by Kristel Carrington, Medical Director at Mantra Health
Treating depression involves a holistic approach that addresses its biological, environmental and psychological causes. Medications, when needed, are just one tool I recommend in the treatment of my depressed patients. However I also prescribe non-medication interventions that focus on building positive experiences and reducing symptoms of depression. These natural antidepressants can help to reduce risks of depression, improve current symptoms of depression, and help to prevent recurring episodes of depression. They are readily available and I enjoy helping clients think of ways to incorporate them into their lives. The supplements and lifestyle goals mentioned below have strong evidence for improving symptoms of depression.
1. Supplements and diet:
There are dietary supplements that have been shown to improve mood due to their ability to boost the building blocks of hormones that can be depleted in those suffering with depression.  Three of these supplements with the most evidence are:
- 5-HTP (5-hydroxytryptophan) is an important ingredient for making serotonin, a major hormone associated with depression symptoms.
- SAMe (S-adenosyl-L-methionine) is a naturally occurring compound in the body which is involved in the creation of other brain hormones hypothesized to play a role in depression.
- Omega-3 Fatty acids have evidence for improving both depression and cognition in adults. Low levels of omega-3 are seen in people with clinical depression. Other than supplements, omega-3 is found in healthy fish, like salmon, and also some nuts and seeds.
Though research on how diet directly affects depression symptoms is lacking, the food that are shown to promote better health have some things in common: less sugar, lean meats, LOTS of fruits and vegetables.  There is an emerging field of research regarding the gut microbiome (the bacteria that populate your gastrointestinal tract) that may offer some clarity as to how diet affects our mental health. 
- See our blog piece on food for more information: https://mantrahealth.com/post/developing-your-food-mantra
2. Improve your sleep hygiene: Sleep disruption is a common symptom of depression and can take the form of sleeping more or getting little to no sleep. Sleep hygiene refers to a set of behaviors that promote better sleep. Better sleep means better mood, more energy, more motivation. 
- See blog piece on sleep habits: https://mantrahealth.com/post/by-kristel-carrington-medical-director-at-mantra-health
3. Establish a routine: There is a specific form of cognitive therapy called behavioral activation. Behavioral activation is a coping strategy designed to increase your contact with positively rewarding activities. In behavioral activation, you small and specific goals and work toward them. The key word is small. Focusing on one or two things that you want to work on. Behavioral activation helps to build a sense of mastery and accomplishment.
4. Connect with nature: Nature can have a powerful influence on depression. Research suggest that interacting with nature can improve cognition and mood.  Many of us live in concrete jungles, which can make it difficult to even think about nature, so try to think about where you can reconnect with it. Remember what it’s like to see the vibrant colors, shapes, and contrasts that natural world offers.
5. Connect with people: Depression makes the sufferer want to isolate, due to diminished energy to engage in social activities and due to feelings of guilt at the prospect of negatively affecting the moods of friends or family. We are social creatures and connecting with others in positive ways can improve mood and coping.
6. Mindfulness: Mindfulness is a practice that cultivates one’s awareness of the present moment, while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations. It is used as a therapeutic technique that helps my clients connect their inner and outer worlds, thereby enhancing awareness of their daily lives in a different, more deliberate way. Research shows that activities like yoga, deep breathing, meditation, and journaling, help to promote a mindful mental state. 
7. Exercise: No surprise here. Exercise is associated with a greater reduction in depression symptoms, improved cognitive function, and better sleep. Research shows that exercise can be as effective as medication for treating depression.  Although there are no clear guidelines regarding advice on exercise for patients with depression, evidence shows that both aerobic and anaerobic exercise has positive effects. Shoot for 120-150 minutes a week of moderate exercise.
8. Challenge negative thinking: Depression can hijack your thinking into becoming more pessimistic and negative. You may find yourself focusing only on things that went wrong instead of the things that are going right. When working with my patients, I teach them about positive affirmations and have them make a list for themselves. They are often skeptical but once doing the exercise, they are reminded of things they are proud of and feel an improved sense of self-worth. They also recognize how much they’ve lost appreciation for those good things.
9. LAUGH: Laughter really IS medicine. Laughter is a positive sensation, and seems to be a useful and healthy way to overcome stress.  I encourage my clients to seek laughter from their favorite sources. I still end up laughing until my stomach hurts when I watch old episodes of Martin.
10. Seek Inspiration: What are you passionate about? Depression makes it hard to get excited about life. Whether you find it in art, nature, people, animals, volunteering, or activism, it is important to seek and cultivate things you are passionate about. When inspired we feel a deeper appreciation for life.
Feeling relief from depression is not the only goal. You have to discover (or reconnect with) things that give you a sense of peace. Maintaining this balance helps foster your resilience when faced with challenges.
- Varteresian et al. Natural Products and Supplements for Geriatric Depression and Cognitive Disorders: An Evaluation of the Research. Current Psychiatry Reports. 2015
- Firth, Wolfgang et al.The Effects of Dietary Improvement on Symptoms of Depression and Anxiety: A Meta-Analysis of Randomized Controlled Trials. Psychosomatic Medicine. 2019
- Dash et al. The gut microbiome and diet in psychiatry. Current Opinion in Psychiatry. Jan 2015
- Carney et al. Cognitive Behavioral Insomnia Therapy for Those With Insomnia and Depression: A Randomized Controlled Clinical Trial. Sleep. 2017
- Can Nature Walks With Psychological Tasks Improve Mood, Self-Reported Restoration, and Sustained Attention? Results From Two Experimental Field Studies
- McCarney et al. Effectiveness of mindfulness-based therapies in reducing symptoms of depression: A meta-analysis. European Journal of Psychotherapy and Counseling.
- Exercise for Depression. JAMA Clinical Evidence Synopsis.2014
- Therapeutic Benefits of Laughter in Mental Health: A Theoretical Review