About Depression

Ian and I have been talking about depression lately, about what causes it and how to overcome it. We’re told these days that depression is caused by a chemical imbalance in the brain and that with the right prescription of drugs (particularly selective serotonin reuptake inhibitors, or SSRIs) and therapy (CDC), it’s readily treatable. According to a National Center for Health Statistics (NCHS) brief from 2011,

Antidepressants were the third most common prescription drug taken by Americans of all ages in 2005–2008 and the most frequently used by persons aged 18–44 years. From 1988–1994 through 2005–2008, the rate of antidepressant use in the United States among all ages increased nearly 400%.

So far, so good.

But at the same time, not so good. Because although doctors do prescribe lots of different SSRIs, the fact remains that 1 in 10 Americans reported struggling with depression 2006 – 2008.

In the last 25 years, the obesity rate has also continued to rise, so today 35% of Americans are obese, an expensive proposition: “The estimated annual medical cost of obesity in the U.S. was $147 billion in 2008 U.S. dollars; the medical costs for people who are obese were $1,429 higher than those of normal weight.” Not only is being overweight or obese terrible for physical health, but a 2010 metastudy in JAMA stated

This meta-analysis confirms a reciprocal link between depression and obesity. Obesity was found to increase the risk of depression, most pronounced among Americans and for clinically diagnosed depression. In addition, depression was found to be predictive of developing obesity.

Several other scholarly articles (here, here) come to the same conclusion, that obesity and depression are linked in a two-way relationship where one can cause the other.

And, finally, the CDC also reports that “insufficient sleep is a public health epidemic,” with a 2013 Gallup poll reporting that 40% of Americans get less sleep than recommended. The National Sleep Foundation conducted a 2011 poll that

…found that 43% of Americans between the ages of 13 and 64 say they rarely or never get a good night’s sleep on weeknights. More than half (60%) say that they experience a sleep problem every night or almost every night (i.e., snoring, waking in the night, waking up too early, or feeling un-refreshed when they get up in the morning.)

About two-thirds (63%) of Americans say their sleep needs are not being met during the week. Most say they need about seven and a half hours of sleep to feel their best, but report getting about six hours and 55 minutes of sleep on average weeknights. About 15% of adults between 19 and 64 and 7% of 13-18 year olds say they sleep less than six hours on weeknights. (Note: This poll also investigated links between technology use and sleep, a fascinating topic but not my current subject.)

The NSF also reports that “Sleep problems are also associated with more severe depressive illness… Evidence suggests that people with insomnia have a ten-fold risk of developing depression compared with those who sleep well.” However, this is complicated: depressive illness can cause sleep disturbance, but it seems sleep disturbance can also cause depression. (Among teenagers, not surprisingly, this 2013 study found that “sleep disturbances were highly related to depressive state and were associated with poorer treatment response in adolescents with depression.”)

In summary, in a period during which antidepressant prescription has increased by 400%, people have also simultaneously continued to both gain weight and lose sleep, both factors linked with depression in a reciprocal way. I suggest that, instead of prescribing drugs right off the bat, doctors work with their depressed patients to effect lifestyle changes to combat depression. Helping patients focus on getting 30 – 60 minutes of exercise daily and 8 hours of sleep per night could be as effective, cheaper, and long-term healthier than taking SSRIs for months or years. I’m not arguing against the use of antidepressants, which certainly have their place (although I’d feel better if we understood how they work), but if improving overall healthiness and restedness can solve a problem, wouldn’t that be better for patients in the long run?

By the way, this isn’t my brilliant idea; The Atlantic Monthly recently reported,

In 1999, a randomized controlled trial showed that depressed adults who took part in aerobic exercise improved as much as those treated with Zoloft. A 2006 meta-analysis of 11 studies bolstered those findings and recommended that physicians counsel their depressed patients to try it. A 2011 study took this conclusion even further: It looked at 127 depressed people who hadn’t experienced relief from SSRIs, a common type of antidepressant, and found that exercise led 30 percent of them into remission—a result that was as good as, or better than, drugs alone.

