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.