Foundational Biohacking Strategies To Fight Depression Naturally

In this guest blog post, Jack Cincotta (MS in Psychology) explain how to counter depression naturally with foundational biohacking strategies.

If you're interested in reading more about Jack's extensive bio, click HERE. If not, continue reading Jack's excellent guest blog post:

The Problem Of Depression In The 21^st Century

If you look around, you’ll easily notice that today’s world is not conducive to optimal health. What's more many people think of poor physical health as one of the major plagues of our current society, but I argue that suboptimal mental health is even more of a concern.

Today, so many more people are struggling with anxiety and depression, among other mental health issues. And this is severely damaging their overall quality of life and negatively affecting others around them.

Perhaps you are one of these people.

After all, more than 260 million people worldwide suffer from depression, and this number is increasing significantly ⁽¹⁾. Now, there are many potential reasons for this increase, but one of the primary reasons is an increasingly modern and, thus, unnatural lifestyle ⁽²⁾.

 

Causes Of Depression

Specifically, many people in modern society are overfed but malnourished, highly sedentary, socially isolated, sleep-deprived, sunlight-deficient, and highly stressed and worried. This contrasts sharply with the lifestyles of our ancestors, who ate an all-natural diet, moved a lot throughout the day (out in nature), had very close social bonds, got plenty of sleep, and only experienced intermittent bursts of stress, followed by longer periods of relaxation. 

Based on overarching theories of basic needs, one can easily see that the fundamental needs for most people simply aren’t being met, in turn causing the detriments in health that are expected to occur.

 

Consequences Of Not Getting Your Basic Needs Met

So, what is the end result of all of this? Severely suboptimal health, both on a physical and mental level. But I particularly want to talk about mental health and how these factors are related to depression. 

From a neuroscience perspective, depression can be analyzed from a number of different levels ^{(3) (4)}:

 

Impaired neurotransmitter function, including the monoamines (dopamine, serotonin, and noradrenaline), but also GABA and glutamate; altered neurotrohpin function, including decreased brain-derived neurotrophic factor (BDNF); neuroendocrine effects, such as HPA-axis dysfunction and chronic inflammation, particularly neuroinflammation; anatomical abnormalities, at both a structural level and functional level in various brain regions; cognitive abnormalities, measured by subjective and objective means, such as biases in information processing and emotional regulation; and last, but definitely not least, relationships between the brain and other body regions, such as the gut-brain axis, but also antioxidant-oxidant imbalance, mitochondrial dysfunction, and circadian rhythm-related dysfunction.

 

And, as you’ll see more specifically later, a modern lifestyle causes disruptions in all of these areas, which easily illuminates why depression is increasing. Thankfully, though, this same perspective affords a relatively easy ability to understand how to optimize all of those levels in order to overcome depression and optimize health.

 

Why Antidepressants Can Be Lifesavers & Should Not Be Universally Used At The Same Time!

And, no, the answer is usually NOT to take antidepressants, maybe unless you have very severe depression. Antidepressants treat symptoms, not the cause of most problems, and sometimes they don’t even counter symptoms very well.

This is an unfortunate downfall of many aspects of Western medicine; people are prescribed pills to treat symptoms rather than figuring out the root cause of the problems. So, sure, antidepressants might make you feel less depressed (though they can actually INCREASE depression in a surprisingly high number of cases), but they really aren’t solving the problem.

 

Finding The Root Cause Of Depression

The crucial question to answer is, “why is a given person depressed?”

Is he/she depressed due to a poor lifestyle? Chronic stress? Traumatic past events? Another underlying mental or physical condition? A combination of these? Once you figure out the cause, then implementing solutions to fix the causes will treat the real issue.

And as you will see, an essential first step is to stop living the typical modern lifestyle and change your diet, lifestyle, and environment to more closely match our natural ways.

Yes, there are other components that potentially need to be addressed when overcoming depression, especially in severe cases. Such things include psychotherapy, brain stimulation, and potentially medication. Another option increasing in popularity is the use of psychedelics.

The purpose of this article is not to illustrate those higher-up treatments because those often shouldn’t be the first step. Yes, they might need to be included in a fair amount of depression cases and can be done with great success. But addressing diet, environment, and lifestyle needs to be the priority in all cases because it will always help.

In this review, you’ll see how there are many simple things you can do to start managing depression and eventually optimize your mental health. And you will see how all of these things are directly related to all of the main neuroscientific levels of depression.

In all honesty, this information would benefit all people, regardless if they have depression, but there are also many things I talk about in here that are depression-specific, and thus should be particularly paid attention to. 

 

A Systematic Approach To Counter Depression

Ultimately, in order to overcome depression, it is necessary to optimize neurotransmitter functioning, reestablish neuroendocrine health, enhance structural and functional activity in key brain regions, eliminate cognitive biases and other negative though patterns, and overall reduce the toxic burden placed on the body.

But remember, those are related to all of the symptoms, not the causes. They are the manifestations of depression. Thus, interventions need to center around fixing the root causes of all of those problems. And to do this requires the following steps, all of which are directly related to living a more natural life.

 

Dietary and Nutritional Protocols for Depression

If you want to overcome depression or minimize the risk if you aren’t depressed, your diet is an essential place to start. If you’re eating a Standard American Diet or any diet typical of the modern world, your risk of depression is much higher than eating a natural, whole-foods diet ⁽⁵⁾.

This is because a poor diet- one that is loaded with sugar, unhealthy fats, refined grains, and processed foods of all sorts- causes disruptions in the microbiota-gut-brain axis, increases oxidative stress and inflammation, and produces more free radicals, in addition to other negative effects, all of which increase depression ^{(6) (7)}. Neurotransmitters and overall brain function as a whole are also disrupted by a suboptimal diet.

 

A Great Starting Point: A Mediterranean-Like Diet

So, the first step is to remove all unhealthy foods and all potentially inflammatory foods, which are ones that you may be sensitive to. While there are a lot of potential culprits, a great place to start is to surely remove all processed foods, especially ones high in sugar and vegetable oils, and then conventional dairy, gluten, and GMOs. Any food that you are allergic or sensitive to needs to be eliminated so as to decrease the toxic burden placed on the body.

From there, it is necessary to include the best anti-depressive foods. Such foods include wild fish, grass-fed meat, fruits, vegetables, properly prepared whole grains, legumes, and nuts, and olive oil ⁽⁷⁾. There is no one best diet for depression, and eating a healthy diet won’t magically erase your depression, but this is a great place to start. Eating in this manner provides a vast array of nutrients that your brain and body need to function well.

A recent massive review on diet and mental health ⁽⁸⁾ showed that the aforementioned foods are the best to consume, and this was for the following reasons: They provide the body with a balance of macronutrients and micronutrients that feed the brain; these foods aid in decreasing neuroinflammation and oxidative stress; this diet optimizes the microbiota-gut-brain axis (especially in the case of fruits, vegetables, whole grains, nuts, and legumes); and these foods increase the production of key neurotransmitters and BDNF.

In other words, eating this Mediterranean-like diet helps to optimize all of the key levels of depression pathophysiology mentioned earlier.

