This particular lifestyle measure cannot be over-emphasized. I have had many patients, including Amada, point to this particular lifestyle measure as perhaps the most important in leading them to success in depression-free living without the use of medications.

Researchers at Ohio State University in Columbus studies 224 middle-aged and older adults who were already dealing with significant stress in their lives. At one-year intervals for three years, participants reported their degree of optimism and pessimism, negative life events, depression, stress, anxiety, and other issues. The researchers found that optimism and pessimism, previously thought to be linked, are actually independent factors that individually influence stressed and non-stressed people. One factor is more influential than the other. Specifically, pessimism predicted anxiety, perceived stress, and self-rated lack of physical health for the next year. An optimistic attitude did not predict anything.ⁱ

This requires a retraining of the thought process. I have found that many depressed individuals have a tendency to look at the down side of life. We are all well aware that there always will be things in this imperfect world to complain about. We are helpless to personally do anything about many of these negative things or events.

In contrast, focusing the mind on enjoying the wonderful blessings of life is not only uplifting but also therapeutic. As soon as conscious awareness of unconstructive negative thought is realized, a positive thought should immediately replace it. This means that the person should plan ahead as to what positive thought to contemplate so that no delay in thought-shifting occurs. The human brain is both flexible and trainable and as positive thoughts become habitual, depression will likely become a thing of the past.

One religious author stated, “It is a positive duty to resist melancholy, discontented thoughts and feelings- as much a duty as it is to pray.”ⁱⁱ If negative-thinking people visited the setting portrayed in Figure 10 and saw the low clouds and dead leaves, they would complain that they did not choose another day to be there. Others would revel in seeing the grand mountains, the valley clothed with living green, and the beautiful flowers.

Incidentally, this may be one of the reasons that country music (now the most listened-to music in the U.S.) does not come out on top in uplifting the mood. Melancholic guitars accompanying voices and lyrics combine to complain about a wrecked pick-up, lost dog, or missed ex-spouse. Even though the rhythm may be classified as upbeat, the effect does not truly uplift the thoughts.

Massage must be included in any list of depression treatments that can favourably influence the frontal lobe. The reason for this is that massage can balance frontal lobe function.

Recently, Jones and Field, of Florida Atlantic University, demonstrated that massage could help balance the greater relative right frontal lobe activation that characterizes depression.ⁱⁱⁱ These same researchers show similar effects for music therapy.

The mental health benefits of massage therapy are not limited to depression per se. Massage has been demonstrated to decrease other symptoms that often accompany depression, such as anxiety. University of Miami researchers, Field and colleagues found that 15-minute massages twice weekly for five weeks not only decreased anxiety levels, but also dropped levels of cortisol, the detrimental stress hormone.^iv Field’s group documented other brain performance benefits from this brief massage treatment, including enhanced alertness and increased speed and accuracy for math computations.

An inner religious experience has been found to be effective in recovery from depression, according to several studies.

For just under a year, researchers from Duke University in North Carolina used diagnostic interviews to track the emotional well-being of 94 individuals, each of whom was more than 60 years of age. They all had been diagnosed as suffering from depression upon discharge from a hospital.^v

Some of their tests and questions focused on the study participant’s level of inner religiosity. To ascertain this level of inner faith, researchers used a ten-question evaluation test that had been developed with the help of a Christian ministers and Jewish rabbis. They also established the level of each participant’s external religious practice—activated such as service attendance and involvement in church-related clubs and activities. During the course of the study 54 percent of the participants recovered from their depression.

Religion helped in that recovery. “Depressed patients with higher intrinsic (inner) religiosity scores had more rapid remissions than patients with lower scores,” according to the study. In fact, patients recovered from depression 70 percent sooner with every ten-point increase in the religiosity evaluation test score. But the researchers found that external religious activity had much less of an impact.

The Duke team urges psychiatrists to initiate inquiries into a patient’s religious faith, especially when patients are depressed, since “these beliefs may bring comfort and facilitate coping.”

Other studies have found that strong religious faith is not only helpful in treating depression, but also in preventing it.^vi,vii,viii

Many studies have suggested that going through the forms of religion without firm belief does little, if any, good to overall metal health.^ix Thus, I do not emphasize a casual reading of the Bible, but a serious study that contemplates the themes of scripture. Reading and meditating on a chapter of the book of Proverbs each day (with the chapter number corresponding to the day of the month—there are 31 chapters) has been helpful for many of my depressed patients. Memorizing and reciting a text a week that summarizes or succinctly states a beautiful Scriptural idea is also very helpful. One new program that has met with wonderful worldwide success in accomplishing these objectives is called FAST.

In animals and in humans, isolation leads to depression and withdrawal, while social support and a sense of belonging leads to improved mood and improved mental and physical health.^x The importance of strong social support should not be underestimated.

One study showed that good support of families and friends can be lifesaving. After suffering a heart attack, 887 patients were followed for a year.^xi Researchers evaluated the patients for depression soon after they were transferred out of intensive care units. The patients were asked questions about the support they receive from family, friends, or a “special person.”

Soon after having the heart attack, about a third of the patients were mildly or moderately depressed. Patients who were depressed were more than three times as likely to die during the year after having the heart attack. But the effect of depression on survival varied depending on a person’s perceived social support.

The odds of dying were highest in depressed people who felt that they did not get enough support from their friends, families, and loved ones. In contrast, the depressed patients who felt the strongest support by friends and family were not any more likely to die than non-depressed people. In addition, symptoms of depression were much more likely to improve in depressed patients who felt well supported.

Another study suggested that there is something even more important than perceived social support. This particular study sent questionnaires to 31 patients with major depression and to 379 community college students in Ann Arbor, Michigan.^xii Questions focused on issues such as a psychological sense of belonging, the extent of one’s social network and social activities, and feelings of conflict and loneliness.

The study showed that from all social factors considered, a sense of belonging is the best predictor of what an individual might experience in terms of depressive symptoms.^xiii The point is that many friends and a busy social life do not necessarily equate with a strong sense of belonging. An individual might have friends that he does not feel belong to him.

I recommend that individuals who do not have a close family or close friends, especially if they have a low sense of belonging, involve themselves in certain community or church projects that are consistent with their own goals. They will often form close relationships in the process, and with a sense of common purpose will soon feel truly “belonged.”