Live Like a Caveman to Cure Depression?
Psychologist Stephen Ilardi was interviewed for an article on depression by the AARP magazine on his approach to treating depression:
Well, I have to ask, could part of the reason cavemen had less depression be because they lived only 30 years or less? No midlife crisis because well, you probably didn't have a midlife, just a short one. Anyway, aside from that comment, go read the article and see what you think.
Update: Ace says these cavemen don't seem happy.
So maybe we've been wrong about depression. Maybe it's not just some mental-chemical problem requiring a Prozac prescription or soulbaring confessions to a Dr. Melfi-type therapist. Maybe, says Stephen Ilardi, Ph.D., an associate professor of psychology at the University of Kansas, what's darkening our lives is the way we actually live our lives....
Since World War II, as the United States has modernized and grown more urban, depression rates have risen tenfold. Nearly a quarter of to day's adult population will have experienced the disorder by age 75. So Ilardi wants us to look back, way back, to our Paleolithic past To our cave-dwelling, hunter-gatherer ancestors, who were somehow protected against depression, most likely by their highly social, active, outdoorsy lives, Ilardi theorizes.
Well, I have to ask, could part of the reason cavemen had less depression be because they lived only 30 years or less? No midlife crisis because well, you probably didn't have a midlife, just a short one. Anyway, aside from that comment, go read the article and see what you think.
Update: Ace says these cavemen don't seem happy.
posted by Helen at 4:31 PM
69 Comments:
As near as I can tell from reading the article, Ilardi hasn't ever said anything about cavemen. The j-school nut who wrote it probably had to scrounge that angle up to sell the article to her editor. Without that, it is basically an article saying "get out, live life, exercise, get omega-3 fatty acids and sunlight, don't spend time dwelling on negative thoughts". Not exactly an exciting article.
If they want us to live like cavemen, then they have no idea how hard life was for cavemen (and women). Their lives were so physically demanding that most has severe osteoarthritis by the time they were 30 and most were probably dead by the time they were 40. And the article was written for the AARP set, whose minimum age is 50?!?!
Of course they were "immune" from depression. They didn't have time for it, being too busy trying to keep from starving to death or being eaten by predators.
There may be something to the caveman way. One of the best days of my adult life was spent fishing on the White River. After fishing all morning, I took a nap on a sun warmed rock, awoke and fished some more. Right before evening I caught a decent sized trout and cooked it over a little fire I had made. Between being outside all day in the sun and fresh Vermont air and the direct reward for my piscatorial acumen, it was very satisfying. No watches, no logins or passwords, no dental or health benefits either, still it reminded me that despite our 21st exteriors, inside resides a hinter gatherer.
There are places, incredible places, that are so beautiful they take my breath away. I have to find a place to sit, and just try to take it all in.
Most woodworking shops hit me like that. So sometimes, I have to just go outside and walk around.
First, Helen, thanks for highlighting my depression treatment research, and for providing your readers with a link to the AARP story.
In response to your specific question: by far the highest risk for depression onset occurs from the ages of 18 to 24. By age 29, fully 25% of Americans have already experienced an episode of depressive illness (Kessler et al., 2003). Thus, even if it were true that modern-day hunter-gatherers could not expect to live beyond 30 (a mistaken view that's nevertheless fairly widespread), they should still face a very large risk of depression onset, especially in light of the fact that they lead very difficult lives, with a high rate of depressogenic, traumatic life events.
And yet we find that modern-day hunter-gatherers are virtually immune to depressive illness. Anthropologist Edward Schieffelin spent over a decade among the Kaluli people of Papua New Guinea, and he could find only a single (marginal) case of clinical depression among 2,000 people he carefully interviewed.
In my view, this is not a trivial finding. Instead, it is one that suggests that there are perhaps protective features of an ancient way of life that we can reclaim, inasmuch as we now face a burgeoning depression epidemic in this country, despite the fact that 150 million antidepressants are being despensed each year.
- Steve Ilardi
I am so disappointed in you Dr. Helen! Using the old idea that cavemen did not live long because the average life exptency was 20 years. The key factor controlling life expectency is infant mortality. For example, up until around a 150 years ago, it was pretty much 50%. This means if the life expectency was 30 (which I believe it was), the life expentency for people who survived infancy was around 60. Clearly, cavemen who survived infancy lived a reasonable time. At least, when dinosaur didn't step on them.
If you want to know why cavemen weren't depressed, it is because when a person is cold, a fire is better entertainment that TV.
Artifactual-- rates have risen because "mental health professionals" have a business interest in diagnosing folks with it. But part of it is reaching and then diagnosing people who just suffered without going for "treatment".
The more people in business to "serve" mental health needs, the more such "needs" will be created, to justify their paid "intervention".
I was once a true believer in psychiatry, psychopharmacology and the genetics of mental illness-- leading to rational classification and specific treatment of particular populations. Maybe in 200 years.. or more. The medical model is the right model-- just no information to plug it into.
Miss American 1986, Susan Akin, was Miss Mississippi, from Meridian, where I live. She lived a block from me. She kept a messy bedroom-----heh, heh,
or at least it looked that way through my binoculars.
Time magazine wrote that her father had been in the Klan. He sued for defamation, said "prove it".. they couldn't.. they settled.. Susan was a public figure , but he wasn't, so Time had a very high burden to meet..... So Mr Akin added to the big bucks he made selling trailers and such to the Feds after Hurricane Camille hit the Mississippi Gulf Coast in 1969.
Question 1: Who says "cave-dwelling, hunter-gatherer ancestors" weren't ever depressed?
Isn't it totally obvious that Ilardi is just making shit up? (Like too many anthropologists Scheiffelin pretty much saw what he wanted to see, so I trust him about as much as a snake oil salesman.)
Question 2: Who says we are any more depressed, in absolute terms, than someone 100 years ago?
It's quite obvious that how depression is diagnosed has changed radically even since WWII. It's equally obvious and provable that the definition of depression has expanded.
Question 3: Why do we assume depression is bad or even abnormal? More directly, why do we assume that we must be happy all the time?
