Wednesday, August 19, 2020

The FAR Plan: A Three Prong Approach to Emotional Health

When was the last time you felt really good, happy and content?

Many of us experience periods of low mood, anxiety, or irritability. How can we deal with these emotions and bring more peace and joy into our lives?

You do not need to do all the suggestions in this article. Many times, all that is needed is a few changes to our behavior or mindset. The FAR plan is for those experiencing mild to moderate emotional distress. If you are in moderate to severe distress, see a therapist and/or a psychiatrist. While under their care, you can then proceed with the FAR plan if you choose. (If at any point you feel like you might harm yourself, call 911, go to an emergency room or call the National Suicide Prevention Lifeline at 1-800-273-8255.)

For a free depression assessment test, click here. The one for anxiety is available here.

Below are tools broken down into three areas which form the FAR (Fortify, Allow and Release) plan for emotional health. Our default state is one of calm contentment. A depressed or anxious state is unnatural and often a sign that we need to strengthen an area of our lives. In the first area, fortify, we focus on fortifying our body, behavior and environment, laying the foundation for optimal mental health. In the second area, allow, we focus on being in the moment, whether the moment is bitter or blessed. So often our mind is stuck either in the past or the future. By allowing ourselves to be in the present moment we enhance our emotional health. In the last area, release, we focus on letting go of stress and tension. Stress and emotional pain are a normal part of life. Problems start when we hold on to those feelings. Finding healthy ways to let go of those feelings allows us to maintain our emotional equilibrium.

Fortify:

1. Get adequate sleep. If you do not feel rested, you are more prone to anxiety and depression. If you are not sleeping enough, try going to sleep 15-20 minutes earlier each week until you feel refreshed in the morning. If you have trouble sleeping, consider the following tips:

Soon after getting up, go outside and get some sunlight, preferably in nature. If you can go for a brisk walk, jog, bike or run, even better. While bright light in the morning helps set our circadian rhythm, bright light at night disrupts it. An hour before going to sleep, stop looking at screens which give off blue light and can keep you awake. Consider installing software to filter out blue light in the evening. Some benefit from wearing blue light blocking glasses 1-2 hours before bed. In addition, engage in relaxing activities, such as journaling, meditation, light reading (not engrossing), or listening to relaxing music. Aromatherapy, where you smell different calming essential oils, either in a bottle or from a diffuser/humidifier can also help you wind down. Cool down the temperature of the bedroom before bed. If after 20-30 minutes of lying in bed, you do not fall asleep, get up and go back to engaging in the relaxing activities described above until you feel tired and then go back to bed.

Keep to a set sleep/wake schedule, especially making sure to wake up the same time each day even if you did not sleep well the night before. If you need to nap, keep it short and early in the day. If internet use is holding you back from going to sleep on time, install software to shut down the internet at a set time.

Magnesium, calming teas or capsules of chamomile, holy basil/Tulsi, valerian or herbal mixes specifically for sleep can be helpful. If that’s not enough, you can try melatonin, either time release or regular release, at the lowest dose that is effective for you, preferably short term. (Talk to your doctor before combining supplements and medication). More information on melatonin and valerian can be found here.

2. Eat healthy. Foods affect our moods. According to one study, eating a whole foods diet (vegetables, fruit, meat, fish, and whole grains) resulted in a 30% risk reduction for depression and anxiety compared to a typical western diet (processed or fried foods, refined grains, sugary products, and beer).

A widely recommended research based diet is the Mediterranean Diet, which emphasizes vegetables, fruits, whole grains, beans, nuts, seeds and olive oil, along with moderate amounts of dairy, fish, poultry, eggs, and a limited amount of red meat (avoid sugar, white flour and highly processed foods except at special occasions). An important part of a healthy diet is drinking mostly water. If you do not like the taste of your water, try a filter.

Some people are sensitive to specific foods which negatively affect their mood. If you are interested in exploring this area, consider doing an elimination diet to determine if you have food sensitivities; the most common ones are gluten and dairy. Articles or books explain how to do an elimination diet.

