Mental Health Archives - Baobab Health

Anxiety and Depression: Why a more holistic approach is needed for treatment

Anxiety and Depression: Why a more holistic approach is needed for treatment

Anxiety and depression are two of the most common mental health disorders that affect people, from all walks of life, worldwide. In fact, depression is one of the most common causes of disability worldwide.

For decades we have tried to treat these mental health issues with medications that target one or two neurotransmitters (brain chemicals) as some research has suggested that low amounts of certain neurotransmitters may be responsible for causing anxiety and depression. While this is true, it is only a snippet of the broader picture.

These treatments have failed as depression and anxiety rates are still on the rise.  Furthermore, anti-depressants have been shown to be no more effective than placebo.

Why is this you may ask?

It is because we have been trying to treat a complex, multifaceted disease, that involves a complex interaction between genes, diet, lifestyle and environmental factors, with one drug and only targeting one pathway in the brain. Mental health issues are far too complex for such simplistic treatment and they require multifaceted treatments to address the underlying causes.

If you suffer from anxiety or depression, consider booking in an experienced holistic health practitioner (e.g. naturopath), who will help you identify the underlying physiological drivers of depression and anxiety, as well as the social/environmental factors. Find someone who will take a holistic approach to your treatment (using referrals if need be). Treatment should always involve diet and lifestyle interventions (with potential for herbal and nutritional supplementation), as well as psychological interventions that will help address these underlying causes. This may require the help of two or more practitioners.

Depression is not a result of a “chemical imbalance”

Depression is not a result of a “chemical imbalance”

In my last post around this topic, I discussed how anti-depressants have been shown to be now more effective than placebo in treating depression and why they are not an effective treatment for depression.

Anti-depressants increase certain neurotransmitters (e.g. seretonin) in the brain, as it was once thought that depression resulted from a “chemical imbalance” of these neurotransmitters. However,  the “chemical imbalance” theory of depression is not grounded in much evidence, which is probably why anti-depressants have been shown to be no more effective than placebo in treating depression.

This post will challenge the “chemical imbalance” theory of depression, which will help you understand the reasons as to why anti-depressants lack efficacy in treating all cases of depression.

Depression is unlikely to be caused by a chemical imbalance in the brain.

It is so ingrained into our psyche (which is probably due to the media and the selling of anti-depressants) that depression results from a “chemical imbalance” in our brain and anti-depressants aim to correct this imbalance. The simplicity of the chemical imbalance theory may be a convenient way to sell drugs, however the similarity of anti-depressants to placebo, certainly casts doubt on this theory.

This is because we have taken a multi faceted disease, which involves a complex interaction between genetic, diet, lifestyle, environmental and social factors and narrowed it down to the imbalance of a couple of neurotransmitters (chemicals) in the brain and developed drugs to increase these neurotransmitters.

Furthermore, there are certain things that we know about neurotransmitters and how they function, which has further casted doubt on the chemical imbalance theory.

For example, we know that 100 or more neurotransmitters have been identified in the pathology of depression and some patients may have low seretonin but others don’t. Some have increased amounts. Cocaine and meth both increase serotonin and norepinephrine but don’t decrease depression. Also, some drugs don’t affect serotonin and norepinephrine however they help with depression. And lastly, anti-depressants take a few weeks to effect your mood however changes in neurotransmitter balance are seen very soon after drug administration.

Obviously these factors cast doubt on the chemical imbalance theory of depression, however at the end of the day it is far easier and cheaper for a health care system to characterise depression as a physical disease due to a simple chemical imbalance, prescribe a drug and send someone on their way. Meanwhile, it is a lot harder and costly to address the social and environmental aspects that contribute to the disease. We fail to remember that our emotions effect our physiology and our physiology effects our emotions.

So if a chemical imbalance does not cause depression, then what does?

Well, there is no one single cause of depression. As I mentioned in the last post, it is a multi-faceted disease that has many different causes and effects people in very different ways.

However, new evidence is emerging that depression, on a physiological basis is an inflammatory disease and there is a lot of evidence to support this. For example:

  1. When healthy patients are injected with LPS (inflammatory molecule produced from bacteria) they display depressive symptoms.
  2. An anti-viral drug used to treat hepatitis called interferon causes significant inflammation in the body and one of its potential adverse reactions is depression.
  3. People with depression usually have heightened inflammatory markers such as CRP and IL-6.

So where does the inflammation come from? Well, the current theory is that this inflammation originates in our guts, which is caused by a  dysfunction of the gut-brain axis.

Our guts are filled with millions of bacterial species and research is starting to reveal how crucial these gut bacteria are to our overall health. An imbalance of good and bad bacteria in our gut is starting to be implicated as a driving factor behind many chronic diseases, including depression.

In depression, it is thought that an overgrowth of “bad” bacteria in the gut causes a condition called small intestinal bacterial overgrowth (SIBO), which I have written about here. SIBO increases the production of inflammatory messengers in the gut, which enter the blood stream, travel to the brain and then activate inflammatory pathways in the brain. Inflammation in the brain can potentially cause depression in those who are predisposed.

It is well established in the scientific literature that there is a strong link between the microbes in our gut and signalling in our brain. This connection is called the gut-brain axis link. The gut-brain axis explains the correlation between IBS (irritable bowel syndrome) and depression. Especially because IBS is closely associated with SIBO and SIBO is associated with depression.

This gut-brain link also provides an explanation as to why probiotic and prebiotic supplementation has been shown to help with depressive symptoms. It also explains why some people can get depression without any significant life circumstances (e.g. poverty, unemployment, negative life situations, life altering events) that would warrant a person to get depressed.

This is because we know that poor diet and lifestyle factors such as a diet high in processed and refined foods, excess alcohol, smoking, long term psychological stress, chronic lack of sleep and a lack of exercise all contribute to bacterial overgrowth through various mechanisms.

Our diet and lifestyle choices effect our physiology and then our physiology effects our emotions, mood, cognition and behavior. Also, once depression occurs, individuals diet and lifestyle choices also tend to get worse.

Furthermore, independent of the gut-brain axis link, depression can certainly be a result of stressful life circumstances as we know stress can have inflammatory and disrupting effects on the brain, which can cause depression in the predisposed. It must also be noted that stress is not only psychological. Poor diet and lifestyle habits are also a form of physical stress.

