Drugs alone won't fix our epidemic of depression

https://www.theguardian.com/society/commentisfree/2018/jul/19/drugs-alone-wont-fix-our-epidemic-of-depression

by pmoriarty • 8 years ago

69 107 8 years ago

WalterSear2• 8 years ago

No, mindfulness training, exercise and nutrition aren't sufficient to counter the increasing adversity any more than drugs are.

mjevans2• 8 years ago

Agreed, depression can also be caused by poor environmental conditions. Being depressed can make escaping those conditions harder or even impossible; and that is assuming that the conditions /can/ be escaped in the first place.

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.

amelius• 8 years ago

Perhaps religion plays a role too. I mean, our brains evolved to be religious, and now we're basically shutting that part off, without asking if that's a good idea from a neurological/psychological (scientific) viewpoint.

Valmar4• 8 years ago

Not on their own, obviously.

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.

WalterSear2• 8 years ago

Keep your opinions to things you have experience with.

m15i• 8 years ago

Maybe we can transform our society into one that is less depressing?

finaliteration2• 8 years ago

I feel like this is something that is often ignored when these discussions arise. We tend to heap blame on some failure of willpower or chemical imbalance within a given individual. Though there are a number of individuals with such a chemical imbalance, how often do we sit down and consider that maybe, just maybe, our society and way of living is fucked up and that is what’s driving so many people to breakdowns and suicide?

danso• 8 years ago

I don't think this problem is "often ignored" as much as it is seen, rightly, as so difficult to be near unfeasible. And looking for intermediate fixes that can help many in the meantime is a reasonable strategy. Anything that would fix society at large, in a reasonable timespan (i.e. to help the people most afflicted) would by necessity require a legislative overhaul and/or massive reallocation of resources. There is no easy path to that.

starpilot• 8 years ago

The system does not and cannot exist to satisfy human needs. Instead, it is human behavior that has to be modified to fit the needs of the system. This has nothing to do with the political or social ideology that may pretend to guide the technological system. It is not the fault of capitalism and it is not the fault of socialism. It is the fault of technology, because the system is guided not by ideology but by technical necessity. 11 * 1 Of course the system does satisfy many human needs, but generally speaking it does this only to the extent that it is to the advantage of the system to do it. It is the needs of the system that are paramount, not those of the human being. For example, the system provides people with food because the system couldn't function if everyone starved; it attends to people's psychological needs whenever it can CONVENIENTLY do so, because it couldn't function if too many people became depressed or rebellious. But the system, for good, solid, practical reasons, must exert constant pressure on people to mold their behavior to the needs of the system. Too much waste accumulating? The government, the media, the educational system, environmentalists, everyone inundates us with a mass of propaganda about recycling. Need more technical personnel? A chorus of voices exhorts kids to study science. No one stops to ask whether it is inhumane to force adolescents to spend the bulk of their time studying subjects that most of them hate. When skilled workers are put out of a job by technical advances and have to undergo "retraining," no one asks whether it is humiliating for them to be pushed around in this way. It is simply taken for granted that everyone must bow to technical necessity. And for good reason: If human needs were put before technical necessity there would be economic problems, unemployment, shortages or worse.

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.

chongli2• 8 years ago

We can't do anything of the sort. Nobody really has control of society. We're a bunch of bumblebees trapped in a beach ball. Sometimes it goes in the direction we want it to go, other times not.

mistermann2• 8 years ago

No one has absolute control, but it can certainly be nudged in certain directions if the will is there and the population is relatively unified, something I don't foresee happening in the West for a very long time.

wu-ikkyu3• 8 years ago

Coordinated human rights movements have made major improvements to the human condition. That's of course not to say they are easy or always successful, quite the contrary.

The Enlightenment/democracy, abolition of slavery, civil rights movements, unions/labor rights movements are all examples of humans consciously improving their societies.

jumelles3• 8 years ago

What do you make of wars, revolutions, and protest movements then?

jschwartzi3• 8 years ago

Let me be blunt and say that this attitude is exactly why nobody ever tries to change society. Instead of assuming that because you're one person you don't matter, why not take the attitude that you're one person and what you do has an impact on everyone around you?

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.

tim333• 8 years ago

There's a lot of variation in depression rates between countries so probably things can be done https://www.washingtonpost.com/news/worldviews/wp/2013/11/07...

zimbatm2• 8 years ago

And maybe we can teach children that it's possible to avoid the eternal pursuit of the next thing, that buying stuff doesn't bring happiness and joy.

majewsky3• 8 years ago

buying stuff for the sake of happiness and joy doesn't bring happiness and joy

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.

refurb• 8 years ago

I don’t think that would help at all. What’s the study that was done on people that won the lottery vs. ended up paralyzed?

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.

rjkennedy98• 8 years ago

There are plenty of reasons to believe that drugs are actually making it worse. Robert Whitaker's Anatomy of an Epidemic was the first to make this point. Burden of mental illness has doubled while the antidepressant treatment has been made common place.

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.

jumelles3• 8 years ago

This is untrue.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

"All antidepressants were more efficacious than placebo in adults with major depressive disorder."

windows_tips3• 8 years ago

That's not a long-term study. It's a one-off 'meta-analysis'.

jschwartzi3• 8 years ago

There's a pretty significant difference between a depressed state and Major Depressive Disorder. My understanding is that people get depressed from all kinds of life events, but that they are typically resilient enough to get better on their own. In contrast, Major Depressive Disorder is the black dog that's always there waiting to pull you down.