3. Exercise. The Mayo Clinic recommends exercising three to five times a week for thirty minutes or more, for mood enhancing effects. One study found that brisk walking for 20 minutes daily, for six weeks, enhanced people’s mood. The American Heart Association recommends at least 150 minutes of moderate aerobic exercise or 75 minutes of vigorous exercise per week. If you exercise for 30 minutes 5 days a week, you will reach the recommended 150 weekly minutes. Include in your exercise routine both aerobic exercise and strength training (lifting weights and core strengthening exercises).According to recent research, more intense aerobic exercise was more effective at reducing anxiety than less intense. So if it is safe for you to do so, get a vigorous workout or do High Intensity Interval Training (HIIT) where you vary the intensity. Exercising in a natural setting and/or in sunlight has added mood enhancing effects. If you have an exercise partner, you will also gain social benefits and increased motivation to stick to your routine. At least once a week, see if you can do a morning brisk walk or jog with someone in the park. For an article on how for some people exercise works as well as an antidepressant, see here.

If you are in a better mood when in sunlight or during the summer months, consider using a lightbox. For more on light therapy and other tools to enhance mood, see TLC Elements.

4. Meditate. Throughout the day the mind is busy jumping from one thought to another. Take a moment to quiet the mind and be present. Meditation can help us do this. Good times to meditate are in the morning, lunch time, after work, or before going to sleep. There are different meditation techniques. You may want to start with a basic breathing meditation. Breathing slowly and easily, mentally count after each exhalation, starting from one and going up to ten and then back to one. Alternatively, focus on the sensation of the breath as the cool air enters your nostrils and the warm air exits. Another option is to think calming phrases on the inhale and exhale, e.g., on the inhale, “I am” and on the exhale, “letting go” or “at peace” etc. When you notice your mind has wandered, which it will, gently bring your focus back to the breath. Calmly keep doing this again and again. Some find listening to a guided meditation helpful in the beginning. It can take time to train the mind to quiet down and to feel the relaxed feeling that meditation can bring.

5. Assess your environment. Assess your job, school, relationships and living environment. Are any of them major contributors to your low mood or anxiety? If yes, speak to someone wise, with life experience or a recommended therapist to help you formulate a plan to address that area. One issue often related to jobs is finances. Being in debt, out of work, or living paycheck to paycheck can be an emotional strain. Speak to someone knowledgeable who can help you make a plan to reduce your debt, live within a budget and get career guidance. In terms of your living environment, is it cluttered? If it is, you may be surprised how much calmer and more relaxed you feel once you declutter. You may find it easier to have someone declutter it with or for you.

6. Set meaningful goals. Many struggle with a lack of meaning in their life which worsens their emotional health. When we feel that we are working toward something of value we enhance our emotional health. Choose and write down a goal, something significant and worthwhile to strive for. Perhaps it is learning a new skill or hobby, advancing your career, spiritual or personal development, or doing something for your community. Break your goal down to mini goals and choose mini rewards to give yourself along the way. At least once a week, engage in an activity which brings you closer to your goal.

According to Dr. Sonja Lyubomirsky, author of The How of Happiness, “Find a happy person and you will find a project.” What’s your project? What gives you meaning? How can you do those activities more often?

(Click on the title of Dr. Lyubomirsky’s book for a listing of, “Happiness-Enhancing Strategies.”)

7. Be of service to others. Each day, or at least once a week, do something for someone else. It could be as simple as giving a sincere compliment, a charitable donation - even a token amount, or calling someone to see how they are doing, volunteering for an organization, visiting the sick or elderly, shopping for them or some other form of kindness.

Research shows that giving to others enhances our health and happiness; it even increases our longevity. Look for ways to share your time, talents and resources. Helping others reminds us that there are those who are less fortunate. When we help others, it takes our mind off our difficulties and reminds us that we can engage in meaningful activities and make a difference in people’s lives even while saddled with our own challenges.

8. Strengthen your faith. Faith helps us deal with challenges and not try to run away from our difficulties. Do the following thought experiment. Bring to mind a specific challenge. Imagine you believe the following with absolute certainty: This challenge comes from God for your eternal benefit. Part of your life’s purpose is doing what you can to overcome and grow from this challenge. No matter how bleak things look now, they will work out in the end; either in this world or in the next. God is with you at all times, giving you the strength and courage you need to triumph.

