There are so many layers to depression and it can be an incredibly destabilising period in a person’s life. The common recommendation is to see a mental health professional, but with therapy costing hundreds of dirhams just for one session, that is just not an option for most of the population here in the UAE.
Despite the fact that globally, more than 264 million people of all ages suffer from depression, according to the World Health Organisation, it has taken a pandemic for everyone to pay more attention to rising mental health frailties. Research from Columbia University’s Mailman School of Public Health has revealed that the global prevalence of both depression and anxiety since Covid-19 began has risen by 24 percent and 21 percent, respectively. Factors contributing to ailing mental health include health anxiety, financial struggles and an overwhelming sense of uncertainty about the world and how it is changing.
Depression comes in many forms. It isn’t a condition you can simply think yourself out of — it grips your mind, but also your body and soul.
Dr Ioannis Delipalas, consultant psychiatrist and medical director of Thrive Wellbeing Centre, says: “Depression and anxiety can be ‘hidden’ in a wide range of physical symptoms such as fatigue, dizziness, gastric dysphoria, headaches, pain and lower pain thresholds, and irregular bowel movement. This is how the mind communicates with the body to flag that something is not OK.”
Adverts about depression talk about sadness but they rarely allude to a symptom that everyone with depression knows all too well: the Impossible Task. The Impossible Task is the inability to face the most routine and mundane parts of life: going to the bank, making your bed, checking your email or paying a bill. Often this is the most debilitating part of depression because even the most basic form of functioning cannot be achieved, therefore compounding further the feelings of inadequacy.
While access to talking therapies has remained available during the pandemic, albeit mostly through Zoom, for many the price of therapy is enough to amplify anxiety and stress. Or they just can’t afford it.
The good news is, there are many home-based approaches and self-driven ways to deal with depression when the purse strings are tight.
Assess physical health first
Before you approach depression management, check your fundamentals first, says Dr Rasha Alani, specialist in family medicine from Medcare Medical Centre Al Khawaneej.
“You need to see if you have a deficiency in vital minerals and vitamins directly related to your daily disposition, like vitamin D, magnesium and vitamin B.”
When these levels are off kilter, they can produce a change in personality and how you conduct yourself with even the most basic tasks, he explains. Hormonal levels can also affect impact mood: men can have low testosterone – aka Low T –at any time, not just as they age. Women can be affected by fluctuations in their estrogen and diminishing progesterone and testosterone that comes with perimenopause, which can start a decade or more before menopause.
Dr Alani also weighs in on the extremely complex anti-N-methyl-D-aspartate receptor antibodies test, “which is linked to major depressive disorders. It’s important to note that these antibodies are related more with complicated brain situations and inflammation”.
On a recent Instagram post, TV doctor Mark Hyman, a leader in functional medicine based in the US, spoke with Dr Todd LePine about the link between neuro-inflammation and mental illness. Doing the NMDA test can reveal that the symptoms are caused by some type of inflammation. Sometimes even the most intractable illnesses, such as bipolar disorder or schizophrenia — whose patients have a high level of gluten antibodies in their bloodstream — can be treated with nutritional improvements. This can help improve the biochemistry of the brain, which can improve depression. In essence, this test addresses the cause and not just the symptoms.
Dr LePine points out that depression is not an inflammatory disease, as not all depressed individuals have elevated levels of inflammation biomarkers.
“But there is new research suggesting that depression and inflammation are biologically linked. Inflammation also lowers the effectiveness of antidepressants by reducing the brain’s production of serotonin which plays a key role in depression treatment. All these findings may lead us to understand better the pathology of depression and lead to better augmentation treatment in the future.”
Food and mood
When it comes to mental health, food and mood are synonymous.
Certain types of food build our neurotransmitters (the chemical messengers in our body such as dopamine or serotonin) to assist with healthy mental functioning. Dr Faryal Luhar, a naturopath based in Dubai, uses chocolate as an example.
“It’s a feel-good type of food and dark chocolate is even better because of the compounds it contains, specifically anandamide (meaning bliss) , so therefore we feel happier. For some people, coffee helps them feel brighter and more alert but for others, it makes them feel out of control. We have to take into account genetics and how each individual body responds to certain foods.”
A sugary diet filled with processed food and inflammatory oils – corn, soy and sunflower, for example – can be directly linked to the state of a person’s brain health, because our guts and our brains are directly connected.
“When someone eats chemically-laden food, there will be sluggishness, mental fogginess and anxiousness,” says Dr Luhar.
It’s important to eat foods high in tryptophan – which is the precursor to the production of serotonin and is found in turkey, nuts and chia or hemp seeds. Healthy fats that are high in omega 3, including mackerel, tuna, sardines, olives, olive oil and avocado are also good for our gut.
