Psychologist Seeks Stone Age Solutions to Depression

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Psychologist Seeks Stone Age Solutions to Depression

(February 23, 2007) - To confront the country's growing depression epidemic, a modern phenomenon, psychologist Steve Ilardi peered backward into human history.

Way back: tens of thousands of years and beyond. His research steered him there, to an examination of the hunter-gatherer way of life, to a time when humans lived in roving, close-knit bands. Back to the Stone Age.

What he learned led Ilardi and his research team at the University of Kansas to propose a program to reclaim six disappearing lifestyle elements. They call it Therapeutic Lifestyle Change, intended to help modern humans deal with depressive illness.

The team identified factors that are antidepressant but are compromised by contemporary culture: Exercise, omega-3 consumption, light exposure, sleep, social connectedness and anti-ruminative behavior.

The latest and sobering statistics predict that one in four Americans will become clinically depressed by age 75, Ilardi said. Americans are 10 times more likely to have depressive illness than they were 60 years ago.

Ilardi is an associate professor of psychology, not a self-help guru. And he knows the hunter-gatherer talk can sound a little wacky. But he said his early results are showing phenomenal success.

About a year ago Becky Foerschler of Lawrence, Kan., a mother of three, felt herself drifting, pulling back from social commitments, uncharacteristically sapped of energy.

Foerschler's situation wasn't dire. But a series of stressful family matters had preceded her troubling lethargy, and friends hinted that her symptoms looked like depression.

"I thought, `This isn't something that's going to go away by itself.'"

She wasn't keen on taking antidepressant drugs, so when she heard about Ilardi's research, she called to make an appointment. She met with therapists and was accepted into the program.

Depression treatment often centers on talk therapy and antidepressant drugs. The drugs have been lifesavers for many people.

But antidepressants aren't working as well as advertised, Ilardi said, and their side effects can go from bad to devastating, including suicide.

In the last two decades, the use of antidepressant drugs has increased 800 percent, yet depressive illness continues to climb. Recently one of the largest studies of an antidepressant drug found a 47 percent favorable response. "Favorable" meant complete recovery or significant reduction in symptoms.

But that's more than half who weren't helped, Ilardi said. And other studies show that only 10 percent of patients using medication alone will have a full recovery that lasts five years.

"Clearly we need to do better," he said.

Depressive illness is more frequent in developed countries than in developing ones and worse among city dwellers than among rural folks. The Amish have very low depression rates.

An anthropologist who studied the Kaluli people, a modern-day hunter-gatherer group in Papua New Guinea, found only one case of depression. Like hunter-gatherers of old, the Kaluli lack modern comforts and medicine. They deal regularly with infant mortality, disease and violence.

Culturally the contrast with modern Americans is huge. Biologically, however, we're not so different, not even from the hunter-gatherer clans going back hundreds of thousands of years.

"In many respects we're walking around with Stone Age brains and Stone Age bodies," Ilardi said.

Rapid cultural change is relatively recent, starting with farming, then city-building, then the technological explosion. So Ilardi asked: Are there built-in features of that ancient way of life that are antidepressant and that we need to reclaim?

Hunter-gatherers walked for miles. They got lots of light exposure. They slept when the sun was down. And they ate differently. Many obesity experts think our appetite and our desire for certain tastes trace back to a time when food was an uncertain commodity.

Ilardi and his team, using evolutionary psychology and cognitive neuroscience, looked for the nexus between lifestyle practices and depression research. For instance, what specifically about food would affect mental states? Studies showed that modern Americans take in much less omega-3 fatty acids, important to brain function, than ancient humans.

So far the program has treated 31 clinically depressed adults. Ilardi is impressed with the results: 86 percent recovered fully or had a significant reduction in symptoms.

Rick Ingram, KU professor of psychology, was skeptical of Ilardi's program at first but sees the results as promising. One caveat is that the treatment program requires further testing, done independently from Ilardi's team.

"This is an innovative program in its initial stages, and, as such, the data are not fully in," he said.

Ingram said the Therapeutic Lifestyle Change program, rather than competing with traditional therapies, could eventually be used in conjunction with them.

"Areas of biology and psychology converge in this program," Ingram said. "The innovation is in bringing them all together."

In the 12-week program the 90-minute, weekly sessions are led by two clinicians and include five to eight clients. The six elements are introduced one week at a time. Clients talk with therapists by phone between sessions.

Foerschler completed the program last summer and remains free of symptoms.

"By the sixth week I was definitely noticing a difference, and by the end of the 12 sessions I wasn't having any symptoms," Foerschler said

THE SIX ELEMENT OF CHANGE

Researchers at KU are studying the effects of a six-part Therapeutic Lifestyle Change program, specifically for people with symptoms of depressive illness.

