Managing Your Depression (4 page)

• Choose a variety of protein foods, which include seafood, lean meat and poultry, eggs, beans and peas, soy products, and unsalted nuts and seeds. Choose a variety of seafood in place of some meat and poultry.

• Use lean, lower-calorie protein foods instead of high-fat protein.

• Reduce the amount of sugar-sweetened beverages you drink.

• Focus on the total number of calories consumed. Monitor your food intake.

• Be aware of portion size: choose smaller portions or lower-calorie options.

• Eat a nutrient-dense breakfast.

• Limit daily sodium (salt) intake to less than 2,300 milligrams (mg) per day.

• Eat less than 10 percent of calories from saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids.

• Eat less than 300 mg per day of dietary cholesterol.

• Increase fat-free or low-fat milk and milk products, such as milk, yogurt, cheese, or fortified soy beverages.

• Use oils to replace solid fats when possible.

• Choose foods that provide more potassium, dietary fiber,
calcium, and vitamin D. These include vegetables, fruits, whole grains, and low-fat milk and milk products.

• Limit foods that contain synthetic sources of trans fats, such as partially hydrogenated oils.

Source:
U.S. Department of Agriculture, U.S. Department of Health and Human Services,
Dietary Guidelines for Americans 2010
, 7th edition (Washington, DC, December 2010),
www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/
PolicyDoc/PolicyDoc.pdf
, accessed April 2012.

You have to work hard to build a healthy eating pattern—it does not come naturally to many people. When you are depressed, it is much easier to eat take-out and prepared foods that are higher in fats and salt and not as healthy for you. Grocery shopping and cooking may seem overwhelming, but try to remind yourself how important it is for your mental and physical health. You may find it easier to stick to a healthy diet when you plan ahead. Do this at times of the day when you have the most energy. First, make a shopping list of healthy foods for the grocery store. There are Web sites that can help you with easy menu planning. Try to go shopping at times when it is least crowded and you are not hungry, and if possible, bring a friend along to help you. Many markets have a salad bar with healthy choices to start—just watch the amount of salad dressing you use. Cook soups, stews, or chicken in large batches so that you can freeze portions for later use, on days when fatigue sets in. Buy vegetables and throw them in a crock pot to cook all day—the result is a healthy, nourishing meal with little effort! Cook on days or times of day when you have more energy, or ask a friend to help you do it together. Make your grocery shopping and cooking part of your weekly routine and schedule them in. Some people find that a weekend day is the best time for them to shop and cook for the week. Then just do it even if you do not really feel like it.

Some people experience anxiety along with their depression, and with this they may have unusual food cravings and a tendency
to snack on junk food. Try to resist this temptation. Have only healthy foods and snacks at home to reach for when the urge is there. Bring a healthy snack with you to work and have it readily available. A piece of fruit, yogurt, or 12 walnuts or almonds are far better choices than chips or candy. Talk to your doctor if unusual food cravings persist. Keep variety in your diet as a way to ensure your body gets the many nutrients it needs. Variety also helps keep you from getting bored with the same old menus. Try a cooking class. This will also get you out of the house and introduce you to new people and new ideas, which are good for your depression.

Eating out at restaurants can also sabotage the best intentions of maintaining a healthy diet and weight. Try to stick to your plan of portion control, limiting fats and salt. Order an appetizer and salad instead of a main course, request that the salad dressing or sauce be put on the side, share a main course, or ask for a doggy-bag to bring the rest of your entrée home for the next day.

If following a healthy diet and regular exercise program does not solve your weight-gain problem, speak with your physician about alternative medications for depression and sleep. Other options include joining a support group plan such as Weight Watchers, getting a referral to the Weight Center at your local hospital, or speaking with your physician about a medication to help counteract the weight-gaining potential of the antidepressant medications.

Physical Exercise

You have often heard that physical exercise is good for your body and overall health. Did you know that it is also good for your brain, in particular that exercise can alleviate depression?

The benefits of physical exercise as a treatment for depression are that it

• promotes the growth of new brain cells and regulates brain chemicals (neurotransmitters)

• helps to keep the level of stress hormones normal and relieves stress

• increases feelings of confidence, self-esteem, competence, and sense of mastery

• has a positive effect on your mood

• improves your sense of well-being

• releases the “feel good” hormones (endorphins)

• improves the quality of your sleep, which in turn improves your mood disorder

• helps to overcome the inertia and sedentary lifestyle that often comes with depression

• increases your social contacts (in an exercise class or in neighborhood or health club interactions)

• builds endurance and physical strength, which combats fatigue

• helps manage your weight

Regular physical exercise may be helpful alone or when used in addition to standard antidepressant treatment. This is called an
augmentation strategy
. Exercise is also considered part of a Relapse Prevention plan (
page 71
) and may be associated with lower relapse rates. It is also a way for you to take a more active role in managing your depression. Before beginning an exercise program, discuss your plan with your physician. Mention any physical health concerns, such as heart disease or bone or joint problems.

