Most patterns of behavior and negative reactions that trigger bouts of depression are usually deeply engrained — and hidden — and take professional help to dissolve them. We always recommend that our patients talk about their emotional issues and combine any physical treatment with counseling. We’ve found Gestalt-type therapy to be especially effective in connecting your current emotional state to past experience and thereby getting at a fundamental cure. So much depends on the skill of the therapist, so we recommend you keep looking until you find a therapy and therapist that are effective for you.

It is important to be clear about one thing. If you have major depression, you need to stay on your antidepressants. We are not recommending that anyone with this diagnosis quit their medication cold turkey (some patients have severe reactions when they get off SSRI’s too quickly). However, we want every person who is on or thinking about taking an antidepressant to know what her choices are. Depression includes a range of normal negative emotions. But clinical depression differs significantly from minor or situational depression or mood disorders, even though the symptoms can be the same. The difference is that in mild depression the symptoms ebb and flow and eventually lift, while in major depression they spiral down into a full-blown, entrenched mental health crisis. Most forms of depression are characterized by overwhelming, persistent feelings of grief, anxiety, guilt or despair; a sense of numbness or hollowness; and a loss of interest or pleasure in activities that were once enjoyed, including sex. Dullness, decreased energy, difficulty concentrating or making decisions, and disrupted sleep patterns are also symptoms, as well as overeating and weight gain, or loss of appetite and weight loss. Suicidal thoughts or attempts and obsessing about death are serious warning signs that need to be addressed immediately.

If you’ve been feeling any of these symptoms consistently for over a month, you should immediately seek out medical advice, preferably from a trained psychiatrist, psychologist, or social worker.

Chronic physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and pain can be an indication of depression, but may be symptoms of an underlying physical condition that warrants further testing. Before taking antidepressants you should get a second opinion. Integrative medical practices (those that combine alternative and conventional medicine) are very successful at finding the true source of mysterious ailments. (For more information see our article on how to make alternative medicine work for you.)

The social stigma of depression.

If you think you may have minor depression, you’re in good company! Everyone has normal, sometimes extended bouts of melancholy or grief, particularly after a trauma or loss. But pain and anguish aren’t often talked about. Our culture doesn’t like “downers,” so many of us put on a brave face and perhaps wonder why we can’t be happy like everyone else.

The truth is that sadness and grief are normal, and psychotropic drugs may interfere with our grieving or mental processing. Before going to the pharmacy, think about the possible reasons why you’re feeling blue. In many cases, you have good reason: death, health crises, financial woes, divorce, break-ups, moves, and other big transitions are common causes of situational depression. Even joyful events like weddings and births can bring on depression by resurfacing unresolved emotional experiences from your past. Minor depression may stem from individual physical stresses such as jet lag, poor nutrition, illness, insomnia, low carbohydrate levels, carbohydrate addiction (more on that below), hormone imbalance, yeast or wheat sensitivity, allergies, and environmental pollutants. Many suffer from a downward cycle of poor health that creates life problems that in turn are depressing.

Then there’s the cast of well documented subcategories of depression that affect millions of people, such as post partum depression (PPD), post traumatic stress syndrome (PTSD), and seasonal affective disorder (SAD). They can be devastating while they last, making doctors quick to prescribe pharmacological solutions. Sometimes medications are needed and can be a useful bridge back to wellness, but it’s important to know that there are other, more natural options that work quickly, too.

And of course, there are those emotional issues we all grow up with. Sometimes we’re blissfully unaware of them until we run smack into them. I know a person who at 47 had a sudden nervous breakdown. For a year she hid in her house, cried all the time, and stopped caring for her children. Today she’d be on antidepressants in a heartbeat. While they might have helped her get out of the house and to the therapist’s office (a good thing for sure), they would not have identified or resolved her underlying emotional issue: Her father had died tragically when he was 46. By outliving him, she fell unwittingly into a deep well of unconscious guilt and grief. With time she was able to work that through and her depression resolved.

The good news is that most forms of mild to moderate depression will respond very well to positive changes in diet, exercise and lifestyle habits and nutrient support. Why? The key is the connection between serotonin and cortisol levels, which are directly influenced by diet and stress.

Serotonin, melatonin, cortisol, and depression

While all of your neurotransmitters are important, serotonin is the star when it comes to your mood. When your serotonin receptors are in sync, you feel good: you sleep and eat well, and you awake refreshed and energized. Contrast this to an abnormal serotonin state in which you suffer all the symptoms of depression.

Serotonin is synthesized in the brain and the digestive tract, which is also the source of its precursors. This is yet another reason why what you eat and how well you digest are crucial to how you feel! L–tryptophan, an essential amino acid found in food and supplements, is converted in your body into 5–hydroxytryptophan (5–HTP), and then into 5–hydroxytryptamine ( 5–HT), which is the chemical name for serotonin.

