Ethereal Knight
Seja um bom soldado, morra onde você caiu.
- Jan 10, 2022
- 817
BACKGROUND
The lifestyle of the average person today is quite different than that of our ancestors. Those living before the 20th century did not have the luxury of many of the innovations we have today. People's days were active and spent outdoors, hunting, farming, building, and traveling. Communities were small and tightly knit. Sleep was more regular and diets were quite different (no McDonald's on every corner or 80 varieties of cereal at the grocery store).
Today, many of us feel the pressure of our fast-paced and demanding lives. We may work long hours, run from activity to activity, and be faced with a constant barrage of news and requests made possible by technological innovations (when was the last time you have not used a cell phone, TV, or computer for an entire day?). As a result, our diets have become filled with processed convenience food, our sleep is often shortened and disturbed, and we spend more time sitting at desks or on couches than being active outdoors. Additionally, in a culture that values independence and success over social connections, we have become increasingly isolated, living farther from family and having smaller groups to look to for social support.
While our lifestyles have changed dramatically over the last few centuries, the evolution of our bodies has not kept up. Our bodies were designed to live the lifestyle our ancestors lived, with a balanced diet, as well as plenty of exercise, sunlight, sleep, and social support. Dr. Ilardi developed the TLC approach based on increasing evidence of the mismatch between our modern environment and the environment our bodies were designed to live in. The elements of TLC can serve to combat this mismatch, thus helping to protect against a medley of mental and physical illnesses, including depression.
ELEMENTS
1) Omega 3 Fatty Acids Supplements
Omega-3 fatty acids come from naturally occurring plants and animals that eat them. These fatty acids have been shown to have antidepressant and anti-inflammatory properties, and studies indicate that they help serotonin and dopamine circuits in our brains function more efficiently. Our bodies cannot produce Omega-3 fatty acids, and our diets generally do not provide the optimal Omega-3 to Omega-6 ratio necessary for an antidepressant effects. Thus, we recommend that you supplement your diet with omega-3 fatty acids.
You can buy Omega-3 fatty acid supplements at a drugstore or health food store. We recommend brands that give you 1000 mg of EPA and 500 mg of DHA per day (this amount has been shown to decrease depressive symptoms and improve mood). This supplement can be taken by those on antidepressant medications, as there are no known interactions. In general, however, it is always recommended that you inform your doctor of any changes or additions to medications or supplements you take.
2) Anti-Rumination Strategies
In the ancestral environment, people had less time to sit alone and think negative thoughts. There were often activities to do, or other people around to serve as distractions. This is no longer the case, and many people in the modern environment may find they have plenty of opportunity to ruminate.
Rumination, a habit that many depressed people get into, is dwelling on negative thoughts and feelings. Rather than coming up with a solution to a problem and acting on it, people with depression often let their negative thoughts spiral out of control. It is important to recognize rumination for what it is and put a stop to it immediately. Rumination only makes peoples' moods worse. When you find yourself doing it, do one of these things: call a friend, exercise, write down the negative thoughts in a journal, or do some other pleasant activity (like knitting, reading, or another hobby).
3) Exercise
Exercise is one of the most beneficial, but most difficult elements of TLC. A cardinal symptom of depression is low energy, which makes exercise difficult. Initially, it takes a lot of energy to exercise, but once you begin, you'll find that you have increased energy, and subsequently, increased mood! In fact, several studies have found that exercise is about as effective, if not more effective, than most antidepressant medications.
We've found the most effective exercise schedule to get antidepressant effects is ~40 minutes of moderate-intensity physical aerobic activity, at least three times per week. Aerobic exercise is anything like running, walking fast, biking, or playing basketball, which gets your heart rate elevated to about 120-160 beats per minute. Anaerobic exercise (like yoga or weightlifting) is better than nothing, but the strongest antidepressant effects have been observed from aerobic exercise. Lots of people report that finding a regular exercise partner and routine helps them stay motivated.
4) Light Exposure
This element of TLC is most helpful to people who notice that there is a seasonal component to their depression. We recommend that people get at least 30 minutes of bright light exposure per day. You can actually go outside in the sun (take off the sunglasses!) or get light exposure from a special light box that emits the same amount of light (10,000 lux).
You should try to get light exposure at the same time every day. Some people like to sit by it while they eat breakfast and read the paper. Some like to sit by it while they read or study in the evening. Experiment to see what works best for you. And don't miss a day of light exposure if you can help it. This is something that will only work for you cumulatively if you are consistent!
5) Social Support
Our ancestors lived in small tight knit communities. Rarely did one do something alone, and community members looked to each other for entertainment, comfort, safety, and support.
You have probably noticed that as you or someone you love becomes more depressed, there is less motivation to seek out others for socializing. Evolutionarily, our brain may interpret depression as an illness. Just as we keep away from others when we have the flu (which gives us time to recover and keeps others from becoming infected), our natural inclination when depressed is to withdraw from our social networks. Unfortunately, this worsens depression.
Thus, it is important to lean on friends and family, not only to get needed social support, but also because spending time with others is a good way to distract yourself from rumination. Try to reconnect with loved ones from whom you've grown apart. Telling friends and family about your struggles with depression can help them better understand what you are going through. For family and friends that do not live nearby, utilize phone calls, email, or video chatting.
6) Sleep Hygiene
Many today see sleep as expendable. When there is extra work at the office, studying for finals, or just a late night TV show to watch while you unwind, it is easy to cut into valuable sleep time. Our ancestors did not have many of these distractions – when the sun went down, there may not have been much else to do but sleep.
While everyone varies in the amount of sleep they need, the average is approximately 8 hours of sleep per night. One of the biggest risk factors for depression is sleep deprivation. Thus, it is important to maintain a regular sleep schedule and protect that time for sleep that may be pushed aside when our lives become hectic.