If you held those beliefs with absolute certainty how would you feel about the challenge?

Likely you would feel calmer, more optimistic and better able to handle the challenge. This illustrates the power of faith to help us overcome our struggles.

To draw strength from your faith, it needs to be deeper than a superficial belief; it needs to travel from the head to the heart; to be deeply felt within you. This can be achieved through effort and is a lifelong journey. To begin, study spiritual teachings, speak to yourself words of faith, read Psalms in a language you understand, and speak to God in your native language. Ask God to strengthen your faith in Him and help you overcome your difficulties. See “How to Build Unshakable Faith.”

9. Be Grateful.
 According to research, being grateful increases our happiness. Each day write down a few things you are grateful for and why. You can also begin your day expressing appreciation to God for at least one blessing in your life, preferably out loud and in your native language; elaborate on how you have benefited from this blessing.

Each day, make a conscious decision to focus on and be grateful for what goes right, the blessings inherent in every day and the bright side of difficulties. Express appreciation for the help others give you.

In addition to appreciating what God and others have done for you, appreciate yourself. Focus on and take delight in your positive qualities; praise yourself for your achievements, good deeds and the challenges you have overcome. Also look for and praise the good you see in others.

At the root of a low mood is often a mindset of minimizing the good in our lives and maximizing the bitter (the things we have that we wish we didn’t and the things we do not have that we wish we did). To feel happier, do the opposite: Maximize what you have and what is going right and minimize what you do not yet have and what is difficult. (Minimizing difficulties means not blowing them out of proportion but still addressing them as appropriate.)

The next time you are in a low mood, ask yourself, “What bitter aspect of my life am I over focusing on? What blessed aspect am I ignoring?” Then switch focus; think about how the bitterness in your life is really manageable, and how the blessings in your life are really amazing.

While focusing on the positive, look for the humor in life. Throughout the day, remind yourself to smile, even if only a slight one; this will help you cultivate an inner sense of lightness and joy.

10. Savor. Savoring is related to being grateful, as they both focus on the positive in our lives. Savoring means that in addition to appreciating a positive experience, we revel and savor it. We are mindful and present during the experience, fully feeling the positive emotions that come with it. We have pleasant and positive experiences every day. Usually though, we are too busy focusing on the negative or just distracted to really enjoy the experience. Young children naturally savor and revel in positive experiences. The next time you have a positive experience, for example eating a delicious meal, savor it. Put away your phone or computer. Just focus on the experience. Include focusing on any pleasant company or surroundings. Make a mental note to imprint this experience in your memory bank so that you can recall it and experience those positive feelings in the future. During the day, ask yourself, “What can I savor?” tune into the experience and use all your senses to be in the moment. 

Allow:

1. Accept. Gratitude and savoring works well when we focus on the positive aspects of our lives, but what about the painful ones? For those we need acceptance. Just like there are three forms of appreciation – appreciating what God and others do for you and appreciating yourself – there are three forms of acceptance, accepting the challenges God gives you, accepting others and accepting yourself. When you find yourself in a low mood, ask, “What am I resisting? Can I be more accepting of that? What aspect of my life can I be more grateful for?”

For discussions on acceptance, see, “3-Dimensional Acceptance: A Pathway to Peace and Power,” “Discover Your Inner Peace,” “Surrendering to God: 3 steps to transcend your ego,” and, “Adversity + Humility + Acceptance = Transcendence.”

2. Have compassion for yourself. There is a growing awareness of the importance of self-compassion, being kind to oneself, with books and websites devoted to the topic. Self-compassion flows naturally from self-acceptance; once we accept ourselves the way we are, we can be kind and loving to ourselves.

Ever notice that people may hate themselves because of a weakness they have, yet when they are dealing with others who have the very same weakness, especially children, they feel no hatred, only tenderness and compassion? Why is that?

Because when dealing with others, we are better able to see the overall picture and not just focus on the weakness. When we look at the child, we are able to see the innocence, the inherent goodness the child possesses, and their struggle to overcome difficulties, which are no fault of their own.

