Depression, Anxiety, and Panic Disorder

Sadness, Image Courtesy of worradmu, FreeDigitalPhotos.net

Depression is common among those with panic disorder and other anxiety disorders. Like anxiety disorders, depression often runs in families (though it’s possible to suffer from depression without a family history of mood disorders).

Both panic disorder and depression arise due to a complicated interplay of genetic, biological, psychological, and environmental factors. In other words, a genetically inherited predisposition, stress or emotional issues, and past experiences come together to trigger depression.

Types of Depression

According to the Anxiety and Depression Association of America (2012), there are three types of depression:

• Major depression: At least five depression symptoms (sadness, hopelessness, loss of interest in previously enjoyed activities, feelings of helplessness or worthlessness, suicidal thoughts, low energy, irritability, appetite changes, sleep changes, persistent physical complaints such as headaches not caused by a specific illness, etc.) lasting for two weeks or more
• Dysthymia: A long-term, chronic, less severe form of depression
• Bipolar disorder (manic depression): A mood cycle alternating between severe depressive lows and episodes of mania (extreme highs)

Depression Treatment

There are a number of treatments available for depression, ranging from medications to psychotherapy. If you experience depression, you should consult a doctor to determine the best primary therapy for you.

There are also plenty of complementary therapies you can do on your own to reduce or eliminate depression. The Depression Cure by Stephen S. Ilardi, PhD, a highly rated six-step program for conquering depression, includes the following excellent recommendations:

• Take omega-3 fatty acid supplements
• Engage in meaningful activities
• Get more exercise
• Increase social interaction and support
• Get more sunshine
• Improve your sleep

Below I examine the research supporting each of these recommendations and provide sources, in addition to Ilardi’s book, where you can find more in-depth information.

Natural Depression Treatment 1: Take omega-3 fatty acid supplements

Many studies have found that depressed people are lower in omega-3 fatty acids (Peet et al., 1998; Su, 2008), and that supplementation brings anti-depressive benefits (Centre hospitalier de l’Université de Montréal, 2010; Nemets et al., 2006; Rondanelli, 2011; Stoll et al., 1999, Su, 2009; Su et al., 2003; Su et al., 2008). However, it should be noted that some studies have found no effect (Lin & Su, 2007).

How might omega-3s work to reduce depression symptoms? The short (and highly simplified) answer is that maintaining an appropriate balance of essential fatty acids is important for healthy brain and nervous system functioning, but our modern diet tends to skew the balance, with a heavier focus on omega-6 fatty acids and not enough omega-3s. Supplementing with omega-3s can correct this imbalance.

For those who want to dig deeper into this topic, here are some articles that explain the connection in depth:

• Logan, A.C. (2004). “Omega-3 Fatty Acids and Major Depression: A Primer for the Mental Health Professional.” Lipids in Health and Disease, 3, 25.
• Su, K.P. (2008). “Mind-Body Interface: The Role of N-3 Fatty Acids in Psychoneuroimmunology, Somatic Presentation, and Medical Illness Comorbidity of Depression.” Asia Pacific Journal of Clinical Nutrition,17(S1), 147-153.
• Su, K.P.; Huang, S.Y.; Chiu, C.C.; & Shen, W.W. (2003). “Omega-3 Fatty Acids in Major Depressive Disorder. A Preliminary Double-Blind, Placebo-Controlled Trial.” European Neuropsychopharmacology 2003; 13(4): 267-271.

Supplements aren’t the only way to increase omega-3 intake. Fish are a great dietary source of omega-3s, particularly salmon, sardines, mackerel, trout, canned white tuna, and shellfish. Eggs, olive oil, and walnuts also contain omega-3s.

Some experts have expressed concerns that those suffering from severe depression, after reading about omega-3 research, will take supplements but do nothing else to treat their depression. Depression is a serious disorder that requires a multifaceted approach. Check with a doctor before taking omega-3 supplements, discuss additional treatment options with your doctor or psychiatrist, and incorporate other complementary depression therapies into your day-to-day life.

If you also suffer from anxiety, see Omega-3 Supplements for Anxiety and Panic Disorder.