In today’s modern world we are more stressed than ever, which is probably a huge contributing factor to the rise in depression.

We live high stress, fast paced lifestyles, where we are working more than ever and having less fun. There are also many aspects of our modern culture that create an environment conducive to depression. For example, we are told to try to attain happiness from external things (rather than within ourselves) or become a certain way that our society/others makes us believe we should aspire to. This leads us to live unfulfilling lives, without a lot of purpose and authenticity. A lack of purpose in life is a huge contributing factor to depression.

Another example is that there is an extreme pressure to “succeed” and be “above average.” This leads us to derive a lot of our self-esteem from being “more successful” than others and causes us to compare ourselves to others. This is a huge disservice to our being as we should try to be the best forms of ourselves.

Increased technology usage causes a culture of social exclusion and decreased face-to-face human connection. The lack of sense of community that we have can really effect us, which may be a reason as to why people in the third world have lower rates of depression. People in the third world have a much greater sense of community and social connection, which is clearly evident in the amount of street socialisation that occurs daily.

I think if we recognise that depression goes far deeper than a few neurotransmitters in the brain, then we can address the underlying causes of this disease and put preventative measures in place, leading to better and more long term therapeutic outcomes.

Using drugs that are no more effective than placebo, with harmful side effects may create dependency and numb our senses, preventing growth and self-change in order to get out of a lifestyle cycle that is causing/contributing to depression.

Treating depression should take a holistic approach by addressing the underlying causes of the depression, which are outlined in this review.

Wrap up.

I want to make it clear that this article was not written to criticise doctors.

We cannot be angry at our health practitioners for prescribing anti-depressants as they are going by what they have been taught. There is no doubt that many doctors refer their patients to psychologists and may even recommend lifestyle changes to patients. However, patients are still usually put on anti-depressants, which I believe should be re-thought due to the existing evidence on these drugs. I am merely advocating for a paradigm shift as depression is reaching epidemic levels and I feel like our current treatment of it is proving ineffectual.

If you suffer from depression or know someone who does, the first step would be to find a good health care practitioner that is aware of the current research and is willing to work with you to change various environmental, cognitive and lifestyle habits that may be the underlying causes to your depression.

Also, they may be able to help introduce certain drug free treatments that have been shown to be helpful in treating depression such as:

  • Psychotherapy
  • Cognitive based therapy
  • Meditation and yoga
  • Animal therapy
  • Nature therapy
  • Exercise 
  • Improving sleeping quality and quantity
  • Light therapy
  • Healthy diet changes
  • Supplementation with zinc, vitamin D, curcumin (tumeric extract), st. johns wart, fish oils and SAM e have also been shown to be helpful, as well as many other nutritional and herbal supplements.

Due to the lack of strong evidence for anti-depressants and the side effects, I believe these options should be explored first in depression treatment. Anti-depressants should be seen as a last resort, while trying to integrate the above treatments. Furthermore, even if someone is on anti-depressants, these treatments should still be addressed.

The ways in which social media effects our health

The ways in which social media effects our health

As I’m sure you are all aware, health is more than just exercising and eating well. Complete health requires the fine balance of the many factors that contribute to health such as diet, exercise, sleep, mindset, spirituality, environmental and social factors.

There is one particular environmental factor that is relatively new to us humans and unknowingly, it is having a profound affect on our health. This factor is the increased usage of the internet and social media. The growing age of technology and social media is having a profound effect on our brain wiring, self-esteem, lifestyle and mental wellbeing. There have been many studies linking problematic internet usage to various psychological issues, including anxiety, ADHD, autism, depression, hostility, schizophrenia, social anxiety disorder, loneliness, and stress.

I want to make it clear that before I get into the crux of this post, I do not think that the use of the Internet and social media is all bad. It does play some extremely important functions in our modern world and can also be used for extremely positive things. I mean, without social media and the Internet, you would not be reading this post. It has revolutionised our world in some very positive ways, however it does not come without its pitfalls.

How can social media negatively affect your health?

A constant distraction that can isolate us:

A definition of addiction: “the relentless pull to a substance or an activity that becomes so compulsive it ultimately interferes with everyday life.”

If we use this definition, it’s fair to say that nearly all of us are addicted to the Internet and social media. What is worse is that this addiction is relatively socially acceptable.

Social media can become a distraction. Think about how often we check our email throughout the day, look at social media accounts, randomly check our phones and spend time randomly browsing the web. Browsing through useless information that adds no benefit to our lives or excessively checking emails/social media distracts us from being on task, decreases productivity and can become a means of procrastination. It can lower our productivity, which can cause us stress when we fail to get things done in our lives.

It can also distract us from being present in our lives. Spending your spare time on social media, looking through random videos and memes can serve a purpose for only so long. So many people distract themselves from critically thinking about their lives and the world around them. Many of us, away from our day job or studies, spend a lot of our free time playing on social media. Now don’t get me wrong, social media can defiantly be used for educational/business purposes (e.g. blogs), however from personal experience, most people I know just scroll through various forms of social media that add no real substance to their lives.

For me, if you are going to use the Internet and social media excessively, why not use it for self-learning and self –development? We are in an age where valuable information is freely accessible and in the time we spend distracting ourselves on unproductive forms of social media, we could be trying to better ourselves at our jobs or just become more holistic humans through self-learning. Why not read more articles/blogs, listen to more podcasts, watch inspiring and educational YouTube videos, learn how to acquire new skills/hobbies? Life is about learning and growing. Don’t become stagnant.

In my opinion a lack of growth/development as a human being is also detrimental to our health and in some aspects, forms of social media is providing a distraction that prevents a lot of people from growing.

Moreover, the overuse of the internet and social media is funnily enough causing social isolation. It is no surprise that recent studies have shown that increased internet usage is associated with decreased relationship quality, loneliness and depression. Not only is it preventing us from actually meeting people in person but it also prevents us from truly engaging with the people who are most important to us (even our kids) when we are with them in person. How often do you see people out at dinner on their phones? Rather than being fully engaged with the people in front of them?

Lots of people say that they can multi task, however, our brain is not capable of multi tasking. Yes we can do two or more things at once, but none of the tasks can get your full attention, which in my opinion is not multi tasking. This is why it is so dangerous to be on your phone while driving!