To create a healthy sleep pattern, try to go to sleep and wake up at the same time each day. Prepare yourself for bed by having a "bedtime ritual". Dim the lights, turn off the TV and computer, put on your PJs, and do a quiet activity, like reading. Avoid caffeine and alcohol for several hours before you plan to go to bed.
RESEARCH
Sleep Hygiene
Sleep problems are a common theme among those suffering from depression. Increased insomnia has been associated with greater levels of depression (Taylor et. al, 2005). However, not only can sleep exacerbate certain depressive symptoms, such as rumination (Thomsen et. al, 2003), but it may also be a risk factor for developing future depressive episodes (Sadeh, 2012). Research suggests that sleep problems may lead to higher rates of relapse in people with recurrent depression and that sleep complaints may precede the series of symptoms that make up the syndrome of major depression (Perlis et. al, 1997).
An initial study by Ford and Kamerow (1989) suggests that individuals who resolve their sleep problems have a decreased risk for depression. As of 2011 the National Sleep Foundation recommends that those with depression should ensure treatment of sleep problems as well as depressive symptoms because alleviating sleep problems can accelerate the rate of recovery from depressive symptoms (Wiebe, Casoff & Gruber, 2012). Through treating the sleep problem, the risk for developing a future episode of depression may be reduced.
Additionally, many people who suffer from depression are on antidepressant medication. However, because of the strong relationship between sleep patterns and depression, those who are currently taking certain medications should be aware of possible side effects that may increase sleep problems. For example, selective serotonin reuptake inhibitors (SSRIs) may increase insomnia symptoms (National Sleep Foundation, 2011) which may inhibit the treatment process. Therefore, it is good to monitor sleep patterns after beginning a new medication (Wiebe et. al, 2012).
Social Support
Researchers have consistently found that social support is good for our minds and bodies. Poor social support is associated with an increased risk of morbidity and mortality across a wide variety of physical illnesses. In addition, lonely individuals have increased levels of stress hormones (Ozbay et al., 2007) and are more prone to poor mental health outcomes (Croezen et al., 2012) than are individuals with healthy social support systems. Specifically, lower levels of social support are significantly associated with increased symptoms of anxiety and depression (Grav et al., 2011). Not only does poor social support worsen depressive symptoms, it also puts one at an increased risk to relapse. High levels of social support have been found to protect against some of the negative outcomes of physical and mental illness. Spending time with positive others also decreases impairment that occurs as a result of depression and increases the likelihood of recovery (Ozbay et al., 2007).
Exercise
The antidepressant benefits of exercise have been well established. For example, one meta-analysis (Stathopoulou, Powers, Berry, Smiths, & Otto, 2006) consisting of 11 randomized controlled trials (RCTs) demonstrated a very large treatment effect for exercise over control conditions. The authors of another review of RCTs (Sjosten & Kivela, 2006) focusing on adults over 60 years of age concluded that exercise interventions may efficiently reduce depression or high levels of depressive symptoms, particularly in the short-term. Knubben et al. (2007) randomized moderately to severely depressed patients who were undergoing standard clinical antidepressant drug treatment to either a walking condition or a placebo stretching/relaxation condition. After 10 days, those in the walking condition had significantly greater reductions in their depression scores than those in the placebo group. Furthermore, more individuals in the walking group had a clinically meaningful response to treatment. Other RCTs comparing exercise to active and placebo treatments for depression have also been conducted with similar positive results (Blumenthal et al., 2007; Brenes et al., 2007). One interesting RCT by Legrand and Heuze (2007) compared the antidepressant effects of low frequency exercise to high frequency exercise and found that those randomized to the high frequency group reported lower depression scores than those randomized to the low frequency group, which suggests that the antidepressant properties of exercise may be dose-dependent.
Several studies have evaluated the effects of exercise on depressive symptoms against alternative treatments for depression, particularly psychotherapy and medication. Craft and Landers (1998) conducted a meta-analysis and found no differences between exercise and psychotherapy or other types of behavioral and pharmacological interventions. In another meta-analysis, exercise was found to be just as effective as cognitive therapy (Lawlor & Hopker, 2001). Response and remission rates with exercise are also comparable to psychological and drug treatments (Dunn, Trivedi, Kampert, & Clark; Blumenthal et al., 2007). Given that several research studies suggest that exercise is a viable treatment for depression, health professionals should consider promoting it to their depressed clientele.
Light Exposure
Prescribed to treat a host of conditions, light therapy (LT), or phototherapy, consists of exposure to daylight or artificial bright light for a determined period of time at a specific time of day. Early intervention research targeted seasonal affective disorder (SAD) with the first published study by Rosenthal and colleagues (1984). A meta-analysis by the American Psychiatric Association Committee on Research on Psychiatric Treatments (Golden et al., 2005), using strict criteria for only the most methodologically sound trials, concluded that LT is superior to placebo in reducing symptoms of seasonal affective disorder, with an effect size of 0.84. In fact, remission rates were found to be nearly three times higher (Odds Ratio of 2.9) among LT patients in comparison with those receiving placebo. Likewise, when limiting their evaluation to the most methodologically sound studies, Golden and colleagues found that LT was an effective stand-alone treatment for nonseasonal depression, with an effect size of 0.53. They also noted that this observed effect size is similar to that of most antidepressant medication trials.
A Cochrane meta-analysis (Tuunainen, Kripke, & Endo, 2004) examining the effect of LT on nonseasonal depression found that treatment response was significantly better in the LT group compared to the control treatment group (18 studies, 505 patients). This finding was mainly due to the significant benefit of short term treatment of seven days or less (12 studies, 367 patient). Medium term treatment did not show any significant superiority of bright light (6 studies, 138 patients). However, due to significant heterogeneity a more conservative statistical model was also employed and the study effects were no longer statistically significant.
