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I think this is a great book and I am going to try, pretty much right away, it's ideas to the letter. As you might know I suffer from depression and am on medication, and I don't want to be like this for the rest of my life. So this book is a breath of fresh air and has already given me the impetus to make some necessary changes in my life.
"The human body was never designed for the modern post-industrial environment."
We will work on six aspects of our lives:
(1) Omega 3 fatty acids - found mainly in fish, game, nuts, seeds and leafy vegetable, all things found in abundance in the hunter-gatherer diet.
(2) Engaging activity - Many depressed people spend literally hours ruminating each day.
(3) Physical Exercise - Of course! Our ancestors were active all through the day.
(4) Sunlight Exposure - Even the natural light of a cloudy day is several times brighter than the inside of most people's houses, so get out and about!
(5) Social Support - Hunter gatherers almost never spent time alone. A strong social support network is needed, or even one supportive confidant can make a difference. Owning a pet also provides some help. The presence of a harshly critical abusive SPOUSE renders a person more vulnerable to depression - even more so than if they had no meaningful social connection at all. Some relationships are so psychologically toxic that they keep the brain's stress response networks in a perpetual state of overdrive, ever teetering on the edge of the depressive abyss.
(6) Sleep - A good nights sleep is essential to your wellbeing.
Depression
It's a syndrome that deprives people of their energy, sleep, concentration, joy, confidence, memory, sex drive - their ability to love and work and play. Over time, depression damages the brain and wreaks havoc on the body. Most people who don't suffer from depression are ignorant about it.
The old adage says :"The best predictor of future behaviour is past behaviour." In other words, most people don't change. However, to beat this, you will to change A LOT.
Antidepressants
They may not help you. A common side effect concerns emotional numbing, a decrease in the intensity of emotions - both positive and negative. On medication people discover that they can no longer feel positive emotions like joy and excitement and romantic love as intensely as they used to.
However among severely depressed patients - those whose symptoms are so profoundly disabling that they can no longer function at all - depression drugs have been found to work much better than placebos.
THE SIX STEPS
(1) Brain Food
Essential fats come in two versions. Omega 3 and Omega 6. They need to be in balance in your diet. However, the ratio of Omega 6 to Omega 3 in the modern American diet now stands at a staggering 16:1.
Omega-3 fats have a potent antidepressant effect.
If you combine the two omega-3 molecules EPA and DHA in a roughly 2:1 ratio then there will be an impressive effect.
I recommend a starting omega-3 dose of 1000 mg EPA and 500 mg DHA each day.
Also, to ensure you have enough antioxidants in your system, it's advisable to take a daily multivitamin, in addition to a vitamin C supplement at a daily dose of 500 mg.
There is one good type of omega-6 fats and it's called GLA. Not many foods have GLA, but oatmeal is one, slowly cooked in the form of porridge. Eating two big bowls a week should give your body all the GLA it needs.
Another option is to take a supplement of evening primrose oil. It has a remarkably high concentration of GLA, so only one 500 mg capsule is necessary per week.
You should store your omega-3 supplement in the fridge.
(2) Rumination/Procrastination
In a nutshell, when we ruminate (think endlessly and deeply), we withdraw. That's especially true on the social front. When spoken to, a depressive may nod politely and say "uh huh", but they won't register anything that's being said!
There are two steps to avoiding rumination : learning to notice when it's happening (increasing awareness), and learning how to redirect your focus to some other activity.
During an episode of depression, dwelling on negative thoughts is so effortless and automatic - it's possible to spend long stretches of time doing so without any awareness of what's happening.
The single biggest risk factor for rumination is simply spending time alone.
One thing to try is writing down your thoughts as a prelude to walking away from them. Simply putting your thoughts down on paper makes it easier to stop thinking them.
Engaging in conversation is great : Carrying on a 2-way conversation takes a surprising amount of mental focus, making it almost impossible to ruminate. This however is a contradiction to what was said earlier about registering what was said.
Make a list of possible conversation partners. Name. How comfortable you would be in contacting them. How available they would be to speak to you when needed.
