Fighting depression so easy a caveman could do it

While the exact numbers are in debate, it is generally accepted that over the past 50 years depression rates in the United States have risen dramatically. Several large epidemiological and family studies have suggested increases in the rates of depression for all ages. According to University of Kansas psychologist Dr. Steve Ilardi, "one in four Americans will become clinically depressed by age 75, [and] Americans are 10 times more likely to have depressive illness than they were 60 years ago."

While some of the increase might be attributed to better and more frequent diagnosis, increased depression does appear to be an artifact of our modernized, industrialized and urbanized lives. While this relationship could be correlation and not causation, it does make one think whether our depression isn't the result of some mismatch between the way we live today and how we lived far back in our past. In other words, maybe working on spreadsheets in a cubicle after a 50-minute commute and subsisting on a diet of junk food just isn't in our DNA. Phrased like this, it's hard to imagine that it is in our DNA.

Further support for the modern-life-leads-to-depression comes from studies on societies who lead less industrial lives. Examples include the Amish and even more notably the Kaluli people of Papua New Guinea, who are contemporary hunter-gatherers, and have been found to be virtually depression-free.

All of this observational data has lead Dr. Ilardi and his University of Kansas team to develop an innovative approach to treating depression called Therapeutic Lifestyle Change for Depression (TLC) and recently referred in the media as "living like a caveman." According to Ilardi:

"We've been engineering the activity out of our lives. The levels of bright-light exposure - time spent outdoors - have been declining. The average adult gets just over six and a half hours of sleep a night. It used to be about nine hours a night. There's increasing isolation, fragmentation, the erosion of community."

The result?

"We feel perpetually stressed. And the more we learn about depression neurologically, the more we learn that it represents the brain's runaway stress response."

Ilardi believes that instead of popping pills, we need to go outside, get physical, chat with our neighbors, and live more as we did in our Paleolithic past.

Were cavemen less depressed?

Ilardi's regimen, the Therapeutic Lifestyle Change for Depression (TLC), is packaged into a 14-week program that combines group therapy with a battery of already established depression- fighting remedies: increased sleep, aerobic exercise, ingesting omega-3 fatty acids, bright-light exposure, social interaction, and replacing rumination (dwelling on negative thoughts) with activity.

Ilardi says of the 64 patients have completed the program:

76.6 percent experienced a favorable response (at least a 50 percent reduction in initial depressive symptoms) compared with 27.3 percent in the control group, which received medication and/or traditional psychotherapy.

In an additional support of his approach, Dr. Ilardi cites studies showing that only about half of depressed patients typically respond to an antidepressant drug (slightly more than will respond to a placebo).

TLC is certainly worthy of the interest it is getting but because if its relative newness as a program for fighting depression there are a number of things to note before you go mimicking "Clan of the Cave Bear". Among them:

The results of Ilardi's regimen have yet to have been independently verified. Something Ilardi agrees is a critical next step.

When Ilardi talks about "living like a caveman" he is referring to changes in diet and activity level. He does not advocate actually returning to the Stone Age has noted in interviews that he quite likes his iPod.

There are studies including the Stirling County Study findings that contradict the conventional wisdom that modern life is so overwhelming that we live in an age of depression. This longitudinal study (1952-current) has found no increase in rates of depression over the past 40+ years though it did find increases of depression within specific demographic groups--especially young women. There are also those who believe that it is the changes in how we classify and diagnose depression that has changed and lead to the significant changes in depression rates.

The cavemen metaphor also has problems. Some have wondered how it is that we even know that cavemen weren't depressed? And is it possible if they were less depressed it was only because they have a life expectancy of 30 years or less? One way to eliminate the depression of midlife crisis is to eliminate midlife in its entirety.

Of the individual elements of the TLC process, some have noted that only exercise has been shown to be effective. (See this post). And that notably Omega-3 has failed the meta-analyses as has light therapy. (I can tell you that there are so many studies and meta-studies on this point going back and forth that it is simply too difficult for a layman to decide. Let's just say that the specific benefits of Omega-3 in fighting depression is doubted by some in the scientific community.)

Other than Omega-3s, TLC does not address diet's role in depression (ironically excluding the so-called "caveman" or Paleolithic diet). I suspect that many of our health problems are related to the types of foods that we intake or forgo. Most processed foods contain preservatives, colors, fillers, etc... that weren't present in primitive diets.

Additional links relating to this topic:

The TLC website

A PDF version of the AARP story on Dr. Ilardi's TLC program.

Dr. Helen website article and discussion.