Omega-3 Fatty Acid Supplements
Omega-3 is an essential fatty acid, a type of polyunsaturated fatty acid, and is naturally occurring in marine and plant oils. However, humans must acquire omega-3s through their diet and the Western diet is particularly rich in omega-6 fatty acids. A high ratio of omega-6 to omega-3 alters cell properties and increases production of inflammatory mediators. In contrast, omega-3 fatty acids are anti-inflammatory (Simopoulos, 2002). The link between omega-3 fatty acids and depression stems from numerous sources of etiological evidence. Particularly, studies of individuals with depression have found reduced Omega-3 levels (Edwards, Peet, Shay & Horrobin, 1998; Peet, Murphy, Shay, & Horrobin, 1998) and populations that consume higher levels of fish, a rich source of Omega-3s, have lower levels of depression (e.g., Timonen et al., 2004).
The empirical findings on treating depression with omega-3 supplementation have been mixed for numerous reasons. Often, lack of consistency between treatment length, type of omega-3 supplement, and sufficient control has led to incongruent outcomes. Meta-analytic review of omega-3 for depression has found that the therapeutic effect appears to come from omega-3s rich in eicosapentaenoic acid (EPA). Two meta-analyses have shown that Omega-3s comprised of at least 60% EPA show a significant therapeutic effect (Martins, 2009; Sublette, Ellis, Geant & Mann, 2011). However, ignoring the ratio of EPA leads to a fading of a therapeutic effect in meta-analysis (Bloch & Hannestad, 2011).
Anti-Rumination Strategies
The process of rumination, which involves dwelling on negative thoughts and feelings, has been recognized as a key characteristic of depression (Ingram, 1984). Rumination has been linked to many negative outcomes including longer and more severe depressive episodes and impaired motivation, concentration, and thinking (Lyubomirsky & Tkach, 2003). A connection has also been found between rumination and longer recovery time from coronary incidents (Fritz, 1999). A majority of the research investigating how to decrease rumination has studied behavioral activation treatments. Behavioral activation involves moving attention away from ruminative thoughts and toward active engagement with the environment (Dimidjian et al., 2006) and increasing participation in pleasant activities (Mazzucchelli, Kane & Rees, 2009).
Behavioral activation (BA) has been found to be as effective as antidepressant medication, and more effective than cognitive therapy, for reducing depressive symptoms (Dimidjian et al., 2006). BA was also shown to be just as effective as antidepressant medication or cognitive therapy in preventing depression relapse over a two-year follow-up period (Dobson et al., 2008). Individuals are less likely to drop out of BA treatment than cognitive therapy (Cuijpers et al., 2008), and BA has also been found to be effective for treating individuals who have not had success in cognitive therapy (Coffman, Martell, Dimidjian, Gallop, & Hollon, 2007). A recent meta-analysis on BA treatments for depression in adults reviewed 34 studies with 2,055 participants (Mazzucchelli, Kane & Rees, 2009). This meta-analysis found a large effect for BA compared to control groups, and there was no difference between BA and cognitive therapy. The authors of the meta-analysis conclude that BA be considered a "well-established and advantageous alternative to other treatments of depression."
TLC Poster Presentations
- Botanov, Y., Keil, K. M., Ilardi, S. S., Scheller, V. K., Sharp, K. L., & Williams, C. L. (2012).
Successful Treatment of Depression via Therapeutic Lifestyle Change: Preliminary Controlled-Trial Results. Poster presentation at the annual conference of the Association for Psychological Science, Chicago, IL.
- Jacobson, J. D., Kenneth, L. A., Stites, B. A., Karwoski, L., Stroupe, N. N., Steidtmann, D. K.,... Ilardi, S. S. (2007).Therapeutic Lifestyle Change for Depression: Results of a Randomized Controlled Trial. Poster presentation at the annual conference of the Association for Behavioral and Cognitive Therapies, Philadelphia, PA.
Modern hunter-gatherer humans. Their lifestyle is massively different from the sedentary, indoor, socially isolated, sleep-deprived, fast-food-laden, frenzied pace of the 21st.
Member of the Hadza tribe shooting an arrow.
Stephen Ilardi. He received his Ph.D. in clinical psychology from Duke University, and has spent the past two decades as an active researcher, university professor, and clinician. He has treated several hundred patients suffering from depressive illness and other serious disorders, and has authored over 40 scholarly articles and papers on mental illness.
Over the past six years, Dr. Ilardi and his clinical research team have developed and refined a new, highly effective program for clinical depression: Therapeutic Lifestyle Change (TLC). This innovative treatment is grounded in the insight that human beings were never designed for the sedentary, indoor, socially isolated, sleep-deprived, fast-food-laden, frenzied pace of 21st-century American life. Understanding the modern depression epidemic as the result of our increasingly toxic lifestyle, Dr. Ilardi has helped numerous depressed individuals overcome the debilitating illness by reclaiming six powerful healing habits from our ancestral past. Inspired by the program's success - even in cases of chronic, severe depression that failed to respond to antidepressant medication - Dr. Ilardi has written "The Depression Cure," a step-by-step guide to the Therapeutic Lifestyle Change program.
He also did a TEDtalk:
This talk:
And this interview:
The majority of the info from this thread has been collected from TLC's official website: https://tlc.ku.edu/
Conflicts of interest: I'm not earning any type of money or benefits from divulging Dr. Ilardi's work or the TLC program. I'm only divulging it because I think a lot of people may benefit from it. No conflicts of interest.
