Low mood and its more severe relative, depression, is a widespread issue. Whether it’s mild ‘blues’ or full-blown major depressive disorder, it and can range from what is known as ‘sub-threshold depression’ to severe major depressive disorder on the most extreme end.
The symptoms of depression and low mood can include:

  • Feeling down, depressed, or hopeless
  • Little interest or pleasure in doing things
  • Fatigue
  • Slowed down physically, or the opposite, feeling agitated
  • Trouble getting motivated
  • Social withdrawal
  • Negative thoughts
  • Feelings of overwhelm with decision making
  • Appetite changes – you may crave carbohydrates or the opposite, have no appetite
  • Low energy
  • Sluggish thinking, poor concentration
  • Feelings of excessive guilt or worthlessness
  • Disrupted sleep – either sleeping too much or waking up in the early morning
  • Suicidal thoughts or acts

Reasons for Depression

The reasons why someone gets depressed are complex and are often down to multiple factors. Different for each person, it can involve cognitive brain neural networking, genetics, environment, and physiological factors such as hormones, inflammatory chemicals, and sleep-wake cycle regulation. Lifestyle factors such as sleep, exercise, and diet are also thought to play a role. The role of stress and its relationship to our gut microbiome is another emerging factor in the causes of depression. Inflammation and neuroimmune factos and microglia also play a role in many forms of depression and may be a core factor in treatment resistant depression although research is still preliminary.

Often in the lead up to an initial depressive episode, significant stressors are involved. In recurrent depression, vulnerability to repeat episodes seems to increase due to a brain-driven process called kindling. Kindling involves central nervous system dysfunction and brain networks, decreased neuroplasticity (the ability of the brain to build new cells and adapt), and more sleep dysfunction such as decreased slow-wave sleep.

If you suffer from a chronic illness or chronic pain, these conditions can also cause depression due to the illness or illness experience or make existing depression worse. Conditions such as chronic pain from any source, neurological disorders, fibromyalgia, and chronic fatigue syndrome/ME all increase the risk of depression and can go hand in hand.

The Resilience Medicine approach to low mood and depression

If you are worried that you, or a loved one, are suffering from depression, always seek medical attention from your doctor as soon as possible for assessment and treatment. Medication and psychotherapy such as cognitive behavioural therapy are the two primary conventional recommended interventions for depression and are often used together in more severe cases.

In addition, other biological tools may help support mood.

Diet
Supplements
Medication
mind-body
BioData + Habit Tracking

Diet

Although depression is not a straightforward nutrition illness and diet doesn’t offer an instant quick fix in most cases, according to emerging research, diet does appear to play a role. Specific diets may influence and improve depression symptoms. You should combine any dietary intervention with other treatments.

  • The Resilience Medicine diet principles especially if mood is affected by changes in blood sugar or insulin regulation (now recognized as a factor in a subset of people with mood disorders)
  • Ketogenic diets have been shown in some studies to improve symptoms of depression via multiple brain mechanisms and this diet is the best nutritional strategy for improving symptoms based on the current preliminary evidence.
  • Mediterranean high polyphenol diet may also decrease symptoms of depression, according to recent research
  • Cut out alcohol completely. This is very important because alcohol can trigger or worsen symptoms even in small amounts previously thought to be healthy.
  • Include best sources of omega 3 fatty acids such as small wild fish (salmon, herring, anchovy) and grass-fed organic beef or bison or omega 3 supplements from algae (vegan friendly)

Supplements

Many people living with depression and low mood find nutraceuticals and botanical supplements can help, including:

  • High EPA fish oil
  • B-complex
  • Probiotics – may affect Brain-derived neurotrophic factor levels
  • Saffron and curcumin extract
  • St John’s Wort (if not on other medications due to interaction risk)
  • CBD and terpenes such as myrcene from the cannabis plant to help with anxiety and stress if present
  • Vitamin D 3 and Magnesium

Cannabinoids:

Micro dosed medicinal cannabis with specific strains for fatigue and mood under medical guidance can help with fatigue, inflammation and mood. Usually, this is done using high CBD low THC strains with chemovars that are good for daytime use (high in D limonene, pinene) and low in myrcene and for helping with sleep disturbance, a very low dose of a chemovar good for sleep (eg. previously these were labelled often as ‘indicas’) in an oil form if you have problems with waking up multiple times or waking up very early in the morning so it lasts most of the night.

 

Medications

  • Novel fast-acting psychotherapeutics (therapeutic psychedelics): These medications are the most promising single drug treatment for treatment resistant depression
  • psilocybin-not currently available yet in the UK outside of a research study
  • Ketamine therapy-currently available in the UK with a specialist doctor in private practice
  • Antidepressant medications, including SSRIs, SNRIs, and other types of antidepressant drugs based on the symptoms and person

 

Mind-body Tools

  • Because many people with depression also suffer from anxiety, simple relaxation techniques can help lower stress, and anxiety levels may also indirectly help depression.
  • Specific types of meditation such as compassion/loving-kindness and also mindfulness-based meditation may help with depression.
  • Cognitive-behavioral therapy (CBT) is one of the most well-researched psychological therapies for treating depression. It is widely available both in one-to-one in-person sessions and also via many online programs.
  • Physical exercise of all varieties and walking in nature can also help boost mood and endorphin levels and reduce stress
  • psychedelic assisted psychotherapy

Apps, BioData and Habit Tracking

You can track your mood and any interventions and resilience tips you have started in the app. For example, is your mood better after a few weeks of doing a loving-kindness or mindfulness meditation practice for a few minutes a day? Have you tried cutting out alcohol for a month to see what difference it makes for you? Are you taking CBD or cannabinoids?

The Resilience Medicine App is a free tool developed over a decade of practice treating patients using a quality of life approach. It can help you track how you feel in the four main Resilience Medicine areas of mood, stress/anxiety, energy, and mental clarity.

Depression is a huge issue and probably still under-recognized and under-treated. But not all depression is the same. That is likely why less than half of people respond optimally to conventional antidepressant drugs. For years my patients have shared with me their healing experiences using psychedelics in a therapeutic capacity but outside of the medical model. Now the research is catching up to this experience of so many people and these compounds are now becoming available as life changing medicines, currently with ketamine in the UK and in the US psilocybin has received breakthrough drug status from the FDA.

Cannabis has a similar story with many patients over the past decade even before I started prescribing medical cannabis telling me that a certain strain of cannabis used vaporized and/or in a tincture in small ‘micro’ amounts was the only thing that helped their depression and had less side effects than medications they had tried. I subsequently found that adding very low doses of a high CBD strain of medical cannabis of the right chemovar can be a great assistance in many types of depression where there is also often fatigue, pain, sleeping issues and anxiety and has led to a huge improvement in quality of life and daily functioning. This is the opposite for what many people think may happen if you take any form of cannabis-eg. that it can make you lazy.

With the right dose and strain and CBD: THC content it actually makes people more able to participate life again not less. Adding a gut healing protocol, RM diet and other approaches has worked for many patients who were deemed ‘treatment resistant’ after trying and failing multiple conventional anti depressant drugs.

Dr Dani Gordon, Founder of Resilience Medicine