Beyond Serotonin: Trend of 2 ‘Prescriptions’ Alleviate Depression, Get at Root Cause

Globally, 5 percent of adults suffer from depression, and a total of 280 million people suffer from depression. Although the use of antidepressants have increased, the treatment results are inconsistent, and people’s symptoms sometimes don’t even improve. However, there are two naturally present antidepressants that people can try.

Antidepressants Don’t Work for Some People?

Data from the National Health Interview Survey showed that in 2019, 18.5 percent of adults had symptoms of depression that were either mild, moderate, or severe in the past 2 weeks. This means that about one in five adults experienced any symptoms of depression. Among them, 22 percent of adult women, and 15 percent of adult men, experienced some degree of depression.

The 2020 National Survey on Drug Use and Health (NSDUH) study found that an estimated 21 million adults in the United States had at least one major depressive episode, accounting for 8.4 percent of all U.S. adults.

Conventional science believes that depression was caused by chemical imbalance in the brain, especially low serotonin; and antidepressants will affect a number of chemicals in the brain that influence mood and anxiety, such as serotonin, among others.

Although antidepressants are constantly being updated, there are still some patients who do not respond to two or more antidepressants. Some patients even find that the medication gradually stops working for them over time. It is unclear what factors lead to increased tolerance to antidepressants.

Perhaps due to the limited effectiveness of medical treatment, the long-term risk of recurrence after recovery from major depressive disorder (MDD) in the general population is high. The estimated cumulative recurrence of MDD was 13.2 percent at five years, 23.2 percent at 10 years, and 42 percent at 20 years.

In other words, antidepressants may not necessarily be the solution to depression.

Johann Hari is one example.

Beyond Serotonin: Deeper Causes of Depression

Hari had depression when he was a teenager. Doctors told him that it was a chemical imbalance, and that antidepressants would help him. He felt better with the medication, but then the pain came back, and a higher dose was given, until he reached the legal dose limit.

Hari visited many doctors and experts in the field. He later concluded that depression wasn’t necessarily caused by simply low serotonin in the brain, not a “malfunction” or “glitch” in the system. Rather, “You’re a human being with unmet psychological needs,” he said.

He wrote his findings in a book titled “Lost Connections: Uncovering the Real Causes of Depression and the Unexpected Solutions.”

In his book, he recorded a story:

A South African psychiatrist named Derek Summerfield arrived in Cambodia in the early 21st century. For the first time, chemical antidepressants were being introduced to local doctors. Dr. Summerfield tried his best to explain to them what antidepressants could actually do. However, they said that they already had antidepressants.

It was the “Rule of the Cow.”

A local doctor told him the story of a man he treated who was living with crippling depression. He was a farmer who used to work in his rice fields every day. One day, upon stepping on a landmine in a rice field, he instantly lost his left leg. Afterwards, he had to work with an artificial limb, which made laboring in water exceptionally painful. He then became desperate and in pain and tears, and became bedridden.

The local doctors visited him, listened to his tearful complaints, and tried to understand the cause of his pain. They later figured out that it was too difficult for the man to work in the paddy fields with his prosthesis, and that his physical pain was causing him great stress. Thus, he did not want to live anymore.

After discussing with his neighbors, the doctors believed that he could become a dairy farmer instead. So he no longer needed to go to the rice fields. They all chipped in and bought him a cow. Several weeks after becoming a dairy farmer, his depression disappeared.

The doctors told Summerfield, “You see, doctor, the cow was an antidepressant.”

“To them,” Hari wrote, “finding an antidepressant didn’t mean finding a way to change your brain chemistry. It meant finding a way to solve the problem that was causing the depression in the first place.”

Hari concluded that people have physiological needs, such as breathing, eating, and sleeping. If their basic physiological needs cannot be met, they will get sick. The human mind also has basic needs. When these psychological needs cannot be met, people will also become sick. These abnormalities in the body, such as lowered serotonin levels and many typical physiological indicators and symptoms of depression, may also be signals from our body, indicating that there are needs deep inside that are not being met.

The World Health Organization has also indicated that depression is the result of a combination of social, psychological, and biological factors.

Loneliness: A Leading Cause of Depression

Researchers at University College London (UCL) identified loneliness as a leading cause of depression in older adults in a 12-year study.