I'm not affiliated to Stephen Ilardi or the TLC program in any way. Opinions expressed here don't necessarily represent Dr. Ilardi's thoughts.
Moderators: I attached the book's PDF below; if any of you can tell me if it's against the rules to post piracy, I can remove it, as people can find it on torrent websites anyway (consider buying the book if it benefited you).
Although this thread has some info on the TLC program, obviously the book is way more detail-rich.
I'm obviously not against the use of medication. Use if you benefit from it and talk to your doctor, but know what you're doing.
Long-term abuse (!) of antidepressants depletes B-vitamins, CoQ10, magnesium-induced vitamin D conversion and decreases serotonin levels. The impairment of neurotransmitter balance causes a life-long dependency on the medication because it promotes the severity of depression without the drug.
In addition, the recovery process from SSRIs (selective serotonin reuptake inhibitors) is long and painful.
They can also cause permanent sexual damage (PSSD - post-SSRI sexual dysfunction).
One comment about the difficulty of changing lifestyle:
Yes, I know lifestyle changes can be unconfortable (and hard). Change in general is tough. I never said it was easy. However, it's like Lisa Feldman Barret says: "The most expensive tasks that brains do are (1) moving your body and (2) learning something new. They have a metabolic cost that may feel unpleasant. So, feeling bad doesn't always mean that something bad happened. You might just be doing something really hard." and Andrew Huberman completes: "The brain, spinal cord and peripheral nervous system can change in response to experience — a process we call neural plasticity or neuroplasticity. In general nervous systems are shaped by mere experience in our early stages of life and until about age 25 (in humans) although that is not a strict cut off. After age 25 neuroplasticity is still possible but requires intense focus followed by periods of deep rest which could be comprised of deep sleep, naps or their combination. Long bouts of sleep (~5-8+ hours) are when most rewiring of neural connections occurs (a.k.a. neuroplasticity). As this quote from Dr. Lisa Feldman Barrett points out, triggering neural plasticity can sometimes be an unpleasant experience even if the thing we are learning is something we want to engage in. This is important to keep in mind when you experience agitation, frustration, and confusion when trying to learn something. Those feelings are actually reflective of the neuroplasticity process."
Change is possible. I encourage everyone to have faith, be optimistic, positive and do the hard work.
If you have any thoughts, please share in the comment below.
I wish everyone a happy day, with a lot of optimism, joy and positivity. And of course rich social connections, engaging-meaningful-outdoor activities, sunlight, natural nutrient-dense foods, exercise, movement and high-quality sleep. Thank you for reading.
The lifestyle of the average person today is quite different than that of our ancestors. Those living before the 20th century did not have the luxury of many of the innovations we have today. People's days were active and spent outdoors, hunting, farming, building, and traveling. Communities were small and tightly knit. Sleep was more regular and diets were quite different (no McDonald's on every corner or 80 varieties of cereal at the grocery store).
Today, many of us feel the pressure of our fast-paced and demanding lives. We may work long hours, run from activity to activity, and be faced with a constant barrage of news and requests made possible by technological innovations (when was the last time you have not used a cell phone, TV, or computer for an entire day?). As a result, our diets have become filled with processed convenience food, our sleep is often shortened and disturbed, and we spend more time sitting at desks or on couches than being active outdoors. Additionally, in a culture that values independence and success over social connections, we have become increasingly isolated, living farther from family and having smaller groups to look to for social support.
While our lifestyles have changed dramatically over the last few centuries, the evolution of our bodies has not kept up. Our bodies were designed to live the lifestyle our ancestors lived, with a balanced diet, as well as plenty of exercise, sunlight, sleep, and social support. Dr. Ilardi developed the TLC approach based on increasing evidence of the mismatch between our modern environment and the environment our bodies were designed to live in. The elements of TLC can serve to combat this mismatch, thus helping to protect against a medley of mental and physical illnesses, including depression.
Sobre el programa TLC
El estilo de vida de la persona promedio es muy diferente al de nuestros ancestros. Aquellos que vivieron antes del siglo 20 no tuvieron acceso a muchas de las innovaciones que tenemos hoy día. En ese tiempo, las personas eran activas y pasaban tiempo al aire libre cazando, cultivando, construyendo, y viajando. Las comunidades eran pequeñas y cercanas. El sueño era más constante, y la dieta era muy diferente (no había un McDonalds en cada esquina u 80 variedades de cereal en el supermercado).
Hoy en día, muchos de nosotros sentimos la presión de un estilo de vida exigente y estresante. Trabajamos durante muchas horas, vamos de actividad a actividad, y enfrentamos responsabilidades constantes, gracias a las nuevas tecnologías (cuando fue la última vez que no usó un teléfono, televisor, o computador en un día entero)? Es por esto que nuestras dietas se han llenado de comidas procesadas, nuestro sueño se ha acortado, y pasamos más tiempo sentados en un escritorio o en un sofá que siendo activos al aire libre. Además, en esta cultura independiente y enfocada en el éxito por encima de las conexiones sociales, nos hemos vuelto más y más aislados, viviendo más lejos de nuestras familias, y teniendo menos seres queridos en quienes contar.
Aunque nuestro estilo de vida ha cambiado drásticamente en los últimos siglos, la evolución de nuestros cuerpos no ha hecho lo mismo. Nuestros cuerpos fueron diseñados para el estilo de vida de nuestros ancestros, quienes disfrutaban de una dieta saludable y balanceada, además de ejercicio diario, exposición a la luz del sol, sueño reparador, y apoyo social. El doctor Ilardi desarrolló el programa de estilo de vida saludable (TLC por sus siglas en inglés) basándose en evidencia científica demuestra la discordancia entre nuestro entorno moderno y el entorno para el que nuestros cuerpos fueron diseñados. Los elementos del programa TLC pueden ayudar a combatir esta discordancia, ayudándonos a protegernos contra una gran variedad de enfermedades, incluyendo la depresión.
