Evidence level: low to moderate

Reduces depression: SAMe, 5-HTP, tryptophan, psychedelics

How long it takes to work: differs across supplements, psychedelics from one day onwards, SAMe two to 12 weeks, NAC 12 to 24 weeks, 5-HTP seven to 56 days

A bit more information: scientists have investigated a number of naturally occurring substances for their antidepressant properties. This search seems to have been motivated in part by the side effects mainstream antidepressants bring with them. I review some of the most researched supplements below, and note which are most effective

SAMe: SAMe is a sulphur-containing compound that may affect regulation of neurotransmitters, among other bodily functions. It has been found to be low in people with Major Depressive Disorder.ⁱ SAMe had more impact on depression than a placebo in the majority of studies done to date (three out of five). A number of studies have found it is as effective as mainstream antidepressants, both tricyclics and SSRIs.ⁱⁱ But most studies found SAMe combined with a mainstream antidepressant didn’t have any impact than the med on its own.ⁱⁱⁱ All of the reviews commented on the low quality of the research, meaning I get to say that thing researchers love to say – more research is needed!^iv For those interested in trying it, the dose used is 200 to 3200mg and it takes two to 12 weeks to have an impact.^v SAMe also appears more effective when injected into a vein or muscle rather than taken orally.^vi Side effects are mild and transient, although no fewer people stop taking SAMe than mainstream meds.^vii

NAC: N-acetylcysteine (NAC) is an antioxidant. It has mainly been studied when taken together with antidepressants. The impact on depression is small.^viii It is well tolerated when taken orally in doses of 200 to 2400mg per day, with the main side effect being stomach upsets.^ix But it has not shown the impact of other supplements like 5-HTP or the psychedelics. To put this in context, 5-HTP has shown three to five times the impact on depression that NAC has, and the psychedelics have shown two to three times the impact.

Inositol: inositol is a polymer of glucose that has been found to be low in people with depression.^x The very few (seven up to 2014) studies that have been done on it find it has no significant impact on depression, although it is well tolerated.^xi It is far out-performed by other supplements such as fish oil, Saint Johns Wort, vitamins and zinc, 5-HTP or the psychedelics (see below for more on the latter two).

5-HTP: 5-htp is a serotonin precursor, that is, something that can be converted by the brain into the neurotransmitter serotonin. It is derived from tryptophan but has an advantage over tryptophan in that it can easily cross the blood-brain barrier.^xii Like inositol, it has had very few studies carried out on it of good quality. To give you a sense of what that means, a review of research from 1966 to 2000 found 108 studies of 5-HTP and tryptophan, of which only ONE on 5-HTP was considered good enough to review! This study showed 5-HTP did better than a placebo against depression.^xiii Luckily by 2020 there were 13 studies good enough to analyze. Their analysis showed that 5-htp had a very large impact on depression, much greater than mainstream antidepressants. It also found something very rare – in some studies 80 to 90% of the people who took it went into remission – that is, didn’t show up on tests as depressed any more.^xiv The only other time I have seen this result is with one study of the Mediterranean diet. Psychiatrist Dr Tracey Marks says the downside of 5-HTP is that is has a very short half-life, which means you need to take it three to four times a day. The dosage used in the studies with the highest recovery rates from depression was 150 to 300mg per day (in total – NOT three to four doses of 150 to 300mg per day. You can take this much but the study that went this high showed quite low recovery rates, and the side effects would be even worse).^xv It can also have some nasty side effects, including severe nausea and even vomiting.

Tryptophan: like 5-HTP, tryptophan is serotonin precursor. But it has a harder time crossing the blood-brain barrier than 5-HTP because it has to hitch a ride with an L-type amino acid transporter, and has a lot of competition for doing so. Once in the brain it is converted into 5-HTP^xvi Again, very few studies of good quality have been carried out on it. One study in a 2002 review found it did better than a placebo in reducing depression.^xvii But the very low numbers of people involved in trials means it is not possible to draw firm conclusions.^xviii A 2013 review concluded tryptophan was at level 3 for evidence of effectiveness in depression, which means the quality of evidence is low.^xix The most recent review in 2016 concluded that results were mixed, but there were no side effects.^xx Overall, 5-HTP seems a better option than tryptophan.

Psychedelic drugs (psilocybin/LSD/ayahuasca): as with other drugs in this list, very few studies have been carried out on the psychedelics – a recent review could come up with only six. Overall, they found a positive impact.^xxi An analysis of three studies found a large impact on depression and no serious side effects.^xxii A larger analysis of eight studies found a large impact on depression from day one for five studies, which was sustained at six months for four studies. They noted transient increases in blood pressure, heart rate and other bodily functions but no large or lasting side effects.^xxiii As for dosage, one study found that a high dose of psilocybin (22-30mg per 70kg of body weight) had more impact at both five to six weeks and six months after being taken than a low dose. It also found that having a mystical experience after taking it explained part of the impact on depression.^xxiv So psychedelics work, although it would be good to have more studies. The big issues are getting strains that are pure, accurately measuring dosage, getting expert supervision for taking them and – the small matter of them being illegal drugs! But apart from that, no problems.

The best and the rest: based on the evidence, this list starts with the best – that is, the most effective – and goes through to the least effective.