Social media and the Internet is supposed to “connect us, ” however it seems to me that the net effect of social media has been less connection, not more. Instead of simply being present in each moment and feeling connected with the people around us, our attention is increasingly elsewhere.

Social connection and human interaction is a key part of our health and social media is causing a barrier between true human connection where we actually listen and engage in one another, without getting distracted by our phones. One of the most important predictors of longevity is a feeling of social connectedness and one of the greatest predictors or mortality is social isolation. Importantly, this feeling of connectedness can be actual or perceived, highlighting the effect of mindset on overall health.

I’m no Luddite. I love my phone. But I’ve also come to recognize that how I use it has a tremendous impact on the quality of my life, my relationships, and my health.

When I imagine myself at 100 years of age in a rocking chair, looking back on my life, I’m pretty sure that I wouldn’t regret not having spent more time on my phone.

But I’m absolutely certain that I would regret having missed opportunities to spend quality time with those I loved because I was constantly distracted by technology. Once those years are gone, I can never get them back.

This is why I’ve made an effort to minimize my phone usage as much as possible when I’m with loved ones.

Disrupted sleep:

Increased screen time and blue light exposure from electronic devices throughout the day and especially at night, has an influence on the human body’s circadian rhythm. Unnatural light exposure, especially during the evening when light exposure is supposed to be minimal, can delay melatonin secretion (the hormone that primes you for sleep). Melatonin is secreted in response to darkness on the retina. When this doesn’t occur, sleep onset hormones are decreased. This can lead to sleep issues, which has many associated chronic and acute health consequences, including weight gain, reduced immunity, cardiovascular health, metabolic disease, cancer, and reduced motor skill function.

Lack of exercise and getting outdoors:

Increased use of the internet and social media usually promotes sedentary behavior. It is well established that sedentary behavior is linked with many chronic health issues like diabetes, high blood pressure, obesity and cardiovascular disease.

Recent studies demonstrate that prolonged sitting is a risk factor for hospitalization, diabetes, cancer, cardiovascular disease, and all-cause mortality, independent of the amount of exercise one gets.

People who spend a lot of time on social media and the internet also tend to get less fresh air, sunlight and spending time in nature. All of these things are known to benefit our health in various ways, such as decreasing stress.

Negative vibes:

We as humans have an innate, self-sabotaging tendency to compare ourselves to others. We use others to evaluate our own abilities and performance. In the absence of objective information about our performance, we will compare ourselves to others to see how we stack up.

Comparison is helpful when it inspires you to strive to be the best version of yourself, to maximize your potential and make the very best of what you were given in life (e.g. genes and environment). It also becomes a necessity for the functioning of society because if there is no comparison, you might be doing something silly in your life and you would think you are doing great. If we do not have benchmarks, we cannot improve our activity. Not everyone is driven by passion to do what they are doing, where they will anyway do their best. They need some benchmarks. This comparison is needed and it is not about you. It’s only about your actions. In activity, all of us are differently capable.

Comparison is an issue when it becomes obsessive and negatively affects your opinion of yourself or makes you feel inadequate and depressed. This is known as the “compare and despair” syndrome.

The human tendency of comparison is a good explanation of why statistics show that increasing use of social media seems to make people more depressed and anxious. This is because in our new age of social media, people are constantly exposed to everyone else’s lives and once again, humans get envious and jealous.

However, firstly, we must understand that social media is not real life! It is a snap shot in time of a person’s life and basically a highlights reel. People only show what they want to show because for many people, it seems the only way they can validate themselves is through a screen, a habit which is just as bad for your health as over-indulging in drink or drugs and just as addictive. No one posts their beans on toast, the fights they have with their partners, or the other 40 selfies that they took before they got the “right” one.

The brag culture of social media is so that people can present a false picture of their lives to the online community; with flattering selfies and faux-glamorous images of holidays, parties and meals. It’s as if they’re starring in a movie of the life they would like to lead because they believe status and material things are what we should aspire to. Also, an underwhelming lack of shares or ‘likes’ can lead to debilitating feelings of inadequacy. People post intimate fragments of their lives to total strangers, falsely believing that a ‘friend’ online is a real friend whose opinions matter. What is also interesting about this is that we often post on social media in order to find validation in likes and comments. Social media seems intrinsically linked with our self-esteem, which is fragile and damaging.

It’s incredibly common to feel inadequate or sad about our own lives after a few minutes of social-media scrolling. Studies show that Facebook can cause feelings of depression and loneliness. A new study published in the Journal of Social and Clinical Psychology found that comparing our lives to the others “better than us” on social media may be what causes the depressive symptoms associated with Facebook browsing. It leads to feelings of inadequacy and loneliness.

Basically, the longer you stay on social media, the more likely you are to become envious of the things and status that you don’t posses. A person with a larger network of ‘friends’ will be more likely to experience ‘the grass is greener’ symptoms than a person with a smaller network.

Furthermore, social media and other forms of media, constantly bombard us with stories, images and videos of humans that are on the extremes of the bell curve. We are flooded with people who are exceptional and not the majority. They are the 99.999999th percentile. Media does this, because it is ultimately what brings in money, however this makes most people feel extremely inadequate as people begin to think it is the norm and it is what we should aspire too.

What most people also don’t realise is that these exceptional humans that we are bombarded with, may be exceptional in one aspect of their lives, but are usually pretty average in other aspects, as it is not possible to become exceptional in a certain area, without completely neglecting other things. As an example, this is usually why sports starts are pretty thick.

Health gurus on social media:

Many of the “health gurus” on social media do not have formal degrees and because they have a lot of followers, they think that they are qualified to give out health advice based on what works for them or based on trendy pseudoscience that will gather likes/followers. Firstly, a lot of them are just promoting certain brands and products because they get money for it and secondly, just because something that works for a genetically gifted model, doesn’t mean it will work for you. Also, some of these people on social media do not even live a healthy lifestyle but what you see them doing on social media is a snap shot in time to promote a lifestyle that is “trendy” at the moment.

It frustrates me because these individuals don’t realize the effect of what they are doing. They may think that what they are doing is seemingly harmless, however they are putting misinformation into the world that people are listening to and it can affect the self-esteem/mindset of others.