Seems like it might be worth trying.


Day’s Verse:
For Wisdom is better than all the trappings of wealth;
nothing you could wish for holds a candle to her.

Proverbs 8:11-ish

The way I assimilate change is to try to understand it. I research it. Having head knowledge helps me feel more in control of situations I’ve never encountered before, even when head knowledge doesn’t guarantee success for those situations.

When I was in high school, I took a class called Athletic Injury. It covered, very lightly, types of athletic injuries high school athletes encountered and various ways of identifying and treating them. I found it deeply fascinating. But when it came down to it, I wasn’t very good at it. Wrapping tape to immobilize a thumb or mitigate shin splints eluded my normally straight-A-student skills. To compensate, I read the textbook diligently. I practically memorized the book and spent hours practicing taping a variety of patient victims friends and family. In the end I did just fine in the class, but I worked harder in that class than most of my standard academic classes.

(After that, I decided hands-on wasn’t really my forte, and stuck to more traditional academic subjects. Now I kind of wish I’d pursued more such outside-the-box classes. I remember enjoying Athletic Injury more than most other classes, and I could very well have ended up some kind of occupational/physical therapist, which I probably would’ve done very well, given the mix of communication/human interaction, science/knowledge, and hands-on required in such careers.)

Anyway, all this to say that I’ve been reading books about parenting, despite the fact that (a) I probably won’t remember more than 5% of what I read now, and I’ll implement even less; and (b) Parenting seems to involve as much instinctual behavior as deliberate choices and odds are I’ll be operating on autopilot most of the time anyway. Reading, thinking, and talking about how we’re going to deal with the boy when he gets here is my way of starting to accept the reality that he is coming.

One thing that all this reading has done is help us start figuring out priorities. Mostly we anticipate being pretty laid-back parents, with less in the way of highly scheduled calendars and more in the way of back yard mud time. But one thing I’m realizing: Sleep is really important to me, even more than to Ian. I don’t caffeinate to get by when I’m tired; I go to bed earlier. Even before I got pregnant, I regularly slept 8 to 9 hours a night, sometimes more. I almost never sacrifice sleep to play. I’ve learned that without adequate sleep, I turn into a horrifying combination between a brain-dead basketcase and a ravening monster — a zombie, perhaps, except instead of braaaaaaains I demand only rest.

One standard expectation I keep hearing: I’ll spend the first six to 12 months of the boy’s life stumbling around sleep-deprived and zombiefied. I dread this potential reality more deeply than anything else about having a child. However, a number of the books I’ve read suggest that endless broken nights aren’t mandatory for parents of infants, but instead are avoidable with certain deliberate decisions made early on in the child’s life. So if we don’t implement any other advice, I plan on following the baby sleep training advice with the diligence and tenacity of a marathon runner preparing for the Boston Marathon. Also, research indicates that adequate sleep is integral to child development, particularly early on. Thus, no compromises: I’m going to be a sleep Nazi. Other things may slide, but sleep won’t.

A topic I’ve found amusing to read about is how to “enhance” your child’s brain development or intelligence. In Brain Rules for Babies, I read with astonishment about parents who wanted to give their babies a boost before they were even born. Now, I don’t know much about psychology or even pregnancy, for that matter, but I’ve spent the last 24 weeks approaching pregnancy and our baby’s development pragmatically. I keep myself healthy — eating, exercising, and resting appropriately — and I trust that our baby will come out healthy, too. Never in a million years would I have considered, say, playing Mozart into my belly to enhance his math skills, or heaven forbid buying some in utero language training to “teach your child a second language before he’s born.”

I feel sorry for kids born into families so obsessed with getting ahead that they have to start achieving before birth. People only get to have a few carefree years as kids, and it does them a disservice to force them early into the kind of miserable, achievement-oriented, over-scheduled, distraction-laden, stressful life most adults endure these days.

* The title refers to this. Props if you knew that already.