1. Biggest bang goes to 5-HTP although this is based on very few studies. It also resulted in remission – that is, a reduction of depression to non-clinical levels – in the majority of people who took it, something that is quite rare in the literature. There are issues with how often you have to take it and nasty side effects but on the plus side – it’s legal!
2. Coming in second, but only just, are the psychedelics, which also showed a large impact on depression. Again this was for a small group of studies, smaller than 5-HTP. Clinically significant reductions in depression were seen in 80% of people who took psilocybin six months after they took it in one study. There are practical issues with getting pure samples, correct dosage and good supervision, not to mention being illegal drugs but as far as effectiveness goes, they’re pretty good.
3. SAMe is as effective as standard antidepressants and more effective than placebo based in quite a few studies, giving it number three place in the list. It also works best when injected, giving it some practical issues compared to drugs that can be taken orally.
4. Tryptophan is far outperformed by 5-HTP and the psychedelics and has some issues with getting across the blood-brain barrier that 6-HTP doesn’t. Likewise NAC is far less researched and less effective than the top two antidepressants in this list.
5. Coming dead last is inositol, which appears to have no impact at all.

i Cuomo A, Crescenzi B B, Bolognesi S, Goracci A, Koukouna D, Rossi R and Fagiolini A (2020) S-Adenosylmethionine (SAMe) in Major Depressive Disorder (MDD): A Clinician-Oriented Systematic Review, Annals of General Psychiatry, 19(1); 1-7.

ii Galizia I, Oldani, L. Macritchie K, Amari E, Dougall D, Jones T N and Young A H (2016) S‐Adenosyl Methionine (SAMe) for Depression in Adults, Cochrane Database of Systematic Reviews, (10); Papakostas G I (2009) Evidence for S-Adenosyl-L-Methionine (SAM-e) for the Treatment of Major Depressive Disorder, The Journal of Clinical Psychiatry, 70: 18.

iii Cuomo A, Crescenzi B B, Bolognesi S, Goracci A, Koukouna D, Rossi R and Fagiolini A (2020) S-Adenosylmethionine (SAMe) in Major Depressive Disorder (MDD): A Clinician-Oriented Systematic Review, Annals of General Psychiatry, 19(1); 1-7; Papakostas G I (2009) Evidence for S-Adenosyl-L-Methionine (SAM-e) for the Treatment of Major Depressive Disorder, The Journal of Clinical Psychiatry, 70: 18

iv Ravindran A V and da Silva T L (2013) Complementary and Alternative Therapies as Add-On to Pharmacotherapy for Mood and Anxiety Disorders: A Systematic Review, Journal of Affective Disorders, 150(3): 707-719.

v Cuomo A, Crescenzi B B, Bolognesi S, Goracci A, Koukouna D, Rossi R and Fagiolini A (2020) S-Adenosylmethionine (SAMe) in Major Depressive Disorder (MDD): A Clinician-Oriented Systematic Review, Annals of General Psychiatry, 19(1); 1-7.

vi Galizia I, Oldani, L. Macritchie K, Amari E, Dougall D, Jones T N and Young A H (2016) S‐Adenosyl Methionine (SAMe) for Depression in Adults, Cochrane Database of Systematic Reviews, (10); Papakostas G I (2009) Evidence for S-Adenosyl-L-Methionine (SAM-e) for the Treatment of Major Depressive Disorder, The Journal of Clinical Psychiatry, 70: 18.

vii Low adverse events, no diff in drop out rates Cuomo A, Crescenzi B B, Bolognesi S, Goracci A, Koukouna D, Rossi R and Fagiolini A (2020) S-Adenosylmethionine (SAMe) in Major Depressive Disorder (MDD): A Clinician-Oriented Systematic Review, Annals of General Psychiatry, 19(1); 1-7 ;Galizia I, Oldani, L. Macritchie K, Amari E, Dougall D, Jones T N and Young A H (2016) S‐Adenosyl Methionine (SAMe) for Depression in Adults, Cochrane Database of Systematic Reviews, (10);

viii Fernandes B S, Dean O M, Dodd S, Malhi G S and Berk M (2016) N-Acetylcysteine in Depressive Symptoms and Functionality: A Systematic Review and Meta-Analysis, The Journal of Clinical Psychiatry, 77(4): e457-66; Kishi T, Miyake, N, Okuya M, Sakuma K and Iwata N (2020) N-Acetylcysteine as an Adjunctive Treatment for Bipolar Depression and Major Depressive Disorder: A Systematic Review and Meta-Analysis of Double-Blind, Randomized Placebo-Controlled Trials, Psychopharmacology, 1-7; Zheng W, Zhang Q E, Cai D B, Yang X H, Qiu Y, Ungvari G S and Xiang Y T (2018) N‐Acetylcysteine for Major Mental Disorders: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials, Acta Psychiatrica Scandinavica, 137(5): 391-400.

ix Ooi S L, Green R and Pak S C (2018) N-Acetylcysteine for the Treatment of Psychiatric Disorders: A Review of Current Evidence, BioMed Research International, 2018.

x Levine J, Barak Y, Gonzalves M, Szor H, Elizur A, Kofman O and Belmaker R H (1995) Double-Blind, Controlled Trial of Inositol Treatment of Depression, American Journal of Psychiatry, 152(5): 792-793.

xi Mukai T, Kishi T, Matsuda Y and Iwata N (2014) A Meta‐Analysis of Inositol for Depression and Anxiety Disorders, Human Psychopharmacology: Clinical and Experimental, 29(1): 55-63; Taylor M J, Wilder H, Bhagwagar Z and Geddes J (2004) Inositol for Depressive Disorders, Cochrane Database of Systematic Reviews, (1).

xii Javelle F, Lampit A, Bloch W, Häussermann P, Johnson S L and Zimmer P (2020) Effects of 5-Hydroxytryptophan on Distinct Types of Depression: A Systematic Review and Meta-Analysis, Nutrition Reviews, 78(1): 77-88.

xiii Shaw K, Turner J and Del Mar C (2002) Are Tryptophan and 5-Hydroxytryptophan Effective Treatments for Depression? A Meta-Analysis, Australian and New Zealand Journal of Psychiatry, 36(4): 488-491.

xiv Javelle F, Lampit A, Bloch W, Häussermann P, Johnson S L and Zimmer P (2020) Effects of 5-Hydroxytryptophan on Distinct Types of Depression: A Systematic Review and Meta-Analysis, Nutrition Reviews, 78(1): 77-88.