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.

ssivark• 8 years ago

Quoting from your link: "We recorded the outcomes as close to 8 weeks as possible for all analyses. If information at 8 weeks was not available, we used data ranging between 4 and 12 weeks (we gave preference to the time point closest to 8 weeks; if equidistant, we took the longer outcome)."

By no means does that say anything about the "long term" effects.

wu-ikkyu3• 8 years ago

I remember my worst bout with depression, it was a downward spiral.

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.

growlist• 8 years ago

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.

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 :)

zokier2• 8 years ago

it was a downward spiral.
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.

Valmar4• 8 years ago

For many people, they believe that it is the final solution, because that is how it is advertized by the drug companies and psychiatrists, and how it is marketed to many doctors. That is how most end up people treating the drug.

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.

jumelles3• 8 years ago

Antidepressants can literally save lives; I worry deeply about articles like this scaring away people who need help.

_bxg12• 8 years ago

The thesis isn't that they're bad, but an incomplete part of the picture. We in the West like simple solutions to complex problems. Throwing medication at your depression and calling it a day is no more effective for mental health than dropping money out of a helicopter is for improving the economy.

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.)

throwaway435388• 8 years ago

Agreed. Antidepressants can be very helpful.

Valmar4• 8 years ago

The many, unpredictable, and very real, negative side effects of anti-depressants can completely outweigh any of the dubious positives, especially when it's impossible to tell which of dozen or so available marketed drugs will or will not have a greater slew of said effects. It's a nasty game of Russian Roulette which can potentially make the depression far worse than if the sufferer decided to err on the side of caution, and not take them at all.

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.

zokier2• 8 years ago

Nice strawman you have there in the title Guardian. It is almost as if you were baiting for clicks.

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?

rednerrus13• 8 years ago

For the majority of people, the following should get you straightened out:

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.

majos• 8 years ago

I promise I am not pursuing the tiresome argumentative tactic of demanding formal sources as a way to postpone defeat. But, seriously, do you have a source for

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.

paradroid• 8 years ago

He's not wrong, but he's not taking into consideration the fact that it's a feedback loop. It's the same perspective as chiding the homeless for not pulling themselves up by their bootstraps. They are in too much mental poverty to do it.

newplagiarist• 8 years ago

I can't agree with this statement more, espousing the tired pull yourself up by your bootstrap motto for clinically depressed people is dangerous.

rednerrus13• 8 years ago

Part of the reason why I quantified it. There are legitimate cases of depression caused by non-self-inflicted chemical imbalances.

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.

majewsky3• 8 years ago

I am very wary of telling a depressed person that it's probably just a matter of making the right lifestyle tweaks.

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.

baccheion2• 8 years ago

Tests like NutrEval can verify/refute the presence of nutrient deficiencies, and combined with genetic testing and a comprehensive hormone panel (includes thyroid panel), provide clarity/perspective/insight.

aklemm2• 8 years ago

I need to improve dramatically in every single area you've listed here, but I'm far from depressed and have no anxiety problems.

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.

rednerrus13• 8 years ago

That’s exactly why I quantified it. There are people who have legitimate chemical imbalance induced depression.

DoreenMichele2• 8 years ago

The specifics here is not bad advice, but the framing sucks big time.

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.

extralego3• 8 years ago

You think extended unemployment followed by a minimum wage job then an injury with no health insurance could have anything to do with it? Or unrelated?

rednerrus13• 8 years ago

That sounds stressful. How was your diet, sleep and exercise while you were going through those rough times?

clumsysmurf• 8 years ago

I do all these things, and more. They all help, even though its like pushing water uphill - but I still suffer major depression. I don't even get the runner's high anymore. Maybe at this point, its been going on long enough my brain is irreversibly damaged.

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.

rednerrus13• 8 years ago

Are you getting help from a professional, therapist, Primary Care Provider, or Psychiatrist? If not, find one. They can help. I was where you are and now I feel better. Ask them to recommend a group. You can go be around people who understand that you’re depressed and want to help, until you don’t feel like isolation is necessary.

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.

nerdponx• 8 years ago

You're right on all counts, but in my experience some of these behaviors are symptoms of depression, rather than causes. It's a vicious cycle.

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.

rednerrus13• 8 years ago

Good call.

krsdcbl• 8 years ago

For the most part you are describing things that are a symptom of depression themselves.

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.

mikekchar• 8 years ago

Kind of personal story, though not directly about depression. A while back, I noticed my blood pressure skyrocketed. Then a bit later, I started having chest pains. My heart was racing and my heart beat was irregular. Sometimes it felt like it just stopped and then wham it would kick in again. Sometimes it felt like a horse was running around inside my chest. My chest felt heavy, like someone had put a 25 kilo weight on it. Every breath hurt.

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.

baccheion2• 8 years ago

Depression/Anxiety is often caused by nutrient deficiencies, especially vitamin D and magnesium. Even with bleak prospects or a meaningless life, depression/anxiety becomes mostly cognitive when properly fed/supplemented. "Hey, this idiot just ruined my life," for example, but as vitamin D + K and magnesium are being supplemented, it's like a passing thought slowly creeping in.

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.

Drugs alone won't fix our epidemic of depression

Related Stories