If literature is any indicator, melancholy seems to be quite normal.
No offense to your profession, Helen, but it seems largely an invention of busy bodies with vivid imaginations.
Jay -
You're right: I never used the word 'caveman' in the story. That was (in my opinion) an unfortunate and misleading editorial decision.
What I did speak about were hunter-gatherers. Until approximately 13,000 years ago, all humans on the planet made their living by hunting and foraging, and our genes still bear the imprint of the human species' lengthy history of selection pressure in the hunter-gatherer Pleistocene context. (This is why, for example, human infants - and other primates, for that matter - readily acquire fears of spiders and snakes but not, say, light sockets, whereas the latter are much more dangerous in the present and the former only dangerous in our distant past.)
Jay, you also suggest that it was "not exactly an exciting article," but most Americans have no idea that simple lifestyle strategies like exercise, high-dose omega-3 supplementation, behavioral activation, and high-intensity light therapy are robustly effective in fighting depression. In fact, aerobic exercise has been tested head-to-head against Zoloft (a popular antidepressant) and was found to be equally effective in the short-term and more effective at an 8-month assessment (Blumenthal et al., 2000). Likewise, anti-ruminative behavioral activation was found to be more effective than Paxil in a recent trial among severely depressed patients (Dimidjian et al., 2006).
Also, etahasgard -
The burgeoning depression epidemic, and the dramatic recent increase in depression prevalence, is not a mere artifact; i.e., it's not merely the result of "mental health professionals with a business interest in promoting it." Rather, it's been found in carefully conducted epidemiological studies (the same kind used to track cancer and heart disease prevalence). These studies don't ever ask people about their diagnoses; they simply ask a set of symptom-based questions (e.g., 'have you ever had a period of time lasting at least two weeks when you lost interest in most things you usually enjoy? How long did that last? Was that every day?' etc.)
Moreover, these surveys reveal a startling increase in depression prevalence across birth cohorts, which is exactly what we'd expect to see if the rate of depression has truly been going up (i.e., not just a reporting artifact). If you have time, take a look at the main post on my blog (psychpundit.blogspot.com) and see the chart that plots depresson risk by birth cohort from the latest epidemiological survey. Our current generation of young adults is so vulnerable to depression it's simply heartbreaking.
- Steve Ilardi
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Joe -
Your post is so rude it hardly warrants a response, but out of respect for the rest of the readers:
1) Modern-day hunter-gatherers provide a reasonable proxy for our hunter-gatherer forebears when it comes to inferences about their way of life. We don't know that the latter weren't depressed, but we do know that the former typically aren't. With respect to your assessment of anthropological methodology, let's just say we disagree (and I suspect of the two of us, I've spent much more time looking carefully at the issue).
2) The increase in depression is clearly evident in cohort analyses, which utilize identical diagnostic criteria across all age groups. What such analyses make abundantly clear is that older Americans (e.g., those who were alive during WWII) have consistently faced a much lower prevalence of depression than their younger contemporaries (take a look at the graph from the Kessler et al. 2003 study at psychpundit.blogspot.com).
If that's too complicated for you to follow, consider this: the Amish, who live essentially a 17th century way of life, have a collective rate of major depression that's a small fraction of that of the rest of the country. And that's using identical diagnostic criteria. (In case you're thinking - "maybe the Amish just won't admit it" - consider that they have a nearly identical rate of bipolar disorder as the rest of us).
3) Depressive illness is neurotoxic. It suppresses levels of BDNF, a key neural growth hormone, which in turn leads to shrinkage of brain areas like the hippocampus and prefrontal cortex. Depression robs people of their ability to concentrate, sleep, love, work, and play. It robs nearly 1 million people each year of their very lives (through depression-linked suicide). So, Joe, perhaps you'd like to reconsider your hypothesis about the disorder being attributable to "busybodies with a vivid imagination."
The reason cavemen were not depressed is because they new true misery and true hardship, not phantoms of the mind.
They sat through freezing rainstorms on empty stomachs and much worse, so when the sun came out and warmed their skins, they did not fret about skin cancer, they rejoiced as if God himself were smiling down on them.
If your feeling depressed, go do something truely miserable and possibly life threatening, if you make it out the other side, you will be extremely happy, with long residual benefit.
Joel:
You are absolutely right. And for that reason I smend a lot of time in third world underdeveloped countries. I'm never depressed when I am there, and I don't know anyone, regardless of the level of poverty they live in, who is.
In fact, I would go so far as to say that my observation is that the poorer, (and I'm talking dirt floor, plastic walls, leaky roof, half your kids die before the age of 2, and you are always hungry poor) the poorer they are, the happier they are.
I heard on the news the other day that the highest rate of depression is in people who do not have work, but are actively looking for work, ~13%.
I think that there's no doubt we are less active and less social than our ancestors. So it may well be that there is something to this. I rather doubt it is a panacea.
Put it all together and I'd say 'we're still missing something here.'
Psych Pundit,
Thanks for coming by to clarify some of these issues. I do think it's very important to explore treatment of depression as you are doing, particularly because so many very young men and those who are elderly have the highest rates of suicide. If there is one thing that psychologists do well, it is treating depression and I admire your dedication.
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I think it's unquestionable that there are high rates of depression these days and that it cannot be accounted for simply by the psych industry. Why this is so, is unclear and drawing the inference that it is the hectic pace of modern life belies the truth that we simply do not know why.
"exercise, high-dose omega-3 supplementation, behavioral activation, and high-intensity light therapy are robustly effective in fighting depression."
Only exercise has been shown to be effective. Omega-3 has failed the meta-analyses as has light therapy. "Behavioral activation" is merely a fancy way of saying that if you're depressed, go do something enjoyable; but, of course, when people are depressed they don't want to do that.
Tomcal, I agree with you. There are a bunch of commercial on TV outlining the extreme poverty in Guatemala. The ads would show an unhappy crying child begging for gruel, often with a dirty face, with worried parents in the background. Naturally the foundation wants money from Americans to make the bad situation go away. Now, if you visit in the heart of Guatemala, yes people are poor, but they are extremely clean, well-dressed and every single one of them has a big smile on their face. From what I see, it's the Americans that are miserable.