xv Javelle F, Lampit A, Bloch W, Häussermann P, Johnson S L and Zimmer P (2020) Effects of 5-Hydroxytryptophan on Distinct Types of Depression: A Systematic Review and Meta-Analysis, Nutrition Reviews, 78(1): 77-88.

xvi Javelle F, Lampit A, Bloch W, Häussermann P, Johnson S L and Zimmer P (2020) Effects of 5-Hydroxytryptophan on Distinct Types of Depression: A Systematic Review and Meta-Analysis, Nutrition Reviews, 78(1): 77-88.

xvii Shaw K, Turner J and Del Mar C (2002) Are Tryptophan and 5-Hydroxytryptophan Effective Treatments for Depression? A Meta-Analysis, Australian and New Zealand Journal of Psychiatry, 36(4): 488-491.

xviii Shaw K, Turner J and Del Mar C (2002) Are Tryptophan and 5-Hydroxytryptophan Effective Treatments for Depression? A Meta-Analysis, Australian and New Zealand Journal of Psychiatry, 36(4): 488-491.

xix Ravindran A V and da Silva T L (2013) Complementary and Alternative Therapies as Add-On to Pharmacotherapy for Mood and Anxiety Disorders: A Systematic Review, Journal of Affective Disorders, 150(3): 707-719.

xx Sarris J, Murphy J, Mischoulon D, Papakostas G I, Fava M, Berk M and Ng C H (2016) Adjunctive Nutraceuticals for Depression: A Systematic Review and Meta-Analyses, American Journal of Psychiatry, 173(6): 575-587.

xxi Dos Santos R G, Osório F L, Crippa J A S, Riba J, Zuardi A W and Hallak J E (2016) Antidepressive, Anxiolytic and Antiaddictive Effects of Ayahuasca, Psilocybin and Lysergic Acid Diethylamide (LSD): A Systematic Review of Clinical Trials Published in the Last 25 Years, Therapeutic Advances in Psychopharmacology, 6(3): 193-213.

xxii Goldberg S B, Pace B T, Nicholas C R, Raison C L and Hutson P R (2020) The Experimental Effects of Psilocybin on Symptoms of Anxiety and Depression: A Meta-Analysis, Psychiatry Research, 284: 112749.

xxiii Romeo B, Karila L, Martelli C and Benyamina A (2020) Efficacy of Psychedelic Treatments on Depressive Symptoms: A Meta-Analysis, Journal of Psychopharmacology, 0269881120919957.

xxiv Griffiths R R, Johnson M W, Carducci M A, Umbricht A, Richards W A, Richards B D and Klinedinst M A (2016) Psilocybin Produces Substantial and Sustained Decreases in Depression and Anxiety in Patients with Life-Threatening Cancer: A Randomized Double-Blind Trial, Journal of Psychopharmacology, 30(12): 1181-1197.

Want to know which food has the biggest impact on your mood? You could be forgiven for saying ‘fish’. We hear a lot about how the omega 3 fatty acids in oily fish are good for depression. and that’s not false – they are.ⁱ

But we really hit pay dirt with fruit and vegetables – for both depression and happiness. Studies show that eating more fruit and vegetables is associated with greater happiness across a wide age-group, from teens to men in their nineties.ⁱⁱ But association doesn’t equal cause. It could be that people who feel happy eat a healthier diet (although research hasn’t found this to be the case so far).ⁱⁱⁱ

The more important finding is that eating more fruit and vegetables is followed by greater psychological well-being over time. Not just happiness, but a long list of other positive outcomes increase, including optimism, self-efficacy, quality of life, vitality, flourishing, curiosity, creativity, mental well-being, life satisfaction, engagement, purpose, meaning in life and motivation.^iv Which is what we want!

And the good feelings go up the more you eat. Each extra serving increases well-being by a significant amount. But to make a meaningful change in positive emotions a total of seven to eight servings per day are required.^v

The impact isn’t small – one study found the change in life satisfaction for changing diet was equal to that of someone who is unemployed finding work, which has a major impact on mental health.^vi The impact on well-being of eating fruit and veg is greater than exercise.^vii If only chocolate had the same effect, I hear you cry. Good news! One study found that a cocoa supplement increased calm and contentedness compared to no supplement.^viii But I think we all knew that already.

Do these foods also pack a big punch for depression? The answer is pretty clear. Eating more fruit and vegetables takes depression down. Along with fiber, this has a greater impact on depression than eating more fish or reducing red meat, fatty meat or cholesterol intake.^ix This holds true even when controlling for other factors, such as age, gender, or social and financial circumstances.^x Eating a diverse range of vegetables also helps,^xi as does eating them raw rather than processed (although processed, such as cooked or tinned, is better than none)^xii.

So to sum up – if you want to feel happier, eat more fruit and vegetables, particularly raw. Eat a diverse range with lots of red and orange colors. You can go as high as eight servings a day – the higher you go, the more your mood will benefit. And it works quickly – you’ll feel the impact from as soon as a day later.

iReduces Depression recent Appleton K M, Rogers P J and Ness A R (2010) Updated Systematic Review and Meta-Analysis of the Effects of N− 3 Long-Chain Polyunsaturated Fatty Acids on Depressed Mood, The American Journal of Clinical Nutrition, 91(3): 757-770; Deacon G, Kettle C, Hayes D, Dennis and Tucci J (2017) omega-3 Polyunsaturated Fatty Acids and the Treatment of Depression, Critical Reviews in Food Science and Nutrition, 57(1): 212-223; Hallahan B, Ryan T, Hibbeln J R, Murray I T, Glynn S, Ramsden C E … and Davis J M (2016) Efficacy of Omega-3 Highly Unsaturated Fatty Acids in the Treatment of Depression.,The British Journal of Psychiatry, 209(3): 192-201; Liao Y, Xie B, Zhang H, He Q, Guo L, Subramaniapillai M … and Mclntyer R S (2019) Efficacy of Omega-3 PUFAs in Depression: A Meta-Analysis, Translational Psychiatry, 9(1): 1-9; Lin P Y and Su K P (2007) A Meta-Analytic Review of Double-Blind, Placebo-Controlled Trials of Antidepressant Efficacy of Omega-3 Fatty Acids, Journal of Clinical Psychiatry, 68(7): 1056-1061; Yang J R, Han D, Qiao Z X, Tian X, Qi D, and Qiu X H (2015) Combined Application of Eicosapentaenoic Acid and Docosahexaenoic Acid on Depression in Women: A Meta-Analysis of Double-Blind Randomized Controlled Trials, Neuropsychiatric Disease and Treatment, 11: 2055.