Listen to Music. Listen to Audiobooks.
Make a list of ten things you could do when you find yourself ruminating.
(3) Exercise
Start off with a brisk half hour walk three times a week. That's it.
Play games and sports as often as possible. Whenever we get caught up in enjoyable, meaningful activity, our tolerance for exercise goes up dramatically.
Hook your bike up to a video game interface - it's called Game Riders - where you have to pedal like crazy to play.
Aerobic activities are very good. For example : Jogging, hiking, swimming, cycling, football, weightlifting, tennis (or padel) and dancing.
Technically speaking, a workout is aerobic whenever it gets your pulse between 60% and 90% of your maximum heart rate.
For a 50 year old man, that's between 102 and 153 bpm.
You only need 90 minutes of aerobic exercise per week to make a difference to your mental state. It takes 5 minutes of working out before you get your pulse into the aerobic range.
Set aside an hour for your 30 minute exercise class, that you do three times a week.
Your target pulse should be 75%, that's 127 for a 50 year old man.
Make it absorbing by listening to music or audiobooks at the same time as working out.
Try Dance Dance Revolution on the Playstation.
(4) Sun Light
If you spend most of your time inside - as people generally do these days - your eyes light receptors simply aren't getting the stimulation they need.
If you live in a cold country then you can use a light box (10,000 lux). It should have an adjustable stand so you can position the box slightly above (6 inches) your head so the light will shine down into your eyes , like the sun. And in front of you, not to the side. And about 18-24 inches in front of you. Do 15 minutes of exposure in the morning.
Try the Day-Light DL930 by Upliff Technologies.
The goal is to get enough Vitamin D into your system. The best evidence says your blood level of Vitamin D should be at least as high as 30 ng/mL (or 75nmol/L) for optimal health.
In Continental Europe, your body should make enough vitamin D from May through August if you average 15 mins of sun exposure between 11am and 3pm. No sun cream.
In March, April, September and October, it will probably take 30 mins per day.
From November through to February it's a good idea to supplement 100mcg per day.
(5) Social connections
Honest disclosures about our struggles are essential to any serious friend. Often, however, mere disclosure may not be enough. Many friends need to be educated/read about depression as well. In particular, they have to understand three things:
1) Depression is an illness that robs people of their ability to function.
2) Depression typically leads its victims to withdraw from friends and loved ones.
3) Social support plays an important part in the recovery process.
Depression shuts down activity in those areas of the brain that allows us to initiate things.
Be careful of the falling into the trap of reassurance seeking with friends and family.
Identify three people that you feel close to. Tell them about your depression. Briefly describe what you have been going through. No sob stories. Then, in order to avoid rumination, reminisce about good times, ask what they have been up to, talk about common interests, get updates on mutual friends etc.
Even casual acquaintances - who are upbeat and sunny - are great. Make an effort to spend more time in their company. If there is no-one, then a good psych can do that once a week.
You can use video chats, or even make friends with strangers online.
The risk of depression goes up for anyone whose spouse is depressed. Emotional contagion can work both ways. It can spread positive and negative moods.
Beware of spouses who give relentless emotional and physical abuse. Your brain will be locked into a depressive runaway stress response and will slowly kill you.
Spouses should be an unwavering source of social support. If they are not, then you are married to the wrong person.
You should also try and volunteer once you are socially able. Saving the environment.
Join a hiking, reading or film group in your area. Join a sports league.
(6) Healthy Sleep
Most adults need about eight hours of sleep each night for optimal physical and emotional well-being. Here are some useful habits to get into :
1) Use the Bed only for sleeping. Anytime you've been laying awake for 30 minutes, get up, leave the bedroom and do something relaxing until you feel drowsy. Avoid getting into bed in the first place when you don't feel drowsy. Avoid sleeping anywhere that isn't your own bed.
2) Get up at the same time every morning.
3) Avoid napping.
4) Avoid bright light at night. Once you are in bed, it's best to keep the room pitch dark. If you want to read, do it in the living room.