I regard my car as merely transport to and from the woods. Since I live in a urban environment I can walk to anywhere I need to go. I know a fair number of people in the hood in my travels. One street that I walk down daily has gone bench. Which means just about every house has a bench in front of it and all the neighbors spend time together in the evening on the benches gossiping. I like this idea so I am going to go bench as well.
Yesterday I went shopping for a bench but it is interesting the comments I am getting from my family and friends. They are afraid that strangers are going to sit on my bench without my permission. I've been trying to convince them (without much success) that that is the whole point.
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Cham -
Thanks for your insightful comments. The rate of depression in non-industrialized nations is generally much lower than it is in the U.S. and Europe . . . except in urban areas, where it is typically very high. Again, when it comes to depression, lifestyle matters.
Ipsedixiter -
Your profile lists you as an academic, but based on the erroneous citations and misrepresentations in your post, I can only conclude your field of expertise must lie outside the behavioral sciences.
You claim, "omega-3 has failed the meta-analyses," and this is simply wrong. There have been 4 published meta-analyses of omega-3 trials in the past year, and the 3 most recent (Ross et al., 2007; Lin & Su, 2007; Freeman et al., 2006) all found a significant and substantial antidepressant effect. The one apparent outlier (Appleton et al, 2006) *still* found a substantial omega-3 effect when they limited the study sample to those that included only patients with major depression (which, of course, is exactly what we're talking about here).
There has been exactly ONE recent meta-analysis of bright light therapy for depression (Golden et al., 2005; Am J Psychiatry) and it concluded overwhelmingly in favor of the efficacy of this form of treatment.
Finally, contrary to your uninformed account, behavioral activation is not "a fancy way of saying go do something enjoyable"; it is a fully articulated 12-session treatment protocol of proven efficacy. Depression is characterized by reduced left frontal cortical activity. Because this area of the brain mediates the ability to INITIATE activity, that means that many depressed individuals can have the *intent* to do something, but will lack the ability to initiate the activity. Once provided the initiative (a gentle nudge, as it were) from someone else, they are typically fully capable of following through (and usually quite willing to do so, as I've found in my clinical research.) In the behavioral activation protocol, depressed patients are given numerous such nudges, which provides them with increasing ability to re-activate (this also, by the way, increases left frontal activity). Patients are also taught to use engaging activity specifically as a means of combating rumination - the psychologically toxic proclivity for dwelling on negative thoughts. In a recent randomized clinical trial (Dimidjian et al., 2006), behavioral activation was found to be superior to both Paxil and to traditional 'cognitive therapy' in the treatment of severe depression.
So, you may want to do your homework next time before making any further bold pronouncements outside your field.
- Steve Ilardi
Wow, I looked at that graph of incidence by age range and the difference between older and younger IS startling.
I know I am by no means the first to come up with this, but it seems to me that some of the increased incidence of depression in the younger age ranges could be due to the lessening of family ties in the last forty years. I say this based primarily on observing my own family; when I was a child in the 60's and early 70's my clan all lived around the same small town and so I had aunts, uncles, and a number of first cousins all within TWO miles of where I lived. So we had a really great family connection.
Fast-forward to today, and MY generation has mostly moved away from that small town in search of employment. Consequently we are scattered from Texas to Georgia, and with only two exceptions, no child of ours has a first cousin living within 90 miles. To say the least, that would really diminish a sense of family connection, and I wonder how often that scene has been repeated across the USA. If it happens a lot, I really think that may be part of the cause of depression among the younger generation.
When I was a kid, as many can also say, it was up at the crack of dawn, on the bike, and down the road. Outside all day long, having fun. Gone from sun up to sun down. The last thing most kids I ever knew wanted to do, was to stay inside. Although more a loner than many, I had plenty of friends. If no one wanted to do what I wanted to do at a particular time, I went by myself. No complaints, no tears. I just felt they had no idea what they were missing. I liked ponds, lakes, streams and the mud, bugs, fish and animals that went with them. I stayed away from snakes though, except garter snakes. And eels. Gooey.
Modern life is too easy in many ways. Perhaps that truly is a problem. Maybe we really do need a particular type of daily challenge to be happy, to feel alive. I sure do prefer the sound of wind rustling through the hardwoods and swishing through the pines to the sound of air coming through the vents of a forced air furnace.
I have bouts with depression at times. I always thought it was me.
Maybe it is just the life I currently lead, and seeing too much Al Gore and Hillary Clinton on TV.
Listen, Steve Ilardi, I am a psychologist at a major US university. There's no reasons to be nasty when people criticize your points. The Ross et al. paper is NOT a meta analysis and the authors only suggest that fatty acids might play a role in depression. The Lin study was published in the J of Clinical Psychiatry -- not exactly a top notch journal and their meta analysis included 10 studies with n=329.. now how reliable do you think their effect sizes are with those numbers (I presume you understand how meta analysis work). Many of those studies also used DHA. What's more, the authors state: "in our analysis, most of the included studies showed a positive standardized mean difference towards beneficial effect of omega-3 PUFA's in improving depression , ALTHOUGH ONLY 3 OF THEM REACHED SIGNIFICANT LEVEL." Now if you saw this in an article about, say, prozac, I suspect you wouldn't be so enthusiast in your support, right? Freeman's study also isn't a meta analysis as the title of the article makes clear: "Omega-3 fatty acids and perinatal depression: A review of the literature and recommendations for future research." And what does the abstract of that study say?:
"Epidemiological and preclinical data support a role of omega-3 fatty acids in perinatal depression. Two studies failed to support a role of omega-3 fatty acids for postpartum depression prophylaxis, although one included a small sample, and the other utilized a low dosage. Two pilot studies suggest good tolerability and potential efficacy in the acute treatment of perinatal depression."
Pilot studies are great, but they hardly prove anything. Sounds like you don't know what you're talking about.