iiEating f/v asscod w greater happiness Blanchflower D G, Oswald A J and Stewart-Brown S (2013) Is Psychological Well-Being Linked to the Consumption of Fruit and Vegetables? Social Indicators Research, 114(3); young people Brookie K L, Best G I and Conner T S (2018) Intake of Raw Fruits and Vegetables is Associated with Better Mental Health than Intake of Processed Fruits and Vegetables, Frontiers in Psychology, 9: 487; Jyvakorpi S K, Urtamo A, Pitkälä K H and Strandberg T E (2018) Happiness of the Oldest-Old Men is Associated with Fruit and Vegetable Intakes, European Geriatric Medicine, 9(5); 687-690; uni students Lesani A, Mohammadpoorasl A, Javadi M, Esfeh J M and Fakhari A (2016) Eating Breakfast, Fruit and Vegetable Intake and their Relation with Happiness in College Students, Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, 21(4): 645-651.

iiiHappier people eat more f/v Tuck N J, Farrow C and Thomas J M (2019) Assessing the Effects of Vegetable Consumption on the Ppsychological Health of Healthy Adults: A Systematic Review of Prospective Research, The American Journal of Clinical Nutrition, 110(1): 196-211.

ivMore f and v leads to greater happiness over time Conner T S, Brookie K L, Richardson, A.C and Polak M A (2015) On Carrots and Curiosity: Eating Fruit and Vegetables is Associated with Greater Flourishing in Daily Life, British Journal of Health Psychology, 20(2): 413-427; Conner T S, Brookie K L, Carr A C, Mainvil L A and Vissers M C (2017) Let Them Eat Fruit! The Effect of Fruit and Vegetable Consumption on Psychological Well-Being in Young Adults: A Randomized Controlled Trial, PloS One, 12(2): e0171206; ADVentist church Ford P A, Jaceldo-Siegl K, Lee J W, Youngberg W and Tonstad S (2013) Intake of Mediterranean Foods Associated with Positive Affect and Low Negative Affect, Journal of Psychosomatic Research, 74(2): 142-148; Głąbska D, Guzek D, Groele B and Gutkowska K (2020) Fruit and Vegetable Intake and Mental Health in Adults: A Systematic Review, Nutrients, 12(1): 115; Mujcic R and J Oswald A (2016) Evolution of Well-Being and Happiness after Increases in Consumption of Fruit and Vegetables, American Journal of Public Health, 106(8): 1504-1510; Ocean N, Howley P and Ensor J (2018) Lettuce Be Happy: The Effects of Fruit and Vegetable Consumption on Subjective Well-Being in the UK, Leeds University Business School Working Paper, (18-12); Tuck N J, Farrow C and Thomas J M (2019) Assessing the Effects of Vegetable Consumption on the Ppsychological Health of Healthy Adults: A Systematic Review of Prospective Research, The American Journal of Clinical Nutrition, 110(1): 196-211; White B A, Horwath C C and Conner T S (2013) Many Apples a Day Keep the Blues Away – Daily Experiences of Negative and Positive Affect and Food Consumption in Young Adults, British Journal of Health Psychology, 18(4): 782-798.

v F/v greater than exercise Tuck N J, Farrow C and Thomas J M (2019) Assessing the Effects of Vegetable Consumption on the Ppsychological Health of Healthy Adults: A Systematic Review of Prospective Research, The American Journal of Clinical Nutrition, 110(1): 196-211.

viImpact of f/v on life satisf as great as finding work Mujcic R and J Oswald A (2016) Evolution of Well-Being and Happiness after Increases in Consumption of Fruit and Vegetables, American Journal of Public Health, 106(8): 1504-1510.

vii F/v greater than exercise Tuck N J, Farrow C and Thomas J M (2019) Assessing the Effects of Vegetable Consumption on the Ppsychological Health of Healthy Adults: A Systematic Review of Prospective Research, The American Journal of Clinical Nutrition, 110(1): 196-211.

viiiCocoa calm contentedness Pase M P, Scholey A B, Pipingas A, Kras M, Nolidin K, Gibbs A … and Stough C (2013) Cocoa Polyphenols Enhance Positive Mood States but not Cognitive Performance: A Randomized, Placebo-Controlled Trial, Journal of Psychopharmacology, 27(5): 451-458, in Bear T L K, Dalziel J E, Coad J, Roy N C, Butts C A and Gopal P K (2020) The Role of the Gut Microbiota in Dietary Interventions for Depression and Anxiety, Advances in Nutrition, 11(4): 890-907.

