Lifestyle Choices for Good Mental Health During COVID-19  

By: James Lake, MD

Simple lifestyle choices can enhance mental health
Because of widespread unemployment and the closing of mental health clinics due to the pandemic, millions of individuals struggling with anxiety, depression, and insomnia do not have access to, or cannot afford psychotherapy or medications. These circumstances may continue for months or even years, depending on how soon effective antivirals and vaccines become available. This post is offered as a concise review of the mental health benefits of lifestyle changes for depressed mood, anxiety, and insomnia, including changes in diet, regular exercise, improved sleep, and a daily mindfulness practice.


Individuals who consume whole foods (as opposed to processed foods and fast food diets) are at reduced risk of developing depressed mood. For example, individuals who closely adhere to a Mediterranean diet, as well as traditional diets in Norway, Japan, and China, which are rich in vegetables and fish, have a 30% lower risk of developing depressed mood than those with the lowest rate of adherence to a Mediterranean diet.

Twelve essential nutrients have established mood-enhancing benefits. These are: folate, iron, long-chain omega-3 fatty acids (EPA, DHA), magnesium, potassium, selenium, thiamine, vitamin A, vitamin B6, vitamin B12, vitamin C, and zinc (LaChance and Ramsey 2018).
Foods with the greatest antidepressant benefits include seafood, leafy greens, and cruciferous vegetables such as broccoli, cauliflower, cabbage, kale, and Brussels sprouts.

Some depressed individuals are deficient in certain B vitamins, omega-3 fatty acids, vitamin D, zinc, and magnesium. Foods rich in folate and B-12 such as whole grains and green leafy vegetables may be especially beneficial for depressed mood. Omega-3s and some B vitamins also have anti-inflammatory and neuroprotective effects on the body and brain, which are believed to enhance their antidepressant benefits. Diet also plays an important role in anxiety. For example, generalized anxiety is often associated with reactive hypoglycemia, resulting in acute anxiety symptoms. Individuals who have anxiety caused by hypoglycemia benefit from reducing sugar and carbohydrate intake, increasing protein intake, and reducing or eliminating caffeine. Excessive consumption of caffeine is also associated with an increased risk of anxiety. Many chronically anxious individuals report significant reductions in the severity of anxiety when they abstain from caffeine.

Finally, recent research findings show that the microbiome-i.e., the microorganisms that naturally populate the large and small intestines-causes beneficial changes in brain levels of serotonin and other neurotransmitters implicated in mood regulation. Research studies suggest that there is a link between imbalances in bowel microflora, increased inflammation of the mucosal lining of the intestines, and systemic immune dysregulation resulting in an increased risk of depressed mood. Findings of animal and human clinical trials suggest that probiotics have beneficial effects on both depressed mood and anxiety.


Short-term and long-term beneficial effects of exercise on mood are mediated by increased brain levels of mood-elevating endorphins, dopamine, norepinephrine, and serotonin (Schuch 2016). Regular exercise may also promote increased neuroplasticity in certain brain regions, resulting in improved mood (Gourgouvelis 2017). 

Regular exercise including both aerobic exercise and non-aerobic strengthening exercise has established anti-depressant effects and less sedentary individuals have a reduced risk of both depressed mood and cardiovascular disease (Schuch 2017). Chronically depressed individuals often experience difficulties with thinking and memory, and regular aerobic exercise can significantly improve cognitive functioning in this population (Oertel-Knochel 2014). 

A meta-analysis of controlled studies on exercise used either as a single intervention or in combination with antidepressants found that regular exercise has beneficial effects on depressed mood (Kvam 2016). A systematic review of studies on exercise as an add-on therapy to antidepressants found that depressed individuals who exercise regularly have better response rates compared to individuals who take an antidepressant only (Mura 2014). Antidepressants and exercise probably have equivalent efficacy against moderately severe depressed mood (Blumenthal 2007).
Regular exercise improves sleep quality in depressed individuals who do not respond to antidepressants (Rethorst 2013). Improved sleep enhances resilience and day to day functioning because of the high prevalence rate of insomnia in chronically depressed individuals. In addition to its mood-enhancing and anxiety-reducing effects, regular exercise enhances self-sufficiency.
Both aerobic exercise and strength training improve anxiety when done on a regular basis (Paluska 2000).  A daily workout lasting 20 to 30 minutes can significantly reduce generalized anxiety and may also reduce the intensity and frequency of panic attacks.

Relaxation, mindfulness and mind-body practices

Relaxation techniques include sustained deep breathing, listening to calming music, and progressive muscle relaxation. Examples of mindfulness training include different styles of meditation and guided imagery. Mind-body practices include taijiquan, qigong, yoga, and other approaches that involve both the mind and the body. A regular meditation or mind-body practice such as yoga, may be as effective as antidepressants and cognitive behavioral therapy (CBT) for moderately severe depressed mood.

Relaxation techniques and mind-body practices also improve sleep quality in individuals with insomnia. Progressive muscle relaxation and sustained deep breathing are especially effective at reducing the time needed to fall asleep in individuals with chronic insomnia. Listening to relaxing music soon before bedtime can also help individuals with insomnia fall asleep quicker. Many individuals who have problems falling asleep because of chronic worrying report improved sleep with guided imagery. Individuals with chronic insomnia who use a cognitive-behavioral technique alone or in combination with a benzodiazepine or other sedative-hypnotic drug report that non-pharmacologic or combined approaches are more effective than medications alone.

