Alternatives to antidepressants?
February 26, 2013 5:33 PM   Subscribe

I am male, 17, with decent physical health but struggling with depression and anxiety. What should I try before going back on meds?

After a stressful first week school, I started homeschooling in 2010. I took 50mg sertraline and went to therapy during that year, but neither of these had an appreciable effect. I went back to public school the following year. I have coped fairly well without meds or therapy (good grades, pursuing hobbies, leading group singing at church, etc.) but I would like to get my depression more under control as I begin college this fall. My parents and my physician are encouraging me to start trying meds and therapy again. However, I would like to take the next five months before college starts to exhaust all other options.

I am currently looking for a part-time job, preferably something that I'm interested in and involves some good physical labor, such as assisting at a local plant nursery. That would certainly help me in many ways.

Going through some of the depression-related AskMe threads, I've noticed that quite a few people have had success with meditation. What kind of meditation? I did yoga three times a week during my homeschooling-year, but the relaxation only lasted for an hour or so after the session. The same goes for walking/running, although I haven't tried doing vigorous exercise on a regular basis.

Has anyone has success with elimination diets such as this paleo-style diet? I already garden, cook, and eat a fairly healthy diet. No supplements, though. I try to get some sun in the winter (in the southern USA) for vitamin D.
posted by gray17 to Health & Fitness (25 answers total) 8 users marked this as a favorite
"although I haven't tried doing vigorous exercise on a regular basis"

Maybe it's worth a shot?
posted by matty at 5:37 PM on February 26, 2013 [2 favorites]

Usually people are promoting "mindfulness meditation" for this. This is, basically, concentrating on breathing, and observing thoughts without identifying with them.
posted by thelonius at 5:53 PM on February 26, 2013

You say you've done yoga. Have you ever tried Bikram yoga? I too was on sertraline, hated it, then started Bikram and it truly changed my life. Depression lifted, physical fitness improved, happiness off-the-charts.
posted by sevensnowflakes at 5:53 PM on February 26, 2013

I was able to go off Zoloft by eliminating sugar and getting at least an hour of vigorous exercise a day. However, I don't think I'd have been able to make those changes without going on Zoloft in the first place.
posted by KathrynT at 6:06 PM on February 26, 2013 [1 favorite]

I also found hot yoga (Moksha) to be totally life-changing as a lifetime anxiety sufferer. I take a class 5 days a week, and it is the only thing I've tried in 30+ years that has made a dent in my anxiety. I would never have believed it had I not almost-accidentally gotten a dirt cheap unlimited first month, but it shifted my anxiety almost instantly and left me racing to classes as often as possible. I try not to sound like a fanatic, but it's been weirdly miraculous for me.
posted by thegreatfleecircus at 6:14 PM on February 26, 2013

Elimination diets are for figuring out what you're allergic to. Whole30 isn't an elimination diet. It can't hurt your mental health and is probably a good idea, but it isn't a treatment for depression.
posted by clavicle at 6:17 PM on February 26, 2013

vitamin D and/or a lightbox if you are at all low on vitamin D or have SAD. omega-3 fish oil capsules and a good b-complex vitamin supplement. exercise is always good too. a calcium-magnesium supplement is also good to take at night to help with sleep but good to take a few hours before going to bed.

some people might suggest SAMe but know that it is similar to an anti-depressant and in europe it is still a prescription drug so you have to be careful with it. it can trigger mania in some people. i tried it but got way too hyper and couldn't sleeep. argh. it can also have withdrawal effects like anti-depressants which for some people can be really bad. personally, i'd stick with vitamin supplements over herbals or Rx meds after having had bad, and very long lasting, withdrawal effects from going off an anti-depressant.
posted by wildflower at 6:29 PM on February 26, 2013

For meditation, I liked the book Mindfulness in Plain English, and if you can find one, having a teacher can make a big difference.
posted by spbmp at 6:29 PM on February 26, 2013

Cognitive Behavioral Therapy helps, I suppose, as does marijuana in moderation. But nothing beats meds.
posted by Charlemagne In Sweatpants at 6:36 PM on February 26, 2013

I have been on medication for my depression on and off for the past ten years. The best I've felt has been when I am on medication, but also doing the following:

--taking a vitamin D supplement, particularly in the winter
--taking a large dose of fish oil (I recommend taking fermented cod liver oil, it's disgusting but the most effective of everything I've tried, the difference is almost tangible)
--exercising consistently. Generally I run every other day, and then on the off days I do a yoga practice that is short, fairly moderate, but just enough to work up a sweat. I frequently switch it up with rock climbing or cross country skiing, and in the warm months I cycle more than I drive.
--eating something very close to a paleo/primal diet
--getting a good night's sleep every night, which all of the above will contribute to

