Drugs alone won't fix our epidemic of depression
theguardian.com
theguardian.com
Get your diet straightened out. Stop eating so many refined carbohydrates. Eat some green vegetables.
Get more sleep. You get 5-6 hours of sleep a night and wonder why you feel sluggish and shitty every day.
Stop with the stimulants. You drink 36 ounces of coffee a day and wonder why you can't get any sleep.
Get some exercise. You want to sleep better, wear yourself out physically as well as mentally.
Put the screens down. It's fucking up your sleep and giving you a false sense that you're getting the human interaction that you need.
Stop drinking so much alcohol. As a society, we drink too much alcohol. It's no wonder we're fucking depressed, we fill our bodies full of CNS depressants. It fucks up your sleep, increases your stress and anxiety levels and makes you feel really shitty the next day.
There are cases of depression that are caused by legitimate, not self-induced, chemical imbalances. The majority of depression cases are relatively self-induced and could be fixed with simple behaviour modifications.
> The majority of depression cases are relatively self-induced and could be fixed with simple behaviour modifications.
I am very wary of telling a depressed person that it's probably just a matter of making the right lifestyle tweaks.
There are certainly people that are clinically depressed that are also physically active (some friends of mine are in that group). OP states as much.
But I agree with OP, if we’re not going to talk about the low hanging fruit of exercise, diet, and sleep, we’re not going to get anywhere with combating depression.
Edit: here’s just one of many studies (there are literally hundreds of them) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC474733/
Yes, there is. It all shows that exercise is moderately better than nothing as a treatment for depression, unless you only include good quality trials in which case the effectiveness drops off.
https://www.cochrane.org/CD004366/DEPRESSN_exercise-for-depr...
> Exercise is moderately more effective than no therapy for reducing symptoms of depression.
[...]
> The reviewers also note that when only high-quality studies were included, the difference between exercise and no therapy is less conclusive.
Personally I choose exercise over medication, and haven’t had any significant depressive episodes since I started swimming, running, and practicing yoga four or five times per week. As a bonus my body feels great and my mind is more clear now too. I just wish I could have made younger me wake up to it (even though I knew what the answer was).
There are certainly people that aren’t able bodied and can’t choose exercise, or are clinically depressed beyond what exercise would be effective for, but for many people a solution seems to be exercise.
Sleep: https://aasm.org/studies-find-new-links-between-sleep-durati... https://www.health.harvard.edu/newsletter_article/sleep-and-... https://adaa.org/understanding-anxiety/related-illnesses/sle...
Stimulants: This one I may be wrong about. My general thinking is if it disturbs your sleep and poor sleep habits cause depression, you should stay away from the stims.
Exercise: https://www.psychologytoday.com/us/blog/the-athletes-way/201... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC474733/ https://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.20...
Screen time: https://www.sciencedirect.com/science/article/pii/S221133551... https://psychcentral.com/news/2017/11/15/more-screen-time-ti...
Alcohol: This one I may be flat out wrong on. Moderate alcohol consumption seems to have an anti-depressant effect. Heavy alcohol consumption is associated with depression and suicide.
Most of what I said, especially about diet, exercise, and sleep are not controversial.
A lot of this research is further confounded by the simple fact that depressed people exercise less as well as eat less healthy. Epidemiology does not show causation here, only interventional studies do with tiny effects.
Example is the studies that show having friends makes one less depressed. Obviously people who are depressed regularly have fewer friends because they're avoided.
But it is controversial. This is the most frustrating thing with ultracrepidarians - you can use a search engine so you think you know better than people who devote their lives to studying this stuff.
If good diet and exercise was effective to prevent depression we'd see lower rates of mental ill health in athletes, but that's not what we see. We see similar rates.
1) you're hurt, you need to rest
2) don't drown so keep as much things you can in check (rhythm, sunlight, diet, movement) even it's just one thing do it, then be proud and rest again
3) you can't see it now but things will improve, just slowly. Again take your time, but keep in mind : slow and steady, you'll be back I promise
I’m not advocating for people who are currently taking anti-depressants to drop their pills tomorrow.
The studies (I’m on the train so I’m not trying to cite these sources, google it) show that lifestyle changes with antidepressants is much more effective than antidepressants alone.