 

The  Best Supplements To Prevent And Counter Depression

However, there are other specific nutrients that should be increased at a higher level for those suffering from depression, and this is sometimes in the form of supplementation. Due to the specific pathophysiology of depression, these individuals should also be particularly mindful of increasing omega-3 fatty acids, magnesium, and B-complex vitamins.

 

Omega-3 Fatty Acids

The brain and central nervous system as a whole have a very high concentration of fatty acids relative to other parts of the body, so it is essential that they are fed the right nutrients.

Specifically, there needs to be a balance between omega-3 and omega-6 fatty acids, somewhere in the neighborhood of 1:1. Many people in today’s society consume far too many omega-6 fatty acids, upwards of 10 to 20x their omega-3 consumption, which leads to neuroinflammation.

On the other hand, consuming plenty of omega-3s will reduce neuroinflammation and most likely decrease both depression and anxiety ⁽⁹⁾. Increasing omega-3s is known to lead to beneficial structural and functional changes in the brain, both in the grey matter and white matter. And the effects are found in various areas, including frontal, temporal, and parietal regions ^{(9) (10)}.

Furthermore, omega-3s play a key role in many other neuroprotective effects, such as in endocannabinoid balance and in HPA-axis regulation, thus further illustrating the importance of omega-3s ^{(9) (10)}.

So, to implement this, the first thing you should do is go straight to the source and consume plenty of wild-caught fatty fish two to three times per week. Salmon and sardines are your best bet as they are loaded with EPA and DHA. Higher consumption of seafood in its whole form is directly related to decreased depression ⁽¹¹⁾.

You may also need to supplement with EPA and DHA, however, because the amount of omega-3s needed to optimize brain health can get pretty high, especially if you’re not someone who enjoys fish. The take home message is simple: eat some wild-caught fatty fish and supplement with EPA/DHA if necessary. Aim for at least 1,500 mg of EPA/DHA daily.

If you're interested in learning more about omega-3s and why they're important in health, read my article Seafood: A Nutritional Powerhouse.

 

Magnesium

There are also a few minerals related to depression, such as magnesium, zinc, and iron, but by far the most relevant one is magnesium. If you are deficient in magnesium, your chances of depression are much higher than someone who isn’t, there’s just no way around it ^{(12) (13)}.

Magnesium has a colossal role in the central nervous system and there are so many implications for its role in depression ⁽¹⁴⁾. For example, magnesium plays an essential role in the stress response; plays a key role in all monoaminergic systems and their neurotransmitters (serotonin, dopamine, and noradrenaline); is greatly involved in the glutamatergic system, in which magnesium is necessary to keep the NMDA ion channels in balance, for example; and finally, plays a key role in attenuating neuroinflammation.

Thus, without enough magnesium, one might experience increased cortisol, decreased serotonin, dopamine, and noradrenaline, and greater inflammation. Furthermore, calcium channels will be biased towards opening which causes neuronal overexcitability, and there will likely be excessive glutamate, thus exacerbating depression.

With all of these reasons, I hope you can see why it is so essential to get enough magnesium.

Unfortunately, consuming magnesium-rich foods, such as beans, grains, nuts, seeds, and leafy greens, is usually not enough for most people, especially those with depression. This is because individuals with depression have much higher levels of stress and thus need to consume much more magnesium than the average person.

It is already hard enough for non-depressed individuals to get enough magnesium, but the needs for depressed people are even higher; thus, supplementation is absolutely necessary. Don’t get me wrong though, be sure to consume plenty of magnesium-rich foods as well. 

In regard to supplementation, many studies have shown reductions in depression after magnesium supplementation, sometimes very rapidly. And this is no doubt due to the massive benefits it has on all aspects of CNS function ^{(14) (15)}.

However, the form of magnesium is important. Steer clear from magnesium oxide and other poorly bioavailable forms.

Your best bet is magnesium glycinate or magnesium l-threonate (latter is more expensive, but crosses the blood-brain barrier the most efficiently). You can also use magnesium oil, but I’ve found that, for the purpose of decreasing depression, glycinate and l-threonate are better. As far as dosage is concerned, studies have shown benefits from 200 mg all the way up to 1,200 mg or more. A great baseline I suggest is to supplement with 500 mg of magnesium glycinate in the evening. Shoot towards 1,000 mg or more if your symptoms are more severe.

 

B-Complex Vitamins

Finally, you should consider supplementing with B complex vitamins, particularly B6, B9 (Folate), and B12.

B-vitamins are involved in essentially every aspect of brain function. All of the B-vitamins effectively cross the blood-brain barrier, and they are also involved in energy production in the brain, neurotransmitter synthesis, and play roles in antioxidant-oxidant balance, immune activity, and inflammation control ⁽¹⁶⁾. Thus, you can see the paramount importance B-vitamins have in brain function.

A deficiency in any of the B-vitamins can be related to depression and its related symptoms, but this is especially true for vitamins B³ (niacin), B⁶, B⁷ (Biotin), Folate, and B^{12 (17)}. Without these sufficient vitamins, and perhaps all B-complex vitamins, the risk for neurotransmitter depletion, inflammation, low energy, and overall poor mood is greatly increased.

This is why it is vital to get enough B-complex vitamins in your diet, and this is most easily done through animal food consumption, such as meat, dairy and eggs, though various plant foods contain many B-vitamins as well.

Just as with omega-3s and magnesium, however, I would strongly consider supplementing with a high-dose B-complex vitamin because levels are typically lower in depressed individuals compared to the general population.

And evidence suggests that optimal brain health requires B-vitamin dosages much higher than the current FDA guidelines, regardless if one is depressed or not ⁽¹⁷⁾.

Thus, high-dose B-complex supplementation could be seen as both a preventive and curative measure for depression. As for exactly how much, there isn’t enough evidence yet from research for me to give you guidelines, but just be sure to choose a highly bioavailable B-complex vitamin rather than the standard ones you see in most stores.

 

Exercise and Movement

Just like a standard modern diet increases the risk of depression, the status quo of a sedentary lifestyle also greatly increases the risk of depression across all age groups ^{(16) (17)}.

And in reality, it isn’t a lack of purposeful exercise that is causing depression, but simply a lack of movement. After all, our ancestors never engaged in purposeful exercise; movement throughout the day was simply their way of life; it wasn’t an option. Now, though, obviously, most people’s lifestyles don’t involve constant movement, so exercise is usually needed. 

A number of studies have shown that regular exercise reduces the risk of depression and enhances mental health ^{(18) (19) (20)}.  

Aerobic exercise received the most attention initially, but we now know that any form of exercise is beneficial, whether it’s aerobic, anaerobic/resistance, or even simple mind-body exercises (e.g. yoga) ⁽²¹⁾. Aerobic exercise does seem to have a slight edge, though, for antidepressive effects.

Nonetheless, this is great news because it means you can choose the form of exercise that you enjoy the most, which should lead to greater adherence for the long term…obviously an important factor.