But the techniques could benefit a wide range of people, said Steve Ilardi, professor of clinical psychology.

All six elements have been shown in previous studies to help ward off depression, he said. That means they likely would be beneficial for anyone at risk of depression or with a family history of depression.

And many of the elements - including exercise, bright light, enhanced sleep and improved social interaction - have been shown to be mood-boosters for most people, not only those with depressive symptoms, Ilardi said.

Here are the six elements. Clients in the Therapeutic Lifestyle Change study are under the guidance of therapists and doctors. Always consult with a doctor before starting an exercise program or using dietary supplements.

OMEGA-3 FATTY ACIDS

The brain needs essential fatty acids, omega-6 and omega-3, for healthy function. The typical American diet provides a 16-to-1 ratio of omega-6 to omega-3 fats. The healthiest ratio is 1-to-1.

Omega-3 intake has dropped precipitously in the last 100 years, due in part to farm-raised meat and fish, Ilardi said. Studies have associated omega-3 deficiency with an increased vulnerability to depression.

Treatment: Daily supplement of 1,000 milligrams of omega-3, known as EPA (eicosopentaenoic acid), a concentrated form of fish oil, and a multivitamin. Ilardi said this is a high, therapeutic dose based on the best information available now, but that "nobody knows for sure what the optimal omega-3 dose is." The multivitamin is intended to lessen the oxidative effects of the supplement. Clients are specifically reporting better sleep with the supplement, he said, a result he plans to study further.

EXERCISE

While people in hunter-gatherer societies spend hours a day in physical activity, walking as much as 10 miles a day, a majority of American adults get no regular physical exercise.

Clinical trials have identified exercise as an effective treatment for depression. One study found just 90 minutes of aerobic exercise a week to be effective.

Treatment: Thirty minutes of aerobic exercise three times a week. Some clients use a walking program. Lawrence Athletic Club offers some free services to study participants

LIGHT EXPOSURE

Hunter-gatherers spend the day outside, exposed to sunlight. The light on a sunny day is at least 10 to 20 times brighter than light indoors, where most Americans spend much of the day.

A lack of light exposure has been found to disrupt sleep and alter hormones, contributing to fatigue. Sunlight deprivation, acute in winter, is known to lead to symptoms of depression. "All of us get a mood boost from bright sunlight," Ilardi said.

Treatment: Thirty minutes of daily exposure to sunlight. The program provides clients with a 10,000-lux light box. (Lux is a measure of illumination.) They can sit next to or under the light box to simulate light exposure on a sunny day.

SLEEP

Americans on average get 6.8 hours of sleep a night. Just 100 years ago, they slept nine hours. Hunter-gatherers spend more than 10 hours in darkness, and some members of modern-day hunter-gatherer societies complain about getting too much sleep.

Lack of sleep is a well-established health risk on many fronts, including an increased risk of depression.

Treatment: The goal is eight hours of sleep a night. Therapists suggest ways to improve sleep, such as dimming lights and lowering the thermostat an hour before bedtime and retiring and rising at the same time each day, including on weekends.

SOCIAL CONNECTEDNESS

Hunter-gatherer societies live in groups of 50 to 100, chiefly with close relatives and friends. American adults for several generations have grown socially isolated from other family members and from friends. Social support is a known safeguard against the risk of depression. "We're designed to be interdependent," Ilardi said. "We're designed to have lots of face time with those closest to us."

Treatment: Therapists and clients discuss relationships that have waned or become shallow. Clients set specific goals for social activities, including scheduling meetings and phone conversations with friends and relatives. Ilardi noted that while spiritual practices are not a specific element of the program, many people find powerful social connections in church communities.

ANTI-RUMINATIVE BEHAVIOR

Rumination is the tendency to dwell on negative thoughts. Episodes of rumination occur most often when alone. Clients often don't realize the amount of time they spend engaged in such thoughts or the amount of distress it causes, Ilardi said.

Hunter-gatherers spend almost no time alone. With nearly constant social activity, they have little opportunity for rumination. Americans spend much more time alone, including sitting in traffic and staring at unengaging TV shows.

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Treatment: Therapists don't try to explore clients' negative thoughts. Instead they explain the toxic effects of rumination. One strategy to combat rumination is to avoid long periods of time alone. Another is to interrupt periods of rumination with an activity or by contacting a loved one.Take part in the study

The Therapeutic Lifestyle Change study at the University of Kansas is looking for participants. They must be 18 to 65 years old and meet the diagnosis criteria for clinical depression. Participants also must be available for 12 sessions over 15 weeks in Lawrence, Kan.

By Edward M. Eveld
Source: The Kansas City Star

Last updated: 02/07

Psychologist Seeks Stone Age Solutions to Depression

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