Non Pharmacological Ways of Improving Mental Health Diagnoses
According Medical Research
By Dustin Jasmer
Updated List as of 7/20/18
Thanks for being patient as it has been a while since this has been updated. On the next list I will work on getting citations for these specific studies. I have some of them here. I will try to update this every few months with more citations as research develops as it constantly does.
I am often asked by patients “What can I do besides medication to help my diagnosis”
I have done lots of research on the subject and according to clinical trials and research here are a few things I've discovered:
1. Exercise 30 minutes per day, 5 days per week. Exercising will suppress cortisol levels for up to 48 hours. Never take more than 2 days off in a row. Research shows that light exercise is no less beneficial than heavy exercise so the important thing is to stay active.
2. Therapy-Therapy in combination with medication is the single most effective means helping with depression/anxiety but often therapy alone can be effective for depression/anxiety and may be a good first line option. There are many styles that can and should be explored such as CBT, DBT, Talk therapy, hypnotherapy, gestalt, integrative, spiritual based, EMDR, trauma based and many other styles as well.
3. Get a pet-Animals have been shown to reduce levels of depression and anxiety in many people according to studies.
4. Keep your family close- Research has shown that having a valued support system like your family and being able to confide in loved ones can be invaluable in times of depression and high anxiety. It is very tempting to push people away during periods of high stress but this is when you need to lean on those that love you.
5. Find a spiritual support system that fits your ideals- Research shows that people that have a belief in something bigger than themselves experience less depression. These studies have shown that no specific religion is superior to another. It does not matter whether you are Christian, Buddhist, Hindu, Islam, Spiritual or other. Find something outside yourself to believe According to the research, you may have find yourself with less depression.
6. Have fewer friends- I often see posts on facebook saying that people would rather have 4 quarters than a 100 pennies when it comes to friends. According to research this is true. It is better to have fewer friends but have closer friends that you can confide in. This will help lower your chances of depression.
7. Eat a low carbohydrate, high fat, high protein diet-Studies have shown that carbohydrates are highly inflammatory and that cutting them out of the diet can be associated with lower depression/anxiety scores. The brain is not meant to function on constant blood sugar peaks and troughs. Humans have only been eating carbohydrates year since the industrial revolution and are not evolved to eat carbohydrates in the manner in which we do in this day in age. Prior to the industrial revolution there were some grains consumed but carbohydrates were eaten one time a year when fruit ripened and was taken off of a tree once per year. The remainder of the year, meat and vegetables were the staples. If you want to reduce depression, try keeping your carbohydrates below 100 Grams per day, unlike the average American that eats over 300-400 Grams per day.
A few recommended diets in order of highest research (based on my opinion) for mental health that can be looked into are:
a. Mediterranean diet
B. Paleo- IE the caveman diet
c. South Beach diet
e. If you simply cannot go without carbs, look at the “Mommy Fit” diet which has less research but seems scientifically sound. It involves removing one major fuel source per meal.
f. Weight watchers, although not low carbohydrate does have a proven track record of weight loss and weight loss has been associated with lower levels depression of anxiety/depression.
8. Find and develop a Hobby-Hobbies have been shown to decrease depression levels according to many clinical studies. Find something interesting that doesn't interfere with your daily life and set some time aside for yourself to do it regularly.
9. Lighting-Recent studies have shown that light therapy for seasonal affective disorder can actually help in non winter months as well. It may be worthwhile to use these lights year round, especially for those people who work night shifts or for those who work in dark offices. This is true in the Winter and the Summer. You can buy these cheaply on Amazon and recently even and wholesale warehouses such as Sams Club.
10. Darkness- I just mentioned that light is helpful. This is can be very true. On the other side. On the other hand people with mood disorders can potentially have mood activation during seasonal changes. In some clinical trials they have done darkness studies where they had them eliminate all light for 8-12 hours at night. In other studies they simply wore glasses that blocked the Blue rays throughout the day during the spring and summer months. In each of these studies people diagnosed with mood disorders had improvements in sleep and mood. These sunglasses can be purchased on Amazon for as cheap as $6 or as much as $400 depending on your style.
11. Meditation- Meditation, self-hypnosis, mindfulness and deep breathing exercises have been shown to reduce levels of depression/Anxiety and may help with ADHD symptoms. There are many CD's and Youtube videos, books, Podcast etc. that can teach you to do this.
12. Acupuncture- Acupuncture and acupressure when done by a trained practitioner have been shown to reduce levels of depression and anxiety in clinical trials.
13. Massage- getting regular massages have been shown to decrease levels of anxiety and depression in some patients, especially older patients in some studies. The have also shown to lower cortisol blood levels and decrease inflammatory markers in the blood in some studies.
14. Bio/Neurofeedback- This is a controversial treatment. The research is still up in the air on this one. I have several patients that have told me this has helped them. I don't have any that have told me that it has hurt them. However the clinical trials show that it is beneficial mainly for short periods of time and that it must be continued on an ongoing basis. I suppose that this is true of most treatments. The downside is that it can be very expensive. I don't recommend against it but as of now the jury is still out on how helpful it is on a long term basis.