Losing any one of these will make me feel crappier. Losing more than one of these will make me feel even worse. That's just how it is. I prefer feeling good, but if I drop one ball I tend to drop several and then there's several weeks of feeling like total shit before I get it all back together. I've learned that just sticking to the routine is the best thing for me and everyone in my life, but admittedly, I've learned this more than once.
posted by padraigin at 6:36 PM on February 26, 2013 [2 favorites]

I've struggled with depression my entire life. Exercise, daily, keeps me feeling good. For me, that's martial arts 2-4x/week, skiing 2x/week, and something physical on the off day (usually a hike). Sitting around on the sofa results in my feeling blue; getting outdoors or on the mat keeps it at bay.
posted by ellF at 7:31 PM on February 26, 2013 [1 favorite]

The scientific evidence for regular exercise helping depression is very strong. It doesn't have to involve going to the gym or running; you can probably pick a fun activity that you actually like. Martial arts and rock climbing tend to have very friendly and supportive communities around them, if you (like me) sometimes find the gym to be hostile and uncomfortable.

Also, don't hesitate to go the school's therapy office when you get there. Freshman year can be particularly rough.
posted by vogon_poet at 7:54 PM on February 26, 2013

The gardening thing sounds like a great idea!
posted by kettleoffish at 8:09 PM on February 26, 2013

When I first was treated for depression, I wanted to avoid meds. My parents said, if you had a broken arm or diabetes, we would treat it with medicine, this isn't any different. I tried a few different drugs but I love the ones I take currently. Seriously, I think they're working and while my life is far from perfect, I feel like I'm in a way better place than I was this time a year ago. I work out. I do yoga and run. But I wouldn't be able to do that without the drugs I'm taking.
posted by kat518 at 8:24 PM on February 26, 2013 [3 favorites]

When I first was treated for depression, I wanted to avoid meds. My parents said, if you had a broken arm or diabetes, we would treat it with medicine, this isn't any different. I tried a few different drugs but I love the ones I take currently. Seriously, I think they're working and while my life is far from perfect, I feel like I'm in a way better place than I was this time a year ago. I work out. I do yoga and run. But I wouldn't be able to do that without the drugs I'm taking.

I agree with this.
posted by Charlemagne In Sweatpants at 8:26 PM on February 26, 2013 [1 favorite]

Just a word of advice about your schedule for this project. The first semester of college can be a difficult time for a lot of people; it's a lot of big changes at once. I would advise you not to wait until the last minute to try meds. You don't want to be depressed or going through a tricky med-adjusting phase during your first few weeks of school.

So talk to your doctor about how long a lead time you should build in, so that -- if you do end up wanting to try meds in addition to the rest of your good plans -- you can start meds and get stable on them before heading off to school.
posted by LobsterMitten at 9:37 PM on February 26, 2013 [2 favorites]

I find that walking, even pretty briskly, doesn't have as much of an effect for me as regular vigorous exercise. Any exercise is good, but especially if you're in decent shape, you might need to do vigorous stuff to get the full benefit.
posted by needs more cowbell at 10:56 PM on February 26, 2013 [1 favorite]

Seconding LobsterMitten that if you want to try a different med, you probably do not want to be doing that the first weeks of college. Those adjustment periods of ramping up/fine-tuning doses can put you out way of whack, and it's far easier to negotiate going on meds and evaluating whether they're actually helping you when you're in a stable, familiar physical and mental space with lots of leeway and no new pressures.

I too am quite resistant to taking medications if I can avoid it. That said, I'd heartily recommend reading the section on Antidepressant Meds in the AskMeFi favorite "Feeling Good", just to get a solid feel for when meds might be effective, how long you should be on an antidepressant before you start evaluating whether it's actually doing anything for you, how exactly to figure out if it IS doing anything for you, when to switch, etc. The whole book is really tremendously helpful, so if you haven't yet checked it out, you might consider giving it a shot now.

Personally, when I hit my worst, longest, and most relentlessly suicidal depression yet a few years back, I finally had to give up on my resistance and (still very reluctantly) tried meds: five different combos and a great many dosage tweaks over the course of three years. Not one of them seemed to do a damn thing besides seriously mess with my focus and balance, make me twitch, and give me tremendous headaches as I came on or off of them to try another. YMMV - some people love them and have great results. I wish I was one of them. It was an incredibly frustrating, awful experience for me.

Nthing a whole bunch of people above: rigorous, regular exercise outdoors (running about 5k 3-5 times a week, in my case) worked like a charm, and is the only thing I have found that remotely keeps my depression in check (though I am in therapy as well). My advice: find something rigorous you like and make it a damn religion.
posted by involution at 12:09 AM on February 27, 2013

Chiming in with nearly every other person in this thread: get some vigorous exercise every day.