These people need to take responsibility for the energy they put into the world. They also take business away from the people in the health industry who know their stuff, have qualifications and genuinely want to help others without promoting themselves in the process or using social media to inflate their ego. By all means everyone is entitled to do what they want. We all have to make our way through this crazy thing we call life. However, when your actions make the lives of other more difficult, then for me, this is a problem.

Issues in kids:

Increased screen time in children has been linked to various behavioural disorders, addictions later in life and obesity. Kids are playing outside less and interacting less with other children/people face to face, as well as their environment around them, which is a crucial part of physical and mental development, proprioception development  self esteem building, risk assessment, social wellbeing,   and learning how to behave/interact in the world. Also, kids become so focused on their screens, they end up lacking awareness of the world/environment around them, causing a disconnect, which in turn leads to a lack of empathy for the natural world around them.

Some parents worry about kids hurting themselves while they are out playing, however statistics show that more injuries occur from children falling out of their beds than out of trees.

In some cases, child and teen use of technology can almost be obsessive and addictive, causing some serious behavioural issues. The destructive obsession with technology is the predictable consequence of a virtually unrecognised merger between the tech industry and psychology. This alliance pairs the consumer tech industry’s immense wealth with the most sophisticated psychological research, making it possible to develop social media, video games, and phones with drug-like power to seduce young users.

Tech companies higher a multitude of psychologists, neuroscientists, and social science experts who use their knowledge of psychological vulnerabilities to devise products that capture kids’ attention for the sake of industry profit. This is quite sad because psychology — a discipline that we associate with healing — is now being used as a weapon against children and teens.

These fields, known as “brain hacking” and “persuasive design,” are highly developed and actively employed by the tech companies that make the products that kids become addicted to.

While technology has a multitude of benefits and can help prepare a child for the advances of the modern world, we need to also support a healthy relationship with technology—one that recognises the addictive nature of these products, hence setting clear boundaries around its use.

Wrap up.

As I have pointed out, there are some potential health issues surrounding the use of the internet and social media. I am not suggesting that you stop using the internet or that it’s inherently unhelpful. I am merely pointing out that excessive use carries proven and significant risks.

Here are some small strategies to reduce Internet and social media time:

  • Turning off notifications on your phone and mobile devices
  • Only checking email 2-3 times a day
  • Focusing on your most important daily tasks before engaging with email/social media/meetings.
  • No social media or Internet before bed.
  • Using a app called F.Lux on your devices. It emits and dimmer, yellow light from your devices at night.
  • Make sure you break up sitting periods with a walk or some light stretches.
  • Planning to catch up with friends and family face to face, as well as turning off your phone while you are with them.
  • Take time to add outdoor activities into your week.
  • Turn your phone on aeroplane mode or place it far away from you while doing something that requires your full attention.
  • Unfollow people on social media that make you feel complex about your life, self-esteem or body image.
  • Schedule a digital detox period or tech free sabbath. This is where you turn off all technological devices for a given period of time. Most people do this when on holiday or when they go into nature. Digital detoxes are refreshing and rejuvenating. Disconnecting from the internet world can be extremely liberating.

The power of social connection for our health

The power of social connection for our health

A study with over 300,000 participants found that social support and social connection was a stronger predictor of survival than physical activity, body mass index, hypertension, air pollution, alcohol consumption, and even smoking fifteen cigarettes a day! Furthermore, many other studies have found that the main determining factor to a happy life is quality relationships. We are social beings, so this is no surprise.

Having good social relationships with friends and/or family help buffer the effects of chronic stress by providing emotional support and as we know, stress can be very damaging to our health. It makes us feel supported, like we have a safety net. Also, social relationships directly influence health through their effect on physiology, behavior, and mood. Good quality social relationships can make us feel happy and increase our self esteem, which in turn is vital for our health and wellbeing.

Not only can social connection maintain our health and prevent disease, it can also help us recover from chronic health issues. If you are suffering from a chronic illness, it is true that diet, supplements and other interventions will play an important role in your recovery and healing. However, making time to focus on social connection is just as, and even more important. Setting up regular dates with friends, working with a therapist and maybe even joining groups to meet people who may be suffering from a similar condition to you, might be the missing key to your healing.

Humans are genetically social creatures and crave meaningful human contact. It is vital to both our mental and physical wellbeing.

Anti-depressants. No more effective than placebo?

Anti-depressants. No more effective than placebo?

By looking at the evidence surrounding anti-depressants for depression, this post will hopefully stimulate some useful dialogue to maybe rethink the way we approach this complex and debilitating disease.

What is depression?

Depression is a debilitating disease that is becoming ever so prevalent in our modern world.

Most of us either know someone with depression or have experienced it first hand.

If we think about this disease critically, it is hard to neatly define and categorize depression. This is because it involves a vast array of symptoms and causes that differ from person to person, however they all come under the umbrella of depression.

Basically, depression is a blanket term for a wide variety of cognitive, behavior and mood disorders that also have physical symptoms.

Despite the heterogeneity of what is classified as depression, the current approach to its treatment is very much uniform, which is the prescription of anti-depressants.

Anti-depressant basics:

There are currently 4 classes of drugs that are classified as anti-depressants.

These include:

  1. SSRI’s (selective serotonin reuptake inhibitors)
  2. SNRI’s (selective noradrenaline reuptake inhibitors)
  3. TCA’s (tricyclic amines)
  4. MAO (monoamine oxidase inhibitors)

SSRI’s are the most commonly used anti-depressants and are the first line treatment for depression. Therefore, in these posts we will focus our discussion mainly on SSRI’s but many of the concepts we address can be generalized to all of the anti-depressants.

SSRI’s contain the active ingredient sertraline, which is believed to exert the anti-depressant effects of SSRI’s, which are sold on the market as things like Zoloft, Prozac, Lexapro, celexa and Paxil.

As their name implies, SSRI’s have a mechanism in the brain whereby they inhibit the reuptake of serotonin (a neurotransmitter) into pre-synaptic neurons in order to increase the bioavailability of serotonin in the brain.

Basically, they increase the amount of serotonin in the brain by inhibiting its reuptake into neurons. Serotonin is a neurotransmitter, which are chemical messengers in the nervous system that play various roles in digestive function as well as cognition, mood, memory and behaviour.