You probably know that exercise feels good; but why exactly does this occur? Well, there are a few specific mechanisms as to why exercise reduces depression:

 

• First, it is known to boost endorphins, serotonin, and dopamine, all of which enhance mood and mental functioning ⁽²²⁾.
• Furthermore, it enhances the structural and functional connectivity of various brain regions, such as the prefrontal cortex, anterior cingulate cortex, hippocampus, and corpus calossum; and leads to increases in grey and white matter ⁽²³⁾.
• Exercise also increases BDNF, is involved in neuronal maintenance, and is associated with better regulation of inflammation and antioxidant activity, all of which are involved in neuroprotective and antidepressant processes ⁽²⁴⁾.
• Lastly, exercise plays a massive role in balancing the endocannabinoid system, which is involved greatly in mood, sleep, and overall well-being ⁽²⁵⁾.Furthermore, exercise and movement throughout the day is important for a healthy lymphatic system and for decreasing inflammation, all of which provide further protective benefits on mood and mental health.

 

Luckily, to receive these benefits can be as simple as walking a few times per week. An overall recommendation for overcoming depression, based on research, is to engage in moderate exercise for 30 to 45 minutes, three times per week. Simply walking is just effective as some antidepressant medications.

You never want to overdo on exercise, as this will increase stress and thereby potentially increase the risk of depression. No need to train for a marathon or try to win a bodybuilding contest. In fact, those quests might very likely increase depression. 

The key is to do something you enjoy and something that makes you feel good and energized, not drained. Some studies show that higher intensity exercise leads to greater benefits, but the overall picture is inconclusive, and exercise at all intensities is beneficial ⁽²⁰⁾.

Thus, don’t feel bad if you only do light exercise. Just pick something you enjoy. Walking, biking, weightlifting, bodyweight circuits, swimming, gardening, basketball, tennis, the list goes on and on! But you have to start somewhere, and you have to move on a consistent basis.

Even if you’re at a very low point right now, start out very small; just 5 minutes per day, three times a week, for example. But eventually work your way up to the recommended dose of 30 to 45 minutes, three times per week.

 

Sunlight and Artificial Light: Circadian-Rhythm Alignment

Yet another simple but highly effective way to improve depression is to match the day and night rhythms of our ancestors. Many people in society do almost the exact opposite in terms of what is natural for light exposure. Most people are indoors all day, never getting exposed to sunlight, and then continuing to stay indoors at night, utilizing all sorts of electronics and other technologies that emit blue light.

In turn, a lack of sunlight during the day and artificial light at night is a massive factor in circadian rhythm disruption and mood disorders, including of course depression ⁽²⁶⁾. We as humans have adapted to a consistent 24-hour day/night cycle, yet this is being completely altered by the modern world and thus causing circadian rhythm disruption ⁽²⁷⁾.

And circadian rhythm disruption is a notable factor in depression, with further evidence pointing to it as an absolutely crucial factor in depression pathology ⁽²⁸⁾.

The day/night alterations are further exacerbated by depression itself which can cause low energy and a lack of “doing” during the day, yet excessive thinking and worrying at night, which obviously does not align with our natural rhythms. 

As to why these problems occur, it is due to alterations in the suprachiasmatic nucleus, which ultimately controls circadian rhythms ⁽²⁹⁾. Living an unnatural lifestyle by being exposed to artificial light at night alters the SCN function and disrupts brain regions linked to mood regulation, thus causing mood disturbances.

Other key factors, of which are related to SCN disruption, include disruptions in melatonin and cortisol rhythms, which play a large role in sleep, mood, and stress. There are also other hormonal and molecular alterations that occur, along with increased nighttime body temperature, and impairments in serotonin, dopamine, and noradrenaline activity.

From both the objective physiological markers and hallmark features of depression, one can see how circadian rhythm disruption and depressive symptoms act together to create a downward spiral on one’s health.

Thus, in order to overcome depression, your circadian rhythm needs to be normalized. Luckily, to do this is quite simple, though simple does not necessarily mean easy. To do this, though, all it takes is getting outside during the day and eliminating artificial light at night, as well as aiming to be more active during the day and restful at night.

More specifically, you should get exposed to the sunlight as soon as possible after waking up; aim to get at least 5 minutes, but ideally 30 minutes every day.

During the afternoon, it would also be wise to get more sunlight; another 15 to 30 minutes is beneficial. This will only increase serotonin further and thus provide you with more melatonin at night, since serotonin is converted to melatonin, provided there is the cue of darkness.

You could also use bright light devices if you can’t get natural sunlight during the day, although this would be less than ideal. Regardless, light therapy, in whatever way you do it, is very likely to significantly reduce depression, and is usually more effective than other treatments, such as antidepressants ⁽³⁰⁾.

Importantly, these effects are for both seasonal and non-seasonal depression. Seasonal depression got the most attention initially for light therapy because of the role lack of sunlight during the colder months played in mood. But even for people with year-round, non-seasonal depression, light therapy is very effective ⁽³¹⁾.

And in the evening, make your environment as close to the natural world as possible. Ideally, this would mean shutting off all electronics and using candles for light. But I know this isn’t feasible for all. So, the other option is to use blue-light blocking glasses and amber lightbulbs, as these create an environment that is still relatively close to what we would’ve seen at night in our ancestral days around a fire, for example.

Oddly, research on eliminating artificial light at night for depression is pretty scant compared to the research on bright light therapy during the day. Nonetheless, there is still enough evidence to suggest that blocking light at night improves sleep, mood, and overall circadian rhythm function, and should improve depression as well.

In addition, there is another reason light has an impact on health, specifically sunlight. Sunlight exposure also has positive effects on the HPA-axis, immune function, and leads to increases in dopamine and serotonin. Unsurprisingly, greater sunlight exposure is related to improved mood, less stress and depression, and overall greater well-being ⁽³²⁾.

Vitamin D was also initially thought to be a reason for sunlight’s beneficial effects on mood, but recent research indicates that vitamin D is more likely just a marker of depression, rather than a cause or consequence ⁽³³⁾.  Still, that points to the importance of getting enough sunlight.

Overall, if you want to reduce depression, it is crucial to realign your body with its natural day and night rhythm.

 

Sleep

It should be obvious by now, but if you are unaware, sleep is essential for mental health. Lack of sleep increases neuroinflammation, leads to increased toxic buildup in the brain, impairs gut function, increases oxidative stress, disrupts the HPA-axis, decreases neurotransmitter function, and negatively affects all brain areas, all of which increases depression ⁽³⁴⁾.

Importantly, both sleep quality and quantity are important. Both long and short sleep duration are associated with increased depression and, unsurprisingly, poor sleep quality is also related to increased depressive symptoms ^{(35) (36)}.

Unfortunately, identifying the exact relationship between sleep and depression is tricky. It was previously thought that sleep problems were simply the result of depression, but emerging evidence definitively shows that the relationship between sleep disturbances and depression is bidirectional ^{(37) (38)}.

Depressed mood can lead to sleep problems but sleep problems can also lead to depressed mood. In most cases, it is likely that both factors are having an effect, causing a downward-spiral dynamic in terms of health outcomes. 

That is why, in order to overcome depression, one has to incorporate things that simultaneously improve sleep and reduce depression ⁽³⁷⁾. In some cases, treating sleep problems should actually be the first priority as opposed to treating depression, since sleep problems so often have a causal role in psychiatric disorders ⁽³⁸⁾.

