Depression is a disease of civilization | Stephen Ilardi | TEDxEmory

This talk was given at a TEDx event using the TED conference format but independently organized by a local community.

Dr. Stephen Ilardi is a professor of clinical psychology and the author of The Depression Cure: The 6-Step Program to Beat Depression Without Drugs. He earned his Ph.D. in clinical psychology from Duke University in 1995, and has since served on the faculties of the University of Colorado and (presently) the University of Kansas. The author of over 40 professional articles on mental illness, Dr. Ilardi is a nationally recognized expert on depression. His work has been honored by the American Psychological Association's prestigious Blau Award for early career contributions to the field, and his research on the neuroscience of depression has been funded by the National Institutes of Mental Health (NIMH).

Dr. Ilardi has also received several major teaching awards in recognition of his dynamic, engaging classroom presence. Recently, he was selected from a pool of over 2,000 instructors as the recipient of the school's highest instructional honor, the HOPE Award for teaching excellence. He also maintains an active clinical practice, and has treated several hundred depressed patients over the course of his career. Dr. Ilardi lives in Lawrence, Kansas with his wife, Maria and daughter, Abby.

I believe depression is one
of the most tragically misunderstood words

in the entire English language.

And here's the problem:

depression has two radically
different meanings,

depending on the context.

So, in everyday conversation,

when people say they're depressed,

they use the word depression
as a synonym for sadness.

It's a normal human reaction

to the slings and arrows
of outrageous fortune.

In that sense, all of us know
the pain of depression.

And yet, in a clinical context,

depression is shorthand
for a devastating illness.

Did I get it? There it is, OK.

For a devastating illness.

We refer to it technically

as major depressive disorder.

This is an illness which robs people

of their restorative sleep,

robs them of their energy,

robs them of their focus,

their concentration, their memory,

their sex drive, their ability
to experience the pleasures of life.

For most individuals,

it robs them of their ability

to love, and work, and play.

It may even rob them

of their will to live,
and I'll tell you why.

Because, we now know depression lights up

the pain circuitry of the brain,

to such an extent that
most clinically depressed individuals,

if you talk to them,
and they let their guard down,

they will tell you,

as they've told me, hundreds of times:

It's torment.

It's agony.

It's torture.

And many begin to look to death,

as a welcome means of escape.

Depression is the main driver
behind suicide,

which now claims over
one million lives every year worldwide.

Now, I know what you're probably
thinking at this point:

Man, this talk is going to be really...

(Laughter)

You know, depressing.

So, I'm going to give
a friendly little spoiler alert:

It's not! It's truly not!

Depression, yes, it is a treacherous foe.

But what I've found in my 20 years

of clinical research and clinical work

is this is a foe that can be defeated.

That's the good news,

and that's the news
that I'm going to focus on

for most of the talk tonight.

First, a little more bad news:

Depression is now a global epidemic.

In fact, if we look in the US,

we now find
that nearly one in four Americans,

will experience the agonizing,
debilitating pain of depressive illness

by the time they reach age 75.

And it gets worse.

The rate of depression
seems to be increasing

generation after generation.

So, every successive birth cohort

is having higher rates of depression,

than the one that preceded it.

Now, I want you to look at these lines.

We've got four different generations
on this graph.

The green line on the right,

that's the oldest Americans.

And by the time they've made it out

into their 60s and 70s,

they have a lifetime rate
of depression of 10%.

That's horrible, but it's much lower

than every succeeding generation.

Now take a look at the line
that really upsets me the most:

It's the one on the far left.

That's our youngest American adults.

You see what's happened?

By the time they're in their mid-20a,

they already have
a rate of depression of 25%.

Remember, we're talking

about a potentially lethal,

debilitating illness.

Left unchecked, it's an illness
that can cause brain damage.

And if we extrapolate that line,

by the time they reach middle age,

their lifetime rate of depression
will already be over 50%.

So what in the world is going on?

What's driving the epidemic?

What can we do about it?

What causes depression?

Well, on one level,

when we ask this question,

we're going to face the answer
that it's really complicated.

There have been, literally,

thousands upon thousands
of published studies

that have identified
a dizzying array of factors

that are implicated
in the onset of depression:

biological, psychological,

cultural, social, behavioral.

But if we wade through this complexity,

what we begin to find,

is that there's a common
underlying pathway.

A primary driver.

A primary trigger.

