I've dealt with my own mental health challenges across most of my adult life. Across that time, I've tested most major mental health practices. Therapy, medication, meditation, journaling, exercise, sleep optimization, dietary interventions, supplements, and various other approaches. Some produced sustained benefit; some didn't. Here's the honest report.
What produced sustained benefit
1. Therapy (specifically with the right therapist)
Years of therapy with multiple therapists. The therapist match matters substantially. With the right therapist, therapy produced sustained benefit; with wrong-fit therapists, less so.
What worked specifically: CBT-trained therapist who combined cognitive work with practical strategies. The combination of insight and tools produced more sustained benefit than insight alone or tools alone.
What I'd tell someone starting: the first therapist isn't always the right therapist. Be willing to switch if the fit isn't producing benefit within 8-12 sessions.
2. Medication (during specific periods)
SSRI medication for several years during particularly challenging periods. Produced substantial benefit during use. Tapered off when stable; current life doesn't require medication.
What worked specifically: medication enabled the cognitive work that wouldn't have been possible without it during certain periods. Without medication, the cognitive interventions weren't accessible.
What I'd tell someone considering: medication isn't failure. For some periods of life, it's the right intervention. The decision should be made with appropriate medical guidance, not through internet research alone.
3. Regular exercise
Movement practices (covered in separate article) produced consistent mental health benefit. Running specifically produced mood improvement on running days.
The mental health effect of exercise is genuine and well-documented. The challenge is sustaining the exercise; the practices that fit my life are documented elsewhere.
4. Consistent sleep
Sleep quality affects mental health more than I'd realized. The year of sleep optimization produced mental health benefits that other interventions hadn't produced.
The bidirectional relationship between sleep and mental health means improvements in either reinforce the other. Sleep work was among the highest-leverage mental health work I did.
5. Meaningful work and relationships
The structural elements of life — work that matters, relationships that sustain — affected mental health more than specific interventions. When these were strong, mental health was easier to maintain. When weak, no specific intervention substituted.
The investment in maintaining meaningful work and strong relationships is mental health work even though it's not framed that way.
What didn't produce sustained benefit
1. Most meditation apps and guided meditation
Tried Headspace, Calm, several others. Used for months. The benefits were modest and didn't sustain across the longer term.
Meditation may work for others; for me, the format didn't produce sustained mental health benefit. The practice that did help was less about meditation specifically and more about general attention practices.
2. Most supplements marketed for mood
Tested various supplements (5-HTP, SAMe, various amino acids, herbal remedies). Produced placebo-level effects. None sustained measurable benefit.
The supplement industry oversells mood benefits substantially. Most products don't produce results commensurate with marketing.
3. Journaling (in most forms)
Tested various journaling approaches. The structured ones (gratitude journals, prompted journals) produced modest short-term benefit but didn't sustain.
Free-form journaling sometimes helped during specific difficult periods but wasn't a sustainable daily practice for me.
4. Various productivity systems applied to mental health
Tried treating mental health as productivity problem with systems. The framing didn't fit; mental health doesn't respond to productivity optimization the way work does.
This was a category error on my part. The corrective: treating mental health as its own domain rather than as a productivity sub-problem.
5. Most "wellness" content consumption
Reading wellness content extensively didn't produce mental health benefit. Often produced anxiety about not doing enough or comparison with others' practices.
Reduced consumption of wellness content produced more benefit than increased consumption.
What I now know about my mental health
Across years of testing:
- Sleep is among the highest-leverage interventions
- Exercise is essential for sustained mental health
- Therapy with right therapist matters more than any specific intervention
- Medication is appropriate during specific periods
- Structural life elements (work, relationships) matter more than specific practices
- Most marketed wellness interventions don't produce promised benefits
What I'd tell someone struggling
The hierarchy of mental health interventions, in roughly the order I'd recommend trying:
- Address sleep, exercise, and basic life structure first
- Find a good therapist; be willing to switch if first isn't fit
- Consider medication appropriately during difficult periods
- Address work and relationship structures that may be contributing
- Skip most wellness products and supplements
- Be patient with the process; mental health work compounds across time
This isn't the order most wellness content recommends. It's the order that produced sustained benefit in my own experience.
The takeaway
Mental health work is real work that produces real benefit when approached well. The interventions that worked for me are mostly the boring fundamentals — sleep, exercise, good therapy, appropriate medication, life structure — rather than the trendy wellness practices.
For your own mental health, focus on what's evidence-based and sustainable. The dramatic claims around specific products and practices usually don't deliver; the unglamorous fundamentals usually do.
