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Depression dilemma: Two new books question why medication may not be the cure-all we wish it were

Hilary Jacobs Hendel.

Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions

By Johann Hari, Bloomsbury, 336 pages, $35

It's Not Always Depression: Working the Change Triangle to Listen to the Body, Discover Core Emotions, and Connect to Your Authentic Self

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By Hilary Jacobs Hendel, Random House, 320 pages, $37

Since most of us live in relative comfort and safety in a country that regularly ranks near the top of the United Nations Human Development Index, why are many of us depressed? Why has the incidence of suicide in Canada increased since the 1950s, and why has youth depression spiked 37 per cent in the past nine years?

Among the latest books to address this situation – which is nearly identical in the United States – Johann Hari's Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions, combines history, anecdote and research with his own personal story. Hari, author of the New York Times bestseller Chasing the Scream, was first diagnosed with depression at 18. His family doctor prescribed the selective serotonin reuptake inhibitor (SSRI) anti-depressant Paxil. His depression was cured, or so he thought. But as often happens, the relief was short-lived. Despite the medications, his deep sadness returned. A few months after taking his first pill, he went back to the doctor, who upped the dose. The story was repeated, first with ever-higher doses of Paxil, then once he had developed a tolerance, with different anti-depressants.

The situation is sadly familiar to many in Canada and the United States. In North America, most people with mental illnesses seek treatment from their family doctor. They are treated by nurses and general practitioners. Most are not seen by specialists such as psychologists and psychiatrists. Although these doctors and nurses do their best under difficult circumstances, they have neither the training, resources, nor time. Patients rarely receive a thorough assessment or integrated care. They are usually given the easiest and cheapest solutions – i.e., medications, and usually anti-depressants.

The interesting thing about these drugs is that they work, but only temporarily. Sixty-seven per cent of people report feeling better after taking anti-depressants, Hari writes. It's a good statistic, but it's largely caused by the placebo effect. Most people, or about 65-80 per cent, fall back into depression, he says, despite the drugs. And the drugs make one-quarter of patients worse, and when given to youth or teenagers, disrupt normal brain development.

As Hari's melancholia returned, he began to wonder why he clung to the pharmacological solution when it obviously wasn't working. There was the ease of the alleged cure: Popping a pill is quicker and cheaper than talk therapy or other interventions such as electroconvulsive therapy. But more than that, it was the story accompanying the medication. His doctor said his depression was caused by a "chemical imbalance in the brain": He had too little serotonin. The prescribed Paxil was supposed to correct his wonky brain chemistry.

Hari's difficulty with accepting that anti-depressants weren't a magical cure-all was because they came with an enchanting story, and that story provided psychological relief. If depression were caused by a chemical imbalance in the brain, rather than something he could control, such as a lack of coping mechanisms or a character flaw, then it was definitely not his fault. And if not his fault, then there was no reason to stigmatize him or anyone else with depression.

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The "chemical imbalance" story of depression has proved mightily helpful to drug companies whose medications are supposed to correct the supposed imbalance. Canada has one of the highest incidences of anti-depressant usage in the world; 9 per cent of the population is currently taking these drugs.

The difficulty with the prevailing narrative is that there is very little scientific evidence to support it. As noted in several books, such as Irving Kirsch's The Emperor's New Drugs, Robert Whitaker's Mad in America and Bonnie Burstow's Psychiatry and the Business of Madness, the link between depression and serotonin is tenuous at best. According to several studies, depressed people don't actually have less serotonin in their brains. And scientists who have tried to establish the link between serotonin and the black dogs have been repeatedly stymied. For example, if depression were caused by a lack of serotonin, then patients who are given a pill lowering their serotonin levels should have an attack of the blues. But in lab experiments, nothing happens.

'"There's no evidence that there's a chemical imbalance' in depressed or anxious people's brains, Prof. Joanna Moncrieff – one of the leading experts on this question – explained to me bluntly in her office at the University College of London," writes Hari. The term doesn't really make any sense, she told him, "because we don't know what a 'chemically balanced' brain would look like."

The tragedy is twofold. First, we've apparently been sold a false narrative, one based on faulty science. Second, our serotonin story masks the real truth. Lack of knowledge prevents us from figuring out what is actually wrong, and doing the real work of reflection, counselling and healing.

How to do this work is the focus of Hilary Jacobs Hendel's book It's Not Always Depression. Hendel suffered from depression for much of her childhood and adult life. It wasn't until she attended an academic conference in New York on the science of emotions that she realized what was wrong. She had spent years burying and ignoring her own emotions, especially negative emotions such as sadness, disgust and anger. It's a common problem, she writes: Many of us hide how we actually feel from others. We may even hide our true feelings from ourselves. Over time, this concealment leaves us shut down and unable to make real connections to others. Anxiety, depression, loneliness and defensiveness are the result. Healing comes from listening to the body. By tuning in to the physical sensation of emotions, we start to understand who we really are and what makes us tick. We gain self-awareness and acceptance. Our well-being improves. And it leads to better relationships, essential to feeling fully alive and being fully human.

Recognizing our own humanity is a lesson as old as literature itself. And yet, in our desire for quick fixes and low-cost solutions to what ails us, we seem to have forgotten that there is more to our mental well-being than having a balanced chemistry, whatever that means, because we are more than the sum of our physical parts. The connection between mind and brain is intricately beautiful and frustratingly complicated. Both these books begin untangling this fragile relationship to make better sense of it. Both are sorely needed.

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Alexandra Shimo is the author of several books, most recently Invisible North: The Search for Answers on a Troubled Reserve. She teaches creative non-fiction at the University of Toronto.

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