Even if you have a non-self-inflicted chemical imbalance, your shrink is likely to prescribe all of the things I listed.
Source: my shrink, and every shrink worth their salt.
You qualified it. If you quantified it, you would have provided numbers backing up your argument.
This is simply untrue.
The false dichotomy between "self-induced" and "non-self-inflicted [sic]" is something that your "shrink" would have dismissed in the first minutes of honest conversation, before turning to your list of lifestyle adjustments and pointing out that there is a wide range of responses to them.
The kind of baseless speculation that you offer, followed by the obligatory confirmation-bias sequence, is precisely how some people end up treating psychiatric illness in highly neglectful and harmful ways.
This is a flag that shows you don't know what you're talking about. No one credible talks about chemical imbalance; it's a model that's been out of use for many years now.
I don't see rednerrus advocating that. But if what they say is true, then psychotherapists need to know that, and plan their therapies accordingly.
On the other hand, a person very close to me takes great care to manage all these important health factors, but it doesn't really move the needle in terms of helping this person's depression.
- Make sure your sleep routine is good. Same bed time every day, same amount of sleep every day, not too little or too much. 7-9 hours depending on what works for you
- Alcohol is bad for depression, this is not controversial.
- Exercise is very important to help stabilise your mood. This is not controversial.
- Get your vitamin D levels tested, many people are low and this is easy to fix and known to worsen depression.
- Make sure your diet is consistent and healthy.
This is the baseline treatment for everyone with depression. After you take care of these basics you go to the next level which would typcially involve therapy (CBT or psychotherapy) and that may or may not include medications like SSRIs etc.
You're grossly irresponsible to push your personal, unevidenced, pet theories.
You talk about your lived experience: that tells us what worked for you. It says fuck all about anyone else. Notice also that the psychiatrists and psychologists you worked with have professional qualifications and professional registration.
If you’re going to a PDoc that isn’t advocating for you to change the behaviours I recommended, along with medication if the circumstances warrant it, find a different PDoc.
Please stop.
Suicide is a leading cause of death. Suicide is a complex phenomena, and we should not attribute it to one cause. But idiots spreading ignorant bullshit cause harm and kill people.
A lot can be done with diet, exercise and lifestyle changes. But the assertion that this means depression is mostly "self induced" is pretty sucktastic. If nothing else, a lot of lifestyle habits are things learned in childhood, which weren't chosen per se.
Sleep: This was the worst part. I layed awake worrying a lot, which would sometimes prompt me to get up and start working on something in the night. It would throw me off schedule. A sleep schedule in sync with others is useful so I had to force myself to wake up early with the alarm some days. Other days I would opt for the 7 hours anyways.
Exercise: I like running but hate the time it takes but I still had a good early morning running routine for about 3 months; even got an elliptical at a yard sale after my shin splints started up. It was nice but just added to the time that I was not putting into problem solving. Giving it up merely gave me more time and energy.
I fear we have developed a habit of ignoring the problems that are not immediately applicable to our individual threshold of acceptable realities and are not socially encouragable in pleasant conversation. I probably would not have this perspective available to me without a good background in history and sociology + my experiences. I honestly hope I change my mind one day.
Right now, I feel like I'm stuck in the US, a society where the powerful bully the weak : from the president on down. I've come to the conclusion I will die destitute and alone, younger than I thought I would. All I see is 'dog eat dog' and the results of extreme individualism : the decay of community.
When I read about the blue zones, and the moais of the Okinawans, I wonder if something like that would help. But I isolate myself because I know, its tough being around people that are depressed.
This is completely anecdotal and kind of besides the point. The two things that were most helpful to me, in the long term, were magnesium supplements and a gratitude journal. Magnesium has helped straighten out a lot of my anxiety and sleeping issues. Writing down five things everyday has really helped put things in perspective. I now realize how many of the things going on around me are magic. Lights in your house, massive grocery stores full of food, hot water that comes out of the tap, airplanes and cars, the internet, cellphones, most of the world’s knowledge in your pocket. It started to wear new paths in my brain. Seriously, six or eight weeks of this and my perspective changed. The world is full of really amazing, really awesome shit.
