely available. The evidence: Little research has been conducted on saffron’s effect on mood. But in a series of small controlled trials conducted in Iran in recent years, the spice has performed surprisingly well in treating mild to moderate depression. Delivered in a single 30 mg dose per day, saffron has outperformed placebo and has demonstrated an antidepressant effect comparable to Prozac and imipramine (an older tricyclic antidepressant), at least in the short term.

102. SAMe – S-adenosylmethionine (SAMe), a naturally occurring compound that affects neurotransmitters, including serotonin and dopamine. In the United States, SAMe has been sold over-the-counter as a tablet since 1998. Dosage 200-600 mg on an empty stomach up to 2x per day. Taper up from base dosage.
The evidence: As with most of the substances on this list, lower levels of SAMe have been associated with depression. In studies, SAMe has been shown to be roughly as effective as tricyclic medications (an older generation of prescription antidepressants). But in many of those studies, the SAMe was injected, and its unclear whether orally ingested SAMe capsules have the same effect. This supplement can interact with medications so don’t take this without talking to your doctor.

103. St. John’s Wort – A yellow-flowered plant, Hypericum perforatum, that has been used for medical purposes since antiquity and as an alternative treatment for depression for decades. St. Johns wort is available as a capsule, tea, or liquid extract. Dosage 300mg 3x per day. The evidence: St. Johns wort is by far the most studied alternative remedy for depression, and for the most part the results have been favorable. In studies involving people with mild to moderate depression, St. Johns wort has consistently outperformed placebo, and it has held its own against prescription antidepressants. It has been shown to be similarly effective and in a few cases, more effective than fluoxetine (Prozac), imipramine, and Celexa. This supplement can interact with medications so don’t take this without talking to your doctor.

104. Theanine – One of the substances found in green tea. L-theanine is an amino acid compound found in tea leaves, however, it has also been isolated from a species of edible mushroom known as Boletus badius, according to Drugs.com. Although clinical research is still limited, some believe that using l-theanine, either through drinking tea or in supplemental form, can help you relax without the drowsiness and other negative side effects of other sedative-type herbs and drugs. Dosage 100-600mg daily. Reduce dosage if you feel sleepy during the day.

105. Tryptophan – An amino acid most famous for being found in Thanksgiving turkey that helps produce serotonin, the neurotransmitter targeted by drugs such as Prozac (SSRIs). It is sold over-the-counter in capsule form as L-tryptophan and 5-HTP, which represent different stages in the serotonin production process. The evidence: Studies have shown a connection between tryptophan depletion and depressive symptoms (especially in women), but the evidence for the use of tryptophan supplements is thin. A 2004 review of tryptophan studies that examined more than 100 trials found only two that were of high quality and did not include other supplements. Tryptophan did outperform placebo in those studies, but the studies were small.

106. Turmeric – Turmeric, the yellow spice that colors curry and American yellow mustard, is a potent natural anti-inflammatory agent. Its active constituent, curcumin, has shown promise as an antidepressant in animal models, and curcumin also has been found to enhance nerve growth in the frontal cortex and hippocampal areas of the brain. Researchers in India have suggested performing clinical trials on humans to explore turmeric’s efficacy as a novel antidepressant.

107. Vitamin B complex multi-vitamin – B-complex vitamins, especially vitamins B-1, B-3, B-5, B-6, B-9 and B-12, play a role in your emotional well-being and mental health because they work directly with your nervous system. Diets that contain a balance of lean proteins, fruits, whole grains, vegetables and healthy fats help prevent B-complex deficiencies. However, if your diet contains mostly processed foods and refined carbohydrates, or you suffer from alcoholism or kidney failure, you might need a B-complex vitamin to help with depression. A remarkable study in the American Journal of Psychiatry that found that 27 percent of severely depressed women over the age of 65 were deficient in B-12.

108. Vitamin B3 – Niacin – Niacin is vitamin B-3, one of the water soluble B-complex vitamins. One of niacin’s unique properties is its ability to help you naturally relax and get to sleep more rapidly at night. Another niacin feature is its ability to greatly reduce anxiety and depression. Be aware that some forms of niacin will create what’s called a “niacin flush” which includes a blushing of the skin. This effect is temporary. You can buy non-flushing forms of niacin if this is a concern.

109. Vitamin B9 – Folic acid – The synthetic form of folate, a B vitamin (B9) found in fruits, leafy vegetables, and other foods, that affects the neurotransmitters known as monoamines. Folic acid is sold in stores as a capsule or tablet. The evidence: Folate deficiency is common among depressed people, especially those who don’t respond to antidepressants. Folic acid has never been tested as a stand-alone treatment for depression, but it has been compared with placebo as an addition to Prozac. In one study, patients who received folic acid responded better than those who received placebo but only the female patients. Nearly 95% of the women who received folic acid responded to the combo treatment, compared to about 60% of the women who received the placebo.

110. Vitamin B12 – Mark Hyman, MD mentions a remarkable study in the American Journal of Psychiatry that found that 27 percent of severely depressed women over the age of 65 were deficient in B-12. In the 1960’s getting a vitamin B12 shot was called going to Doctor Feelgood. Hey if it was good enough for JFK, it’s good enough for me.

111. Vitamin C – Some animals can make their own vitamin C, but people must get this vitamin from food and other sources. Good sources of vitamin C are fresh fruits and vegetables, especially citrus fruits. Vitamin C can also be made in a laboratory. Some research points out that if you take B3 (Niacin) you should also be taking the same amount of Vitamin C.