Although our bodies age, the child inside of us remains. Never shame or insult that child. The next time you are about to berate yourself over a perceived flaw or failure, instead, bring to mind your many struggles and feel tenderness and compassion for yourself. Talk to yourself soothing words of support and encouragement. Show yourself the same kindness, warmth and care you would show a child who is going through a tough time.

When you need to give yourself constructive criticism, do so lovingly and respectfully, after all, you are speaking to one of God’s children. Do not dwell on the past mistake, instead, focus on encouraging yourself to do better in the future.

In addition to extending compassion to yourself, tap into the compassion God gives you. He is constantly supporting you (Song of Songs 2:6), “His left hand is under my head and His right arm embraces me.” God tells you (Isaiah 66:13), “As one whom his mother comforts, so will I comfort you…” Pray to Him to send you comfort and strength. Then imagine waves of these feelings washing over you.

When you feel emotional distress, think while slowly breathing in, “God is with me,” and while slowly breathing out, “God is soothing and comforting me.”

After feeling Divine compassion, see if you can feel a sense of oneness with God. As Moses taught us (Deuteronomy 4:35), “…There is nothing beside Him.” In this state, there is no separate self receiving compassion from God. Instead, there is only compassion; there is only God.

3. Love yourself. After accepting the parts of yourself that you do not like and having compassion for your struggles, learn to love yourself! There is so much good within you! People often focus on what they don’t like about themselves. Instead focus on your good qualities. Make a list of your abilities, the struggles you have overcome, the tough choices you made and the good deeds you did. When you find yourself dwelling on something you don’t like about yourself, try to be a little more accepting of the flaw and give yourself some self-compassion that you have this struggle. Then switch focus to the things and aspects of yourself that you downright love! (Consult the sheet you made with your good qualities). For more details, see: “How to Stop Hating and Start Loving Yourself.”

Release:

1. Forgive. Many of us are carrying a heavy burden of anger and resentment toward others and ourselves. This only hurts us. Decide that enough is enough! You are not going to continue carrying this heavy load anymore. You are going to release and let go of the emotional pain of the past. This may not happen automatically but the first step is being willing to let go. Then whether you want to fully forgive the person or just let go of the hurt as best you can depends on the situation. For more details, see: “The Freedom of Forgiveness: 3 Strategies to Letting Go” and “Discover Your Inner Peace.”

2. Connect with others. Social connection and support is crucial for our emotional health. Have family members, mentors and/or friends whom you talk to on a regular basis, enjoying their company and sharing your struggles with them. Sometimes, you need to vent, other times, you want advice or encouragement; let them know what you want. Many people have a set schedule of either daily or weekly heart-to-heart talks with a friend or family member. Look for one or more people to set that up with. An underutilized resource for social support is senior citizens. Many of them are good listeners with wise input.

3. Who’s your mentor? Life can be very challenging. The Talmud says (Berachot 5b), “A prisoner cannot free himself from prison.” Along those lines, Einstein is quoted as saying, “We cannot solve our problems with the same level of thinking that created them.” One of the biggest mistakes people make with mood disorders or with any challenge, is trying to solve it on their own. We need to humbly acknowledge that we will benefit from asking someone wise, with life experience, for help enhancing our moods (or dealing with any life challenge). If you have difficulty finding someone to advise you, try seeing a recommended therapist.

4. Walk in nature. Going for a walk in a park or a hike on a regular basis, preferably with a friend but even alone is a great way to destress. Walking along rivers, lakes or oceans may have added benefits.

5. Journal. Journaling about emotionally charged issues from the past and present, is a great way to let go of tension. You can also journal about things you are grateful for, tapping into the power of gratitude.

6. Tap into your creativity. Many find creative pursuits, such as drawing, singing, playing an instrument, gardening, engaging in a hobby etc. to be very helpful in reducing stress.

7. Turn on the music. Music can boost our moods. Listen regularly to upbeat music, especially in the morning to set the tone for the day or after work to destress (if it’s inspirational music, even better). You can walk, dance or exercise to the music or just let it play in the background. Some enjoy classical music, such as the music of Haydn, Mozart or Beethoven.