El estilo de vida de la persona promedio es muy diferente al de nuestros ancestros. Aquellos que vivieron antes del siglo 20 no tuvieron acceso a muchas de las innovaciones que tenemos hoy día. En ese tiempo, las personas eran activas y pasaban tiempo al aire libre cazando, cultivando, construyendo, y viajando. Las comunidades eran pequeñas y cercanas. El sueño era más constante, y la dieta era muy diferente (no había un McDonalds en cada esquina u 80 variedades de cereal en el supermercado).
Hoy en día, muchos de nosotros sentimos la presión de un estilo de vida exigente y estresante. Trabajamos durante muchas horas, vamos de actividad a actividad, y enfrentamos responsabilidades constantes, gracias a las nuevas tecnologías (cuando fue la última vez que no usó un teléfono, televisor, o computador en un día entero)? Es por esto que nuestras dietas se han llenado de comidas procesadas, nuestro sueño se ha acortado, y pasamos más tiempo sentados en un escritorio o en un sofá que siendo activos al aire libre. Además, en esta cultura independiente y enfocada en el éxito por encima de las conexiones sociales, nos hemos vuelto más y más aislados, viviendo más lejos de nuestras familias, y teniendo menos seres queridos en quienes contar.
Aunque nuestro estilo de vida ha cambiado drásticamente en los últimos siglos, la evolución de nuestros cuerpos no ha hecho lo mismo. Nuestros cuerpos fueron diseñados para el estilo de vida de nuestros ancestros, quienes disfrutaban de una dieta saludable y balanceada, además de ejercicio diario, exposición a la luz del sol, sueño reparador, y apoyo social. El doctor Ilardi desarrolló el programa de estilo de vida saludable (TLC por sus siglas en inglés) basándose en evidencia científica demuestra la discordancia entre nuestro entorno moderno y el entorno para el que nuestros cuerpos fueron diseñados. Los elementos del programa TLC pueden ayudar a combatir esta discordancia, ayudándonos a protegernos contra una gran variedad de enfermedades, incluyendo la depresión.
ELEMENTS
1) Omega 3 Fatty Acids Supplements
Omega-3 fatty acids come from naturally occurring plants and animals that eat them. These fatty acids have been shown to have antidepressant and anti-inflammatory properties, and studies indicate that they help serotonin and dopamine circuits in our brains function more efficiently. Our bodies cannot produce Omega-3 fatty acids, and our diets generally do not provide the optimal Omega-3 to Omega-6 ratio necessary for an antidepressant effects. Thus, we recommend that you supplement your diet with omega-3 fatty acids.
You can buy Omega-3 fatty acid supplements at a drugstore or health food store. We recommend brands that give you 1000 mg of EPA and 500 mg of DHA per day (this amount has been shown to decrease depressive symptoms and improve mood). This supplement can be taken by those on antidepressant medications, as there are no known interactions. In general, however, it is always recommended that you inform your doctor of any changes or additions to medications or supplements you take.
2) Anti-Rumination Strategies
In the ancestral environment, people had less time to sit alone and think negative thoughts. There were often activities to do, or other people around to serve as distractions. This is no longer the case, and many people in the modern environment may find they have plenty of opportunity to ruminate.
Rumination, a habit that many depressed people get into, is dwelling on negative thoughts and feelings. Rather than coming up with a solution to a problem and acting on it, people with depression often let their negative thoughts spiral out of control. It is important to recognize rumination for what it is and put a stop to it immediately. Rumination only makes peoples' moods worse. When you find yourself doing it, do one of these things: call a friend, exercise, write down the negative thoughts in a journal, or do some other pleasant activity (like knitting, reading, or another hobby).
3) Exercise
Exercise is one of the most beneficial, but most difficult elements of TLC. A cardinal symptom of depression is low energy, which makes exercise difficult. Initially, it takes a lot of energy to exercise, but once you begin, you'll find that you have increased energy, and subsequently, increased mood! In fact, several studies have found that exercise is about as effective, if not more effective, than most antidepressant medications.
We've found the most effective exercise schedule to get antidepressant effects is ~40 minutes of moderate-intensity physical aerobic activity, at least three times per week. Aerobic exercise is anything like running, walking fast, biking, or playing basketball, which gets your heart rate elevated to about 120-160 beats per minute. Anaerobic exercise (like yoga or weightlifting) is better than nothing, but the strongest antidepressant effects have been observed from aerobic exercise. Lots of people report that finding a regular exercise partner and routine helps them stay motivated.
4) Light Exposure
This element of TLC is most helpful to people who notice that there is a seasonal component to their depression. We recommend that people get at least 30 minutes of bright light exposure per day. You can actually go outside in the sun (take off the sunglasses!) or get light exposure from a special light box that emits the same amount of light (10,000 lux).
You should try to get light exposure at the same time every day. Some people like to sit by it while they eat breakfast and read the paper. Some like to sit by it while they read or study in the evening. Experiment to see what works best for you. And don't miss a day of light exposure if you can help it. This is something that will only work for you cumulatively if you are consistent!
5) Social Support
Our ancestors lived in small tight knit communities. Rarely did one do something alone, and community members looked to each other for entertainment, comfort, safety, and support.
You have probably noticed that as you or someone you love becomes more depressed, there is less motivation to seek out others for socializing. Evolutionarily, our brain may interpret depression as an illness. Just as we keep away from others when we have the flu (which gives us time to recover and keeps others from becoming infected), our natural inclination when depressed is to withdraw from our social networks. Unfortunately, this worsens depression.
