Move Over, Prozac. Some of the Most Effective Antidepressants Aren’t Drugs at All
Everything we think we know about depression is wrong.
READ ON TO DISCOVER:
How a cow was used (successfully) as an antidepressant
What the United Nations gets right about treating mental health around the world
How to build social antidepressants into your everyday life
Johann Hari is a bestselling author and award-winning journalist who has written for publications such as the New York Times, the Los Angeles Times, The Guardian, and Politico. His most recent book, Lost Connections: Uncovering the Real Causes of Depression—and the Unexpected Solutions, is a groundbreaking investigation into how depression really works. He recently joined Heleo’s Editorial Director, Panio Gianopoulos, to discuss why everything we know about depression is wrong, and what we can do to solve the world’s most pressing mental health crisis.
This conversation has been edited and condensed. To view the full version, click the video below.
Panio: I tore through your book. It was full of really surprising insights, both the research, and the consequences of the research. Let’s start out with the basic concept of the book, if you can narrow it down to a few sentences.
Johann: Well, it was a really personal journey for me. There were these two mysteries that were hanging over me, that I really wanted to understand. The first was, “Why was I still depressed?” When I was a teenager, I had gone to my doctor and explained that I had this feeling, like pain was bleeding out of me, I couldn’t understand or control it. My doctor said, “We know why you feel this way. There’s a chemical called serotonin in people’s brains. It makes them feel good. Some people naturally lack it. You’re clearly one of them, we’ll give you these drugs, they’ll make you feel better.”
I started taking the drugs and felt a huge boost, but within a couple of months, the sense of pain started to bleed back. I went back, he gave me a higher dose. Again I felt better, again the pain came back. I was in that cycle, taking the maximum possible dose for 13 years, at the end of which I still felt terrible. I thought, “What’s going on here? I’m doing everything I’m told.”
The bigger and much more important mystery is, “Why are there so many other people in despair in our culture?” One in five Americans is going to take a psychiatric drug in their lifetime. One in four middle-aged women is taking an antidepressant in the United States. My instinct was that it probably isn’t that our brains were just spontaneously malfunctioning.
So I ended up going on this huge journey, and meeting leading experts in the world on what really causes depression and what really solves it.
Panio: So when you talk about [the typical view that] serotonin levels correlate with depression, that’s fundamentally a flawed hypothesis?
Johann: Yes—there are real biological factors that can certainly make your depression and anxiety worse. But it was shocking to me to discover the story I was told by my doctor is not true. Professor Andrew Scull at Princeton University, who’s one of leading figures on this, says it’s deeply misleading and unscientific to say low serotonin causes depression. That story was never credited, there was never a time when half of the scientists in the field would have believed it.
While there are biological factors that make it worse, overwhelmingly the causes are not in our heads. They’re in the way we’re living. Some of them are significantly rising, which helps to explain why we have a rising depression and anxiety epidemic. And most of them require us to respond in a very different way than the way we’ve been responding up to now.
Panio: Even though it runs counter to the mainstream belief around depression, from an intuitive sense, it’s reasonable to say that your environment will affect how you feel.
Johann: We’ve been having the completely wrong debate about depression. The World Health Organization explained in 2011 that mental health is produced socially—it’s a social phenomenon, it’s a social indicator. And it needs social solutions.
“Mental health is produced socially—it’s a social phenomenon, it’s a social indicator. And it needs social solutions.”
That can sound a bit weird in the abstract, so I’ll give you a very concrete example of one of the nine causes of depression and anxiety, and how we might solve it. I noticed that lots of people I know who are depressed and anxious, their depression and anxiety focuses around their work. Gallup did the most detailed study here in the U.S. on how people feel about their work. They found that 13 percent of us like our work most of the time, 63 percent of us are “sleepwalking” through work, tolerating it, and 24 percent of people hate their work, fear it, and try to sabotage it.
87 percent of people don’t like the thing they’re doing most of their waking life. And you’re almost twice as likely to hate and fear your job as you are to like it. I thought that could be having some effect on our mental and emotional health, so I got to know Professor Michael Marmot, an Australian social scientist, [who] had actually discovered something absolutely crucial about this in the 1970s. The key factor that causes depression at work is if you go to work and are controlled—you have low choices or no choices—then you are radically more likely to become depressed.
Everyone knows that they have natural physical needs—you need food, you need water, clean air, shelter. If I took them away from you, you would be in trouble really quickly. There’s equally strong evidence that we have natural psychological needs. You’ve got to feel you belong. You’ve got to feel your life has meaning and purpose. You’ve got to feel that people see you and value you. You’ve got to feel that you’ve got a future that makes sense to you. Our culture is good at lots of things, but we’ve been getting less and less good in many key areas of meeting people’s psychological needs. That is not the only reason, but it’s one of the reasons why we have this rising depression and anxiety crisis.
“Our culture is good at lots of things, but we’ve been getting less and less good in many key areas of meeting people’s psychological needs.”