8. Let go of addictive behavior. Addictive behavior can negatively impact our mood in a number of ways. We may feel badly about ourselves because we engage in those behaviors. In addition, those behaviors can take up valuable time and keep us from taking care of ourselves and being productive. They can also cause harm in their own right. For how to address addictions, see, “Overcoming Our Soft Addictions.”

9. Pray. Daily engage in both formal prayer, including reciting psalms in a language you understand and informal prayer. This is where you talk out loud to God in your native language. Thank Him for His blessings, pour out your heart to Him about your challenges and ask for His help. Let go and let God. 

The following FAR checklist is to help you pinpoint which areas to work on. Do not feel overwhelmed if you realize you need to work on many areas. Just a few positive changes may be all you need to tip the scales to a calmer and happier state of mind.

The FAR Checklist:

Do I feel refreshed when I get up in the morning or am I not getting enough quality sleep?

Do I eat a Mediterranean style diet, focusing on whole foods and limiting sugars and refined grains?

Do I exercise at least 3 times a week? Do I do both aerobic exercise and also strengthening exercises?

Do I meditate or engage in another relaxing activity to quiet the mind?

Do I feel better during the summer months or when out in the sunshine? If yes, have I done a trial to see if light therapy is beneficial to me (either natural sunlight or a lightbox)?

Is there an issue weighing on me or an area I feel stuck in my life? Is my school, job, finances, relationships or living environment playing a major role in my anxiety or depression? If yes, who can I speak to to address that?

Do I have an activity I’m involved in that gives me a sense of achievement, meaning or purpose?

Do I do acts of kindness on a regular basis?

Do I remind myself daily that my challenges come from God for my benefit and that with His help I will overcome?

Do I think daily about at least one of my blessings and feel grateful for it (preferably writing it down in a journal)?

When I have a positive experience, do I take a moment to savor it?

Am I able to mostly accept my challenges while I work on them, or do I strongly resist the difficulties in my life?

Do I have self-compassion for my challenges or do I berate myself?

Do I love myself or do I struggle with feelings of self-loathing?

Who do I carry hurt or resentment toward? Am I willing to forgive or at least reduce the hurt I feel? 

Do I often feel lonely? In the last week have I had a heart to heart talk with someone to express my feelings or at least enjoyed the company of a friend or family member?

Do I have a mentor? Who can I ask for advice on enhancing my mood and dealing with my challenges?

Have I tried walking in nature or going for a hike, to help clear my thoughts?

For at least a week, have I tried writing about emotionally charged issues, from the past or present? Was it helpful? Is this something I want to make part of my daily or weekly routine?

Do I have an addictive behavior that is keeping me stuck?

Do I pray daily? Thanking God for His blessings, describing my challenges and asking for His help?

How can we start implementing The FAR Plan? 

Most of us should start with sleep, diet and exercise, or whichever ones we are motivated to address. Also increase positive social interactions. Try combining exercise with a social component, e.g., get together with someone at least weekly to exercise or go for a brisk walk. Engage in a meaningful activity that has a social component, e.g., going to a class on spiritual teachings, volunteering, visiting the sick or elderly or performing some other form of kindness. 

The tools of gratitude, acceptance and self-compassion, are especially useful in the moment, as emotional first aid. So the next time you feel down or anxious, find something for which to be grateful, whether a blessing in another area of your life, or a bright side of the painful situation (Write down daily some things you are grateful for and why). Then, talk to yourself words of faith, and see if you can be more accepting of the challenge. Lastly, remind yourself that you are going through a difficult time; give yourself compassion and feel God’s compassion for you. If these tools are not sufficient, try to distract yourself with a neutral activity that is engrossing ( reading, exercising, engaging in a  hobby etc.) that takes your attention away from depressing or anxious thoughts. 

Every day there are going to be positive experiences, e.g., eating a tasty dish, experiencing a cool breeze, seeing a beautiful sunset or hearing a kind word. Make sure to savor those moments! Each day compliment others so that they too will have something to savor.

