Just finished this excellent book by Johann Hari. Check out my summary below:
The traditional cause of depression: low serotonin. The traditional cure: SSRI drugs. Yet many people on antidepressants are still depressed, plus they have the added negative side effects. Depression and anxiety used to be thought of as two separate things, but we now know they’re two sides of the same coin.
How antidepressants actually work: 25% natural recovery without the drugs, 50% placebo effect (the story you’ve been told about the drugs), and only 25% efficacy to the actual chemicals in the drugs. BUT, when you factor in the unpublished clinical trials the drug companies don’t want you to see, the beneficial chemical effects are WAY less.
Antidepressants can seem to work for a time, but because they are mainly placebo, the effects don’t last.
There is actually no real scientific evidence for the low serotonin story about depression. But drug companies make billions off of this lie and push it hard. “It works because you believe you’re being looked after and offered a solution.” (placebo) “There’s no evidence that there’s a chemical imbalance in depressed or anxious brains.” “Almost everything you were told is bullshit. The serotonin theory is a lie.” “The referee is paid by the drug company team, and so that team almost always wins.”
So the positive effects of antidepressants aren’t real, but the side effects are: weight gain, sexual dysfunction, increased suicide risk, increased risk of type 2 diabetes, increased risk of miscarriage and autism, and serious withdrawal symptoms. In addition, the way many clinical trials are run is a total sham. Those who have money to make are gaming the system. “The people on antidepressants who continue to be depressed is found to be 65-80%.”
Depression can actually be an appropriate response to challenging life circumstances. It’s not just a mental health thing – it’s also about emotional health. Real treatment is not throwing some pseudo drug/supposed magic bullet at people; real treatment is about helping people get to the root issues that are driving their depression. What is the pain trying to tell you? To skip this inner work is like putting a bandaid on a bullet wound. “We’re such an utterly disconnected culture. We just don’t get human suffering.”
“What if depression is in fact a form of grief for our own lives not being what they should? What if it is a form of grief for the connections we’ve lost, yet still need?”
Depression is not a random brain imbalance. It’s a response to real world losses, stresses, and disconnections. It’s not a problem with your brain as much as a problem with your life.
Nine Causes of Depression and Anxiety
- Disconnection from meaningful work. According to 2012 Gallup poll, only 13% of people are engaged in their work, 63% are not engaged, and 23% are actively disengaged. Most people hate their jobs. And hard edges on work hours are disappearing. The more our work is marked by autonomy, purpose, and meaningful rewards, the less likely we are to become depressed and stressed.
- Disconnection from other people. Being really lonely is as stressful as experiencing a physical attack. Your body responds in the same way. The more lonely you are, the more likely you are to get sick. Loneliness leads to depression. “Humans need tribes as much as bees need hives.” Loneliness is not random or inevitable, “it’s a product of the way we live now. We do things together less than any humans who came before us.” The more lonely we are, the more we become distrustful and distant from others, creating a snowball effect. You can be surrounded by people and still be lonely. You have to have meaningful, two-way connections with others in order to break out of loneliness – transactional conversations don’t cut it. Superficial online interactions aren’t enough.
- Disconnection from meaningful values. The more materialistic and extrinsically motivated you are, the more likely you are to have depression and anxiety. In the same way that many societies have shifted from eating real food to eating junk food, we’ve left behind real values in exchange for junk values. “Materialism is KFC for the soul.” Materialism (seeking status and stuff) poisons your relationships with others, cuts you off from joyful flow states, gets you stuck playing the comparison game, and crowds out the most important things in life. Marketing trains us to be unhappy with who we are and what we have and spend lots of time, money, and energy chasing things that never satisfy and only leave us feeling more anxious and depressed.
- Disconnection from childhood trauma. Depression is often the symptom of childhood abuse or neglect. “Depression isn’t a disease. It’s a normal response to abnormal life experiences.” Like women who were raped and then become obese to protect themselves from sexual predators, many adults become depressed by refusing to face their early childhood trauma.
- Disconnection from status and respect. As with baboon hierarchies, the higher your status, the less stressed and the easier your life is; the lower your status, the more stressed and depressed you become. The more inequality a society has, the more depression it has.
- Disconnection from the natural world. We evolved to be in nature and thrive in nature. Like animals in captivity, when we are caged away from our natural habitat, we become lethargic and depressed.
- Disconnection from a hopeful or secure future. Without hope, you can’t imagine that your pain will ever go away or your life will ever improve. You’re stuck in the now. The gig economy has understandably led to massive worker fear, anxiety, and depression.
- The real role of genes – 30-40% of depression and anxiety is inherited through our genes. But due to our understanding of epigenetics, we now know that we can control which genes get turned on and off based on our behavior.
- The real role of brain changes – we now know that the brain changes itself in response to our actions (neuroplasticity). So a bad brain scan doesn’t mean you’re doomed to stay depressed forever – it’s just a snapshot of where you’re at today.
When we buy the pharmaceutical diagnosis and “solution” to depression, we disempower ourselves, wrongly believe we are at war with ourselves, and believe our distress has no meaning – no rational source.
Reconnection – a different kind of antidepressant
- Reconnection to other people. The more self-absorbed we are, the more miserable we are. Our highly individualistic Western culture sets us up to lose. When we are connected to meaningful relationships and giving ourselves away on behalf of others, we discover joy.
- Reconnection to social prescribing. Since the best antidepressants aren’t drugs, we need doctors who get this and can prescribe things that actually work (alternative antidepressants).
- Reconnection to meaningful work. “It’s not the work itself that makes you sick, it’s three other things: 1) the feeling of being controlled, 2) the feeling that no matter how hard you work, you’ll be treated just the same (an imbalance between efforts and rewards), 3) the feeling of being low in the hierarchy – being a low status person.” You could be doing the exact same job and either love it or hate it based on the kind of work environment.
- Reconnection to meaningful values. Our culture has programmed us to have shallow, materialistic values that leave us feeling empty and alone…but we can choose to name them as such and embrace a better set of values.
- Reconnection to sympathetic joy and overcoming addiction to the self. Meditation, prayer, cognitive behavioral therapy, and psychotherapy can all reduce depression and anxiety. Psychedelics can also have powerful antidepressant effects, as they help remove us from our ego and gain perspective on our place in the universe.
- Reconnection to acknowledging and overcoming childhood trauma. Shame makes us sick. We need loving, empathic, supportive people in our lives who we can open up to about our deepest emotional wounds.
- Reconnection to restoring the future. Programs like a universal basic income relieve stress and anxiety about the future, giving people newfound freedom to leave horrible jobs and pursue more meaningful work and time with loved ones.
Experts agree, depression has three major causes: biological, psychological, and social. It’s not about a chemical imbalance in the brain. We need the seven reconnections. “It’s not serotonin, it’s society. It’s not your brain, it’s your pain. Your distress is not a malfunction; it is a signal. This pain is not your enemy; it’s your ally.”
Depression is a rational response to things that have gone wrong or aren’t working in your life. “It’s only when we listen to our pain that we can follow it back to its source. And only there, when we can see it’s true causes, can we begin to overcome it.”
Since depression is a societal problem, it requires societal solutions. We were created to be connected to ourselves, others, and the world around us. We need meaningful work and meaningful values and a future full of hope.