Hello,
As a fellow APOE4 carrier with a strong family history of Alzheimer and of depression maybe my personal experience and research help. If not, just disregard.
I have been mildly depressed on and off for decades and am now struggling with a particularly nasty bout of anxious depression since the beginning of the year. Awful insomnia too.
During my life of “my brain and I are not always friends” I tried a multitude of medications, herbs and alternative approaches. I also tried my best to research whether any of these might contribute to an Alzheimer (or other health related) risk.
I am not a doctor and not a scientist, just a patient, and this is strictly personal and not in any way medical advice.
This is what I can share:
1. About medication: I have had this for so long and met so many other people with a wide variety of mental illnesses that I believe medication is only strictly necessary for a very few conditions (meaning you can overcome most without - or cannot overcome some even with meds ). Like bipolar or schizophrenia. Not for depression unless it is left untreated until a critical point (severe depression needs medical attention asap!). But medication can be IMMENSELY helpful if you find the right one and your metabolism isn’t extra whacky like, e.g., mine. I met a lot of people who say their medication saved their lives, or at least the quality of their life.
I personally have not benefited from any of the about 20 I tried because they had paradoxical or no effects. I have even had the personal suspicion that my APOE4 variant causes deviations in metabolism which makes these medications unpredictable- after all their mechanism is widely unknown. That would sadly mean my daughter is a carrier too, because for her, not even all anaesthetics work! They won’t put her under. The hospital had to try out several. However we may have a different genetic variant causing that, no one knows.
I would take the right med at once if I could, provided it is not heavily anticholinergic. Depression, anxiety, insomnia or similar will put the body and brain under immense stress. One has to balance out what is unhealthier. This venue is out for me because the medication doesn’t work like it should, but most people will benefit. My research into the risks has shown me that all medications which are heavily anticholinergic are apparently increasing dementia risk and so I try to avoid a high anticholinergic burden.
Then there are some medications with hepatotoxic properties or risks associated with parkinson-like symptoms. I would avoid these unless they are the only ones that work, in which case close monitoring is needed.
Some antidepressive medication has even been shown to be possibly neuroprotective. I think Mao-B inhibitors and trazodone and agomelatine were among them, but there were several. The science is still very medieval and controversial here, but there seems to be some hope. It may be useful to research some here if you want to try if you are one of the lucky people who are immensely helped by antidepressants.
But this thread was about non drug approaches so here goes:
2. I am by now firmly convinced that no herb or med will do the main work, which is changing your habits, reprogram your brain and changeing your thought patterns. This is immensely difficult work and you need a lot of persistence and patience but it is definitely possible.
I recommend finding an experienced therapist who isn’t set on any one psychological approach and maybe a few good books which resonate with you (pm me if you want some recommendations). Thought patterns and thinking habits as well as reaction habits and ingrained belief are, in my opinion and experience, behind all mental issues except thouse which are strictly physical. I was helped most by an experienced therapist in a clinical setting who specializes in schematic therapy but just uses them all tailored to the patient in front of her. But the main work was and is with me. I have to watch myself, my thinking habits, my reaction habits and work actively to change them. It takes a long time, sometimes increases symptoms for a time and can be exhausting but it is so so rewarding.
3. Exercise. Physical exercise is an important part in mental health. My old psychiatrist who practiced for 45 years said 5-6 hours of physical activity a day will replace any medication for most conditions. However, it is not a cure all, I have a fellow patient who has severe depression and is a marathon runner (he has very unhealthy thought patterns though).
https://pubmed.ncbi.nlm.nih.gov/24026850/
4. Cold. Exposing oneself to varying temperatures and especially cold seems to do some resetting and invigorating for the brain. I know I saw studies but it is still very vague.
https://pubmed.ncbi.nlm.nih.gov/17993252/
5. Be less strict and strong. Huh? What’s this? What I mean is, of course inner strength is good and right to overcome any illness or live with it or even live this sometimes hard life. But what I find is that many many people with mental illnesses are really strong personalities with a lot of convictions and codes on how to live. Many of us just aren’t able to let go, to flow through life, to let bygones be bygones, to accept what cannot be controlled. Probably (and again that is just personal observation ) because many of us have had harsh experiences which shattered our trust in the basic “all will be ok “. But hey, that can be rebuilt.
5. Self compassion and kindness are really really important. I can’t stress this enough. Being a good friend to yourself. Focus on what does you good, what you enjoy. And do it. I don’t think there are any studies for this but it is an approach used by all the best therapists I met. My current one even treats it a little like a school subject and makes people identify and write down and then implement strategies “to feel good”. It makes a world of difference.
6. Here is a very personal one: When not 100% mentally strong, avoid news and current affairs and social media unless that is something that gives you immense joy. Most people will be left stressed, angry, anxious, sad, outraged etc. after looking at media which are all not good states to be in. For me, self compassion means a news diet.
7. Speaking of diet, gut health is important. Changeing my diet to mediterranean, avoiding sugar and transfats withing reasonable limits (christmastime, the time for sweets… ), changeing my breakfast to millet, berries and nuts with yoghurt and also taking a supplement for my gut health has helped my condition a bit I think. Since I am really severely affected this won’t be curing me, but anything that contributes to being better is good. I haven’t tried a keto diet or fasting since my hormones are totally out of whack anyway and I don’t want to stir them up more.
8. Having a pet. The studies are mixed and there is no clear evidence for pets alleviating depression, but for some people it helps. It may be worth a trial (helping in a local shelter for example and see how the animals affect your mood, also at the same time engaging with people and a meaningful pursuit, winwin).
9. Light therapy. There are multiple studies for it, but I didn’t find a good one out of hand. It cannot hurt much so it’s worth a try. Going outside in the light is even better.
10. Nature. Nature can be a great healer. Our biology means for us to be outside and move and be exposed to the trees, the birds, the animals, the wind and the sun and the stars. Without machine noise, without pollution..ah, dreaming here. But seriously engaging with nature has been used as a therapeutic approach for millenia and it can’t hurt at least.
11. Last but nit least check if there are no other medical conditions hidden behind the depression. A common culprit is thyroid malfunction. But heart or kidney disease and some viral conditions can also cause mental health issues.
Hope that helps a bit.
Best
Chris
51 years old. APO E3/4. Mother, grandmother and great grandmother had/are starting with dementia. Afflicted with anxiety disorder atm. Very eager to save brain and live a long healthy life. Grateful to you all for your knowledge and kindness!