Natural Depression Treatment 2: Engage in meaningful activities

What is a meaningful, engaging activity? The definition is subjective, which means that it will vary from one person to the next, but there are activities that regularly appear on lists of meaningful pastimes. These include:

• Volunteer work (helping people, caring for animals, improving the local community, protecting or restoring the natural environment, etc.)
• Creating something (art, music, crafts, cooking, writing, building, etc.)
• Gardening or other outdoor work (for example, helping to clean up a beach or park)
• Fitness activities (cardio exercise, pilates, dance, strength training, etc.)
• Connecting with others (spending time with friends and family, participating in clubs and other group activities, taking classes, team sports)
• Activities that challenge the brain (taking classes, reading, learning new skills, solving puzzles, playing scrabble, etc.)
• Traveling (learning about other cultures, seeing new things)
• Teaching (helping others learn new skills, sharing important information)
• Getting out into nature (hiking, walking in the woods, swimming in a lake or in the ocean, kayaking, etc.)
• Mind-and-spirit activities (meditation, yoga, tai chi, healing rituals, prayer, cultivating forgiveness and mindfulness, compassionate service to help others)

There is plenty of evidence that meaningful activity is a potent weapon against depressive despair. The following are just a few of the many studies supporting the antidepressant effects of meaningful, engaging activity:

• Musick and Wilson (2003): Doing volunteer work reduces depression in the elderly.
• Maton (1990): Meaningful, instrumental activity is positively correlated with self-esteem and life satisfaction among at-risk urban teens.
• Waters and Moore (2010): Engaging in meaningful leisure activities improves the psychological health of unemployed people (who are at heightened risk for depression).
• Eakman et al. (2010): Participation in meaningful activities is associated with better psychological well-being.

How does engaged, meaningful activity reduce depression? The effects are fourfold. First, it helps to turn your focus outward so that you don’t ruminate and exacerbate your depressive symptoms. Second, many of these activities bring value, meaning, and hope into a life that is otherwise perceived as meaningless and hopeless. Third, engaged activity tends to keep the mind and body active, which is critical for emotional and physical health. Fourth, meaningful activities usually increase interaction with other people, animals, and the natural world, which all tend to reduce depression.

Natural Depression Treatment 3: Do regular cardio exercise

Nearly everyone knows that regular cardio exercise improves health and fitness, but many people aren’t aware of the incredible mood enhancing effects of exercise. Studies indicate that exercise is as effective as antidepressants in treating depression (Harvard Medical School, n.d.). Also, while medications can have negative side effects, the side effects of exercise (increased confidence, improved health, better physical appearance) are overwhelmingly positive.

For information on how exercise works to help prevent depression, as well as studies of the effects of regular exercise on depression, see:

• Copley, J. (2012). “Exercise Boosts Mood, Enhances Learning Ability, Improves Academic Performance“
• Ratey, J.J. (2008). Spark: The Revolutionary New Science of Exercise and the Brain. New York, NY: Little, Brown and Company.
• Harvard Medical School. (n.d.). “Exercise and Depression.” Health.Harvard.edu.

Natural Depression Treatment 4: Get more sunlight

Sunlight is a natural source of vitamin D, but in recent years, people have been avoiding the sun due to fear of skin cancer. Working indoors all day also prevents people from getting enough sun exposure. As a result, rates of vitamin D deficiency have increased.

Many studies have found that depressed people are more likely to be deficient in vitamin D, and those who are deficient in vitamin D are at heightened risk for other health problems as well.

To obtain vitamin D from sunshine, you need to go outdoors on sunny days between 10 and 3 pm (peak sun hours) for 5 to 30 minutes several days a week with your skin exposed (wearing shorts or a short-sleeved shirt and not using sun screen). Most people won’t burn in this amount of time, though people with pale skin, moles, or a history of sunburns or skin cancer should check with a doctor first. For those who can’t or won’t go out into the sun during peak hours (and for the wintertime in cooler nations), there are vitamin D supplements available. For information on recommended daily amounts of vitamin D and good natural food sources, see the Vitamin D information page.