It sounds like you may be spending a lot of time on social media, where unproductive inflammatory messages run on a loop, wearing the wrong kind of tracks in your brain. Try an experiment, find a non-political hobby and stick to forums about that instead of news and politics for a while and see if that helps. Try two weeks without Facebook and Twitter.
If you’re really worried the world is only getting worse, read Stephen Pinker’s “The Better Angels of Our Nature”. He argues, pretty convincingly that we are living in the safest time in history and the trend is towards more safety and less dog eat dog.
I empathize with your desire for community and perspective regarding its decay. While we don’t have as much default real life community as we used to, it does still exist. I don’t know what you’re interested in or what your geography is but there are still groups of like minded people who get together to do like minded stuff. There are knitting circles, hackathons, bowling leagues, Boy Scouts, meetups, meditation circles, church, game nights, pub quiz, BINGO with the Eagles, Ultimate leagues, book clubs, support groups, walking clubs, and 100s of others all going on now. It takes a little more work to find them, but these communities are usually very welcoming.
So let me add one more thing to your list:
Go to therapy.
Most people carry lots of stress around with them. Many people silently bear feelings they don't even realize they are having, or are not emotionally literate enough to express them. They might not have family or friends can listen effectively. Etc.
Having a safe place to just "talk things out" is tremendously important. Carrying around un-expressed feelings almost invariably leads to stress. There are significant, physical, negative effects of chronic stress. Low-level depression follows, and then you end up in these behaviors that reinforce the stress-depression cycle.
Not to mention the fact that many people bear all sorts of traumas (real, imagined, mild, severe) from their pasts, especially childhood. These things can stay with a person for their whole life, if they aren't addressed.
It is a vicious circle alright, but the "it's your own fault just make your life better" approach is exactly what depressed people worry about constantly, and downright cynical in my opinion.
Work and school had me indoors 60+ hours a week, so lots of stress and no Vitamin D.
I had little to no time for cooking, so I ate junk processed fast food for most meals.
All of these things left me so drained that I stopped exercising and didn't have the energy to go to social events. I stopped hanging out with my best friends.
What little time and energy I had left was spent laying on the couch indoors on my phone obsessing over the news (which of course is overtly negative and divisive) and arguing politics on social media.
Anti-depressant drugs provided marginal relief from a complete breakdown but it wasn't until I started "working to live", getting outdoors, eating healthy, exercising frequently, meditating (when needed), quit watching the news and deleted my social media accounts that my mental health returned.
There are a handful of simple things that human beings require for adequate mental health or "chemical balance", and yet there are massive societal pressures and trillions of dollars being spent sabotaging those basic human needs. Unfortunately it's much easier to pop a pill than to confront such difficulties.
This is the crux of it for me. I know all I really need are the simple things yet the world does its best to stop me from having them, and pollutes my mind with materialism, and meanwhile the prevailing culture is going to shit.
Edit: I promise myself though that one day I'll end up living on that mountain with pure air, nature, peace and quiet, and a bit of solitude :)
> Anti-depressant drugs provided marginal relief
> Unfortunately it's much easier to pop a pill than to confront such difficulties
Don't you feel that that final statement is a bit disingenuous considering that for many people (of course can not comment if that was the case for you) medication is the tool that enables them to cut the spiral and start working on their issues.
The drugs themselves don't actually offer very much. It is the belief that they're working, the placebo effect, that makes them seem to offer relief. Eventually, many negative side effects will rear their ugly heads... and the cycle goes on. They then switch to a different drug or withdraw completely, suffering the negatives along the way, only worsening their mental health.
It's better to not start using the drugs at all, but instead engage with regular face-to-face social connections and a healthy lifestyle of healthy nutrition, more exercise, meditation, socializing, etc. This way, one does not have to deal with any of the potential negatives of the drugs.
Of course I don’t believe in absolute free will so that may have something to do with my outlook...
The concept of "mental health" in our society is defined largely by the extent to which an individual behaves in accord with the needs of the system and does so without showing signs of stress.
We needn't halt it -- after all, if we can create a good desirable society, a billion more societies would be welcome.