The basic sleep hygiene tips are definitely beneficial, but for those with depression, cognitive behavioral techniques are also often needed. But I do want to briefly list the important basic sleep hygiene tips, as doing all of these things is known to improve sleep in people with clinically diagnosed depression, just as well or better than pharmaceuticals ⁽³⁹⁾.

Such things include:

• maintaining a regular sleep-wake schedule;
• making the bedroom dark, cool, and well-ventilated;
• ensuring you have a comfortable mattress and pillow;
• not eating big meals close to bedtime;
• eliminating caffeine and alcohol use;
• not exercising intensely too close to bedtime;
• journaling before bed;
• relaxing one hour or so before bed;
• eliminating technology and other artificial light at night, or at least one hour before bed;
• and, lastly getting exposed to light in the morning (review the sunlight and artificial light section).

 

All of these things will increase sleep quality and should help you to feel better. Beyond this, though, many people with depression struggle with cognitive distortions. Specific to sleep, these can be in the form of sleep anxiety or general anxiety, in which they worry about not sleeping enough and worry about their life in general, respectively. Thus, cognitive behavioral techniques need to be implemented.

Cognitive behavioral therapy for insomnia (CBT-i) is the most effective non-pharmaceutical treatment for insomnia ^{(37) (40) (41)}.

CBT involves stimulus control, which limiting the bed for only sleeping and sex, and not any stimulating behaviors; sleep restriction, meaning only spending the amount of time in bed actually sleeping, thereby improving sleep efficiency; implementing sleep hygiene practices (talked about earlier); relaxation training, such as guided imagery and progressive muscle relaxation; and last, but definitely not least, cognitive techniques to change distorted thoughts into healthier ones.

With further regard to the cognitive aspects, many with insomnia and depression have worrisome thoughts about sleep and engage in a lot of repetitive thinking patterns, so it is vital to correct these.

Fortunately, CBT-i improves both depression and insomnia in individuals with these comorbid conditions ^{(40) (41)}. And CBT-I appears to specifically reduce the negative thinking patterns surrounding sleep that so often occur in depression ⁽⁴¹⁾.

 It is likely that a number of pathways are involved, such as that treating insomnia would improve depression, treating depression would improve insomnia, and doing both at the same time would result in an upward-spiral dynamic of improvement.

It should be noted, though, that the benefits of CBT-i for comorbid insomnia and depression are more beneficial for insomnia than depression. Both conditions definitely benefit, but insomnia seems to benefit more so ⁽⁴⁰⁾. Furthermore, repetitive negative thoughts about sleep are reduced more compared to repetitive negative thoughts in general ⁽⁴¹⁾.

This is still very positive though, because insomnia improvements by itself will lead to improved depression. And, given that there ARE depression-specific improvements from CBT-i as well, this should be seen as a first line of treatment for all people with sleep problems and depression.

Even if you don’t want to seek professional help, you can still get benefits. CBT-I can most definitely be practiced on your own, with great success. Indeed, self-help CBT-i is also very effective for reducing insomnia and depression as well ⁽⁴²⁾. Like anything, it will take practice, but over time you will definitely start to notice healthier thought patterns surrounding sleep and depression and thus improvement in both areas.

Aiming solely to treat depression in order to improve sleep is the wrong mindset. Treating both simultaneously is necessary in order to improve both conditions and thus lead to an overall healthier mental state.

 

Socialization

Another vital factor in depression is loneliness or social isolation. 

Loneliness literally kills. Social connection is a vital human need, and without it, many negative effects result. Related specifically to this article, loneliness is known to significantly increase the risk of depression, and it is often seen as a predisposing factor to depression ^{(43) (44)}.

We never lived in isolation. In our early years, humans always lived in groups and relied on each other for survival. These tight-knit groups continued to be the norm until only very recently, with advances in technology and industry leading to a greater capacity for us to be able to move away and not need to interact with others as much. We just don’t need others as much for survival as we used to.

Or do we?

Sure, we don’t need to go in groups to hunt and gather anymore, but our brains still require social support for optimal functioning. Without it, the brain goes haywire.

Loneliness and social isolation are related to increased inflammation, higher cortisol levels, disrupted HPA-axis function, and overall declines in neuroendocrine health ^{(45) (46)}.

Moreover, these are also related to disruptions in structural and functional aspects of brain regions involved in various social processes and mentalizing in general, such as prefrontal, parietal, and temporal areas, as well as the hippocampus, amygdala, and insula, among many other regions ⁽⁴⁷⁾. Thus, one can see how loneliness and social isolation are huge causes of the key symptoms of depression noted earlier.

Therefore, the need for quality social support and connections is vital. Note that I said quality, not necessarily quantity. Having greater social support is most definitely beneficial for all aspects of mental health ⁽⁴⁸⁾. This is especially true for those who perceive a greater amount of quality social relationships ⁽⁴⁹⁾.

One of the primary reasons for this is that greater social support and better relationships are reciprocally related to higher self-esteem ⁽⁵⁰⁾. And high self-esteem is obviously a protective factor against depression. 

Social support also reduces stress, increases feel-good hormones and neurotransmitters, such as serotonin, dopamine, and even oxytocin (especially with physical contact), and overall just gives the brain the right “nutrients” for optimal functioning. The brain is simply designed to respond best in a world of social interaction. 

Social connections provide one with a feeling of comfort, hope, enjoyment, and many other things, all of which improve mood and decrease the risk of depression. Simply put, life is just more enjoyable when there are others around to share it with. This is especially important if you’re depressed because it often feels easier to just go off by yourself and not talk to anyone; but that is the exact opposite of what you need to be doing.

Furthermore, friends and family are vital people to turn to and talk things over with when things get tough, and when there are many obstacles to overcome. Without social support, depression may very likely develop into suicidal ideation and eventual suicide.

On the other hand, the likelihood of overcoming depression becomes much higher if one is socially connected ⁽⁴⁹⁾. Also, engaging in social groups is a great way to prevent relapse when coming off of antidepressants and to continue being able to stay off of them ⁽⁵¹⁾.

This is why, if you’re depressed or feeling more down than usual, make a point to see people often. Schedule a night with your friends to hang out, ideally once a week. And talk to your family often, unless you have significant problems with them (which obviously need to get handled).

Use these moments to see if they can help you out with what you’re going through, but also use these moments to have a lot of fun too. Friends and family are there to support you, but they’re also there to have fun with you. A nice balance of these things is surely the best way to use social support.

Also: stay off of social media, or at least reduce your consumption of it.

Sure, it might feel good in the moment, but social media provides a virtual sense of connection and support. Other times, staying on social media can lead to feelings of worthlessness and low self-esteem, especially since many people engage in upward social comparisons when on those sites, and this isn’t doing any good for your symptoms.

Furthermore, using social media can replace the necessary face-to-face social interactions, thereby potentially decreasing mood and overall mental health. 

Importantly, the way one uses social media is the most crucial. Increased social media use as a whole is related to increased depression, but the effects are even greater when one engages in problematic social media use ^{(52) (53)}.

Problematic social media use involves using it in a passive manner by scrolling through social media and all of the profiles, using it excessively, checking it very often, and using it to fill voids in one’s life. And depression is a risk factor for problematic social media use, thus further increasing these problems.