15. Find a Purpose to your Life-This is perhaps the hardest thing on the list. Find a reason to wake up every day and be excited about your day. Enjoy what do you with your life. If you hate your job, the things that you do, your situation in life and your surroundings it will be difficult to get your depression under control. I am not recommending that people with severe depression make huge life changes like quit a good paying job but try to find meaning within what you are doing. Some have done this by feeding the homeless, others through bodybuilding, through volunteer work, others do this by spending time in nature, others find meaning by spending extra time with their family or their art work. Whatever it is, you must find a purpose to your life rather than going through life like a robot.
1. Take Omega 3 and 9 Omega Fatty Acids- A good source of these are from fish like salmon or you can get supplements from the health food store or even walmart, costco, or sams club. This is safe for children and has been shown to increase levels of focus in ADHD in some studies and decrease depression and anxiety in other studies. I recommend around 2400 mg daily. Studies have also shown that Omega fatty acids have beneficial cholesterol effects. Since the majority of the cholesterol is processed by the liver at night, I recommend taking fish oil at bedtime. There are tasteless and “burpless” preparations of fishoil that can purchased. One specific brand that I like is a lemon cream pie liquid version that can be bought at Costco which children actually like. Flax-seed or plant based omega oils are not as effective as fish oil per research.
2. Increase B-12 Consumption. This is a water soluble vitamin that the body often has trouble absorbing. Sub-lingual preparations are often best. I recommend between 2,000-5,000 mcg. This is much higher than the FDA recommended daily allowance but it it is water soluble and easily eliminated in the urine. I recommend methycobalamin (methyl-B12) as not everyone can utilize cyanocobolamin which is the most common type of B12 that is available. You need to be aware of tingling in your fingers and toes however because there have been reports of neuropathy with long term high dose B12 exposure but this is rare and possibly due to the fact that b-12 deficiency itself can cause neuropathy as well but either way it is good to be watchful of side effects. B-12 deficiency can cause depression, anemia, fatigue, lethargy and in severe cases even stupor. It is more common with alcoholics, those on stomach acid reducing medications, celiacs or those with the MTHFR gene who can have symptoms even with “normal” b-12 levels.
3. Methylfolate- There is research that many people with depression may benefit from methyl folate. Deplin is a prescription Folate medication that has been approved by the FDA for depression but methylfolate is also available over the counter at health food stores. In many studies it has been shown to help with ADHD, austism, mood disorders and even schizophrenia, You must be careful when taking methylfolate because folate is responsible for nearly 200 metabolic processes in the body. Methyfolate is different than folic acid. Some people cannot convert folic acid to methyfolate in their body due to a gene which is very common in the United states so it is better to take the active form of this nutrient just in case. You must start slow when taking methylfolate (400 mcg). Slowly increase your dose over a period of a few weeks. Do not start this until you have been on methyl-b12 for at least two months first. There have have isolated studies of spinal cord atrophy if a person starts this prematurely although these are very early studies. When you get too high on your dose you can become agitated, angry, have sleep problems or have tremors. The benefits include higher levels of energy, mental clarity and often reduced need for medications but be careful and watchful as it is potent. Dose ranges vary from person and can be as wide as 400 mcg-15 mg so once again easy does it. Please check with Dustin or Jillian before you consider taking this because it is extremely potent and there is some guidance that you may need.
4. Magnesium Glycinate- Magnesium is a mineral which a mineral that has increasing research which is favorable towards depression, anxiety, bipolar and restless leg syndrome. There are many forms of Magnesium that are available commercially including magnesium carbonate, magnesium stearate, magnesium sulfate and other magnesium preparations. Some of these may be acceptable in increasing the blood magnesium levels but the best clinical evidence is for Magnesium Glycinate for Bio-availability in the blood stream when taken orally.
5. Increase your Vitamin D intake. Many people suffer from Seasonal Affective Disorder on top of Major Depression or Bipolar Depression.Vitamin D supplementation has has been shown to be helpful with mood disorders. People function much better with optimal blood levels of vitamin D between the levels of 60-90. About 70% of people in the United States are below 30 when their labs are drawn due to our geographic location. I recommend most people start with 5,000 IU daily and then have their blood level drawn after three months. The USDA recommends 1,200 IU which is the bare minimum.
6. N-A-C: N- Acetyl Cysteine. N-A-C is an amino acid that has a very interesting history. It has been found to be helpful to reduce symptoms of OCD, Skin Picking and Trichotillomania. In several small studies doses varying between 500 mg twice daily to 1200 mg twice showed to reduce compulsive skin picking and hair pulling urges in humans with almost no side effects. This was was originally discovered on accident after love birds who plucked their feathers stopped plucking their feathers were fed bird seed high in this amino acid and they found that this potent amino acid may have the ability to work on the NMDA-Glutamate system in the brain. This amino acid is now in clinical trials for Bipolar, Anxiety and several other conditions at research locations across the world.