Thus, it is important to lean on friends and family, not only to get needed social support, but also because spending time with others is a good way to distract yourself from rumination. Try to reconnect with loved ones from whom you've grown apart. Telling friends and family about your struggles with depression can help them better understand what you are going through. For family and friends that do not live nearby, utilize phone calls, email, or video chatting.
6) Sleep Hygiene
Many today see sleep as expendable. When there is extra work at the office, studying for finals, or just a late night TV show to watch while you unwind, it is easy to cut into valuable sleep time. Our ancestors did not have many of these distractions – when the sun went down, there may not have been much else to do but sleep.
While everyone varies in the amount of sleep they need, the average is approximately 8 hours of sleep per night. One of the biggest risk factors for depression is sleep deprivation. Thus, it is important to maintain a regular sleep schedule and protect that time for sleep that may be pushed aside when our lives become hectic.
To create a healthy sleep pattern, try to go to sleep and wake up at the same time each day. Prepare yourself for bed by having a "bedtime ritual". Dim the lights, turn off the TV and computer, put on your PJs, and do a quiet activity, like reading. Avoid caffeine and alcohol for several hours before you plan to go to bed.
RESEARCH
Sleep Hygiene
Sleep problems are a common theme among those suffering from depression. Increased insomnia has been associated with greater levels of depression (Taylor et. al, 2005). However, not only can sleep exacerbate certain depressive symptoms, such as rumination (Thomsen et. al, 2003), but it may also be a risk factor for developing future depressive episodes (Sadeh, 2012). Research suggests that sleep problems may lead to higher rates of relapse in people with recurrent depression and that sleep complaints may precede the series of symptoms that make up the syndrome of major depression (Perlis et. al, 1997).
An initial study by Ford and Kamerow (1989) suggests that individuals who resolve their sleep problems have a decreased risk for depression. As of 2011 the National Sleep Foundation recommends that those with depression should ensure treatment of sleep problems as well as depressive symptoms because alleviating sleep problems can accelerate the rate of recovery from depressive symptoms (Wiebe, Casoff & Gruber, 2012). Through treating the sleep problem, the risk for developing a future episode of depression may be reduced.
Additionally, many people who suffer from depression are on antidepressant medication. However, because of the strong relationship between sleep patterns and depression, those who are currently taking certain medications should be aware of possible side effects that may increase sleep problems. For example, selective serotonin reuptake inhibitors (SSRIs) may increase insomnia symptoms (National Sleep Foundation, 2011) which may inhibit the treatment process. Therefore, it is good to monitor sleep patterns after beginning a new medication (Wiebe et. al, 2012).
Social Support
Researchers have consistently found that social support is good for our minds and bodies. Poor social support is associated with an increased risk of morbidity and mortality across a wide variety of physical illnesses. In addition, lonely individuals have increased levels of stress hormones (Ozbay et al., 2007) and are more prone to poor mental health outcomes (Croezen et al., 2012) than are individuals with healthy social support systems. Specifically, lower levels of social support are significantly associated with increased symptoms of anxiety and depression (Grav et al., 2011). Not only does poor social support worsen depressive symptoms, it also puts one at an increased risk to relapse. High levels of social support have been found to protect against some of the negative outcomes of physical and mental illness. Spending time with positive others also decreases impairment that occurs as a result of depression and increases the likelihood of recovery (Ozbay et al., 2007).
Exercise
The antidepressant benefits of exercise have been well established. For example, one meta-analysis (Stathopoulou, Powers, Berry, Smiths, & Otto, 2006) consisting of 11 randomized controlled trials (RCTs) demonstrated a very large treatment effect for exercise over control conditions. The authors of another review of RCTs (Sjosten & Kivela, 2006) focusing on adults over 60 years of age concluded that exercise interventions may efficiently reduce depression or high levels of depressive symptoms, particularly in the short-term. Knubben et al. (2007) randomized moderately to severely depressed patients who were undergoing standard clinical antidepressant drug treatment to either a walking condition or a placebo stretching/relaxation condition. After 10 days, those in the walking condition had significantly greater reductions in their depression scores than those in the placebo group. Furthermore, more individuals in the walking group had a clinically meaningful response to treatment. Other RCTs comparing exercise to active and placebo treatments for depression have also been conducted with similar positive results (Blumenthal et al., 2007; Brenes et al., 2007). One interesting RCT by Legrand and Heuze (2007) compared the antidepressant effects of low frequency exercise to high frequency exercise and found that those randomized to the high frequency group reported lower depression scores than those randomized to the low frequency group, which suggests that the antidepressant properties of exercise may be dose-dependent.
Several studies have evaluated the effects of exercise on depressive symptoms against alternative treatments for depression, particularly psychotherapy and medication. Craft and Landers (1998) conducted a meta-analysis and found no differences between exercise and psychotherapy or other types of behavioral and pharmacological interventions. In another meta-analysis, exercise was found to be just as effective as cognitive therapy (Lawlor & Hopker, 2001). Response and remission rates with exercise are also comparable to psychological and drug treatments (Dunn, Trivedi, Kampert, & Clark; Blumenthal et al., 2007). Given that several research studies suggest that exercise is a viable treatment for depression, health professionals should consider promoting it to their depressed clientele.
