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Understanding & Conquering Depression

Episode 34 Aug 23, 2021 1h 59m 16 insights
This episode, I explain what major depression is at the biological and psychological level and the various treatments that peer-reviewed studies have revealed can help prevent and treat depression. I explain the three major chemical systems that are altered in depression: norepinephrine, serotonin and dopamine. I discuss genetic predispositions to depression and how stress, thyroid hormone and cortisol play a role in many forms of depression. I also discuss inflammation as a common feature of many depression symptoms. I review 8 specific science-supported protocols for treating and avoiding depression, including EPA fatty acids (which have been shown to rival certain prescription treatments), how exercise protects against depression, studies of creatine, adjusting dopamine balance and more. I also discuss the results of ongoing clinical trials for ketamine and psilocybin for depression, how these compounds work and finally, I review how ketogenic diets can help in certain cases of depression, especially treatment-resistant major depression. Read the full show notes for this episode at hubermanlab.com.
Actionable Insights

1. Control Your Stress System

Learn to control your stress system to prevent short-term stress from escalating into medium or long-term stress, especially if you have a genetic predisposition to depression. This is crucial because stress is a major factor that can trigger depressive episodes and impacts mood-regulating neuromodulators.

2. Get Daily Sunlight & Sleep

Ensure you get sunlight in your eyes and achieve a good night’s sleep daily. These fundamental behaviors are vital for improving sleep quality and alleviating stress, both of which are critical for maintaining overall mood and well-being.

3. Increase EPA Omega-3 Intake

Increase your daily intake of EPA omega-3 fatty acids, aiming for 1000-2000 milligrams, through supplements or food sources. This helps reduce inflammation, which otherwise diverts tryptophan from serotonin production into a neurotoxic pathway, thereby relieving depressive symptoms.

4. Engage in Regular Exercise

Incorporate regular exercise, including aerobic and resistance training, into your routine. Exercise helps sequester kynurine (a neurotoxin derived from tryptophan under inflammation) into muscles, preventing its conversion into a pro-depressive substance and promoting serotonin production.

5. Ingest Fermented Foods Daily

Consume 2-4 servings of fermented foods daily or nearly daily. This practice is shown to keep the gut microbiome healthy and effectively offsets inflammatory cytokines, which are known to exacerbate depression by limiting serotonin production.

6. Avoid Overwhelming Pleasure Centers

Be cautious of any activities or substances that lead to very large, repeated increases in dopamine to avoid overwhelming your pleasure system. Over-pursuit of pleasure can tip the pleasure-pain balance, leading to less pleasure, increased craving, anhedonia, and depression.

7. Reset Pleasure-Pain Balance

To reset the pleasure-pain balance, intentionally enter states of boredom or mild anxiety. This allows the system to rebalance, enabling a healthier and more sustainable pursuit of pleasure without leading to addiction or anhedonia.

8. Deliberate Cold Exposure

Engage in deliberate cold exposure, such as cold showers. This activity reliably releases norepinephrine and epinephrine in the brain and body, which can help alleviate aspects of depression related to low norepinephrine levels and enhance mood.

9. Creatine Monohydrate Supplementation

Consider supplementing with 3-5 grams (up to 10 grams) of creatine monohydrate daily, after consulting with your healthcare provider. Creatine can increase mood and improve symptoms of major depression by enhancing the phosphocreatine system in the forebrain and modulating NMDA receptors.

10. Electrolyte Supplementation

Dissolve one packet of an electrolyte mix (e.g., Element) in 16-32 ounces of water and drink it first thing in the morning and during physical exercise. This ensures adequate hydration and electrolyte balance, which is critical for optimal brain and body function and performance.

11. All-in-One Nutritional Drink

Consider taking an all-in-one vitamin, mineral, and probiotic drink (e.g., Athletic Greens) once or twice a day. This helps cover basic nutritional needs, addresses potential deficiencies, and supports microbiome health, which is vital for mood regulation.

12. Utilize Meditation & NSDR

Use meditation apps (e.g., Waking Up) for various meditation programs, mindfulness training, yoga nidra, or non-sleep deep rest (NSDR) protocols. These practices can help place the brain and body into different states and restore cognitive and physical energy, even in short sessions.

13. Seek Professional Diagnosis

If you recognize symptoms of mood disorders in yourself or others, take note but seek accurate diagnosis from a qualified healthcare professional. Professional evaluation is essential for proper diagnosis and treatment, as self-diagnosis can be misleading.

14. Check Thyroid & Cortisol Levels

If experiencing symptoms related to postpartum depression, menstrual cycle fluctuations, or menopause, consult a doctor for a blood panel that includes measures of thyroid hormone and cortisol. Hormonal shifts can significantly impact susceptibility to or worsening of depression.

15. Ketogenic Diet for Refractory Depression

For individuals with major depression that is refractory (does not respond) to classical antidepressants, discuss the ketogenic diet with a psychiatrist. This diet can increase GABA transmission and modulate the GABA-glutamate balance, potentially providing relief for depressive symptoms.

16. 30-Day Detox for Overindulgence

If you feel the need to reset your pleasure system due to overindulgence in a particular activity or substance, undertake a 30-day complete detox from it. This helps rebalance the pleasure-pain pathway, especially when anhedonia or addiction has developed.