Most of the drugs used to treat depression have actions in which they alter the activity of and increase the amounts of various neurotransmitters in the brain, mainly being serotonin, dopamine and noradrenaline, as low levels and imbalances of these are supposedly implicated in the cause of depression, however this idea of a  “chemical imbalance” in the pathology of depression will be addressed later on.

Like all drugs, SSRI’s and anti-depressants in general come with a cocktail of side effects and potential adverse reactions. These include:

-Weight loss, appetite changes

-Sleep disturbances

-Nausea

-Diarrhoea

-Rash/hypersensitivity

-Agitation

-Anxiety

-Nervousness

-Restlessness

-Sexual dysfunction

-Headache

-Dry mouth

-Changes in mood, memory and cognitive function

-Increased blood pressure

-Increased suicide risk

-Impaired vision

-Movement disorders

They have also been known to increase suicide risk (especially in children and teenagers), and result in the worsening of depressive symptoms like:

-Sleep disturbances

-Anxiety

-Panic

-Irritability

-Restlessness

-Hyperactivity

-Impulsivity

-Aggression

They also have the potential to alter the brain chemistry permanently, predisposing a person to future depressive episodes and increasing the chronicity of depression.

Anti-depressants are no more effective than placebo.

Now with a side effect rap sheet like that, you would hope these drugs are effective at treating depression??? But the current evidence is starting to cast doubt on the effectiveness of anti-depressants in treating depression.

Which is clearly demonstrated in the fact that that despite the increased use of anti-depressants, the depression rates are still rising.

In any one year, around 1 million Australian adults have depression. On average, 1 in 6 people – 1 in 5 women and 1 in 8 men –will experience depression at some stage of their lives.

Australia is second in the world for anti-depressant prescriptions and prescriptions in Australia appear to have doubled between 2000 and 2011. Eighty-nine Australians in every 1,000 are now prescribed some form of daily anti-depressant.

The potential explanation for these statistics is probably due to the fact that anti-depressants have been shown to be NO MORE EFFECTIVE than placebo in treating depression and decreasing suicide risk.

This means that a sugar pill when compared to an active pill shows no difference in clinical outcome. This was clearly demonstrated in the ever so controversial meta-analyses of Irving Kirsch.

Now people often say that anti-depressants are useful and necessary for severely depressed patients, however, the patients in the trials analyzed by Kirsch had a mean baseline severity rating that was in the ‘very severe’ range of depression for all but one of the trials. This rating was done using the American Psychiatric Association classification scheme. The one exception was a clinical trial involving moderately depressed patients, in which the response to a drug was virtually identical to the response to placebo.

These studies also make us realize the power of the placebo effect, which is likely to be the main driving factor behind anti-depressants (as well as natural anti-depressant supplements) working in clinical settings, because people believe they will work (which is influenced by the media), rather than having an actual effect, solely due to their chemical composition. Anti-depressants can be a crutch to a persons debilitating mental illness and it also requires relatively little effort to take an anti-depressant daily, as opposed to changing diet and lifestyle habits, which have been shown to be more effective than anti-depressants.

Placebo effects have been tested in clinical trials and can reverse the effects of powerful medications. They can affect the body as well as the mind. They produce side effects as well as beneficial effects. They can produce symptoms and also alleviate them.

Kirsch points out that there is good reason to believe that the placebo effect should be even greater on depression, which is why clinical trials display the results that they do. This is because hopelessness is a core feature of depression, and one of the presumed effects of a placebo is to instill hope.

Kirsch also mentions that it is feasible that there are other subgroups of patients for which antidepressants are more effective. This also points towards the fact that there are probably many different types of depression with differing causes and pathologies, hence anti-depressants only work for certain types and we are yet to define the different sub-types of depression.

This is important to note because there is no doubt that they work in some people with depression, however this is likely to be because the people that they do work in, have a certain type of depression in which anti-depressants can be useful. Depression can be caused by multiple factors, which is why a uniform treatment may not be effective.

Lastly, another criticism of the studies done on anti-depressants is that they usually only use participants who only have depression and no other health conditions or previous health issues. This is to reduce confounding variables. Therefore people with other medical conditions are excluded, however in the real world, most depressed patients have other concurrent conditions such as anxiety, IBS and insomnia.

Overall, in conclusion, it can be said that both clinical studies and clinical experience shows that antidepressant drugs work, in the sense that patients get better when given medication. However, the same can be said for placebo drugs in depression. Patients given antidepressants in the clinical trials showed substantial and clinically significant improvement, as did those given placebo.

But if anti-depressants are no more effective than placebo, it makes me wonder why are they still on the market? This is an issue because they are not harmless.

In the next post, I will explore a likely explanation as to why anti-depressants have been shown to be no more effective than placebo.

Note: If you are currently taking anti-depressants, DO NOT stop taking them as a result of reading this article. Please consult your doctor first.

4 Reasons why people in “poor” countries are happier than people in “rich” countries

4 Reasons why people in “poor” countries are happier than people in “rich” countries

The more I travel to “third world” countries; I am simply amazed at the happiness shown by people who have the least amount of “stuff” and material wealth. Not only do these people appear happy, but when you talk to them and ask them about their lives, they are generally joyful people who are content with their lives. This started to make me question why? I had my own theories and it turns out that they were supported by research.

When I looked to the research, large epidemiological studies indicate that high-income countries tend to have higher depression and anxiety rates than middle to low-income countries (that are without wars, famine, natural disasters and conflict). The World Health Organization has found that depression and anxiety is the leading cause of disability worldwide and estimates that depression affects 121 million people worldwide. Divorce, separation, or the death of a spouse were commonly associated with depression across all countries, however on average, there are higher rates of depression among those in higher income/richer countries compared to lower income/poorer countries. This has baffled researchers as it is counterintuitive to what we think brings happiness in the western world. There are some theories behind these interesting statistics, which I think are all contributing factors.

Greater income disparities in rich countries increase depression.

Rich countries tend to have greater income disparities between the very rich and very poor, which could play a role in the development of depression and anxiety and lead to higher rates of depression/anxiety in developed countries. The reason behind this could simply be envy and jealousy, which is a natural human tendency. Jealousy and envy is usually a core feature behind wars and battles since the dawn of man kind. “I don’t have what you have, but I want it, so I will kill you to get it.” In poor countries, almost everyone is poor. In rich countries, contrastingly, the poor are constantly confronted with the vast wealth of the rich.