5) Avoid caffeine and nicotine from mid-afternoon onwards.
6) Avoid alcohol in the late evening.
7) If possible, keep the same bedtime every night.
8) Keep the bedroom cool. It will help you sleep. Don't agree!
9) Avoid taking your problems to bed. For many people, the prime time for dwelling on negative thoughts is when they're lying in bed, trying to fall asleep. Such rumination starts up the brains stress response circuits, making it virtually impossible to fall asleep. So it's crucial that you don't succumb to any bouts of bedtime brooding.
There's really only one option : mental activity. The challenge is to find some sort of mental task that's engrossing, and yet simultaneously relaxing enough to allow you to fall asleep.
For example : replaying scenes from a nice movie in your head, visualizing a relaxing scene, playing a round of golf in your imagination, using progressive muscle relaxation, deep breathing from your stomach, guided imagery.
10) Finally : Don't try to fall asleep!
Hypersomnia:
This is multiple awakenings throughout the night and a reduced amount of restorative slow-wave sleep. People with this get such poor quality sleep, that they may find themselves in bed for 12 to 14 hours a night, and yet still feeling tired the next day.
WEEK BY WEEK:
Week 1
Take your supplements (Omega-3 , Vitamin D if necessary, Daily Multivitamin, 500mg Vitamin C, Evening Primrose once a week.
Start to notice Rumination.
Complete the Depression Scale
Week 2
Supplements as week 1.
Try redirecting your attention to an engaging activity when ruminating.
Complete the Depression Scale
Week 3
Supplements as week 2.
Catch yourself the moment rumination begins. Play online games to stop it.
Start exercising if you haven't already. Keep your bpm in the aerobic range.
We recommend that you begin with 30 mins brisk walking three times a week.
Complete the Depression Scale
Week 4
Supplements as week 3.
Rumination as before.
Exercise as before.
Sunlight: Get the benefit of natural light if you can during the day (especially from 11am to 3pm, when vitamin D synthesis is possible).
Complete the Depression Scale
Week 5
Supplements as week 4.
Rumination as before.
Exercise as before.
Sunlight as before.
Social Support : Schedule at least 3 social activities for the week, writing them in your calendar. It's best to spend time with friends and family whom you can see in person. If that is not possible, use phone calls (or video chats). Another alternative is online forums.
Complete the Depression Scale
Week 6
Supplements as week 5.
Rumination as before.
Exercise as before.
Sunlight as before.
Social Support : Schedule at least 4 social activities for the week, writing them in your calendar. Evaluate whether you have any truly toxic relationships in your life. Try to improve them if you can, otherwise reduce your contact by at least 50% with toxic individuals.
Sleep : Get 8 hours sleep a night. Put into practice the first two habits of healthy sleep : Use your bed only for sleeping and wake up at the same time each morning.
Complete the Depression Scale
Week 7
Evaluation : You've now been doing TLC for six weeks. Most people will see benefits at this point. Do you see an improvement in the Depression Scale of at least 25%? If not, you need to go to the Troubleshooting section ahead.
Supplements : If you haven't seen a 50% reduction in your symptoms from baseline then consider increasing your dose of Omega-3 to 2000mg EPA and 1000mg DHA.
Rumination as before.
Exercise : If you haven't seen a 50% reduction in your symptoms from baseline then consider bumping up your exercise regime to 5 thirty minute workouts per week.
Sunlight as before.
Social support : Schedule at least 5 social activities this week. Try limiting your contact with any irredeemably toxic individuals by an additional 50%.
Sleep : Incorporate the rest of the habits of healthy sleep.
Complete the Depression Scale
Week 8
Supplements as week 7.
Rumination as before.
Exercise as before.
Sunlight as before.
Social Support : Schedule at least one social activity each day. In addition, target at least one form of community involvement to participate in during the upcoming week. Finally, try eliminating completely your contact with any toxic individuals.
Sleep as before.
Complete the Depression Scale.
Weeks 9 through 12
Supplements as week 8.
Rumination as before.