Supportive relationships

Finally, I want to emphasize the importance of relationships. In addition to engaging in healthy lifestyle choices, supportive relationships with friends and family members can provide important buffers to day to day stresses and uncertainties that we will all face at this time of great uncertainty. Video calls or phone calls can be very heartening and encouraging even when shelter-in-place orders restrict us from direct contact with family, friends, and loved ones.

Maltby, J.; Day, L.; Macaskill, A. (2017). Personality, Individual Differences and Intelligence (4th ed.). Harlow: Pearson Prentice Hall. 

More Resource Articles

Gardening and Mental Health: A Brief Overview

Gardening enhances general well-being, reduces stress, and improves mood.

Managing COVID-19 Anxiety Without Benzodiazepines (Part 4)

Part 4 of a series on taking care of stress and anxiety without benzodiazepines in the time of COVID-19.

Managing COVID-19 Anxiety Without Benzodiazepines (Part 3)

Globally hundreds of millions of people are experiencing high levels of stress and anxiety in the face of the COVID-19 pandemic. Benzodiazepines such as alprazolam (Xanax), clonazepam (Klonopin), lorazepam (Ativan) are being widely prescribed by doctors to help people manage their symptoms, and there has been an increase in the illicit market for benzodiazepines.

Kava and l-theanine for COVID-19 Anxiety (Part 2)

This is the second post in a series of non-pharmacologic management of anxiety during the COVID-19 pandemic. In the first post, I commented on the limited efficacy of benzodiazepines for anxiety and highlighted the medical and psychiatric risks associated with benzodiazepine use, which are greater during the COVID-19 pandemic. In this post, I briefly review the evidence for kava-kava and l-theanine, two natural products widely used for stress and anxiety.

Managing Anxiety During COVID-19 (Part 1)

This post is the first in a series on the management of anxiety during the COVID-19 pandemic. Millions of people have been relying on benzodiazepines such as alprazolam (Xanax), clonazepam (Klonopin), lorazepam (Ativan) and other prescription drugs to manage symptoms of stress and anxiety. While some medications are safe and effective treatments of anxiety, they have limited overall efficacy and potentially serious safety concerns.

Parenting In a Pandemic

The coronavirus pandemic has thoroughly changed the time spent with our families. With parents and children working and learning from home, many of us are getting more family time than we ever expected. Furthermore, the coronavirus threatening public health as well as the current conditions breeding economic and political uncertainty are significant stressors on parents and children alike.

The Relationship Between Immune Health and Mental Health

The importance of cultivating a strong immune system has become evident as we navigate the coronavirus pandemic. It is no secret that a strong immune system can help defend against illnesses, but there may also be a hidden benefit to mental wellbeing. 

COVID-19 Pandemic Fatigue

It's hard to believe that we are nearly one year into the COVID-19 pandemic. The initial panic and hoarding of toilet paper have worn off, yet for many the psychological impacts of the pandemic are still very much present and may last longer than the pandemic itself.

Locus of Control and COVID-19

The COVID-19 pandemic is causing enormous stress for countless millions of people in all world regions. There has been no crisis of comparable magnitude within living memory. Individuals, communities, and entire populations are acutely aware of "loss of control" over their health, their finances, and their daily activities. The impact of "loss of control" on our mental health is made even worse by uncertainty over the future that is unprecedented in modern times...

Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity)...

Bipolar Disorder

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. Symptoms of bipolar disorder are severe. They are different from the normal ups and downs that everyone goes through from time to time...


Everyone occasionally feels blue or sad. But these feelings are usually short-lived and pass within a couple of days. When you have depression, it interferes with daily life and causes pain for both you and those who care about you. Depression is a common but serious illness...

Eating Disorders

An eating disorder is an illness that causes serious disturbances to your everyday diet, such as eating extremely small amounts of food or severely overeating. A person with an eating disorder may have started out just eating smaller or larger amounts of food, but at some point, the urge to eat less or more spiraled out of control. Severe distress or concern about body weight or shape may also signal an eating disorder...

Generalized Anxiety Disorder

All of us worry about things like health, money, or family problems. But people with generalized anxiety disorder (GAD) are extremely worried about these and many other things, even when there is little or no reason to worry about them...

Panic Disorder

People with panic disorder have sudden and repeated attacks of fear that last for several minutes. Sometimes symptoms may last longer. These are called panic attacks. Panic attacks are characterized by a fear of disaster or of losing control even when there is no real danger...

Post-traumatic Stress Disorder

When in danger, it's natural to feel afraid. This fear triggers many split-second changes in the body to prepare to defend against the danger or to avoid it. This "fight-or-flight' response is a healthy reaction meant to protect a person from harm. But in post-traumatic stress disorder (PTSD), this reaction is changed or damaged. People who have PTSD may feel stressed or frightened even when they're no longer in danger...

Social Phobia (Social Anxiety Disorder)

Social phobia is a strong fear of being judged by others and of being embarrassed. This fear can be so strong that it gets in the way of going to work or school or doing other everyday things...

Obsessive Compulsive Disorder

Everyone double checks things sometimes. For example, you might double check to make sure the stove or iron is turned off before leaving the house. But people with obsessive-compulsive disorder (OCD) feel the need to check things repeatedly, or have certain thoughts or perform routines and rituals over and over. The thoughts and rituals associated with OCD cause distress and get in the way of daily life...