While I am not an organic food proponent or vegan or anything like that, I suspect that many of our health problems are related to our food. Most processed foods contain preservatives, colors, fillers, etc... that weren't present in primitive diets. I've found that when I eat a very simple diet of fresh food, I feel much better overall. Unfortunately, in our busy society, it's hard to maintain this. I have a full-time job and 2 children and have a hard time keeping the house stocked with food, much less fresh (spoilable) foods that take longer to prepare.
EI
Cham:
Any time you want you can borrow my house in Granada, Nicaragua, and see the same thing in all of the poor communities on the outskirts.
I love spending time in those communities. The people are, as you say, very clean, friendly, and just plain joyful to be alive.
Cham:
Re: "Going Bench"
You may know that I am an evil real estate developer and industrial slumlord in Los Angeles.
The City where I live, Ventura, CA, has recently mandated "Going Bench" for all new residential construction. In fact it is the latest fad in virtually all city planning departments (just Google "New Urbanism"). To me, this is wrong. People should have the right to go bench if they want to, but should not be required to do so.
That being said, when I restored my house in Granada, NI, which is on a corner, I elevated the entire primeter sidewalk around it, creating what is essentially a 120 foot long bench. Everyone hangs out there telling tall tales in the evening. Some even pull out plastic chairs so they can sit in the street facing the "bench".
So I know all of my neighbors, they know me, and we all get along just fine.
Oh, and let's also look more at the Lin & Su study:
1. The pooled ES was .61 (where 1.0 shows better than placebo)
2. Figure 3: Funnel Plot: "The asymmetric distribution of scattered dots on both sides of the dotted line postulates the presence of publication bias, SUCH AS THE UNDERREPORT OF NONSIGNIFICANT small studies.
And the light therapy study you so proudly cited?
1. As reported in the study itslef only 13% of the studies met the inclusion criteria.
2. The author's own conclusion: "Many reports of the efficacy of light therapy are not based on rigorous study designs"
3. The ES for this study was .83, but given the above weaknesses and the simple fact that it's very hard to blind people to a light study, I don't think we can take too much comfort in that stat.
4. And let's not forget the fact that one of the proponents of light therapy (who author's many of the studies), D. Kripke, has a vested interest in seeing that they work since he sells the damn things: http://www.dankripke.org/
I have no problem with people selling stuff, but when people criticize docs for taking money from the drug companies, it's not like everyone else is a saint.
Now, with behavioral activation:
"Depression is characterized by reduced left frontal cortical activity." That's just a partial explanation. Depression is characterized by lots of effects. Now you say that patients are given "nudges" what, exactly is that? Kendra Webdale was given a nudge you know.
I could do on and on, but we all get the idea.
I remember reading an article about this topic a few months ago. I think the conclusion is reasonable. We definitely exercise a lot less than we used to and our diet is probably worse.
It seems reasonable the decline is sleep time, being outdoors, and exercise could play a role in depression. Indeed, I buy into this theory. I've always been an active, outdoorsy type and never had more than a day or two of the blues.
But when I think about mental illnesses (Is that term still acceptable?), I think about a point one of my psychology professors made in class. Freud had all sorts of patients with hysterical blindness, paralysis and such. These maladies are extremely rare today. My professor attributed it to more "sophisticated" patients (i.e. the hysterics had been found out so it was time to move on to something else less evident) as well as a malady de jour phenomena. I wonder if this could be playing a role also.
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I'm bloody sick and tired of people telling us depressed folks to "get over it" that that it's "all in your head."
Depression is a physical disease; and no matter how you disagree on the cure thereof (drugs, exercise, light-boxes, whatever), depression requires treatment.
If you love someone who is depressed and you tell them that their illness doesn't exist or that they're just making it up, then you might as well just give them the razor blade with which to slit their wrists.
This isn't the 12th century.
We're not crazy.
We're not monsters.
We're not possessed.
If you have depression, don't listen to the asses who tell you to "suck it up."
Get help.
DBSA.org
Todd
raretodd.net
Correction:
http://www.dbsalliance.org/
Damned good advice, todd.
Steve,
I don't think it's possible to be rude enough to you. You are a quack. You deliberately misreport scientific reports to support your pet theories and ignore legitimate scientific studies which contradict your claims. Above all, you completely fail to understand that correlation is not causation.
The fact is you have no clue what the depression rates were of "cave-dwelling, hunter-gatherer ancestors". None. To claim otherwise makes you a total fraud.
I often scuba dive and kayak in the sea caves of the north side of Santa Cruz Island. The longest of these caves, Painted Cave, is the longest sea cave in the world.
http://www.goodearthgraphics.com/virtcave/seacaves/seacaves.html
Anyway, while am in the caves, I think it is fair to say that I am "dwelling" there. I am also usually hunting and gathering Rock Scallops and Lobsters for my family's future consumption.
While in the caves, I have never felt the slightest hint of depression. Outright terror and fear of death, yes, but the blues, no.
Tomcal says:
Any time you want you can borrow my house in Granada, Nicaragua, and see the same thing in all of the poor communities on the outskirts.I love spending time in those communities. The people are, as you say, very clean, friendly, and just plain joyful to be alive.
Be careful with your words when there is Google Earth. Nicaragua looks pretty flat,...the only volcans available for fun times are, well, very near Granada: Mombacho, Concepcion and Maderas. Then there is something called the Crater de Masaya. I could probably find a thousands ways to entertain myself there. I travel light, have a current well-used passport and can get by on my limited Spanish. I also an a pro with the chicken buses, am very willing to sit 3 to a seat and share my dulce.
So when is this place available?
First, I want to express my thanks and sincere appreciation to all of you who have posted thoughtful, insightful comments here regarding depression, its devastating impact, and my work regarding its treatment with lifestyle-based strategies. I'm especially grateful to Rare Todd for the superb first-hand account of depression, and for directing readers to the DBSA website (I was invited to speak at the Kansas City chapter of DBSA last year, and was delighted to do so.)
