How Come They're Happy and I'm Not? (7 page)

I went to medical school in Seattle, a city that boasts averages of 201 cloudy days, 93 partly cloudy days, and 71 sunny days per year. In my clinic, we saw a ton of depression and low vitamin D. (That's probably why so many people in Seattle love coffee.) I learned early on in my training that for some of my patients with depressed mood, morning sunlight exposure was crucial—especially for treating seasonal affective disorder (SAD), a condition marked by low mood as the days get shorter.

Light therapy works by decreasing morning melatonin secretion, which sets up the body to release it more robustly in the evening. In a fantastic eight-week study of 112 women ages nineteen to seventy-eight with mild to moderate depression, University of Washington researchers had these women do two things: take a twenty-minute brisk walk outside during daylight hours five days a week and take a multivitamin supplement that included 50 mg each of vitamins B
₁
, and B
₂
, and B
₆
; 400 mcg of folic acid; 400 IU of vitamin D; and 200 mcg of selenium. A control group received a placebo and didn't exercise. The group that exercised and took the real vitamins enjoyed decreased depression and improved overall mood, reduced depression symptoms, and increased self-esteem and general well-being. In this study, the combination of morning light, exercise, and vitamins helped 85 percent of the group's mood, a much better effect than we see with medication.

I love this study, for it's one of the very few that uses more than one natural remedy to support the body's own healing process. This is how naturopathic medicine works. Currently, research is conducted mostly on drugs. When natural remedies are researched, they are often studied in isolation—meaning only one treatment is used at a time for patients who have depression. This creates a much slimmer chance of working than if a few different treatments are used at the same time to support the body. Hopefully future research will study combinations of treatments as this one did.

Besides sunlight's ability to suppress daytime melatonin, which contributes to a healthy circadian rhythm, sunlight's other likely contributor to healthy mood is vitamin D. The components of sunlight are visible light, ultraviolet radiation, and infrared radiation. The two ultraviolet wavelengths are ultraviolet A and ultraviolet B, which converts to vitamin D.

One study investigated the importance of ultraviolet light's exposure on skin to mood. In this test, frequent tanners used two different tanning beds over a period of six weeks. The beds were identical except that in one, the ultraviolet light was filtered out. Even though study participants could not tell which bed had the ultraviolet light, they reported that they were more relaxed and less tense after exposure to the bed with ultraviolet light. When allowed to choose which bed to use, eleven of twelve participants chose the one with ultraviolet light. Scientists think ultraviolet light helps the skin transform the cutaneous chemical 7-dehydrocholesterol into vitamin D
₃
. We will talk a bit more about vitamin D in
chapter 5
.

Sunlight's infrared wavelengths may also help. A 2007 animal study showed an increase in the amount of time before an animal will show signs of depression under continuous stress when the animals are exposed to infrared irradiation for four weeks. This suggests that a continuous application of infrared irradiation has an antidepressant effect. In my office, I often use an infrared device called a TDP lamp while giving patients acupuncture to help with their mood. Patients tell me the lamp makes them feel secure and nourished as well as warm during their acupuncture session.

The first step to healthy sunlight exposure is to get out there into nature, whether it's for a walk in a park or an early morning jog. If weather permits, wear less clothing to allow the sunlight to reach your skin. Some reports claim that ten to twenty minutes of full
sun exposure per day—during non-peak sun—provide enough healthy sun effects without causing the damage. To see if your skin is getting too much sun, look at your skin through a good set of sunglasses—if you start to see some redness, it's time to cover up. One journal article reports that twelve minutes of noontime, cloudless sun exposure on 50 percent of the skin is equivalent to oral intake of 3,000 IU of vitamin D
₃
. Keep in mind that if you are at high risk for skin cancer, you may need to be more cautious. A vitamin D supplement and light box phototherapy may be good alternative solutions.

A second step, if needed, would be phototherapy, or light box therapy. This can be used to treat depressive illness, and it is particularly useful for obvious cases of fall and winter seasonal affective disorder, although I have seen light therapy help general depression and sleep issues. Treatment, typically prescribed for mild to moderate depression, consists of exposure to full-spectrum white light (at a power of 10,000 lux) for at least thirty minutes every morning. There is no known risk of light therapy.

Whether it's related to family, work, relationships, or money, stress is a major factor in depression. This is recognized in both written literature and research. In animal studies, short-term stress causes us to respond to our world, which is healthy. But chronic stress (the kind we humans seem to sustain) decreases an animal's ability and encourages withdrawal-type behaviors associated with depression.

As a researcher at the National Institute of Mental Health, I studied the effect of stress on animals. What I learned is that if you want to make an animal depressed, all you need to do is stress it out every day for a few weeks. You may be saying, “I know what that feels like.” Well, if your life is a chronic stress, you are participating in a depression experiment of your own.

You may be interested to know that the standard animal model of depression consists of subjecting an animal to a random schedule
of severe, uncontrollable stress until the animal withdraws into a shell of “learned helplessness.” Oftentimes, I explain this when I lecture to medical students, and invariably, some overworked, harried, half-awake medical student or resident (who sat in my talk not so much because of my charisma, but more likely due to the free lunch or dinner) will raise her hand and say, “Hey, that sounds like my life.”

Chronic stress in animals creates similar inflammatory profiles and behavior patterns as those seen in humans with depression. (We will talk a lot more about inflammation in the next chapter.) Stressed animals stop drinking sweet water that they formerly enjoyed—this behavior change is likened to anhedonia in humans—an inability to experience pleasure from normally pleasurable life events. Anhedonia can be a core symptom of depression. The hypothesis correlating the symptoms in animals with those in humans is that chronic mild stress (CMS) induces a change in brain reward function that resembles the symptoms of major depression—namely, a decrease in responsiveness to rewarding stimuli.