After trying the above tools, experiment with the other ones. Whichever tools you choose, make a chart to  track of how often you do them. You can use software such as Google Keep or Evernote to schedule weekly or daily recurring reminders. You may find it helpful to have a family member, friend, life coach or therapist check in with you weekly or even daily to confirm that you are doing the behaviors you chose. Knowing that they will be checking in on you, can give you added motivation to stay on track.

After trying these tools, write down which ones work best for you. The next time you feel emotional distress, look at the list and do those tools.

If you get stuck implementing this plan, you can begin with a shorter, less comprehensive one,
The SIMPLE3 Plan: 8 Steps to Emotional and Physical Wellbeing.

In addition to the above tools, many benefit from reading self-help books. Some popular self-help books for mood issues include:

The Happiness Trap: How to Stop Struggling and Start Living (Second Edition) by Russ Harris

Retrain Your Brain: Cognitive Behavioral Therapy in 7 Weeks: A Workbook for Managing Depression and Anxiety by Seth J. Gillihan.

Feeling Great: The Revolutionary New Treatment for Depression and Anxiety by David D. Burns.

The Upward Spiral Workbook: A Practical Neuroscience Program for Reversing the Course of Depression by Alex Korb.

If you are experiencing moderate to severe distress, or even if your distress is only mild to moderate but is not improving, see a therapist and/or psychiatrist. For a therapist, look for a recommended one, preferably someone who practices a research validated approach such as cognitive behavioral therapy (CBT). If you have experienced significant trauma in your life, see if you can find a therapist who specializes in that area, as there are specific interventions that can be used for trauma, such as EMDR, among others. Keep in mind that often people need to try more than one therapist/psychiatrist or medication(s) before finding the right one for them. Some therapists/psychiatrists are more skilled than others. If you are seeing one and either you do not feel understood, or do not see improvement, consider trying someone else. If possible also see your primary care doctor and get a physical which includes being tested for vitamin D, iron, B12 and thyroid function.

If you are unable to find a psychiatrist on your insurance, and the ones people recommend are cost prohibitive, you may want to look into this service which pairs you with a psychiatric nurse practitioner and charges a standardized fee for intakes and follow up appointments: https://helloahead.zendesk.com/hc/en-us. They say they vet their practitioners and they currently charge $275 for the initial appointment and $160 for follow ups. They have multiple locations, but may not be available in your area. (There may be other companies that offer a similar service).

If you have straight anxiety or depression, another option is to ask your primary care physician to prescribe something for that. If you think you may have Bipolar or multiple diagnoses, it is best to see a psychiatrist. For an article which discusses primary care doctors prescribing antidepressants, see here.

Here is a brief discussion on medication. Medication works best when used with other tools, especially Cognitive Behavioral Therapy. For straight or unipolar depression, doctors often start with an SSRI (selective serotonin reuptake inhibitor) such as Lexapro. If that does not work, they may either try a different SSRI such as Zoloft or they may suggest switching to or adding Wellbutrin, which is often more energizing than an SSRI. Some do well on a combo of Wellbutrin and an SSRI which work by targeting different neurotransmitters. There are many different medications to choose from and often doctors have their favorite antidepressants that they like to use. It can take a few tries or combinations before you get a good response.

If your depression is not responding to treatment or you are on Wellbutrin but getting only a partial response, you can discuss with your psychiatrist the combination of Wellbutrin and Dextromethorphan. This combination goes by the research name AXS-05 as it is not yet FDA approved. You can read a study comparing the combination to Wellbutrin alone here. Even though it is not yet approved, if your psychiatrist thinks it is worth a try, you can get Dextromethorphan over the counter as a cough suppressant pill or at a compounding pharmacy.

For Bipolar I or II your doctor may prescribe Lithium Carbonate, Lamictal, or one of the new atypical antipsychotics. Lithium is particularly indicated when thoughts of suicide are present, whether the person has bipolar or unipolar depression, as discussed in this article. For OCD, two common medications used are Luvox and Chlomipramine (among other choices). For research based recommendations for psychiatric medications for different conditions, see here (click on the top right dropdown menu that says “Algorithms” for a list of conditions). For those with treatment resistant depression, see a review of promising strategies here.