ixMore fruit and veg lead to less depression Blanchflower D G, Oswald A J and Stewart-Brown S (2013) Is Psychological Well-Being Linked to the Consumption of Fruit and Vegetables? Social Indicators Research, 114(3): 785-801; Brookie K L, Best G I and Conner T S (2018) Intake of Raw Fruits and Vegetables is Associated with Better Mental Health than Intake of Processed Fruits and Vegetables, Frontiers in Psychology, 9: 487; Carr A C, Pullar J M and Vissers M C (2013) Beating the Blues -The Association between Fruit and Vegetable Intake and Improved Mood, The New Zealand Medical Journal, 126: 131-132; Ford P A, Jaceldo-Siegl K, Lee J W, Youngberg W and Tonstad S (2013) Intake of Mediterranean FoodsAssociated with Positive Affect and Low Negative Affect, Journal of Psychosomatic Research, 74(2): 142-148; Głąbska D, Guzek D, Groele B and Gutkowska K (2020) Fruit and Vegetable Intake and Mental Health in Adults: A Systematic Review, Nutrients, 12(1): 115; Huang Q, Liu H, Suzuki K, Ma, S and Liu C (2019) Linking What we Eat to our Mood: A Review of Diet, Dietary Antioxidants and Depression. Antioxidants, 8(9): 376; Liu X, Yan Y, Li F and Zhang D (2016) Fruit and Vegetable Consumption and the Risk of Depression: A Meta-Analysis, Nutrition, 32: 296–302; McMartin S E, Jacka F N and Colman I (2013) The Association between Fruit and Vegetable Consumption and Mental Health Disorders: Evidence from Five Waves of a National Survey of Canadians, Preventive Medicine, 56(3-4): 225-230; Opie R S, O’Neil A, Itsiopoulos C and Jacka F N (2015) The Impact of Whole-of-Diet Interventions on Depression and Anxiety: A Systematic Review of Randomised Controlled Trials, Public Health Nutrition, 18(11): 2074-2093; Tuck N J, Farrow C and Thomas J M (2019) Assessing the Effects of Vegetable Consumption on the Ppsychological Health of Healthy Adults: A Systematic Review of Prospective Research, The American Journal of Clinical Nutrition, 110(1): 196-211.

xImpact of f/v holds true controlling for other factors Blanchflower D G, Oswald A J and Stewart-Brown S (2013) “Is Psychological Well-Being Linked to the Consumption of Fruit and Vegetables?” Social Indicators Research, 114(3); McMartin S E, Jacka F N and Colman I (2013) The Association between Fruit and Vegetable Consumption and Mental Health Disorders: Evidence from Five Waves of a National Survey of Canadians, Preventive Medicine, 56(3-4): 225-230; 225-230; Tuck N J, Farrow C and Thomas J M (2019) Assessing the Effects of Vegetable Consumption on the Ppsychological Health of Healthy Adults: A Systematic Review of Prospective Research, The American Journal of Clinical Nutrition, 110(1): 196-211.

xiDiverse range of veges Parletta N, Zarnowiecki D, Cho J, Wilson A, Bogomolova S, Villani A, Itsiopoulos C, Niyonsanga T, Blunden S, Segal L et al (2019) A Mediterranean-Style Dietary Intervention Supplemented with Fish Oil improves Diet Quality and Mental Health in People with Depression: A Randomized Controlled Trial (HELFIMED), Nutritional Neuroscience, 22: 474–487.

xiiRaw rather than processed Brookie K L, Best G I and Conner T S (2018) Intake of Raw Fruits and Vegetables is Associated with Better Mental Health than Intake of Processed Fruits and Vegetables, Frontiers in Psychology, 9: 487.

It worries me that people are so distressed about BREXIT.  Some people are going beyond angst to clinical anxiety and depression.  So I’ve compiled a list of things you can do, say/think and read that might make you feel better.  And once you feel better, you’ll be more able and motivated to take action to help get Britain to a better place.  If you want to!

All of these things – taking action, answering negative thoughts and bibliotherapy – are proven effective in reducing sadness and worry.

1. What to do: this is just as effective in reducing negative thoughts as changing your thoughts directly.

• Write a letter to your local M.P.
• Start a petition to re-join the EU.
• Join a political party that you think might get Britain to a better place.
• Read up on the EU and the pros and cons of belonging.
• Talk online about this topic, in terms of ‘what actions shall we take?’.
• Volunteer to help at a homeless shelter or some other charity that helps people in need, to address the problems caused by inequality.
• Organize a march, whether for or against re-joining the EU.
• Make a sign and put it in your front yard or window.
• Start a Facebook group to work towards re-joining the EU or staying out of it.
• Write a list of things that are still good about Britain.
• Write a flyer and deliver it locally.

2. What to think/say: a lot of the discussion about BREXIT is characterized by mistakes in logic and reasoning such as catastrophizing, all or nothing thinking, fortune telling, emotional reasoning and overgeneralization. I’m not on either side – I just want people to not stress over it or get so paralyzed by emotion they can’t take action. Here are some different ways of looking at it that may make you feel better.

• The predictions about the dire effects of leaving the EU are words and thoughts, not facts. These things have not happened yet.  They may never (mistakes = catastrophizing i.e. thinking something is going to be terrible, and fortune telling, or predicting the future).
• Just because talking and thinking about these dire predictions makes me feel bad, doesn’t make them true (mistake = emotional reasoning i.e. believing that because a thought makes you feel bad that means it is true).
• Maybe not all the consequences of leaving – or even the majority – will be negative. In life things are generally a mix of negative and positive, even the worst things, and there may be good consequences (mistakes = all or nothing thinking, focus on the negatives).
• Just because one bad thing has happened as a result (the drop in value of the pound – I don’t think we can count the resignation of David Cameron as a bad thing!) does not mean all the bad things predicted will happen, or even most of them. This may be a panic reaction and could change (mistake = overgeneralization i.e. predicting a lot of bad things based on one bad thing).

• This situation may not last forever. Britain may decide it’s better off in the EU and vote to go back, in which case the EU is highly likely to say ‘yes’ (mistake = permanence i.e. believing bad things will last forever).
• Britain has survived much worse things, like Maggie Thatcher and World War 2. It will survive this, and possibly even end up better.
• Overall, history shows us that the life circumstances of human beings have improved, despite ups and downs. Dire predictions of how changes are likely to be disastrous (such as the industrial revolution) have usually turned out to be untrue.  This may be the case now (mistake = catastrophizing).
• The media is in the business of selling bad news and fear in order to make money, so it pays not to take them too seriously (mistake = focus on the negative).
• The best thing to do to prevent the far right gaining power in Europe, Britain and the U.S. is to take action – run for local council, volunteer for a party you believe in, put up posters, deliver flyers, stand on a soapbox! If everyone who cares works to stop it happening, they will probably succeed.