This opens up a very different way of thinking about solving it. I’m not opposed to chemical antidepressants. They give some relief to some people and absolutely should remain on the menu. But what learning about the deeper causes of depression and anxiety taught me is that we have to expand that menu radically.
I’ll give you an example of what I think of as an antidepressant for that problem of control at work, which is making so many people feel terrible. In Baltimore, I met an amazing person called Meredith Keogh. Meredith is a young woman who used to go to bed every Sunday night just sick with anxiety about the week ahead. She worked in an office, and it wasn’t the worst office in the world—she wasn’t being bullied or anything. But she just couldn’t stand the thought that this was going to be 40 years of her life.
One day Meredith, with her husband Josh, did this quite bold thing. Meredith quit her job, and Josh quit his job. Josh had worked in bike stories in Baltimore since he was a teenager, which is controlled, insecure work. And Josh, in the bike store, had said to his friends he worked with, “What does our boss actually do?” So they decided to set up a bike store of their own that would work on a different principle. They don’t have a boss. It’s a democratic cooperative. So they take all the big decisions together by voting. They share out the good tasks and the crappy tasks.
One of the things that was so fascinating to me, which completely fits with Professor Marmot’s research, is how many of them talked about having been depressed and anxious before, when they worked in this controlled environment, but were not depressed and anxious in this different environment. It’s not like they quit their jobs fixing bikes and went and became Beyoncé’s backup singers. They fixed bikes before, they fix bikes now. What changed is the factor that causes depression, which is the control.
Panio: That’s fascinating, and I think part of that might be that there has been increasing instability around work. It used to be that there was a trade-off—you agreed to do a rather tedious or dull job, but you knew that you had a job for life. Now that’s gone—you surrender your control for insecurity. You don’t know if you’ll have a job six months from now.
Johann: And there’s really fascinating research about how that insecurity is driving up depression. In Canada, First Nations people, what we would call Native Americans, have extremely high levels of suicide. A professor called Michael Chandler wanted to figure out what was going on. There are 196 First Nations groups in Canada—some of them have really high suicide [rates], and some of them have no suicide at all. So he spends years studying this, gathering loads of data, and he sees something really interesting. Some First Nations groups in Canada have banded together and fought to regain control of their community—they control their schools, they speak their language. But some have been so beaten down and destroyed by the way they’ve been treated, that they have not been able to do that, and the suicide rate tracks very tightly with how much control [they] have over [their] communities.
I don’t think that’s just true for First Nations people. There’s good evidence it’s true in a much wider way. In the run-up to the 2016 election, I spent a lot of time in the Rust Belt. You could really see that people have been deprived of a sense of the future, a sense of stability; [it’s] not a coincidence that the suicide rate is massively rising there. We have to look at ways of restoring a sense of the future, which brings me to another antidepressant.
In the 1970s, the Canadian government randomly chose a town in Canada to give [citizens] a guaranteed income, equivalent to $15,000 in today’s U.S. money. Loads of interesting things happened. But to me, the most important is that there was a big fall in mental health problems. In fact, depression and anxiety [requiring] hospitalization fell by nine percent in just three years. It almost seems banal to say, “If you’re really financially insecure, you’re going to be a lot more unhappy.” The UN said, “We need to talk less about chemical imbalances, and more about power imbalances.” That universal basic income is an antidepressant. It’s dealing with one of the reasons why people feel so terrible.
“We need to talk less about chemical imbalances, and more about power imbalances.”
Panio: What do you do if you can’t enact enormous, systemic change? What can I do as a person?
Johann: We don’t say that the solution to car crashes has to [come] from people who’ve just been mangled in a car wreck, and the doctors in the emergency room. We have seat belts and airbags, speed limits and driving tests. The whole society changes. Part of the solution is that we need to change the causes of depression and anxiety that are deep in the culture.
Now, there are lots of things that individuals can do. There were lots of individual lessons that I integrated into my life from this [journey,] not just fighting for big political things. I’ll give you an example: I interviewed an amazing person called Dr. Brett Ford, [who] did this research that really changed how I live. She wanted to figure out, if you deliberately decided you were going to spend more time trying to be happy, would you actually become happier? They did this research in four countries—the U.S., Japan, Russia, and Taiwan. What they found is fascinating. In the U.S., if you spend more time trying to be happier, you did not become happier. In the other countries, you did.
So they looked more and they found in the U.S., when we try to be happier, we do something for ourselves. You buy something for yourself, you show off on Instagram, you try to get a promotion. We have an individualist conception of happiness. In all the other countries, when you tried to make yourself happier, most of the time you did something for someone else. Something for your family, your friends, your community. They have an instinctively collectionist vision of happiness. It turns out, our vision of happiness just doesn’t work.
One of the people who really helped me to understand this is Professor John Cacioppo at the University of Chicago. He’s an amazing person, the world expert on loneliness. He explained to me that you and I exist for one really simple reason. Our ancestors on the savannas of Africa were really good at one thing: banding together. They weren’t bigger than the animals they took down, but they were much better at cooperating. Bees need a hive, humans need a tribe. And yet we are the first humans ever to try to live without a tribe.