Light Exposure
Prescribed to treat a host of conditions, light therapy (LT), or phototherapy, consists of exposure to daylight or artificial bright light for a determined period of time at a specific time of day. Early intervention research targeted seasonal affective disorder (SAD) with the first published study by Rosenthal and colleagues (1984). A meta-analysis by the American Psychiatric Association Committee on Research on Psychiatric Treatments (Golden et al., 2005), using strict criteria for only the most methodologically sound trials, concluded that LT is superior to placebo in reducing symptoms of seasonal affective disorder, with an effect size of 0.84. In fact, remission rates were found to be nearly three times higher (Odds Ratio of 2.9) among LT patients in comparison with those receiving placebo. Likewise, when limiting their evaluation to the most methodologically sound studies, Golden and colleagues found that LT was an effective stand-alone treatment for nonseasonal depression, with an effect size of 0.53. They also noted that this observed effect size is similar to that of most antidepressant medication trials.
A Cochrane meta-analysis (Tuunainen, Kripke, & Endo, 2004) examining the effect of LT on nonseasonal depression found that treatment response was significantly better in the LT group compared to the control treatment group (18 studies, 505 patients). This finding was mainly due to the significant benefit of short term treatment of seven days or less (12 studies, 367 patient). Medium term treatment did not show any significant superiority of bright light (6 studies, 138 patients). However, due to significant heterogeneity a more conservative statistical model was also employed and the study effects were no longer statistically significant.
Omega-3 Fatty Acid Supplements
Omega-3 is an essential fatty acid, a type of polyunsaturated fatty acid, and is naturally occurring in marine and plant oils. However, humans must acquire omega-3s through their diet and the Western diet is particularly rich in omega-6 fatty acids. A high ratio of omega-6 to omega-3 alters cell properties and increases production of inflammatory mediators. In contrast, omega-3 fatty acids are anti-inflammatory (Simopoulos, 2002). The link between omega-3 fatty acids and depression stems from numerous sources of etiological evidence. Particularly, studies of individuals with depression have found reduced Omega-3 levels (Edwards, Peet, Shay & Horrobin, 1998; Peet, Murphy, Shay, & Horrobin, 1998) and populations that consume higher levels of fish, a rich source of Omega-3s, have lower levels of depression (e.g., Timonen et al., 2004).
The empirical findings on treating depression with omega-3 supplementation have been mixed for numerous reasons. Often, lack of consistency between treatment length, type of omega-3 supplement, and sufficient control has led to incongruent outcomes. Meta-analytic review of omega-3 for depression has found that the therapeutic effect appears to come from omega-3s rich in eicosapentaenoic acid (EPA). Two meta-analyses have shown that Omega-3s comprised of at least 60% EPA show a significant therapeutic effect (Martins, 2009; Sublette, Ellis, Geant & Mann, 2011). However, ignoring the ratio of EPA leads to a fading of a therapeutic effect in meta-analysis (Bloch & Hannestad, 2011).
Anti-Rumination Strategies
The process of rumination, which involves dwelling on negative thoughts and feelings, has been recognized as a key characteristic of depression (Ingram, 1984). Rumination has been linked to many negative outcomes including longer and more severe depressive episodes and impaired motivation, concentration, and thinking (Lyubomirsky & Tkach, 2003). A connection has also been found between rumination and longer recovery time from coronary incidents (Fritz, 1999). A majority of the research investigating how to decrease rumination has studied behavioral activation treatments. Behavioral activation involves moving attention away from ruminative thoughts and toward active engagement with the environment (Dimidjian et al., 2006) and increasing participation in pleasant activities (Mazzucchelli, Kane & Rees, 2009).
Behavioral activation (BA) has been found to be as effective as antidepressant medication, and more effective than cognitive therapy, for reducing depressive symptoms (Dimidjian et al., 2006). BA was also shown to be just as effective as antidepressant medication or cognitive therapy in preventing depression relapse over a two-year follow-up period (Dobson et al., 2008). Individuals are less likely to drop out of BA treatment than cognitive therapy (Cuijpers et al., 2008), and BA has also been found to be effective for treating individuals who have not had success in cognitive therapy (Coffman, Martell, Dimidjian, Gallop, & Hollon, 2007). A recent meta-analysis on BA treatments for depression in adults reviewed 34 studies with 2,055 participants (Mazzucchelli, Kane & Rees, 2009). This meta-analysis found a large effect for BA compared to control groups, and there was no difference between BA and cognitive therapy. The authors of the meta-analysis conclude that BA be considered a "well-established and advantageous alternative to other treatments of depression."
TLC Poster Presentations
- Botanov, Y., Keil, K. M., Ilardi, S. S., Scheller, V. K., Sharp, K. L., & Williams, C. L. (2012).
Successful Treatment of Depression via Therapeutic Lifestyle Change: Preliminary Controlled-Trial Results. Poster presentation at the annual conference of the Association for Psychological Science, Chicago, IL.
- Jacobson, J. D., Kenneth, L. A., Stites, B. A., Karwoski, L., Stroupe, N. N., Steidtmann, D. K.,... Ilardi, S. S. (2007).Therapeutic Lifestyle Change for Depression: Results of a Randomized Controlled Trial. Poster presentation at the annual conference of the Association for Behavioral and Cognitive Therapies, Philadelphia, PA.
Modern hunter-gatherer humans. Their lifestyle is massively different from the sedentary, indoor, socially isolated, sleep-deprived, fast-food-laden, frenzied pace of the 21st.
Member of the Hadza tribe shooting an arrow.
Stephen Ilardi. He received his Ph.D. in clinical psychology from Duke University, and has spent the past two decades as an active researcher, university professor, and clinician. He has treated several hundred patients suffering from depressive illness and other serious disorders, and has authored over 40 scholarly articles and papers on mental illness.