3.Things to read: bibliotherapy is a proven way of reducing anxiety and depression.  Suggested books include a more positive look at history, a memoir by someone who found the positive in even the most negative experiences and a book about how things that look bad at first can turn out to be blessings in disguise.

• Man’s Search for Meaning by Viktor Frankl. An inspiring memoir of how one man coped in a concentration camp in World War 2, in solitude, cold and hungry.  He took power over his thoughts and refused to let his circumstances control him.

• The Rational Optimist by Matt Ridley, about how life has improved and prosperity increased, despite dire predictions about the effects of the industrial revolution, migrations from the country to the city, how the world will run out of food and may other things
• http://www.rationaloptimist.com/blog/a-global-future-for-britain/ Matt Ridley’s blog post on how the EU was once a good thing to belong to but now is stuck in economic stagnation, and Britain might be better off financially to be an independent trader again, forming its own trade alliances.
• When One Door Closes, Another Door Opens by Arthur Pine. This is full of stories of people who have had bad things happen to them, and then found that the setback or disappointment they suffered actually led to a better outcome.  It could give you hope that Brexit could lead to a good outome for Britain, or that your own life could end up getting better.

Gabrielle Bernstein’s latest book is Miracles Now- 108 Life-Changing Tools for Less Stress, More Flow, and Finding Your True Purpose. Bernstein is a successful motivational speaker and self-help author of May Cause Miracles, Add More ~ing to Your Life, and Spirit Junkie. Gabrielle Bernstein has really been gaining momentum in the past few years. Oprah…

via Miracles Now Book Review: 108 Life-Changing Tools for Less Stress, More Flow — Emily Susie

Don’t worry, I’m not one of those annoying people who was once a bit depressed, then took a pill and got over it.  No, my story is much, much worse than that.  (For my 10 steps, skip to the end. Also,if you are interested in coaching to become happier for $50 per hour from a certified Authentic Happiness Coach – me! – please email me on: kaye.mclaren@gmail.com)

Also email me if you would like to receive the full list of 714 new ways to use strengths.

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I was a sad child.  So sad that when a counselor once asked me to re-experience my emotions from that time I felt such terrible pain that I dissociated, unable to talk or look at her.  I’d forgotten how miserable I had been.

I used to wish that I hadn’t been born.  The unpredictable mood swings that were as shameful as peeing my pants in public didn’t help me enjoy my childhood more.  I just wanted everyone to stop shouting and telling me what was wrong with me and give me a hug and say something nice.  Thankfully I didn’t know how much worse it would get.

Adolescence

But first it got better. I was so terrified of going to high school I thought I would die of sheer anxiety before I got there.  Instead an even greater miracle happened.  I became popular.  I made friends, got in the top class.  I was happy.

Clearly something was terribly wrong.  I knew I was a bad person who didn’t deserve any of this.  I knew because I’d been told so.  I had to set things right.

By the time I left I’d behaved so oddly for so long that I had only one friend left.  She didn’t last a year after we both started work.  She got fed up with my depressions, my self-hatred and my new solution –alcohol.

University saved me.  I found focus, meaning, friends, success.  Having ballooned up to over 200 pounds (15 stone, 100 kilos) I trimmed down to 140, and fell in love with a man who fell in love with me (not in that order).  I still got depressed but not as much as before.

Twenties

After university I got lost.  I didn’t know what to do next.  I travelled, smoked a lot of dope, saw some amazing things, then got too lonely and came home. So I tried the other way – volunteered at the local prison, worked at a girl’s home, lived with my folks for the first time in five years, got confirmed as a Christian.

Then two unexpected things happened.  First I fell in love with a woman, not for the first time.  Second, I went crazy.

I came home from work late one night in so much pain that I sat in my car in the driveway and howled like an animal.  The doctor my father took me to at 8am the next morning confirmed what was wrong.  Depression.  It was like having a D branded on my forehead.  I was defective, definitely and decidedly. I left clutching a prescription.

I had no way of knowing what would come next, ‘cos I’d never been this bad before.  I stopped going to work, stopped eating, dressing, showering, talking.

I tried to sleep to avoid the agony, so dreadful it was the mental equivalent of someone trying saw my leg off without anaesthetic.  But sleep was hard to find.  Even when it happened, I would wake to find I was already crying.  For the first time ever, I thought of killing myself. I even had a plan.

Finally the meds kicked in, after two weeks of indescribable suffering.  I had a shower, got dressed, started doing the shopping for the family, doing the crossword, going out.  My sister would say to me ‘come on zombie’, not unkindly, and take me for a walk, like a silent and dejected dog.  I wasn’t happy, but I was functioning.

I figured now I had a diagnosis I could go and get therapy.  I’d been looking longingly at the yellow pages ads for psychiatrists and psychologists for the past eight years.  Now I picked up the phone and made an appointment.  I was terrified of what it would be like.

Luckily, therapy helped.  I started to do more, go swimming, go for walks on my own, encouraged by my therapist.  Then I took a trip that changed my life.  It took all of half an hour, from where my parents lived in the ‘burbs to my old university in the middle of the city.

I walked into the library, pulled out the drawer of the card catalogue at ‘e’ for ‘effective therapy of depression’ et voila.  There it was.  A book called The Effective Therapy of Depression.  I almost ran to the stack where it was shelved.

Reading it I laughed, really laughed, for the first time in weeks.  It was the chapter on Cognitive Behavioral Therapy (CBT) that got me.  I could see so much of myself in it, and the idea that my negative thoughts might be wrong made me almost giddy.

Next I read Cognitive Therapy of Depression and started using the thinking and behavioral techniques it taught.  I fired my lovely neo-Freudian therapist and signed on with a clinical psychologist.  Then something amazing happened.