7. Melatonin- Melatonin. Melatonin is extremely safe. It can be use safely for children, infants, adults and geriatric patients. Here are many studies on it. There are some research hospitals that use melatonin intravenously to treat brain injuries in premature infants and have seen success. It should be the first line option for insomnia in every case in my opinion. I don't know of any interaction or reason a person cannot take it. Often when a person has tried it an it is not effective the reason it is not effective is either due to the brand or dose they tried. They may need something additional but they will often get some effect if dosed appropriately. In studies it has been shown to be safe up to 20 mg in children and 100 mg in adults.
Great study on usefulness and safety of melatonin in infants and children for various conditions. There are very few side effects from it except nightmares:
Higher risk of diabetes mellitus in those with lower urine melatonin levels.
Helpful in reducing headaches.according to the American headache association.
Pediatric Neurology recommendations for melatonin
Can be used to treat pediatric breath holding.
Melatonin increases memory consolidation even during the day.
Treatment with melatonin reduces night terrors.
8. DHEA- DHEA has research that supports that DHEA at the correct doses monitored by blood work and not to excess levels can have various positive benefits in the human body. Long terms depression does have the ability to suppress DHEA. DHEA in some studies has been shown to decrease autoimmune responses in lupus, decrease abdominal fat, increase bone density, decrease incidence of blood clots, and decrease sexual decline with age. There are some studies that show it can improve depression. I typically recommend women start low with 2.5 mg-5 mg twice daily or 5-10 sustained release. Men can start higher at 25-50 mg twice daily or take sustained release 25-50 mg once daily. A person (man or woman) will notice very little benefit if they take it only once daily because it leaves the body within about 12-16 hours if taken with an instant release product. Another thing to know is that any person doing testosterone therapy should be on DHEA because DHEA is suppressed over time with testosterone therapy and it is important to know that DHEA converts into nearly every hormone in the body. Side effects include acne and hair loss in excess doses. Pregnant women should not take it. Neither should women who have PCOS unless told otherwise.
https://www.ncbi.nlm.nih.gov/pubmed/25022952 (Basic Autoimmune study)
Vitamins/Supplements that I am neutral/Hesitant to recommend for or against due to lack of strong evidence.
1. SAM- E. This can be helpful but needs to be taken at lower doses for depression. This works on the transulfuration pathway of the methylation pathway. It has been shown in some studies to be useful for depression but only minimally and can have side effects such as muscle cramps and irritability.
L-Theanine- for anxiety. I have had patients tell me this works for them but there is limited research to support it. It seems safe according to the research available.
Gaba as needed for anxiety. Many patients report this can be helpful but the research is very lacking in terms of effectiveness. GABA is the neurotransmitter that is in the brain responsible for decreasing anxiety. This should not be able to cross the blood brain barrier per research. Nevertheless patients often tell me that it works for them. I hesitate to recommend anything that doesn't have research but it is worth mentioning because it has been studied at very high doses (up to 500 times a typical dose) in Europe without major side effects other that tingling in the skin and diarhea.
5-htp-Has shown to be useful in helping with very mild-depression. It is often touted as a sleep aid. It has not been shown in clinical trial to be helpful with insomnia. It does appear to be safe to take, especially in doses of 50-100 mg.
CBD- oil, This might be helpful so long as it is free from THC. Research is still emerging. For now I am recommending to avoid. Some research is strong for pain, sleep apnea or for seizures but it is lacking in regards to mental health diagnoses such as secondary insomnia, insomnia, bipolar etc.
Herbs for fatigue:
Ashwaghanda has some research for Fatigue if taken intermittently during times of sleep loss.
Rodiola can also be taken as well so long as a person does not have a diagnosis of a mood disorder as several studies have shown that this can worsen mood disorders. It can help with fatigue in some individuals.
Vitamins and minerals that I specifically recommend against unless needed:
1. A multivitamin- Several studies have shown that a multivitamin can be neutral or harmful to a person. Many of the vitamins compete and actually some multivitamins in observational studies may be associated with premature death.
2. Calcium- Unless a person has a reason to be on it- studies show that it increases bowel cancer risk. Don't take it unless you have osteoporosis and are told to by an orthopedic doctor.
3. St. Johns Wort. This is a structurally similar to very old antidepressants MAOI and should not be considered safe. It interacts with many medications.
4. Kava Kava- This can cause liver damage although it can help with anxiety according to some people. No large studies have been performed to my knowledge that show it is helpful.
5. Milk-Thistle- This is often touted as a liver cleansing agent but in many studies has been shown to worsen liver damage. Avoid it.
6. B- Complex, Iron, Zinc and others. A complex has several competing b-vitamins that decrease the ability for other vitamins to work properly for example. Niacin is a methylation acceptor (basically sucks up other vitamins like folate and b-12 like a sponge) while folic acid or b-12, and b6 are methylation donor. In a recent study done by the Journal of American Cardiology and Published 5/18/18 showed Niacin increased the risk of “all-cause mortality” as did b6 (They studied pyroxidine hydrochloride not p-5-phoshate which seems safe or helpful in many studies), a multivitamin, betacetacarotene. Vitamins A, B6, and E, multivitamins well as zinc, iron which all had no significant effect on cardiac outcomes and all-cause mortality. That is not to say there aren't times when these are needed, just that a person should not be taking vitamins for no good reason.