I call it the brain's
runaway stress response.

Now we all know the stress response.

We think of it, probably,
as the fight-or-flight response

in its most extreme form.

I want you to think about that response.

Especially, how it was evolved
and adapted to serve us.

The fight-or-flight response
was designed

primarily to aid our ancestors

when they faced predators,

or other physical dangers.

They required what?

Intense physical activity

that would go on for a few seconds,

for a few minutes,

maybe, in extreme cases, for a few hours.

It's a very costly response.

But fine, if it shuts off
what it's supposed to.

Here's the problem.

For many Americans, Europeans, and people

throughout the Western world,

the stress response goes on for weeks,

and months, and even years at a time.

And when it does that,

it's incredibly toxic to the body
and to the brain.

It's disruptive to neural circuits
in the brain

that use neuro-chemicals you've heard of,

like dopamine and serotonin,

acetyl-choline, glutamate.

This disruption can lead directly
to depressive illness.

It also can actually damage the brain,

when left unchecked over time.

Especially in regions like the hippocampus

which is involved in memory consolidation
and the frontal cortex.

It also triggers an inflammatory reaction

throughout the body and brain.

And here's what we've learned
about depression:

The inflamed brain is a depressed brain.

Now this is really intriguing,

because epidemiologists
have now identified a number,

a big constellation of illnesses

that are rampant and epidemic.

Throughout the entire developed world

you can see the list:

atherosclerosis,

diabetes,

obesity,

allergies,

asthma,

many forms of cancer,

these are all inflammatory illnesses.

They're all illnesses that are epidemic

in the industrialized, modernized world

and largely non-existent

among modern day aboriginal groups.

I believe we need to add depression,

clinical depression,

to this list.

It shows all the hallmarks
of being a disease of civilization.

And, you know what that means?

It's a disease of lifestyle.

So consider the experience
of the Kaluli people,

of the highlands of Papua New Guinea.

They've been studied extensively,

by the anthropologist Edward Shieffelin.

He spent over a decade among the Kaluli.

One of his research questions was,

how often do the Kaluli experience

the same kind of mental illness
that we do?

He certainly found some forms of it.

He interviewed over two thousand
members of the Kaluli,

and extensively queried them

for their experience
of clinical depression.

And you know what he found?

One marginal case out of 2,000!

That gives them a rate
of clinical depression,

that's probably about
a hundred times lower than ours.

I'll tell you why I find
that really remarkable.

Because, among other things,

the Kaluli lead really really hard lives.

Really!

They have high rates of infant mortality.

They have high rates
of parasitic infections.

They have high rates of violent death.

But they don't become
clinically depressed!

They grieve, absolutely.

They don't get shut down.

What's protecting them?

Lifestyle.

Specifically, the Kaluli live a lifestyle

very similar to that of our ancestors

over the entire Pleistocene epoch,

that lasted for 1.8 million years.

Did you know that 99.9% of the human

and pre-human experience

was lived in a hunter-gatherer context?

So, what does that mean?

Most of the selection pressures

that have sculpted and shaped our genomes

are Pleistocene.

We're still really well adapted

for that sort of environment
and that sort of lifestyle.

I'm not saying there hasn't been
any change since then.

Because, of course,
10 to 12, 000 years ago,

we had the invention of agriculture.

And there has been some genetic selection

over that period of time.

It's been more minor.

But what happened 200 years ago,

with the industrial revolution?

It's been termed
"radical environmental mutation".

I like that term.

It's as if modern American
and Western life

is radically discontinuous

from everything that came before.

Our environment has radically mutated,

but how much has the human genome changed

over the last 200 years?

It hasn't.

It hasn't. That's eight generations.

It's not enough time.

What does that mean?

There's a profound mismatch

between the genes that we carry,

the bodies and the brains
that they're building,

and the world that we find ourselves in.

I'm going to put it for you
as pithily as I can:

We were never designed,

we were never designed for this.

We were never designed

for the sedentary, indoor,

socially isolated, sleep-deprived,

fast-food-laden,
frenzied pace of modern life.

The result?

An epidemic of depressive illness.

Now, I'm a depression researcher.

I was trained in a traditional
form of psychotherapy.

I was trained in a context where I learned
all about antidepressant medications.

I want to tell you right at the outset:
I am not anti medication.

I believe in fighting depression

with every possible tool that we have.

But, you know what?