Problematic social media use is related to lower self-esteem and life satisfaction, as well as greater distress and loneliness, which points out some of the mediators between problematic social media use and depression ⁽⁵³⁾. This is why it is best to cut out social media as much as possible, at least for a while until you start feeling better. 

Overall, I hope you see how social connection and support is so vital for mental health, and that engaging in social connection through a virtual sense is definitely not the answer.

 

Spending Time In Nature

Another way to greatly improve your depression is to get out into nature. Urban environments are associated with lower mental health compared to rural environments, in large part because the former environments have so many factors that increase stress, such as crowding, noise, light and air pollution, and a frenetic pace ⁽⁵⁴⁾.

So, it is best to live in a rural environment if your goal is to overcome depression. However, even if you live in a city, you can still get the benefits by engaging in forest therapy.

Forest therapy should be done by everyone, regardless of where they live. It simply means participating in various activities in the natural world, yes usually a forest. But beaches, mountains, and grasslands obviously all work too.

Recent analyses and reviews on forest therapy shows that it significantly reduces the risk for depression and is a very effective way to treat depression too ⁽⁵⁵⁾. In fact, forest therapy is much more beneficial than therapy in a traditional setting, and it also is more effective than other alternative therapies.

These decreases in depression are likely due to the fact that forest therapy leads to improvements in many areas of physiological and psychological health ⁽⁵⁴⁾. Such benefits include reduced stress and cortisol, improved heart rate variability, lower blood pressure, less tension and anxiety, decreased rumination, higher feelings of restoration and vigor, better emotional regulation, and increased feelings of connectedness ^{(54) (56)}.

Related specifically to the key features of depression, spending time in nature is associated with more relaxed central nervous system activity, increased parasympathetic nervous system activity, lower cortisol and optimization of other hormones, in addition to a healthier gut microbiota, all of which reduce the risk of depression and improve mood and well-being ⁽⁵⁶⁾.

The benefits are even better if you practice “grounding”, which is direct contact with the earth; doing so significantly decreases inflammation, reduces cortisol, improves sleep, shifts your nervous system into a more relaxed state, and can even play a role in balancing day and night rhythms ⁽⁵⁷⁾. As you can see, the benefits of forest therapy are massive, and all of these are potential mediators in decreasing depression.

All of this really shouldn’t be too surprising. After all nature is where we’re meant to live. Everybody would benefit from getting more time inside. So many people are cooped up indoors all day and night, never getting exposed to the best environment that life can offer. And while everyone should do this, it is especially important for those with depression.

Simply put, if you have depression, you’re in a state of higher stress and much lower state of health than some other people, so you need to do all you can to improve your symptoms. And simply getting outside is a great first step 

Aim to get out in nature for 30 minutes every day, the more the better. And remember to be barefoot for at least part of this time, if not all of it in order to further increase the benefits.

Use it for periods of reflection or just “being”; or use it to exercise, have fun, and do activities with others.

Getting out into nature puts things into perspective and reminds you of the sheer beauty and complexity of life, yet at the same time how seemingly effortless it operates. Returning to nature provides an instant calm, even amidst the most negative emotions, thoughts, or feelings.

All people, but especially those with depression, can get caught up and dwell on the chaos or negatives of life, but returning to nature acts as a reminder of how we’re truly meant to live. It might even provide an “aha” moment for you as you realize just how wrong a lot of our society is operating, and that there is always a simpler alternative. But I’m moving into speculation now rather than science, so I’ll stop there.

 

Addressing Rumination & Cognitive Distortions

All of the lifestyle components mentioned so far are vital for overcoming depression. However, there are also key components beyond these factors that need to be addressed in individuals with depression. Mainly, rumination and cognitive distortions need to be addressed, as these are very common factors associated with depression.

Rumination is the act of repeatedly dwelling on thoughts and involves excessive focus and emotional attachment to thoughts as well. These are usually of a negative nature too, especially in people with depression. Depression is significantly associated with ruminative activity, so it is vital to correct this ^{(59) (60)}.

One of the main ways rumination or otherwise negative thinking can increase depression is because it acts as yet another stressor on the body. Through the constant stream of negative, critical, sad, angry, or other unhelpful thoughts and feelings, the body senses that it is under threat.

Thus, the stress response is activated over and over again, leading to disruptions in all areas related to depression mentioned so far. Even though the stress is psychological, and not physical, it is still having the same effect (from a physiological/biological standpoint), so it is absolutely essential to correct these patterns.

And one of the best ways to address rumination, as well as cognitive distortions in general, is to employ mindfulness therapy.

Mindfulness therapy ⁽⁶¹⁾, with a specific focus on rumination, helps you to simply acknowledge your thoughts, see them for what they are, and to act in a less-emotional, more rational way. Rather than seeing thoughts as dangerous and a massive bombardment on your well-being, mindfulness teaches you how to recognize that thoughts are just thoughts, nothing more, and it then puts you in a better place to take action in order to solve your issues and/or reframe your perspectives. 

When you engage in mindfulness, you become fully present and you are more able to understand why you might be having certain thoughts, and you are also more able to address the rationality of your thoughts. Often times, in people with depression, thoughts are highly irrational, so mindfulness is a great way to assess the reality (or lack thereof) of what your thoughts are telling you. 

Briefly, some of the common categories of irrational thoughts in individuals with depression include black and white thinking, overexaggerating the negatives, underestimating or disqualifying the positives, all-or-nothing thinking, and overgeneralization.  For an example, let’s say someone was able to enjoy a day of fun with family and friends and had many positive experiences, yet they dwelled on the one bad conversation they had with a relative who annoyed them.

This is a very simple example, and there are probably endless amounts of cognitive distortions that occur, but the take-home point is that mindfulness helps you to stop the negative thoughts from spiraling out of control and to really look at your situation from a more rational standpoint.

Because a depressed brain is NOT rational; it is biased towards the stress response and seeing things in a negative light. This is why you have to slowly but surely rewire the brain over time to its natural, healthier state.

The trouble is that when you’re in a biased state, you so firmly believe what your negatively wired brain is telling you, and this is why it takes time to change. So, you just have to look for one small thing at a time to correct. If you can say, “wait a minute, that’s not entirely true”, then you’re headed in the right direction. But you have to be fully present to do this, and this is exactly what mindfulness is great for.

It is no surprise, then, that mindfulness-based therapy for rumination significantly decreases rumination and depression ^{(61) (62)}. And it is significantly better than usual care for depression alone ⁽⁶¹⁾.

Now, the best way to use this is to practice in the morning and evening, even for as little as 5 minutes, but preferably 20 minutes or more. When you do this, don’t TRY to do anything; just let the thoughts come, acknowledge them, and recognize why they might be occurring. Ask yourself if the thoughts are rational and if they present a real threat; and if so, what exactly can you DO to solve them.

It takes practice to correct these thought patterns, and you may very well need to go to therapy for help here, and CBT is a great route ⁽⁶³⁾, but some of you may be able to use this technique on your own with great success. This is especially true for those of you with milder forms of depression.

