February 20, 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, 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 suicidal behavior.
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.
“Clearly we need to do better,� Ilardi 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 among 2,000 people interviewed. 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 appetites trace back to a time when food was an uncertain commodity.
So far, 47 clinically depressed adults have completed treatment in the program. Ilardi is impressed with the results: 75 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.�
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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 elements of change
Researchers at KU are studying the effects of a six-part Therapeutic Lifestyle Change program for people with symptoms of depressive illness.
But the techniques could benefit a wide range of people, said Steve Ilardi, associate professor of psychology, including those at risk of depression or with a family history. And many of the elements have been shown to be mood-boosters, he 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 grain-fed meat and fish, Ilardi said. Some studies associate omega-3 deficiency with increased depression risk.
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 but “there’s still no consensus among researchers on the optimal omega-3 dose.� The multivitamin is to reduce oxidative effects.
EXERCISE
While people in hunter-gatherer societies spend hours a day in physical activity, a majority of American adults get no regular physical exercise. Clinical trials have identified exercise as an effective depression treatment, with just 90 minutes a week being effective.
Treatment: Thirty minutes of aerobic exercise three times a week.
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. A lack of light exposure has been found to disrupt sleep and alter hormones, contributing to fatigue.
Treatment: Thirty minutes of daily exposure to sunlight. The program also provides clients with a 10,000-lux light box — lux is a measure of illumination — for use in simulating a sunny day.
SLEEP
Americans on average get 6.8 hours of sleep a night. Just 100 years ago, they slept nine hours. Some members of modern-day hunter-gatherer societies complain about getting too much sleep. Lack of sleep is a well-established health risk.
Treatment: The goal is eight hours. Therapists suggest ways to improve sleep, such as dimming lights and lowering the thermostat an hour before bedtime.
SOCIAL CONNECTEDNESS
Hunter-gatherer societies live in groups of 50 to 150, chiefly with close relatives and friends. American adults have grown isolated from other family members and from friends. Social support is a safeguard against the risk of depression. “We’re designed to have lots of face time with those closest to us,� Ilardi said.
Treatment: Therapists and clients discuss ways to improve relationships and to overcome social withdrawal. Clients set goals for social activities, including scheduling conversations with friends and relatives. Ilardi noted that while spiritual practices are not specifically in the program, many 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. With nearly constant social activity, hunter-gatherers have little opportunity for rumination. Many Americans spend a lot of time alone, including sitting in traffic and staring at TV.
Treatment: Therapists explain the toxic effects of rumination and how to combat it by avoiding long periods alone and by interrupting such periods with an activity or by contacting a loved one.
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