If we only throw medication
at this epidemic,

we are not going to fix it.

At least we haven't so far.

How much do you think

antidepressant use has gone up

over the past 20 years?

(Laughter)

Would you care to guess?

(indistinct answers from audience)

I like that guess.

1,700 %? It's gone up over 300%.

So you're close.

(Laughter)

Over 300%!

And what's happened

to the rate of depression in interim?

It's continued to increase.

One in nine Americans over the age of 12

is currently taking an antidepressant.

One in nine!

Currently, one in five,

according to some estimates,

have tried it at some point.

Have we solved the epidemic?

No, we haven't made a dent.

The answer, I believe,
is the change of lifestyle.

Now, you'll see behind you

a list of six lifestyle elements.

When my research team and I,

seven years ago, had this epiphany,

we got together and we started scouring
through the depressive literature,

asking the question,

„What are the Kaluli doing
that's protecting them?”

Specifically, based on everything
we know about depression.

What did our ancestors do
that protected them?

We quickly found six factors

that changed neural chemistry.

Six factors that are known
to be antidepressant.

Six factors that we can reclaim

and weave into the fabric

of our day-to-day life in the present.

To protect ourselves...

from this devastating illness.

And so, we designed
a new treatment program.

It's really ambitious, I admit that.

Did I think it would work?

I really wasn't sure.

You know what?

I was not trained as a psychotherapist,

as an interventionist researcher.

I was doing
basic neuroscience psycho-pathology.

But I had a passion to see this epidemic

brought to its knees.

I had a passion to treat individuals

whom I knew, who had tried everything,

and were still depressed.

And so, with great trepidation,

we set out to design this program.

The results have exceeded
my wildest dreams!

There are six major elements.

I'm going to run though them
as quickly as I can in our remaining time.

The first is exercise.

Now, exercise is good for us.

How many of you--
Can I see a show of hands?

How many of you came in here today

knowing that exercise
is really really good for us?

Right? Every hand goes up.

Now, has it changed your behavior?

For some yes.

Everybody knows
that exercise is good for us.

Here's the problem:

many people have trouble making it happen.

And you know what?

A lot of people don't realize
just how good exercise--

I'm going to say something
that may be a little bit controversial,

and I am not speaking metaphorically:
exercise is medicine.

Exercise literally is medicine.

It changes the brain and the body
in beneficial ways

that are more powerful

than any pill you can take.

Yeah, I said it.

More powerful than any pill you can...

In fact, I'm going to say something
even more controversial.

If you could take the neurological
and physiological effects of exercise

and capture them in a pill,

all the beneficial effects
of neuro-signalling in the brain,

the anti-aging effects all the way down
to the level of chromosomes

in every cell of your body,

the mental clarity enhancing effects,

I believe, tell me if you think I'm crazy,

I believe that pill would become

the best selling drug of all time.

And I think people would pay
any price to have it.

There's a problem though.

We don't exercise.

We don't.

CDC again tells us
that 60% of all American adults

get no regular physical activity.

And yet, if we look
at hunter-gatherer groups,

they get four or more hours

of vigorous activity every day.

In fact, they look like elite athletes.

Even when they're in
their middle age and beyond.

Here's the thing I love though:

If you ask them,

they will tell you they do not exercise.

They don't!

They do not work out.

Working out would be crazy to them.

What do they do?

They live!

They live!

Here is...

(Laughter)

Yeah, I know. I like it, too.

Here's the dirty little secret
in the business.

And I really want you, if you remember
nothing else from this talk:

exercise is not natural.

We are designed to be physically active

in the service of adaptive goals.

We are not designed to exercise.

When you put a lab rat on a treadmill

and crank that thing up to the point

where it's moving faster
than it wants to move,

you know what it will do, if you let it..

It'll squat down on its haunches

and the treadmill starts to wear the fur
and the skin right off its backside.

So, it kind of feels our pain, right?

(Laughter)

When you stare
at a piece of exercise equipment,

there's a piece of your brain
that's screaming out,

"Don't do it! You're not going
anywhere on that thing!”

(Laughter)

So how do we solve this conundrum?

In our treatment program,

we've done two things.

We've made exercise natural,

and we've made it social.

What's the most natural
activity in the world?

Walking!

And guess what?

Brisk walking, you know the kind?

Like you're late for the bus.
Like you might miss your plane.

