Big Pharma has spent 25 years and billions of dollars marketing depression as a genetic "serotonin deficiency." Which they have used to justify a line of enormously profitable drugs called serotonin reuptake inhibitors. There is still no solid research evidence that "serotonin deficiency" actually exists. And sadly the exclusive focus on drug treatment has led tesearchers to totally neglect other important causes.

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After 32 years of psychiatric practice I, like many of my colleagues, can't help but be alarmed by the dramatic increase in acute and chronic depression in the last three decades. If anything the incidence of clinical depression and tragically suicide have undergone a dramatic upsurge with the recent economic downturn (and associated unemployment, bankruptcies, foreclosures and homelessness).

The most recent epidemiological data, which predates the October 2008 crash, is as follows:

• 5.3% of adults are depressed on any given day

• 12% of women and 7% of men will experience depression in any given year

• 20% of women will experience depression in their lifetime (the prevalence of depression in men is more difficult to estimate as they are less likely to acknowledge feeling depressed or to seek help).

Given the frequent visits all doctors receive from drug salesman, I am well aware that the pharmaceutical industry has very successfully marketed clinical depression as a "genetic" deficiency of a brain neurotransmitter called serotonin. Which they used to justify a line of enormously profitable drugs called serotonin reuptake inhibitors (SSRIs Prozac is the best known). While antidepressants can be literally life saving for some people, approximately 50% of patients who take them never achieve full recovery. And in the eyes of the medical community, a 50% response rate is a definite embarrassment. This poor response rate is one of the main factors suggesting something other that a genetically inherited "biochemical imbalance" is causing Americans to become depressed.

Animal Models of Depression

The other argument against a strictly biochemical cause of clinical depression is the reality that other mammals including primates don't experience genetically based serotonin deficiency. In order to study the effect of new antidepressants in laboratory animals, depressive disordershave to be artificially created because they don't exist in the wild. Given the high prevalence of depression in human beings, coupled with the fact that the human and chimpanzee DNA is 99% identical, one would expect great apes to show some evidence of genetic, biochemically based depression if this were a genuine medical disorder.

Because depression occurs so rarely in lower mammals, pharmaceutical companies artificially create depressive states in lab animals to test new antidepressants on them. Traditionally researchers employ one of six approaches in making animals depressed all of which induce depression by depleting neurotransmitters (mainly serotonin and norepinephrine):

1. Causing the animal massive, unrelenting stress

2. Imposing social isolation by removing it from other animals

3. Premature separation of pups from their mother

4.Deliberate brain injury

5. Administering neurotransmitter depleting drugs, such a reserpine (an old blood pressure medication) and tetrabenazine (used to treat movement disorders)

6.Triggering amphetamine withdrawal (by first "addicting" rats to amphetamine, resulting in profound depression with its withdrawal).

Recently a strain of mice (the Flinders Sensitive Line) has been deliberately inbred and a second strain (HPA Transgenic) genetically engineered to develop depressive symptoms for use in testing new antidepressants.

However most animal testing of new antidepressants is based on the "learned helplessness" model and involves submitting mice and rats to traumatic stress levels of stress. In the most common experiment, mice are dropped into a large vat of water and the researcher times how long they keep swimming before they give up. After taking a dose of Prozac, they swim longer before giving up.

Newer methodologies involve hanging mice by their tails those given antidepressants struggle longer before giving up on trying to escape and teaching mice to avoid an electric shock by pushing a lever. The researcher then inactivates the lever, and the mice continue to push it anyway, even though they still get shocked.Mice under the influence of antidepressants keep pushing it longer.

Is it Time to Look for Other Causes of Depression?

Although I don't consider myself an animal rights activist (I am much more concerned about the horrible things we do to human beings), there is something incredibly sad about the drug companies' persistence in torturing small animals. It's also well past time for them to admit that primates don't experience genetic, biochemically caused depression despite a 25 year, multibillion dollar campaign to convince us that they do.That the time has come to give a serious look at other potential causes (and cures),including, among other possibilities, nutritional deficiencies, environmental toxins and the systematic degradation of American family and community life.

The Role of Poverty and the Corporatization of Food

I have always found it quite ego-deflating that as a psychiatrist I can only help about half the patients who come to me for depression. However as a social activist, I am also increasingly aware of the role social factors play in depressive disorders. I would rank nutritional deficiencies stemming both from poverty and our dysfunctional system of food production, marketing and supply as number one on the list of social factors leading to depression. The link between omega 3 deficiency (as opposed to so-called serotonin deficiency) and depression has been clearly established. Numerous studies show that cultures which consume a minimum three to five servings of fish per week experience miniscule rates of depression. There are also demonstrated links between depression and vitamin B, folic acid and various phytonutient (newly discovered plant based "vitamins") deficiencies, as well as increasing evidence for the role of Vitamin D and specific mineral deficiencies (mainly calcium and magnesium) in mood regulation. Except for Vitamin D (derived from sunlight and Vitamin D enriched dairy products) and Vitamin B12 (derived mainly from meat), the best source of these other nutrients is fresh broccoli and leafy green vegetables.

Owing to recent skyrocketing food costs, I feel a little silly advising low income depressives to eat more oily fish and fresh vegetables it's simply not an option. I also find it hard to suppress feelings of disgust for our government's corporate driven health policy whereby Medicaid and insurance companies are happy to pay for a prescription for Prozac (to help out their friends at Big Pharma) but not to subsidize fresh, organically grown food for low income patients with obvious nutritional deficiencies.