There are many other things you can do to decrease rumination and to reduce negatively biased thinking as well. All of the lifestyle components mentioned so far, especially exercise and getting out into nature, should help decrease rumination. Some other good techniques are to simply write your thoughts down; doing so “gets it out of your head” and allows you to look at thoughts from a more objective angle.

Gratitude journaling and self-compassion journaling are also great techniques. These interventions come from the field of positive psychology and have been shown to reduce depression and increase feelings of well-being, happiness, and life satisfaction ^{(64) (65)}. It just makes sense, really. Often, individuals with depression only focus on the negatives in the world and in themselves, so gratitude and self-compassion help one to recognize good things in life and positives about oneself, thereby reducing depression.

 

Finishing Thoughts: That’s a Wrap - The Human Body Is A Complex System And So Should Be Your Solutions!

As you’ve seen from above, the modern world is not at all conducive to optimal levels of mental health. Many factors of modern life greatly increase the risk of depression and/or exacerbate pre-existing depressive symptoms.

Fortunately, with this understanding, you can easily see what you should cut out from your life and what to add to it. 

And as noted, if you have depression, you need to return to a more natural lifestyle, and you also need to address your tendencies towards rumination and cognitive distortions in general.

Essentially, depression is a signal telling you that something or many things in your life are not how they’re meant to be. It doesn’t matter if you take the perspective of biology, psychology, physiology, or even spirituality. The point is that something or many things are missing from your life; ones that we so desperately need for optimal mental health.

Thus, implementing all of the things mentioned will surely help you be on your way to feeling better. As I said before, all people could potentially benefit from these points, but they are especially helpful for those of you with depression.

If you have mild to moderate depression, these changes may be all you need to overcome depression. But even if you have severe depression, these changes will help, though many other things might need to be implemented as well.

The main point of all I’ve said so far is that we are not meant to be living the modern life that so many of us are. We are meant to eat natural foods; to move around a lot; to enjoy the sun and nature; to get up when it’s day and sleep when it’s night; to have fun with family and friends; and to be able to stay in the present moment without worry, rumination, or unhelpful thoughts and feelings.

That is why if you start to do all of these things, your mental health will improve dramatically, and you will very likely feel the weight of depression being lifted off of your shoulders.

 

Items Mentioned:

• Magnesium glycinate
• Magnesium l-threonate
• Jarrow B complex vitamins

 

Author Background 

 