“A lot of serotonin is made in the gut,” says Dr Luhar. “Diverse strains of healthy bacteria help us extract nutrients from food because essentially, what you feed yourself also feeds or alleviates depression. Stodgy foods such as breads and cakes exacerbate symptoms of depression.”
The gut is so integral to the way we feel mentally that Dr Luhar says in many cases anti-depressants can be futile if no attention is paid to gut health.
“If a person is already taking anti-depressants, they usually respond a lot better when they see a functional medicine doctor to correct a state of unhealthy gut bacteria or dysbiosis (digestive disturbances). You’ll find that when you deal with your gut properly, you require a lower dosage of anti-depressants. It’s also important to replenish healthy bacteria with good quality probiotics and never forger that simply staying hydrated is incredibly important. Water with lemon is preferable.
Therapy without the price tag
There are many cost-effective resources to stabilize and aid recovery. The LightHouse Arabia’s online support group: Emotional Health During Times of Covid-19 is a place where individuals can meet and discuss emotional and mental health concerns, stresses related to social isolation and quarantine, and any other anxieties and stressors related to the coronavirus situation.
Society teaches us that men are not allowed to be anything less than strong and fit for purpose and that has led to an assortment of issues that fall under the category of “toxic masculinity.” The Anyman movement has a chapter in Dubai and provides a non-judgmental, confidential and supportive refuge to all men; past sessions have been on offer for Dh60. Anyman host events and workshops open to all men who need to stop and take a moment to reflect on everything that’s going on around them.
The Australia-based platform MoodGYM is an interactive, cognitive behavioral site that teaches people to change their thinking to help prevent and reduce symptoms of depression.
A more formal program would be the Happiness Trap – an 8-week online course based on building genuine happiness from the inside out using easy-to-learn skills and strategies that are scientifically proven to create real change. And if attention spans haven’t been affected too much and you can still get through a book (as this can also be an Impossible Task) Do the Work by Nicole LePera is an essential guide on living a more joyous life, drawing on the latest research from a range of scientific fields and healing modalities.
The proliferation of self-help apps is another viable option to tap into. For many, depression feels physically painful. Curable is an app for anyone who has exhausted many avenues and is still in pain. Touted as ‘a different approach to pain,’ this app offers evidence-based, safe, and effective chronic pain solutions.
As far as mobility and mental health, “It has been well-known for centuries that physical conditions affect mental health and that mental conditions affect physical health. In fact, Hippocrates, who is considered to be the Father of Medicine, stated that body and mind should be in harmony and that physical exercise helps maintain ‘a healthy mind in a healthy body,’ says Dr Delipalas.
Ronette Zaaiman, clinical psychologist at The Lighthouse Arabia, says there is a clear link between what we do with our physical body and our mental state.
“By following a balanced diet, avoiding mood altering substances, balanced sleep and regular exercise, we can take care of our minds through taking care of our bodies,” she says.
Seem like another Impossible Task? Take a short walk. Or try the 7-minute workout app, which offers short but effective activity to make you feel like you have achieved something for yourself, thereby triggering feel-good chemicals in your brain.
Another way you can assuage the symptoms of depression is by chanting or humming. A 2016 study from the Department of Psychology at Macquarie University in Sydney, Australia, indicated that chanting “om” for 10 minutes can help reduce stress, anxiety, and depressive symptoms while improving attention and enhancing positive mood. Listening to a sound therapy class online can have the same effect.
Affirmations are another technique directed at the self, which are meant to calm, soothe and motivate and offer a sense of relief and perspective.
Repeating ‘I will feel good again’ or ‘I listen to my body’ reminds you that depressive episodes won’t last forever. The popular Lovingkindness Meditation focuses on eliminating some of the negative thoughts that are common during depression and repeating these phrases: “May I be happy, may I be safe, may I be healthy, peaceful and strong, may I give and receive appreciation today. May I be happy.”
If you’re struggling with depression right now, it’s important to remember that you’re not alone and that the way you feel does not define you.
“A thing that really helped me was seeing a separation between myself and depression,” says Matt Haig, the British author and mental health advocate. “I used to say ‘Oh, I’m a depressive’ or ‘I’m a bit of a depressive’ and that is a very toxic way of looking at it, because your identity becomes the depression. If you are in a hurricane, you are not the hurricane. You are the thing going through the hurricane.”
Georgie Bradley is a British/Greek editor and journalist based in Dubai after being bred in Bahrain. She's been published by The Guardian UK, The Telegraph UK, BuzzFeed, The Huffington Post UK, Buro 24/7 and Harper's Bazaar Arabia. Most recently she was the deputy editor of Emirates Woman. You're most likely to find her in the aisle seat.