That kind of walking will get
your pulse up in the aerobic range,

and that's where it needs to be.

Based on your age, depending on your age,
your pulse needs to be between 120-150.

That's enough to enhance signaling

in your dopamine circuits,
your serotonin circuits.

It's been tested head to head
against Zoloft twice.

In the long term, it won.

At what dose?

Thirty minutes, three times a week.

That's a low dose.

It can change your life.

Now, I wish I had time
to cover everything else

that we need to cover,

but I'm going to tell you about
one more thing:

Omega-3 fats.

Did you know that your brain

is mostly made out of fat?

Did you know

the brain is 60% fat by dry weight?

So, if somebody calls you a fat head...

(Laughter)

they might be paying you a compliment.

(Laughter)

All right, here's the thing:

Our bodies can make all the fats
that we need, with two exceptions.

They're called essential fats.

You've heard of them,
Omega-6s and Omega-3s.

They play complementary roles
in the body and the brain.

Omega-6s are inflammatory.

Omega-3s are anti-inflammatory.

We need them in balance.

We're designed to have them in balance.

Omega-3s come from grasses and plants

and algae, and the animals that eat them.

Omega-6s from grains, and nuts,

and seeds and the animals that eat them.

Which is, by the way,

most of our meat supply.

Our hunter-gatherer ancestors
got Omega-6s and Omega-3s

in the optimal balance,
which is roughly 1-1.

We can do fine at 2-1.

We can probably even do OK at 3-1.

But, guess what?

The modern American diet,

which is riddled with fast food,

and processed food,

and grain-fed meat...

You see the ratio there?

17-1! Things are way out of balance.

It's very heavily inflammatory.

it's very heavily depressant.

That suggests to us, of course,
that if we could supplement with Omega-3s,

that might just be antidepressant.

Guess what?

Over a dozen controlled research trials
have now shown this to be the case.

What's the anti-depressant dose,

and I'll leave you with this,
hopefully, important tip.

The best research suggests
that there's a specific Omega-3 molecule

that's called EPA.

And at a dose, this is a pretty high dose,

of 1,000-2,000 mg per day,

it's shown to be antidepressant.

Many of our patients
have benefited remarkably,

not just with respect to their depression,

but other inflammatory conditions as well.

My own story, when I began
supplementing with Omega-3s,

several years ago,

the tendinitis in my knees went away,

and I could start running
full court basketball again.

The dryness in my eyes cleared up,

and I could keep wearing my contacts.

It's remarkably health promoting,

in many different ways.

Now, for those of you
who want to get more details

about this treatment program,

I'm just going to zip ahead,

because I'm out of time.

There's a lot more to share with you.

I don't really talk about cows.

We are designed as a very social species.

We're designed to connect.

Did you know that face-time,

time in the physical presence
of our loved ones,

actually puts the breaks
on our stress response?

Did you know that our ancestors
spent all day,

every day, in the company
of their loved ones?

Their friends?

Think about the extent of face-time

they shared with the people
that mattered most,

and what have we done?

We've traded face-time for screen-time.

Face-time for Facebook, is that better?

(Laughter)

And the result is devastating.

The result is devastating.

We're born to connect.
We need that connection.

In our treatment protocol
we work very, very hard

to help each depressed individual

resist the urge to withdraw.

Because, when you're ill,
your body tells you

to shut down and pull away.

When you're physically ill with the flu,

that's adaptive.

When you have clinical depression,

it's the worst thing
in the world you can do.

Even though every fiber of your being
is telling you exactly the opposite.

We've got lots of good data
on our outcomes

and, as I've said, they've exceeded
our wildest expectations.

Most of the patients that have come to us

have tried meds,

and they haven't gotten well.

Most of them have tried
traditional therapy,

and it hasn't been the answer.

The majority have gotten well,

as they have been willing
to change the way they live.

We had a man, a year and a half ago,

who had been fighting
depression for 41 years.

Consecutively.

And it was one
of the happiest days of my life

when he came in
to a session, after 14 weeks,

and he looked around the room
with tears in his eyes, and said,

"This is what I remembered
it felt like, to be free."

It can happen!

Now, we're still working
to improve this program.

We're still working to make it better.

I wish I had time to share with you

some of the things we're learning.

For those of you who want
to learn more about it,

I'd invite you to go to our website.

We have lots of details.

I wish you all
a joyful and depression-free life.

Thank you.

(Applause)