A Psychiatrist’s Most Overlooked Prescription

We all know the basics: get enough sleep, exercise, and eat well. Advice like this is everywhere, but sticking with it for more than a couple of weeks is tough for most people.

Dr. Steven Storage is a psychiatrist at Amen Clinics, board-certified in adult psychiatry and in child and adolescent psychiatry, and teaches at USC. He joined Dave Barney and me on an episode of the Mental Fitness Podcast to share one key message: mental health is brain health, and your daily choices shape your brain.

Why lifestyle comes first

Dr. Storage regularly prescribes medication, but he prefers to start with what might be driving the problem and build from there.

For example, one 16-week study followed 141 adults with depression or anxiety. Some took antidepressants, others joined group running therapy at least twice a week. The results were nearly the same: about 45% on medication and 43% in the running group saw their symptoms go into remission. The runners also improved their physical health, like weight and blood pressure. Most participants chose their own treatment, so the comparison isn’t perfect.

The hosts put it in perspective: out of 168 hours in a week, even if you spend one with the best therapist, you still have 167 hours influenced by your daily habits.

When Dr. Storage does prescribe medication, he encourages patients to look at six-month windows and focus on daily habits at the same time. Medication changes are always between you and your provider. Don’t stop any medication on your own based on this article.

Protect your sleep like a prescription

If he could suggest just one habit, it would be to guard your sleep like it’s medicine.

Sleep is usually the first thing people give up because it feels expendable. Your brain stays busy at night, though. He describes it as running a cleaning cycle. Research in mice found that the space between brain cells grew by about 60% during sleep, which sped up the removal of waste that builds up while awake.

He gives patients three places to start.

• Wake up at the same time each day. Dr. Storage says wake time matters more than bedtime because it sets your body clock. Get sunlight soon after waking, or use a bright light therapy lamp for 15 to 20 minutes. Staying within an hour on weekends is good enough.
• Keep your bed for sleep. If you work or use your phone in bed, your brain learns that bed means being awake. If you can’t fall back asleep at night, move to a dim, quiet chair and return to bed when you feel tired.
• Put away screens an hour before bed. In one study, people who read on a light-up e-reader took longer to fall asleep, made less melatonin, and felt less alert the next morning than those who read printed books.

The American Academy of Sleep Medicine includes all three in its healthy sleep habits, with 30 minutes as the minimum screen cutoff.

Get your heart rate up

If you only have 80 minutes a week, try 20 minutes of high-intensity cardio on four days. He says a harder-working heart and lungs send more blood and oxygen to your brain.

It makes a real difference. In one study of 120 older adults, those who did aerobic exercise increased the size of their hippocampus, a brain area linked to memory, by 2%. That reversed up to two years of age-related shrinkage. In the comparison group, the hippocampus got smaller.

He also does strength training two or three times a week and says he sleeps best on those days.

High intensity is relative. If you haven’t been active, even a brisk walk can count.

Eat for your brain most of the time

When it comes to food, Dr. Storage targets refined sugar and processed foods first, but he doesn’t expect perfection. He prefers an 80/20 approach: eat well most of the time, and don’t quit if you’re not perfect.

He recommends a Mediterranean-style diet with protein, healthy fats like nuts and olive oil, and plenty of colorful fruits and vegetables.

Diet makes a difference. In a 12-week trial of 67 adults with moderate to severe depression, most of them already in treatment, those who worked with a dietitian had a 32% remission rate, compared to 8% in the group that just got social support.

He even plays a game with his kids: “Is this good for my brain or bad for my brain?” They get it right, and most adults would too.

Knowing is the easy part

None of this is new, so why is it so hard to do what we already know we should?

Dr. Storage says it comes down to habits. Habits form slowly, like how a river carves out a canyon over time. Water keeps running the same way until it cuts a deep channel.

Motivation alone won’t change your habits forever. He compares motivation to the first push on a swing: it gets you started, but it doesn’t last. He actually worries most about people who dive in with lots of motivation, because it usually fades fast.

What really works is structure. Start with small steps. Even a two-minute walk four days a week is progress. Having someone else involved helps too. Dr. Storage admits he knows all the exercises his trainer gives him, but he still works harder with support.

Finding your real reason matters. “I want to get healthier” isn’t enough. You need a reason that hits home, like “I want to be strong for my kids.” His test: if your reason makes you emotional, you’ve found it.