This is why even as a young child, when travelling to South Africa, I realized there was a difference between a poor person in the city streets/squatter camps of Johannesburg, compared to a poor person living in a rural community with a few animals, a mud hut and the basic necessities to live. The person in the rural community has no mode of comparison for their life situation and everyone else is living in the same way as them, where is the poor person in the city sees how the wealthy live everyday and it is very different to them.

This is likely to be one explanation as to why individuals of lower socio-economic classes in developed nations tend to exhibit high rates of depression and anxiety, not taking into account diet and lifestyle habits, which we know also effect mental health and tend to be worse in people of lower socio-economic status.

Obviously in poorer countries, there is always going to be an upper class that enjoys a life of luxury, however it is not as common, therefore it is not in the sight of those who are poor.

There is an old joke that highlights our tendency towards jealousy of other people’s wealth. It goes like this.

A genie granted a man whatever he wanted with the caveat that whatever he gets, his neighbors will get twice as much.

When he wished for a house, for example, his neighbour got two.  When he wished for a car, the same thing happened. Finally, the man became so enraged that he wished to be blind in one eye so his neighbours would become blind in both eyes.

While the above story is comical and ridiculous, this pattern of thinking is likely to be true amongst humans and has been demonstrated in research.

A University of Warwick study, for example, found that money only makes people happy if it makes them richer than their peers. Earning a million dollars a year appears to be not enough to make you happy if you know your friends all earn 2 million a year.

This research clearly demonstrates why people in richer countries may be unhappier due to jealousy and envy of the large income disparity, which is not as prevalent in poorer countries. The human tendency to think in this way means that jealousy can occur at all levels of socio-economic status, which is why people are always wanting more!

It also supports the notion that money, material things and status can’t buy/bring happiness and life satisfaction, if that is all that you are seeking in life to validate yourself. Because there will always be someone with more money, more status and cooler stuff than you – leading to jealousy and envy. This is clearly evident in wealthy and famous people who are clinically depressed and sometimes commit suicide. Money and status can’t take away feelings of jealousy, envy, as well as sadness, anxiety and inadequacy in a person.

In richer nations, we tend to define success by how much money you earn, what possessions you own and social status, which causes people to try impress others they don’t know and to work highly stressful and socially acceptable jobs (that give you status) to make lots of money to buy lots of things, that they never have time to enjoy anyway. People lead lives that they think others will look highly upon instead of doing what they really want, which leaves them feeling empty, anxious and depressed. We also know stress and long hours are correlated with depression as it predisposes a person to poor sleeping habits, poor diet choices, decreased exercise and decreased time for social connection, self care, engaging in hobbies, relaxation and having fun – which are all important aspects for maintaining physical and mental health.

Research shows that once one is able to provide for basic physical needs (i.e. food, shelter and so on), the correlation between happiness and worldly success quickly approaches zero. So if you are starving on the streets of India, an extra ten thousand dollars a year will affect happiness. However, if you are a middle class person in a developed country, an extra ten thousand dollars per year doesn’t mean much – meaning that you are killing yourself working overtime, neglecting everything else (i.e. family, friends, partners, your own hobbies, self care, relaxation, fun) for basically nothing. This “business” is seen as a badge of honour in our society because it is intrinsically linked with money and feelings of importance.

This is different to poorer nations, where it seems that as long as people have the basic necessities to live, they tend to be happy. Their lives tend to be simpler and happier because their social pressures to live a certain way are vastly different to richer countries.

It seems that we humans have a self-sabotaging need to compare ourselves to others. This leads us to compete to be better than our peers in order to be validated. However, if this is our mentality, we will never feel happy and validated, because no matter what, there are always going to be people who have more of what we may want.

The mere fact that income disparities can be a contributing factor to depression, anxiety and unhappiness, clearly demonstrates how wayward our values and moral compasses are. We put so much value in money and social status that we forget what is truly important in life. This is not completely our fault though as we live in a world of scarcity. This means that no matter what we do, we are never good enough, we have not achieved enough and never have enough stuff. The media is always marketing new things to us to improve our appearance, health, income, social status, or increase the amount/type possessions we have. This in turn leads to constant feelings of inadequacy and anxiety, because we are always wanting more and ultimately never feel satisfied. We are overwhelmed with options and we become anxious as a result of this.

Lastly, it goes without saying that a lot of people in developed nations are not constantly driven by money, social status, success and material things, however yet they still may find themselves in the trap of feeling unhappy, dissatisfied and inadequate due to comparison. It is not uncommon to hear people say that they are are “not where they want to be in their life.” A lot of the time, they feel like this because they are comparing themselves to other people who are in a similar life stage and believe that they should be in a similar position regarding financial success and career success. This is despite these individuals having everything they need and more, to live on a day to day basis and enjoy their lives. Yet they are still unhappy because they compare themselves to others instead of living their most authentic life. While it is natural to somewhat envy what others have (e.g. a nice house, freedom to travel), it shouldn’t make us unhappy with our own lives.

Overuse of social media in richer countries increases depression.

As mentioned above, we as humans have an innate, self-sabotaging tendency to compare ourselves to others. We use others to evaluate our own abilities and performance. In the absence of objective information about our performance, we will compare ourselves to others to see how we stack up.

Comparison is helpful when it inspires you to strive to be the best version of yourself, to maximize your potential and make the very best of what you were given in life (e.g. genes and environment). It also becomes a necessity for the functioning of society because if there is no comparison, you might be doing something silly in your life and you would think you are doing great. If we do not have benchmarks, we cannot improve our activity. Not everyone is driven by passion to do what they are doing, where they will anyway do their best. They need some benchmarks. This comparison is needed and it is not about you. It’s only about your actions. In activity, all of us are differently capable.

Comparison is an issue when it becomes obsessive and negatively affects your opinion of yourself or makes you feel inadequate, anxious and depressed. This is known as the “compare and despair” syndrome.

The human tendency of comparison is a good explanation of why statistics show that increasing use of social media seems to make people more depressed and anxious. This is because in our new age of social media, people are constantly exposed to everyone else’s lives and once again, humans get envious and jealous.

However, firstly, we must understand that social media is not real life! It is a snap shot in time of a person’s life and basically a highlights reel. People only show what they want to show because for many people, it seems the only way they can validate themselves is through a screen, a habit which is just as bad for your health as over-indulging in drink or drugs and just as addictive. No one posts their beans on toast, the fights they have with their partners, or the other 40 selfies that they took before they got the “right” one.