However, when I was trying to not go on meds and take care of it all, exercise wasn't enough. Even now with the medication, if I go a couple of days without exercising, I can feel things getting worse. So for me, it's not either/or, it needs to be both.
posted by fiercecupcake at 5:18 AM on February 27, 2013 [1 favorite]

Depression is a real, physical condition, like Diabetes. Sure there are things you can do to help your depression that don't involve drugs, but at the end of the day, just like a diabetic, if you need drugs you need them.

College is hard enough with significant life changes, a completely different class structure, communal living in dorms, without also having to keep depression at bay.

Needing to take drugs to keep your brain chemistry at equalibrium isn't a bad thing, it's just a thing.

If you don't like the way one drug makes you feel, try another until you get one you like.

Also, check out a sleep study. Husbunny had severe depression, and finally was diagnosed with sleep apnea. A CPAP changed his life.
posted by Ruthless Bunny at 7:17 AM on February 27, 2013 [1 favorite]

I'm going against the grain: I dislike and distrust psychoactive drugs. Significant research indicates that many are effectively psychosomatic, with the primary difference being the side effects rather than the primary effects.

That said, sure, they work for many people. But they are absolutely not required for everyone, and you shouldn't feel strange saying "no thanks" to using them.
posted by ellF at 7:52 AM on February 27, 2013

Just wanted to add, on the mindfulness meditation piece, that in my own experience (anxiety), a multi-week meditation seminar I took on overcoming fear ended up being the best thing I tried for taking the edge off without medication. Even better than the meditation practice itself. So much of it is about learning the right attitude to take toward these difficult emotions, acceptance, generally being as zen as you can about things, etc. The right psychologist could also teach that attitude, of course. Good luck!
posted by lovingkindness at 7:54 AM on February 27, 2013

Agreeing with LobsterMitten - "The first semester of college can be a difficult time for a lot of people; it's a lot of big changes at once." My first semester was kind of awful. Do what you need to do to stay healthy. Can you schedule physical classes at college? A lot of classmates at my school took yoga. I took swimming. If you try something new and different, that alone will give you a bit of excitement and something to look forward to. Just a thought.
posted by kat518 at 8:46 AM on February 27, 2013

I would like to point out to people that the poster said that in the past the sertraline (which AFAIK is also called Zoloft) didn't have an appreciable affect.

I agree that depression is a real condition, just like diabetes, and it's fine to take meds for it and there should be no stigma, but it's important to realize that unfortunately, it's often a lot more complex and less understood and harder to control than diabetes. SSRIs don't have the same efficacy (when compared to placebo) at knocking out depression as insulin does to help manage blood sugar.

Sometimes you might have to try several different drugs and/or dosages, and you might find one that helps and doesn't have unpalatable side effects. But it's not as clear-cut as taking insulin as a diabetic or getting your arm set in a cast when it's broken. For some folks taking meds is life-changing but for some it's not.
posted by needs more cowbell at 8:52 AM on February 27, 2013 [2 favorites]

exercise!! like hardcore, break a sweat for half an hour EXERCISE... you'll also build a lot of muscle and get stronger and that will make you more confident too!
also maybe cut out sugars which wreak havoc on your hormones and moods! this will help give you idea of what you need to be eating. Also counselling (if you aren't already getting it), sunlight and vitamin D, and sitcoms/movies that make you happy!!

Talking to friends about it, just be soft and honest, one awkward disclosure at a time (this is a great chance to strengthen your support system)

and quit ruminating!! Set aside 30 minutes a day to think about thngs that are bothering you but you have to talk about it or write it down so that your thoughts are outside of you, in a corporeal form. Other than that, the other 23 hours and 40 minutes you are NOT allowed to think about scenarios or relive images, that takes a lot of mental discipline but you can do it! Instead focus on your breathing or ask questions, or make up fun daydreams. No ruminating you hear?!

It takes a lot of effort actually and nobody will do it for you, so you have to WANT to feel better and like yourself and be happy! I say this because when I was depressed a big part of me wanted to get better but a part of me also liked being sad and took for granted that being nervous/sad was a part of my identity, or somehow part of who I am. BUT IT'S NOT! You can be as happy and interesting as you want but you need to WANT it BAD!

Finally, the answers are already there in the threads that you have read or the counselling you have taken, or the books you have read... You know the answers, but the taking the leap of faith to put these suggestions into practice has to be ALL you! You have to do it for yourself. It's part of showing yourself self respect. So reading these answers are not enough, you have to apply them into your life! Every day! Make a list of 3-5 things you will do every single day and try to do it for one week! That's a good place to start.

Good luck, you will get better!
Source: 19 year old girl who used to be super anxious and depressed when she was 17 but is sometimes being told she is a happy person nowadays :)
posted by dinosaurprincess at 2:20 PM on February 27, 2013 [1 favorite]

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