But we have, and should continue to, what's truly valuable and worthwhile to pursue. An universe filled with automatons (even if scientific or mathematics god-like savants) is boring -- and I love mathematics -- but in general problem-solving ability is certainly not the whole story of cognitive experience, even general problem-solving ability. The life experience of Lee Sedol is more interesting than the synthetic "experience" of AlphaGo, even if it is superior at his life's work. If we had an AGI strictly geared towards solving technological problems the same might be said, even if ultimately other aspects of human experience are "wasteful", unnecessary for conquest and dominion.
Getting the bumble bees back to a state of working in the same direction so we can be competitive with countries who've already achieved that is the tricky part.
The Enlightenment/democracy, abolition of slavery, civil rights movements, unions/labor rights movements are all examples of humans consciously improving their societies.
Great list though, maybe add on reproductive justice and climate science.
You can't change the world by treating everyone well but you can sure as shit make all their days better, and that's what we should be doing. If you want to live in a world that isn't isolating, stop isolating the strangers around you.
That said I think there's an element of truth that society generally creates incentives that can lead to outcomes nobody wants [1]. You can get equilibriums where without effective coordination people are trapped, sometimes the trapped state can prevent effective coordination itself.
It's not an easy problem to fix.
[1] http://slatestarcodex.com/2014/07/30/meditations-on-moloch/
When people chose to smoke pot, knowing that it was illegal, they were normalizing it. Those were small decisions by individuals that snowballed into legalization. Gay marriage and the acceptance of homosexuality followed the same pattern, where individuals decided to be more accepting, and that snowballed into societal acceptance.
Society is made up of individuals, and we are part of society. Throwing up our hands and abdicating responsibility doesn't serve anyone.
FTFY
When I buy stuff because I feel empty inside, sure. When I buy tools to pursue a certain goal, things look a bit different.
After 6 months they had the same level of happiness.
Humans are great at growing accustom to their circumstances and then wanting more. It would help for a little while, but then everyone goes back to how they were before.
We have no long term studies showing SSRIs help in the long term. None. (My brother even wrote a review paper on long term studies of mental health treatments). And we all know people that have troubled with SSRI withdrawal symptoms, had to switch drugs, change doses, add a mood stabilizer to continually manage what in the beginning was a mild depression due to loved one's death or some other temporary condition.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
"All antidepressants were more efficacious than placebo in adults with major depressive disorder."
The authors do note that 8 weeks is not long enough to see some antidepressant side effects, which is a problem, but if they see evidence of improvement after 8 weeks, that's quite different from having no evidence of improvement at all.
Unless you mean to suggest that over the very long term, say several years, people on antidepressants end up no better off? I would be interested to know if that has been studied.
I do not consider 8 weeks to be "long term".
There may show that there are short-term improvements, but it says nothing about the medium to long-term effects on depression.
It's therefore worthless for being able to perceive any of the longer-term negative side effectives of the drugs.
It almost seems like a study that the drug companies would find as favourable advertizing for their drugs. It makes me suspicious that it may have been funded by drug company money.
That’s the problem. Always has been. Always will be.
The funding is openly disclosed:
> This study was funded by the National Institute for Health Research (NIHR) Oxford Health Biomedical Research Centre (BRC-1215-20005) and the Japan Society for the Promotion of Science (17K19808). The views expressed are those of the authors and not necessarily those of the UK National Health Service, the NIHR, or the UK Department of Health.
One of the authors, John Ioannidis, is famous as a crusader for better evidence and better statistics in medicine; he's the author of the famous "Why Most Published Research Findings Are False" paper about the potential for false positives for medicine. I would be willing to trust the statistical evidence, though I think you're right to be concerned about 8 weeks as too short a time period.
You probably don't need a pill if you're depressed because your husband died. It's normal to be depressed, and what you probably need in that case is some kind of social structure or coping mechanism that doesn't involve ruminating about how much you miss your husband.
It's not a disorder to feel sad sometimes.
By no means does that say anything about the "long term" effects.
My own personal theory is that at least some of the 'depression' we are seeing today is the result of dysfunction in society and the general social contact. People no longer have a place they feel they can belong, a stable /career/ path let alone one that offers actual opportunity to become the best they want to be out of their potential.
