WHO declares depression the leading cause of ill health around the globe
For British writer Johann Hari, his own struggle with depression set him off on a global search for answers. Hari began to struggle with overwhelming spells of sadness in childhood. As a teenager, he began to realize there was more to these emotional valleys than just sadness. He figured out that it must be a medical condition and found relief after a diagnosis and treatment with antidepressants when he was 18. He says the doctor explained that depression was a brain disease and Hari had depleted serotonin levels. The promising news was that a new generation of drugs, called Selective Serotonin Reuptake Inhibitors, or SSRIs, would restore the correct chemical balance.
But even though he kept up with antidepressant medication, Hari’s work as a journalist took him to countries around the world and he found his “...sadness just kept creeping back.”
Hari’s continuing search for answers resulted in his book, Lost Connections: Uncovering the Real Causes of Depression-and the Unexpected Solutions. His theory is that the most concise explanation for the increase in depression, on a large-scale social level, is that the way we live today is causing a sense of isolation that is destructive to the natural yearnings of human beings.
Biological and Social Causes of Depression
Hari’s search for deeper answers came a decade after being on antidepressants. He found himself, overweight, anxious and still struggling with times of depression.
"There were two mysteries hanging over me,” says Hari. “One was, 'Why was I still depressed?' The second mystery, the much more important one to me, 'Why are so many people in our culture, becoming so depressed and so anxious?'"
Psychiatrist Patrick McGorry is a professor of youth mental health at The University of Melbourne in Australia. McGorry says depression is, “...a bio-psychosocial problem. There are biological factors and psychological and social factors. What Hari is talking about are the social drivers of depression." McGorry cautions against dismissing the benefits of medication for depression. "There are people who are very severely depressed and I believe, if you look at all the evidence, there is absolutely no doubt that antidepressants are lifesaving for them," McGorry says.
Other Medical Professionals Disagree with Hari’s Theory
Psychiatrist Carmine Parianti also cautions against giving too little credit to medication in treating depression.
“Rather than seeing mental illness as annexed from the rest of people’s lives, helping patients through assessing their social and psychological situations, as well as biological aspects, is the bread and butter of the work of psychiatrists and other mental health professionals,” says Parianti.
“All of us experience sadness and distress. While this might not be pleasant, these are healthy, human, manageable emotions. But for some, this ‘normal sadness’ grows, enduring for months, dogging the sufferer all day, every day, rendering them with no appetite, low sex drive and unable to sleep properly. This is clinical depression,” says Parianti. “It is a life-impairing condition.”
“Depression makes sufferers think life is not worth living. They may even take their own life out of desperation for the future. Worldwide, someone dies by suicide every 40 seconds,” Parianti says.
“Of course, it is important to emphasize that antidepressants are only one of a range of possible treatments for depression, and should only be prescribed for clinical depression. These drugs are not perfect, but for now they are useful for many depressed patients,” says Parianti. “And they do save lives.”
Improving Social Connection and Meaning
Hari’s theory that our current way of life contributes to depression rests on the decline of community involvement, entertainment like movies often experienced at home, and long work hours often spent alone due to remote access.
His book tells some stories of social and business connections, such as a housing project in Berlin where the community mobilized to ward off rent increases, a therapeutic horticulture group in east London, and a group of bike mechanics in Baltimore who successfully set up a workers’ cooperative. Hari says these collective endeavors return a sense of connection and even more important, a sense of meaning in daily life.
For those whose depression has its roots in childhood trauma, Hari advocates working through unresolved issues. Traditional talk therapy can be healing in those cases.
The most important point is that anyone who is concerned about depression in themselves or a loved one will find it helpful to reach out to a trained mental health professional. An individualized plan of treatment takes medical and social conditions into consideration. Creating a trusting relationship with a professional counselor who is experienced in treating depression is the first and most critical step toward healing.
Adler-Gillies, Mira, “More than brain chemistry: Is society, not just serotonin, contributing to increasing rates of depression?” ABC Australia, Feb. 20, 2018
Hari, Johann, Lost Connections: Uncovering the Real Causes of Depression- and the Unexpected Solutions,” Bloomsbury, 2018