One of the privileges a physician has is the ability to walk with their patients in their struggles. Some of those struggles are physical but for many more people those struggles are in the area of mental health.
The statistics are quite shocking: 30 percent of people live day to day with symptoms of anxiety. Twenty-five percent live with depressive symptoms.
The medical profession is not immune to this phenomenon. A recent survey of 13,000 physicians found close to one in four are suffering from depressive symptoms and 25 percent of those with symptoms of frank clinical depression.
There are many reasons for this which I will not dive into now. I want to focus on a different approach to mental health than we have traditionally been taught. Instead of a focus on therapy and medications (which are useful tools when used in the right individual), let us reference Dignity’s Optimal Health Pyramid (again a nod to Andrew Huberman @HubermanLabs).
The focus of this approach should be on brain health. Specifically, providing the proper environment for the brain to function at its most optimal level. How do we do that?
Behaviors
Behaviors are foundational to how we live our day to day lives. From the time we wake up until the time we lay our heads down at night, intentionally or unintentionally, we decide on activities that contribute or detract from our overall health and well being.
Nutrition
Nutrition has a dramatic impact on mental health. Evidence continues to mount on the link between ultra-processed foods and worsening mental health states. Mental health is really a reflection of brain health. In order for your brain to properly function you need the right nutrients to provide the proper energy for the billions of biochemical reactions which occur on a day to day basis. An often-quoted statistic is that your brain makes up 2 percent of your body weight but 20 percent of all metabolic activity occurs in the brain.
Quality daily nutrients are key.
Movement
Movement is a key component for brain health. It is stated, accurately, that the best anti-depressant is exercise. Regular movement improves mood. High intensity activity has been shown to release brain derived neurotrophic factor (BDNF). BDNF increases connections between neurons, a benefit known as neuroplasticity.
An integrative medicine approach to mental health—the specifics
Now, let's get specific:
What is the first thing you do when you wake up? Hint, the answer should not be check email! Find a few minutes in the morning or wake up 15 minutes early to set your intention for the day with a mindfulness activity. This can be a few minutes of breath work, meditation, spiritual reading and reflection or a moment of gratitude. In this way you allow yourself the chance to have a great and productive day.
Do you get outside to allow the sun to shine on your face early in the day for 10 minutes? It resets your body clock, releases cortisol to start your day and helps you get a better night’s sleep (yes) the coming night.
What about something as simple as your shower. There is emerging evidence of the benefits of cold-water exposure. It helps to reset your immune and inflammatory system as well as wake you up. Two minutes of cold exposure three times a week at the end of that hot shower is all you need.
What is your fuel source for the day? If it is a saturated fat or sugar laden food devoid of most nutrients your brain and body need to function you will likely be fatigued by mid-morning. Your body needs a combination of healthy fats, quality protein and carbohydrates. Each person is different in their ratio of these. Some do well focusing more on healthy carbs and others on healthy fats. All should get a clean source of protein in the morning as the overnight ‘fast’ primes your body for protein intake early in the day. If you want a deeper discussion on what foods are right for you check out my previous post on nutrition here.
Do you get some dedicated movement early in the day? Moderate to high intensity activity early in the day releases cortisol, epinephrine and other hormones that are stimulating.
Do you take the morning to do your hardest work? For most people the early morning hours are when they are the most productive. Don’t scroll through emails (or Tik tok videos) early in the morning wasting the most productive few hours of your day. Take the time to block out a period of the morning hours to do the brain work. The endless meetings can wait. Focus on the top two priorities you need to get done. One for the day and one for the week and have at it. If you are on someone else’s schedule you will have to get creative in finding that time. If you are doing a primarily manual labor job and can’t do it in the morning then set aside time at the end of the day to think, be creative, and make you plan for the next day.
If your butt is planted in a chair for more than an hour, get up! Take 5 minutes to move around, do some squats, lunges or jumping jacks. Yes, I know you look ridiculous. But it is more ridiculous that you don’t move for 2-3 hours causing chronic low back and neck pain, weight gain and fatigue. Recharge yourself every 60-90 minutes. Get outside for some fresh air at some point in the day.
At your mid-day break do you take in something healthy like a fresh salad or head to the nearest fast-food place? Be diligent about this as it will impact how you perform the rest of your day.