In addition to vitamin D, the bright light of the sun may influence depression, particularly among those who suffer from seasonal affective disorder (SAD), a type of depression that arises or worsens during the darker months. Some SAD sufferers benefit from light box therapy.

Natural Depression Treatment 5: Increase social contact and support

Social interaction can help to reduce depression in a number of ways:

• Socializing stops you from isolating yourself and becoming trapped in a chronic state of miserable rumination.
• You’re more likely to get out, engage in enjoyable activities, and get more physical exercise when you do things with others.
• The advice and insights of others can provide a reality check for unrealistically negative thoughts, beliefs, and expectations.
• Other people can provide direct support and impart their own best coping strategies, giving you more tools for combating depression.

Unsurprisingly, many studies have shown that people who socialize more are less likely to become depressed or stay depressed if they experience hardship (Nordic School of Public Health, 2010; Peirce et al., 2000; Tiwari & Ruhela, 2012; Wiley-Blackwell, 2009).

If it’s difficult to get out and meet people in your area, there are plenty of online forums and support groups for people who suffer from depression. Or, if you don’t want to talk about your depression, you could join an online group based on your interests and make friends that way.

This recommendation overlaps with the suggestion to seek engaged, meaningful activity in that many activities undertaken with others are meaningful, and many meaningful activities increase social contact. If you can combine socializing with meaningful activity and/or physical exercise, the anti-depressive benefits should rise significantly.

Natural Depression Treatment 6: Improve your sleep

People who suffer from insomnia are more likely to suffer from depression and anxiety than those who have no trouble sleeping (National Sleep Foundation, 2011; Taylor et al., 2005). See How to Improve Sleep for tips that can help you conquer insomnia.

More on Anxiety and Related Problems

This article is part of a series on conditions that often accompany anxiety disorders. If you suffer from anxiety in addition to depression, see the main Anxiety and Panic Disorder Remedies page (many natural anxiety treatments are also beneficial for depression).

This article is provided for informational purposes only and is not intended as a substitute for medical or psychiatric advice. Medical concerns should be referred to a qualified doctor.

References:

• Anxiety and Depression Association of America. (2012). “Symptoms” and “Depression.” ADAA.org.
• Centre hospitalier de l’Université de Montréal. (2010, June 21). “Treating Depression with Omega-3: Encouraging Results from Largest Clinical Study.” ScienceDaily.com.
• Eakman, A.M.; Carlson, M.E.; & Clark, F.A. (2010). “The Meaningful Activity Participation Assessment: A Measure of Engagement in Personally Valued Activities.” International Journal of Aging and Human Development, 70(4), 299-317.
• Hall-Flavin, D., MD. (2010, July 23). “Fish Oil Supplements: Can They Treat Depression?” MayoClinic.com.
• Harvard Medical School. (n.d.). “Exercise and Depression.” Health.Harvard.edu.
• Ilardi, S.S., PhD. (2009). The Depression Cure: The 6-Step Program to Beat Depression without Drugs. Da Capo Press.
• Lin, P.Y., & Su, K.P. (2007). “A Meta-Analytic Review Of Double-Blind, Placebo-Controlled Trials of Antidepressant Efficacy of Omega-3 Fatty Acids.” Journal of Clinical Psychiatry, 68(7), 1,056-1,061.
• Logan, A.C. (2004). “Omega-3 Fatty Acids and Major Depression: A Primer for the Mental Health Professional.” Lipids in Health and Disease, 3, 25.
• Maton, K.I. (1990). “Meaningful Involvement in Instrumental Activity and Well-Being: Studies of Older Adolescents and At Risk Urban Teen-Agers.” American Journal of Community Psychology, 18(2), 297-320.
• Musick, M.A., & Wilson, J. (2003). “Volunteering and Depression: The Role of Psychological and Social Resources in Different Age Groups.” Social Science & Medicine, 56(2), 259-269.
• National Institute of Mental Health. (2012, March 2). “Depression.” NIMH.NIH.gov.
• National Sleep Foundation. (2011). “Depression and Sleep.” SleepFoundation.org.
• Nemets, H.; Nemets, B.; Apter, Z.; Bracha, Z.; & Belmaker, R.H. (2006), “Omega-3 Treatment of Childhood Depression: A Controlled, Double-Blind Pilot Study.” American Journal of Psychiatry, 163(6), 1,098-1,100.
• Nordic School of Public Health (2010, December 10). “Social Activities Effective in Preventing Depression Among Older Adults.” ScienceDaily.com.
• Peet, M.; Murphy, B.; Shay, J.; & Horrobin, D. (1998). “Depletion of Omega-3 Fatty Acid Levels in Red Blood Cell Membranes of Depressive Patients.” Biological Psychiatry, 43(5), 315-319.
• Peirce, R.S.; Frone, M.R.; Russell, M.; Cooper, M.L.; & Mudar, P. (2000). “A Longitudinal Model of Social Contact, Social Support, Depression, and Alcohol Use.” Health Psychology, 19(1), 28-38.
• Ratey, J.J. (2008). Spark: The Revolutionary New Science of Exercise and the Brain. New York, NY: Little, Brown and Company.
• Rondanelli, M.; Giacosa, A.; Opizzi, A.; Pelucchi, C.; La Vecchia, C.; Montorfano, G.; Negroni, M.; Berra, B.; Politi, P.; & Rizzo, A.M. (2011). “Long Chain Omega 3 Polyunsaturated Fatty Acids Supplementation in the Treatment of Elderly Depression: Effects on Depressive Symptoms, on Phospholipids Fatty Acids Profile and on Health-Related Quality of Life.” Journal of Nutrition, Health, and Aging, 15(1), 37-44.
• Stoll, A.L.; Severus, W.E.; Freeman, M.P.; Rueter, S.; Zboyan, H.A.; Diamond, E.; Cress, K.K.; & Marangell, L.B. (1999), “Omega 3 Fatty Acids in Bipolar Disorder: A Preliminary Double-Blind, Placebo-Controlled Trial.” Archives of General Psychiatry, 56(5), 407-12.
• Su, K.; Huang, S.; Chiu, C.; & Shen, W. (2003). “Omega-3 Fatty Acids in Major Depressive Disorder.” European Neuropsychopharmacology, 13(4), 267-271.
• Su, K.; Huang, S.; Chiu, T.; Huang, K.; Huang, C.; Chang, H.; & Pariante, C. (2008). “Omega-3 Fatty Acids for Major Depressive Disorder During Pregnancy: Results from a Randomized, Double-Blind, Placebo-Controlled Trial.” Journal of Clinical Psychiatry, 69(4), 644-651.
• Su, K.P. (2008). “Mind-Body Interface: The Role of N-3 Fatty Acids in Psychoneuroimmunology, Somatic Presentation, and Medical Illness Comorbidity of Depression.” Asia Pacific Journal of Clinical Nutrition, 17(S1), 147-153.
• Su, K.P. (2009). “The Biological Mechanism of Antidepressant Effect of Omega-3 Fatty Acids: How Does Fish Oil Acts as a ’mind-Body Interface?’” NeuroSignals, 17(2), 144-152.
• Taylor, D.J.; Lichstein, K.L.; Durrence, H.H.; Reidel, B.W.; & Bush, A.J. (2005). “Epidemiology of Insomnia, Depression, and Anxiety.” Sleep, 28(11), 1,457-1,464.
• Tiwari, P., & Ruhela, S. (2012). “Social Isolation and Depression Among Adolescents: A Comparative Perspective.” 2012 2nd International Conference on Social Science and Humanity, IPEDR Vol. 31. IPEDR.com.
• Vitamin D Council. (2011, September 27). “Depression.” VitaminDCouncil.org.
• Waters, L.E., & Moore, K.A. (2010). “Reducing Latent Deprivation During Unemployment: The Role of Meaningful Leisure Activity.” Journal of Occupational and Organizational Psychology, 75(1), 15-32.
• Wiley-Blackwell (2009, September 28). “Lack Of Social Support Tied To Parental Depression.” ScienceDaily.com.