Achieving overall well-being can be a journey; many people start with seeing a therapist and some people find they need to add in medication. It is easy to lose sight of the simple things that keep us feeling well, especially when consumed with depression and anxiety. Here I will outline a few steps you can start taking to improve your overall wellness. Broken down to the basics:

*Sleep *Nutrition *Exercise *Socially connecting *Mindfulness *Supplements

Lets talk sleep. Regulated and good sleep is very important in order to feel good physically and mentally. In addition to sleep, neurotransmitters keep us balanced…. or not. A disruption in neurotransmitters correlates to depression, anxiety and other mental health disorders. REM sleep is when our neurotransmitters are replenished. Failing to replenish neurotransmitters can exacerbate underlying symptoms of depression and anxiety. So, how can we get good sleep? These tips may sound simple, but often we let them slip (many of these come from The National Sleep Foundation[1]):

Avoid naps longer than 30 minutes during the day and stimulants (caffeine, sugar, alcohol, nicotine) 3 hours before bed

Be mindful that alcohol can help a person fall asleep, but it is often very disruptive to the second half of our night-time sleep

Exercising- as little as 10 minutes of aerobic exercise a day leads to better, deeper sleep (it is suggsted to avoid exercise up to two hours before bed)

Implement good sleep hygiene and try your best to have a regular sleep schedule. This can be as simple as putting on your pajamas, brushing your teeth, washing your face and getting in bed. Any electronic activity (TV, phones, Ipads, etc) are very disruptive to falling asleep. Listening to music, reading a book, or listening to guided mindfulness (apps, such as headspace) are great ways to relax your busy mind

Nutrition. I work in a mental health out-patient practice. Our provider staff consists of psychiatric nurse practitioners, a psychiatrist, therapists, AND a dietician. Why a dietician? Because nutritional intake has a significant impact on mental health. Havard Health put together an article discussing Nutritional Psychiatry [2]. The author compares your brain to a car, it works best with premium fuel. Fuel your body with clean food. What is clean food? Food the way nature made it. Obviously it is not possible for many people to only eat this way, but be mindful of what you are putting in your body. Also, make sure you are getting enough nutrients. If you need a quick reminder of what your daily food intake should look like, glance here:

Click to access FGPPamphlet.pdf

One of the primary neurotransmitters that keeps our mood in check, serotonin, is produced in the gastrointestinal tract. The gastrointestinal and nutritional connection to mental health is taking off in the research industry- we are realizing how important “gut health” is. My take home: make sure you are getting close to the recommended daily caloric intake, and fuel your body with clean foods.

Exercise. This one can be hard, I know. I am a mother of two young boys (1 and 3 years old). My mornings start early and crazy– (I don’t want to get dressed, I don’t want that for breakfast, I want to wear my pajamas, mom you forgot my shoes…) and my day’s end late (dinner, bath, 5 night-time books, followed by 3 night-time stories, only to tip toe downstairs and hear the 1-year-old crying). How can you squeeze in exercise and is it really that important? Columbia University wrote an article stating that 2-4 hours per week correlated with the most significant improvement in mental health [3]. That boils down to about 20-30 minutes of exercise each day. Keep it simple if you need to— walk your dog, walk to work, walk during your lunch break, do Pilates before work…..

Maintain a Social Connection. This one is JUST as important as sleep, nutrition and exercise! Standford University published an article discussing a handful of studies that have correlated strong social connection to a longer, happier life; in addition, it’s correlated to a stronger immune system and quick disease recovery [4]! What else can social relationships do for you? Studies indicate that people who are more socially connected have lower levels of anxiety and depression, higher self-esteem, and greater trust and empathy for others. What can you do to maintain social connectedness? Call a friend or family member each day, talk to a stranger at the grocery store, cook dinner with a friend, take up a new hobby, join a social skills group, AND- make sure you are Present when you are socially connecting (put your phone and social media away for awhile).

Mindfulness. Mindfulness is having moment to moment awareness, being present in the moment. It is not stressing about the past or obsessing about the future. It is focusing on the here and now. When I worked on an in-patient child and adolescent psychiatric unit, we would practice mindfulness with eating. Each patient would receive a piece of food, and the goal was to be mindful while eating. We would focus on being mindful of what the food looked like before we ate it, the texture of the food in our mouth, the taste while chewing and swallowing, the smell, and the noises it made while we ate it. In my experience many people think of meditation when they think of mindfulness. Meditation is great for some and very anxiety producing for others. It is a skill to be achieved. If you have not mastered mediation, I would start with something more simple. If you have a smart phone try the app Headspace, this is a form of guided mindfulness and meditation that I have personally found to be fantastic! If you can carve out 1 to 3 minute each day you will find Headspace to be quite beneficial.

Supplements. When it comes to mental illness and well-being there are a few supplements that can be beneficial to mental health. In my practice we obtain blood work on most patients. Living in Colorado I am surprised to find many of my patients are deficient of Vitamin D. I recommend to almost all of patients adding Vitamin D 1,000 IU each day. Vitamin D deficiency can present with symptoms of low energy and mood. More recent research has suggested that Omega-3 fatty acids play a role in not only cardiac health but mental health, more specifically depression and ADHD symptoms. Supplementation with a good Omega includes both EPA and DHA. Finally, Probiotics have gained a lot of support from the mental health and GI community. Researchers continue to find that our gut has a significant impact on our mental health. Current research is suggesting that a change in our GI bacteria can have a negative impact on our mental health (not surprising as neurotransmitters are not only found in our brain but also our GI track). I will say that this is a new science, one that Harvard Health has been investigating- at best, research is limited but a handful of studies have correlated a positive change in mental in individuals taking probiotics. [5]. However, I will say that I have suggested to a handful of patients starting a probiotic (a heavy hitter initially like VSL#3) and I have witnessed overall improvement in depression and anxiety.

When it comes to mental health and wellbeing, this is where I like to start. Good luck, changing poor habits and implementing good habits takes commitment and perseverance. However, making changes that affect your day-to-day living can have a significant positive impact on your long term mental health and wellbeing!

http://www.tc.columbia.edu/articles/2012/november/study-pinpoints-just-how-much-exercise-is-good-for-mental-he/

Dr. Seppala- About Dr. Emma SeppalaEmma Seppälä, Ph.D, is Science Director of Stanford University’s Center for Compassion and Altruism Research and Education and the author of The Happiness Track (HarperOne, 2016). – http://ccare.stanford.edu/uncategorized/connectedness-health-the-science-of-social-connection-infographic/

MD Bousvaros – https://www.health.harvard.edu/blog/can-probiotics-help-treat-depression-anxiety-2017072612085

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[1]Sleep.org by the National Sleep Foudation. https://sleep.org/articles/sleep-hygiene/ [2]Eva MD. https://www.health.harvard.edu/blog/nutritional-psychiatry-your-brain-on-food-201511168626 [3][4][5]