Lifestyle Tips for Treatment-Resistant Depression

How you live can help support expert medical care.

From the WebMD Archives

If you have treatment-resistant depression, getting expert medical and psychological treatment is crucial. But recovery isn't only about dutifully taking your medicine and seeing your therapist. There is actually a lot that you can do on your own to support your treatment.

"Because some treatments have already failed you, you want to do everything you can to improve your chances of success," says Ian A. Cook, MD, director of the Depression Research Program at the University of California, Los Angeles. "That includes paying more attention to your lifestyle -- your stress levels, your sleep, your exercise, and your diet." Making some changes -- when combined with treatment -- can have a big impact on your health, Cook tells WebMD.

While treatment-resistant depression can make you feel powerless, you're not. Taking an active role in your treatment can make a difference. Here are some suggestions for what you can do.

Treatment-Resistant Depression: Taking Control of Your Life

Get on a schedule. When you have treatment-resistant depression -- especially if you're not working or in school -- the hours and days can blend together. That lack of structure in your life, that chaos, can make it very hard to recover.

"If your life has no form to it, if you wake up in the morning with no idea of what to do with yourself, you're going to be miserable," says Dean F. MacKinnon, MD, associate professor of psychiatry at the Johns Hopkins Hospital in Baltimore. "Actually, that can make anyone miserable, whether they're clinically depressed or not."

One of the first things you should try to do is impose some order on your day. You don't need to schedule every minute, but come up with the basics. Set a time for waking up, going to bed, and eating meals. Then start to set times for other activities -- like exercising or seeing friends.

Set goals. This goes along with establishing a schedule for treatment-resistant depression. "I think in order to feel happy with your life," says MacKinnon, "you need to feel like you've accomplished something in a day."

So set some modest goals for your day and for your week, and make sure that they're things that you can realistically accomplish. Break big tasks into smaller ones, so that you can chip away at them gradually.

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Get involved. Some people with treatment-resistant depression need to take time off from work or school because they can't keep up with the responsibilities. The problem is that having nothing to do can be a very bad thing for people with depression.

So even if you're taking time off, find new ways to occupy yourself and stay involved. Consider working a part-time job that's not so demanding. Or think about volunteering. You could find that helping others could give you a new sense of purpose, says MacKinnon.

Treatment-Resistant Depression: Taking Care of Your Body

Get more physical activity. "A lot of my patients say that they feel better during exercise," says MacKinnon. And research backs them up. In people who are depressed, studies have shown that exercise can improve mood, improve sleep, and complement treatment.

Of course, right now, the idea that you could leap out of bed each morning to go for a run might seem ludicrous. But don't get overwhelmed. Every little bit can help, so start small. Just take a walk around the block a few times a week. As you get stronger, try to work up to exercising on most days of the week.

Eat well. While there is no special diet that helps with treatment-resistant depression, eating healthy is -- as always -- a good idea.Good nutrition can help you feel better physically, and sticking to a healthy eating plan can give you back a feeling of control.

"When people are depressed, there's often a tendency to go for comfort foods, which might not be especially nutritious," MacKinnon tells WebMD. So aim for the basics: more fruits and vegetables and fewer fatty foods and sweets.

Get a good night's sleep. When people are depressed, their sleep schedule often suffers. Some sleep excessively and can barely get out of bed. Others lie awake through the night, fretful and miserable.

If sleep is a problem for you, try to adopt some good habits, MacKinnon says. Establish a regular schedule for when you get up and when you go to bed and stick to it -- no matter how hard it might be at the outset. Keep naps brief or skip them altogether. If you can, try to make your bedroom a calming place -- and rid it of distractions like TVs. And check with your doctor about when you're supposed to be taking your medication; sometimes, shifting your dose to the morning from the evening will help with sleep, MacKinnon says.

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Don't rely on alcohol or other substances. Many people who have treatment-resistant depression also struggle with alcohol or drug abuse. While substances might seem to offer a temporary escape, they also make depression worse -- and they can prevent your medicines from working as well as they should. If you think you might have a problem, you need to get help.

Talk to a doctor about supplements. So far, the research is mixed on the effectiveness of supplements for treatment-resistant depression. There's some promising evidence that fish oil -- which is rich in omega-3 fatty acids -- might have some benefit. Some research has indicated that folic acid supplements might also help boost the effectiveness of antidepressants. A folate-based medicinal food which is available by prescription for people who haven't fully recovered with an antidepressant. In general, more research needs to be done into supplements for treatment-resistant depression. If you're interested in trying one, talk to your doctor first.