Several times a day consider pausing for 1-2 minutes and doing some box breathing. It is a simple way to recharge and clear the mind to help refocus on new tasks especially in the afternoon hours.
What are the right snacks to enjoy? It is best to carry a small container of nuts, carrots or other healthy snacks because there will be times that hunger strikes you. The last thing you want to do is reach for a bag of processed foods which can paradoxically spike blood sugars leading to a ‘crash’ several hours later.
Once the workday is over, take some time to do some gently activity like a casual walk. If you eat dinner early, then the best time to do this is just after a meal. It smooths out blood glucose spikes by having that extra energy sent to the muscles for walking.
Have a wind down routine. Whether it is getting the kids ready for bed or it’s just you building in habits to help get a good night’s sleep. This may involve some quiet time doing some meditation or more breath work. Be cognizant of bright lights as they suppress melatonin release. Melatonin signals the body and brain to get ready to sleep.
Target eight hours of in bed time for a good night's sleep. For more on sleep check out my blog post here.
While you may not be able to incorporate every point above it gives a roadmap and options for you to consider as you move through your day.
Targeted Supplements for Mental Health
The next consideration for brain health is a structured approach to supplements. While the best way to obtain essential nutrients is through food it is often not enough. There are numerous supplements to consider for mental health conditions. While that list can be exhaustive let’s focus on a few key ones I have found to often be out of balance with my patients.
These include:
Vitamin D
B Vitamins
Omega 3 Fatty Acids
Magnesium
Iron
Vitamin D is a critical vitamin that not only supports healthy bones. Vitamin D has other roles in the body, including reduction of inflammation as well as modulation of such processes as cell growth, neuromuscular and immune function, and glucose metabolism [1-3]. There are continued studies showing its link to mental health conditions including depression and anxiety. While the recommendation is to maintain Vitamin D levels of over 30 ng/ml more experts are recommending an optimal level of 50-70. Check your level and if low take 2,000-5,000 units (50-125mcg) daily of supplemental Vitamin D3.
B Vitamins are essential cofactors in numerous biochemical reactions in your body. A lack of B vitamins results in sluggish reactions and inefficient production of energy and slower detoxification of toxic substances normally produced as part of these reactions. While there are 8 B vitamins, and all are important, we focus on B9 (folate) and B12 (cyanocobalamin) in mental health. Low levels of these key vitamins have been shown to result in depressive symptoms.
Omega 3 fatty acids are essential building blocks for, literally, every cell in your body. While there is conflicting information on targeted supplementation of Omega 3 for depression more and more evidence is emerging. Recommendations focus on 2 specific omega 3s, EPA and DHA. Taking 1,000-2,000 mg daily of a high-quality Omega 3 supplement with particular attention to EPA and DHA is considered safe.
Magnesium is a cofactor in more than 300 enzyme systems that regulate diverse biochemical reactions in the body, including protein synthesis, muscle and nerve function, blood glucose control, and blood pressure regulation. There is evidence of low magnesium levels in several mental health conditions including depression. Supplementation is readily available. Look for 2 specific types; magnesium glycinate and l-threonate. Both have been shown to cross the blood brain barrier and can positively impact brain health. Take 100-400 mg at night as it has been also shown to help sleep through its impact on relaxation of muscles.
Iron can be associated with mental health disorders including depression. This becomes especially important in menstruating women who are more likely to be anemic due to monthly blood loss. Checking routine labs, including a blood count and ferritin level, can be informative. Iron supplements should not be taken without a recommendation from a physician as toxicity can occur if taken in excess.
What about medication?
The reality for people with mild to moderate depression (approximately 70% of all patients) is that anti-depressant medications have not been proven to be effective. See this conclusion from a study quoted by other authors over 2500 times: "The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms, and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms (emphasis added)."
For patients with very severe depression, the benefit of medications over placebo is substantial. This study’s conclusion, similar to others, reinforces the point that for the vast majority of people with depression medications have questionable positive effects.
Above is a framework to apply when seeking out an integrative approach to mental health. The good news is that it is available to each and every person who struggles with these conditions. The better news is most of the recommendations do not cost anything to implement in your lives.
The best news is that if you follow the above "prescription" for living then you will not only feel better but also have lower risk of all chronic diseases. Seems like a prescription definitely worth implementing in your life.
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