The Demise of Civic Engagement: Possible Links to Depression

Unfortunately less than one quarter of the depression I encounter in clinical practice is nutritionally based and responsive to improved diet. In fact over the past decade, I find myself looking more and more to the breakdown of extended family and community as a possible cause of depression. "Civic engagement" is a subject that both Robert Putnam (Bowling Alone 2000) and Ralph Nader have written about extensively. Their work has mostly focused on the negative effect declining civic engagement has had on overall quality of life in American communities. Whereas I myself see increasing evidence of links between our withdrawal from community life and the growing epidemic of clinical depression.

Decades of anthropological and ethnological research have established unequivocally that human, like other primates, such as apes, monkeys and gorillas, are fundamentally social beings. Behavioral experiments consistently find that the vast majority of people function very poorly when deprived of contact with their fellow creatures. It is well established that subjecting prisoners to solitary confinement is one of the most severe and most poorly tolerated punishments that can be inflicted rating far higher than beatings by guards and other inmates and some forms of deliberate torture.

Owing to my medical training, I have a particular interest on the effect social activity (or its absence) has on human beings' biological functioning specifically on brain function. Recent advances in neurophysiology been quite spectacular to the extent that we can identify electrochemical events in the human brain associated with specific psychological functions, such as trust, bonding, empathy and altruism.

Oxytocin

Oxytocin is the best known chemical influencing social activity, most likely because a nasal spray containing oxytocin, called Liquid Trust, is being heavily marketed by the manufacturer. At present it's being promoted as a potential treatment to parents of children with Autism and Asperger's Disorder. The hormone itself is associated with phenomena such as collaboration, altruism, empathy, compassion, parent-child bonding, monogamy, trust and forgiveness. Some researchers believe that oxytocin, rather than testosterone as previously believed, regulates female sex drive (contrary to popular belief female hormones such as estrogen and progesterone, which regulate ovulation and pregnancy, tend to suppress women's sex drive).

Oxytocin was first synthesized by Vincent du Vigneaud in 1953, for which he received the Nobel Prize for Chemistry in 1955. It's secreted by the posterior lobe of the pituitary gland and can be made synthetically. Physiologically, it promotes the secretion of breast milk and stimulates the contraction of the uterus during labor. Its structure is very closely related (differing by two amino acids) to a second pituitary hormone called vasopressin, which regulates fluid balance. However both hormones are produced and result in emotional and behavioral effects in both sexes.

Oxytocin has been dubbed the "bonding" hormone, primarily as a result of animal experiments, in which males become super attentive to their young following treatment with oxytocin. Oxytocin effects seem to work both ways: high oxytocin (or vasopressin) levels in human beings seem to stimulate bonding and group affiliation whereas various group activities clearly increase oxytocin levels. And because high oxytocin/vasopressin levels are associated with subjectively pleasurable feelings people who engage in these activities (gang banging for example) experience a distinct neurophysiological reward for doing so. And are motivated to seek out activities likely to replicate the experience.

Endorphins

Research shows that endorphins, which are opiate-like substances produced by the human brain (as opposed to synthetic opiates like morphine, codeine and heroin), are also increased by social and group activity (as well as by sex, vigorous exercise and creative activities). Whether increasing brain endorphins also stimulates social interaction is less well studied. Although endorphins (which are complex polypeptides) can be synthesized in the laboratory, they are extremely expensive and not as readily available. Research showing the benefits of exercise in the treatment of depression suggest thatvigorous physical activity increases endorphins, which in turn elevate mood.

Neurotransmitters

Neurotransmitters, such as dopamine, norepinephrine and serotonin (the same biochemicals affected by antidepressants) also appear to increase with social activity though these effects have received even less study.

Mirror Neurons

A mirror neuron is a neuron that fires when an animal observes another animal performing a specific action as if the first animal were performing the action itself. Researchers believe that these neurons are essential in lower animals for learning new skills. Their function in human beings is less clear. It's hypothesized mirror neurons make it possible for us to make inferences about another person's mental state and more importantly develop the capacity for empathy.

The Absence of Social Needs Research

Cleary more social needs research is urgently needed for an extremely disabling and costly (in terms of medical expense and lost work days) condition that has reached epidemic proportions. Most current socially oriented research occurring in Europe, where there is a widely agreed role for publicly (government) funded medical research. Unfortunately in the US the vast majority of depression research is funded by drug companies, who obviously have no profit incentive to investigate non-pharmaceutical approaches to depression. There is a small amount of government and foundation funding to investigate "non-medical" factors that can trigger or aggravate depression. However the competition for these non-corporate grants is fierce which translates into a dearth of good studies into the effect nutrition, exercise, emotional intimacy, prenatal influences, early poverty, job satisfaction and fulfillment of social needs in an individual's ability to regulate their mood.

Authors Website: http://www.stuartbramhall.com

Authors Bio:
I am a 63 year old American child and adolescent psychiatrist and political refugee in New Zealand. I have just published a young adult novel THE BATTLE FOR TOMORROW (which won a NABE Pinnacle Achievement Award) about a 16 year old girl who participates in the blockade and occupation of the US Capitol. I also have a new non-fiction ebook REVOLUTIONARY CHANGE and a 2010 memoir, THE MOST REVOLUTIONARY ACT: MEMOIR OF AN AMERICAN REFUGEE describing the circumstances that led me to leave the US in 2002 to start a new life in New Zealand. My memoir won an Allbooks Review Editor's Choice Award. I have a political commentary blog at my website.