And so, 20 milligrams became 30 milligrams; the white pill became blue. I felt better for several months. And then the pain came back through once more. My dose kept being jacked up, until I was on 80mg, where it stayed for many years, with only a few short breaks. And still the pain broke back through. Why was I still depressed when I was doing everything I had been told to do? I had identified the low serotonin in my brain, and I was boosting my serotonin levels — yet I still felt awful. But there was a deeper mystery still.
Why were so many other people across the western world feeling like me? Around one in five US adults are taking at least one drug for a psychiatric problem. In Britain, antidepressant prescriptions have doubled in a decade, to the point where now one in 11 of us drug ourselves to deal with these feelings. What has been causing depression and its twin, anxiety, to spiral in this way?
I began to ask myself: could it really be that in our separate heads, all of us had brain chemistries that were spontaneously malfunctioning at the same time? To find the answers, I ended up going on a 40,mile journey across the world and back. I talked to the leading social scientists investigating these questions, and to people who have been overcoming depression in unexpected ways — from an Amish village in Indiana, to a Brazilian city that banned advertising and a laboratory in Baltimore conducting a startling wave of experiments. From these people, I learned the best scientific evidence about what really causes depression and anxiety.
They taught me that it is not what we have been told it is up to now. I found there is evidence that seven specific factors in the way we are living today are causing depression and anxiety to rise — alongside two real biological factors such as your genes that can combine with these forces to make it worse. Once I learned this, I was able to see that a very different set of solutions to my depression — and to our depression — had been waiting for me all along. To understand this different way of thinking, though, I had to first investigate the old story, the one that had given me so much relief at first.
Professor Irving Kirsch at Harvard University is the Sherlock Holmes of chemical antidepressants — the man who has scrutinised the evidence about giving drugs to depressed and anxious people most closely in the world. In the s, he prescribed chemical antidepressants to his patients with confidence. He began to investigate this further, and put in a freedom of information request to get the data that the drug companies had been privately gathering into these drugs. He was confident that he would find all sorts of other positive effects — but then he bumped into something peculiar.
We all know that when you take selfies, you take 30 pictures, throw away the 29 where you look bleary-eyed or double-chinned, and pick out the best one to be your Tinder profile picture. It turned out that the drug companies — who fund almost all the research into these drugs — were taking this approach to studying chemical antidepressants. They would fund huge numbers of studies, throw away all the ones that suggested the drugs had very limited effects, and then only release the ones that showed success.
To give one example: in one trial, the drug was given to patients, but the drug company published the results for only 27 of them. Those 27 patients happened to be the ones the drug seemed to work for. I had thought that I was freakish for remaining depressed while on these drugs. In fact, Kirsch explained to me in Massachusetts, I was totally typical. At the moment, we offer depressed people a menu with only one option on it. This led Professor Kirsch to ask a more basic question, one he was surprised to be asking. How do we know depression is even caused by low serotonin at all?
When he began to dig, it turned out that the evidence was strikingly shaky. It was just marketing copy. Once you settle into a story about your pain, you are extremely reluctant to challenge it. It was like a leash I had put on my distress to keep it under some control. I feared that if I messed with the story I had lived with for so long, the pain would run wild, like an unchained animal.
So, what is really going on?
Depression Survival Guide | NAMI: National Alliance on Mental Illness
We all know that every human being has basic physical needs: for food, for water, for shelter, for clean air. It turns out that, in the same way, all humans have certain basic psychological needs.
We need to feel we belong. We need to feel valued. We need to feel we have a secure future. I kept learning that, in very different ways, we have become disconnected from things we really need, and this deep disconnection is driving this epidemic of depression and anxiety all around us. There is strong evidence that human beings need to feel their lives are meaningful — that they are doing something with purpose that makes a difference. But between and , the polling company Gallup conducted the most detailed study ever carried out of how people feel about the thing we spend most of our waking lives doing — our paid work.
I started to dig around to see if there is any evidence that this might be related to depression. It turned out that a breakthrough had been made in answering this question in the s, by an Australian scientist called Michael Marmot. This small army of bureaucrats was divided into 19 different layers, from the permanent secretary at the top, down to the typists.
But when Marmot published his results, he revealed the truth to be the exact opposite. The lower an employee ranked in the hierarchy, the higher their stress levels and likelihood of having a heart attack. Now he wanted to know: why? Among adults, people between ages 18 and 25 are most at risk for depression When racial and ethnic factors are considered, adults who identify with two or more racial or ethnic groups show the highest rate of depression Having one depressive episode increases your risk of having another later in life.
According to a study in Psychological Medicine , more than 13 percent of people who recover from their first episode of major depression go on to have another episode within five years; 23 percent within 10 years; and 42 percent within 20 years. Globally, depression affects more than million people of all ages, according to the World Health Organization WHO. That is the equivalent of 4. Depression is the leading cause of disability worldwide. Fewer than half those living with depression — and in some countries, fewer than 10 percent — receive the care they need.
A number of factors prevent people from getting treatment, such as lack of trained health-care providers, social stigma, and misdiagnosis. For instance, the prevalence of depressive disorders appears to be low in Papua New Guinea 3 percent of the total population and high in Ukraine 6. There are numerous factors that can trigger the onset of depression, including bereavement, illness such as cancer or chronic pain , social isolation or loneliness, and stressful life events such as divorce or money difficulties.
Depression can also occur spontaneously, without any obvious cause. A person who experiences anxiety is at high risk for developing depression, and vice versa. Nearly half those who are diagnosed with anxiety are also diagnosed with depression. Several factors most likely contribute to the development of depression, including:. Everyone has times when they feel sad, hopeless, frustrated, or worn out. But unless your life is dominated by negative feelings on most days, for most of the day, for weeks on end, you may not have depression.
