The incidence of both acute and chronic depression has been steadily increasing for as long as I have been a psychiatrist (32 years). With the recent economic downturn (and associated unemployment, bankruptcies, foreclosures and homelessness) clinical depression and – tragically – suicide are reaching epidemic proportions.
Big Pharma Invents Serotonin Deficiency
Over the last 20 years our giant pharmaceutical industry has very successfully marketed clinical depression as a deficiency of a brain neurotransmitter called serotonin – to justify a line of enormously profitable drugs called serotonin reuptake inhibitors (SSRIs). And it’s true that some depressed patients (about half) are helped by SSRIs and related drugs. However there are still an embarrassing number of double blind studies in which the improvement in SSRI treated patients, compared to the placebo treated patients, is not statistically significant.
For awhile it looked as if a new psychotherapeutic approach, called cognitive behavior therapy, enhanced patients’ response to SSRIs. However more recent outcome studies challenge whether these benefits are sustained over the long term.
The Role of Poverty and the Corporatization of Food
As a psychiatrist, I feel somewhat of a failure being unable to help half the patients who come to me for depression. However as a social activist, I am also increasingly aware of the role social factors play in depressive disorders. I would rank nutritional deficiencies – stemming both from poverty and our dysfunctional system of food production, marketing and supply – as number one on the list of social factors leading to depression. The link between omega 3 deficiency (as opposed to so-called serotonin deficiency) and depression has been clearly established. Numerous studies show that cultures which consume a minimum three to five servings of fish per week experience miniscule rates of depression. There are also demonstrated links between depression and vitamin B, folic acid and various phytonutient (newly discovered plant based “vitamins”) deficiencies, as well as increasing evidence for the role of Vitamin D and specific mineral deficiencies (mainly calcium and magnesium) in mood regulation. Except for Vitamin D (derived from sunlight and Vitamin D enriched dairy products) and Vitamin B12 (derived mainly from meat), the best source of these other nutrients is fresh broccoli and leafy green vegetables.
Owing to recent skyrocketing food costs, I feel a little silly advising low income depressives to eat more oily fish and fresh vegetables – it’s simply not an option. I also find it hard to suppress feelings of disgust for our government’s corporate driven health policy – whereby Medicaid and insurance companies are happy to pay for a prescription for Prozac (to help out their friends at Big Pharma) but not to subsidize fresh, organically grown food for low income patients with obvious nutritional deficiencies.
The Demise of Civic Engagement: Possible Links to Depression
Unfortunately less than half the depression I encounter in clinical practice is nutritionally based and responsive to improved diet. In fact over the past decade, I find myself looking more and more to the absence of “civic engagement” as a cause for depression. It is a subject that both Robert Putnam (Bowling Alone 2000) and Ralph Nader have written about extensively. Their work has mostly focused on the negative effect declining civic engagement has had on overall quality of life in American communities. Whereas I am seeing increasing evidence of links between our withdrawal from community life and the growing epidemic of clinical depression. To be continued . . .