The brag culture of social media is so that people can present a false picture of their lives to the online community; with flattering selfies and faux-glamorous images of holidays, parties and meals. It’s as if they’re starring in a movie of the life they would like to lead because they believe status and material things are what we should aspire to. Also, an underwhelming lack of shares or ‘likes’ can lead to debilitating feelings of inadequacy. People post intimate fragments of their lives to total strangers, falsely believing that a ‘friend’ online is a real friend whose opinions matter. What is also interesting about this is that we often post on social media in order to find validation in likes and comments. Social media seems intrinsically linked with our self-esteem, which is fragile and damaging.

It’s incredibly common to feel inadequate or sad about our own lives after a few minutes of social-media scrolling. Studies show that Facebook can cause feelings of depression and loneliness. A new study published in the Journal of Social and Clinical Psychology found that comparing our lives to the others “better than us” on social media may be what causes the depressive symptoms associated with Facebook browsing. It leads to feelings of inadequacy and loneliness.

Basically, the longer you stay on social media, the more likely you are to become envious of the things and status that you don’t posses. A person with a larger network of ‘friends’ will be more likely to experience ‘the grass is greener’ symptoms than a person with a smaller network.

Furthermore, social media and other forms of media, constantly bombard us with stories, images and videos of humans that are on the extremes of the bell curve. We are flooded with people who are exceptional and not the majority. They are the 99.999999th percentile. Media does this, because it is ultimately what brings in money, however this makes most people feel extremely inadequate as people begin to think it is the norm and it is what we should aspire to.

What most people also don’t realise is that these exceptional humans that we are bombarded with, may be exceptional in one aspect of their lives, but are usually pretty average in other aspects, as it is not possible to become exceptional in a certain area, without completely neglecting other things. As an example, this is usually why sports stars are pretty thick.

Lastly, social media use is also isolating the face-to-face human connection that is vital to our well-being and mental health, which brings me to the next topic.

Lack of social connection and good relationships increases depression.

A study with over 300,000 participants found that social support, social connection and strong, healthy relationships was a stronger predictor of survival than physical activity, body mass index, hypertension, air pollution, alcohol consumption, and even smoking fifteen cigarettes a day! Furthermore, many other studies have found that the main determining factor to a happy life is quality relationships.

Social relationships help buffer the effects of chronic stress by providing emotional support and as we know, stress can be very damaging to our health. Also, social relationships directly influence health through their effect on physiology, behavior, and mood.

Not only can social connection maintain our health and prevent disease like depression, it can also help us recover from chronic health issues.

People in poorer nations tend to have a greater sense of community and there is more of a “street culture” compared to richer countries where depression is more prevalent. In richer countries, especially within cities, people live in relative isolation and hardly know their neighbours/local communities. We tend to stick to our immediate social network and don’t really engage with others. Where in poorer nations, people have a greater sense of community. Also, people in richer countries tend to have more individualistic attitudes toward life, where as in poorer countries, people have more community-based attitudes.

People underestimate the importance of having healthy and strong relationships with our friends, family and partners. Good relationships make us feel secure, supported and also enhance our enjoyment of life. Experiences in life are always best shared with good company, no matter what we are doing.

This means that working hard to have solid relationships in our lives is one of the main keys to happiness. No matter how much money, social status or material things you may have, it can’t buy or replace great relationships. Chaotic life situations driven by unhealthy and stressful relationships, such as in divorce, can cause significant stress and unhappiness, no matter how much wealth, social status and material things that a person may have.

People in the developed world often stretch themselves financially and live beyond their financial means to keep with norms that they compare themselves too. They often do this without even realising what they are actually doing. They get stuck in a cycle of financial stress to keep up with a lifestyle that they don’t need, but feel like they should have. These financial stressors can often put unnecessary strain on important relationships (e.g. kids, partners etc).

People need to shift and re-think their priorities. Rather than stretching themselves with stress in order to keep up with the Jones’s, they should focus on building healthy and strong relationships that enhance the enjoyment of their lives. There is no denying that having enough money to go on expensive holidays, driving a fancy car, having a big house and working in a job that hold a lot of social status is all very “nice,” however if the pursuit of these of these things puts stress on key/foundational relationships in your life, they are not worth it. Because even if you do achieve these end goals, you will be left feeling empty and with the feeling of, “ok, what’s next?” It leads to a constant cycle of dissatisfaction because there will always be more things you can have and more things you can do.

If you may not be able to afford a big house, a nice car and an expensive holiday, trust me, the small house, basic car and camping trip is much more enjoyable and satisfying if it is done with people you genuinely love and enjoy spending time with. As stated above, once the basic living necessities are taken care of, happiness does not exponentially grow with more money. It will grow with better relationships.

Once we realise that our unhappiness and stress is driven by comparing ourselves to what others have, we can change our priorities and start to live a more authentic life that is ours. The reality is that some people have more money than us and can do more things with their money, however we can still enjoy our lives by making the most of what we have with people we love the most.

Lastly, if you live in a developed nation and have the basic necessities to live, just realise that you are far better off than most people in the world and taking a trip to the slums of some countries may give you some perspective. While you may be worrying about the fact that you can’t always travel when you want, a lot of these people are struggling to survive on a daily basis.

A lack of life purpose increases depression.

Recently, for a subject at uni, I had to answer an online forum question, which asked students to investigate possible non-pharmaceutical treatment options for Alzheimer’s disease.

On the online forum, one student investigated the effects of curcumin supplementation on patients with Alzheimer’s. Curcumin is the main active ingredient in turmeric, which is a spice that is commonly used in traditional Indian food. It has been shown to have various anti-inflammatory, neuro-protective and anti-cancer effects. It has also been shown to have amazing results in Alzheimer’s patients.

In his response, the student hypothesized that increased turmeric in the diet might be a likely explanation for the low rates of Alzheimer’s in rural Indian populations that eat a lot of tumeric. While this may be plausible, I thought it was unlikely. This is because curcumin is very poorly absorbed from oral ingestion of dietary turmeric. Therefore it needs to be supplemented with in order for curcumin to be absorbed into the blood and have widespread effects.