Importantly, serotonin is the “parent” for the hormone melatonin, which regulates our circadian rhythm, or sleep cycles. If you have insufficient serotonin, your melatonin levels become imbalanced and your sleep gets disrupted. This can be a downward spiral, leading to further disruption of serotonin function.

Sudden changes in serotonin levels cause irritability, fuzzy thinking, and anxiety. Stimulants like coffee, sugar, simple carbohydrates, nicotine, and recreational drugs can release a flood of serotonin for a few hours, creating a pleasurable effect. When the stimulants wear off, serotonin levels plunge and we crave another “hit.” A reliance on stimulants puts your body and mind on a vicious up-and-down treadmill, resulting in chronic serotonin pathway dysfunction — not to mention weight gain. Maybe you’ve heard the recommendation to eat a potato at night to help carbohydrate cravings and depression. This may sound silly, but potatoes and turkey contain L–tryptophan, that important building block of serotonin.

Stress is truly big here, too. When we are stressed, our body releases the hormone cortisol. A surge in cortisol is always accompanied by a surge in serotonin — and the inevitable dip a few hours later. Women who suffer from fatigue and cravings for carbohydrates in the late afternoon are probably on the high-cortisol/low-serotonin rollercoaster. And guess what? They usually feel depressed.

So what can you do? Once you see the connection between nutrition, stress, and serotonin levels, it gets easier to understand how simple lifestyle and diet changes will make huge improvements in your mood — and overall health — without resorting to drugs. What you eat affects your brain chemistry. I can’t say it more simply.

Many people with mild to moderate depression don’t feel they have the energy to make dietary or other changes in their health habits. They’re discouraged and tired. I tell them to just give it two weeks: you can do that for yourself. And the lift you’ll feel in your energy will be remarkable. You’ll have the strength to keep going with other changes. Here’s how to get started:

* Limit consumption of carbohydrates, especially simple carbohydrates, including alcohol. (Don’t eliminate all complex carbohydrates, however. Too few carbohydrates will cause serotonin levels to plummet because the brain is not being fed properly.)

* Eat a balanced diet and take a rich nutritional supplement. Many factors that contribute to low serotonin production are created by nutritional deficiencies. Similarly, if you suffer from digestive problems, find an alternative practitioner to help you. (You may also want to consider digestive testing.) Pharmaceutical–grade nutritional supplement help cover any gaps in your diet.

* Reduce stimulant use and known physical stressors to help balance out serotonin levels. See our article on reducing caffeine, as well as our full-length article on healing stress for guidance.)

* Exercise is a good way to reduce stress and enhance mood. It releases endorphins — which create a natural euphoria — and reduces cortisol levels. You don’t have to join a gym, even a daily walk to the mailbox is a good place to start. Experts recommend beginning slowly, working up to 30 minutes, six times a week. Or just start with burst training — one minute four times a day, three times weekly. Combining some weight-bearing exercise with aerobic activity (like walking or biking) provides the most relief.

* Get moderate sun or full-spectrum light exposure year-round. A real connection exists between vitamin D deficiency and depression. It’s commonly known that full-spectrum light exposure, especially natural sunlight (which stimulates vitamin D production), is a very effective treatment for SAD. Same with supplements of vitamin D. Future research will tell us more about this link (as well as low vitamin E levels). Patients are being tested regularly for vitamin D deficiency. For people with symptoms of depression, this is one of the first places to look. Even if you decide not to undergo testing, supplementing your diet with 2000 IU vitamin D daily is an easy, safe, inexpensive, and extremely beneficial measure.

If these steps don’t help, find a practitioner who’s experienced with neuroendocrine testing and have your neurotransmitter and amino acid levels checked. While this is controversial, we have found it helpful to gain a picture of your levels at a moment in time. A customized combination of either 5–HTP or St. John’s wort, plus tyrosine, other amino acids, vitamins, and minerals for such patients, based on their test results and response over time may work. St. John’s wort works by inhibiting the reuptake of not only serotonin, but also dopamine and norepinephrine. Supplemental 5–HTP, which is more easily converted into serotonin than L–tryptophan, can be especially effective. It should be used with caution, however, as it can cause increased anxiety in patients with high cortisol levels, and it should not be used in conjunction with St. John’s wort. These support measures are useful whether or not you are taking an antidepressant. Many of my patients use our protocol to help wean slowly off their meds. Remember, it’s wise to seek guidance from an experienced professional when it comes to weaning off antidepressant medications.

Last, but definitely not least... The natural remedies outlined above are remarkably effective, but won’t work for long without dealing with the emotional experience that lies behind depression. That requires work on the emotional factors that affect you: childhood trauma, relationships, work, memories, fears.