As I'm sure most of you can imagine, it's a bit of a daunting thing to have one's work unfairly criticized in a public forum. I've been a clinical researcher for 17 years, specializing mostly in the neuroscience of depression, and outside of academic circles that work was never in the public eye. I look back on those days very fondly! Now that I've turned my attention to actually treating depression, I've been exposed to a whole new world of publicity - one in which being subjected to harsh (and often grossly unfair) public criticism is apparently de rigeur. I'm still on a bit of a learning curve on that one, and I believe I've now arrived at a place where I've decided from now on when that happens to simply ignore it and let it go. If I have let my annoyance at this process seep through in any of my posts here, please accept my sincere apologies. I've certainly tried to remain civil at all times, but I'm human, and can get irritated by unfair attacks as much as the next guy.
When it comes to the Joe's of the world, who say things like "I don't think it's possible to be rude enough to you" . . . well, that's so flagrantly beyond the bounds of civil discourse it's pretty easy to ignore (along with the rest of his vitriolic screed).
With ipsedixiter, I have to confess it's a little tougher. He claims to be an academic psychologist, but he hides behind the safe veil of anonymity as he calls me out by name and issues ad hominem attacks. That's not exactly playing by the rules of the academy, is it? Ipsedixiter, if you're truly a "psychologist at a major US university" then let's see you put your credentials on the line here. (I have.) Who are you? If you can't or won't say, I hope you'll understand if I fail to take any further attempted substantive critiques on your part seriously.
I will, however, address your extant claims and accusations. (This will be my last word on the subject unless you'd care to continue the exchange civilly by email.) Here goes:
1) Your initial claim was, "omega-3 has failed the meta-analyses, as has light therapy." You provided no citations for the claim. When I showed that this claim was simply untrue (and gave citations), you simply changed the subject by trying - mostly unsuccessfully, I might add - to critique the methodology of the relevant meta-analyses. Let's look at those unsuccessful (and erroneous) critiques . . .
2) You say, "Ross et al. paper is NOT a meta analysis". Really? Have you read the paper? I've got it sitting right in front of me, and am rather struck by the section starting on p. 25 that's titled "Meta-analysis of effect upon depression" and a subsequent sentence that reads, "using meta-analytical techniques shows that omega-3 fatty acid supplementation is significantly more effective than placebo in the treatment of depression."
Did you even read the article? It looks to this researcher like you simply eyeballed the Abstract, and when you didn't see the word 'meta-analysis' jump right out at you concluded it wasn't there. That's the sort of carelessness that I might expect from one of my grad students (a rookie mistake, if you will), but not from an expert in the field.
3) An even bigger mistake comes from your claim about the Lin & Su (2007) study. You say that "the pooled ES was .61 (where 1.0 shows better than placebo)." Uh, no, not even close. The placebo effect comparison is 0.0, and the true pooled effect size of 0.69 indicates that the omega-3 condition outperformed the average placebo condition by roughly 0.7 standard deviations: a large effect, and one statistically significant at the (p=.002 level).
4) You harp on the fact that many of the relevant omega-3 studies had small sample sizes, but that's precisely why we do meta-analyses in the first place! (i.e., to aggregate across studies to get more stable estimates of effect size.) And, yes, I'll concede the point that even with meta-analysis the aggregate sample is not large enough to put a tight confidence interval around the effect size estimate, but it's clear that the effect is significantly greater than that of placebo.
5) That, by the way, is more than we can say of many antidepressant drug trials. In the FDA's own massive database of placebo-controlled trials submitted by drug companies for antidepressant approval, the drug failed to beat the placebo in 56% of trials (Kirsch et al., 2002). In aggregate, the placebo had roughly 85% of the effect size observed in the antidepressant med. Thus, BEATING PLACEBO is no small matter.
What the meta-analyses I've cited clearly show is that the overwhelming preponderance of available evidence supports the contention that both omega-3 supplementation and bright light therapy are clinically effective. For you to argue otherwise and to attempt to obscure the clinical record with patently false claims is, quite frankly, rather baffling.
6) Bizarrely, in response to my pointing out that depression is characterized by left lateralized hypofrontality, you find it necessary to point out "that's just a partial explanation." Obviously! Did I ever claim otherwise? Of course not. I simply noted a salient phenomenon in the context of my point about the efficacy of behavioral activation. True to form, you completely ignored the main point, presumably because it utterly contradicted your previous, erroneously claim to the contrary: behavioral activation is an efficacious intervention for depression.
Ipsedixiter, I have nothing further to say. No doubt you will attempt to do a bit more hand-waving on this forum to "dispute" a few of the points I've just proferred, so I'll issue an open invitaton to any readers (since I won't be back again on this forum) . . . feel free to email me if you'd like a further clarification of anything I've written here, or of any critiques published by other readers.
Finally, Helen, thanks again for your interest in my work. It's been quite an educational experience for me to drop by your site for these exchanges - a tough learning curve, to be sure, by valuable experience nonetheless.
Well, you have to admit, ipsedixiter has only proven he knows how to read.
He has no proven credentials. None.
I have no dog in this fight other than my personal occasional indulgences in fisticuffs with mild depression.
Let's face it, I could be Bill Gates, and no one would no it, if my profile were as enlightening as ipsedixiters.
If it were true, I doubt he would be a "psychologist at a major university" but perhaps a "professor of psychology at a major university" instead.
But that's just me.
OK, OK, I'll come right out and say it. Eschew obfuscation.
I think it's all in his handle.
ips a dick.
I think there's an industry affecting our depression rates - and it's neither pharmaceutical nor psychological.
It's the fearmongers. You can't open a newspaper or magazine without being told that something we've been doing/eating all our lives is suddenly our bane. Butter. Eggs. Milk. Spinach panics over e.coli. The entire world hates us, and is going to march on our cities unless we give up our will to the savior du jour and put on the latest style in hairshirt. And don't go out on Halloween! There might be pins or razor-blades in the candy, or perverts behind the bushes!
Shoot-fire, a lifelong diet of this would depress Pollyanna. But hunter-gatherers don't read newspapers or magazines, so they're safe.
There's no such thing as depression---it doesn't exist!