It used to be that when I felt down, I would do something for myself. Now, when I feel those painful feelings coming, I force myself to go and do something for someone else. Something as simple as leaving your phone at home and sitting with someone and really listening to them. The best gift you can give someone is your presence and your attention.
“The best gift you can give someone is your presence and your attention.”
Panio: It’s true that individualism and happiness are, in our minds, one for one. “I’m going to become happy by acquiring this thing.” That’s the whole advertising model: you’re unhappy, and this product will make you happy.
Johann: Weirdly, no one had actually investigated this until Professor Tim Kasser, who I got to know. We all know that junk food has taken over our diets and makes us physically sick. As you can see from my chins, I am a KFC aficionado. But what was interesting to me is that a similar thing has happened with our minds. Junk values have taken over our minds and made us mentally sick. Professor Kasser knew that there are basically two kinds of motives that humans have. Imagine you play the piano. If you play the piano in the morning because it gives you joy, that would be an intrinsic reason to play the piano. Now imagine you play the piano in a dive bar to pay the rent. That would be an extrinsic reason to do it. You’re not doing it for the experience. You’re doing it to get something out of the experience.
We’re all a mixture of intrinsic and extrinsic values, obviously. But Professor Kasser has shown a few things. The first is, the more you are driven by extrinsic values, the more depressed and anxious you will become. He has also shown that as a culture, we’ve become much more driven by extrinsic values. But it’s not just advertising; advertising is the tip of the spear of this wider system that’s constantly trying to get us to consume. More 18-month-old children recognize the McDonalds “M” than know their own surname.
What we’ve been fed is a kind of KFC for the soul. It’s these extrinsic values, these junk values, which as Professor Kasser says, are constantly driving us away from what’s really good about life.
Panio: That’s heavy. I just don’t know how you would avoid our entire culture.
Johann: Well, he’s shown me a way you can de-program this. Professor Kasser worked with kids in schools in middle-class areas. The schools were really disturbed, because these kids got furious if they didn’t get the latest sneakers, the latest consumer goods. They asked Nathan Dungan, a local financial advisor, to talk to these kids about budgeting. So Nathan goes to speak to them and he quickly realizes that this is nothing to do with budgeting, which is why he teamed up with Professor Kasser.
They did a series of meetings over three months. Teenagers and their parents regularly met in small groups, basically AA for consumerism. So at first, the kids would talk about their extrinsic desires, [like] the sneakers they just had to have. They’d say to them, “Could you write down what you feel you’ll gain when you’ve got these sneakers?” And very quickly, they’d say, “Well, I’d feel I belonged. I’d feel I had a sense of status.”
It didn’t need much prodding for the teens to go, “Wait a minute. Maybe I could get that some other way.” First it was about deprogramming extrinsic values. But then, the more interesting bit is over time, they would just talk. The parents and the teenagers would lay out what they thought was important in life. Then they would say, “How could you act on that more?” Just meeting a few times significantly reduced their extrinsic values and significantly increased their intrinsic values.
I think people instinctively know that there’s something not right about what we’ve been doing. What we have is a society of people who are increasingly isolated, taught to value junk, screaming at each other through screens. If we carry on with that, we’re going to have more and more people being depressed and anxious. We’ve been telling this exclusively biological story for more than 30 years now, and every year we’ve done it, depression and anxiety have increased.
There was a moment it really fell into place for me. I interviewed an amazing South African psychiatrist called Dr. Derek Summerfield. Derek happened to be in Cambodia when chemical antidepressants were first introduced there. The doctors there didn’t know what they were, so he explained [antidepressants] to them.
And the Cambodian doctors said, “We don’t need them. We’ve already got antidepressants.” Derek said, “What do you mean?” He thought they were going to talk about an herbal remedy or something. Instead, they told him a story.
There was a farmer in their community who one day, working in the rice fields, stood on a land mine and got his leg blown off. They gave him an artificial limb, and he went back to work in the fields. But it was super painful and traumatic to work under water with an artificial limb, and he became depressed. The Cambodian doctors said they gave him an antidepressant by sitting with him, and listening to him. They saw that his pain made sense, that it wasn’t a pathology. And they figured that if they bought him a cow, he could become a dairy farmer. He wouldn’t have to be in the situation that was making him depressed. So they bought him a cow. Within a few weeks, he was fine. They said to Derek, “So you see, Doctor, that cow was an antidepressant.”
Now, if you’ve been raised to think about depression the way we have, that sounds like a bad joke. But it makes perfect sense. This is the most important thing I learned, that I really want to communicate to people who have depression and anxiety: You’re not crazy. You’re not broken. If you’re depressed and anxious, you’re not a machine with broken parts. You’re a human being with unmet needs. And what you deserve is to have exactly what those Cambodian doctors intuitively knew and what the World Health Organization has been trying to tell us for years. You need support and love and help to get those deep unmet needs met. I learned in so many places in the world that I went, from Sydney to San Francisco, from Berlin to Buenos Aires, that those are the solutions that work best.