One reason depression is difficult to identify is that its symptoms can vary depending on age and sex. Adults with depression generally feel overwhelmed by sadness, while depression in adolescents tends to express itself mainly as irritability. Women with depression are more likely to note symptoms like anxiety and indecisiveness, while men are more likely to report anger and aggression. If you think you may have depression, describe your symptoms to a doctor.
Learn More About Depression Symptoms. The vast majority of people with depression who seek treatment will find a cure, with success rates of about 80 or 90 percent. Antidepressants remain a powerful tool, especially as researchers learn more about brain chemistry and develop new drugs that better correct neurological imbalances, with fewer side effects. For the most intractable cases of depression, physicians may turn to brain-stimulation treatments like electroconvulsive therapy ECT.
ECT can provide fast relief with far fewer side effects than electroshock therapy did so infamously. On the other end of the spectrum, researchers are exploring a salvage medication for people with suicidal depression: ketamine, a street drug that can induce hallucinations and out-of-body experiences but that can also provide astonishingly swift relief from depression. Ketamine is currently undergoing clinical trials; meanwhile, physicians warn that this drug can be abused.
Learn More About Depression Treatment. An estimated 13 percent of Americans age 12 and up take antidepressants — a 65 percent increase from to These represent categories of drugs, grouped together because of their effect on various neurotransmitters chemical messengers in the brain. SSRIs selective serotonin reuptake inhibitors like Prozac fluoxetine , Celexa citalopram , and Zoloft sertraline are the most commonly prescribed antidepressants.
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They target serotonin, a neurotransmitter that helps control mood, appetite, and sleep. People with depression often have abnormally low levels of serotonin. All antidepressants can have side effects, but some may be more problematic than others. Keep in mind that they do not work immediately and usually take at least several weeks for maximal benefit. Combining the right medication with psychotherapy or another intervention, like a support group, might be what you need to feel better.
Learn More About Medication for Depression. Postpartum depression — depression after giving birth — has been well documented, with women like Brooke Shields and Drew Barrymore opening up to the media about their experiences. There are a number of potential reasons for this.
Women may be reluctant to reveal negative feelings at a time in their lives when society, family, and friends all expect them to be joyful. Women who are poor or who became pregnant unintentionally may regard symptoms of depression as a realistic response to their situation. Therapists and physicians generally attempt to treat antenatal depression with non-medication methods first, as there is evidence that antidepressants may pose a risk to fetuses. For women with severe antenatal depression, however, antidepressants may be essential.
Women need to educate themselves and work with their physicians to balance the risks and the benefits to both themselves and their infants. A type of mild to severe depression that typically sets in as the hours of daylight wane in the fall, seasonal affective disorder SAD afflicts as many as 6 percent of Americans. Women are particularly at risk, experiencing SAD four times more often than men, as are people who have a relative with depression.
- 30 Famous People Alive Today Who Have Battled Depression;
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- How to look after your mental health using exercise | Mental Health Foundation.
The causes of SAD are unclear, says NIMH, but research suggests it may be due to seasonal fluctuations in levels of serotonin, a brain chemical that helps regulate mood, or to an overproduction of melatonin, the hormone that regulates sleep. As part of his research into human evolution, David Raichlen, Ph. Endocannabinoids are substances that bind to the same receptors in the brain as THC, the primary substance responsible for a marijuana high.
Raichlen says there are two leading theories on why running causes increased levels of endorphins and endocannabinoids. In this scenario, the feel-good aspect is a byproduct. Second, higher levels of these chemicals while active could have motivated continued movement, which would lead to getting more food and ultimately higher survival rates. Raichlen says the two mechanisms might have worked in tandem.
A short-term mood boost thanks to endorphins and endocannibinoids is one thing. Granted, one much-appreciated thing.
30 Best Self-Improvement Books for Those Battling Depression
But where running really helps with mental health is over time, thanks to a change in brain structure. Neurogenesis occurs primarily due to a protein called brain-derived neurotrophic factor, which has been been called the Miracle-Gro of the brain. As Ekkekakis notes, you have to be fit to really get the daily benefits that can lead to structural changes.
But success in running on an especially tough day makes it easier to get out the next time. And it can spur another key mental health benefit of running. Levels of chemicals in the brain are only part of your mental state.
How to cope with a depressive episode
On a daily basis, running reminds me that I can overcome apathy and torpor. Seeing that small victory, I can convince myself that progress is possible on meeting professional goals, or not feeling lonely so often, or figuring out how to afford retirement. Is there something uniquely effective about running for managing mental health?
Or can any form of exercise provide similar relief? The short answer is nobody knows for sure, and definitive research comparing the mood-boosting properties of various ways of working out is unlikely. The amount of government funding available is simply not at that level. It is safe to say that purposeful exercise is better than incidental physical activity.
- Through the Open Window.
- Made possible by a grant from HealthPartners and the Make It OK campaign;
- Texas Shorts Vol 1.
- Depression and anxiety: Exercise eases symptoms.
- Coping With Depression: A Guide to Good Treatment | Everyday Health.
- Why is dealing with depression so difficult?.
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Aerobic exercise seems more effective than something like lifting weights. In fact, a review of research published in Preventive Medicine found that people with low levels of cardiovascular fitness were at greater risk of developing depression. You have a lot more control over your speed than even in something like cycling, where your effort level is more dictated by the topography or even stop lights.
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Nothing is the same as running. The net that keeps me from plummeting starts to fray and sag. But when running is going well, the net is taut and strong.