I started to feel happy.  Really happy.  Happier than I ever had before.  I saw myself and the world completely differently as I realized my negative thoughts were faulty and started to challenge them, and built more enjoyable activities into my life.  I went back to work, made new friends, had good times.

So that’s the end of my story. I was cured and have been happy ever since.

Ha, ha, as if.  No, that took a bit longer to achieve.  What happened next was conflict at work followed by a relapse.  Back to depression.  Looking back, relapse was inevitable, because my new habits just weren’t strong enough.  But at the time it felt like paradise lost.  I wish I’d known then how happy I would be again.

I staggered through to my 30^th birthday having one relapse after another.  Even in the good patches I wasn’t as happy as I had been after my big breakdown.  I was starting to suspect that tricyclic antidepressants and Cognitive-Behavioral Therapy (CBT) were not the cures they were touted to be.  I was starting to suspect I’d need more.

Thirties

For my thirtieth birthday present I got a diagnosis of Myalgic Encephalitis, commonly (and misleadingly) known as Chronic Fatigue Syndrome.  It came with features – lethargy, nausea so severe I could feel it in my legs and arms, the need for an afternoon nap.

It was unexpected and derailed the slow progress I’d been making.  With the help of new friends, a support group and a new home with people I liked I’d gradually achieved a better mood.  But ME was one step on the way to undoing that.

The second step was my brilliant new career.  After years of trying I finally got the job of my dreams – working on prison policy.  It was unexpectedly dull and my new boss clearly hated me.

The third step was conflict in my close relationships.  As months went by my fragile happiness disintegrated.  But this time it was worse than mood swings and mild depression or dysthymia.

This time it was solid, painful depression day after day, week after week, with very little let up or variance. like a mental toothache.  To cope, I started to fantasise in obscene detail about killing myself.  I called it suicide pornography.  It was the only thing that gave me any relief.

This went on for four years.  I kept using all my cognitive and behavioral skills, which probably saved my life some days.  I got outside and did exercise and did fun and social things, which all helped.  I kept taking the meds, which didn’t seem to do much of anything.  And I kept dreaming about death, my great escape from the pain of life.

What saved me was a fellowship to Canada and America.  I felt well and happy for six weeks on end, for the first time since I was 30.  I decided if I could be happy overseas, I could be happy at home.  Once I got home I moved in with some fun friends, and started doing new hobbies and activities and waited to see if it worked.

I had the happiest year of my life.  I just didn’t know it was possible to feel so good.  I got a new boss, work was better, I made new friends, I went out and had fun and as I felt happier, my health also improved.  I decided the only thing missing was a romance. Bad decision.  Or at least the man I chose was.

WARNING: TRIGGERS IN THIS SECTION, CONTAINS SUICIDE ATTEMPT. Scroll down to see ‘Suicide section ends’

When he dumped me he said if I could just not show any grief or sadness we could maybe get back together.  So I tried.  I exercised, I got bright light, I did social things, fun things.  I fought against the sadness, refused to let myself feel it or show it.  I wouldn’t tell anyone.  I stopped sleeping.  I started crying, even at my desk at work where people could see me.

I started to feel so bad that death held out its beckoning arms again, promising relief.  As I slipped deeper into agony I screamed ‘no, don’t make me go there’.  But it made me go there anyway.

When I woke up after the overdose I couldn’t stand up, my legs were so weak.  I lay in the bushes in the dark, shivering.  Weirdly, I was filled with the conviction that my life had a purpose, that it wasn’t over for a reason, that I wouldn’t die until this purpose was fulfilled.

After I crawled up the hill and found someone to take me to hospital, I found the doctors there had other ideas.  They said my liver was practically dead.  I’d been unconscious for 36 hours, not 12.  They would try the antidote but they didn’t hold out much hope.  Family and friends started to gather to say good bye to me.

I really didn’t think I was going to die.  What I was much more concerned about was how I’d got to such a bad place and how I could stop myself going there again.  I lay in my bed, trapped by drips in each arm, and between visits tried to figure out what I needed to do differently.

Clearly, I knew something about how to be happy.  I decided part of the problem was I hadn’t been doing the things that worked for me regularly enough to make them strong habits.  Also, I suspected that if I accepted all my feelings and felt them rather than fighting them, I wouldn’t get so depressed.  I also needed to monitor myself for signs I was slipping, and have a written plan of what to do if I went downhill.

I went home to two people who were so angry with me they moved out.  I got depressed and suicidal again but I still put my plan into action.  Guess what?  It worked.

SUICIDE SECTION ENDS

The acceptance was like a magic trick – it really stopped the depression getting worse.  The other thing that really helped was slowly – very slowly and carefully over a period of months, supervised by a doctor – cutting down my dose of tricyclics to nothing and starting on St John’s Wort.  I started feeling emotions I’d forgotten existed.

The overdose was April 25.  By December 25, nine months later, I was happy again.  And I stayed happy, for many years.

Forties

For my fortieth birthday present I got a gorgeous younger man who looked a lot like Keanu Reeves and adored me.  Just what the doctor ordered!

By the time April 25 rolled round after my 40^th birthday I’d been happy for two solid years.  I had the odd bad day, occasionally felt suicidal, but I put my Suicide Prevention Plan into action and it worked.

I went back to university and started a new job I liked a lot.  After two years my partner and I finally moved out of the house where I’d been so suicidally depressed and into a place on our own.  Then he had an affair.  But I didn’t get depressed.  I coped.  He ditched her and came back to me and we had a great year.

But life doesn’t always have totally happy endings.  My younger man decided he wanted to be a bachelor again, so I took our cats and moved to a place on my own.  My hard work at university pushed me into a relapse of ME, so I had to leave my new dream job and work from bed.  But I stayed friends with my ex, made new friends, had fun times and stayed happy.  It really seemed like it would never end.

I didn’t have another relapse for eight and a half years, longer than ever before.  What pushed me back over the edge were hormonal changes and another toxic relationship.