References

1. James, S. L., Abate, D., Abate, K. H., Abay, S. M., Abbafati, C., Abbasi, N., ... & Abdollahpour, I. (2018). Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. The Lancet, 392(10159), 1789-1858. https://doi.org/10.1016/S0140-6736(18)32279-7
2. Hidaka B. H. (2012). Depression as a disease of modernity: Explanations for increasing prevalence. Journal of Affective Disorders, 140(3), 205–214. https://doi.org/10.1016/j.jad.2011.12.036
3. Li, Z., Ruan, M., Chen, J., & Fang, Y. (2021). Major Depressive Disorder: Advances in Neuroscience Research and Translational Applications. Neuroscience bulletin, 1-18. https://doi.org/10.1007/s12264-021-00638-3
4. Kaltenboeck, A., & Harmer, C. (2018). The neuroscience of depressive disorders: A brief review of the past and some considerations about the future. Brain and Neuroscience Advances. https://doi.org/10.1177/2398212818799269
5. Nicolaou, M., Colpo, M., Vermeulen, E., Elstgeest, L. E., Cabout, M., Gibson-Smith, D., ... & Visser, M. (2020). Association of a priori dietary patterns with depressive symptoms: a harmonised meta-analysis of observational studies. Psychological medicine, 50(11), 1872-1883. . https:// doi.org/10.1017/S0033291719001958
6. Koopman, M., & El Aidy, S. (2017). Depressed gut? The microbiota-diet-inflammation trialogue in depression. Current opinion in psychiatry, 30(5), 369-377. https://doi.org/10.1097/YCO.0000000000000350
7. Kris-Etherton, P. M., Petersen, K. S., Hibbeln, J. R., Hurley, D., Kolick, V., Peoples, S., ... & Woodward-Lopez, G. (2021). Nutrition and behavioral health disorders: depression and anxiety. Nutrition reviews, 79(3), 247-260. https://doi.org/10.1093/nutrit/nuaa025
8. Godos, J., Currenti, W., Angelino, D., Mena, P., Castellano, S., Caraci, F., ... & Grosso, G. (2020). Diet and mental health: Review of the recent updates on molecular mechanisms. Antioxidants, 9(4), 346.
9. Liao, Y., Xie, B., Zhang, H., He, Q., Guo, L., Subramaniapillai, M., ... & Mclntyer, R. S. (2019). Efficacy of omega-3 PUFAs in depression: a meta-analysis. Translational psychiatry, 9(1), 1-9. https://doi.org/10.1038/s41398-019-0515-5
10. Larrieu, T., & Layé, S. (2018). Food for mood: Relevance of nutritional omega-3 fatty acids for depression and anxiety. Frontiers in physiology, 9, 1047. doi: 10.3389/fphys.2018.01047
11. Sánchez-Villegas, A., Álvarez-Pérez, J., Toledo, E., Salas-Salvadó, J., Ortega-Azorín, C., Zomeño, M. D., ... & Serra-Majem, L. (2018). Seafood consumption, omega-3 fatty acids intake, and life-time prevalence of depression in the PREDIMED-plus trial. Nutrients, 10(12), 2000. https://doi.org/10.3390/nu10122000
12. Sun, C., Wang, R., Li, Z., & Zhang, D. (2019). Dietary magnesium intake and risk of depression. Journal of affective disorders, 246, 627-632. doi: 10.1016/j.jad.2018.12.114
13. Yary, T., Lehto, S. M., Tolmunen, T., Tuomainen, T. P., Kauhanen, J., Voutilainen, S., & Ruusunen, A. (2016). Dietary magnesium intake and the incidence of depression: A 20-year follow-up study. Journal of affective disorders, 193, 94-98. doi: 10.1016/j.jad.2015.12.056
14. Eby, G. A., Eby, K. L., & Murck, H. (2011). Magnesium and major depression.  In: Vink R, Nechifor M, editors. Magnesium in the Central Nervous System [Internet]. Adelaide (AU): University of Adelaide Press. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507265/
15. Derom, M. L., Sayón-Orea, C., Martínez-Ortega, J. M., & Martínez-González, M. A. (2013). Magnesium and depression: a systematic review. Nutritional neuroscience, 16(5), 191-206. doi: 10.1179/1476830512Y.0000000044
16. Mikkelsen, K., Stojanovska, L., & Apostolopoulos, V. (2016). The effects of vitamin B in depression. Current medicinal chemistry, 23(38), 4317-4337. https://vuir.vu.edu.au/32892/1/01052017124229-0001.pdf
17. Kennedy, D. O. (2016). B vitamins and the brain: mechanisms, dose and efficacy—a review. Nutrients, 8(2), 68. https://doi.org/10.3390/nu8020068
18. Huang, Y., Li, L., Gan, Y., Wang, C., Jiang, H., Cao, S., & Lu, Z. (2020). Sedentary behaviors and risk of depression: a meta-analysis of prospective studies. Translational psychiatry, 10(1), https://doi.org/10.1038/s41398-020-0715-z
19. del Pozo Cruz, B., Alfonso-Rosa, R. M., McGregor, D., Chastin, S. F., Palarea-Albaladejo, J., & del Pozo Cruz, J. (2020). Sedentary behaviour is associated with depression symptoms: compositional data analysis from a representative sample of 3233 US adults and older adults assessed with accelerometers. Journal of affective disorders, 265, 59-62. https://doi.org/10.1016/j.jad.2020.01.023
20. Kvam, S., Kleppe, C. L., Nordhus, I. H., & Hovland, A. (2016). Exercise as a treatment for depression: a meta-analysis. Journal of affective disorders, 202, 67-86. https://doi.org/10.1016/j.jad.2016.03.063
21. Schuch, F. B., Vancampfort, D., Richards, J., Rosenbaum, S., Ward, P. B., & Stubbs, B. (2016). Exercise as a treatment for depression: a meta-analysis adjusting for publication bias. Journal of psychiatric research, 77, 42-51. https://doi.org/10.1016/j.jpsychires.2016.02.023
22. Hu, M. X., Turner, D., Generaal, E., Bos, D., Ikram, M. K., Ikram, M. A., ... & Penninx, B. W. (2020). Exercise interventions for the prevention of depression: a systematic review of meta-analyses. BMC public health, 20(1), 1-11. https://doi.org/10.1186/s12889-020-09323-y
23. Miller, K. J., Gonçalves-Bradley, D. C., Areerob, P., Hennessy, D., Mesagno, C., & Grace, F. (2020). Comparative effectiveness of three exercise types to treat clinical depression in older adults: A systematic review and network meta-analysis of randomised controlled trials. Ageing Research Reviews, 58, 100999. https://doi.org/10.1016/j.arr.2019.100999
24. Heijnen, S., Hommel, B., Kibele, A., & Colzato, L. S. (2016). Neuromodulation of aerobic exercise—a review. Frontiers in psychology, 6, 1890. doi: 10.3389/fpsyg.2015.01890
25. Gujral, S., Aizenstein, H., Reynolds III, C. F., Butters, M. A., & Erickson, K. I. (2017). Exercise effects on depression: possible neural mechanisms. General hospital psychiatry, 49, 2-10. https://doi.org/10.1016/j.genhosppsych.2017.04.012
26. Gultyaeva, V. V., Zinchenko, M. I., Uryumtsev, D. Y., Krivoschekov, S. G., & Aftanas, L. I. (2019). Exercise for depression treatment. Physiological mechanisms. Zhurnal nevrologii i psikhiatrii imeni SS Korsakova, 119(7), 112-119. doi: 10.17116/jnevro2019119071112.
27. Forteza, F., Giorgini, G., & Raymond, F. (2021). Neurobiological Processes Induced by Aerobic Exercise through the Endocannabinoidome. Cells, 10(4), 938. . https://doi.org/10.3390/ cells10040938
28. Walker, W. H., Walton, J. C., DeVries, A. C., & Nelson, R. J. (2020). Circadian rhythm disruption and mental health. Translational psychiatry, 10(1), 1-13. https://doi.org/10.1038/s41398-020-0694-0
29. Bedrosian, T. A., & Nelson, R. J. (2013). Influence of the modern light environment on mood. Molecular psychiatry, 18(7), 751-757. https://doi.org/10.1038/mp.2013.70
30. Salgado-Delgado, R., Tapia Osorio, A., Saderi, N., & Escobar, C. (2011). Disruption of circadian rhythms: a crucial factor in the etiology of depression. Depression research and treatment, 2011. https://doi.org/10.1155/2011/839743
31. Vadnie, C. A., & McClung, C. A. (2017). Circadian rhythm disturbances in mood disorders: insights into the role of the suprachiasmatic nucleus. Neural plasticity, 2017. https://doi.org/10.1155/2017/1504507
32. Humpston, C., Benedetti, F., Serfaty, M., Markham, S., Hodsoll, J., Young, A. H., & Veale, D. (2020). Chronotherapy for the rapid treatment of depression: A meta-analysis. Journal of affective disorders, 261, 91-102. https://doi.org/10.1016/j.jad.2019.09.078
33. Tao, L., Jiang, R., Zhang, K., Qian, Z., Chen, P., Lv, Y., & Yao, Y. (2020). Light therapy in non-seasonal depression: An update meta-analysis. Psychiatry Research, 113247. https://doi.org/10.1016/j.psychres.2020.113247
34. Veleva, B. I., van Bezooijen, R. L., Chel, V. G., Numans, M. E., & Caljouw, M. A. (2018). Effect of ultraviolet light on mood, depressive disorders and well‐being. Photodermatology, photoimmunology & photomedicine, 34(5), 288-297. https://doi.org/10.1111/phpp.12396