The poor absorption of dietary curcumin from turmeric causes curcumin to go into the large intestine where it acts as a potent anti-oxidant and has shown to be protective against colon cancer.  This is likely to be one of the reasons as to why rural Indian populations have low rates of colon cancer.

So if it is not the turmeric, I wondered why rural Indian populations have lower rates of Alzheimer’s. One of the main hypotheses is that these people have an increased sense of ‘life purpose.’ A lot of them are farmers, so they wake up every morning and there are fields to tend to, animals to look after, structures to build and food to make. They have a purpose every morning when they wake up. Our mindset affects our physiology, which is why these people suffer less from Alzheimer’s as they feel more content with their life.

As I delved into the research more, a strong sense of ‘life purpose’ significantly decreased the risk of mental health issues like depression and increased longevity. The strong correlation between ‘life purpose’ and good mental health is particularly evident when examining people in blue zones (i.e. communities all over the world that have the highest life expectancy). Communities living in blue zones share many commonalities with each other and one is ‘increased sense of life purpose.’ These people also have a whole food diet, good sleep habits, social connection, spend lots of time outdoors, have time to relax and have fun, and are active on a daily basis, which also indicates the importance of other healthy diet and lifestyle habits for disease prevention such as depression and anxiety.

In the richer nations, statistics show that most people are severely lacking life purpose. Our societal structure is more individualistic/capitalistic, therefore our jobs are more centred around what we can gain for ourselves, rather than what we can do for our community. This already increases the risk of people lacking purpose in their lives, as it it becomes the individual’s responsibility to assign meaning to their roles in society. For most people, providing an income for their families is not enough to feel fulfilled as we spend so much of our days at work, we want to feel somewhat fulfilled.

This is what also leads to the entitlement of our generation. Everyone wants to be special and extraordinary (which is partly driven by the fact we are bombarded by extraordinary humans every day). Our generation have no idea what we want to do with our lives because we all want to be special and the endeavour towards this makes us depressed and anxious.

People are working in jobs they dislike (or feel indifferent about) to make enough money to carry on living their unfulfilling lives and working in that same job. Much of the time they are not working, but slaves to these jobs, in order to make money to keep up with lifestyles that provide superficial highs, either through substances (e.g. drugs, alcohol, food, drugs), social media, material things or socially/individually destructive behaviours, which ultimately cover up dealing with feelings of insecurities or inadequacy.

Wrap up

The various factors that may explain the differences between depression rates in poor countries compared to rich countries, provides us with valuable information. It helps us to become aware of the possible causes behind our lack of fulfilment and unhappiness within our lives, which can in turn lead to positive change. Most of us live in a society where our basic living needs are taken care of and we are safe, however we are still unhappy and anxious. These feelings of inadequacy and discomfort are also sometimes be numbed by food, alcohol, smoking, drugs, social media and material things that give us temporary highs. This further impacts our health, wellbeing and mental health.

Now this doesn’t mean we should all go live in poorer countries, however it does mean that we need to change certain aspects around the way we approach our lives.

It must first all start with our value system. We need to define better values. Good values are controllable, socially constructive or internal. A simple example is honesty, its internal, constructive and controllable. Bad values are the opposite, they are socially destructive (or require destructive means to achieve them), beyond your control or external to you. Good values will always be a work in progress and never a destination (e.g. honesty), they don’t let us fall into the cycle of “once I have/do X, I will be happy.” If they are a destination, we will always want more or feel empty once we have reached the destination. The same goes for happiness, happiness is a work in progress that comes and goes in our lives and it is internal to ourselves. It is not something that just happens on a Tuesday night as a result of external factors that are marketed to us.

And while we all want happiness, we all must realise is that sometimes life can cause hurt, pain, sadness and anxiety, which are not only normal but inevitable. Happiness is not a destination, it is rather a feeling that comes with a whole lot of other feelings in your life. We are lead to believe that happiness is an end goal that is reached once you look a certain way and have certain things, but rather happiness is pat of a spectrum of human emotions that we feel throughout our lives. While it is obviously desirable to feel happy more than sadness, we must also be ok with the fact that sadness, anxiety and uncomfortable feelings are part of life as well.

However, these feelings should be a result of problems that are worth suffering for because we have changed our value system. For example, getting anxious and sad about material things, social status and money can throw you into a cycle of constant anxiety because as shown above, chasing after these things will always lead to feelings of anxiety and inadequacy. But, feeling anxious and sad about not sticking to a value of honesty or integrity is healthy. We should get down about this because this is a good value to have and it is personally and socially constructive. Feeling anxious and sad about something we care about is normal, we just need to make sure that what we are caring about is based on a good set of values.

Also, if we come to the realisation that feelings of discomfort like sadness and anxiety are part of the human existence and we realise “happiness” is constantly marketed to us like an end goal, we become more comfortable with them and ride them out as they do eventually pass. Rather than trying to numb those feeling with food, being busy, substances, social media/technology, or buying more stuff.

After we define our values we need to prioritise them in our lives and work towards them. Addressing and reshaping  our value system can be confronting and often very painful at first, which is why most people shy away from it and drown themselves in short term, superficial highs. However, those scary and anxious feelings that people seek to suppress are and live in denial of, are often what tells us what we need to work on the most. This is why the constant seeking of “superficial pleasure” can actually be quite dangerous. Far too often we seek out superficial highs to fill the void that is lurking inside of us and it is this void in which companies target to sell you more things to make you “happy.”

Lastly, you must also realise that you are not special and most of life is mundane and ordinary and in the grand scheme of things, your life really doesn’t mean anything. While this may sound bleak, it is actually quite empowering, as it alleviates all those pressures to be extra-ordinary. Once we realise this, we can start to focus on what really actually matters to us in our lives and we can derive pleasure out of the seemingly ordinary but amazing things like forming strong, meaningful, inspiring and trustworthy relationships. This will all in turn lead you to live a life that is yours and one that you want to live, not what others think you should live. And this life should be followed with passion, grit, honesty, trying your best, resilience and the openness to fail many times, because failure is the way forward.

Note: I do want to acknowledge that the reality of modern life is that money is important and can make life easier, however it should not be the primary focus behind what you do in your life as this leads to constant feelings of inadequacy and anxiety as you will never have enough. Sticking to a good value system will naturally bring money into your life, as well as good people.