There's a growing consensus about the future of depression treatment, and it goes beyond medication.
"For decades, the dominant narrative has been that depression is a brain disease that can be reversed—or at least managed—with antidepressants," writes Justin Garson, but new guidelines published in The Lancet focus on four different pillars for healing depression:
1. Exercise. Physical activity directly targets inflammation, metabolism, sleep, and our response to stress—the exact factors that tend to break down when someone is experiencing depression.
2. Sleep. When we can't adequately rest, it becomes harder to regulate our mood, largely due to the impact on the amygdala, prefrontal cortex, and stress hormones. The current consensus favors cognitive behavioral therapy for insomnia (CBT-I), and not sleeping pills, as the first line of defense for sleep issues.
3. Diet. What you eat is partially tied to a healthy gut-brain axis. Your gut microbiome can become impoverished by ultra-processed foods and refined sugars, leading to depression risk factors such as inflammation, poor immune response, and increased stress hormones.
4. Psychotherapy. The authors of the review note that SSRIs can help, but they work best in the context of a productive therapeutic relationship.
"The newer recommendations for depression aren’t just a matter of supplementing the status quo," writes Garson. "They point toward a shift that is likely to transform how we think about and treat depression."
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