Feb 20

“Lost Connections” by Johann Hari

Through a breath-taking journey across the world, Johann Hari exposes us to extraordinary people and concepts that will change the way we see depression forever. It is a brave, moving, brilliant, simple and earth-shattering book that must be read by everyone and anyone who is longing for a life of meaning and connection. Eve Ensler, on Lost Connections by Johann Hari

In journalist Johann Hari‘s Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions, he tells readers his own long-term depression has been blamed on a chemical imbalance in the brain. However, at some point in his therapeutic process “…he began to investigate whether this was true – and he learned that almost everything we have been told about depression and anxiety is wrong.”

Hari’s research led him to this basic conclusion (HuffPost): “I learned that there are in fact nine major causes of depression and anxiety that are unfolding all around us. Two are biological, and seven are out in here in the world, rather than sealed away inside our skulls in the way my doctor told me…I was even more startled to discover this isn’t some fringe position – the World Health Organization has been warning for years that we need to start dealing with the deeper causes of depression in this way.”

According to Fiona Sturges, The Guardian, the factors cited by Hari that contribute to reactive depression “include hardship, trauma, loneliness, lack of fulfilment, absence of status and disconnection from nature.”

Particularly salient is what Hari gleaned about one of these from physician and researcher Vincent Felitti‘s work (HuffPost): “Childhood trauma caused the risk of adult depression to explode. If you had seven categories of traumatic event as a child, you were 3,100 percent more likely to attempt to commit suicide as an adult, and more than 4,000 percent more likely to be an injecting drug user.”

Hari, furthermore, makes this helpful point:

One day, one of Dr. Vincent Felitti’s colleagues, Dr. Robert Anda, told me something I have been thinking about ever since.
When people are behaving in apparently self-destructive ways, ‘it’s time to stop asking what’s wrong with them,’ he said, ‘and time to start asking what happened to them.’

In the case of more endogenous depression, or the biologically based type, Hari now believes Big Pharma and prescribers take advantage of the popularized but not necessarily accurate notion of the brain having a chemical imbalance. There is a significant body of research that disputes both this theory and the efficacy of the prevailing remedy, antidepressant medications.

If meds aren’t always effective, what other kinds of solutions to depression/anxiety did Hari find and thus present in Lost Connections? Kirkus Reviews reports the author’s view that there are “immense (natural) antidepressive benefits of meaningful work, social interaction, and selflessness.”

For further details we have to read the book.

Jun 28

Antidepressants Do Work “Ordinarily Well”

In “Ordinarily Well,” Dr. Kramer, who has written so well about the curse of melancholia — that thief who steals your blood and slyly replaces it with lead — has done something very valuable: He has waded into the contentious debate about the efficacy of antidepressants. It’s an important and confusing subject. One in eight Americans rely on these medications, hardly a trivial number. Jennifer Senior, New York Times, on the idea that antidepressants do work

Ordinarily Well: The Case for Antidepressants by psychiatrist Peter Kramer, who has sometimes been dubbed “Dr. Prozac” by the media, returns to a subject he famously visited before in Listening to Prozac (1993). Antidepressants do work, Kramer claims in this newest book, opposing the views of some other experts in the field.

Why Kramer Wrote Ordinarily Well

Publishers Weekly cites one incentive for this book: “…Kramer’s more captivating story is about the resistance to antidepressants that emerged in the 1970s and was further stoked by Irving Kirsch’s 1998 essay, “Listening to Prozac but Hearing Placebo,” which took direct aim at Kramer’s work.”

Miller offers another: “…The book is written partly in response to an article by Dr. Marcia Angell, former editor in chief of the New England Journal of Medicine, published in June 2011 in the New York Review of Books, and Dr. Angell’s assertion that psychiatric medications are no more effective than placebo. Since psychotropics come with more side effects than placebos, the next logical conclusion is that they are not only ineffective – they are harmful.”

Kramer’s Main Conclusions

Kramer’s conclusion, states Miller, is that “(m)ost patients with depression, be it mild, moderate, severe, or long-standing dysthymia, have a good response to antidepressants. It’s the minority who don’t respond.” Antidepressants do work, in other words.

‘This book is about two influences on medical practice,’ he writes, ‘rigorous trials and clinical encounters.’ Kramer worries that overemphasis on rigorous trials and statistical analysis of outcomes is eroding the doctor-patient relationship, not allowing for a more flexible, case-by-case approach to treatment. ‘A tiny fraction of what doctors do finds direct representation in research,’ he writes. While the efficacy of antidepressants combined with psychotherapy is well-established, how long to maintain their use following recovery is still under debate. It is a question of achieving a balance between preventing the recurrence of depression and side effects such as the occurrence of cataracts and lowered calcium absorption.

Thomas R. Insel, MD: “Antidepressants work, keeping depression at bay. For some they are not sufficient. And for an unfortunate few, they are not effective. But remembering the hopeless state of treatment only a few decades ago, Kramer reminds us with compelling prose and compassionate insight that today millions of us are much better off with access to these medications.”

Jun 17

“The Noonday Demon”: Andrew Solomon Examines Depression

Listen to the people who love you. Believe that they are worth living for even when you don’t believe it. Seek out the memories depression takes away and project them into the future. Be brave; be strong; take your pills. Exercise because it’s good for you even if every step weighs a thousand pounds. Eat when food itself disgusts you. Reason with yourself when you have lost your reason. Andrew Solomon, The Noonday Demon

Recently I posted about Andrew Solomon‘s new TED talk “Forge Meaning, Build Identity.” Also pertinent to Minding Therapy is his 2001 The Noonday Demon: An Atlas of Depression, a book that’s both personal and sociocultural in scope.