Discuss any side effects from medications with your doctor, sometimes you will need to stop the medication. Other times, you can try a lower dose (if you are already taking the lowest dose and still have side effects, for drugs available as a generic, you can often get them compounded by pharmacy into a liquid for microdosing). Your doctor may say to see if the side effect decreases or goes away with time. If you need to or decide to stop a medication, discuss with your doctor how best to do that. Some medications need to be stopped gradually, especially if you have been on them for a while, to avoid withdrawal effects.

If medication does not help or you do not tolerate them, consider Transcranial Magnetic Stimulation (TMS), an FDA approved treatment for depression covered by an increasing number of insurance companies. One manufacturer of TMS equipment is Brainsway, which has a provider search function on their website.

For mild cases or for those who do not respond or tolerate medications, you can look into dietary supplements. Here is a brief listing of popular choices. Do not take supplements if you are on medication (especially psychiatric medications) without first checking with your doctor or pharmacist. When possible, work with a healthcare practitioner knowledgeable about supplements who can recommend specific products and dosages for you.

Dietary Supplements: 

Magnesium. Some find this mineral calming and helpful for sleep and constipation. Follow the dosage on the label.

B-complex with the coenzyme forms of folic acid and B12. Follow the dosage on the label.

Fish oil. Do not take more than 1 gram of fish oil without discussing it with your doctor, as high dosages can cause Atrial Fibrillation.

5-HTP and/or St. John’s Wort. You can take 5-HTP at bedtime working up to 300mg (or take 100mg three times daily, best away from protein and with a small amount of carbs such as a slice of apple or a rice cake). If after two weeks you do not experience any benefit, Peter Bongiorno ND author of Put Anxiety Behind You writes that you can increase the dose to 200mg three times a day. If there is still no benefit, you can try a combination of 5-HTP and St. John’s Wort extract, but you will need to lower the dosage of 5-HTP. David Edelberg, MD, recommends taking 100mg of 5-HTP at bedtime along with St. John’s Wort (450mg twice daily) and a once daily B-complex (click here for his other suggestions). 5-HTP is available in a time release formulation which may work better for some. 5-HTP and St. John’s Worth can cause interactions with antidepressants and either one should not be taken with psychiatric medications without the guidance of a psychiatrist.

Rhodiola or Sam-e. These are both considered more activating than 5-HTP or St. John’s wort. More information on Rhodiola, SAM-e, fish oil and St. John’s Wort can be found here: How to Prescribe Natural Medications? Part 1. Rhodiola can cause overstimulation or excess libido, so start with the lowest dose on an empty stomach and gradually increase it to 250-500mg. A note about SAM-e: Patricia Gerbarg MD recommends the brand Azendus. If you take a different brand, make sure it is enteric coated and in blister packs. She recommends starting with 400mg and if tolerated after a few days, increase the dose to between 800-1600mg daily. Take it on an empty stomach around 30 minutes before breakfast or lunch.

Lithium Orotate. This form of lithium is available over the counter and some recommend taking it with fish oil. The usual dose is 5mg with some practitioners using up to 20mg daily. If you find Lithium helpful and want to take it long term, especially more than 5mg daily, have your doctor monitor it, as there is not a lot of research on it. An article on Lithium Orotate is available here.

Saffron Extract. This is being used for stress, mood enhancement and appetite suppression. Follow the dosage on the label.

L-Theanine. This is an amino acid found in green tea and is being used for stress. Follow the dosage on the label.

Supplements may cause side effects, so add new supplements one at a time, gradually increase the dose and stick to the recommended dosage and either lower the dose or stop taking it if you experience any side effects. Use reputable brands that are GMP certified, which shows attention to quality controls. If you think you may have Bipolar (I or II), see a doctor before taking supplements as some can exacerbate the condition. For more on dietary supplements for mood disorders, Peter Bongiorno ND has a podcast here and a more recent one here or you can read one of his books (or books by James Greenblatt MD).

Many treatment options exist and new ones are being developed. Never give up! Keep trying until with God's help, you find the right treatment for you.


For a 12 month personal growth plan, see Living an Optimized Life: A 12 month plan

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