Over the past six years, Dr. Ilardi and his clinical research team have developed and refined a new, highly effective program for clinical depression: Therapeutic Lifestyle Change (TLC). This innovative treatment is grounded in the insight that human beings were never designed for the sedentary, indoor, socially isolated, sleep-deprived, fast-food-laden, frenzied pace of 21st-century American life. Understanding the modern depression epidemic as the result of our increasingly toxic lifestyle, Dr. Ilardi has helped numerous depressed individuals overcome the debilitating illness by reclaiming six powerful healing habits from our ancestral past. Inspired by the program's success - even in cases of chronic, severe depression that failed to respond to antidepressant medication - Dr. Ilardi has written "The Depression Cure," a step-by-step guide to the Therapeutic Lifestyle Change program.
He also did a TEDtalk:
This talk:
And this interview:
This book is based on the highly effective, proven Therapeutic Lifestyle Change (TLC) program: a practical plan for natural ways to treat depression -- without medication
In the past decade, depression rates have skyrocketed, and one in four Americans suffer from major depression at some point in their lives. Where have we gone wrong? Dr. Stephen Ilardi sheds light on our current predicament and reminds us that our bodies were never designed for the sleep-deprived, poorly nourished, frenzied pace of twenty-first century life. Inspired by the extraordinary resilience of aboriginal groups like the Kaluli of Papua New Guinea, Dr. Ilardi prescribes an easy-to-follow, clinically proven program that harks back to what our bodies were originally made for and what they continue to need with these six components:
- Brain Food
- Don't Think, Do (Anti-Rumination Strategies)
- Antidepressant Exercise
- Let There Be Light
- Get Connected (Social Life)
- Habits of Healthy Sleep
The Depression Cure's holistic approach has been met with great success rates, helping even those who have failed to respond to traditional medications. For anyone looking to supplement their treatment, The Depression Cure offers hope and a practical path to wellness for anyone.
In the past decade, depression rates have skyrocketed, and one in four Americans suffer from major depression at some point in their lives. Where have we gone wrong? Dr. Stephen Ilardi sheds light on our current predicament and reminds us that our bodies were never designed for the sleep-deprived, poorly nourished, frenzied pace of twenty-first century life. Inspired by the extraordinary resilience of aboriginal groups like the Kaluli of Papua New Guinea, Dr. Ilardi prescribes an easy-to-follow, clinically proven program that harks back to what our bodies were originally made for and what they continue to need with these six components:
- Brain Food
- Don't Think, Do (Anti-Rumination Strategies)
- Antidepressant Exercise
- Let There Be Light
- Get Connected (Social Life)
- Habits of Healthy Sleep
The Depression Cure's holistic approach has been met with great success rates, helping even those who have failed to respond to traditional medications. For anyone looking to supplement their treatment, The Depression Cure offers hope and a practical path to wellness for anyone.
The majority of the info from this thread has been collected from TLC's official website: https://tlc.ku.edu/
Conflicts of interest: I'm not earning any type of money or benefits from divulging Dr. Ilardi's work or the TLC program. I'm only divulging it because I think a lot of people may benefit from it. No conflicts of interest.
I'm not affiliated to Stephen Ilardi or the TLC program in any way. Opinions expressed here don't necessarily represent Dr. Ilardi's thoughts.
Moderators: I attached the book's PDF below; if any of you can tell me if it's against the rules to post piracy, I can remove it, as people can find it on torrent websites anyway (consider buying the book if it benefited you).
Although this thread has some info on the TLC program, obviously the book is way more detail-rich.
I'm obviously not against the use of medication. Use if you benefit from it and talk to your doctor, but know what you're doing.
Long-term abuse (!) of antidepressants depletes B-vitamins, CoQ10, magnesium-induced vitamin D conversion and decreases serotonin levels. The impairment of neurotransmitter balance causes a life-long dependency on the medication because it promotes the severity of depression without the drug.
In addition, the recovery process from SSRIs (selective serotonin reuptake inhibitors) is long and painful.
They can also cause permanent sexual damage (PSSD - post-SSRI sexual dysfunction).
One comment about the difficulty of changing lifestyle:
Yes, I know lifestyle changes can be unconfortable (and hard). Change in general is tough. I never said it was easy. However, it's like Lisa Feldman Barret says: "The most expensive tasks that brains do are (1) moving your body and (2) learning something new. They have a metabolic cost that may feel unpleasant. So, feeling bad doesn't always mean that something bad happened. You might just be doing something really hard." and Andrew Huberman completes: "The brain, spinal cord and peripheral nervous system can change in response to experience — a process we call neural plasticity or neuroplasticity. In general nervous systems are shaped by mere experience in our early stages of life and until about age 25 (in humans) although that is not a strict cut off. After age 25 neuroplasticity is still possible but requires intense focus followed by periods of deep rest which could be comprised of deep sleep, naps or their combination. Long bouts of sleep (~5-8+ hours) are when most rewiring of neural connections occurs (a.k.a. neuroplasticity). As this quote from Dr. Lisa Feldman Barrett points out, triggering neural plasticity can sometimes be an unpleasant experience even if the thing we are learning is something we want to engage in. This is important to keep in mind when you experience agitation, frustration, and confusion when trying to learn something. Those feelings are actually reflective of the neuroplasticity process."
[email protected]
785-864-4274
Department of Psychology
334 Fraser Hall
1415 Jayhawk Blvd.
University of Kansas
Lawrence, KS 66045-7556
785-864-4274
Department of Psychology
334 Fraser Hall
1415 Jayhawk Blvd.
University of Kansas
Lawrence, KS 66045-7556
Change is possible. I encourage everyone to have faith, be optimistic, positive and do the hard work.
If you have any thoughts, please share in the comment below.
I wish everyone a happy day, with a lot of optimism, joy and positivity. And of course rich social connections, engaging-meaningful-outdoor activities, sunlight, natural nutrient-dense foods, exercise, movement and high-quality sleep. Thank you for reading.
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