112. Vitamin D – Vitamin D receptors have been found in many parts of the brain. Receptors are found on the surface of a cell where they receive chemical signals. By attaching themselves to a receptor, these chemical signals direct a cell to do something, for example to act in a certain way, or to divide or die. Some of the receptors in the brain are receptors for vitamin D, which means that vitamin D is acting in some way in the brain. These receptors are found in the areas of the brain that are linked to the development of depression. For this reason, vitamin D has been linked with depression and with other mental health problems. If you are taking Vitamin D, be sure to take Magnesium as well. Higher doses of Vitamin D can bring on anxiety and the Magnesium will help with that.

113. Zinc – According to the US National Institutes of Health there is correlation between zinc and mental health. See: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5492454/

Social support

You are what you do.

114. Accountability partner – In recovery this role is called a sponsor. For depression this should be a safe person whom you trust that can be objective and provide non-judgmental feedback.

115. Acts of service – Helping out your fellow human being can have an amazing effect on mood. Don’t become codependent or a martyr, help people but not at the expense of your own health and well being.

116. Ask for help – We often try to do things alone. Depression is more powerful than an individual. Seek help from others.

117. Attend a support group – Finding people who share a similar difficulty can help dramatically. You find that you are not alone in your difficulties. You can reach out to others to get support. Others can provide experience, strength, and hope and that you can manage your life differently.

118. Avoid toxic people – Some people are negative Nancies and should be avoided. These people could be know it alls, hypercritical, judgemental, or high drama. These people trigger internal turmoil within you. Minimize or avoid contact with these people. You can re-engage with these people in the future, when you are feeling better if you feel they must remain in your life.

119. Contact with family and friends – These should be safe, mature family and friends. If they are toxic then avoid them (see above).

120. Define boundaries – Label what is acceptable and unacceptable behavior, and come up with plans of action to cope. You can’t dictate and change another person’s behavior, you can only change yourself. Use I language and don’t blame. Example: When you raise your voice and speak to me in a harsh way I feel angry and afraid. If you continue with this behavior I will calmly and quietly leave and go for a 15 minute walk.

121. Hug family and friends – We all need to feel love and connected. Give hugs and you will get hugs.

122. Practice laughing – We can get out of the habit of laughing. Try to laugh if even a little. Eventually it will feel normal and it will have a positive effect on you.

123. Saying I love you – Let others know you love them.

Out there treatments

No consensus that they are effective, considered by many to be quackery.

124. Colon Cleanse – There is a high correlation between depression and constipation. Many people say they feel energized and more focused after a colon cleanse. At a minimum this includes fiber, lots of water, and potentially herbal and vitamin supplements. Warning considered by many to be quackery.

125. Botox – A single Botox injection into the facial frown muscles provided lasting relief from depression symptoms, according to a study published last spring in the Journal of Psychiatric Research.

126. Fiber – Constipation and depression (and other mood disorders) are highly correlated (not causal, but often occurring together). Studies have shown that of those people with mood or anxiety disorders there is a significantly higher incidence of constipation. Although this is a correlation and not a causal relationship (higher burden of proof) so it can’t be said constipation causes depression, but since they are correlated easing constipation could ease depression. To be blunt you should have a BM at least once a day. Many people do not. Add fiber to your diet. Be sure to drink adequate water. (See item 80 in the Diet section above.)

127. Hallucinogens – LSD, peyote mushrooms and the like. There have been many anecdotal stories from history about how hallucinogens can help with depression. Scientific studies done during the 1960’s were not able to replicate the positive results from yesteryear. In fact the only hallucinogen still being studied for its positive effect on depression is ketamine. (See item 22 in the Medical Treatments section above.)  Warning, this class of drugs has been shown to not have an impact on depression and these drugs are illegal and possessing even small quantities can result in hefty criminal penalties.

128. Heavy metal cleanse – Heavy metals can have a dramatic effect on the mind and body. Extreme forms of this approach include taking out silver dental cavity fillers, also called amalgam. Warning this tactic is considered by many to be quackery and can be quite expensive so try other methods first.

129. Ion therapy – Negative ions have been found to have a positive effect on mood. Warning this tactic is considered by many to be quackery. There are however several low cost ($50-100) solutions available online that you may want to give a try.

130. Listen to positive and encouraging music – Music can affect mood, why not listen to positive music? I don’t know of any scientific studies on the effects of positive music, but it couldn’t hurt.

131. Liver and kidney cleanse – They filter your blood and your body. How about cleaning them up as well? Warning this tactic is considered by many to be quackery. You can find low cost solutions and recipes online that you may want to give a try even though others doubt its validity.

132. Marijuana – Some studies have shown that marijuana can bring about short term reduction of symptoms of anxiety and depression. However other studies show that chronic continued use of cannabis can actually increase the symptoms of depression over the long term. https://www.medicalnewstoday.com/articles/321589.php also https://www.psychcongress.com/article/cannabis-lightens-mood-may-worsen-depression-over-time Warning marijuana is still considered illegal by the US federal government so you still risk criminal penalties and loss of a government security clearance if you partake in the use of marijuana.

133. Nicotine – I’m not suggesting that you take up smoking, but there have been studies indicating that nicotine has a positive impact on mood. Duke University Medical Center is doing research on this very topic. Warning nicotine is addicting so be careful about your intake.

134. Nitrous oxide – Nitrous oxide, better known as laughing gas has been shown to quickly but temporarily relieve depression symptoms. The positive effects last between 24 hours and up to one week of relief. Warning nitrous oxide is highly addictive and it should not be taken without being under the supervision of a doctor.

135. Ultrasound – Medical trials of focused ultrasound are being done now that show great potential, but there is no consensus in the medical community.