Exercise as before.
Sunlight as before.
Social Support : As before, but increase your community involvement to two activities per week.
Sleep as before.
Complete the Depression Scale.
Evaluation : You've now been doing TLC for 12 weeks. You should have at least a 50% reduction in symptoms at which point you should no longer be clinically depressed. If you don't have such an improvement, look ahead at the Troubleshooting Section.
Over half of those who recover from depression will face the disorder again.
They key is to continue living the TLC way every day.
Stress Management : ANY relationship that consistently provokes a high level of stress is one that adds to your risk of future depression.
High risk relapse situations to watch out for include the death of a loved one, divorce, physical illness, caring for a sick relative, geographic relocation, job loss, financial setbacks, and even extended periods of gloomy weather (and ensuing low sunlight exposure).
TROUBLESHOOTING:
You may need the help of a professional, such as a clinical psychologist, if you are not making progress. A superb resource for finding one in your area is the European Association of Behavioural and Cognitive Therapies (EABCT).
Once you have found a psychologist, if it doesn't feel like a good fit early on, it's probably best to consider moving on to the next name on your list.
Some people are fortunate to have a spouse, parents, sibling, child or friend who is both willing and able to be their TLC coach.
To make a good coach their must be a good rapport, good knowledge from the coaches side and dedication.
See page 237-239 in the book for more TLC Trouble Spots and Solutions.
There are some illnesses or conditions that may cause depression such as Hypothyroidism (low thyroid function) and PTSD.
And many medications can maintain depression once you've been on them long enough.
Benzodiazepines such as Rivotril are dangerous.
Other Anxiety Disorders:
Social anxiety disorder, General Anxiety Disorder. You need Therapy!
Substance Abuse : Alcohol brings about high levels of depressive life stress. It wreaks havoc on the user's social support networks. In brief , substance use can make it impossible to recover from an episode of depression until effectively addressed with treatment.
Personality Disorders:
There are individuals, for example, who have great trouble forming healthy relationships due to their profound insecurity. Others can suffer from extreme perfectionism that they are continually stressed out from an inability to live to their own high standards.
HERE IS THE GIST OF IT : UNTIL SUCH DISORDERS ARE ADDRESSED IN TREATMENT, IT IS DIFFICULT TO BENEFIT FROM THE TLC PROTOCOL.
One treatment could be Schema Therapy developed by Dr. Jeffrey Young, of the New York Center for Cognitive Therapy.
Troubleshooting Exercise : Up it as much as you can. Exercise is probably the number one of the six ways to make you less depressed.
TIP : Use honey instead of sugar. Honey is anti-inflammatory, and it has an array of health benefits (It's antibiotic, antiviral, and even seems to protect against diabetes!) Use it to sweeten your drinks if required, or for a snack.
Stevia and Xylitol are also safer than sugar and they are natural!
Eat more Tryptophan:
The brain makes Serotonin out of Tryptophan. It is found in abundance in meats as well as Dairy products, beans and soy.
Eat several servings of meat, eggs, dairy, and soy products each day. Another alternative is to take a tryptophan supplement. Typical dose is 2mg daily.
Social Support Boost:
The most effective coping strategy - by far - involves turning to loved ones, friends, and extended community for intensive social support.
Even one caring, committed individual can make all the difference - even if its a psychologist you see once a week.
The principles of TLC have proven to be effective in treating depression in patients of all ages. Equally important, however, is their ability to protect against the future onset of illness.
Remember, we were never designed for the sedentary, socially isolated, sleep-deprived, poorly nourished, indoor, frenetic pace of modern life. Our brains, our bodies, our minds, our hearts, and our souls were all built for something different - for a life filled with abundant physical activity, social connection, healthful sleep, balanced nutrition, natural sunlight, and the sort of meaningful, engaging activities that leave little time for depressive rumination. By living the lives we were meant to lead, reclaiming the protective features of the past and integrating them into the present, we can overcome depression for the long haul. We can vanquish that treacherous foe once and for all. We can live the depression cure.
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