Let's just say that if you are able to squeeze in exercise followed by dinner plans, there is a chance you might not be able to squeeze in a shower as well. Just hope you're with someone who has a weak sense of smell! When establishing an exercise habit--especially if you struggle with it at first--it's best to match your efforts with the times when you're in peak mode to perform. Are you better off exercising in the morning or night? If you're considering setting a morning workout, do note: a crucial determinant in successfully waking up and working out is whether you went to bed at a reasonable hour. If your sleep habits are off-kilter and you've been going to bed later than your norm, you may need to make sleep your keystone habit. Clearing up your sleep will naturally influence your ability to wake up in the morning and exercise. But if you are going to bed later than usual because you are awake worrying or feeling too keyed up to sleep, exercise might be the keystone habit that cascades into feeling tired at night, which will improve your sleep. For larks who do better early in the day, a morning workout might help establish an exercise habit. Your wake-up ritual might follow this order: get out of bed, make your bed, open the blinds, change into workout clothes, head into the kitchen for water and a snack, and then head to wherever you go for exercise, be it the gym, your at-home treadmill, or your yoga mat in the living room. Maybe to pep up this routine you read an inspiring quote of the day or something spiritual that energizes you right before you get dressed. Maybe you create a "wake up and get moving" playlist that you listen to while suiting up in your exercise clothes. Some people even sleep in their gym clothes--they're comfortable and the process of getting ready becomes automatic when they are already geared up for success. For owls, if it makes sense to exercise in the morning, try it. Then gauge how successful you are. You may or may not struggle to establish this new habit. If you find yourself scheduling an early morning workout, hitting snooze, saying "I'll do better tomorrow," and then tomorrow comes and you do the same thing--don't be hard on yourself. Owls are notorious for hitting the snooze button through a planned morning run. If this happens, match your goal with the time you are in peak mode to perform and work out in the afternoon or evening. Those times may feel a little more natural.

A poor metabolizer (PM) is a person whose metabolism takes in the medication very slowly, resulting in increased levels of the medicine in the bloodstream. This sluggish process causes significant side effects, and poses toxicity risks such as serotonin syndrome--a potentially life-threatening condition caused by toxic levels of serotonin.7 If you're a poor metabolizer, you not only have the hardship of experiencing side effects and toxicity, you also continue to have depressive symptoms. An intermediate metabolizer (IM) is a person whose metabolism of a drug occurs at a slower rate than normal. People in this category experience side effects and mild toxicity but not as intensely as do poor metabolizers. As you might expect, medication success is guarded in this category. You notice some symptom relief, but it won't be substantial. Extensive metabolizers (EM) have an average expected range for metabolism. Herein, you absorb medication effectively and are able to experience symptom relief with few if any side effects. I fall into this category with my fluoxetine. Ultrarapid metabolizers (UM) quickly process medication, ren-dering drug treatment virtually ineffective. Because your genetic metabolism synthesizes the medication too fast, you cannot experience its therapeutic effects. If you're an ultrarapid metabolizer, you feel no symptom relief whatsoever. Pharmacogenomics research also observes differences in genes that regulate the entire serotonin system.8 Specifically, the serotonin transporter gene (SERT) and the Serotonin 2A Receptor Gene (5HTR2A). Genetic testing reveals that children and adults with such gene variations have poorer therapeutic responses with antidepressant medications and more frequent serious side effects during treatment. The good news is that there are tests available to identify these genetic variations. Known as DNA microarray tests, they usually require a blood sample or cheek swab. The results can determine if you're a poor, intermediate, extensive, or ultrarapid metabolizer-and/or if you have gene variations in the serotonin system. Now, I've never been good with the hard sciences, so my head begins to hurt when I try to make sense of all these findings. For me, the simplest way to understand this data is to view metabolism and the target delivery systems for medicine as being variable from person to person. Big Pharma needs to work alongside pharmacogenomic experts to create medications that address these issues.