Data shows that human beings are further on the path to loneliness.

A 2018 online survey conducted among over 20,000 U.S. adults showed that 54 percent of them felt as though no one knew them well; 46 percent reported sometimes or always feeling alone; 43 percent lacked companionship, felt that their relationships were not meaningful, or were isolated from others; and 39 percent were no longer close to anyone.

An online survey of approximately 950 Americans conducted in October 2020 by Harvard University suggests that 36 percent of all Americans—including 61 percent of young adults—feel “serious loneliness.”

The association between loneliness and depressive symptoms has been analyzed by many researchers.

Loneliness can lead to even more severe depressive symptoms. Compared to the risk factors such as marital status, social support, hostility, and perceived stress, loneliness has a larger impact on depression.

Some research by the UCL showed that 11 to 18 percent of depression cases could potentially be prevented if loneliness were eliminated in older adults.

A senior author of the research paper, Gemma Lewis, said, “We found that whether people considered themselves to be lonely was a bigger risk factor for depression.”

Furthermore, loneliness could lead to frequent elevation of stress-sensitive hormone cortisol. And irregular release of cortisol will have negative impacts on our health. Former Surgeon General, Vivek Murthy, indicated that loneliness can cause a reduction in lifespan, similar to that caused by smoking 15 cigarettes a day (pdf).

2 Methods to Eliminate Loneliness and Relieve Depression

In Hari’s book, he also recorded another case.

A nurse named Lisa suffered from a severe depression, and she led an isolated life in her apartment for seven years, until Dr. Sam Everington prescribed an alternative medicine to cure her.

Lisa visited Dr. Everington’s clinic twice a week. Together, she and other patients worked on a project to turn a weedy corner into a small garden.

When she first met the group of people who were also suffering from depression, she was so nervous that she vomited. However, through their outdoor gardening work, they learned to feel nature by basking under the sun and stretching their arms into the soil under their feet. Gradually, they worked together and learned to communicate with each other, following the tempo and the rhythm of nature.

Lisa started to share her story with the group. They learned to trust and care for each other. When someone was absent, they would call him or her up and see if there was anything they could help with. Lisa even called the city government to help a homeless patient to find a shelter.

As the flowers bloomed, so did the patients’ lives. They found their two major reconnection needs–reconnection with others and with nature. A few years later, Lisa stopped taking antidepressants and successfully lost 62 pounds.

1. Connecting with others

The more connections and interactions with friends and family, the lower the risk of depression. Lacking close friends and family will increase the odds of depression.

Gemma Lewis stressed that it’s not just spending time with other people that matters, but also having meaningful relationships and companionships.

An Australian survey of 8,841 participants aged 16 to 85 years showed that those with three or more family members or friends to rely on or confide in were less likely to have a mental disorder.

2. Being close to nature

In addition to spending more time with people who are close to you, spending more time with nature can also reduce loneliness, and relieve and treat depression.

Nowadays, people spend less and less time outdoors. The pandemic had also kept people at home longer, and relied on electronic products such as mobile phones, computers, and TVs to kill time and relieve boredom. However, this also exacerbates depression.

Researchers have found that people who spend over four hours of screen time per day to watch TV or use computers are at a higher risk of developing depression. It is also reported that people with major depressive disorders spend significantly more hours watching TV and/or using computers in a day. Compared with those who spend less than four hours of screen time per day, those who spend 4 to 6 hours of screen time are almost twice as likely to develop depression. Those who spend more than 6 hours of screen time per day have 2.3 times the risk of depression compared to the average person.

On the other hand, people who spend less time outdoors may be 3 to 6 times more depressed and anxious than people who spend more time outdoors.

When patients walk out of the house and into nature, they quickly notice reversal in their feelings.

Currently, natural interventions are becoming more and more prevalent. Doctors in many countries have begun to value and use this social prescription to improve the treatment of mental illness and the quality of life of their patients. A review of 50 studies of nature-based interventions (NBIs) found that NBIs were effective for improving depressed mood, reducing anxiety, and reducing negative influences.

In particular, gardening, forest therapy and wilderness therapy have been shown to have significant benefits in reducing depressive symptoms. The best therapeutic results were seen in people who continued with natural therapies for 20 to 90 minutes for 8 to 12 weeks.