Another classic stress model with rats amounts to a mild torture that is minor enough not to hurt the animal overtly but over time causes its mood to plummet. In detail, researchers house rats individually and subject them to a light electric shock to the foot for ten seconds per minute for thirty minutes, and then have the animal fast for forty-eight hours. Then researchers have the rats swim in ice water for five minutes, followed by deprivation of water for twenty-four hours, after which they are subjected to a warm room for five minutes, followed by tottering (walking on unstable ground) for fifteen minutes. Finally, researchers squeeze the rats' tails for one minute. This stress is repeated two to three times in the course of twenty-one days. This mild torture creates the same functional effect in the rats' brain and behavior as we see in human depression. When you think about your own depression, you may want to outline the tortuous route you take, not for self-pity, but instead to understand how to break this cycle. We are going talk about different ways to handle stress in
chapter 6
.

Television's role in influencing the mental and physical state of our society has been profound. In the short term, TV seems to have a relaxing effect. A 2004 article in
Neuroimage
details studies using functional MRI during TV viewing that have determined that humorous television programming can activate regions of the brain called the insular cortex and amygdala, areas needed for balanced mood. Unfortunately, TV watching over the long term seems to be related to problems: watching television more than two hours per day and eating while watching television are both associated with obesity (60 percent of people in the United States are obese) and exacerbate risk factors for cardiovascular disease, cancer, and diabetes. It was also shown that after the initial two hours, each extra hour of television that kids watch per day is associated with an 8 percent increase in developing depressive symptoms by young adulthood. Although many people report lack of time as a major barrier to regular exercise, the average American adult spends more than four hours per day watching television.

Analysis of more than thirty years of national data shows that spending time watching television may contribute to viewers' happiness in the moment, but the long-term effects are not good. In these studies, participants reported that on a scale from 0 (dislike) to 10 (greatly enjoy), TV watching was nearly an 8. Despite the favorable rating, it seems that the enjoyment from TV is very short lasting and gives way to discontent. What was found is that unhappy people glue themselves to the television 30 percent more than happy people do. These results held even after taking into account education, income, age, and marital status. This data from nearly thirty thousand adults led the authors of this study to conclude that

TV doesn't really seem to satisfy people over the long haul the way that social involvement or reading a newspaper does. We looked at 8 to 10 activities that happy people engage in, and for each one, the people who did
the activities more—visiting others, going to church, all those things—were more happy. TV was the one activity that showed a negative relationship. Unhappy people did it more, and happy people did it less. The data suggest to us that the TV habit may offer short-run pleasure at the expense of long-term malaise.

In the words of T. S. Eliot, “The remarkable thing about television is that it permits several million people to laugh at the same joke and still feel lonely.” In short, happy people do not watch a lot of TV.

* * *

So, this chapter discussed what your grandmother already knew: that good sleep, good food, exercise, and getting out into the sun are very healthy and that stress and too much TV are not so good. What I hope came through in this chapter is that these basic concepts have strong research behind them and hold promise to treat even the most difficult depression issues. My vision for the future treatment of depression is to make each of these a priority item to be checked by every doctor and worked with by every depression sufferer to the best of his or her ability. Even if each person trying to feel better can achieve some improvement in just one or two areas, this will go a long way toward a better mood.

Emotions play out in the theatre of the body
.

—A
NTONIO
D
AMASIO

You are probably getting the idea that depression is almost never caused by just one event or problem in the body; it's caused by multiple factors. At its most simplistic, you can narrow these factors down to two causes: external and internal. Using a car analogy, the external problems are like bad gasoline, a lead foot, or harsh weather and road conditions, all of which can wreck a good car over time. Internal problems are like car parts that just are not working well due to manufacturer error. Complicating this scenario, it's clear that physical external problems will make internal issues—such as mood—become more apparent, and mood problems then contribute to physical problems.

Chapter 3 talked about what we can do to change some of the key lifestyle factors that contribute to depression. Such lifestyle changes work by shifting your brain and body physiology—the external and internal factors mentioned in the car analogy—to help them heal and repair.

Chapter 4 is dedicated solely to the physical processes that contribute to depression. However, these are often not outwardly visible. The problems we will discuss here are not as obvious as, say,
constipation, so they require some explanation. This chapter gives you the knowledge to identify and address issues that you, and possibly your doctor, may not know are affecting you.

In
chapter 2
, I gave you a list of blood tests to ask your physician to run for you. These tests are designed to check on factors that may be affecting your mood. Any of these can be crucial to helping your mood improve. Read on to understand the reasons for the specific tests and what you can do based on the results.

I first met my wife, Pina, in 1997 in the psychiatric medicine halls of the National Institute of Mental Health in Bethesda, Maryland. There, we researched how stress affects the brain and hormonal system. One of the first things I noticed about Pina when we were first dating was that, for an otherwise happy and positive person, if we waited too long for a dinner table at a restaurant, her mood became very irritable, somewhat difficult, and then negative. This is because when blood sugar drops or bounces up and down, it stresses the body out and can create low mood.

While many people (like my wife) can have transient mood problems if they haven't eaten, some people who tend to have low blood sugar may have hypoglycemia. People with hypoglycemia are known to be at greater risk for depression. A 2008 study from Johns Hopkins University watched intensive care patients and noticed that those with blood sugar hovering under 60 (normal is 70 to 100) had a 360 percent risk of depression when researchers checked in three months later.