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The current depression theory is that mood disorders are caused by chronic inflammatory effects in the brain and body. Below is a checklist of things you can do to reduce these inflammatory changes and improve your chances for a complete recovery. They are listed in order of importance. Begin with Tier 1 and work your way down to Tier 4.

 
Tier 1 

• Set a routine wake-up time and get 7-8 hours of sleep each night.
• Bedtime can vary but prepare with a “bedtime ritual."
• Ask for complete list of proper sleep hygiene suggestions or consider a hypnotic medication if needed. 

• Can usually begin noticing positive effects within first 2 weeks.
• Requires 4-6 weeks to be effective, with maximum effectiveness at 12 weeks.
• Should be taken for minimum of 6 months. 

• Education and counseling to address your identified distressing issues
• Usually time limited.
• Medical research has shown this to be as effective as antidepressant medication.
• May involve specific anti-rumination strategies to reduce negative thinking. 

• At least 45 minutes of moderate-intensity activity, 5 days per week: this means“breaking a sweat”, such as fast walking, cycling, or lawn work.
• At least 30 minutes of vigorous-intensity activity, 4 days per week, such as jogging, stair climbing, or swimming).
• If you can schedule with a partner who is committed, you are more likely to  be consistent.
• Medical research has shown that aerobic exercise has the same therapeutic effects on the brain as an antidepressant.
• Read Spark: The Revolutionary New Science of Exercise and the Brain by John Ratey, M.D. and Eric Hagerman.

• Eat a low glycemic-load, Mediterranean-style diet with adequate protein and plant foods. Avoid highly-processed foods.
• Eat foods high in antioxidants such flavonoids and carotenes. Examples include colorful foods such as carrots, broccoli, oranges, red grapes, strawberries, blueberries, tea, tomatoes, apples, and dark chocolate (yes, chocolate!).
• Always eat breakfast.
• When snacking, eat nutritious combination such as:
  
  • Whole grain bagel and fruit (blueberries or tomatoes)                     
  • Piece of fruit with crackers and cheese
  • Yogurt or cottage cheese with a piece of fruit.
  • Carrots or celery with peanut butter or cream cheese.
• If uncertain about what to eat, read: AntiCancer- A New Way of Life by David Servan-Schrieber, MD 

• Seek out and surround yourself with positive, happy friends or family.
• Avoid negative or unhappy people.
• Avoid spending time alone as this increases negative ruminations and worry. 

• The easiest to use is “The Relaxation Response.”
• Has been shown to improve sleep and your immune response, reduce anxiety, and prevent relapse of depression.
• Perform 3-4 times weekly.
• Ask for handout if interested in this. 

• Maximum limit for healthy MEN up to age 65: no more than 4 drinks per day, and no more than 14 drinks per week.
• Maximum limit for healthy WOMEN (and healthy men over 65): no more than 3 drinks per day, and no more than 7 drinks per week.
  
• Limit yourself to 1-2 drinks per setting.
• Remember alcohol is a depressant and will exacerbate depression.
• Alcohol can also disrupt sleep.  

• Obesity causes multiple health problems, including sleep disturbance, depression, and reduced energy.
• Begin to gradually “trend down” weight toward target Body Mass Index (BMI) 18.5-25. Ask for handout if this interests you. 

• Studies show a “bad” marriage reduces your chances of recovery by 50%.
• Consider marital or couple counseling.
• Read The Seven Principles for Making Marriage Work by John Gottman, Ph.D.  

• If working more than 50 hours per week, consider reducing work hours to less than 45 hours per week.
• Take regular vacations (at least 2-4 weeks)
• Ask for time off from work until feeling better.  

• Studies show that people who believe in a higher power are healthier and happier.
• Begin a “spiritual practice.”
• Examples include regular prayer, meditative practice, yoga, gratitude work, drumming, or joining a church.  

• SAMe
  
  • A salt-like metabolite involved in biosynthesis of norepineprine, serotonin and dopamine.
  • Dosage is 800-1600 mg/day for 6 weeks.
  • Can speed the onset of antidepressants or augment effects of antidepressants.
•  Omega-3 Fatty Acids (EPA or DHA)
  
  • Usually from fish oils and may increase CNS serotonin and have anti-inflammatory effects.
  • Dosage is 1 gram daily.
  • Augments effects of antidepressant and EPA is more effective than DHA.
• N-acetylcysteine (NAC)
  
  • Enhances production of glutathione (GSH), a powerful antioxidant that protects the brain from stress.
  • Dosage starts at 600 mg twice daily.
  • Augments antidepressant or may even work without an antidepressant.

• Especially effective for those who notice a seasonal (fall/winter) component of depressed mood.             
• 10 to 15 minutes per day of full-body direct sun skin exposure.
• An alternative would be at least 30 minutes per day by using a special light box that  emits 10,000 lux.
• Light boxes can be ordered on-line at www.northernlighttechnologies.com or www.LightTherapyProducts.com. 

• Medical studies have shown this can reduce depressive symptoms, reduce tension, and decrease chronic pain.
• Twice weekly for 30-60 minutes.
• Best suited for younger people or those who are relatively fit. 

      16. Education (Bibliotherapy)

• Reading self-help books will assist you in your recovery.
• Suggested books include:
  • The Art of Happiness by Howard Cutler, MD and the Dalai Lama.
  • Learned Optimism or Authentic Happiness by Martin Seligman, Ph.D.
  • Feeling Good by David Burns, MD.

• Support Groups
  • National Alliance for Mentally Ill (NAMI) www.nami.org.
  • Depression and Bipolar Support Alliance (DBSA) www.dbsalliance.org.