35. Milaneschi, Y., Peyrot, W. J., Nivard, M. G., Mbarek, H., Boomsma, D. I., & Penninx, B. W. (2019). Vitamin D: marker, cause or consequence of depression? An exploration using genomics. bioRxiv, 516013. https://doi.org/10.1101/516013
36. Bishir, M., Bhat, A., Essa, M. M., Ekpo, O., Ihunwo, A. O., Veeraraghavan, V. P., ... & Ojcius, D. J. (2020). Sleep Deprivation and Neurological Disorders. BioMed research international, 2020. https://doi.org/10.1155/2020/5764017
37. Zhai, L., Zhang, H., & Zhang, D. (2015). Sleep duration and depression among adults: A meta‐analysis of prospective studies. Depression and anxiety, 32(9), 664-670. https://doi.org/10.1002/da.22386
38. Becker, N. B., Jesus, S. N., Joao, K. A., Viseu, J. N., & Martins, R. I. (2017). Depression and sleep quality in older adults: a meta-analysis. Psychology, health & medicine, 22(8), 889-895. https://doi.org/10.1080/13548506.2016.1274042
39. Fang, H., Tu, S., Sheng, J., & Shao, A. (2019). Depression in sleep disturbance: a review on a bidirectional relationship, mechanisms and treatment. Journal of cellular and molecular medicine, 23(4), 2324-2332. https://doi.org/10.1111/jcmm.14170
40. Freeman, D., Sheaves, B., Waite, F., Harvey, A. G., & Harrison, P. J. (2020). Sleep disturbance and psychiatric disorders. The Lancet Psychiatry, 7(7), 628-637. https://doi.org/10.1016/S2215-0366(20)30136-X
41. Rahimi, A., Ahmadpanah, M., Shamsaei, F., Cheraghi, F., Bahmani, D. S., Holsboer-Trachsler, E., & Brand, S. (2016). Effect of adjuvant sleep hygiene psychoeducation and lorazepam on depression and sleep quality in patients with major depressive disorders: results from a randomized three-arm intervention. Neuropsychiatric disease and treatment, 12, 1507. https://doi.org/10.2147/NDT.S110978
42. Feng, G., Han, M., Li, X., Geng, L., & Miao, Y. (2020). The Clinical Effectiveness of Cognitive Behavioral Therapy for Patients with Insomnia and Depression: A Systematic Review and Meta-Analysis. Evidence-Based Complementary and Alternative Medicine, 2020. https://doi.org/10.1155/2020/8071821
43. Ballesio, A., Bacaro, V., Vacca, M., Chirico, A., Lucidi, F., Riemann, D., ... & Lombardo, C. (2020). Does cognitive behaviour therapy for insomnia reduce repetitive negative thinking and sleep-related worry beliefs? A systematic review and meta-analysis. Sleep Medicine Reviews, 101378. https://doi.org/10.1016/j.smrv.2020.101378
44. Ho, F. Y. Y., Chan, C. S., Lo, W. Y., & Leung, J. C. Y. (2020). The effect of self-help cognitive behavioral therapy for insomnia on depressive symptoms: an updated meta-analysis of randomized controlled trials. Journal of affective disorders, 265, 287-304. https://doi.org/10.1016/j.jad.2020.01.062
45. Erzen, E., & Çikrikci, Ö. (2018). The effect of loneliness on depression: A meta-analysis. International Journal of Social Psychiatry, 64(5), 427-435. https://doi.org/10.1177/0020764018776349
46. Mann, F., Wang, J., Pearce, E., Ma, R., Schlief, M., Lloyd-Evans, B., & Johnson, S. (2021). Loneliness and the onset of new mental health problems in the general population: a systematic review. medRxiv. https://doi.org/10.1101/2021.01.26.21250587
47. Smith, K. J., Gavey, S., RIddell, N. E., Kontari, P., & Victor, C. (2020). The association between loneliness, social isolation and inflammation: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, 112, 519-541. https://doi.org/10.1016/j.neubiorev.2020.02.002
48. Zilioli, S., & Jiang, Y. (2021). Endocrine and immunomodulatory effects of social isolation and loneliness across adulthood. Psychoneuroendocrinology, 128, 105194. https://doi.org/10.1016/j.psyneuen.2021.105194
49. Zovetti, N., Rossetti, M. G., Perlini, C., Brambilla, P., & Bellani, M. (2021). Neuroimaging studies exploring the neural basis of social isolation. Epidemiology and Psychiatric Sciences, 30. https://doi.org/10.1017/S2045796021000135
50. Harandi, T. F., Taghinasab, M. M., & Nayeri, T. D. (2017). The correlation of social support with mental health: A meta-analysis. Electronic physician, 9(9), 5212. doi: 10.19082/5212
51. Wang, J., Mann, F., Lloyd-Evans, B., Ma, R., & Johnson, S. (2018). Associations between loneliness and perceived social support and outcomes of mental health problems: a systematic review. BMC psychiatry, 18(1), 1-16. https://doi.org/10.1186/s12888-018-1736-5
52. Harris, M. A., & Orth, U. (2020). The link between self-esteem and social relationships: A meta-analysis of longitudinal studies. Journal of personality and social psychology, 119(6), 1459. http://dx.doi.org/10.1037/pspp0000265
53. Dinglea, G. A., Sharman, L. S., Haslam, C., Donald, M., Turner, C., Partanen, R., ... & van Driel, M. L. (2020). The effects of social group interventions for depression: systematic review. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2020.11.125
54. Cunningham, S., Hudson, C. C., & Harkness, K. (2021). Social media and depression symptoms: A meta-analysis. Research on Child and Adolescent Psychopathology, 49(2), 241-253. https://doi.org/10.1007/s10802-020-00715-7
55. Huang, C. (2020). A meta-analysis of the problematic social media use and mental health. International Journal of Social Psychiatry, 0020764020978434. https://doi.org/10.1177/0020764020978434
56. Rajoo, K. S., Karam, D. S., & Abdullah, M. Z. (2020). The physiological and psychosocial effects of forest therapy: A systematic review. Urban Forestry & Urban Greening, 126744. https://doi.org/10.1016/j.ufug.2020.126744
57. Rosa, C. D., Larson, L. R., Collado, S., & Profice, C. C. (2020). Forest therapy can prevent and treat depression: evidence from meta-analyses. Urban Forestry & Urban Greening, 126943. https://doi.org/10.1016/j.ufug.2020.126943
58. Chen, C., & Nakagawa, S. (n.d.). Nature’s pathways on human health. https://www.researchgate.net/profile/Chong_Chen4/publication/340619435_Nature's_pathways_on_human_health/links/5e954f9fa6fdcca7891554d6/Natures-pathways-on-human-health.pdf
59. Sinatra, S. T., Oschman, J. L., Chevalier, G., & Sinatra, D. (2017). Electric nutrition: The surprising health and healing benefits of biological grounding (Earthing). Altern Ther Health Med, 23(5), 8-16. PMID: 28987038.
60. Menigoz, W., Latz, T. T., Ely, R. A., Kamei, C., Melvin, G., & Sinatra, D. (2020). Integrative and lifestyle medicine strategies should include Earthing (grounding): Review of research evidence and clinical observations. EXPLORE, 16(3), 152-160. Wendy MenigozTracy T. LatzRobin A. ElyCimone KameiGregory MelvinDrew Sinatra123
61. Watkins, E. R., & Roberts, H. (2020). Reflecting on rumination: Consequences, causes, mechanisms and treatment of rumination. Behaviour Research and Therapy, 127, 103573. https://doi.org/10.1016/j.brat.2020.103573
62. Kovács, L. N., Takács, Z. K., Tóth, Z., Simon, E., Schmelowszky, Á., & Kökönyei, G. (2020). Rumination in Major Depressive and Bipolar Disorder–a Meta-analysis. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2020.07.131
63. Perestelo-Perez, L., Barraca, J., Penate, W., Rivero-Santana, A., & Alvarez-Perez, Y. (2017). Mindfulness-based interventions for the treatment of depressive rumination: Systematic review and meta-analysis. International Journal of Clinical and Health Psychology, 17(3), 282-295. https://doi.org/10.1016/j.ijchp.2017.07.004
64. Goldberg, S. B., Tucker, R. P., Greene, P. A., Davidson, R. J., Kearney, D. J., & Simpson, T. L. (2019). Mindfulness-based cognitive therapy for the treatment of current depressive symptoms: a meta-analysis. Cognitive behaviour therapy, 48(6), 445-462. https://doi.org/10.1080/16506073.2018.1556330
65. Spinhoven, P., Klein, N., Kennis, M., Cramer, A. O., Siegle, G., Cuijpers, P., ... & Bockting, C. L. (2018). The effects of cognitive-behavior therapy for depression on repetitive negative thinking: A meta-analysis. Behaviour research and therapy, 106, 71-85. https://doi.org/10.1016/j.brat.2018.04.002
66. Iodice, J., Malouff, J., & Schutte, N. (2020). The Association Between Gratitude and Depression: A Meta-Analysis. https://hdl.handle.net/1959.11/29808
67. Ferrari, M., Hunt, C., Harrysunker, A., Abbott, M. J., Beath, A. P., & Einstein, D. A. (2019). Self-compassion interventions and psychosocial outcomes: A meta-analysis of RCTs. Mindfulness, 10(8), 1455-1473. https://doi.org/10.1007/s12671-019-01134-6