The myth of mental illness:
www.szasz.com
Cham:
Well there are a few caveats, provisos, and quid pro quos; all of which involve checking and reporting on how about ten kids I am trying to keep in school and off the streets are doing. Your limited spanish will be fine because I have a full time adminstrator, Jeannette, who oversees things when we are not there. She is Nicaraguan and totally bilingual. My other administrator, Karla, who handles the street smarts aspects of our operation, speaks only Spanish; but she is so charismatic and expressive that you will have no trouble communicating with her using facial expressions.
Other than that, the only times which are unavailable right now are Oct. 19 - 27; and Nov 4 -10.
Cham: Yes, all of the places are very fun and within easy driving distance. Mombacho is the closest of the places you mention. I actually have a coffee farm up there and sell to tourists under the brand "Cafe Che".
You missed the Laguna de Apoyo in your list - about 20 min away. And if you are into beaches, check out San Juan del Sur, about 2 hours south on the pacific coast.
Concepcion and Maderas are two volcanoes that merged together close to the western shore of lake Nicaragua. One is active, one is not. It's beautiful out there but the boat ride to get there will scare the s*** out of you. Just imagine a floating chicken bus crossing 7 miles of 8 foot swells, below which live some of the world's only fresh water sharks.
http://travel.nytimes.com/2007/09/23/travel/tmagazine/10well-granada-t.html?pagewanted=print
This is a good and recent article about Granada. Several paragraphs down it mentions my friend Glenda, whose restaurant, "El Tercer Ojo", which is a block up the street from our house. Glenda is a free spirt who loves to show people around. I'm sure you would like her, even though I don't know you.
I will try to make my points short here:
1. It doesn’t matter who I am, what matters are your claims.
2. You say that I tried to change the subject. No, you provided partial citations to buttress your claim; I reviewed those citations and found problems with them.
You say that the Ross paper was a meta-analysis. I’m sorry, I medlined Ross and the only paper he published in 2007 on this topic was: Ross,B. “x _ 3 Fatty acid deficiency in major depressive disorder is caused by the interaction between diet and a genetically determined abnormality in phospholipid metabolism” 68 Med Hypthosis 515 (2007). That study clearly is not a meta analysis. When I dug around the internet, I found the study you referred to: Ross et al. “Omega-3 fatty acids as treatments for mental illness: which disorder and which fatty acid” 6 Lipids in Health Disease 21 (2007), which is in an open access, non indexed (peer reviewed?) journal whose editors, surprise, surprise have financial stakes in Omega 3 products.
3. Let’s cut through the chase, shall we? You claim that Omega 3 is as good as antidepressants and you cite these studies. What you fail to mention – and I suspect your readers would like to know – is that in the majority of these studies the patients received Omega 3 and antidepressants together. Here is a table from one of the studies you cite, which clearly shows this fact: http://docs.google.com/Doc?id=df89hcjc_0fsbkss. Now, it may be that Omega 3 acid helps some folks get a better response from their antidepressant, but that wasn’t your claim, now was it? You inferred that Omega 3 is just as good as antidepressants.
4. As for the Lin paper, yes, I made a mistake, you’re correct about the effect size. However, you didn’t comment at all on these vitally important aspects:
a. The funnel plot clearly shows tremendous variability among the studies, which suggest strong caution is in order when interpreting the effect size (as the authors mention).
b. The authors discuss how many studies which likely showed no effect are unreported and how this probably INFLATED the effect size.
c. The whole problem with meta analysis is that it’s only as good as the original studies. The small number of subjects in these studies likely inflates their p values, which meta analysis is notoriously unable to account for.
5. And what of light therapy? You fail to mention one big problem with all of the light studies – how does one blind a subject to exposure to light therapy?
6. When you say the “overwhelming amount of evidence” … this is the problem. Your rhetoric is overheated; the evidence might support your side in some aspects, but it is hardly as airtight as you claim. If light therapy and Omega really worked as well as you say, people would be using these agents with guesto. But they’re not and it has nothing to do with (and you didn’t say this, but I can imagine some will) MD’s/Pharma suppressing them: It is MDs at major medical centers who brought these agents to the forefront to begin with and NIH has spent considerable monies investigating them.
7. The whole point of this original post by Dr. Helen was to ask whether your claim about “cave men” not having as much depression as modern people was a bit overstated. In apparent typical fashion, you failed to fully account for:
a. The evidence of depression during the "stone age" as currently constructed is very limited (come on, your suggesting that anthropological “evidence” gives us the precision to assess prevalence rates of psychiatric disease over 1,00 years ago?) ;
b. The likely rise in diagnosis of all psychiatric diseases during the past 100 years or so is probably due to: (1) the birth of modern mental health as a profession; (b) increased awareness; (3) diagnosis and treatment
c. And I could go on and on… but the point is that you oversell your ideas. Now as one academic to another, I understand that it’s all about overselling ideas, but don’t be surprised when people call you on it.
I have to agree with ipsedixiter on this one. The studies seem weak.
And br549, there's not much on your profile, so it's kinda of like the kettle calling the pot black.
Plus, what about the fact that the Omega trials used antidepressants? That seems like a big hole.
Okay, Tomcal, I can check on the kids for you , that isn't a problem. They may need some sort of shoes that are hike-worthy if they want to hang with me, as in no holes in the bottoms and laces (kids like to go lace-free these days, it's the current fashion). I always find it amazing that when you point at a volcan a few miles away to a local and then ask if they have ever been there, they just about always they shrug their shoulders.
I will read the NYT article carefully this evening. My Nicaragua trip will have to occur in 2008, as I am extremely traveled-out this year, I went a little overboard. Also, I have a couple of hiker friends who keep telling me that the US is the bestest country in the world yet have never crossed a border, not even to an all-inclusive honeymoon resort with a 30 foot concrete wall around it. I'd like to invite them to actually see what is out there.
I, BTW, consider a non-leaking roof over my head a luxury item. So whatever your home is like in Nicaragua, I will consider to be the Ritz-Carlton.