Depression symptoms may make it more difficult to start and stick with an exercise program. These symptoms include loss of interest in activities, decreased physical and mental energy, decreased motivation, and loss of focus and concentration. However, there are effective steps you can take to deal with these challenges. First, choose an exercise activity that you enjoy, or used to enjoy, and can do regularly. Once you pick your exercise program, sticking with it is the most important part. How do you do that when you are depressed? Make it part of your daily routine and schedule it as a key part of your day. Here is where action precedes motivation. This means that you should start your exercise program now and keep at it, even if you don’t really feel like doing it. The motivation for doing it will come later.

If you have not exercised in a while, start slow and gradually build up your time and effort. Commit to walking around the block for 10 minutes each day, and then gradually increase the amount of time you walk each week. Or start by walking 10 minutes away from your house, and then 10 minutes back home, and gradually increase your time. You may want to purchase an inexpensive step counter, a small plastic device you clip to your waist that counts each step as you go about your daily life. The goal is to add 1,000 steps in the course of your day, so that you eventually walk up to 10,000 steps daily. Incorporate small changes into your daily activities, such as walking more places, taking the stairs instead of the elevator, or getting off the subway or bus two stops earlier.

Get Started and Keep It Going

• Do what you enjoy or used to enjoy. Do something that is fun.

• Assess what type of exercise resources are available to you. Look for a safe area to walk in your neighborhood. Find out if there is a community center or health club facility available to you with exercise classes or equipment. Consider whether you have or can invest in home exercise equipment. See what kind of social supports are available to keep you motivated to exercise.

• Plan a specific and realistic activity that you can do. Define the type of activity, how often you will do it, and for how long (frequency and duration).

• Make exercise a priority in your day and a key part of your daily routine.

• Believe that the exercise will have benefit for you—this will make it easier to do.

• List the pros and cons of exercising compared to having a sedentary lifestyle.

• Come up with your own personal reasons for exercising.

• Exercise with a partner (a walking partner or join a class)—you will have to be accountable to him or her to show up and exercise together. This is a good social support.

• Consider having a personal trainer help you set up a program, then monitor and motivate you.

• Identify and address any barriers ahead of time, such as the time of day, your energy level, balancing other obligations, too busy, too tired, too sick, bored, embarrassed, and so forth.

• Work toward a goal that has personal meaning. This could be a walking or running distance or length of time, or a specific exercise accomplishment.

• Train for a charity event (such as a walk, run, bike ride).

• Track your progress in a journal or log and review it periodically.

• Focus on the activity and not on your performance. Try not to make comparisons to your past or to others’ performance.

• As you get stronger, vary your activity so that you avoid boredom and repetitive injury.

• Give yourself credit for what you can do now.

Exercise Guidelines

What counts as exercise? Exercise is any physical activity or movement of the body that uses energy. The American College of Sports Medicine considers a regular exercise program to be essential for most adults. It endorses one that includes cardiorespiratory, resistance, flexibility, and neuromotor exercise training, beyond the usual activities of daily living, to improve and maintain physical fitness and health. It is recommended that you do a combination of
aerobic
activities that increase your heart rate and breathing (see the Examples of Aerobic Exercise Intensity table below),
strength
activities that build and maintain bones and muscle, and
balance and stretching
activities that increase physical stability and flexibility, such as yoga, tai chi, or just basic stretches.

When you do aerobic exercise, your body’s large muscles (such as your quadriceps or hamstring muscles in your legs) move for a sustained period, your heart rate and breathing rate increase, and you get sweaty. Three components of aerobic exercise influence the amount of benefit you get from each workout:

1. Intensity—how hard you work (described as moderate or vigorous intensity)

2. Frequency—how often you do the activity (once or twice a week, for example)

3. Duration—how long you do the activity (10 minutes? half an hour?)

Strength activities are those that cause the body’s muscles to work against a force, such as when you pick up a weight or press against a resistance band. This is also called resistance exercise. Muscle-strengthening activities also have three components that influence the amount of benefit you derive from the exercise:

1. Intensity—how much weight is used (how heavy a weight you lift in pounds)

2. Frequency—how often you do the activity

3. Repetitions—how many times you lift the weight or repeat the motion

Intensity and Duration of Physical Activity

The recommended exercise guidelines for healthy adults are

• at least 30 minutes of moderate activity 5 times a week and 2 or more days of strength training each week

or

• at least 25 minutes of vigorous activity 3 times a week and 2 or more days of strength training each week

Examples of Aerobic Exercise Intensity

Sources
: U.S. Department of Health and Human Services, 2008 Physical Activity Guidelines for Americans,
www.health.gov/paguidelines
, accessed April 2012; Centers for Disease Control and Prevention, “Measuring Physical Activity Intensity,”
www.cdc.gov/physicalactivity/everyone/measuring
, accessed April 2012.