Last year he gave the following TED talk, “Depression, The Secret We Share”:

If you’ve neither watched the above talk nor read The Noonday Demon, you may be interested in some of these quotes from The Noonday Demon:

The Opening Lines

“Depression is the flaw in love. To be creatures who love, we must be creatures who can despair at what we lose, and depression is the mechanism of that despair.”

The Nature of Depression

“Antonin Artaud wrote on one of his drawings, ‘Never real and always true,’ and that is how depression feels. You know that it is not real, that you are someone else, and yet you know that it is absolutely true.”

“Grief is depression in proportion to circumstance; depression is grief out of proportion to circumstance.”

“The most important thing to remember about depression is this: you do not get the time back. It is not tacked on at the end of your life to make up for the disaster years. Whatever time is eaten by a depression is gone forever. The minutes that are ticking by as you experience the illness are minutes you will not know again.”

What Helps Depression  

“The people who succeed despite depression do three things. First, they seek an understanding of what’s happening. They they accept that this is a permanent situation. And then they have to transcend their experience and grow from it and put themselves out into the world of real people.”

“A sense of humor is the best indicator that you will recover; it is often the best indicator that people will love you. Sustain that and you have hope.”

“It is important not to suppress your feelings altogether when you are depressed. It is equally important to avoid terrible arguments or expressions of outrage. You should steer clear of emotionally damaging behavior. People forgive, but it is best not to stir things up to the point at which forgiveness is required. When you are depressed, you need the love of other people, and yet depression fosters actions that destroy that love. Depressed people often stick pins into their own life rafts. The conscious mind can intervene. One is not helpless.”

Being on Medication

“Since I am writing a book about depression, I am often asked in social situations to describe my own experiences, and I usually end by saying that I am on medication.
“Still?” people ask. “But you seem fine!” To which I invariably reply that I seem fine because I am fine, and that I am fine in part because of medication.
“So how long do you expect to go on taking this stuff?” people ask. When I say that I will be on medication indefinitely, people who have dealt calmly and sympathetically with the news of suicide attempts, catatonia, missed years of work, significant loss of body weight, and so on stare at me with alarm.
“But it’s really bad to be on medicine that way,” they say. “Surely now you are strong enough to be able to phase out some of these drugs!” If you say to them that this is like phasing the carburetor out of your car or the buttresses out of Notre Dame, they laugh.
“So maybe you’ll stay on a really low maintenance dose?” They ask. You explain that the level of medication you take was chosen because it normalizes the systems that can go haywire, and that a low dose of medication would be like removing half of your carburetor. You add that you have experienced almost no side effects from the medication you are taking, and that there is no evidence of negative effects of long-term medication. You say that you really don’t want to get sick again. But wellness is still, in this area, associated not with achieving control of your problem, but with discontinuation of medication.
“Well, I sure hope you get off it sometime soon,” they say.

Life with Recurrent Depression

“The opposite of depression is not happiness, but vitality and my life, as I write this, is vital even when sad. I may wake up sometime next year without my mind again; it is not likely to stick around all the time. Meanwhile, however, I have discovered what I would have to call a soul, a part of myself I could never have imagined until one day, seven years ago, when hell came to pay me a surprise visit. It’s a precious discovery. Almost every day I feel momentary flashes of hopelessness and wonder every time whether I am slipping. For a petrifying instant here and there, a lightning-quick flash, I want a car to run me over…I hate these feelings but, but I know that they have driven me to look deeper at life, to find and cling to reasons for living, I cannot find it in me to regret entirely the course my life has taken. Every day, I choose, sometimes gamely, and sometimes against the moment’s reason, to be alive. Is that not a rare joy?”

Apr 12

Andrew Weil: Another View On Depression and Pills

Andrew Weil, MD, is the founder and program director of the Arizona Center for Integrative Medicine and the author of many bestselling books on health topics. His most recent, Spontaneous Happiness (2011), echoes some key features of Dr. Kirsch’s sentiments (“Do Antidepressants Really Not Work?“) and reflects more than just professional experience with the issue of depression—he’s been there.

From Publisher’s Weekly: “Weil’s program aims for ‘positive emotionality’—a far better destination than the roller-coaster ride between bliss and despair. This is more than a New Age prescription for contentment. Weil’s revelations and insights from his own lifelong battle with depression lift this guide from a hip and clinical ‘how to’ to a generous and heartfelt ‘here’s how.'”

Like Kirsch, Andrew Weil notes that many people take medications that are in fact worthless and possibly harmful. Among the problems with these meds is the existence of a condition known as tardive dysphoria, meaning “lingering bad mood,” that can occur over time on antidepressants.

As possible treatments for depression, Weil prefers more consideration to lifestyle changes and less to ineffective drugs. Two things that he says have been proven to work well, for example, are walking regularly and having sufficient omega 3 fatty acids in one’s diet.

Weil admits, however, that he has tried only one antidepressant himself and that he stopped using it after only a few days—he didn’t like the way it made him feel. Many other users have tried various medications before finding one that works well for them, just as many have decided to wait out initial periods of discomfort, as these often pass.

Although the views of both Kirsch and Weil are important contributions to this area of study, I want to emphasize that neither is saying that antidepressant medications don’t in fact help some folks, particularly those with more serious depressive disorders.