My smart ass remarks were an effort to get something more on the above to be said, for purely selfish reasons. If omega 3 fatty acids fight depression, it's off to GNC, etc., for me.
Kettle and pot, rich old boy?
Apparently, my stated resolution last night not to reply again to ipsedixiter's continued mischaracterizations was about as effective as a typical New Year's resolution. So, I offer one last comment and rebuttal to my "colleague" who continues to hide behind the veil of anonymity, rather than put his reputation on the line in public:
1) First, you state, "in the majority of these studies the patients received Omega 3 and antidepressants together." True to form, you failed to mention the crucial piece of information here - that the basic design of those studies was to examine whether or not adding omega-3 to the current standard of care (antidepressant meds) would be of benefit when compared with adding a placebo. In nearly all such studies, the omega-3 supplement has provided considerable benefit ABOVE AND BEYOND THE EFFECT OF MEDS.
Take, for example, the study of Peet and Horribin (2002) - published in the field's premiere psychiatric journal. They looked at patients who had FAILED TO RESPOND to Paxil for 8 weeks, and then randomized them to various doses of omega-3 or placebo while they stayed on a medication (Paxil) that had already been established as unhelpful. Those who got the placebo had a response rate of 25%, while there was a 69% favorable response among those who received 1,000mg/day of EPA (the most psychoactive molecular form of omega-3).
As you doubtless know, the treatment outcome literature in depression generally shows very poor results when COMBINING treatments. For example, a majority of studies adding cognitive therapy to existing med treatment for depression have not shown any additional benefit to adding cognitive therapy (even though we know from other studies that this treatment works about as well as meds when administered on its own). Thus, THE ABILITY OF OMEGA-3 TO SIGNIFICANTLY ADD TO THE EFFICACY OF MEDS IS, CONTRARY TO YOUR ASSERTION, ESPECIALLY STRONG EVIDENCE OF ITS CLINICAL UTILITY.
And, when Omega-3 (EPA) was recently tested by itself in a blinded, placebo-controlled trial (Nemets et al., 2006), IT WAS FOUND TO BE EFFECTIVE ON ITS OWN (just as we would be led to expect based on the aformentioned studies).
2) The reason the majority of omega-3 trials to date have occurred in tandem with meds is the simple fact that the field is very slow to change. Despite overwhelming evidence that antidepressants only provide substantial benefit for about half the patients who take them, they are the accepted standard of care. They are aggressively promoted by Big Pharma to the tune of hundreds of millions of dollars each year. This has been money well spent. Consider the case of OCD. Every head-to-head study of meds versus behavior therapy has shown an enormous advantage of behavior therapy (biggest study: 86% response to behavior therapy, 48% response to Anafranil, 40% response to SSRI; Foa et al., 2006). And yet virtually everyone diagnosed with OCD still gets referred for meds.
3) Thus, it is patently absurd for you to claim, "if light therapy and omega3 really worked as well as you say, people would be using these agents with guesto." Are you kidding me? Clearly, you are not a clinician, or you would know better than to make such a naive claim. The evidence on the protective nature of omega-3 supplemention vis-a-vis heart disease has been pretty strong for a couple decades (given the fact that, without major funding from Big Pharma, the studies were usually modest in sample size), and yet cardiologists have only begun to recommend omega-3 to their patients on a widespread basis in the past few years. It takes time - lots of time - to get the word out about effective interventions when you don't have hundreds of millions of dollars sitting around for an advertising budget.
4) The heterogeneity of omega-3 studies noted by Lin (funnel plot) can readily be accounted for by the fact that investigators have often used the less psychoactive molecular form of omega-3 (DHA) rather than EPA.
5) Your clinical naivete shows through most clearly in the following question: "how does one blind a subject to exposure to light therapy?" Because natural sunlight is so much brighter (10,000 lux) than indoor incandescent/fluorescent light (200-500 lux), the typical controlled study design has involved exposure either to a high-intensity light box (10,000 lux) or a low-intensity lightbox (often with a red-colored light filter to enhance placebo-esque expectancies).
6) The Ross et al. (2007) is right there on Pubmed. It's in a peer-reviewed journal (Lipids in Health and Disease), as you should have known if you had truly taken the time to look up its editorial board as you claim. And, by the way, I had to laugh out loud at your claim that "its editorial board has financial stakes in omega-3 products." Name a single psychiatric journal that doesn't have editorial board members with ties to the pharmaceutical industry! Such ties are not, in and of themselves, evidence of malfeasance, by the way: they often simply reflect the reality that board members are in high demand as consultants to the industries that can benefit from their expertise. But trust me, the financial stakes in omega-3 sales are mere peanuts compared with the revenue stream generated by Big Pharma.
7) Finally, contrary to your assertion, I have never claimed to know the precise rate of depression among 'cavemen.' In fact, I have never once even used the term 'caveman'. What I claimed is the mere fact that: (a) our hunter-gatherer forebears led decidedly difficult lives, inasmuch as they were similar in many respects to those of modern-day hunter-gatherers like the Kaluli(no one disputes this); (b) the available evidence suggests that modern-day hunter-gatherers are considerably less vulnerable to depression than we are, despite the fact that they lead (on balance) much more difficult lives; ergo (c) it's reasonable to infer that there may be protective features inherent in the hunter-gatherer milieu and associated lifestyle, which is especially plausible in light of the fact that the human genome is still well adapted to such a milieu; and(d) this hypothesis is consistent with the evidence of a robust antidepressant effect associated with things that hunter-gatherers do that we often don't, like getting: abundant physical exercise, dietary omega-3, sunlight exposure, extensive social support, ample sleep, and engaging (anti-ruminative) activity.
If this is tantamount to "overselling my ideas", then you can label me guilty as charged.
P.S. One last little nugget in closing: ipse dixit (literally from Latin, "himself said it") is a legal term referring to something that is asserted but unproved. Likewise, "Ipsedixitism is the pejorative term for an unsupported rhetorical assertion; it is a term in logic for a missing argument." (Wikipedia).
Shall we thus infer that an "ipsedixiter" is a person with a proclivity for employing such logical fallacies? Or maybe I'm missing something . . . ;-)
I knew you'd be back...