The trouble starts when you mix different (or groups without) religions; the defect in the meme shows ugly results such as the crusades, etc.
It seems we no longer have a prevailing/guiding myth or set of values that society as a whole genuinely believes in.
They must be combined with a decent helping of psychotherapy.
Combined with psychotherapy, I'd say they're superior to drugs, because they don't mess with the body in hard-to-measure ways. A healthy lifestyle lets the body adjust itself naturally.
The key role that medication plays is to shake you out of a vicious cycle; it gives you a window, a break from the deepening groove your mind has gotten itself into so that you have the capacity to do other things that will have a more lasting effect. It doesn't solve the problem all by itself, yet many people expect it to.
(Speaking as someone who's dealt with depression and who has many friends with varying combinations of depression and anxiety, who have taken varying strategies for dealing with them.)
The negatives have affected many people, and who knows just how many and even how bad the side effects are for people.
Being driven over the edge, to suicide, is horrifying effect of some of the drugs. Others have gone on killing sprees because the drugs drove them insane, while taking them or from the withdrawal effects.
I'm mainly referring to general depression that's not clinical. Many get depressed/anxious "for no reason," but it's often due to deficiencies or imbalances. It's not hard to believe when poor sleep, excess stimulant/caffeine use, poor nutrition and eating habits, high stress/drain, insufficient sunlight, etc all combine.
Many would benefit from a high-quality multivitamin, D + K, and chelated/TRAACS magnesium supplement. And maybe DHA + krill oil.
Take enough vitamin D3 to keep 25-Hydroxyvitamin D [25(OH)D] in the 40-60 ng/mL range. Dose calculator: http://www.vitamindservice.com/node/87. Take at least 10 mcg vitamin K2 MK-4 or 2 mcg K2 MK-7 for each 50 IUs of vitamin D3. For example, add at least 1,000 mcg vitamin K2 MK-4 if taking 5,000 IU vitamin D3.
PS: a magnesium deficiency can be corrected by applying an oil spray all over like lotion (rinsing after 20-30 minutes) for a few weeks.
I went to the hospital and they hooked me up to every variety of machine imaginable. The result? Apart from my blood pressure, everything was fine. They wired me up to a recorder and recorded my heart for 24 hours. The result? Everything was fine. The symptoms lasted for a week (!) and finally slowly subsided. The blood work they took said that everything was fine.
I don't know what was going on, but my doctor said to me, "It's probably stress. Has it been a stressful time lately?" It really hadn't. Everything was the same as always. True, I had been quite upset about work. But when was I not upset about work? I love working and I'm serious. I go at it full throttle. True, I had been working some stupid hours. I work remotely and I'm 8-9 hours shifted from the rest of the team. I often start at 8 am, work all day and then work again in the evening when the rest of the team gets in. I'm tired at the end of the day, but I like working hard.
But you know, even if all the tests in the world say that I'm fine -- I was definitely not fine. I was convinced I was going to die during that week. A body is not supposed to feel that way. And so I decided to take it easy. I like work, but I like other things as well. I decided to be strict on my hours and rely on my team to fight fires in the evening (even if I started them during the day!). I decided to take a different view of my role on the team. Instead of trying to drive the team to success, I'll let them drive where they want to go and watch out the window. Occasionally I'll say, "Turn left at the next stoplight. I think you'll enjoy the view", but that's the extent of my navigation.
I fee better now than I have in ages. I just want to warn people: stress will kill you. I never really appreciated that before. It will actually kill you, just like any other super killer disease that haunts your nightmares. Be aware of your mental state. You can't go through life thinking your are invincible. Or, you can, but that life will be cut short. A lot of this stuff is in your control and it's simply a choice to be healthy or be ill.
Of course, there are people who have mental illnesses for which they have no control. But there are a lot of people, like myself, who just don't understand the harm that they are doing to themselves by putting themselves in unhealthy places. Just try to be aware and to take action once you see that there is a problem.
I hope that helps some people. I'd rather other people no have the experience that I had.
> Unfortunately, the prevalent view of depression as a “Prozac deficiency disease”
Do you have numbers to back up that statement that such view is the prevalent one?