"Please tell me where I can go for help for depression," a correspondent wrote me a few days ago. "I have had diabetes a long time, and I am so tired of everything. Can you point me in the right direction for some help?"
I replied by suggesting five strategies that seem to work for me. For about two months after I had an emergency operation on October 1 while traveling, I wasn't a happy camper. A friend told me that general anesthesia can cause depression, and a quick search of the Web confirmed it.
Two months must have been far too long for the anesthetic to hang around in my body. But for the past several weeks I have been continuously happy.
Maybe it's because I've been getting out regularly for walks to some of my favorite winter destinations. Or maybe it's because I've getting a lot more long-chain omega-3 fatty acids from fish (and a lot less omega-6). Possibly it's the continued effect of the 10,000 IU of vitamin D I take every day. We have some evidence that each of these strategies help to counteract depression.
I have also started to meditate for half an hour every day. That makes me happier. With my present good cheer I naturally gravitated to Loving-Kindness or Metta meditation. The way I started was to envision myself smiling not only with my mouth and face but also with my whole body and smiling at everyone I see. That may bring a little happiness to them, and it certainly brings a lot of it to me.
My greater happiness has become a virtuous circle. Because I'm happier, I listen to my favorite music much more. When I'm home, iTunes is on almost all the time. When I'm walking around town, I listen to my iPod with earphones or earbuds. When I've driving, I listen to my iPod connected to my SUV's speakers.
The best review of exercise and depression concluded that, "Exercise seems to improve depressive symptoms in people with a diagnosis of depression." But this Cochrane review says that the evidence is weak. Maybe exercise helps more when people step out of their cozy private rooms and get a lot more face-time with others, as I started again to do a few weeks ago.
The most recent review of the benefits of Omega-3 polyunsaturated fatty acids (PUFA) reached a similarly tentative conclusion. "Current evidence increasingly supports an inverse association between omega-3 PUFA and depression." But this 2009 study in Current Pharmaceutical Design adds that methodological issues limit the extent of the conclusions we can draw.
The evidence that vitamin D can help us ward off depression is stronger. About five weeks ago I reviewed a large trial showing that high levels of vitamin D in our blood affects our mood. After following their subjects for more than a year, the researchers found that those who had very low levels were one-third more likely to develop depression than those with normal levels. The association was even stronger among those with no prior diagnose of depression.
I'm likely not the only one who feels better when I meditate. "Mindfulness-Based Cognitive Therapy is mainly efficacious in reducing relapses of depression in patients with three or more episodes, Zen meditation significantly reduces blood pressure and Vipassana meditation shows efficacy in reducing alcohol and substance abuse in prisoners," according to a study last year in Psychological Medicine. But again, "Despite encouraging findings, several limitations affect current studies."
Listening to music helps. "Music therapy is an effective treatment which helps people with psychotic and non-psychotic severe mental disorders to improve global state, symptoms, and functioning," according to a study last year in Clinical Psychology Review. The problem for me is that when I am in a bad mood I don't want to listen to music. One of the other strategies has to kick me into gear.
Individually, the evidence for each of these five strategies isn't as strong as I would like. But together I think they add up to a winning formula to break the insidious connection between diabetes and depression that I have written about here before.
Even if you haven't had general anesthesia recently, Seasonal Affective Disorder, or SAD, also known as winter depression or winter blues, tends to strike about now. If you want to reverse your depression without taking antidepressant medication, a cocktail consisting of several of these strategies might be a natural cure for you too.