Like I said, the handle says it all.
Science Daily — Brain imaging has revealed a breakdown in normal patterns of emotional processing that impairs the ability of people with clinical depression to suppress negative emotional states. Efforts by depressed patients to suppress their feelings when viewing emotionally negative images enhanced activity in several brain areas, including the amygdala, known to play a role in generating emotion, according to a report in the August 15 issue of The Journal of Neuroscience.
"Identifying areas in the nervous system that correlate to pathological mood states is one of the pressing questions in mental illness today," says Carol Tamminga, MD, of the University of Texas Southwest Medical Center. Tamminga was not involved in the study.
Tom Johnstone, PhD, of the University of Wisconsin, and colleagues there and at Tufts University studied 21 adults diagnosed with major depressive disorder and 18 healthy subjects of comparable ages. Participants were asked to view a series of emotionally positive and negative images and then indicate their reaction to each one. Four seconds after the presentation of each picture, participants were asked either to increase their emotional response (for example, imagining a loved one experiencing what was depicted in the image), to decrease it, or simply to continue watching the image.
During the test, a functional magnetic resonance imaging scanner detected changes in neural activity. Johnstone and his colleagues also recorded levels of emotional excitement by measuring pupil dilation.
The data showed distinctive patterns of activity in the ventromedial prefrontal cortex (VMPFC) and the right prefrontal cortex (PFC), areas that regulate the emotional output generated from the amygdala. The VMPFC is compromised in depression, likely because of the inappropriate engagement of right PFC circuitry in depressed individuals.
"These findings underscore the importance of emotional regulation deficits in depression," says Johnstone. "They also suggest targets for therapeutic intervention."
According to previous research, normal interaction between the amygdala and the VMPFC may underlie the proper adaptation of levels of the stress hormone cortisol on a daily basis. These levels do not vary as widely in people with major depressive disorder; future research may now be able to clarify the mechanism that underlies this aspect of depression. It could also examine the possibility of using measurements of activity in the amygdala to predict the effectiveness of treatments for depression such as cognitive behavioral therapy.
The work was supported by the National Institute of Mental Health, part of the National Institutes of Health, and Wyeth-Ayerst Pharmaceuticals.
Note: This story has been adapted from material provided by Society for Neuroscience.
Fausto Intilla
www.oloscience.com
My money's on "ipsedixiter" being an undergraduate psychology major, which is why he refuses to identify himself: he obviously has some knowledge, but has no real credentials. I would suggest a more effective approach for him (or her) would be questioning and argument, instead of challenge and attack. But then again, it's been a long time since I myself was an undergrad psych major.
Look, I quite approve of Modernity; I'm an Enlightenment sort of guy. However, let's not forget that the Enlightenment was one of the most self-aware movements in human history. Indeed, there is a giant academic industry that recycles old critiques of the Enlightenment by Enlightenment thinkers themselves! Read Rameau's Nephew if you doubt this.
What does this have to do with the current topic? Modern life provides longevity, but for many people it seems to also provide for unhappiness. Modern psychology seems to have attended to humans, but not to humanity.
There have existed different ways of living. Why not examine which those ways promoted human flourishing? Psychologists seem very happy to question all manner of social customs with theories of evolutionary psychology. Then why can't we critique psychological theories themselves, by the same method?
Humor.
If the "scientific community" can have so much difference of opinion, and argue like little girls in the school yard over hop scotch, then what is an individual walking through this life supposed to believe? I guess that's why its called a "practice".
There are as many "proven facts" or "test results shows" out there as there are mouths to speak them. Only meteorologists and those in the medical profession can be as wrong as both often are, and still keep their jobs. Even when the results, when doctors are involved anyway, can sometimes be death. Maybe you guys should consider carpentry, or perhaps sell men's wear at Sears.
And if we believe things are less then optimum now, wait until "health care for all" comes into play.
This comment has been removed by the author.
As a person suffering--and I mean suffering!--from depression, I can tell you that it needs to be treated by medications, therapy AND a so-called "caveman" lifestyle. Every professional I've seen (3 so far in 10 years because of moving around)has recommended exercise, diverting activities and stopping the bad- thought juggernaut. Without the medication, the last three just aren't possible. Just my two cents. I don't see why we can't try multiple approaches.
So, to help with depression you should live a life of feast or famine living, strenuous work, high infant mortality, sure death from severe injury, high risk of death from child birth and a constant stream of potentially fatal threats from weather, wild animals and natural disasters.
Add a likely highly patriarchal society? A society with mystical religions, and certainly one that is highly structured society with strong cultural standards, which probably included not emoting about everything.
Come to think of it, this is probably very helpful (the lack of mental health professionals no doubt would also be a great advantage, though the lack of an ER or simply antibiotics would be a real bummer.)
My mother was severely depressed all the years we were growing up. I carried on the tradition, feeling chronically, clinically depressed and seeking a cure for my depression for over twenty-five years. I was, oddly enough, one of the “lucky” ones: my depression was partner to an equally common disorder called Attention Deficit Disorder.
So though I was at first treated only for the cure for depression alone, with Prozac, which saved me from offing myself but added a hundred pounds to my already hefty frame, I was eventually (in my early forties) treated for ADD with medication that took away the depression for the most part. Some days I can hear it coming, can feel in my gut the angst churning and brewing, but can embrace it for what it is, climb in bed with books and toys and whatever other comfort items I choose, and ride that bitch of a malady out. For it does pass. And as to a “cure” for depression, I still say really good drugs help.
Muna wa Wanjiru has been researching and reporting on Health for years. If You Have Any Comments Or Views That You Would Wish To Share With Our Readers on Cure for Depression, Post Them On His Blog HERE CURE FOR DEPRESSION
Now in this age also people are also not aware about mental health, even people are don’t have enough time to think about it, but mental health have a huge effects at our life and also our surrounding also.I also suffered a lot from this type of panic disorder, depression and lots of mental health problems. Xanax is one of the best medicines for all this mental health problems.
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