All the things that used to work didn’t work anymore.  I was back to driving while screaming and crying, back to dangerously longing to kill myself, back to calling emergency helplines in desperation and fear I would try again to take my own life.

So it was back to the drawing board.  Again.  This time I looked at diet, especially protein and carbs, and also at vitamins and minerals proven to be important for depression in women.  I also tried meditation, and went to another support group.  And on the advice of a professional supervisor, I found another counselor.

It all helped.  The counselor was incredibly supportive and warm, the support group a source of good advice and strategies, the diet and supplements seemed to make me less reactive, and the meditation calmed me down.

Oh, and I manipulated my toxic lover into dumping me when it was clear he wouldn’t tolerate me ending it.  That gave me space to focus on myself and heal.

I had signed on for a positive psychology coaching course just before the meltdown happened, so I tried any techniques from that I hadn’t used before.  My tool kit now had a whole lot of shiny new tools in it.  Not all of them were a good fit, but the ones that were, I kept and kept using.

It took work and it took a while.  But around 18 months later I was back to my good space.  What is surprising to me now is that it took longer than after my overdose.  I put this down to the powerful effect of the hormonal changes I went through, which really rocked all my carefully developed habits, and rendered some of them completely useless.

It seemed like things were finally coming right, with my mind, at least.  But my body had other ideas.

Fifities

For my fiftieth birthday present I got a relapse of ME so severe I had to sell my house, give up work and go onto state benefits.  No gorgeous young man this time round, although maybe that was a blessing.  I really didn’t have enough energy for hanky panky!  I really didn’t know how long it would be before I got well again.

To save money I moved into a rundown old house my brother owned, far away from my friends.  I struggled to cope on an income about a fifth of what I was used to.

My lovely townhouse with its sea views was gone, my successful career as a sought after researcher and writer earning $120 an hour was gone, my savings were gone, replaced by debts, and my health was worse than it had ever been.  I couldn’t go for walks, couldn’t do my own grocery shopping, at times couldn’t get out of bed except to make a simple meal, and sometimes not even then.  So a relapse of depression was pretty much a foregone conclusion.

Except that it didn’t happen.  Somehow all those years of trying things out, monitoring my moods, adding new tools to the toolkit, and using the tools that worked best for me on a daily to weekly basis had made me almost bullet proof.  I had lost a lot, but I retained my most precious possession – happiness.

Did I mention the friend I supported through Motor Neurone Disease who died that year?  Or my mother developing dementia?  Or getting so desperate for money I had a screaming match with the family I’d lent $200 to, including their son who was famous for once almost having killed someone with a hammer and had to be held back from attacking me?

But none of it seemed to really have the power to knock me down any more.  I had a few months of mild depression just after my 51^st birthday, when it became clear I wasn’t going to miraculously get well.  But I did all the things that worked for me and that passed, just faded away like mist in the sun.

I had the odd scary day when I desperately, dangerously longed for death.  But again, I did all the things that worked for me, and those days passed too.  But most of the time I was happy, even when I was bedridden for days on end.

All my hard work, all my trying new things, all my picking myself up when I fell down and white knuckling my way through the bad days/weeks/months had paid off.  I had learned how to be happy, and how to stay happy.

That period has lasted – so far – for ten years, and shows no signs of abating.  Conflict with friends, problems at work, being evicted, the death of my mother, financial stresses, getting so deeply in debt I had to rent out my bedroom and sleep in the lounge – I’ve weathered all this and more without another relapse.  The most I’ve had is the odd bad day, which I can usually get over by going for a walk on the beach and having an ice cream.

My local beach

So this is my message: it is possible to be happy, even after years of depression, even after depression so bad it almost kills you.  If I can do it, so can you.

Is this a happy ending?  In my book it is.  If you offered me a million dollars but I had to be depressed I’d turn it down.  If you promised me a wonderful relationship with someone who adored me but I had to be depressed I’d say no thanks.  If you said I could have my dream job but I had to be depressed I’d pass.  If you promised me a new home, perfect health, to be slim and beautiful, but told me I had to be depressed I’d turn my back on all of them.

My ending isn’t happy for any of those reasons.  It’s a happy ending because I am happy, and that is enough.

My 10 steps for transforming depression into happiness

1. I looked for information on things that might make me feel better, in books, research papers, from friends and therapists, wherever I could find it.  (Good sources of ideas are the free Happify app, positive psychology books like Learned Optimism, The How of Happiness, Flow, The Mindful Way through Depression and Positivity, mainstream books like Feeling Good, The Depression Cure and I Can if I Want To, books on physical approaches such as When Your Body Gets the Blues and Winter Blues and the youtube video I Had a Black Dog.)
2.  I tried a lot of different things.
3. I kept doing the ones that worked for me, that I liked enough to do regularly, and kept adding new techniques until I was doing enough of them to achieve the mood I wanted (I had to use a lot of techniques because my depression was so severe).
4. I built the techniques into my daily and weekly routines, often linking them with existing habits or activities (like having a bath at night or writing my to do list in the morning) so I remembered to do them and they became automatic.
5. When I felt bad, I named the feeling, took a deep breath, felt it, reassured myself it would pass if I just accepted it, and focused on doing something constructive, rather than fighting or suppressing it.

 

6. I found ways to motivate myself to keep active, even on the worst days, so I didn’t slip into doing nothing, which feeds depression.
7. I saw therapists and went to personal growth and support groups whenever I felt the need, and also talked openly about my moods to friends.
8. I made sure I got time outside every day, did exercise I liked, ate a balanced diet, spent time with people I liked, did fun things, and had goals and work I found meaningful.
9. When I had a relapse, I kept doing the things that worked for me.  If they didn’t work, I looked for new ideas and techniques and tried them.
10. I developed a Suicide Prevention Plan where I identified triggers and stressful situations, listed warning signs and what I would do about them, and signed off on it with my therapist, doctor, friends and family.

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