Try light therapy. Some people with treatment-resistant depression find that the changes in the seasons -- specifically the onset of winter -- can make them feel worse. So talk to your doctor about trying light therapy -- using a special lamp that provides artificial sunlight.

Treatment-Resistant Depression: Changing How You Think and Act

Stop assuming the worst. When you're depressed, you begin to see the world -- and yourself -- in the worst possible way. You might "catastrophize" -- you come to the most depressing and terrible interpretation of any given situation.

"When you're depressed for a long time, you learn to expect the worst out of life," MacKinnon says. Adjusting that negative outlook isn't easy. Some people find that even when the overt symptoms of depression have lifted, that distorted way of seeing things lingers on. It's like a bad habit, says MacKinnon, and it can be hard to break.

So what should you do? The first step, experts say, is to start paying more attention to your thoughts. Try to catch yourself when you're making those assumptions. Before you get carried away and leap to a conclusion, reason with yourself. Is there a less depressing -- and more likely -- interpretation?

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Have fun (even when it doesn't feel fun.) Friends and family might keep encouraging you to have some fun. But there's a problem: nothing feels fun anymore.

"When you're depressed, you might stop doing positive things because you don't have any faith they'll turn out well," MacKinnon says. "You don't go to the party because you know you'll have a bad time. You don't try anything new because you know that you'll fail."

MacKinnon says that your problem is simple: when it comes to fun, you're out of practice. And to recapture that feeling, you have to work at it. Start by doing the things that you used to enjoy, even if you're convinced you won't enjoy them now. In time, you might find that just by doing these things again, you'll regain the sense of pleasure you lost.

Reach out. Living with treatment-resistant depression, you might have isolated yourself from your friends and family. But you really do need their help to get through this. Even if it's hard -- even if you feel that they don't want to hear from you -- try to reconnect with people you care about.

"I really encourage people who are depressed to be around other people, to be engaged socially," says MacKinnon. "Sometimes it’s a necessary first step toward recovery."

You might feel overwhelmed at the prospect of seeing a friend and having to explain everything, of having to delve into the terrible things you've been feeling. But if you don't want to get into the subject, that's fine. Sometimes getting a break from thinking about treatment-resistant depression -- just having coffee with a friend and talking about something else -- is the best idea.

Join a support group. Depression is isolating. Even if your family members are sticking by you, and even if they're sympathetic and well-intentioned, they still might have trouble understanding what you feel. Joining a support group will get you in touch with people who will.

While you might know that adopting these suggestions could help, it might still seem too hard -- or even impossible -- to act on them right now.

But remember that just making an effort to change -- even if it's small and even if it's not completely successful -- is the real point. Modest changes to your life can still give you back a sense of control and accomplishment. In time, those minor victories will give you the confidence to make bigger changes.

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Lifestyle and Treatment-Resistant Depression

Unfortunately, when it comes to the benefits of lifestyle changes, many people with depression draw the wrong lesson. Rather than focusing on the potential they have to help themselves, they focus on a darker possibility.

"People with depression can start to feel like they're causing their illness," says Cook. "They blame themselves for not doing enough. They start to think that if only they ate better, or exercised more regularly, or meditated with enough dedication, they wouldn't be depressed."

But that's not the case, Cook says. Treatment-resistant depression is a real illness, and blaming yourself for it is a mistake. It's not something that can be conquered through force of will alone.

Instead, you should see lifestyle changes as another potential tool -- just like therapy and medication --that could help. Try a few out. If they help, that's great. If they don't, try something else. The point is to keep using different approaches -- whether types of medication, or types of therapy, or types of exercise -- until you find the approach that works for you.

Whatever you do, don't give up on treatment, MacKinnon says -- and don't let your doctor give up either. If your health care provider has run out of ideas for your treatment-resistant depression, get a referral to an expert.

"There's always a treatment for everybody with treatment-resistant depression," says MacKinnon. "Eventually, we find something that works."

WebMD Feature Reviewed by Brunilda Nazario, MD on April 29, 2011

Sources

SOURCES:

Ian A. Cook, MD, director, Depression Research Program, University of California, Los Angeles.

Dean F. MacKinnon, MD, associate professor, Johns Hopkins Hospital, Baltimore.

DBSA web site: "Understanding Hospitalization for Mental Health."

Leibenluft E. Am J Psychiatry, December 2008; vol 165: pp 1501-1504.

Matthew S.J. Depression and Anxiety, 2008; vol 25: pp 989-992.

National Sleep Foundation: "Depression and Sleep," "Sleep Hygiene."

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