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Expert Q&A

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What besides medicine can help depression?

Asked by April, Pittsburgh, Pennsylvania

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I am 29 and have been suffering from depression for more than 10 years. It started with losing my virginity in an unpleasant situation, and continues through my mother's battles with severe depression, alcoholism and drug abuse. I have also lost two grandparents to slow, declining dementia. I have tried talk therapy but didn't find it to be very useful. I walk 20 miles a week, try to eat well and maintain social relationships.

I don't want to try antidepressants, because I do not believe that my problems should be solved with pills. Do I have any other recourse?

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Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

Expert Answer

Dear April,

I am sorry to hear of your struggles. Your story points out to important truths about depression: First it runs in families, and second it is often started by a severe life stressor, especially in folks for whom the disorder runs in the family.

A lot of scientific evidence has emerged in the past decade showing that being raised by mothers with problems like your mom's is a fairly sure-fire way to get depressed oneself. When it comes to depression, nothing seems more important than the love and stability a person receives from his or her parents as a child.

The fact that you are able to be so proactive with the illness is very promising and bodes well, I think, for your chances of recovering. I am worried, however, that you have been depressed for 10 years. That's a long time, and we know that the longer depression persists, the harder it is to treat.

It has a nasty way of burrowing its way into one's brain and body, making it harder and harder to wipe out with the passage of time. Plus, as you know from your own experience, depression really robs people of the ability to make the most of their lives, which just makes people feel more depressed.

So to answer your question, yes there are things you can do to help yourself other than taking an antidepressant medication. You are off to a good start by eating well and maintaining good social relationships. Try changing the walking to running. A large recent study showed that for exercise to work as an antidepressant, it has to be vigorous and has to last for at least 30 minutes a day.

The best proven non-medication treatment for depression is psychotherapy, and I strongly recommend you avail yourself of this option if you are able.

Many studies show that it works as well as medications, at least until people are very severely depressed. The two types of psychotherapy best studied for depression are cognitive behavioral therapy and interpersonal therapy. Choose a therapist that is well regarded, that you like and that you feel has your best interests at heart. If you don't click with the first therapist you try, try another. Data show that the relationship between therapist and patient is an essential element of the cure.

Do you know about alternative treatments for depression? If not, I recommend that you read about them -- especially St. John's wort and S-Adenosyl-L-Methionine (SAM-e). Although not as well studied as antidepressants, there is pretty good evidence that they are helpful for depression. Take a look at this government Web site for a ton of information on both St. John's wort and SAM-e.

And here is a final thought. I spend my life researching mind-body connections, and this work has convinced me that we all carry around a lot of false distinctions between the mind and body.

I think it is a great thing to take an antidepressant when depressed, and I also think it is a great thing to exercise, and to meditate and to eat right, because all these things appear to do very similar things in the brain and the body. Indeed, recent data show that hope for a cure activates exactly the same brain circuitry as do antidepressants. The mind and body truly are one. Good luck with whatever you decide.

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