Antidepressants are the first line of treatment prescribed by GPs and psychiatrists to treat symptoms of depression – the rationale for this being that they help to restore a chemical imbalance in the brain – an imbalance that causes depression.  However, despite widespread administering of prescription drugs – over 8 million in the UK in 2021 – there is no evidence that a chemical imbalance, or low serotonin levels, cause depression, or any other mental health condition for that matter.  This is not to say that future research may not establish a causal relationship, however, as of yet, it is still an unproven hypothesis.  Furthermore, some reviews of evidence, conducted by Irving Kirsch and colleagues, which were replicated by others including the FDA, seem to suggest few beneficial effects of taking antidepressants.  In fact, following the meta analyses, Kirsch concluded that almost all beneficial effects of antidepressants were due to the placebo effect, and that antidepressants should be considered the last line of treatment, if considered at all, largely due to the many adverse effects of the drugs.  

For this and other reasons some people don’t want to take antidepressant drugs.  In such a situation then, what alternative choices are available to either heal from or manage symptoms of depression?  Fortunately there are many.  Some of these I list in the following section, however please be aware that the type of treatment administered will depend upon individual factors including the severity of the condition, and the following suggestions are in no way intended to be a substitute for personalised support or psychiatric care.  

1. Exercise

This is one of my favourite non-pharmacological recommendations, and for good reason.  A plethora of studies have shown the beneficial effects of exercise for reducing symptoms of depression, stress, and anxiety,  Did you know however that research also demonstrates that exercise is as beneficial, if not more effective, than prescription medicines? 

You may be wondering what type of exercise to practice? Any type of physical movement is likely good for you, however some studies suggest that low intensity movement, carried out regularly, may be most effective.   

Of course, you need not rely on research evidence – simply try out different types of exercises and assess the results for yourself!

2. Kindness

A key feature of depression is that people withdraw, and become very much preoccupied with chronic negative thoughts, which in turn exacerbates low mood. Doing the opposite of this then and focusing positively on others may help you to step out of that mindset, reduce rumination and improve your mood.  

In fact, recent research has found that small acts of kindness, such as baking a cake for friends, offering to give a ride, or leaving motivational sticky notes, carried out on two days a week, may be more effective at improving life satisfaction and reducing depression than some CBT techniques!  

Whilst the study showing that kindness may be superior to other established therapeutic techniques is recent, the research literature nevertheless shows quite a strong link between helping others and improved mental health.  

Some other examples of acts of kindness also include giving your time to work for a charity that helps people in war torn countries; giving money to a charity that is transparent about how it spends its money; planting a tree in the community; or donating unused clothes or other items.  This is not an exhaustive list and there are numerous other acts of kindness you can practice.  I would suggest write down what you may enjoy doing the most and then apply regularly to boost your mental, emotional, physical and social wellbeing.  

3. Getting professional support

Depression starts in the mind, and cognitive distortions play a significant part in causing depressive symptoms.  Thus, to effectively heal from depression for good requires the transformation of maladaptive thoughts and emotions, which are often rooted in specific traumatic events.  Working with a therapist can be extremely beneficial because they will have the knowledge, skills and experience of specific tools to help and support you to quickly and effectively overcome depression successfully.  There are many therapeutic techniques to choose from, however some that have proven to be particularly effective include: Counselling, interpersonal therapy, EMDR, EFT, hypnosis, psychodynamic psychotherapy, CBT, mindfulness based cognitive therapy, and Wellbeing Therapy.  

Ayurvedic medicine, a holistic, non-pharmacological modality to healing may also assist. In particular, studies have shown Smrthi meditation therapy to be quite beneficial.  A typical session would involve sitting or lying comfortably, and the therapist guiding you to a deep relaxed mental and bodily state.  Once deeply relaxed you are guided to observe sense impressions, with suggestions being made to access deep emotional memories and the letting go of emotional stress.  The process can also help you develop a clearer awareness of the root cause of the problem, which is reported to aid healing.  

4. Engage in a problem solving task 

This is another constructive way to shift attention away from chronic ruminating to problem solving, which will help to improve your mood.  Try an activity you enjoy and set yourself a goal of doing it for just 5 mins.  This can be playing a video game, playing an old fashioned puzzle, or even doing household chores!  If you can spend more time then you could also try cooking, baking a cake, or even gardening.  Any activity that helps you solve a problem that you enjoy doing is good and will benefit your health.  

5. Challenge cognitive distortions

Cognitive distortions play a significant part in causing depressive symptoms.  Unhelpful thinking patterns such as ‘I’m a failure’, ‘the world is a bad place’, ‘I can’t solve anything’, ‘I’m not good enough’, are just some common forms of distortions that fuel feeling sad, low, down, upset and withdrawn. 

What can you do when your mind is constantly thinking negative thoughts? Firstly, know that it is your thoughts that feed the low mood and distress.  Know too that just as your thoughts can cause negative emotions, thinking positive or constructive thoughts will do the opposite.  One way to achieve this is to first question the validity of the thoughts.  For example, is the thought even true?  If so, is there any objective evidence for this belief? What other possibilities are there?  Is there any evidence to disprove it? Is the belief rooted in one event that you’ve generalised to all contexts? Are you focussing only on negative information and discounting all positive information?  Try to look for contradictory evidence to the belief – evidence that is rooted in actual experience.  

Another simple way you might challenge and change a belief is vis the following exercise.  Create two columns on a piece of paper.  In the left column write the belief, which could be ‘I’m useless’.  Then in the second column make a list of all your experiences that contradict this belief. Be as specific as possible and let as many examples emerge.  It can be any number of experiences you’ve had such as making someone a cup of tea, helping a person complete an application, offering someone a ride, etc.  Once you’ve created this list, bring your attention back to the negative belief for a few seconds, then switch back to reflecting on the opposite example, focussing on the details of the positive experience – and do this at least 3 times.  Thereafter, each time your mind reverts back to the belief of ‘I’m useless’, simply bring to mind the examples contradicting this core belief. 

6. Self-forgiveness

Do you experience chronic feelings of guilt, self-condemnation, and feel like a failure for making mistakes?  Sometimes this can happen due to forming judgments about yourself that are entirely unwarranted – being overly critical with yourself when you have no reason to whatsoever.  However, at other times, people make genuine mistakes and they don’t feel able to let go of past transgressions, which can cause chronic feelings of guilt, self-criticism and anger.  Maybe you didn’t following through on an action that had consequences?  Maybe you abused someone in the past, stole, cheated on a partner, lied, or engaged in malicious talk?  Whatever the mistake, everyone makes them.  However, when you can’t let go of what you did and continually dwell on transgressions of the past, it can contribute towards causing depressive symptoms. What is important however is that you acknowledge the wrong, apologise where possible and learn from the past action so that you don’t do it again.   Studies show that when we are kind to ourselves and others it can significantly reduce the risk of depressive symptoms.  

Studies also show that forgiveness of self is essential for reducing the effects of depression, and can help to promote bio-psychosocial wellbeing.  

Remember, when you practice self-forgiveness it is because you have committed a harm or wrongful action, therefore be mindful that this is in fact the case and not an unfounded cognitive distortion.  

I hope you find these suggestions useful.  Remember, they are not an exhaustive list, and the methods you utilise will very much depend upon individual factors.  Nevertheless, research does suggest that addressing past traumas, general stress and maintaining regular self-care vis strategies such as compassion, exercise, healthy eating and mindfulness may be very much beneficial for purposes of improving mental, emotional and physical wellbeing.  

With best wishes,

Sadaf