Until then, the rate of medication success for those with depression will remain at this low rate. Stopping medication abruptly can cause serious health issues. Often, professionals prescribing medication will take you through a very detailed list of how to take your medications. This is a very important process, and one that you should follow with regularity. Medication success has a great deal to do with timing of your doses and consistency in taking them as prescribed. Many people hear the word purpose and think it applies only to epic, world-changing work. Not so. I define purpose as the one unique thing we each have to offer the world, no matter how big or small. Its absence might not make headlines, but it absolutely would be missed by those who stand to benefit from your gifts. Your personal purpose may be to pour all your energy and creativity into raising healthy children; to teach watercolor painting to residents in a retirement center; to be the most caring and conscientious insurance agent your clients have ever known; or to teach preschool in a way that endows kids with self-respect and self-confidence. The list of possibilities is infinite. Only you can know which one best describes you. Here's the secret to finding your purpose: start by looking again at the list you made of things you have loved in your life. Chances are, what you're meant to do now is something you couldn't stop doing as a younger person but that you abandoned along the way. Or it may be the thing you still didn't dare put on the list but that tugs at your sleeve anyway. Why is finding and following your purpose so important when revitalizing your future? Because it's what gets you out of bed on a dreary Monday morning in midwinter. Purpose is your answer to the question "Why?" Why keep a grip on my addictive impulses? Why watch what I eat? Why care about toxic emotions and their effect on my health and well-being?

Why guard against old habits? Because you have a purpose, a role to play in the lives of others. Those others may be abandoned animals at the local shelter or everyone who looks at a piece of your art and is inspired or moved. It may be cliche these days, but it's never been more true: the world needs everyone to fulfill their purpose--you included. One of the most common conversation killers in my experience is the age old cliche. Pretty much anything you say that sounds silly or recycled is going to pull you both out of the conversation and lead to an uncomfortable silence. The last thing you want is to kill the flow of conversation when it was going so nicely. To avoid cliches, stick to topics that you can offer original opinions on and try not to sum anything up in a single sentence or phrase. While cliches are bad, remember that jokes can be endearing. If you can make a joke out of a cliche or catchphrase from pop culture, go for it - people will love it. If you sit and have a conversation with a master, you'll notice one thing above all else - they know how to tell a darn good story. Someone with the ability to tell stories about seemingly any topic with gusto is generally the most likable people in the room. They draw attention to themselves like flies to honey as men and women lean closer to learn about their wayward microwave or their uncannily intelligent dog. But, it's not a secret genetic trait; it's a skill and anyone can learn how to do it. It just takes practice and a careful ear for what's interesting. Engaging hooks, humorous anecdotes, careful retelling and the ability to cut out the details that just plain don't matter will all make your stories infinitely more engaging. They don't need to be deep or highly entertaining. You don't need to make up trips to the Antarctic or hiking trips into Everest - you just need to be yourself and let your natural humor and energy flow into every story you tell. Your exercise ritual may begin after work when you walk in the door to your home, which is your cue to change into workout clothes and head to the spot where you exercise. If you get too tempted by the sight of your couch, you could head straight from work to your exercise facility.

When you pair leaving your workplace with going to exercise, you establish a powerful cue, particularly because going home instead would be a big deviation from your habit. You can streamline the process of going from point A to point B by packing your workout clothes in the morning so you have them with you already. This step further cuts down on the many temptations of home (including Netflix). Finally, exercising immediately after your workday ends can set a cue for you to relax and leave those work-related thoughts and stresses behind at work. Indeed, exercising may function as a reward for a long day at work--imagine that! One crucial aspect of successfully working out in the evening is planning your meals so that you are not uncomfortably hungry when it's time to exercise. When you're feeling ravenous, getting yourself to workout enjoyably will be much harder to achieve. If your meal schedules are off and are keeping you from having the energy to exercise, you may want to make eating your keystone habit. Or maybe you tend to forget to prepare your meals, or get too busy to eat at all, because you have not worked out and don't feel hungry enough. In this case, exercise might be the keystone habit that naturally triggers cues to plan balanced meals or to stop at the grocery store on the way home. For both larks and owls, whatever your cues are, the main trick is to make them so consistent in your environment that the routine becomes automatic. To further increase the likelihood that you create an exercise habit, you may want to set up an initial reward for yourself. Maybe that means recording it in a log, which feels good when you track progress. Perhaps you celebrate your success with others, as I'll discuss more in Principle 5. Or you could treat yourself in a reasonable way, like picking up a caffe Americano on the way to work or allowing yourself to watch a second episode of your favorite TV show when you get home. Natural rewards might include the endorphin release, sense of accomplishment, and feelings of contentment that can be enough to motivate you. The more rewarding exercise feels, the more likely it is to shape into a habit, so be sure to give yourself credit that you did it. Usually, you will begin your antidepressant medication at a low dose, with a possible increase over time to reduce symptoms. At this stage, your neurochemistry is gently shifting, working slowly to bring you closer to well-being. It generally takes approximately four-to-six weeks for medication to reach its full effect.