The moment you feel nervous, anxious, extremely overwhelmed, or simply worried that you can’t deal with life, the hypothalamus releases a corticotropin-releasing hormone (CRH), a substance that starts a cascade of reactions, ending with cortisol flowing into your bloodstream. While this process has been well defined for a long time, newer research reveals that perceptions of stress trigger inflammatory signaling from the body to travel to the brain, priming it for hyper-response.29
You’re probably already familiar with cortisol, the body’s main stress hormone that aids in that famous fight-or-flight response. It also controls how your body processes carbohydrates, fats, and proteins. Because it’s the hormone responsible for protecting you during times of stress, its actions increase your appetite, promote more fat storage, and break down complex molecules and tissues that can be used for quick forms of energy, including muscle. For this reason, continual exposure to excess cortisol over time can lead to increased abdominal fat, bone loss, a suppressed immune system, fatigue, and a heightened risk for insulin resistance, diabetes, heart disease, and full-blown depression. Cortisol does, however, serve a positive role. It directs and buffers the immune system and primes the body for attack. This would all be great if the attack were short-lived and easily resolved. The attack of our modern-day lifestyles is unrelenting.
The scientific study of the impact of stress on the body from the inside out, and even the outside in, has made tremendous advances in the fifteen years starting in 1998 when Harvard University researchers conducted a joint study with several Boston-area hospitals designed to examine the interactions between the mind and the body, specifically the skin. They called their discovery the NICE (neuro-immuno-cutaneous-endocrine) network.30 In plain speak, it’s a giant interactive network consisting of your nervous system, immune system, the skin, and your endocrine (hormonal) system. All of these are intimately connected through a dialogue of a complex array of biochemicals.
The Boston researchers studied how various external forces influence our state of mind, from massage and aromatherapy to depression and isolation. What they discovered confirmed what many in the scientific community have known anecdotally for centuries: our state of mind has a definite impact on our health and even our appearance. People suffering from depression, for example, often look older than their chronological age. They don’t appear healthy and vibrant, as the stress of coping with depression has accelerated the aging process and damaged their health.
Since the NICE network entered our vocabulary, dozens of other studies have been performed to confirm the powerful interplay between psychology and biology or, put simply, mind over matter. An analogy I like to use in my practice goes like this: If you’re walking down a dark alleyway at night and hear footsteps behind you, you might be alerted in uncomfortable ways, and your body will prepare to fight or flee. But if you then hear your friend’s voice, everything in your body’s physiology changes in that one instant. Yet the only thing that’s changed is your perception!
So going back to the question “Can depression be good for us?” Was depression once an adaptive response to the environment? I subscribe to the idea that the body doesn’t make mistakes after millions of years of evolution. A 2014 review in the Journal of Affective Disorders attempts to answer the question of why we get depressed, rather than just looking at how, and what to do about it. Often the best approach to root cause resolution of symptoms comes from an understanding of the reasons why the body is responding in the way that it is. Speaking to the concept of evolutionary mismatch, the authors of the paper state: “. . . modern humans exist in environments that are critically different from those in which we evolved, and that our new environments interact with our ancient genomes to lead to disorder . . .”31
The authors discuss how depression may have served a purpose at some point, but the nature and intensity of today’s modern-day triggers may be leaving more of us depressed (up to 41 percent of us!) more of the time than seems reasonable. This perspective encompasses the inflammatory model of depression, which posits that both psychological stress and bodily inflammation result in brain-based changes that would serve us if they were brief, but may kill us if they are persistent (something like that).
The researchers of the review go on to explain how antidepressants are missing the mark, and why their prescription should be reconsidered, citing side effects including:
. . . headache, nausea, insomnia, sexual dysfunction, agitation, sedation, hyponatremia, stroke, cardiac conduction defects, and increased risk of mortality. The long-term use of antidepressants may be associated with additional adverse effects. For instance, some antidepressants may be weakly carcinogenic or cause osteoporosis. Antidepressants have also been associated with an increased acute risk of suicide in younger patients while they may decrease the risk of suicide in older patients or with longer-term use. Also, all major classes of antidepressants have been associated with unpleasant (and sometimes dangerous) symptoms when they are discontinued abruptly. Discontinuation of antidepressants is associated with relapse and recurrence of MDD (Major Depressive Disorder). In a meta-analysis, this risk was shown to be higher for antidepressants that cause greater disruption to neurotransmitter systems . . . [And] there is a growing body of research suggesting that when they are used in the long term as a maintenance treatment, antidepressants can lose efficacy, and may even result in chronic and treatment-resistant depression. Such reactions may be due to the brain’s attempt to maintain homeostasis and a functioning adaptation in spite of the medication.
For someone like me, this is a profound summary of the perspectives I have curated since my departure from conventional practice. The call to action is to view depression as the vague descriptive term that it is. Put simply, depression is a sign for us to stop and figure out what’s causing our imbalance. Another way to appreciate this perspective is to say depression is an opportunity.
Many of my patients are initially surprised to experience my wrath about the prescribing that’s going on all around me. I don’t think New York is any different from Anytown USA in how heavy-handed the average practitioner, whether it’s a family practice doctor or an internist or psychiatrist, is with prescriptions. In my opinion, it has become reckless. Their patients have never consented to the long-term effects of these medications because pharmaceutical research is, by nature, short term.32 There’s no incentive on the part of the pharmaceutical companies to take a good look at what happens to the average individual when she takes a medication for a decade or so. That said, in recent years there’s been a spat of studies linking antidepressants to an increased risk of aggression, homicide, and suicide, as well as fingers pointed at these drugs for their involvement in school shootings, airplane crashes, and other unfortunate events often blamed on terrorists, gun access, or lack of treatment.33
In one particularly alarming paper published in 2015 in no less an authority than the British Medical Journal, researchers from the Nordic Cochrane Centre, an independent drug safety analysis group based in Denmark, found that more than half a million people aged sixty-five and older in the West die every year from psych meds.34 Using an impressive meta-analysis of placebo-controlled trials, these researchers discovered that more patients die from taking FDA-approved antidepressants than do patients who take no drugs or who use other unconventional treatment methods. Similarly, the all-cause mortality rate (translation: dying from any cause) was found to be 3.6 percent higher among patients who take newly approved antidepressants compared to patients who take no antidepressants. The study’s scientists highlighted the fact most industry-funded studies favoring psych meds tend to skew the sample groups and test data so much that the results end up becoming meaningless. Underreporting of deaths, according to the study’s authors, is another major problem in the clinical trial process. The Nordic group estimates that the suicide rate among antidepressant users is some fifteen times higher than what the Food and Drug Administration (FDA) reports publicly.
Studies like this that uncover our modern medical assault on humanity are just the tip of the proverbial iceberg. I could write a whole book on the high-profile research demonstrating that patients are held hostage by psychiatric medications, made sicker,
